Chapter 29: The Child with a Genitourinary Condition
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Questions and Answers

What condition occurs when urine can't pass through the ureter into the bladder, leading to kidney dilation?

  • Cystitis
  • Urinary incontinence
  • Hydronephrosis (correct)
  • Nephritis

What term describes the strong urge to void even when unable to do so?

  • Dysuria
  • Frequency
  • Retention
  • Urgency (correct)

How should a nurse document a 30-gram weight of a wet diaper in terms of fluid output?

  • 30 mL (correct)
  • 300 mL
  • 0 mL
  • 3 mL

What condition involves the narrowing of the preputial opening that prevents the retraction of the foreskin?

<p>Phimosis (C)</p> Signup and view all the answers

Which process is primarily related to data collection in nursing regarding urine output measurement in infants?

<p>Weighing the diaper (B)</p> Signup and view all the answers

What x-ray examination is used to assess the bladder and urethra during micturition?

<p>Voiding cystourethrogram (D)</p> Signup and view all the answers

Which sign indicates a urinary tract infection in a child with daytime enuresis?

<p>Dysuria (D)</p> Signup and view all the answers

What is the most appropriate action for a child with nephrotic syndrome who is edematous and has reduced mobility?

<p>Change the child's position frequently. (B)</p> Signup and view all the answers

What does a parent’s statement about assessing their child's urine for protein indicate?

<p>Awareness of monitoring nephrotic syndrome. (A)</p> Signup and view all the answers

What likely precedes the development of acute glomerulonephritis in a child?

<p>Sore throat 2 weeks ago (C)</p> Signup and view all the answers

Which beverage should be recommended to maintain urine acidity and help prevent urinary tract infections?

<p>Cranberry juice (C)</p> Signup and view all the answers

When a 6-year-old asks about the upcoming orchiopexy, what is the best response?

<p>Let's discuss your feelings and what you know about it. (D)</p> Signup and view all the answers

What should parents be advised regarding their child who has undergone a nephrectomy?

<p>Avoid activities that may risk injury to the remaining kidney. (C)</p> Signup and view all the answers

What does an enlarged and swollen scrotum in a newborn typically indicate?

<p>Hydrocele (D)</p> Signup and view all the answers

What condition may be associated with bilateral cryptorchidism in a newborn?

<p>Inguinal hernia (C)</p> Signup and view all the answers

What is a key symptom of nephrotic syndrome in children that affects their well-being?

<p>Generalized edema (D)</p> Signup and view all the answers

What dietary modification might be advised for children diagnosed with nephrotic syndrome?

<p>Low-sodium diet (D)</p> Signup and view all the answers

What is the primary nursing consideration when caring for a child post-nephrectomy?

<p>Monitor for signs of infection at the surgical site. (D)</p> Signup and view all the answers

Which symptom is not typically associated with urinary tract infections in children?

<p>Rash (D)</p> Signup and view all the answers

What action should a nurse take if a 5-year-old patient has a retracted and tight foreskin that cannot be returned over the head of the penis?

<p>Notify the charge nurse. (A)</p> Signup and view all the answers

What is the most appropriate nursing intervention for a 7-year-old with acute glomerulonephritis and gross hematuria?

<p>Providing activities for the child on restricted activity. (B)</p> Signup and view all the answers

Which urinary diversion procedure is least likely to affect the body image of an adolescent?

<p>Ileal conduit (C)</p> Signup and view all the answers

What clarification should a nurse provide to a parent about immunizations for a 5-year-old child on prednisone for nephrotic syndrome?

<p>Should be delayed. (C)</p> Signup and view all the answers

Which protocol can the nurse recommend to encourage diuresis in a child with nephrotic syndrome who has not responded to corticosteroids?

<p>Cyclophosphamide (Cytoxan), an antisuppressant. (B)</p> Signup and view all the answers

What food should a nurse recommend a child with acute glomerulonephritis avoid to prevent hyperkalemia?

<p>Bananas (D)</p> Signup and view all the answers

Which assessment technique should the nurse omit when caring for a 2-year-old with Wilms tumor?

<p>Palpating the abdomen. (D)</p> Signup and view all the answers

Which statement by a child's father indicates an understanding of the risks associated with an undescended testicle?

<p>An undescended testicle can reduce fertility. (D)</p> Signup and view all the answers

What is the name of the x-ray test performed while a child is urinating to examine the bladder and urethra?

<p>Voiding cystourethrogram (A)</p> Signup and view all the answers

What is the recommended response when a nurse suspects a child is showing signs of dehydration due to nephrotic syndrome?

<p>Monitor vital signs for changes. (A)</p> Signup and view all the answers

What is the key nursing consideration when administering furosemide to a child with nephrotic syndrome?

<p>Ensure the child is well-hydrated before administration. (A)</p> Signup and view all the answers

Which of the following findings would most likely indicate the need for immediate nursing intervention in a child with nephrotic syndrome?

<p>Sudden weight gain (D)</p> Signup and view all the answers

Which of the following is the most effective long-term management option for a child with nephrotic syndrome?

<p>Regular follow-up with a nephrologist. (C)</p> Signup and view all the answers

What vital sign change should a nurse anticipate in a child experiencing an exacerbation of nephrotic syndrome?

<p>Tachycardia (C)</p> Signup and view all the answers

Which statement by a parent indicates a need for further teaching about preventing urinary tract infections in children?

<p>It is acceptable to take frequent bubble baths. (B)</p> Signup and view all the answers

What is the recommended age for surgical repair of hypospadias in a newborn?

<p>Before 18 months of age. (D)</p> Signup and view all the answers

What is an initial sign of nephrosis that a nurse might note in a child?

<p>Periorbital edema. (B)</p> Signup and view all the answers

Which of the following assessments is most important for a child receiving prednisone to treat nephrotic syndrome?

<p>Infection. (D)</p> Signup and view all the answers

In addition to preventing urinary tract infections, which practice is important for a child’s hygiene?

<p>Wiping from front to back. (A)</p> Signup and view all the answers

What is a potential consequence of delaying surgery for hypospadias beyond 18 months?

<p>Psychological issues related to body image. (C)</p> Signup and view all the answers

What type of edema may commonly be observed in a child with nephrotic syndrome?

<p>Periocular edema. (C)</p> Signup and view all the answers

Which of the following conditions is NOT usually associated with the use of prednisone in children?

<p>Heightened immune response. (D)</p> Signup and view all the answers

What is a potential consequence of both testes failing to descend properly during infancy?

<p>Infertility (C)</p> Signup and view all the answers

What condition is suggested by acute scrotal pain in an adolescent male with a history of cryptorchidism?

<p>Testicular torsion (A)</p> Signup and view all the answers

Which of the following lab values might indicate dehydration in a child?

<p>BUN of 25 mg/dL (C)</p> Signup and view all the answers

In caring for a newborn with exstrophy of the bladder, which action is essential?

<p>Covering the exposed bladder with a shield (C)</p> Signup and view all the answers

What is a classic symptom of nephrotic syndrome in children?

<p>Proteinuria (A)</p> Signup and view all the answers

Which psychological factor contributes to stress in preschool children undergoing genitourinary surgery?

<p>Perception of treatment as punishment (D)</p> Signup and view all the answers

What long-term effect might children experience as a result of prolonged prednisone therapy?

<p>Delayed immunization (D)</p> Signup and view all the answers

Which device is used to measure the pressure and volume of the urine stream?

<p>Uroflowmeter (A)</p> Signup and view all the answers

What is the principal function of the nephron in the kidney?

<p>Filtering and regulating fluids (A)</p> Signup and view all the answers

When both testes do not descend, what procedure might be performed to correct it?

<p>Orchiopexy (D)</p> Signup and view all the answers

What is a possible indication of nephrotic syndrome in a child?

<p>Generalized edema (D)</p> Signup and view all the answers

What does not contribute to stress in preschoolers undergoing surgery?

<p>Understanding of surgery purpose (B)</p> Signup and view all the answers

Which of the following conditions is NOT commonly associated with cryptorchidism?

<p>Genital warts (A)</p> Signup and view all the answers

What complication is most likely to arise from untreated testicular torsion?

<p>Infertility (C)</p> Signup and view all the answers

Flashcards

Urinary tract infection (UTI) prevention in children

Washing and wiping the perineal area from front to back, wearing cotton underwear, drinking lots of fluids, and voiding frequently are key strategies to prevent UTIs in children.

Hypospadias treatment

Surgical repair of hypospadias is typically done before the child is 18 months old.

Early sign of nephrotic syndrome

Periorbital edema (swelling around the eyes) is an initial sign of nephrotic syndrome in children, though generalized edema may occur.

Prednisone's effect on children

Prednisone, used to treat nephrotic syndrome, suppresses the immune system and increases risk of infection.

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UTI prevention: Bubble baths

Frequent bubble baths are NOT recommended for UTI prevention, as bubble bath ingredients may irritate the urethra.

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Importance of infection assessment for prednisone

Children on prednisone need careful monitoring for infections as signs may be subtle, because the medication suppresses the immune system.

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Hypospadias surgery timing

Before 18 months old

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Nephrotic Syndrome symptom

Periorbital edema is an early sign of nephrotic syndrome

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Paraphimosis

A condition where the foreskin of the penis is tight and cannot be retracted over the glans.

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Paraphimosis treatment

Contact the charge nurse immediately, as the tight foreskin can impede blood flow.

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Acute Glomerulonephritis activity

Limit activity until hematuria resolves, even if the child seems well.

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Least damaging urinary diversion

Ileal conduit is the least damaging urinary diversion, as it doesn't require an external appliance.

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Immunizations and Prednisone

Delay immunizations during active nephrotic syndrome and immunosuppressive therapy.

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Nephrotic Syndrome diuresis

If corticosteroids are ineffective, a potent antisuppressant (like Cytoxan) may induce diuresis.

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Foods to avoid with acute glomerulonephritis

Avoid high-potassium foods, like bananas, to prevent hyperkalemia.

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Wilms tumor physical assessment

Omit abdominal palpation to avoid disturbing the tumor and potentially spreading it.

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Undescended testicle impact

An undescended testicle can decrease fertility.

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Undescended testicle correction

Surgical correction reduces the risk of testicular tumors, but may reduce fertility.

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Voiding cystourethrogram (VCUG)

An x-ray of the bladder and urethra performed while the child is urinating.

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Cryptorchidism

A medical condition characterized by one or both testicles failing to descend into the scrotum.

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Orchiopexy

Surgical procedure to bring an undescended testicle into the scrotum.

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What is hydronephrosis?

Hydronephrosis is a condition where urine backs up into the kidney, causing swelling and dilation. This happens when urine can't pass through the ureter into the bladder.

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What is urgency?

Urgency is the strong feeling of needing to urinate, even if you can't actually go.

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Phimosis

Phimosis is when the foreskin is too tight and can't be pulled back over the head of the penis.

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How to measure urine output in an infant?

To measure an infant's urine output, weigh the diaper before and after the baby uses it. 1 gram of weight equals 1 milliliter of urine.

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What is the least damaging urinary diversion?

Ileal conduit is considered the least damaging urinary diversion because it doesn't require an external appliance.

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Voiding Cystourethrogram

An x-ray of the bladder and urethra taken before and during urination.

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Dysuria and Urgency in Children

Painful or difficult urination, along with a sudden need to urinate, often point to a urinary tract infection (UTI).

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Edema and Reduced Mobility

Children with nephrotic syndrome (kidney disorder) experience swelling (edema) that can limit their movement. Frequent position changes help prevent complications.

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Monitoring Urinary Protein in Nephrotic Syndrome

Parents of children with nephrotic syndrome need to check the child's urine for protein regularly.

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Glomerulonephritis Cause

Often develops 1 to 3 weeks after a strep infection, potentially causing allergic-type response affecting the kidney.

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Cranberry Juice and UTI Prevention

Apple or cranberry juice helps keep urine acidic, which can naturally inhibit UTI growth.

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Child's Perspective on Orchiopexy

Children often fear bodily harm. Encourage them to express their feelings and concerns about the surgery.

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Post-Nephrectomy Activity Restriction

Children with one kidney should avoid contact sports to protect that kidney from injury.

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Hydrocele in Newborns

A hydrocele is a fluid collection in the scrotum that usually resolves within a year.

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Bilateral Cryptorchidism

The condition where both testes fail to descend into the scrotum, sometimes accompanied by an inguinal hernia.

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Acute Glomerulonephritis

Inflammation of the tiny filters in the kidneys. Often a delayed reaction to a strep infection.

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Nephrotic Syndrome

A disorder that causes leakage of protein into the urine, leading to swelling and other symptoms.

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Urinary Tract Infection (UTI)

An infection of the urinary tract, often caused by bacteria, Typically presents with dysuria, urgency, and frequency.

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Nephrectomy

A surgical procedure to remove a kidney.

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Testicular Torsion

Twisting of the spermatic cord, causing acute scrotal pain and potentially damaging the testicle.

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Elevated BUN

Increased blood urea nitrogen levels, indicating potential dehydration, renal disease, or need for steroid therapy.

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Exstrophy of the Bladder

Birth defect where the bladder is exposed outside the body.

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Preschooler Stress During Genitourinary Surgery

Preschool children undergoing genitourinary surgery may experience heightened stress due to perceived punishment, separation anxiety, sexual curiosity, and fear of castration.

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Long-Term Prednisone Therapy in Preschoolers

Concerns with long-term prednisone therapy in preschoolers include delayed immunization and increased risk of infection.

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Uroflowmeter

Device that measures the pressure and volume of the urine stream.

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Nephron

The functional unit of the kidney, responsible for filtering and regulating fluids.

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Ureteral Obstruction

Complete blockage of the ureter, potentially leading to reflux of urine back into the renal pelvis and causing damage.

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Periorbital Edema

Swelling around the eyes, often an early sign of nephrotic syndrome.

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Hypoalbuminemia in Nephrotic Syndrome

Low levels of albumin in the blood, a hallmark of nephrotic syndrome.

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Genitourinary Surgery in Preschoolers: Fear of Castration

Preschool children undergoing genitourinary surgery may specifically fear castration due to their developmental stage and lack of understanding.

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Prednisone's Effect on Immunity

Prednisone suppresses the immune system, increasing the risk of infection.

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Uroflowmeter's Function

It helps assess urinary flow rate and potential problems with urination.

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Study Notes

Urinary Tract Infection (UTI) Prevention

  • Parent teaching gap: Frequent bubble baths with oils are inappropriate as the oils can irritate the urethra.
  • Front-to-back wiping: Washing and wiping the perineal area from front to back is essential.
  • Cotton underwear: Cotton underwear is beneficial.
  • Fluid intake: Ample fluid intake and frequent voiding are crucial.

Hypospadias

  • Surgical repair: Hypospadias surgical repair is typically done before 18 months of age.
  • No spontaneous correction: Hypospadias will not correct itself over time.
  • Preschool delay is incorrect: Corrective surgery is not typically delayed until preschool age.
  • Testicular cancer risk: Surgical repair does not increase testicular cancer risk.

Nephrotic Syndrome

  • Early sign: Periorbital edema (swelling around the eyes) is an initial sign.
  • Generalized edema: Edema in nephrotic syndrome is widespread but not always obvious to parents.

Prednisone Therapy for Nephrotic Syndrome

  • Infection risk: Prednisone increases the likelihood of infection.
  • Infection signs: Watch for subtle signs and symptoms of infection.
  • Bruising and hypoglycemia: Prednisone's effects do not typically cause easy bruising or hypoglycemia.

Paraphimosis

  • Incorrect action: Do not forcibly push the foreskin back over the penis.
  • Action: Notify the charge nurse immediately.

Acute Glomerulonephritis

  • Activity restrictions: Limited activity until hematuria (blood in the urine) resolves.
  • Protein restriction (not in all cases): A protein-restricted diet may be needed.
  • Careful handling of edematous areas: Gentle handling of swollen areas is necessary.
  • Monitor hypotension: Watch for signs of low blood pressure.

Urinary Diversions

  • Least damaging to body image: Ileal conduit diversion is the least physically invasive and less disruptive to body image.
  • Other diversion methods: Urostomy, nephrostomy, and suprapubic placements all involve more noticeable external appliances.

Immunizations and Prednisone

  • Immunizations during prednisone: Avoid immunizations while on immunosuppressive therapy. Immunizations should be delayed.

Nephrotic Syndrome and Diuresis

  • Corticosteroid ineffectiveness: If corticosteroids are ineffective in inducing diuresis, a strong anti-suppressant like Cytoxan may be needed.
  • Diuretic use: A standard diuretic like furosemide (Lasix) might be employed if steriods are ineffective.

Acute Glomerulonephritis and Diet

  • Potassium-rich foods: Avoid high potassium foods like bananas to prevent hyperkalemia.
  • Other foods: Other potassium-rich or high-protein food limitations may exist, depending on the specific case.

Wilms Tumor

  • Abdominal palpation: Avoid abdominal palpation to prevent spreading of the tumor.

Undescended Testicle (Cryptorchidism)

  • Fertility reduction: Undescended testicle can reduce fertility.
  • Surgical correction: Surgical correction, called orchiopexy, reduces risks.
  • Optimal time: Surgical correction is often done at diagnosis.
  • Spontaneous descent: Spontaneous descent sometimes occurs within the first year.

Voiding Cystourethrogram

  • Test description: An X-ray taken while the child is urinating to image the bladder and urethra.

Daytime Enuresis and Dysuria

  • Indication: Signs of dysuria (painful urination) and urgency mean a possible urinary tract infection (UTI).

Nephrotic Syndrome and Edema

  • Positioning: Frequent position changes are essential to prevent pressure sores and infections.
  • Moist skin: Keep edematous areas clean and dry.

Nephrotic Syndrome and Discharge Teaching

  • Urine protein checks: Parents should monitor urine for protein.
  • Medication discontinuation: Medication should be stopped only when instructed by a healthcare professional.
  • Immunization delay: Immunizations should be avoided while on immunosuppressive therapy.
  • Diet (in some cases): A specific diet may be medically necessary.

Acute Glomerulonephritis Cause

  • Streptococcal infection: Acute glomerulonephritis often follows a streptococcal infection.

Maintaining Urine Acidity

  • Beverage recommendations: Apple juice or cranberry juice can help maintain acidic urine.

Orchiopexy and Child Communication

  • Open communication: Encourage the child to ask questions and express fears.

Post-Nephrectomy Considerations

  • Contact sports: Avoid contact sports.
  • Other restrictions: May exist, depending on specific circumstances

Hydrocele

  • Definition: A collection of fluid in the scrotum that usually resolves on its own within a year.

Bilateral Cryptorchidism

  • Common form? Not the most common form.
  • Fertility: Fertility can be highly affected.
  • Surgical intervention: Surgical intervention is often recommended.
  • Inguinal hernia: Inguinal hernia may also be present.

Testicular Torsion Symptoms

  • Acute scrotal pain: Acute scrotal pain, in conjunction with a history of cryptorchidism, could be indicative of testicular torsion.
  • Immediate intervention: Immediate surgery may be necessary.

BUN (Blood Urea Nitrogen) Elevated

  • Possible causes: Dehydration, renal disease, or need for steroid therapy.
  • Other considerations: Diabetes or pituitary issues could potentially elevate BUN however that is not the most typical reason.

Exstrophy of the Bladder

  • Skin protection: Protect the exposed bladder skin.
  • Positioning: Position infant on their back or side.
  • Diapering: Diaper loosely.
  • Surgical closure scheduling: Surgical correction should be done promptly.
  • Bladder shield: Cover the exposed bladder/urethra with a shield.

Nephrotic Syndrome Symptoms

  • Proteinuria: Presence of protein in the urine.
  • Bloody urine: Grossly bloody urine may be a sign of a related condition, not simply nephrotic syndrome.
  • Hypoalbuminemia(Not hyper): Reduced albumin in the blood.
  • Edema: Generalized swelling.
  • Fatigue: Fatigue can be a symptom.

Preschooler Stress During Genitourinary Surgery

  • Perceived punishment: Children may view treatment as punishment.
  • Separation anxiety: Preschool children are susceptible to separation anxiety.
  • Sexual curiosity: Children are sexually curious, fixated on their genitals, and may fear castration.

Prednisone Therapy in Preschoolers

  • Immunization postponement: Immunizations may need delaying.
  • Risk for infection: Increased risk for infection.
  • Other potential effects: Possible effects like hypertension or changes in nutrition could occur.

Uroflowmeter

  • Description: Device used to measure pressure and volume of urine stream.

Nephron

  • Function: The working unit of the kidney that filters and regulates fluids.

Hydronephrosis

  • Cause: Obstruction of the ureter.
  • Prevention: Urinary diversion to avoid urinary reflux and kidney swelling.

Urgency

  • Definition: A strong urge to void despite the inability to void.

Infant Urine Output Measurement

  • Measurement: Weight of wet diaper minus weight of dry diaper in grams; recorded as milliliters (mL).

Phimosis

  • Definition: Narrowing of the preputial opening around the foreskin.
  • Cause: Prevents foreskin retraction.

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This quiz covers essential concepts related to urinary tract infection prevention, hypospadias, and nephrotic syndrome in children. Key prevention strategies, surgical considerations, and early signs of these conditions will be explored. Perfect for parents and healthcare professionals alike.

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