Nursing Care of the Child with Urinary Elimination Disorders PDF

Nursing Care of the Child with an Alteration of Urinary Elimination/Genitourinary Disorder Amy Millsaps, MSN, RN, CPN Learning Objectives Compare anatomic and physiologic differences of the genitourinary system in infants and children versus adults. Describe nursing care related to common labo...

Nursing Care of the Child with an Alteration of Urinary Elimination/Genitourinary Disorder Amy Millsaps, MSN, RN, CPN Learning Objectives Compare anatomic and physiologic differences of the genitourinary system in infants and children versus adults. Describe nursing care related to common laboratory and diagnostic testing used in the medical diagnosis of pediatric genitourinary and reproductive system conditions. Distinguish alterations in urinary elimination and genitourinary disorders common in infants, children, and adolescents. Identify appropriate nursing assessments and interventions related to medications and treatments for alterations in urinary elimination, genitourinary, and reproductive system disorders in children. Focused Content Urinary Tract and Renal Disorders Reproductive Organ Disorder Bladder exstrophy Phimosis Hypospadias/Epispadias Cryptorchidism Vesicoureteral Reflux UTI Nephrotic Syndrome Acute Poststreptococcal Glomerulonephritis Hemolytic Uremic Syndrome (Kyle and Carman, 2021) Bladder Exstrophy A midline closure defect leaving the bladder open and exposed outside the abdomen Bony pelvis may be malformed May be diagnosed by prenatal US UTI a complication Surgical repair (Kyle and Carman, 2021) Nursing Assessment – Red appearance to the bladder – Visible draining urine – Females: malformed urethra; bifid clitoris – Males: unformed, malformed (Boston Children's Hospital) or normal penis with epispadias (Kyle and Carman, 2021)  – Preventing infection or skin breakdown o Supine Nursing Management o Bladder moist and covered o Change diapers immediately o Sponge bath o Protective barrier creams – Postoperative care o Preventing infection Note: Children with congenital urologic o Indwelling or suprapubic catheter malformations are at high risk for latex allergy o Oxybutynin for bladder spasms o Pain management (Kyle and Carman, 2021) Hypospadias/Epispadias Hypospadias is a urethral defect in which the opening is on the ventral surface of the penis rather than the end of the penis Epispadias is a urethral defect in which the opening is on the dorsal surface of the penis May result in erectile dysfunction or deposition of sperm (Narayana Health) Surgical repair between 6 months and 1 year of age (Kyle and Carman, 2021) (Sukhayu Hospital) (Manchester University) Nursing Assessment – History of unusual urine stream – Inspect for placement of urethral meatus – Inspect for chordee – Palpate for cryptorchidism, inguinal hernia or hydrocele (Kyle and Carman, 2021) Nursing Management Routine postoperative care ▪ Prevent infection Circumcision after surgical repair ▪ Pain management ▪ Antispasmodics Education ▪ Urinary catheter ▪ Sponge baths ▪ Activity (Kyle and Carman, 2021) Vesicoureteral Reflux Urine from the bladder flows back up the ureters If UTI present, pyelonephritis may result Renal scarring, hypertension, renal insufficiency or failure can occur later in life VCUG diagnoses and grades VUR Grades III, IV and V require surgical intervention (Kyle and Carman, 2021) Nursing Assessment –Symptoms oFever oDysuria oFrequency or urgency oNocturia oHematuria or back, abdomen or flank pain –Monitor for hypertension (Kyle and Carman, 2021) Nursing Management – Avoid UTI o Bladder emptying o Toilet hygiene o Prophylactic antibiotics (NOC) o Serial urine cultures o VCUGs – Postoperative care o Encourage high urinary output o Monitor output via catheter o Pain management o Promote bowel function o Avoid bladder spasms (catheter manipulation) (Kyle and Carman, 2021) Urinary Tract Infection Infection of the urinary Tract More common in females Presents differently in infants than children (Cleveland Clinic) (Kyle and Carman, 2021) Nursing – Health history o Current illness Assessment o Past medical history o Risk factors Infants – Physical assessment ▪ Fever o Observe urine ▪ Irritability o Monitor BP ▪ Vomiting o Palpate abdomen ▪ Failure to thrive – Lab and Diagnostic tests ▪ Jaundice o UA Children o Culture ▪ Fever o Renal US ▪ Vomiting o VCUG ▪ Usual symptoms (Kyle and Carman, 2021)  Preventing UTI in Females Nursing Management ▪ Adequate fluid intake ▪ Cranberry juice – Eradicating infection ▪ Avoid cola and caffeine o Antibiotics ▪ Urinate frequently o Adequate fluid intake ▪ Avoid bubble baths – Promoting comfort ▪ Wipe front to back o Antipyretics ▪ Cotton underwear ▪ Avoid tight clothing – Preventing recurrence of infection ▪ Wash daily ▪ Change sanitary pads frequently ▪ Void after sexual intercourse (Kyle and Carman, 2021) Nephrotic Syndrome Result of increased glomerular basement permeability, allowing abnormal loss of protein in the urine 3 forms: congenital, idiopathic, and secondary Complications: anemia, infection, poor growth, peritonitis, thrombosis, and renal failure (Kyle and Carman, 2021) (Mayo Clinic)  Health history: – Nausea and vomiting Nursing – Recent weight gain – Periorbital edema progressing to generalized throughout the day Assessment – Weakness or fatigue – Irritability or fussiness Physical assessment – Edema: – Skin appearance – Respiratory status – Blood pressure – Abdomen for ascites Lab and Diagnostic testing: – Urine dipstick (Stepwards) – Serum protein and albumin – Serum cholesterol and triglyceride (Kyle and Carman, 2021) Nursing Management – Promoting diuresis – Encourage adequate nutrition and growth o Nutrient-rich diet within restrictions o Corticosteroids o Fluid restriction with massive edema only o Diuretics o Restricted sodium intake o Monitor for hypokalemia o Protein-rich snacks o Monitor urine output and protein o Supplemental shakes o Weigh daily – Educate Family o Medication administration and adverse effects o Assess edema resolution o Demonstrate and document urine dipstick for o Pulse rate and BP protein o Albumin infusion possible o Avoid sick playmates to avoid relapse with exposure to infection o Immunosuppressive therapy possible – Provide emotional support – Preventing infection o Chronic condition o Administer pneumococcal vaccine o Relapses take a toll on family o Frequent hospitalizations o 2 weeks after steroid therapy ceases o Social isolation of child o Ensure varicella vaccine current o Appearance (Kyle and Carman, 2021) Acute Poststreptococcal Nephritogenic strain of group A Beta- Glomerulonephritis hemolytic streptococcus (URI or skin) Immune processes injure the glomeruli Altered glomerular Antibody-antigen structure and function More frequently in males in both kidneys reaction Complications: uremia and renal failure Immune mechanisms cause inflammation (Kyle and Carman, 2021) Nursing Assessment Health history Physical assessment Fever BP Lethargy Edema Headache Cardiopulmonary congestion Decreased urine output Gross hematuria (Cola or tea-colored) Abdominal pain Lab and Diagnostic testing Vomiting Urine dipstick Anorexia o Protein Past medical history o Hematuria Pharyngitis or streptococcal ESR infection Antistreptolysin O Older than 3 years of age DNAase B antigen titer Male Nursing Management – Antihypertensives o Labetalol o Nifedipine – Diuretics – Monitor BP – Maintain fluid and sodium restrictions – Weigh daily – Monitor urine output – Monitor urine color – Neurologic evaluation o Encephalopathy and seizures – Cluster care for rest – Education for child and family o Management o Avoid strenuous activity until proteinuria and hematuria resolves o Hemodialysis may be necessary with progression (Kyle and Carman, 2021) Hemolytic Uremic Syndrome Defined by 3 features: Complications: ▪ Hemolytic anemia Chronic renal failure ▪ Thrombocytopenia Seizures ▪ Acute renal failure Coma Usually a verotoxin-producing strain of Pancreatitis E-coli Intussusception Rectal prolapse Transmitted by animal and human feces Cardiomyopathy CHF ARDS (Kyle and Carman, 2021)  Health history ▪ Watery diarrhea progressing to hemorrhagic colitis, then to the triad of HUS Nursing Assessment ▪ Cramping ▪ Sometimes vomiting Risk factors ▪ Ingestion of ground beef ▪ Petting zoo ▪ Swimming pools Physical assessment ▪ Pallor ▪ Toxic appearance ▪ Edema ▪ Oliguria ▪ Anuria ▪ Elevated BP ▪ Abdominal tenderness (Marler Clark) ▪ Neurological involvement (Kyle and Carman, 2021) Lab and Diagnostic Testing – Elevated BUN and Creatinine – Moderate to severe anemia – Increased reticulocyte count – Increased bilirubin and LDH levels – Leukocytosis with left shift – Hyponatremia – Hyperkalemia – Hyperphosphatemia – Metabolic acidosis (Kyle and Carman, 2021)  – Maintaining Appropriate Fluid Volume Balance Nursing Management o Strict I&O o Monitor IVF and labs o Monitor BP frequently o Monitor for bleeding o Encourage adequate nutrition o Diuretics o Antihypertensives o May require dialysis – Preventing HUS o Hand hygiene o Cook meat o Wash fruits and vegetables o Clean drinking water o Avoid unpasteurized products (Kyle and Carman, 2021) Phimosis Cryptorchidism