Lecture 2 - GU and Fluid/Electrolytes

The primary function of the renal system is the maintain the composition and ____ of body fluids.

The secondary function is to produce humoral substnaces like renin, _____, and calcitriol.

The cell of the kidney is called the ___. Initial filtration happens at the _____. The ____ is a way to measure the function of the kidney.

As the urine moves through the ureters, it is _____ that propels it forward.

The ______ unit is the lower urinary tract which includes the bladder, urethra, and ____ muscles.

volume; erythropoietin; nephron; glomerulus; GFR; peristalsis; urethrovesical; pelvic

Clinical manifestations of renal disease include:

1. Too much urine which is ____

2. Too little urine which is ____

3. No urine which is ____

4. An abnormal ____ of urine

5. Having _____ or involuntary urinating after 8 years of age

6. Pain w voiding and frequent ____

7. Abnormal urinalysis whic hshould not have any blood, ____, glucose, WBCs, or ketones in it. The specific gravity should be between 1.005 and 1.025 with the ideal being ______.

polyuria; oliguria; anuria; color; enuresis; UTIs; protein; 1.010

A bladder infection is called ____. Common S/S include fever, irritability, poor _____, vomiting, ____ upon voiding, a change in urine odor/color like ____, and abdominal pain.

A kidney infection is called _______. It is caused by the ____ of urine into the kidney. It has the same symptoms as children with _____. Other symptoms include fever, back and _____ pain, N/v, appearing ____, and _____ angle tenderness.

Prevention of UTIs includes:

1. Adequate ___ intake

2. Voiding ____

3. Avoid bubble ____

4. Wear ___ underwear.

cystitis; feeding; pain; hematuria; pyelonenephritis; reflux; UTIs; flank; sick; costovertebral; fluid; frequently; baths; cotton

Diagnostic tests for UTIs include:

1. A urine ____ to identify the causal organism. You will do this and then place the patient on broad spectrum ____.

2. A urinalysis

3. A renal ____

4. A VCUG or voiding cystourethrogram which is an ____ that looks at the bladder/urethra while the patient is urinating to test for ____

5. Intravenous ______

culture; antibiotics; ultrasound; xray; reflux; pyelogram

The _______ reflux refers to the retrograde flow of baldder urine into the ureters. It increases the chance for ____.

Most resolve spontaneously for each ___ year period throughout childhood.

Most are treated with chronic _____ and good ___. Severe cases may need surgery like a _____.

vesicoureteral; infections; 2; antibiotics; hydration; transplant

Infection/inflammation of the glomerulus is claled acute _________. A specfiic type called acute post-strept glomerulonephritis occurs after an illness with Group A beta ______.

This occurs when ____ complexes are formed/deposited in the glomeruli and causes damage. This disrupts the ____ process which allows RBCs and protein into the urine.

It can last from 4 days to ___ weeks and most usualy recover.

It is diagnosed via ___ in which you are looking for hematuria and proteinuria. The urine specific gravity, BUN, and creatinine levels would be _____. Use a ____ titer to test for antibody that would be present after a strept infection. The serum level of C3 should be ____. A chest ____ may show cardiac enlargement and pulmonary effusion.

Clinical manifestations include:

1. Oliguria

2. Hematuria which is smoky or ____ colored.

3. _____ edema

4. HTN, fatigue,

5. Feels sick like ____ and apathy.

Therapeutic measures includes:

1. Controlling symptoms

2. Balance fluids by doing strick I&Os and restricting ____ and fluid.

3. Give ____ to treat HTN like ACEs and ARBs

4. Educating patient to keep a low Na and ___ diet. They may also need to restrict ____ in severe cases

5. Use _____ if Strept is left untreated

glomerulonephritis; streptococcus; immune; filtration; 3; urinalysis; increased; ASO; low; xray; tea; periorbital; anorexia; Na; antihypertensives; K; protein; antibiotics

A syndrome in which the glomerular filter becomes very leaky is called _____ syndrome. There are different types:

1. The most common is teh ____ ____ nephrotic syndrome. This occurs normally in preschoolers after a viral _____ due to the immune system causing hte barrier to become permeably. It affects ___ twice as often as the other gender.

2. Secondary nephrotic syndrome occurs after glomerular ____. Causes can include stings, ___ exposure, and pediatric AIDs/_____.

3. Congential nephrotic syndrome is caused by the Finnish type ___ gene. This occurs in ____ for gestational age infants which can affect their groth. Death occurs without TXt like ____ or transplant.

Clinical manifestations includes:

1. Massive ____ due to the leaky barrier

2. Hypoalbuminemia and ________ (lipid)

3. ____ which can be generalized, facial, or periorbital

Diagnostic Evaluation includes:

1. A ___ to detect large protein

2. A renal ____ for glomerular damage

3. An ____ H&H due to fluid leaving the blood.

Therapeutic management includes:

1. A diet low in Na and K as well as ____ restrictions

2. A high dose of ____ therapy to stop the process especially in minimal

3. Immunosuppressive therapy

4. Diuretics

Nursing care includes strict I&Os

nephrotic; minimal change; URI; males; damage; venom; HIV; recessive; small; dialysis; proteinuria; hyperlipidemia; edema; urinalysis; biopsy; inc; fluid; corticosteroid

Renal tubular acidosis occurs when the kidney’s ____ cannot control acid/bicarbonate causing a state of metabolic _____.

There are different types:

1. Type 1 occurs in the ____ tubule in which it cannot secrete ____ effectively which causes it to stay in the ____

2. Type 2 occurs in the ____ tubule in which it cannot absorb ____ properly so it is lost in the ____.

tubules; acidosis; distal; H; blood; proximal; bicarb; urine

When there is undersecretion of ADH this is called ____ ____.

Clinical manifestations includes _____, polydispia, enuresis, a _____ urine, etc.

Diagnostic evaluations includes:

1. A water _____ test in which no change in volume or ____ is diagnostic

2. A test fose of ____ to distinguish b/w central and nephrogenic DI.

Nursing care includes daily ____, strict I&Os, fluid and dietary ____. Also assess for __ mucous membranes.

diabetes insipidus; polyuria; dilute; deprivation; concentration; desmopressin; weights; restrictions; dry

When there is oversecretion of ADH this is called ____. This leads to retention of water and causes the ____ to be diluted while the urine becomes more _____.

Clinical manifestations includes _____, N/V, ____ progressing to stupor and ____. They may also see weight ____and ____ urinary output

Diagnostic evaluations includes:

1. A ____ serum osmolarity

2. A ___ urine osmolarity

3. A ____ serum sodium

4. Assess for ____ or tumor as the cuase.

Nursing management includes daily weights, strict I&Os, and ___ restrictions.

SIADH; blood; concentrated; anorexia; confusion; seizures; gain; low; low; high; low; infection; fluid

Hemolytic uremic syndrome usually occurs due to ingestion of meat that is infected with a type of E.coli that produces the ____ toxin.

As the bacteria infects the intestines, it leads to bloody ____. As the bacteria releases the toxin it damages the ____ ___. This leads to the triad which is:

1. Hemolytic ____ as the RBCs get destroyed

2. ____ due to the platelets being used up

3. Acute renal ____.

Clinical manifestations includes:

1. Occurs in ages 3 months to ___ years

2. Diarrhea and vomiting

3. ____ (skin color)

4. Rectal ___

5. Petechia/purpura

6. LOC = _____ and stupor

shiga; diarrhea; blood vessels; anemia; thrombocytopenia; failure; 6; pallor; bleeding; seizures

An AKI can have different causes:

1. Pre-renal AKI is due to decreased renal ___. This can be due to ____ from diarrhea and persistent vomiting

2. Intrinsic causes cause damage to the glomeruli, ___ or renal vasculature.

3. Post-renal is due to an ____.

Clinical manifestations includes:

1. Oliguria of less than ____ mL/kg/hr

2. _____ to retention of water

3. ____ due to release of renin to maintian perfusion

4. Heart failure and ___

5. ____ due to low Na and Ca

6. Pulmonary ____

Diagnostic evaluation includes:

1. Increase in BUN, creatinine, and ___

2. A ____ in Na

3. Metabolic ____

Therapeutic management includes:

1. For fluid and calories, patient should be on fluid ___ with strict I&Os. They should be on a diet of high carb/fat, and low in ____ and K

2. For hyperkalemia, they should be on dietary restrictions or on _____.

3. For HTN, give meds

4. Monitor VS and do daily ___

perfusion; dehydration; tubules; obstruction; 1; edema; HTN; arrhythmias; seizures; edema; K; decrease; acidosis; restrictions; protein; dialysis; weights

CKD occurs when there is destruction of the ____. This leads to complications like:

1. Retention of ___ products, Na, and water

2. An ___ in K

3. Acidosis

4. ____ and Phosphorus disturbances

5. ____ due to dec release of EPO

6. Growth disturbances

Clinical manifestations usually have a slow onset and only shows symptoms when ___% of kidney function is lost. These include a lack of ___, growth disturbance, pallor, and ___.

Diagnositc eval includes BMP, ____, and ID the cause.

Therapeutic management includes:

1. Antihypertensive meds

2. Giving Na bicarb and Ca Carbonate to fix the ____

3. Giving human ___ hormone for growth disturbances

4. Give calcium carbonate and vitamin ___ for osteodystrophy

5. EPO for ____

6. Dialysis in which hemodialysis is usually done ___ times a week, peritoneal dialysis is done ____ at home, and CVVH is done in ___ care.

nephrons; waste; increase; calcium; anemia; 50; energy; pruritis; CBC; acidosis; growth; D; anemia; 3; daily; critical

For hemodialysis, this requires ___ access such as a shunt/cath and special equipment. It is best suidted for children who can be brought to facility ___ times per week for 4-6 hrs. It achieves rapid correction of fluid and ____ abnormalities.

Peritoneal dialysis is when the ____ acts as a semipermeable membrane for filtration. It can be managed at ___. A warmed solution enters the cavity by ___ and remains for a period of time before removal.

For transplantation, selection of donor tissue can be live or from a _____. We need to suppress the ____ response using non-steroidal treatment and prevent ____.

vascular; 3; electrolyte; peritoneum; home; gravity; cadaver; immune; rejection

Defects of the genitourinary tract include:

1. The narrowing/stenosis of the opening of the foreskin which is called ____. Most will outgrow but some may need _____.

2. Fluid in the scrotum called ____. Most resolve spontaneously

3. Failure of the testes to descent is called _____. An ____ is done at 6-24 months for those that do not descent

4. When the urethral opening is below or behind glans penis, this is callled ____. This requires ___ repair

5. ____ is failure of urethra to close properly. This requires ___ repain

6. Extrsion of the bladder through abdominal wall is called ____. This requires extensive ____ repair and is usuallly paired w epispadias.

phimosis; circumcision; hydrocele; cryptochidism; orchipexy; hypospadias; surgical; epispadias; surgical; exstrophy; surgical

Any structural or functional abnormality that obstructs normal flow is called obstructive ____. This is the largest single cause of renal ____ leading to the need for transplantation.

Symptoms include:

1. _____

2. Hydroureteronephrosis

3. Ureterocele

TXT consists of ____ removal or ____ the obstruction.

uropathy; failure; hydronephrosis; surgical; bypassing

Water is needed to replace insensible water losses and those that is lost in ____ and stool. If they are unable to absorb, are NPO, have GI issues, then you need to replace via ____

There are inc requirements for water when the patient has a ____, tachypnea, ____, diarrhea, DI/DKA, shocks, burns, etc.

There are decreased requirements when the patient has ___ failure, SIADH, inc ____ and mechanical ventilation, ____ renal failure, and a post-op period.

The ____ ___ rate is the amount of energy your body needs to keep you alive while completely at risk. The higher the metabolism, the ____ water your body needs.

The amount of fluid in a compartment is determine by the concentration of solute, specifically ____ which is the prime determinant of _____. Compensatory mechanisms consist of _____ which fluctuates depending on the body’s needs.

Osmolarity changes are detected by the _____. These cahnges will cause the release of ADH. If osmolarity is high, there will an ____ in ADH. If osmolarity is low, then there will be a ____ in ADH,

The urine ____ ___ tells how concetrated the urine is.

urine; IV; fever; vomiting; heart; ICP; oliguric; basal metabolic; sodium; ECF: ADH; hypothalamus; inc; dec; specific gravity

Changes in fluid volume related to growth include:

1. The % of TBW is related to the amount of body ____ and ICF/ECF compartments. Infants tend to have higher ____ while adults have more ICF.

2. Infants have a ____ fluid intake/output relative to size. Disturbances occur more frequently and rapidly due to ____ losses like sweating, breathing, etc.

3. Their body ____ is greater leading to greater loss.

4. The metabolic rate leads to a greater production of metabolic ____

5. Their kidney function is ____ at excreting such waste which is why they cannot conserve water or electrolytes well.

fat; ECF; greater; insensible; SA; wastes; inefficient

Main causes of hyponatremia include:

1. Decreased _____ of sodium

2. Vomiting and GI ____ like from NG tube

3. Diarrhea and ______

4. Addison disease as it leads to low _____

5. ISADH due to retention of water

6. An ____ of fluid like from CHF, hypotonic fluids, and renal failure

7. ____ usage like thiazides.

Symptoms include:

1. S= ____ and stupor

2. A = ____ cramping

3. L = _____

4. T = tendon reflex _____

5. L = loss of urine and ___

6. O = ____ hypotension

7. S = _____ respirations

8. S = ____ of muscles

Nursing managemnet includes:

1. Monitoring ____ status and I&O

2. Daily weights

3. Place on fluid ____ as needed

4. Adminster solution as needed via oral, IV ____ saline, or 3% saline depending on severity

consumption; suctioning; sweating; aldosterone; overload; diuretic; seizures; abdominal; lethargy; diminished; appetite; orthostatic; shallow; spasm; neurologic; restrictions; isotonic

Main causes of hypernatremia include:

1. ____ syndrom which is increased cortisol

2. Conn’s syndrome which leads to inc in _____

3. Corticosteroids

4. Hypertonic solutions

5. No drinking or losing too much water via DI or ____.

Symptoms include:

1. F = fatigue

2. R = ______

3. I = ____ reflex

4. E = extreme ____

5. D = ____ mouth/skin

Managemnt includes:

1. Adminstering ___ fluids as prescribed

2. Monitor I&O and ___ status

3. Provide ____ assistance

cushing; aldosterone; burns; restlessness; increased; thirst; dry; hypotonic; neurologic; lactation

Main causes of hypochloremia include:

1. GI related issues like ____

2. Diuretics and ____ fibrosis

3. Burns and fluid ____

4. Metabolic ____

Main causes of hyperchloremia are consistent with causes of ___. It is often seen w metabolic _____due to formation fo HCl-

vomiting; cystic; overload; alkalosis; hypernatremia; acidosis

Main causes of hypokalemia include:

1. The use of ____ direutics

2. Corticosteroids

3. Too much ___ which causes K to move into cells

4. Cushing

5. Losing too much via GI or _____

Symptoms include:

1. L = ___

2. S = ______ respirations

3. Cardiac issues like ___

Managemnt includes monitoring VS and obtaining an _____. Adminster K replacement ___

loop; insulin; starvation; lethargy; shallow; dysrhythmias; ECG; slowly

Main causes of hyperkalemia include:

1. Burns and ___ damage as K leaks out of cell

2. _____ or breakdown of muscle

3. Renal ____

4. K+ sparing diuretics, ____ inhibitors, NSAIDs

Symptoms include:

1. M = ____ weakness

2. U = little to no ____

3. R = ____ failure

4. D = decreased cardiac ____

5. E = early ____

6. R = prolonged ____ intervals

Nursing managment includes:

1. Monitor VS and ____

2. Admin IVF, _____ gluconate, and insulin ____ as ordered

3. Monitor kidney function

4. Some patients may require _____ to filter out the blood

tissue; rhabdomyolysis; failure; ACE: muscle; urine; respiratory; contractility; arrhythmias; QR; ECG; calcium; kayexalate; dialysis

Main causes of hypocalcemia includes:

1. A decrease in the ____ hormone

2. Thyroidectomy

3. Dec intake such as those are who are ____ intolerant

4. Low vitamin ___ level

5. kidney disease

6. Meds like ______ (mycins) and anticonvulsants

Symptoms include:

1. C = ___

2. R = ______ reflex

3. A = ______

4. M = ____spasms

5. P = positive ______ signs

6. S = _____ or tingling/numbness

Nursing management includes:

1. Admin replacement

2. Avoid ___ milk in infants younger than 12 mon

3. Assess ____ and cardiac status

4. Check for Chvostek sign by tapping on ____ nerve to see if the muscles twitch

5. Trousseau sign to see if there is a spasm in the ____ or hand when inflating the cuff

parathyroid; lactose; D; aminoglycosides; confusion; hyperactive; muscle; neurological; sensation; cow; neurologic; facial; wrist

Hypercalcemic can be caused by:

1. A hyperactive parathyroid

2. Increase in Vitamin D or ____ with Ca+

3. Bone ____

4. Thiazides and _____

Symptoms include:

1. W = profound _____

2. E = _____ changes

3. A = _____ reflex

4. K = kidney ____

Nursing management includes:

1. Assess neuro and ___ status

2. Promote ____ to excrete more calcium

3. Encourage ____ to prevent calcium resorption

4. Adminster bisphosphonates, ____ and loop diuretics.

supplements; cancer; lithium; weakness; EKG; absent; stones; cardiac; hydration; ambulation; calcitonin

Hypomagnesemia can be caused by:

1. Not ___ enough

2. Other electrolyte imbalances

3. Malabsorption from the ___ intestine

4. _____ which is seen more in adolescents than in children.

Hypermagnesemia is really rare and can be due to over _____ or dec renal function.

Symptoms include profound ____ and EKG changes.

consuming; small; alcoholism; supplementation; lethargic

There are different types of dehydration:

1. _____ dehydration is when there is greater water loss than electrolyte leading to ______. Signs of dehydration occur ___ and this dehydration may be caused due to SIADH. This is relatively rare and increases the risk for ___ and neuro compromise. This is why it is important to check ____ and sodium levels.

2. _____ dehydration is when there is greater electrolyte loss than water loss. Hypovolemic ____ is frequent as there is less fluid in the vasculture.

3. ____ dehydration is when the electrolytes and water loss is abt the same. This is the most ___ form of dehydration. The ____, BUN, and specfic gravity increases.

hypertonic; hypernatremia; later; seizures; glucose; hypotonic; shock; isotonic common; HCT

For dehydration, assess I&O and ____ function. Check turgor and ____ membranes.

For mild/moderate dehydration, the patient should be given 50-100mL/kg over ___ hours plus 10mL/kg for each ____ stool. The rehydration solution should contain 75 to ___mEq of Na/L

For moderate to severe dehydration, ____ fluids to rehydrate. Give 20mL/kg ____ immediately. Check labs and avoid ____ administration until kidney function verified. This dehydration can have the patient to have a AKI so first give IV ____ without electrolytes to restore perfusion. After the child ____ then you can add the same IVF with electrolytes.

cardiac; mucous; 4; diarrheal; 90; IV; isotonic; potassium; fluids; urinates

The body weight fluid calculation by:

For 10 or less kg it is ____mL/kg.

For 11-20 kg, its 1000mL + ____mL/kg for each additional kg between 10 and 20.

For greater than 20, its ____mL + ___mL/kg for each additional kg greater than 20kg

100; 50; 1500; 20

Hypotonic fluids has a ___ osmolarity than the blood. It causes water to move into the ____. Examples include 0.45% or less saline and D5W wihich originally starts out as ____ but becomes hypotonic.

Isotonic fluids has the ___ osmolarity as the blood. This helps expand plasma or _____ space. Examples include D5W, 0.9% saline, and ____.

Hypertonic fluids have a ____ osmolarity than the blood. It cause swater to move into the ____. Examples include:

1. 3% saline

2. Dextrose 10% inw ater

3. Dextrose in ____ or 0.45% saline

lower; ICF; isotonic; same; intravascular; LR; higher; ECF; 0.9

Infusion devices includes:

1. A central line which can infuse the ____ dextrose you want. ____ technique should be used at all times. Placement is confirmed via ___ and dressings should be changed as needed

2. A peripheral IV has a dextrose limit of ___. Be careful of ____ and use a 22 gauge.

3. Midline

4. Intraosseous

highest; sterile; xray; 12.5; infiltration

For blood and blood productts:

1. Veriffy identity of recipient and the donor’s blood ____

2. Monitor the ____

3. Use appropriate filter an duse blood within ____ mins of arrival

4. Infuse over a __ hour maximum

Reactions you need to watch for include:

1. ____ which is when the immune system attacks the transfused RBCs. This is the most ___ but also rare.

2. Febrile reactions like fever and ____

3. ____ reactions like uritcaria, pruritis, laryngral edema

4. An air emboli which can occur when transfused under ____

5. Hypothermia

6. Electrolyte disturbances like ____ from massive transfusions or w renal problems.

Nursing responsibilities include:

1. Tranfuse ___ for the first 15-20 minutes.

2. Observe the Vs at the frist ___ min and then every 5 min

3. ____ the transfusion if S/S of reaction and notify practioner

group; VS; 30; 4; hemolytic; severe; chills; allergic; pressure; hyperkalemia; slowly; 15; stop

Water _____ may occur after ingestion of large amounts of fluid. In infants, this can also be due to inappropriately prepared ____.

This can lead to an inc in ___ due to swelling of cranial tissue which inc the risk of CNS symptoms like ____.

intoxication; formula; ICP; seizures

The extent of the injur of a burn is based on the percentage of total body ____ burned.

Superficial/partial thickness burns include 1st and ___ degree burns. This is damage to the entire ___ and part of the dermis. The skin appears pink to ___ and is always ____. Healing can take 3-21 days and they may have no/variable _____.

Full thickness burns are your 3rd and 4th degree burns that damage the entire epidermis/dermis and possible damage to _____ tissues like sweat gland, hair follicles, and ____ endings. The skin appeara red, tan, brown, or ___ in color and no blanching. There is ___ to no pain. It may take weeks or ___ to heal and scarring can be severe.

SA; 2nd; epidermis; blistering; painful; scarring; subcutaneous; nerve; black; little; months

TXT for mild burns is usually done ____. First you want to clean the wound and and cover w clean cloth or _____. Provide ____ for pain and check the immunization status. Monitor for signs of ____.

For moderate-major burns, they will need an IV asap and ___ replacement is priority to prevent shock. Monitor for shock and infection. Restore ____ and provide nutritional support. Dermal replacemnts or ____ may be used. Provide pyscho-social support.

Meds include topical ____ like bacitracin, mupirocin, and silvadene.

Oral/IM/IV meds include ____ pain meds, NSAIDs, antibiotics, and ___ which helps with the metabolic response to burns.

outpatient; dressing; analgesia; infection; fluid; mobility; grafts; antibiotics; opioid; propanolol