The Child With A Genitourinary Disorder PDF

2/15/2024 Introduction to Maternity & Pediatric Nursing, 8th Ed. pg. 686-698 NP03L009 ELO C / Version 2.0 1 Urine production begins in utero  Approximately 3 months gestation  Contributes to AFV  Low-set ears warrant further assessment Kidney function immature...

2/15/2024 Introduction to Maternity & Pediatric Nursing, 8th Ed. pg. 686-698 NP03L009 ELO C / Version 2.0 1 Urine production begins in utero  Approximately 3 months gestation  Contributes to AFV  Low-set ears warrant further assessment Kidney function immature until 2 years  Low GFR increases changes of fluid volume excess & dehydration Normal urine output  Infants & Toddlers 2-3 mL/kg/hr  Children 0.5-2 mL/kg/hr 2 Sex genetically determined at fertilization External genitalia distinguishable by 12 weeks gestation Sex organs do not mature until puberty 3 1  2/15/2024 Warning signs  Urinary frequency  Excessive masturbation  Encopresis  Severe nightmares  Bedwetting  Genital irritation or pain  Suggestive posturing  Explicit knowledge of sex  Decrease in physical or emotional development 4 Reproductive System Urinary System  Pap smear  UA  Blood tests  Ultrasound  Cultures  IV pyelogram  Ultrasound  CT scan  Pregnancy tests  Renal biopsy  Urine tests  Uroflow  Cystoscopy  Voiding cystourethrography  Cystometrogram  Urethral pressure 5 Common Lab Tests  BUN  Uric Acid  Creatinine  Urinalysis 6 2  2/15/2024 Urinary dysfunction  Dysuria  Frequency  Urgency  Nocturia  Enuresis  Polyuria  Oliguria 7 True or False _____The newborn’s kidneys function immaturely. _____ There is an unexplained relationship between low-set ears and anomalies of the urinary tract. _____ There is no symptoms or behaviors that will cue the health care provider of sexual abuse. 8 What are 5 test used to determine the cause of urinary dysfunction? 9 3  2/15/2024 10 Phimosis Nephrotic Hypospadias & Syndrome Epispadias Acute Exstrophy of the Glomerulonephritis Bladder Wilms’ Tumor Obstructive Hydrocele Uropathy Cryptorchidism Acute Urinary Tract Infection 11 Narrowing of the preputial opening of the foreskin  Prevents foreskin from being retracted  May cause dribbling or irritation  Considered normal up to 3 years old May be complicated by paraphimosis  Foreskin cannot be returned to normal position  Leads to swelling & impaired circulation Circumcision eliminates the condition 12 4  2/15/2024 13 Hypospadias  Urinary meatus on lower shaft of penis  May be accompanied by chordee Epispadias  Urinary meatus on upper surface of penis Circumcision is avoided Surgical repair at 6-12 months old  Double diaper  Avoid straddling 14 15 5  2/15/2024 Lower abdominal wall & anterior wall of bladder are missing  Bladder lies open, exposed on the abdomen  May range from small cutaneous fistula to complete exstrophy Urine leaks continuously & surrounding skin becomes excoriated Requires surgical closure within 48 hours of life 16 17 Nursing care  Cover bladder with plastic shield  Apply skin protectant  Promote urine drainage  Place diaper under infant  Administer antibiotics  Promote bonding  Educate & support parents 18 6  2/15/2024 Obstruction of normal urine flow  Manifestations dependent upon location May be congenital or acquired Blockage may be partial or complete One or both kidneys may be affected May be complicated by…  Hydronephrosis  Polycystic kidney disease Can lead to metabolic acidosis & UTI 19 20 Treatment  Urinary diversion Ureterostomy Ileal or colon conduit Nephrostomy Suprapubic tube placement Vesicostomy 21 7  2/15/2024 Nursing care  Educate & support family Hygiene & infection control Skin integrity Age-related considerations  Assess for bladder distention Bladder capacity for children Age (years) +2 = Ounces of bladder volume 22 Risk Factors Males Females  Uncircumcised  Short urethra newborns due to  Proximity of urinary trapped pathogens meatus to rectum between the prepuce & glans  Close-fitting nylon underwear  Risk dissipates in older males related to  Bubble baths longer urethra &  Retention of urine antibacterial prostatic  Vaginitis secretions 23 Types of infections  Urethritis  Cystitis  Bacteriuria  Pyelonephritis  Ureteritis  Vesicoureteral reflux Alkaline urine favors pathogens! 24 8  2/15/2024 Diagnostic considerations  SxS age-dependent  Do not collect urine specimen from diaper  Toilet-trained children provide clean catch  May need ultrasound or voiding cystourethrogram 25 Treatment  Broad-spectrum antibiotics  Maintain accurate I&Os  Patient & family education 26 Preventive measures  Fluid intake  Anticipatory guidance  Bladder training  Teach to wipe front-to-back  Avoid baths  Cotton underwear & loose-fitting attire  Acidic diet  Menstrual hygiene 27 9  2/15/2024 Distinguished by…  Marked proteinuria  Edema  Hypoalbuminemia Minimal Change Nephrotic Syndrome (MCNS)  Steroid therapy  More common in young boys  Often follows viral infection 28 Treatment  Minimize edema  Prevent infection  Reduce proteinuria  Prevent medication toxicity 29 Steroid therapy  Monitor closely for & prevent infection Neutropenia Temperature Behavior changes Compromised skin integrity May need immunosuppressive treatment if resistant to steroids 30 10  2/15/2024 Nursing care  Frequent  Dietary repositioning considerations  Prevent infection  Maintain skin Vaccination integrity schedule  Strict I&Os No LIVE vaccines Urine Avoid exposure to characteristics illness Daily weights  Patient & family Abdominal education circumference  Vital signs 31 Patient & family education  Daily weights  Urine collection  Medications  SxS infection  I&O measurements  Infection prevention 32 Allergic reaction to group A beta- hemolytic streptococcal infection  Strep throat  Scarlet fever  Skin infections May be complicated by…  Brain ischemia  Cardiac toxicity 33 11  2/15/2024 Clinical  Increased BUN, manifestations creatinine, &  Periorbital edema sedimentation rates  Smoky brown or  Decreased C3 level bloody urine  Positive ASO titer  Oliguria  Hyperkalemia  Increased urine  Hypertension specific gravity, albumin, RBC, WBC, & casts 34 Treatment  Activity restrictions  Routine urine evaluations  Prevent infection  Dietary restrictions Sodium & fluid Potassium 35 Nursing care  Monitor medication  Prevent infection response  Prevent fatigue Diuretics  Strict I&Os Antihypertensives  Frequent vital  Patient & family signs education Maintain follow-  Monitor ICP ups 36 12  2/15/2024 37 Nephroblastoma  Malignant renal tumor  Encapsulated tumor compresses kidney tissue Often discovered by 3 years old  Presents with mass in abdomen IV pyelogram to confirm growth May be complicated by hypertension 38 Treatment  Surgery Remove kidney & tumor Careful care of remaining kidney  Radiation  Chemotherapy DO NOT palpate the abdomen! 39 13  2/15/2024 Excessive amount of fluid in the sac surrounding the testicle  Peritoneal fluid in the inguinal canal  Due to unfused processus vaginalis Often resolves by 1 year old  May need surgery if persists 40 41 One or both testes fail to descend into scrotum May be complicated by…  Sterility  Inguinal hernia  Testicular torsion Monitor for acute scrotal pain Requires emergent surgery 42 14  2/15/2024 43 44 Treatment & care  Spontaneous descension May occur by 4 months old  Orchiopexy Maintain scrotal support postoperatively  Promote self-examination  Monitor urine output  Prevent infection  Emotional support & education 45 15  2/15/2024 Need anticipatory guidance Minimize negative impact on growth & development Home care  Avoid tub baths  Inspect dressings daily  Restrict certain play activities Consider body image, sexual function, & perception 46 A 16-year-old boy enters the emergency department reporting acute scrotal pain. He is diagnosed with testicular torsion. What treatment for this condition will the nurse expect? A. Application of cool compresses B. Immediate surgery C. Ultrasound-guided external manipulation D. Rest & elevation 47 What is the approximate bladder capacity of a 4-year-old child? A. 2 ounces B. 4 ounces C. 6 ounces D. 8 ounces 48 16  2/15/2024 What is included in preventive teaching for urinary tract infections in girls? Select all that apply. A. Wear nylon underwear B. Encourage fluids C. Wipe front-to-back D. Soak in the tub E. Encourage use of talcum powder F. Consume meats, cheeses, & prunes 49 The administration of prednisone to children with nephrosis creates the problem of: A. Intolerance to foods B. Increased risk of infection C. Increased periorbital edema D. Weight loss 50 The nurse is caring for a child diagnosed with nephrotic syndrome. symptoms that are characteristic of nephrotic syndrome include which of the following? Select all that apply. A. Massive proteinuria B. Edema C. Positive antistreptolysin titer D. Bacteriuria 51 17  2/15/2024 A 2 ½ -year-old child is being discharged after a hypospadias repair. Which of the following cautions should the nurse include in the post-op instructions for parents? Select all that apply. A. Leave the diaper off until the site is healed B. Restrict fluids to reduce output for 1 week C. Continue with toilet training D. Avoid straddling the infant on the hip E. Avoid tricycle riding as a play activity 52 The nurse understands that genitourinary surgery affects growth and development. When caring for a 4-year-old child post-operatively, a priority nursing responsibility would include: a. Strategies to preserve the child’s body image b. Assurances that appearance and sexual function will not be affected c. Providing age-appropriate toys such as tricycles d. Preventing embarrassment by limiting visitation of family and friends 53 Development of Nephrotic Syndrome Urinary and Reproductive Systems Acute Glomerulonephritis Phimosis Wilm’s Tumor Hypospadias/Epispadi as Crytochidism Exstrophy of the Hydrocele Bladder Impact of surgery Obstructive Uropathy UTI 54 18  2/15/2024 55 19