Download NSG 6665 Genitourinary (GU) System Study Guide: Key Concepts, Questions & Answers and more Exams Nursing in PDF only on Docsity!
NSG 6665 TEST 2: GU STUDY GUIDE A+ GRADED
kidney functions - ANSWER FILTER, CLEAR, REABSORB AND SECRETE SUBSTANCES ESSENTIAL FOR METABOLISM TO MAINTAIN HOMEOSTASIS • REGULATE ACID -BASE BALANCE • REGULATE BLOOD PRESSURE • WATER & WASTE SECRETE HORMONES • EXCRETE EXCESS Ureturs - ANSWER transports urine to the bladder from the kidneys bladder tissue type - ANSWER muscleurethra purpose - ANSWER CARRIES URINE OUTSIDE BODY • MALES - CARRIES SEMEN ALSO kidneys mature at what age - ANSWER 2 yowhen do kidneys begin to form and excrete urine - ANSWER 3 mo gestation (8-12 weeks) normal urine excretion - ANSWER 1.5-5 ml/kg/hr EXTRACELLULAR FLUID VOLUME COMPARED TO ADULTS - ANSWER increased in kidsRENAL BLOOD FLOW & GFR AT BIRTH - ANSWER decreased but stabilizes at 1-2 yo tanner stages - ANSWER Five stages of sexual development in adolescence evaluatingpubic hair, genitals and breast development why are kids <2yo at great risk for dehydration - ANSWER DECREASED RENAL BLOODFLOW & GFR age of puberty start - ANSWER 8-13 yo femalesfemale puberty starts with - ANSWER breast buds then pubic hair when does underarm hair and menses start after puberty - ANSWER 2 years after start how long does puberty last in females - ANSWER 3 yearsmale puberty start time - ANSWER 9-13. male puberty lasts - ANSWER 2-5 yearsmale puberty begins with - ANSWER enlargement of testes followed by public hair and then increase in penis size subjective data - PROBLEM - IMMUNIZATIONS • ALLERGIES • HOSPITALIZATIONS/SURGERIES • ANSWER PAST MEDICAL HISTORY • H/O UTI OR ANY OTHER GU INJURIES • MEDICATIONS • ORAL CONTRACEPTIVES, STEROIDS, ANTIBIOTICS, OTCMEDS • FAMILY HISTORY • SOCIAL HISTORY - SEXUAL ACTIVITY, NUMBER OF
PARTNERS, SAFE SEX PRACTICES • NUTRITIONAL HISTORY • ELIMINATION HISTORY • VOIDING PATTERN, COLOR/ODOR/FREQUENCY/URGENCY, DYSURIA • DIARRHEA OR -
CONSTIPATION • MENSTRUAL HISTORY CRAMPS • HPI VERY IMPORTANT • BE VERY SPECIFIC • SYMPTOMS, -LMP, FIRST PERIOD, DAYS OF CYCLE,
ABDOMINAL/FLANK PAIN, FEVER
ROS - ALOPECIA, HIRSUTISM • CARDIAC • RESPIRATORY • GASTROINTESTINAL • ANSWER GENERAL HEALTH • SKIN • ACNE, ACANTHOSIS NIGRICANS,
GENITOURINARY • STI, UTI, EPISPADIAS, HYPOSPADIAS, DYSURIA, HEMATURIA,URGENCY, FREQUENCY, ENURESIS, VESICOURETERAL REFLUX • ENDOCRINE •
POLYCYSTIC OVARY SYNDROME, DIABETES, HYPO/HYPERTHYROIDISM •REPRODUCTIVE • GYNECOMASTIA IN MALES, DYSMENORRHEA, AMENORRHEA,
MENORRHAGIA, PID • HEMATOLOGIC • NEUROLOGIC • PSYCHOSOCIAL •DEPRESSION, OBESITY, ANOREXIA NERVOSA, BULIMIA • LOOK AT GROWTH CHARTS
social history in adolesence if you suspect sexually active - ANSWER ask about wholives in home and drug or alcohol use GU assessment - ANSWER -INSPECTION
- PALPATION • KIDNEYS • BLADDER • FLANK TENDERNESSGENITALS • FEMALE • BREAST • PELVIC EXAM • MALE • BREAST • INGUINAL hernia enuresis - ANSWER bed wetting gynecomastia - ANSWER development of breast tissue in maleswhen to do pelvic exam - ANSWER only when indicated UTI subjective - ANSWER RECURRENT, FAMILY HISTORY, CIRCUMCISED, VOIDINGPATTERN, HYGIENE, SEXUALLY ACTIVE males at higher risk for UTI - ANSWER uncircumcised UTI objective data - ANSWER GENERAL APPEARANCE, VITAL SIGNS, NEURO, CARDIAC, RESPIRATORY, ABDOMINAL, GI, GU EXAM • FLANK PAIN, CVA & BLADDER TENDERNESS • LABIAL ADHESIONS - FEMALE • UNCIRCUMCISED -MALE UTI dx -CULTURE ANSWER • UA & URINE CULTURE • IF TOXIC - CBC, ESR, CRP, BLOOD -if recurrent, may need radiology tests to find out why (reflux, etc) UTI ddx - ANSWER - URETHRITIS, VAGINITIS, APPENDICITIS, PID
hematuria objective - ANSWER GENERAL APPEARANCE (EDEMA), VITAL SIGNS (BP), GROWTH CHARTS, NEURO, CARDIAC, RESPIRATORY, ABDOMINAL, GI, GU EXAM • FLANK PAIN, CVA & BLADDER TENDERNESS glomerulonephritis suspicion if recent what - ANSWER strep infection or viral infections hematuria dx - ULTRASOUND, BIOPSY • DD ANSWER • UA, URINE CULTURE, 24 HOUR URINE • RENAL - PSGN, UTI, TRAUMA, NEPHROLITHIASIS
hematuria plan - ANSWER RULE OUT SERIOUS CAUSESREFERRAL IF GROSS HEMATURIA OR PROTEINURIA
hematuria past history focus - ANSWER pt and familysickle cell, lupus, kidney disease
protenuria subjective - ANSWER HISTORY OR FAMILY HISTORY OF RENAL DISEASE,FEBRILE ILLNESS
protenuria objective - ANSWER GENERAL APPEARANCE, VITAL SIGNS (BP), GROWTHCHARTS, NEURO, CARDIAC, RESPIRATORY, ABDOMINAL (ENLARGED KIDNEYS), EDEMA • FLANK PAIN, CVA & BLADDER TENDERNESS protenuria dx - ANSWER UA X 3 OVER 1- HOUR URINE, • IF HIGH - CBC, BMP, BUN, CREATININE • RULE OUT SYSTEMIC2 WEEKS • FIRST AM UA IF POSSIBLE • 24 DISEASE • DD - CAN BE CAUSED BY MEDS SUCH AS NSAIDS meds that may cause protenuria - ANSWER NSAIDS protenuria plan - NEPHRITIS • BURNS, ET AL., FIGURE 35 ANSWER DEPENDS ON AMOUNT OF PROTEIN • EVALUATE FOR -6; FIGURE 41.4 (7TH EDITION)-- ALGORITHM •
REFER PEDIATRIC NEPHROLOGIST
illness that may cause kidney issues - ANSWER strep or viral pharyngitis if protein urine, how many UA do you need - ANSWER -UA X 3 OVER 1- AM UA IF POSSIBLE 2 WEEKS • FIRST -24 HOUR URINE nephrotic syndrome - ANSWER characterized by massive proteinuria caused byglomerular damage
nephrotic syndrome major symptom - ANSWER edema nephrotic syndrom subjective - URINE OUTPUT, RESPIRATORY & GI SYMPTOMS ANSWER • EDEMA (PERIORBITAL & DEPENDENT), LOW
nephrotic syndrome UO - ANSWER low nephrotic syndrome objective - ANSWER GENERAL APPEARANCE, VITAL SIGNS,GROWTH CHARTS, NEURO, CARDIAC, RESPIRATORY, ABDOMINAL, EDEMA, MUSCULOSKELETAL nephrotic syndrome GI and respiratory symptoms caused by - ANSWER increasededema and pressure on these organs
nephrotic syndrom BP - ANSWER may be elevated nephrotic syndrome dx - CREATININE, POSSIBLE BIOPSY • DD ANSWER • UA, 24 HOUR URINE, CBC, BMP, BUN, - DEPENDS ON AGE, GN
Post-streptococcal glomerulonephritis tx - ANSWER goes away on its own GN autoimmune cause - ANSWER lupus-can cause irreversible damage RTA subjective - ANSWER DYSFUNCTION IN THE TRANSPORT CAPABILITY OF THE TUBULES RESULTING IN METABOLIC ACIDOSIS • HISTORY GROWTH PATTERNS (FAILURE OT GAIN WEIGHT AND/OR HEIGHT, IRRITABILITY, GI SYMPTOMS,POLYDIPSIA & POLYURIA, MUSCLE WEAKNESS
prefer liquids over food may indicate - ANSWER RTA RTA physical exam - ANSWER often normal RTA dx - HOUR CREATININE CLEARANCE, ULTRASOUND • DD ANSWER • FIRST AM UA FOR GLUCOSE AND PH, BMP, BUN, CREATININE • 24 - FTT, HYPOTHYROIDISM, ACIDOSIS RTA plan - ANSWER CORRECT ACIDOSIS & MAINTAIN BICARB TO RESTORE GROWTH & PREVENT COMPLICATIONS • ENSURE CALORIES • PEDIATRIC NEPHROLOGIST
NEPHROLITHIASIS/UROLITHIASIS - ANSWER - kidney stones/ureteral stones most commonly kidney more common kidney or bladder stones in peds - ANSWER k NEPHROLITHIASIS/UROLITHIASIS subjective - ANSWER HISTORY/FAMILY HISTORY OF STONES, RENAL DISEASE, ARTHRITIS, GOUT, COLIC, UTI SYMPTOMS • DIET HIGH IS CALCIUM, OXALATE, PROTEIN, SALT diet common with NEPHROLITHIASIS/UROLITHIASIS - ANSWER DIET HIGH ISCALCIUM, OXALATE, PROTEIN, SALT
gout goes along with - ANSWER DIET HIGH IS CALCIUM, OXALATE, PROTEIN, SALT NEPHROLITHIASIS/UROLITHIASIS objective - ANSWER GENERAL APPEARANCE, VITAL SIGNS, NEURO, CARDIAC, RESPIRATORY, ABDOMINAL, EDEMA • ABDOMINAL, FLANK OR PELVIC PAIN drink common with NEPHROLITHIASIS/UROLITHIASIS - ANSWER sweet tea because fullof oxalate
NEPHROLITHIASIS/UROLITHIASIS dx - ANSWER UA, URINE CULTURE, ABDOMINAL XRAY/ULTRASOUND/CT • ANALYZE STONE • DD - UTI, PYELONEPHRITIS, TRAUMA ua usually bloody NEPHROLITHIASIS/UROLITHIASIS plan - ANSWER INCREASE FLUIDS TO INCREASE URINE OUTPUT • STONE REMOVAL IF NEEDED • NUTRITION REFERRAL IF RECURRENT-flush stone out
wilms tumor - ANSWER malignant tumor of the kidney occurring in childhood wilms tumor subjective - ANSWER MOST COMMON MALIGNANCY OF THE GENITOURINARY TRACT • MOST OFTEN DIAGNOSED BETWEEN AGES 2 - 5 • INCREASED SIZE OF ABDOMEN • SMOOTH, FIRM MASS IN ABDOMEN/FLANK • PAINMAY BE PRESENT IF BLEEDING • FEVER, GI SYMPTOMS, WEIGHT LOSS, DYSPNEA
most common malignancy of GU tract - ANSWER Wilms tumor wilms tumor common age - ANSWER 2-5 yo most commonly 3 yo abdominal exam of wilms tumor - ANSWER - FIRM, SMOOTH MASS USUALLY DOESN'T
hypospadias plan - 6- 12 MONTHS • CAN NOT CIRCUMCISE ANSWER REFERRAL PEDIATRIC UROLOGIST AT BIRTH • SURGERY
why. not to circ hypospadias - ANSWER may need to use foreskin in surgical repair when to do surgery on hypospadias - ANSWER 6-12 mo cryptorchidism - ANSWER undescended testicles cryptorchidism subjective - BATH ANSWER FAMILY HISTORY • PARENTS NOTICE DURING
cryptorchidism always up - ANSWER no they can float up and down objective cryptorchidism - RETRACTILE • LOCATION ANSWER GU EXAM • UNILATERAL OR BILATERAL •
cryptorchidism dx -ABNORMALITIES ANSWER NO DIAGNOSTIC EXAMS • DD - CHROMOSOMAL
cryptorchidism plan - PEDIATRIC UROLOGIST • SURGERY IF NEEDED 9 ANSWER IMPROVE FERTILITY OUTCOME • REFERRAL -15 MONTHS
cryptorchidism intervention why and when - ANSWER fertility outcome and do surgeryat 9-15 mo
hydrocele - ANSWER sac of clear fluid in the scrotumincreases with activity
hydrocele subjective - ANSWER COLLECTION OF SEROUS FLUID IN THE SCROTAL SAC • INCREASED SIZE OF SCROTUM WITH ACTIVITY, CHANGE IN SIZE, HISTORY OF TRAUMA, VOMITING vomiting or pain with hydrocele - ANSWER no - this could indicate a different issue hydrocele physical exam - ANSWER GU EXAM - SCROTUM, TESTES, HERNIA, USUALLY UNILATERAL SWELLING • TRANSILLUMINATION • COMMUNICATING— PROCESSUS VAGINALIS IS PATENT SO THERE IS COMMUNICATION WITH THE ABDOMEN AND YOU SUSPECT HERNIA (REDUCES, COMES AND GOES) • NON -COMMUNICATING- FLUID ONLY IN THE SCROTUM (DOES NOT REDUCE) hydrocele unilateral or bilateral - ANSWER usually unilateral noncommunicating hydrocele - ANSWER only in scrotum communicating hydrocele - ANSWER communicating with abdomen-indicates hernia,typically comes and goes
hydrocele dx -RETRACTILE TESTICLE, LYMPHADENOPATHY ANSWER • NO DIAGNOSTIC EXAM • DD - HERNIA, UNDESCENDED OR
hydrocele plan - ANSWER NON-COMMUNICATING - MAY RESOLVE, REFERRAL PEDIATRIC UROLOGIST • IF HERNIA RESOLVES • (^) - REFERRAL SURGERYCOMMUNICATING -
Spermatocele Subjective: - ANSWER painless nodule in scrotum and increase inscrotum size
do hydroceles resolve - ANSWER non-communicating typically do but communicatingprobably need surgery for hernia
HERNIA, HYDROCELE, SPERMATOCELE, TUMOR
varicocele plan -TREATMENT - ULTRASOUND EVERY 6 MONTHS • REFERRAL UROLOGIST OR ANSWER TREATMENT DEPENDS ON GRADE • GRADE 1 -NO SURGEON IF GRADES 2-3, PAINFUL, BILATERAL OR RIGHTSIDED age of varicocele - ANSWER >10 yo refer if younger inguinal hernia - ANSWER the protrusion of a small loop of bowel through a weak placein the lower abdominal wall or groin
inguinal hernia subjective - ANSWER HISTORY OF UNDESCENDED TESTES, FAMILYHISTORY, SWELLING THAT CHANGES WITH CRYING OR STRAINING, PREMATURITY, OBESITY, WEIGHT LIFTING inguinal hernia more common in what infants - ANSWER premature inguinal hernia objective - THE INGUINAL AREA/ SCROTAL AREA; IS IT REDUCIBLE? • SICK IF INCARCERATED ANSWER ABDOMINAL, INGUINAL, GU EXAMS • SWELLING IN
inguinal hernia dx - ANSWER ABDOMINAL X-HYDROCELE, UNDESCENDED TESTES, LYMPHADENOPATHY RAY • ABDOMINAL ULTRASOUND • DD -
incarcerated inguinal hernia - ANSWER hernia that is stuck in the groin or scrotum &cannot be reduced back into the abdomen; caused by swelling; can lead to a strangulated hernia inguinal hernia plan - SURGEON ANSWER REDUCE HERNIA • PEDIATRIC UROLOGIST OR
testicular mass typically malignant or benign - ANSWER malignant testicular mass subjective - ANSWER FAMILY HISTORY, SWELLING, TRAUMA testicular mass transillumination - ANSWER typically does NOT testicular mass objective - DOES NOT TRANSILLUMINATE • ASSESS FOR ABDOMINAL AND SUPRACLAVICULAR ANSWER ABDOMINAL, INGUINAL, GU EXAMS • MASS THAT LYMPH NODES testicular mass dx -VARICOCELE, HYDROCELE, SPERMATOCELE ANSWER TESTICULAR ULTRASOUND, CT • DD - HERNIA,
testicular mass plan - RADIATION, CHEMO ANSWER PEDIATRIC ONCOLOGIST & SURGEON • SURGERY,
Phimosis - ANSWER foreskin cannot be retracted Paraphimosis - ANSWER condition in which a retracted prepuce cannot be pulledforward to cover the glans
Phimosis and Paraphimosis subjective - ANSWER HISTORY OF INFECTION, IRRITATION • CAN'T REDUCE FORESKIN • URINARY PROBLEMS typically younger kids Phimosis and Paraphimosis objective - ANSWER ABDOMINAL, INGUINAL, GU EXAMS •PHIMOSIS • FORESKIN CAN'T RETRACT •PARAPHIMOSIS • PAIN, EDEMA, & BLUE DISCOLORATION
balanitis and balanoposthitis plan - ANSWER TOPICAL ANTIBIOTICS SUCH AS BACTROBAN & ORAL ANTIBIOTICS IF NEEDED • HYGIENE, WARMS SOAKS • IF SWELLING SEVERE, TOPICAL STEROIDS scrotal trauma subjective - SWELLING, TENDERNESS, DISCOLORATION ANSWER HISTORY OF TRAUMA, SPORTS OR PLAYING •
common time of balanitis and balanoposthitis - ANSWER summer because of bathingsuits
scrotal trauma objective - SWELLING, DISCOLORATION, BRUISING, TENDERNESS, HEMATOMA ANSWER ABDOMINAL, INGUINAL, GU EXAMS • PAIN,
scrotal trauma dx -URETHRITIS, EPIDIDYMITIS, HEMATOMA, TESTICULAR TORSION ANSWER TESTICULAR ULTRASOUND IF SEVERE • DD -
scrotal trauma plans - ANSWER COOL COMPRESS, SCROTAL SUPPORT, REST, NSAIDS FOR PAIN • PEDIATRIC UROLOGIST OR SURGEON
testicular torsion - ANSWER twisting of the spermatic cord causing decreased bloodflow to the testis
testicular torsion subjective - ANSWER HISTORY OF SUDDEN ONSET UNILATERALSCROTAL PAIN, TRAUMA, NAUSEA/VOMITING
testicular torsion objective - SCROTAL SWELLING, REDNESS, WARMTH, TENDERNESS, ONE TESTES LARGER. ANSWER VITAL SIGNS, ABDOMINAL, GU EXAMS • TOUCHING CAUSES PAIN. CREMASTERIC REFLEX ABSENT • SPERMATIC CORD THICK & TWISTED, PAINFUL
testicular torsion dx -EPIDIDYMITIS, HERNIA, HYDROCELE, VARICOCELE ANSWER UA, TESTICULAR ULTRASOUND • DD - ACUTE
testicular torsion plan - ANSWER • EMERGENCY PEDIATRIC SURGEON testicular torsion age - ANSWER usually around 10 yo epididymitis - ANSWER inflammation of the epididymis epididymitis subjective - PAINFUL SCROTAL SWELLING, FEVER, NAUSEA/VOMITING, DYSURIA ANSWER HISTORY OF TRAUMA, SEXUAL ENCOUNTERS •
epididymitis objective - EDEMA & ERYTHEMA • EPIDIDYMIS ANSWER ABDOMINAL, INGUINAL, GU EXAMS • SCROTAL - HARD, SWOLLEN, TENDER • CREMASTERIC REFLEX NORMAL • ELEVATION TESTIS RELIEVES PAIN • MAY HAVE URETHRAL DISCHARGE, AS CHLAMYDIA AND GONORRHOEAE ARE COMMON CAUSES
epididymitis most common causes - ANSWER chlamydia or gonorrhea epididymitis dx - DOPPLER TESTICULAR ULTRASOUND • DD ANSWER UA, URINE CULTURE & GRAM STAIN, CBC • STI'S & HIV • - TESTICULAR TORSION, HERNIA, HYDROCELE, VARICOCELE, SPERMATOCELE, TRAUMA, TUMOR epididymitis plan - ANSWER TREAT CAUSE- INFECTION - SUPPORT, REST, ICE, SITZ BATH, NSAIDS • PEDIATRIC UROLOGIST IF NEEDED ANTIBIOTICS • SCROTAL
cremasteric reflex in epidymitis - ANSWER present and normal Labial adhesions - ANSWER Fiberous adhesions between the labial majora Labial adhesions subjective - ANSWER PARENTAL CONCERN, DYSURIA
Mittelschmerz objective - PALPATION OF ABDOMEN & OVARIES ANSWER ABDOMINAL, INGUINAL, GU EXAMS • PAIN WITH
Mittelschmerz dx -CYST, ECTOPIC PREGNANCY ANSWER • NO DIAGNOSTIC EXAMS • DD - APPENDICITIS, OVARIAN
Mittelschmerz plan - 400- 800MG EVERY 8H AND NAPROXEN 550MG EVERY 12H & HEATING PAD • ANSWER SYMPTOMATIC RELIEF OF PAIN • NSAIDS IBUPROFEN REFERRAL GYNECOLOGIST • OCPS IN SOME CASES dysmenorrhea - ANSWER painful menstruation dysmenorrhea subjective - ANSWER HISTORY OF MENSTRUAL CYCLE, 7 VARIABLES,NAUSEA/VOMITING, MEDICATIONS, FAMILY HISTORY, SCHOOL MISSED -usually with period but may be 1-2 days before dysmenorrhea objective - ANSWER COMPLETE PHYSICAL EXAM • PELVIC EXAM dysmenorrhea dx - ULTRASOUND • DD ANSWER UA, CBC, SED RATE, PREGNANCY TEST • PELVIC - ENDOMETRIOSIS, PID
dysmenorrhea plan - IBUPROFEN 400- 800MG Q8H OR NAPROXEN 550MG EVERY 12H & HEATING PAD • ANSWER • SYMPTOMATIC RELIEF OF PAIN • NSAIDS SUCH AS REFERRAL GYNECOLOGIST • OCPS Mittleschmerz drug of choice - ANSWER ibuprofen dysmenorrhea cause - ANSWER release of prostaglandins
dysmenorrhea primary - ANSWER no pelvic animalities mastalgia - ANSWER pain in the breast mastalgia subjective - ANSWER LAST MENSTRUAL CYCLE, PAIN RELATED TO CYCLE,MASSES, REDNESS, DISCHARGE, MEDICATIONS, FAMILY HISTORY
mastalgia objective - ASYMMETRY IS NORMAL IN ADOLESCENCE), MASSES, TENDERNESS, HEAT, NIPPLE ANSWER VITAL SIGNS • BREAST EXAM • SYMMETRY (A LITTLE DISCHARGE mastalgia dx - • DD - INFECTION, FIBROCYSTIC BREAST DISEASE, MASS, BREAST CANCER ANSWER PREGNANCY TEST, CBC IF INFECTED • ULTRASOUND IF CYST (ALTHOUGH ADOLESCENT BREAST CANCER IS RARE*) mastalgia plan - DEPENDING ON FINDINGS OF ULTRASOUND ANSWER • SYMPTOMATIC FOR PAIN - NSAIDS • REFERRAL
amenorrhea - ANSWER absence of menstruation amenorrhea subjective - DETAILED GROWTH, SYSTEMIC ILLNESS, NUTRITION, MEDICATIONS, STRESS • ANSWER • FAMILY HISTORY, AGE OF MOM & SIBLINGS, • TABLE-"PATIENT HISTORY FOR EVALUATING THE CAUSE OF AMENORRHEA" amenorrhea objective - ANSWER VITAL SIGNS, GROWTH CHARTS, TANNER STAGE,NEURO, RESPIRATORY, BREAST, THYROID, CARDIAC, ABDOMINAL, GU
amenorrhea dx - TURNER SYNDROME, EATING DISORDERS • BOX 42.5 TESTS FOR EVALUATING ANSWER UA, TSH, FSH, PROLACTIN, PREGNANCY TEST • DD - AMENORRHEA
