NUR 4010- Pediatrics Exam II Questions With
100% Correct Answers
What is the most important host factors for a UTI in pediatrics?
urinary stasis (also diarrhea= e.Coli closer to urethra)
What type of children are at higher risk for a UTI <2 years?
uncircumcised males
What is sterile pyuria?
small amount of bacteria in urine
What is urosepsis?
bacteria has spread to blood (rare, but very concerning)
Whenever a child has a UTI we consider it "pyelonephritis", why?
because their urethra and ureters are so short
What are considered lower tract infections of the GU system?
-cystitis
-urethritis
What are considered upper tract infections of the GI system?
-pyelonephritis
-vesicouretal reflux (VUR)
-glomerulonephritis
What diagnostic tool do we use when a child comes in with a suspected/confirmed UTI?
ultrasound of the kidneys
What is vesicoureteral reflux (VUR)?
abnormal retrograde (backward) flow of urine from bladder into upper urinary tract
Any time there is stenosis of a ureter, what happens to the kidney?
it becomes smaller, "hydronephrosis"
What is the purpose of doing an ultrasound on a child with a UTI?
check anatomical features of the GU
What is urethral stenosis related to?
trauma
The risk of UTI's ________ with alteration of defense mechanisms.
increase
,What are examples of alterations in defense mechanisms leading to increasing UTI's?
-skin breakdown
-repeated UTI's (are they colonized with this bacteria, or is this new?)
What is the organism that commonly causes UTI's?
E. coli
What are the clinical manifestations of UTI's?
-vary depending on age
-urinary frequency
-febrile (in some cases)
-odiferous urine
-blood or blood-tinged urine (kidney involvement)
*even with significant bacteria, a pediatric patient may have no symptoms or nonspecific symptoms
such as fatigue or anorexia
What should we suspect when there is blood-tinged urine?
kidney involvement
In a urinalysis, what is the most significant finding that would diagnose a UTI?
+ nitrites--they are a byproduct of E. coli
What does an elevated specific gravity (>1.025) indicative of?
dehydration
What does a decreased specific gravity (<1.001) indicative of?
dilute (did you fluid resuscitate? well hydrated?)
What is the normal specific gravity in a UA?
1.001 to 1.025
What is the normal amount of proteins in a UA?
< 20mg/dL
What is the normal amount of urobilinogen in a UA?
up to 1 mg/dL
What does it indicate when a patient has glucose in their UA?
DKA
A patient with a negative glucose, but positive ketones in UA, what does this indicate?
dehydration
What does it indicate when a patient has Hb or RBC's in their UA?
, kidney injury (could have small amounts and be trauma from catheterization)
What does it indicate when a patient has WBC's or leukocyte esterase?
infection
What does it indicate when a patient has casts in their UA?
kidney stones; along with lower back pain
If you catheterize a child and they have 20-50 WBCs, and 1-2+ leukocyte esterase what would you
conclude?
UTI
Why are nitrites not always seen on a UA in an infant?
because they are urinating so much
If you do a clean catch UA, what amount of WBC's would be indicative of a UTI?
at least >50 WBC's
What types of diagnostic studies are done to monitor the GU system?
-ultrasound
-urinalysis
-urine C&S
-BUN/Creatinine
-voiding cystourethrogram (VCUG/VCG)
If you have a patient who is <2 years old with a febrile UTI, what must be done per guidelines?
ultrasound; make sure anatomy is normal
What is the care of a UTI?
-ultrasound (if first febrile UTI)
-sent home with prophylaxis: low dose Bactrim
-set up appointment for a voiding cystourethrogram
What is a voiding cystourethrogram?
-fill child's bladder with dye
-monitor for retrograde flow of bladder dye into the ureters
-reflux is graded
Is Bactrim prophylaxis a good idea in children?
a meta-analysis revealed decreased septic UTI's, but no change in renal scarring
What is the problem with patients on prophylaxis Bactrim?
patient might present with an illness, but the UA doesn't show infection (must wait 24 hr for urine
culture)
100% Correct Answers
What is the most important host factors for a UTI in pediatrics?
urinary stasis (also diarrhea= e.Coli closer to urethra)
What type of children are at higher risk for a UTI <2 years?
uncircumcised males
What is sterile pyuria?
small amount of bacteria in urine
What is urosepsis?
bacteria has spread to blood (rare, but very concerning)
Whenever a child has a UTI we consider it "pyelonephritis", why?
because their urethra and ureters are so short
What are considered lower tract infections of the GU system?
-cystitis
-urethritis
What are considered upper tract infections of the GI system?
-pyelonephritis
-vesicouretal reflux (VUR)
-glomerulonephritis
What diagnostic tool do we use when a child comes in with a suspected/confirmed UTI?
ultrasound of the kidneys
What is vesicoureteral reflux (VUR)?
abnormal retrograde (backward) flow of urine from bladder into upper urinary tract
Any time there is stenosis of a ureter, what happens to the kidney?
it becomes smaller, "hydronephrosis"
What is the purpose of doing an ultrasound on a child with a UTI?
check anatomical features of the GU
What is urethral stenosis related to?
trauma
The risk of UTI's ________ with alteration of defense mechanisms.
increase
,What are examples of alterations in defense mechanisms leading to increasing UTI's?
-skin breakdown
-repeated UTI's (are they colonized with this bacteria, or is this new?)
What is the organism that commonly causes UTI's?
E. coli
What are the clinical manifestations of UTI's?
-vary depending on age
-urinary frequency
-febrile (in some cases)
-odiferous urine
-blood or blood-tinged urine (kidney involvement)
*even with significant bacteria, a pediatric patient may have no symptoms or nonspecific symptoms
such as fatigue or anorexia
What should we suspect when there is blood-tinged urine?
kidney involvement
In a urinalysis, what is the most significant finding that would diagnose a UTI?
+ nitrites--they are a byproduct of E. coli
What does an elevated specific gravity (>1.025) indicative of?
dehydration
What does a decreased specific gravity (<1.001) indicative of?
dilute (did you fluid resuscitate? well hydrated?)
What is the normal specific gravity in a UA?
1.001 to 1.025
What is the normal amount of proteins in a UA?
< 20mg/dL
What is the normal amount of urobilinogen in a UA?
up to 1 mg/dL
What does it indicate when a patient has glucose in their UA?
DKA
A patient with a negative glucose, but positive ketones in UA, what does this indicate?
dehydration
What does it indicate when a patient has Hb or RBC's in their UA?
, kidney injury (could have small amounts and be trauma from catheterization)
What does it indicate when a patient has WBC's or leukocyte esterase?
infection
What does it indicate when a patient has casts in their UA?
kidney stones; along with lower back pain
If you catheterize a child and they have 20-50 WBCs, and 1-2+ leukocyte esterase what would you
conclude?
UTI
Why are nitrites not always seen on a UA in an infant?
because they are urinating so much
If you do a clean catch UA, what amount of WBC's would be indicative of a UTI?
at least >50 WBC's
What types of diagnostic studies are done to monitor the GU system?
-ultrasound
-urinalysis
-urine C&S
-BUN/Creatinine
-voiding cystourethrogram (VCUG/VCG)
If you have a patient who is <2 years old with a febrile UTI, what must be done per guidelines?
ultrasound; make sure anatomy is normal
What is the care of a UTI?
-ultrasound (if first febrile UTI)
-sent home with prophylaxis: low dose Bactrim
-set up appointment for a voiding cystourethrogram
What is a voiding cystourethrogram?
-fill child's bladder with dye
-monitor for retrograde flow of bladder dye into the ureters
-reflux is graded
Is Bactrim prophylaxis a good idea in children?
a meta-analysis revealed decreased septic UTI's, but no change in renal scarring
What is the problem with patients on prophylaxis Bactrim?
patient might present with an illness, but the UA doesn't show infection (must wait 24 hr for urine
culture)
