Genitourinary System and Diagnostics

Genitourinary System Overview

• Involves the kidneys, bladder, ureters, and urethra for urine formation and elimination.

Common Diagnostic Procedures

• Urinalysis: General test of urine.
• Urine culture: Identifies bacteria or other microbes in urine.
• Renal ultrasound: Assesses kidney structure using sound waves.
• Voiding cystourethrogram (VCUG): X-ray of the bladder and urethra while urinating.
• IV pyelogram (IVP): X-ray using contrast to view the kidneys, ureters, and bladder.
• Cystoscopy: Visual examination of the bladder through a scope.

Types of Urinary Dysfunction

• Urinary incontinence: Involuntary leakage of urine.
• Urinary retention: Inability to empty the bladder completely.
• Neurogenic bladder: Bladder dysfunction due to nerve damage.

Structural Anomalies

• Hypospadias: Urethral opening on the underside of the penis.
• Epispadias: Urethral opening on the upper side of the penis.
• Vesicoureteral reflux (VUR): Urine backflow from the bladder into the ureters or kidneys.
• Bladder exstrophy: Bladder exposed outside the body.

Urinary Tract Infections (UTIs)

• Causes: Bacterial infection, poor hygiene, dehydration, urinary stasis, VUR.
• Symptoms: Dysuria, frequent urination, fever, foul-smelling urine, abdominal pain.
• Treatment: Antibiotics, increased fluid intake, proper hygiene.

Glomerulonephritis

• Causes: Inflammation of the glomeruli, often following a strep infection.
• Symptoms: Hematuria, proteinuria, hypertension, edema.
• Treatment: Supportive care, blood pressure management, fluid restriction.

Nephrotic Syndrome

• Causes: Kidney disorder causing excessive protein loss in urine.
• Symptoms: Severe edema, foamy urine, hypoalbuminemia.
• Treatment: Corticosteroids, diuretics, a protein-rich diet.

Obstructive Uropathy

• Definition: Blockage in the urinary tract leading to urine build-up and kidney damage.
• Symptoms: Pain, difficulty urinating, UTIs.
• Treatment: Surgery to remove the obstruction or create a new route for urine drainage.

Musculoskeletal System Overview

• Includes bones, muscles, joints, and connective tissues for support and movement.

Skeletal System

• Includes bones, joints, cartilage, and ligaments
• Functions: Support, movement, blood cell production, and mineral storage.

Clubfoot

• Definition: Congenital deformity where the foot is twisted out of normal position.
• Treatment: Serial casting (Ponseti method), surgery if needed.

Muscular Dystrophy (MD)

• Types: Duchenne (most common), Becker, limb-girdle.
• Prognosis: Progressive muscle weakness; Duchenne MD leads to loss of mobility and respiratory failure.

Fractures

• Types: Greenstick (partial break), spiral (twisting injury), comminuted (multiple fragments), compound (bone breaks skin).
• Treatment: Casting, splints, or surgery.

Traction

• Purpose: Aligns bones and reduces muscle spasms.
• Types: Skin, skeletal, halo, manual.
• Skin traction: Non-invasive.
• Skeletal traction: Pins or screws inserted into bone.
• Halo traction: Used for spinal injuries.
• Manual traction: Performed by a healthcare provider.

Casting and Splints: Compartment Syndrome

• Swelling compresses nerves and blood flow.
• Causes severe pain and potential tissue damage.
• Requires immediate medical intervention.

Legg-Calve-Perthes Disease

• Cause: Disruption of blood flow to the femoral head, leading to bone death.
• Treatment: Physical therapy, braces, and sometimes surgery.

Osteosarcoma

• Definition: Most common type of bone cancer in children.
• Treatment: Chemotherapy and surgery (amputation or limb-sparing).

Developmental Dysplasia of the Hip (DDH)

• Symptoms: Hip instability, asymmetric leg creases.
• Treatment: Pavlik harness, casting, or surgery.

Scoliosis

• Definition: Lateral curvature of the spine.
• Treatment: Bracing or surgery depending on severity.

Respiratory System Overview

• Includes the lungs and airways responsible for gas exchange.

Nasopharyngitis vs. Allergic Rhinitis

• Nasopharyngitis: Common cold, caused by viruses.
• Allergic Rhinitis: Triggered by allergens, not infections.

Strep Pharyngitis

• Cause: Group A streptococcus
• Symptoms: Sore throat, fever, white patches on tonsils.
• Treatment: Antibiotics

Croup Syndromes

• Cause: Viral infection causing airway inflammation.
• Symptoms: Barking cough, stridor.
• Treatment: Humidified air, steroids, nebulized epinephrine if severe.

Respiratory Distress Syndrome (RDS)

• Who is at risk? Premature infants due to surfactant deficiency.
• Treatment: Oxygen and surfactant replacement therapy.

Tonsillitis and Adenoiditis

• Cause: Viral or bacterial infection.
• Symptoms: Swollen tonsils, sore throat and fever.
• Treatment: Antibiotics or tonsillectomy if recurrent.

Bronchitis and Bronchiolitis

• Bronchitis: Inflammation of larger airways, usually viral.
• Bronchiolitis: Inflammation of small airways, often caused by RSV.
• Treatment: Supportive care, hydration, oxygen if needed.

Cystic Fibrosis

• Cause: Genetic disorder affecting mucus production.
• Symptoms: Thick mucus, lung infections, poor growth.
• Treatment: Chest physiotherapy, enzyme replacement, and antibiotics.

Asthma

• Symptoms: Wheezing, coughing, shortness of breath.
• Treatment: Bronchodilators, inhaled corticosteroids.

Pneumonia

• Cause: Viral, bacterial, or fungal infection.
• Symptoms: Fever, cough, difficulty breathing.
• Treatment: Antibiotics (if bacterial) and oxygen therapy if needed.

Pediatric Respiratory Disorders: Nasopharyngitis vs. Allergic Rhinitis

• Nasopharyngitis: Viral upper respiratory tract infection lasting 10-14 days; symptoms include sneezing, runny nose, sore throat, mild fever, and cough; managed with supportive care.
• Allergic Rhinitis: Allergic reaction causing sneezing, itchy nose/eyes, clear nasal discharge, and congestion; managed by avoiding allergens and using antihistamines, decongestants, or nasal corticosteroids.

Upper Airway Infections: Pharyngitis

• Pharyngitis: Abrupt onset with management including antibiotics (if bacterial) and antipyretics; emphasize hand hygiene, hydration, and symptom monitoring.

Croup Syndromes

• Croup: Viral inflammation causing barking cough, hoarseness, and stridor; managed with humidified air, corticosteroids, and nebulized epinephrine for severe cases.
• Acute Epiglottitis: Bacterial infection (Haemophilus influenzae type B) in 2-6 year olds with rapid onset, stridor, tripod position, drooling, and fever; requires emergency intubation and antibiotics.
• Acute Laryngotracheal Bronchitis (LTB): Viral infection in 3 month - 3 year olds with gradual onset, barking cough, mild fever, and stridor; managed with cool air, humidified oxygen, and corticosteroids.
• Acute Spasmodic Laryngitis: Viral or allergic cause in 1-3 year olds with sudden onset, stridor, and barking cough disappearing during the day; managed with steam, cool mist, and supportive care.

Respiratory Distress Syndrome (RDS)

• RDS: Caused by lack of surfactant in preterm infants; risk factors include prematurity, multiple births, C-section, and birth anomalies; symptoms include nasal flaring, grunting, retractions, low oxygen saturation, and abnormal ABGs; managed with oxygen therapy, CPAP, mechanical ventilation, IV fluids, and surfactant replacement therapy.

Tonsillitis and Adenoiditis

• Tonsillitis: Viral or bacterial cause leading to sore throat, fever, difficulty swallowing, and enlarged, red tonsils with white patches; managed with supportive care for viral infections, antibiotics for bacterial infections, and tonsillectomy for recurrent infections or complications.

Bronchitis vs. Bronchiolitis

• Bronchitis: Viral upper respiratory infection causing cough, mucus production, and wheezing; self-limiting in about 10 days and managed with fluids, rest, and cough suppressants if necessary.
• Bronchiolitis (RSV Infection): Caused by Respiratory Syncytial Virus (RSV); early symptoms include runny nose, mild fever, and cough; progression leads to wheezing and difficulty breathing; severe cases may cause cyanosis and apnea; managed with humidified oxygen, IV fluids, bronchodilators, and antiviral medications in high-risk cases.

Cystic Fibrosis (CF)

• CF: Autosomal recessive disorder affecting mucus secretion, impacting respiratory, digestive, skin, and reproductive systems; symptoms include chronic cough, wheezing, poor weight gain, bulky foul-smelling stools, and salty-tasting skin; managed with airway clearance therapy, bronchodilators, antibiotics, pancreatic enzyme supplements, and a high-calorie diet.

Asthma

• Asthma: Chronic airway inflammation leading to bronchospasm; triggered by allergens, infections, exercise, and cold air; symptoms include coughing, wheezing, chest tightness, dyspnea, and prolonged expiration; managed with short-acting beta-agonists (Albuterol) for rescue and inhaled corticosteroids or leukotriene modifiers for maintenance.

Pneumonia

• Pneumonia: Infection caused by bacterial, viral, or fungal pathogens; symptoms include fever, cough with sputum, tachypnea, crackles, and diminished breath sounds; managed with supportive care for viral infections, antibiotics for bacterial infections, and oxygen therapy.

Key Nursing Considerations for Respiratory Disorders

• Airway Clearance: Positioning, suctioning, breathing treatments.
• Oxygen Therapy: Monitor SpO₂, adjust oxygen delivery as needed.
• Infection Control: Hand hygiene, isolation precautions (RSV, flu).
• Parental Education: Signs of worsening respiratory distress, medication adherence.
• Nutrition & Hydration: Encourage fluids, high-calorie diet for CF patients.

Pediatric Musculoskeletal Conditions: Characteristics of Musculoskeletal System in Children

• Characteristics: Bones are not fully ossified, contain epiphyses, thick periosteum allows for rapid callus formation and healing, lower mineral content makes bones more porous and resilient, and increased bone overgrowth in children under 10.

Overview of the Musculoskeletal System

• Muscles and bones work together for movement, originating from the mesoderm in the embryo; key growth period is the 4th to 8th week of fetal life, with gradual and orderly development of locomotion.

Diagnostic Tests for Musculoskeletal Conditions

• Imaging Tests: X-rays for fractures and bone abnormalities, bone scans for bone metabolism and injury, CT scans & MRI for detailed visualization, and ultrasound for soft tissue and joint assessments. Laboratory Tests: CBC, ESR, and HLA-B27.

Common Musculoskeletal Treatments

• Arthroscopy: Minimally invasive joint surgery.
• Bone Biopsy: Assesses bone tumors/infections.
• Traction: Aligns and immobilizes fractures.
• Casting & Splints: Stabilizes bones and prevents further injury.

Principles of Soft Tissue Injury Management (RICE)

• Rest: Avoid further injury.
• Ice: Reduce swelling and pain.
• Compression: Prevent excessive swelling.
• Elevation: Reduce swelling and improve circulation.

Fractures in Children

• Causes: Trauma, falls, abuse. Symptoms: Pain, swelling, deformity, decreased mobility.
• Healing: Faster due to thick periosteum.
• Diagnostic Test: X-ray.

Types of Fractures

• Plastic deformation (bend)
• Buckle (torus)
• Greenstick
• Transverse
• Oblique
• Spiral
• Physeal (growth plate)
• Stress.

Nursing Care for Fractures

• Assess history of injury and symptoms; monitor vitals for shock signs; stabilize injury and immobilize; apply ice & elevate to reduce swelling; monitor neurovascular status; pain management; administer tetanus shot & antibiotics for open fractures.

Traction Types & Care

• Purpose: Immobilize fracture, prevent deformity, reduce pain/spasms.
• Types: Skin, skeletal, halo, manual.
• Nursing Care: Maintain alignment, ensure weights hang freely, perform frequent neuro checks, monitor respiration, skin integrity, and ROM.

Cast & Splint Care

• Risk Factors: Skin breakdown from pressure or rubbing, compartment syndrome.
• Signs of Compartment Syndrome ("5 P’s"): Pain, paresthesia, pulselessness, paralysis, pallor.
• Nursing Interventions: Elevate limb for 24-48 hours, apply ice for swelling, reposition every 2 hours, check skin integrity & monitor for drainage, and educate patient/family on cast care & crutch use.

Common Musculoskeletal Disorders: Clubfoot

• Deformity of ankle/foot (unilateral or bilateral); associated with spina bifida & cerebral palsy; treatment involves serial casting & manipulation, bracing & surgery.

Muscular Dystrophy (MD)

• Progressive muscle degeneration.
• Types: Duchenne MD, Facioscapulohumeral MD, Limb-Girdle MD.
• Key Symptoms: Progressive weakness, clumsiness, frequent falls, Gower’s Sign.
• Nursing Care: Monitor ADLs, respiratory & cardiac function, encourage physical therapy & mobility maintenance, and provide genetic counseling for families.

Legg-Calvé-Perthes Disease

• Avascular necrosis of femoral head.
• Most common in boys 5-12 years.
• Symptoms: Hip pain, limp, decreased ROM.
• Treatment: Non-weight bearing, reconstructive surgery if needed.

Osteosarcoma & Ewing’s Sarcoma

• Osteosarcoma: Primary bone tumor (ages 10-15); rapid metastasis to lungs; treatment involves limb salvage surgery and chemotherapy.
• Ewing’s Sarcoma: Malignant tumor in bone marrow; poor prognosis with metastasis; treatment involves chemotherapy and radiation.

Developmental Dysplasia of the Hip (DDH)

• Abnormal hip development (infancy/childhood); types include acetabular dysplasia, subluxation, and dislocation; symptoms include uneven thigh folds and hip clicking; treatment involves Pavlik harness, surgery & casting.

Scoliosis

• Lateral spinal curvature & rotation; screening via X-ray and scoliometer; treatment involves bracing and surgery.

Pediatric Genitourinary Conditions: Assessment of Urinary Function

• Diagnostic Tests: Urinalysis, ultrasound, IV Pyelogram, CT Scan of Kidneys, Biopsy, Uroflow Test, Cystoscopy, Voiding Cystourethrography (VCUG), Cystometrogram, and Urethral Pressure Studies.

Terms for Urinary Dysfunction

• Dysuria, frequency, urgency, nocturia, enuresis, polyuria, oliguria.

Anomalies of the Urinary Tract

• Phimosis: Tight foreskin that cannot retract; circumcision recommended for severe cases; avoid forced retraction.
• Cryptorchidism: Testes fail to descend into scrotum; complications include testicular atrophy and sterility; treatment involves hormone therapy or orchiopexy.
• Epispadias & Hypospadias: Urinary meatus on upper penile shaft or lower penile shaft; may be associated with chordee; treatment involves surgical correction before 18 months; avoid circumcision.
• Exstrophy of the Bladder: Bladder exposed on abdomen; treatment involves immediate surgical closure (within 48 hrs of birth); manage with plastic wrap over bladder, diapers underneath, and antibiotics.

Obstructive Uropathy

• Causes: Kidney stones, tumors, strictures, scarring; conditions include hydronephrosis and polycystic kidney disease; treatment involves surgery to remove obstruction or urinary diversion.

Urinary Tract Infection (UTI)

• Types: Recurrent, Persistent, Urethritis, Pyelonephritis, Cystitis, Bacteriuria, Asymptomatic, Ureteritis, Vesicoureteral Reflux (VUR).
• Risk Factors: More common in girls, urinary tract anomalies, toilet training, uncircumcised boys, sexual activity.
• Symptoms: Children < 2 years old present with fever, vomiting, irritability, poor feeding; Children > 2 years old Frequent urination, burning, urgency, foul-smelling urine.
• Management: Antibiotics, increase fluids & encourage frequent voiding, correct anatomic defects.

Nephrotic Syndrome (Nephrosis)

• Etiology: Unknown cause; symptoms include edema, proteinuria, hypoalbuminemia, weight gain; managed with Corticosteroids, Diuretics, and high-protein/low-sodium diet.

Acute Glomerulonephritis

• Etiology: Recent Group A beta-hemolytic streptococcus infection; symptoms include edema, hematuria, hypertension, oliguria; manage with monitoring vitals, LOC, behavior plus low sodium and fluid-restricted diet.

Impact of Urinary or Genital Surgery on Development

• Children (3-6 years old) may develop body image concerns; guidance & preparation help reduce psychological effects.

Key Nursing Considerations for Genitourinary Conditions

• Assess urinary function & pain levels, encourage hydration & proper hygiene, educate families on treatment & prevention, provide emotional support, and monitor for complications.