Nursing Care of the Child Nursing Care of the Child with GU disorderswith GU disorders

Renal System Assessment

• Physical assessment

– Palpation, percussion

• Health history

– Previous UTIs, calculi, stasis, retention, pregnancy, STDs, bladder cancer

– Meds: antibiotics, anticholinergics, antispasmodics

– Urologic instrumentation

– Urinary hygiene

– Patterns of elimination

Radiography and other Radiography and other tests of urinary system tests of urinary system

functionfunctionUrine Urine culture & culture & sensitivitysensitivity

Renal/Renal/

bladder USbladder US

VCUGVCUG Imaging Imaging studiesstudies

Testicular Testicular USUS

IVPIVP cystoscopycystoscopy

Renal bx, Renal bx,

Physical tests for Gu Physical tests for Gu functionfunction

• Volume for polyuria, oliguriaVolume for polyuria, oliguria• Specific gravitySpecific gravity• OsmolalityOsmolality• AppearanceAppearance• Chemistries on urine (Chemistries on urine (√ for blood, √ for blood,

WBCs, bacteria, casts)WBCs, bacteria, casts)

Blood tests of renal Blood tests of renal functionfunction

• BUN (blood urea nitrogen)BUN (blood urea nitrogen)• Uric acidUric acid• CreatinineCreatinine

Nursing responsibilities Nursing responsibilities with testingwith testing

• Responsible for preparation and Responsible for preparation and collection of urine or bloodcollection of urine or blood

• Maintains careful intake and Maintains careful intake and outputoutput

• Recognizes that renal disease can Recognizes that renal disease can diminish the glomerular filtration diminish the glomerular filtration raterate

External Defects

Hypospadius / Epispadius

• Epispadias– Congenital urethral defect in which

the uretheral opening is on the upper aspect of the penis and not on the end

• Hypospadias– Congenital urethral defect in which the uretheral opening is on the lower aspect of the penis and not on the tip. May have associated

chordee.

Hypospadius

• Occurs from incomplete development of urethra in utero.

• Occurs in 1 of 100 male children. Increased risk if father or siblings have defect.

• Ranges from mild to severe. • Cyrptorchidism/Undescended testes may be found in

conjunction with hypospadias.

Assessment

Usually discovered during Newborn Physical Assessment

Interventions

• Medical Treatment:– Do NOT circumcise infant. May need to

use foreskin in reconstruction.

• Surgery– Reconstructive – repositions uretheral

opening at tip of penis

• The reason for surgery at about 1 year of age is because:a. children will experience less pain.b. chordee may be reabsorbed.c. the child has not developed body

image and castration anxiety.d. the repair is easier before toilet

training.

Post –op Nursing Care 1. Assess pressure dressing (use to control

bleeding. 2. Maintain urinary drainage. 3. Control bladder spasms.

Antispasmotics (relax the bladder muscle)Pro-Banthine (probantheline)Ditropan (oxybutinin)Levsin (hyoscyamine)

A double diapering technique protects the urinary stent after surgery. The inner diaper collects stool and the

outer diaper collects urine.

4. Control Pain.5. Increase fluids intake. 6. Do not allow to play on any straddle toys.7. Prevent infection. – no bathing or swimming

until stents removed.8. Discharge teaching:

When to call doctor.No bathing or swimming until stents

removed.

Cryptorchidism

Failure of one or both of the testes to descend from abdominal

cavity to the scrotum

Etiology and Pathophysiology

• Testes usually descend into the scrotal sac during the 7-9 gestation

• They may descend anytime up to 6 weeks after birth. Rarely descend after that time.

• Cause unknown• Theories

– Inadequate length of spermatic vessels – Lowered testosterone levels

Assessment

Therapeutic Interventions

• Surgery – Orchiopexy done via laproscopy– Done around 1 year of age

• Nursing Care – Post-op– Minimal activity for few day to ensure

that the internal sutures remain intact– Allow opportunity to express fears

Why is early surgery important?

• Morphologic changes to testis from higher temperature in abd cavity

• Decreased sperm count=infertility?

• Testicular cancer

Urinary Tract Infections

Urinary tract infectionsUrinary tract infections• Most common type of bacterial Most common type of bacterial

infections occurring in childreninfections occurring in children• Bacteria passes up the urethra Bacteria passes up the urethra

into the bladderinto the bladder• Most common types of bacteria Most common types of bacteria

are those near the meatus…staph are those near the meatus…staph as well as e.colias well as e.coli

Contributing factorsContributing factors

• Those with lower resistance, Those with lower resistance, particularly those with recurrent particularly those with recurrent infectionsinfections

• Unusual voiding and bowel habits may Unusual voiding and bowel habits may contribute to UTI in childrencontribute to UTI in children

• ““forget to go to bathroom”forget to go to bathroom”• Symptoms vary by age of childSymptoms vary by age of child

Therapeutic Therapeutic managementmanagement

• Eliminate the current infectionsEliminate the current infections• Identify contributing factors to Identify contributing factors to

reduce the risk of re-infectionreduce the risk of re-infection• Prevent systemic spread of the Prevent systemic spread of the

infectioninfection• Preserve renal functionPreserve renal function

Therapeutic Interventions

• Drug Therapy– Antibiotics – specific to causative

organism– Analgesics –

• Nursing Care– Force fluids – childs choice– Dysuria – sit in warm water in bathtub

and void into the water

Parent Teaching

Change diaper frequentlyTeach girls to wipe front to backDiscourage bubble bathsEncourage fluids frequently throughout

dayBathe dailyAdolescent girls when menstruating are

to change of pad every 4 hours

• The single most important host The single most important host factor influencing the occurrence factor influencing the occurrence of UTI is urinary stasisof UTI is urinary stasis

• What is the chief cause of urinary What is the chief cause of urinary stasis?stasis?

Glomerular diseasesGlomerular diseases

• Acute glomerulonephritis (AGN)Acute glomerulonephritis (AGN)• Nephrotic syndrome or minimal-Nephrotic syndrome or minimal-

change nephrotic syndromechange nephrotic syndrome

Nephrotic SyndromeNephrotic Syndrome

Chronic renal disorder in which the basement membrane surfaces

of the glomeruli are affected, cause loss of protein in the urine.

Nephrotic syndromeNephrotic syndrome

Nephrotic syndrome, contNephrotic syndrome, cont

Contrast of normal gloumerular activity with changes seen in Nephrotic Syndrome

Etiology

• Insidious onset with periods of remission / exacerbations throughout life- No cure

• 95% idiopathic, possibly a hypersensitivity reaction.

• Other causes: post acute glomerulonephritis, sickle cell disease, Diabetes Mellitus, or drug toxicity.

• Usually seen in preschool yrs (2-4). M>F

AssessmentFour most common characteristics:

1. Massive proteinuria

2. Hypoalbuminemia (K+ normal, BP normal)

3. Edema – usually starts in periorbital area and dependent areas of the body and progresses to generalized, massive edema. Pitting edema of 4+. Caused by hypo albumin which causes shift of fluids to extracellular space. *There is an insidious weight gain- shoes don't fit, etc

4. Hyperlipidemia

* Of note is that there is no

hematuria or hypertension

Other signs and symptoms

Fatigue

Anorexia

Weight gain

Abdominal pain – from large amount of fluid in abdominal

Treatment of nephrotic Treatment of nephrotic syndromesyndrome

• Varies with degree of severityVaries with degree of severity• Treatment of the underlying causeTreatment of the underlying cause• Prognosis depends on the causePrognosis depends on the cause• Children usually have the Children usually have the

“minimal change syndrome” which “minimal change syndrome” which responds well to treatmentresponds well to treatment

Ask Yourself?

• Which of the following signs and symptoms are characteristic of minimal change nephrotic syndrome?a. gross hematuria, proteinuria, feverb. hypertension, edema, fatiguec. poor appetite, proteinuria, edemad. body image change, hypotension

Acute Glomerulonephritis

Immune-complex disease which causes inflammation

of the glomeruli of the kidney as a result of an

infection elsewhere in the body.

Acute Glomerulonephritis

Etiology/Pathophysiology

• Usual organism is Group A beta-hemolytic streptococcus

• Organism not found in kidney, but the antigen-antibody complexes become trapped in the membrane of the glomeruli causing inflammation, obstruction and edema in kidney

• The glomeruli become inflamed and scarred, and slowly lose their ability to remove wastes and excess water from the blood to make urine.

AGNAGN• Treatment and nursing care:Treatment and nursing care:• Bed rest may be recommended Bed rest may be recommended

during the acute phase of the during the acute phase of the diseasedisease

• A record of daily weight is the A record of daily weight is the most useful means for assessing most useful means for assessing fluid balancefluid balance

Nursing care specific to Nursing care specific to the child with AGNthe child with AGN

• Allow activities that do not expend Allow activities that do not expend energyenergy

• Diet should not have any added saltDiet should not have any added salt• Fluid restriction, if prescribedFluid restriction, if prescribed• Monitor weightsMonitor weights• Education of the parentsEducation of the parents

Therapeutic Therapeutic managementmanagement

• Corticosteroids (prednisone)Corticosteroids (prednisone)• Dietary managementDietary management• Restriction of fluid intakeRestriction of fluid intake• Prevention of infectionsPrevention of infections• Monitoring for complications: Monitoring for complications:

infections, severe GI upset, ascites, infections, severe GI upset, ascites, or respiratory distressor respiratory distress

Nursing diagnosis for the Nursing diagnosis for the child with child with

glomerulonephritisglomerulonephritis• Fluid volume excess r/t to decreased Fluid volume excess r/t to decreased

plasma filtrationplasma filtration• Activity intolerance r/t fatigueActivity intolerance r/t fatigue• Altered patterns of urinary elimination Altered patterns of urinary elimination

r/t fluid retention and impaired filtrationr/t fluid retention and impaired filtration• Altered family process r/t child with Altered family process r/t child with

chronic disease, hospitalizationschronic disease, hospitalizations