NURS 629 Exam 2 Questions with 100% Correct Answers | Verified | Updated 2024/2025

NURS 629 Exam 2 Questions with 100% Correct Answers | Verified | Updated 2024/2025 3 kinds of UTI - answer1) Asymptomatic bacteriuria 2) Cystitis 3) Pyelonephritis Asymptomatic bacteriuria: - answerbacteria in the urine w/o other symptoms Cystitis - answerInfection of the bladder that produces lower tract symptoms but does not cause fever or renal injury Pyelonephritis - answerSevere UTI involving the renal parenchyma or kidneys; potential for irreversible renal damage S/S - fever, irritability, vomiting in an infant, and urinary symptoms associated w/ a fever, bacteriuria, vomiting and renal tenderness in older children Main cause of UTI - answerE coli (70% of cases) UTI diagnosis - answer1. Urine culture to confirm (>100,000 colonies in a clean catch urine; or 10,000 colonies in a single pathogen and the child is symptomatic) = UTI 2. UA - foul odor, cloudiness, nitrities, leukocytes, alkaline pH, proteinuria, hematuria, pyuria, bacteriuria 3. CBC, ESR, CRP, BUN, and creatinine for children <1, appears ill or if pyelo is suspected UTI Prevention - answerwipe front to back, bathe in clean water, then wash child, and get out; increase water; void after intercourse; frequent and complete voiding; avoid bubble baths and perfumed soaps; wear cotton underwear; treat perineal inflammation to prevent UTI; treat constipation; decrease caffeine, carbonated beverages, chocolate, and citrus, aspartame, alcohol and spicy foods UTI Treatment in uncomplicated cystitis - answerUncomplicated cystitis: children 2-24 months old and febrile children treated for 7-14 days a. Trimethoprim-sulfamethoxazole (if >2 mo old) 8-12 mg/kg in 2 doses; adolescents - 160mg BID b. Amoxicillin c. Amoxicillin clavulanate d. Cephalexin e. Cefixime (if >6 mo old) f. Cefpodoxime proxetil (if >2 mo old) g. Ciprofloxacin (if >18 years) 500 mg once daily x3 days h. Nitrofurantoin (if >1 mo) UTI Treatment in Pyelonephritis - answera. Hospitalization if dehydrated, vomiting, or not drinking b. If uncomplicated = well hydrated, no vomiting, no abdominal pain = cefixime, ceftibuten, or amox clav c. Adolescents w/ uncomplicated = amox clav or ciprofloxacin Treatment of recurrent UTI - answerRenal and bladder ultrasound, if not done previously and voiding cystourethrogram (VCUG) What is GER? - answerRefers to the passage of gastric contents into the esophagus from the stomach through the LES; normal physiological process in healthy individuals What is GERD? - answerpresent when the reflux causes troublesome symptoms and/or complications; most common esophageal disorder in children GERD etiology - answerInappropriate relaxation of LES w/ failure to prevent gastric acid reflux into the esophagus, prolonged esophageal clearance of the gastric refluxate, and impaired esophageal mucosal barrier function 1. Infants have increased intraabdominal pressure because of their inability to sit upright; regurgitation is highest in the first month of life and decreases by 50% by the 5th month of life GER symptoms - answer1. Infancy = regurgitation; signs of esophagitis (irritability, arching, choking, gagging, feeding aversion); usually resolves 12-24 months of age 2. Child and adolescent = regurgitation during preschool years, complains of abdominal or chest pain, neck contortions (arching, turning of head), asthma, sinusitis, laryngitis 3. Symptoms in all children = regurgitation w/ or w/o vomiting; ruminative behavior; heartburn or chest pain; hematemesis; dysphagia; respiratory disorders (wheezing, stridor, cough, hoarseness, persistent throat clearing or cough); halitosis 4. Signs in all children = esophagitis, esophageal stricture, barrett esophagus, laryngeal/pharyngeal inflammation, recurrent pneumonia, anemia, dental erosion, apnea spells, apparent life-threatening events, weight loss or poor weight gain GERD diagnosis - answerBy history and physical exam; sometimes an empiric trial of acid suppression w/a PPI x 4 weeks may be used as a diagnostic test in older children and adolescents, but not recommended in infants and young children 1. Labs = obtain CBC w/ diff to r/o anemia and infection; UA and urine culture; stool for occult blood; testing for H. pylori 2. Gold standard to diagnose reflux - esophageal pH monitoring GERD management - answer1. H2RA and buffering agents - rapid onset of action, useful in on-demand treatment; result in tolerance ----H2RA examples: cimetidine, famotidine, nizatidine, ranitidine 2. PPI - superior to H2RAs in relieving symptoms and promoting mucosal healing and do not result in tolerance as do H2RA ----PPI examples: lansoprazole (prevacid), omeprazole (Prilosec), rabeprazole (aciphex), pantoprazole (protonix), esomeprazole (nexium) 3. Cytoprotective agent - sucralfate (Carafate) GERD: nutrition - answerthickening agents for formula in 1 tablespoon rice cereal/ounce formula reduce regurgitation but not significantly; no evidence to support dietary restrictions to decrease symptoms; avoid eating <2 hours before bedtime GERD lifestyle - answerWith GER, position infant in flat prone position after feeding if awake and being observed Position in flat supine position if sleeping Semi-sitting position applies abdominal pressure and causes more reflux; positioning infants upright may worsen reflux; Burp frequently during feeding Left-side positioning for older children during sleep or elevation of the head of the bed What is Celiac disease? - answerImmune-mediated systemic disorder triggered by dietary exposure to wheat gluten and related proteins in barley and rye What is celiac characterized by? - answerCharacterized by the presence of a variable combination of gluten-dependent clinical manifestations, celiac disease-specific antibodies, HLA-DQ2.5 or HLA-DQ8 haplotypes, and enteropathy