Peds Exam 3 Review PDF

Musculoskeletal Disorders Genu Varum o What is it? § Bowlegs o How is it caused? § Blount’s disease Low Vitamin D § Rickett’s Low Calcium and/or Low Vitamin D o Manifestations § Knee...

Musculoskeletal Disorders Genu Varum o What is it? § Bowlegs o How is it caused? § Blount’s disease Low Vitamin D § Rickett’s Low Calcium and/or Low Vitamin D o Manifestations § Knees widely separated § Ankles close together § Lower legs turned inwards (varum) o Diagnoses § Normal until 2-3 years old § Xray, MRI, CT o Treatment § Braces for mild deformities § Osteotomy & cast Cut & straighten bones o Nursing Considerations § Supplement vitamin D Genu Valgum o What is it? § Knock-Knees o How is it caused? § Blount’s disease Low Vitamin D § Rickett’s Low Calcium and/or Low Vitamin D o Manifestations § Knees close together § Lower legs turned outwards (valgus) o Diagnoses § Normal until 4-5 years old o Treatment § Braces for mild deformities  § Osteotomy & cast Cut & straighten bones o Nursing Considerations § Supplement vitamin D Clubfoot o What is it? § Congenital abnormality where foot is twisted out of normal position o How is it caused? § Unknown § Spina bifida § Position while in utero o Manifestations § Equinus Cant bring foot upwards § Varus Foot is turned inwards § Forefoot curls toward heel & turns upward in partial supination § Foot is small with short Achilles tendon § Muscles in lower leg are atrophied (smaller) Limb is typically shorter in a\ected foot Can be unilateral or bilateral o Bilateral more common o Diagnoses § Visual inspection § Xray o Treatment § Serial casting Cast changes every 1-2 weeks Manipulation & casting for 8-12 weeks total If corrected: o Wear braces/splints à maintain correction o Corrective shoes à maintain correction § Surgery Posterior – heel cord lengthening Medial – ankle capsulotomy Lateral – plantar fasciotomy Release tendons  o These will pull foot back into normal position o Complications § Muscles, tendons, & bones are all involved Dysplasia of the Hip o What is it? § Hip Dysplasia § Femoral head & Acetabulum are improperly aligned o How is it caused? § Unknown § Genetics § Development § Breech position during delivery o Manifestations § Dislocation § Subluxation § Dysplasia § Instability § Limb shortening on a\ected side § Restricted abduction on a\ected side § Unequal gluteal folds § Positive Ortolani & Barlow test o Diagnoses § Barlow test Click Sound Pressure from the front Femoral head is felt to slip out over the surface of the acetabulum & slips back into place once pressure is released § Ortolani test Clunk Sound o Pressure from the behind the femoral head can be felt to slip forwards into the acetabulum § Both tests most reliable: Birth – 4 weeks § Xray not reliable until: 4-6 months o Treatment § Newborn – 6 months Pavlik Harness o Wear 24/7 à remove during bathing & skin checks o Will have a special car seat  § >6 months Closed reduction & Spica Cast o Go to the OR à pop hip back into place o Do not place anything into cast o Check pedal pulses & if they are able to move feet o Double diaper § >24 months Open or closed reduction with cast/brace o Nursing Considerations § Keep hips Abducted § Treatment ASAP § Skin integrity § Diaper under Pavlik Harness § Monitor for cast syndrome Abdominal distension à cuts o\ circulation Pt can only move slightly § Assess for hip deviations § Observe gait in older children § Harness/Cast care § Facilitate developmental tasks § Support family § Skin integrity § Proper home equipment for the casts and harnesses § Harness may be removed for bathing § Cast Syndrome Abdominal distension sometimes seen with spica or body casts Slipped Capital Femoral Epiphysis (SCFE) o What is it? § Femoral head is displaced from femoral neck o How is it caused? § Unknown § Obesity o Manifestations § Limp § Pain § Loss of hip motion § Out – toeing  Foot is rotated externally o Diagnoses § Xray § Bone scan § Ultrasound § CT § MRI o Treatment § Surgery – with screws or pins NPO for surgery o Nursing Considerations § High fall risk § Non weight bearing – PRE OP § Give Tylenol or narcotics for pain Legg-Calve-Perthes Disease o What is it? § Necrosis of the Femoral head Can be unilateral or bilateral o How is it caused? § Unknown o Manifestations § Limp § Ache § Sti\ness Worse with activity § Hip soreness radiating to knee o Diagnoses § Xray § MRI Looks at blood flow o Treatment § NSAIDS § Maintain Rest § Limit weight bearing § Casts – keep femoral head in place § PT § Traction – pins to keep the femoral head in place § Surgery  Osteotomy o Cutting out the bad part of the bone o Nursing Considerations § More common in boys Osteomyelitis o What is it? § Infection of the bone Most common in long bones of leg (Femur very common) Acute or Chronic o How is it caused? § Bacterial Infection (Staph) Spreads through bloodstream Penetrating injury to bone o Manifestations § Pain § Tenderness § Swelling § Decreased Mobility of infected joiny § Redness § Limping or refusing to walk § Fever à late sign o Diagnoses § Labs ESR – inflammation marker CRP – inflammation marker CBC – increased WBC , Decreased H&H à Anemic Blood Culture Bone Biopsy – determines what antibiotics are needed § Xray § Bone Scan § MRI o Treatment § IV Antibiotics Vancomycin or Clindamycin 3-4 weeks 6 weeks – 4 months – depending on severity § PICC Line placement  IV antibiotics very hard on veins Only can place one if blood cultures are negative § IV Fluids § Surgical Drainage If IV antibiotics are not working o Nursing Considerations § Need Early Treatment o Complications § Necrosis resulting from inflammation & abscess formation (pocket of puss) Scoliosis o What is it? § Lateral S or C shaped curvature of spine § >10 degrees is abnormal o How is it caused? § Idiopathic – most common § Congenital – born with it § Acquired – Fetal development in utero o Manifestations § Truncal asymmetry – chest & trunks uneven § Uneven shoulder & hip height § One-sided rib hump § Prominent Scapula § NO PAIN o Diagnoses § Adam’s Test Bending forward to look at curvature of spine § Diagnosed during or after growth spurt usually § Xray § MRI, CT, Bone scan as needed o Treatment § Mild – 10-25 degree curve Exercise & stretching § Moderate – 25-45 degree curve Bracing & exercise o Prevents progression o Pt specific braces, need to be fit for them  o Wear underclothes o Sleep with braces on § Severe - >45 degree curve Surgery o Spinal Fusion (Anterior & Posterior) o Rod Placement o Improves curve à relieves pain, improves lung function o Nursing Considerations § Support to adolescent à will have body image issues § Pre OP Labs, Xray, Pregnancy test, Pulmonary test, education § Post OP Neurovascular assessments o Q2 at first o Temp, cap refill, pulses Wound assessments Log-Rolling o Everything needs to stay aligned Post surgical drains PCA Pump first 24 hours Catheter care PT I&O very important Muscular Dystrophy o What is it? § Inherited disease à leads to muscle fiber degeneration & muscle wasting o How is it caused? § Most common – Duchenne’s o Manifestations § Early Signs: 3-5 years old Delayed walking Frequent falls Toe walking Waddling gait Gowers sign – how they go from sitting à standing § Late Signs: 9-12 years old  Hypertrophied calves (really small) Respiratory weakness Scoliosis Cardiomegaly Wheelchair dependent Contractures o Diagnoses § Clinical presentation § Family history § Elevated CPK § Low muscle response § Muscle biopsy Degeneration of muscle fibers § Genetic blood test Looking for gene mutation o Treatment § NO CURE § Supportive care § Goal: have child stay as active as possible to delay issues § Therapy § Braces § Wheelchair § Contracture surgery § Genetic counseling § Vaccinations & respiratory support – Very Important Juvenile Idiopathic Arthritis (JRA) o What is it? § Autoimmune disorder § Occurs before 16, peak onset at 1-3 years old o Manifestations § Swelling, tenderness, & warmth in joints § Sti\ness especially in the morning § S/S usually in hands o Diagnoses o Treatment § NO CURE § NSAIDS, methotrexate, biologic agents (Enbrel, Humira), Steroids  Help with inflammation Taper o\ steroids § Therapy Make them move, prevents joints from getting worse Avoid weight gain Swimming helps them o Complications § Cataracts, glaucoma, blindness Need frequent eye exams § Growth problems Osteogenesis Imperfecta o What is it? § Inherited disorder § Bones fracture easily o Manifestations § Fractures § Blue sclera § Early hearing loss § Small discolored teeth § Short stature § CAN BE MISTAKEN FOR ABUSE o Diagnoses § Bone biopsy § Xray § Genetic testing o Treatment § Prevention!!! § PT § Casting, bracing § High Vitamin D & Calcium diet § Pamidronate – Increases bone density o Nursing Considerations o Complications Strain o What is it? § Stress to Ligaments o How is it caused?  § Twisting injury § Tearing of capsule or ligaments surrounding a joint o Manifestations § Pain § Limited movement § Superficial edema § Bruising, tenderness o Treatment § RICE Rest, Ice, Compression, Elevation Strain o What is it? § Injury to muscle & tendons Associated with sprains or fractures o How is it caused? § Overstretching, misuse or extension o Treatment § May require surgery if: rupture at tendon-bone § RICE Rest, Ice, Compression, Elevation o Nursing Considerations Fractures o Types of Fractures § Complete Completely separate § Incomplete Fragments of bone are still attached § Compound/open Bone is protruding through skin High risk of infection § Comminuted Small bone fragments lie in the surrounding tissue § Bends Bend in bone without a break § Spiral Twisting § Buckle  Compression of the porous bone produces a buckle o Raised bulging projection at the fracture site § Greenstick Bone is angled beyond limits fo bending Not a complete fracture o Manifestations § Pain § Loss of normal function § Deformity possible § Crepitus à grading sound § Soft tissue edema § Warmth (over injured area) § Bruising § Loss of sensation o Diagnosis § Xray o Treatment § Regain alignment § Restore fuction § Prevent further injury § Immobilization § Nonsurgical management - Casts § Surgery - Tractions § Neurovascular assessments o Cast Management § Elevate cast § Observe extremities § Do not hang cast in dependent position § Nothing inside of cast § Do not get it wet § Turn patient § Double diaper (leg casts or spica cast) § Pedal cast (Spica cast) o Complications § Compartment syndrome EMERGENCY Tissue perfusion is reduced d/t internal or external pressure o Pressure traps nerves, blood vessels & muscle  Untreated à sepsis & necrosis S/S o Pain o Pressure o Paresthesia (numbness/tingling) o Pallor o Paralysis o Early: § Pain § Decresed pulse § Cool to touch o Late: Tissue necrosis may result if untreated § Cyanosis or pallor § Tingling , loss of sensation § Severe pain with motor involvement Treatment o Notify provider o Urgently relieve pressure § Splint cast § Fasciotomy Epiphyseal plate o Growth plate § Damaged à may cause abnormal growth § Closes around adolescence Other things o External fixator devices § No weight on foot at first § Have for 4-6 weeks o Halo traction § Used for unstable C-spine injury Skeletal Tractions o What is it? § Weights & pins used to hold/pull leg into place § Used for pelvic or femur fractures o Nursing Considerations § Maintain ttraction § Maintain alignment § Monitor for skin breakdown – usually have a special mattress  § Prevent complications Clean pin sites Prevent foot drop § Pain management Relaxation Diazepam – reduce muscle spasms Ice compression Repositioning Strength & mobility Preservation o Allow & encourage other movement o Self care o Muscle toning exercise o PT Cardiac Disorders Congenital heart Disease o What is it? § Defect in the heart, great vessels, or persistence of fetal structure o How is it caused? § Risk Factors: Maternal – drug use during pregnancy Family history Down Syndrome DiGeorge syndrome Noonan syndrome § Categories Increased Pulmonary Flow Decraesed Pulmonary Flow Obstruction of blood flow Blood mixing defects Acyanotic o Increased pulmonary flow o Obstruction to blood flow from ventricles Cyanotic o Decreased pulmonary flow o Mixed blood flow o Manifestations § Irregular HR & BP § Increased HR & RR § Murmurs (irregular heart sound) § Poor perfusion à cool, irregular color § Small size § Di\iculty eating & breathing o Diagnoses § Cardiac Cath § EKG § Xray § Echo – looks at heart structure § Holter monitor – 24/7 monitoring § CT § MRI § Labs CBC, ABG, ASO Titer (strep à untreated à rheumatic fever), CRP, Digoxin level § Newborn screening o Treatment § Cardiac Cath Catheter to heart from peritoneum Pre Op o Sedation, Analgesics, education o NPO – 6 Hours Minimum o Labs § PT/PTT – clotting factors § CBC § Looks at these d/t major risk of hemmorhage o Hold Morning Meds o Check pulses – know baseline o EMLA cream to insertion site § Numbing topical cream § Put on groin area o Assess for diaper rash – infection risk Post OP o Pulses – Poor perfusion = Emergency o Temp & color – check perfusion  o VS – 15 minutes initially § Decreased BP à Hemorrhage o Dressing – pressure dressing § Looking for blood à if blood, hold pressure on site § Look for hematoma formation o 4-8 hours bedrest à lying completely flat, no movement, keep legs straight o Clear liquid at first à regular diet o Tylenol or acetaminophen for pain § Surgery Ventricular Septal Defect (VSD) o What is it? § Opening in septum à increased pulmonary flow § Most common § Pt may say they have a “hole in their heart” o Manifestations § Congestive Heart Failure § Pulmonary infections § Pulmonary Hypertension § Systolic murmur § Crackles in lungs o Diagnoses § Chest Xray, ECG, Echo, cardiac Cath o Treatment § Pulmonary artery banding (make it smaller) § Patch (close it if it is small) § Cardiac Cath o Nursing Considerations § Left à Right Shunting, leading to increased pulmonary flow (Acyanotic Condition) Patent Ductus Arteriosus (PDA) o What is it? § Persistent fetal circulation § (Utero Circulation) à normal baby closes in 24 hours o Manifestations § Dypsnea § Tachypnea  § Tachycardia § Hypotension § Full, bounding pulse § Congestive Heart failure § Intercostal retractions § Poor growth § Murmur § PNA o Diagnoses § Chest Xray, ECG, Echo o Treatment § Indomethacin – closes the hole if it small enough § Surgical w/ thoracostomy § Prostaglandins Keep open if they have other heart conditions If other conditions are causing lack of perfusion Coarctation of the Aorta (COA) o What is it? § Narrowing or constricting in the descending aorta o Manifestations § Asymptomatic § High or normal BP in Arms § Bounding pulses in Arms § Low BP in Legs § Weak Pulses in legs – may even be absent § Murmur § Cool Bilateral Extremities – poor perfusion o Diagnoses § Chest Xray, CT/MRI, ECG, Echo o Treatment § Surgical resection with end to end anastomosis May cause residual hypertension o Nursing Considerations o Complications Tetralogy of Fallot o What is it? § 4 defects Pulmonic stenosis  Right Ventricular Hypertrophy Ventricular Septal Defect (VSD) Overriding aorta (really large & mixes blood) o Manifestations § Hypoxia § Cyanosis § Murmur § Retractions § Hypercyanotic spells (Tet Spells) § Poor growth – d/t not being able to eat § Clubbing § Exercise intolerance o Diagnoses § Chest Xray, ECG, Echo, Cardiac Cath o Treatment § Tet Spell – heart is spasming Happens when stressed or eating They turn blue o Give O2, stop feeding, keep calm, knees to chest, PRN Morphine sometimes § Multiple surgeries (Staged surgical repair) Transposition of the great vessels o What is it? § Pulmonary artery leaves the left ventricle § Aorta exits from right ventricle § NO COMMUNICATION between systemic & pulmonary circulation No oxygenated blood is going to the rest of the body o Manifestations § Cyanosis § Congestive heart failure § Murmur § Growth failure § Poor feeding § Tachypnea § retractions o Diagnoses § Chest Xray, ECG, Echo, Cardiac Cath  o Treatment § Prostaglandins à keep PDA open § Arterial switch § Need surgery o Nursing Considerations § Cyanotic heart defect Hypoplastic Left Heart Syndrome (HLHS) o What is it? § Mitral & aortic valves are absent or stenosed § Abnormally small left ventricle & aorta o Manifestations § Cyanosis § Tachycardia § Tachypnea § Dyspnea § Retractions § Decreased peripheral pulses § Congestive heart failure § Low O2 – 75%-85% o Diagnoses § Chest Xray, Echo o Treatment § Prostaglandins § Surgery § Heart Transplant o Nursing Considerations § Cyanotic heart defect Congestive Heart Failure o What is it? § Inadequate cardiac output to support needs o How is it caused? § Heart defects § Anemia § Respiratory Distress § Kawasaki Disease o Manifestations § Tachycardia § Fatigue  § Restlessness § Gallop rhythm § Decreased output § Pale, cool extremities § Slow capillary refill § Weak peripheral pulses § Decreased BP § Sweating – especially while eating § Anorexia § Cardiomegaly § Irritability § Left Sided Tachypnea Retractions Exercise intolerance Cough, hoarness Wheezing Inability to feed Dyspnea Nasal flaring Orthopnea Cyanosis Grunting § Right Sided Weight gain Ascites Edema Hepatomegaly Neck vein distension o Need diuretics typically o Diagnoses § Chest Xray, S/S, Echo, ECG, Labs o Treatment § Goals Make heart work more e\iciently Removing excess fluid à helps them breathe easier Decrease cardiac demands  Improve tissue oxygenation § Surgery § Cardiac Cath § Supportive care Vent, airway, O2 Rest à should cluster care Fluid & diet management o High Calorie formula à small amounts o Only feed for 30 minutes à rest through NG tube § Strict I&O § Daily weights – same time daily, Increased weight, should increase diuretics § Keep pt warm § Elevate HOB to help with swelling o Meds to know § ALWAYS know HR (Apical 1 min) & BP before administration § Digoxin – increase heart contractility, lowers HR Therapeutic range 0.8-2.0 nanograms S/S toxicity o Bradycardia o Arrythmia o N/V o Anorexia Increased risk for Toxicity: o Low Potassium, Magnesium & T4 o High Calcium Doses are rarely more than 1 mL Pt throws up à DO NOT give repeat dose or double next § Furosemide – diuretic, removes fluid, lowers Potassium Need to know BP & K before giving § ACE Inhibitors – decreases workload § Propranolol – Beta Blocker, decreases HR & BP Supraventricular Tachycardia (SVT) o What is it? § Abrupt onset, rapid regular HR § > 220 bpm in infant § > 180 bpm in child  § A\ects cardiac output o Manifestations § Irritability § Pallor § Poor feeding § Palpitations § Chest pain § Dizziness § SOB § Syncope o Treatment § None if it resolves on own § Vagal maneuvers Hold breath, bear down, cough, ice to face § Adenosine – stops heart on monitor & restarts it to normal rhythm § Cardioversion – shocking heart (MUST BE SEDATED) § Long term Beta Blockers Digoxin Cardiac Ablation o Go through groin, burn o\ part of heart that is working improperly Rheumatic Fever o What is it? § Inflammatory disorder of connective tissue o How is it caused? § Autoimmune response related to untreated Strep Throat Usually within 4-6 weeks o Manifestations § Major S/S Murmurs, Tachycardia, Congestive Heart failure Polyarthritis – arthritis in large joints, very painful Erythema Marginatum – rash Subcutaneous nodules – over bony prominences à gradually go away Chorea – involuntary muscle movement (St. Vitus Dance) § Minor S/S  Joint pain (arthralgia) Fever – low grade in morning, spikes in afternoon o Diagnoses § Jones Criteria § Positive Throat culture OR positive ASO titer o Treatment § Strep treatment – Penicillin § Aspirin 75-100 mg/kg/day divided Q4-Q6 Overdose S/S – tinnitus, diaphoresis, easy bleeding & bruising § Treatment for 3-4 weeks d/c when sed-rate decreases § Carditis – 6-8 weeks for treatment § Congestive Heart failure Steroids Digitalis Diuretics Afterload reducing agents § Will have Antibiotic Prophylaxis to prevent recurrent Strep o Nursing Considerations § Don’t want them up & running around while in acute phase § Keep them hydrated § No diet restrictions o Complications § Long term damage to heart valves § A\ects joints, brain, & skin tissue Kawasaki Disease o What is it? § Acute febrile, systemic vascular inflammatory disorder o How is it caused? § unknown o Manifestations § Acute (1-2 weeks) Irritability Not sleeping High fever lasting more than 5 days o Antipyretics will not help Red throat  Strawberry tongue Swollen hands & feet Rash Increased WBC, ESR, Liver function Parents are extremely stressed during this phase § Subacute (2-4 weeks) Cracking lips & fissures Desquamation of skin Joint Pain § Convalescent Stage (6-8 weeks post onset) Child appears normal Lingering inflammation signs still present o Diagnoses § Fever for 5 or more days AND § 4/5 of the following Bilateral conjunctival inflammation Change in oral mucous membranes Changes in extremities Rash Cervical lymphadenopathy § Increased C-Reactive protein & Sed rate, Increased WBC o Treatment § High dose IV gamma Globulin (IGG) Helps with swelling Given for 7-10 days § High dose aspirin until no fever, lower dose until platelets normal Usually 6-8 weeks total § Antithrombotic medications o Nursing Considerations § Involves small & midsize arteries § Assess for HF § Daily weights § I&O § Comfort: Cool clothes, lotion, oral care, keep calm & quiet environment, lip moisturizer, clear liquid à soft food o Complications  § Aneurism § Myocardial infarctions (Heart attack) Look @ last 2 slides at end of Cardiac Renal Disorders Labs o BUN & Creatinine § Increased – kidneys not functioning properly, dehydration o Urinalysis § Shows how much protein, ketones, & glucose are in urine § Nephrotic Syndrome – Very high protein & increased WBCS § UTI – increased WBC, blood in urine sometimes Urinary Tract Infection (UTI) o What is it? § Bacterial, viral or fungal infection § Can be in upper or lower urinary tract § Acute or chronic o How is it caused? § Most commonly caused by E. Coli § Risk Factors Stasis – urine just sitting there Tract anomalies Reflux – urine backing up into the kidneys Constipation Uncircumsized males Female urethra location Tight clothing, underweae & wet bathing suits Sexual activity Bubble baths Improper wiping Spina Bifida – very high risk o Manifestations § Infants Poor feeding Vomiting Foul smelling urine  Fever Dehydration Seizures – low sodium Pallor Will not sleep § Children Poor appetite Painful urination Abdominal or back pain Increased thirst Vomiting Urinary frequency – go a lot, but a small amount Dysuria Pallor Fatigue Hematuria – usually d/t irritation Edema Hypertension Seizures Enuresis or incontinence for a child that is potty trained o Bed wetting o Diagnoses § Clean catch urine sample Pee, stop, catch clean urine from bladder § Straight Cath Sterile, straight from bladder § Urine analysis (UA) Positive: protein, glucose, ketones, nitrites, leukocytes (WBCs) § Urine culture Positive for organism § US § VCUG (Voiding Cystourography) Put a catheter into a pt, inject dye, look to see the movement of the dye using an Xray § IVP (Intravenous Pylogram) Dye through the veins, watch how blood flows to kidneys o Treatment  § Encourage fluids & frequent voiding § I&O § Acetaminophen PRN – pain / fever § Antibiotics (Penicillin) § Prevent recurrence o Nursing Considerations § Prophylactic Antibiotic therapy Somone with bad reflux, spina bifida, recurrant UTI Take: Bactrum o Complications § Renal damage or scarring Vesicoureteral Reflux o What is it? § Backwards flow of urine from bladder to ureters § Stage 1-5, higher number, worse stage § Prevents complete emptying of the bladder § Creates reservoir for bacterial growth o Diagnoses § US § VCUG – definitive o Treatment § Prophylactic antibiotics (Bactrum) § Surgery – ureteral reimplantation IVF Catheter 2-3 days post op o Prevents urinary retention à can cause surgical site damage o Pt should void within 6 hours once catheter is removed Antibiotics – if severe Antispasmotics o Bladder spasms occur frequently post op o Meds help relax bladder & allows pt to void o Also relieves pain Have blood urine at first, will lighten up after a few days o Complications § Renal scarring § Severe kidney damage  Enuresis (Bed Wetting) o What is it? § Innapropriate urination at least 2x/week for 3 months § Pt is 5 years old at least § Types: Primary o Child has never been free of bedwetting for an extended period of time Secondary o Child who started bedwetting after having urinary control o How is it caused? § Risk Factors Family History – Diabetes, UTI Disorders w/ bladder dysfunction Males Emotional Factors: major life stressors, abuse, neglect, behavioral situations o Manifestations § History of: alterations in toilet training, voiding behaviors & BM patterns History of acute or chronic illness Emotional stressors / family disruptions Fluid intake, especially in evening o Treatment § Fluid control – avoid fluid & ca\eine at night (2 hours before bed) § Set scheduled toileting § Enuresis alarms – goes in underwear and if it gets wet it will alarm § Positive reinforcement § Education § Behavior modification – have them help clean the mess § Reassurance § Medications – not a first approach (inhibits urination) ADH – Desmopressin Trycyclic antidepressant – imipramine hyrdrochloride Anticholinergic – Oxybutynin chloride o Nursing Considerations  § Assess bladder habits, testing related to causes (VCGU) ect. § Get the full picture of things Hypospadias o What is it? § Urethra meatus (opening) located anywhere along the coarse of the urethra on the ventral surface of penis § Severity is based on position of the opening & chordee o Diagnoses § Prenatal US § Birth exam o Treatment § Surgery 6-12 months (non emergent but needs repaired) o Avoid circumcision pre op § This is repaired by using skin & tissue from circumcision Stent or Cath post op 5-10 days Petroleum jelly to incision o Helps to prevent diaper from sticking to incision No baths for 5-10 days Cryptorchidism o What is it? § One or both testes fail to descend through inguinal canal into the scrotum o Diagnoses § Newborn exam § CT, MRI US o Treatment § Orchiopexy Positions testis into normal scrotal position Done at 6-12 months if they don’t go down on their own Avoid any straddling toys for 2-4 weeks post op o Complications § Fertility issues § Testicular cancer Bladder Exstrophy o What is it?  § Rare congenital defect § Involves: musculoskeletal, urinary, reproductive & intestines o Manifestations § Posterior bladder wall extrudes through lower abdominal wall Bladder mucosa – bright red tissue Urine leaks from ureters onto the skin (High Infection Risk) Epispadias Present o Urethra opening sitting there up higher, sometimes cant see it § Hip dysplasia § Urinary issues o Treatment § Repaired within 2-3 days (multiple procedures) § Surgical goals Preserve renal function Closure of bladder & abdominal wall Urinary continence Functional & normal appearing genitals Promote later sexual functioning § Primary closure within 72 hours Pre Op o Tissue covered w/ plastic wrap o Epidural Post Op o Monitor I&O o Infection – still will have urine leakage (need antibiotics) o Immobilization of pelvis o Nursing Considerations o Complications Inguinal Hernia o What is it? § Painless inguinal or scrotal swelling of variable size § Occurs when abdominal tissue extends into inguinal canal o How is it caused? o Manifestations § Asymptomatic unless abdominal contents are forced into patent sac § Appears when infant: cries or strains  § Appears when older child: strains, coughs, or stands for long period of time § Incarcerated / strangulated – no blood flow getting to intestines EMERGENCY o Diagnoses o Treatment § Disappears during periods of rest § Reduces w/ gentle compression § Can also resolve on own sometimes § EMERGECY à surgery, change diaper right after surgery (I&O), no rough sports for 3 weeks post op o Nursing Considerations §