Chapter 29: The Child w/Genitourinary Condition Urine Output: Infant- 2ml/kg/hr. Child (above 3yrs)- 0.5-1ml/kg/hr (going to be a range). Dysuria- Difficulty urinating. Frequency- How often the person voids in a short period of time. Urgency- Strong urge to void. Polyuria- Excessive urination. Ex: more than 2ml/kg/h for an infant. Oliguria- Little urination. Ex: less than 2ml/kg/hr infant and less than 0.5ml/kg/hr for a child. Nocturia- Waking up to urinate in the night. Enuresis- Uncontrolled voiding after voiding control has been established. Primary Enuresis: The child has never been free of bed wetting for an extended period. 1g=1ml Hypospadias- Opening of the penis is on the bottom. Epispadias- Opening of the penis is on the top. Urinary Tract Infection: - Usually caused by E. coli. - Change diapers often - Drink water or cranberry juice - Wipe from front to back. S/S of UTI: - Dysuria: Painful or difficulty urinating. Frequency Urgency: Subjective Infant: - Fever - Foul odor in diaper d/t bacterial buildup Nephrotic Syndrome: - Proteinuria - Edema - Hypoalbuminemia Tx: - Diuretics Acute Glomerulonephritis: - An allergic reaction to strep throat infection (Group A beta hemolytic streptococcal infection). - Check culture: Present. - Titers vaccination: Past Symptom: - Edema: Give diuretics Wilms’s Tumor: - Nephroblastoma (Cancer in the kidney) - Radiation kills the immature cells hoping when it comes back it's no longer Tx: immature and cancerous. - Chemotherapy - Surgery to remove the tumor and one of the kidneys (Unilateral) - If the tumor is in both kidneys you need to be on dialysis until a transplant happens. Chapter 30: The Child w/Skin Condition Acne Vulgaris: Comedo- A bump filled with pus bacteria or sebum. - Blackhead: An open comedo (Popped), the surface is darkened by melanin. - Whitehead: Closed comedo. (Are responsible for the inflammatory process of acne.) - With Continued buildup the walls of the follicle rupture, releasing their irritating contents into surrounding skin. Main Ingredient of Acne treatment: - Salicylic acid - Moisturizer Systemic Acne: - Bad acne - Accutane - Teratogenic - Prescribe with birth control (oral contraceptives). Herpes: - Viral infection - Treat symptoms - Type I- Cold sores - Types II- Genital sores - Tx w/Acyclovir Burns: - Chapter 31: The Child w/Metabolic Condition Type I Diabetes: - Insulin deficiency at birth Classic Triad Symptoms of Diabetes: - Polydipsia (Excessive thirst) - Polyuria (More than 2 ml/kg/hr for infants and more than 0.5-1 ml/kg/hr for a child) - Polyphagia (Excessive hungry) Other Symptoms of Diabetes: - Lethargy, weakness, and weight loss - Glucosuria - Hyperglycemia - Give insulin subcutaneously at 45 degrees for a thin Pt and 90 degrees for an obese Pt. Tx: Type II Diabetes: - Insulin resistance Risk Factors: - Sedentary lifestyle - Poor diet (High fat, High carb) - Genetics - Obesity - Change lifestyle - Exercise (mimics insulin) - Decrease fat and carbohydrates. - Administer Metformin Tx: Fasting blood glucose: - Measured in the morning as Pt wakes up. - If blood sugar is greater than 126 mg on two consecutive occasions and has a history, they are positive for diabetes. Glucose tolerance test: - Give a sweet drink and assess to see if their blood sugar will drop an hour later. Glycosylated hemoglobin test: - Diagnostic and gauge compliance. - Is used to assess if a Pt has diabetes and can show if they are doing what they need to maintain their blood sugar level. - Is usually done every 3 months (120 days), as this is when erythrocytes die and reproduce. *Insulin can be given either subcutaneously or IV. Types of Insulin: Regular- Fast acting and clear in color NPH- Slow/long-acting and cloudy. Mixing Insulin: 1. Inject air into NPH (cloudy) 2. Inject air into Regular (clear) 3. Withdraw Regular insulin (clear) 4. Withdraw NPH insulin (cloudy) Oral Antidiabetic Medication: - Metformin
