NURS 651 Exam 3 (Maryville) Includes : GU, MS, ID, Immunizations, Nutrition UTI: Defintion - Includes bladder, (cystitis) urethera (urethritis) and kidney (pyelonephritis) Signs and symptoms of UTI - -Fever may be only sign infants a & young child -Older children=urinary symptoms ( new onset incontinence, dysuria, frequency, abdo minal pain Risk factors of UTI - FEMALE, Uncircumcised male, GENETICS, (Anatomy), BOWEL/BLADDER Dysfunction, Obstruction, Catheterization, SEX, Reflux Exam for UTI - Temp, BP, abd exam for mass, tenderness. suprapubic or costovertebral tenderness, check external genitalia, eval lower back for signs of occult myelomeningiocele, check other sources for fever. UTI testing - -clean catch, cath, suprapubic UA *dipstick, urine culture. -+ leukocyte esterase=pyuria -+nitrate=bacteria *C/S -+100,000 colonies fo r dx; may treat 50,000 or greater UTI cal app to estimate probability of UTI (ages 2 -23 months) Indications for urine sample - Girls: 2-11 months of age temp > 100.4 (non -black) 2-11 months of age temp of 102.2 OR the,p 100.4 and no other fever source identified. 12-24 months of age temp 102.2 (non black) 12-24 months of age 102.2 and no other source of fever identified. >24 months One or more of the following: dysuria, frequency, new onset incontinence, back pain, abdominal pain, fever of 102.2 and no other acute cause. Infant UTI - non specific symptoms or asymptomatic UTI symptom cluster - Newborn - irritability, poor feeding, diarrhea, fever, vomiting. jaundice, hypothermia, cyanosis, lethargy Infants//todlers/preschool: diarrhea, vomiting, fever, poor feeding, strong urine odor, irritability, poor weight gain, diaper r ash Schoolage/adolescents; fever, vomiting, strong urine odor, urethral pain or suprapubic, dysuria, incontinence. UTI differential diagnosis - Chemical irritation (bubble bath) vulvovaginitis dysfunctional voiding acute abdomen ( appe, STD) Foreign bod y Sexual abuse Dysfunctional voiding related to constipation UTI specimen collection - Clean catch urine midstream (bagged specimen don't do it) Straight Cath for mod to severe symptoms Suprapubic aspiration: only when culture is urgently needed. ( + is > 1000 colonies) _blood culture obtained for <12months and suspected sepsis Indications for radiology in UTI - -Symptoms of pyelonephritis regardless of age and gender -UTI in child <3 months -males with first infection and females with second infection. even if not pyelonephritis and child > 3 months of age. UTI treatment - -IV ABX - newborns, infants, or older children with vomiting, severe symptoms systemic illness or unable to take fluids -ORAL - 10 day regimen, or 14 days with completed infection. UTI drugs - 1. Bactrim ( infants >2 months) TMP 8 -10mg/kg.BID Recommended until sensitivities are back since most UTI are caused by E. coli. 2. Amoxicillin 30 -40 mg/kg/day TID <3months 3. Augmentin 40mg/kg/day TID 4. Sulfisoxazole 150mg/kg/day QID 5. Cephalexin 50mg/kg/day TID 6. Nitrofurantin 5 -7mg/kg/day in divided doses (ideal treatment for UTI due to highly concentrated in the urine, but less effective for systemic/renal infections as it does not concentrate well in blood) Follow up Urine cultu res - -2nd culture at 72 hours after initiating treatment if symptoms are not rsolving -culture 1 week after completion of treatment when test of cure is indicated. Tanner staging female pubic hair - 1. No pubic hair (preadolescent) 2. little pigment str aight hair, 3. Pigmented, straight medial border of labia sparse 4. pigment, curly, abundant but less than adult 5. lateral spread of hair, triangle 6. only occurs in 10% of women Tanner staging female breast development - 1. Preadolescent nipple elevati on 2. Breast buds with areolar enlargement 3. Breast enlargement without separate contour with nipple. 4. Projection of areola and nipple as separate mount to breast 5. Adult breast with areola receding and nipple projection from breast Tanner staging gen ital maturity males - 1. preadolescent 2. enlargement of scrotum and testes scrotum reddens and roughens 3. penis lengthens 4. penis enlarges in glans and and width 4. adult size and shape Glomerulonephritis Treatment - inflammation of the glomeruli of th e kidney Supportive treatment due to spontaneous resolution occurs 95% of the time. Course does not seem to be positively affected by steroids, etc. -Peak of oliguria and hypertension may need hospitalization for sodium/fluid restriction or and diuretics/ antihypertensice. ABX only if cultures are positive. -gross hematuria presists for 1 -2 weeks. Symptoms of pyelonephritis - fever, back or flank pain Symptoms of chronic renal failure (7 red flags) - 1.FTT 2. Chronic anemia 3. Complicated enuresis 4. Prolonged unexplained vomiting (a.m.) 5. Hypotension 6. Unusual bone disease 7. Poor school performance due to memory, HA, fatigue)
