Nursing Care of the Child with Genitourinary Disorder PDF

Chapter 43 Nursing Care of the Child with an Alteration in Elimination/ Genitourinary Disorder Anatomy and Physiology Differences v Kidney o Large in relation to the stomach o Prone to injury v Urethra: shorter (increases risk for bacteria entry into bladder) v Glomerular filtration...

Chapter 43 Nursing Care of the Child with an Alteration in Elimination/ Genitourinary Disorder Anatomy and Physiology Differences v Kidney o Large in relation to the stomach o Prone to injury v Urethra: shorter (increases risk for bacteria entry into bladder) v Glomerular filtration rate: slower in infant (increases risk for dehydration) v Bladder capacity o 30 mL in newborn o Adult size by 1 year- A healthy human bladder can hold between 400 to 500 milliliters of urine, or about 2 cups before it reaches capacity. v Reproductive organs o Immature at birth o Mature at adolescence Copyright © 2021 Wolters Kluwer. All Rights Reserved Common Laboratory and Diagnostic Tests Box 43.1 pg 1554-1555 vCBC, BUN, electrolytes, vCystoscopy, urodynamic studies creatinine, total protein, albumin vVoiding cystourethrogram vUrinalysis (clean catch, (VCUG) suprapubic, or catheterized), culture and sensitivity vRenal ultrasound, intravenous pyelogram (IVP) vCreatinine clearance vRenal biopsy vTimed urine collections (24 hours) for creatinine, total protein Copyright © 2021 Wolters Kluwer. All Rights Reserved Structural Disorders vHypospadias/epispadias- Fig 43.1 pg 1561 vObstructive uropathy Table 43.1 pg 1563 vHydronephrosis Fig 43.2 pg 1564 vVesicoureteral reflux Fig 43.3 pg 1565 Copyright © 2021 Wolters Kluwer. All Rights Reserved Hypospadias vs Epispadias Copyright © 2021 Wolters Kluwer. All Rights Reserved Hypospadias and Epispadias v Congenital conditions, possibly genetic, characterized by an abnormal positioning of the urethral meatus o In hypospadias, the meatus is inferior to its usual position o In epispadias, the meatus is superior to its usual position; surgical correction with possible penile urethral lengthening may be necessary v Corrective surgery is usually done during the second 6 months of the boys life and before toilet training; all surgery should be done before they start school v Circumcision cannot be done until after the procedure – foreskin is used in the repair Copyright © 2021 Wolters Kluwer. All Rights Reserved Common Sites of Obstructive Uropathy vAny obstruction along the ureter between the kidney, pelvis, and bladder. This occurs when urine annot drain through the urinary tract vHydronephrosis is when urine backs up into the kidney and causes it to become swollen. o Ureteropelvic junction (pelvis to ureter) o Ureterovesical junction (lower ureter to bladder) o Ureterocele (ureter swells into bladder) o Posterior urethral valves (flaps of tissue in proximal urethra, males only) Copyright © 2021 Wolters Kluwer. All Rights Reserved Vesicoureteral Reflux vUrine flow backward up the ureter Copyright © 2021 Wolters Kluwer. All Rights Reserved  Vesicoureteral Reflux Urine normally flows downward from kidneys; in vesicoureteral reflux (VUR), urine backflows from bladder to ureters, and sometimes back to kidneys; this occurs at vesicoureteral junction VUR is a common cause of UTIs in children Usually diagnosed between 2 and 3 years of age Signs and symptoms o Most common presentation: recurrent UTI o Flank pain, abdominal pain, and enuresis ( bed wetting) may coexist o Fever o Nausea/vomiting o UTI symptoms Copyright © 2021 Wolters Kluwer. All Rights Reserved  Vesicoureteral Reflux (con't) v Diagnosis o Based on voiding cystourethrogram (VCUG) radiograph § Uses radiographic contrast material § Observes the bladder, urethra and ureters during micturition § Material observed refluxing back into ureters and kidneys from bladder o Ancillary tests may also be ordered: § Renal ultrasound § Nuclear scan § Intravenous pyelography (IVP) Copyright © 2021 Wolters Kluwer. All Rights Reserved  Vesicoureteral Reflux (con't) Collaborative care o Treatment plan varies based on grade of actual reflux o Goal: prevent recurrent UTI’s and pyelonephritis ( inflammation/ infection of kidneys) o Surgical intervention may be required Education/discharge instructions Educate family members about signs and symptoms of UTI Emphasize importance of medication in this chronic disorder Encourage adequate fluid intake Emphasize importance of early identification of UTIs Risk of pyelonephritis Pyelonephritis causes renal scarring and damage to kidneys Copyright © 2021 Wolters Kluwer. All Rights Reserved Acquired/Functional Disorders vUrinary tract infection pg 1566 is an infection of the urinary tract affecting the bladder vEnuresis pg 1567 Box 43.1 is incontinence of urine past the age of toileting vNephrotic syndrome pg 1569 occurs as a result of increased glomerular basement membrane permeability, which allows abnormal loss of protein. vAcute glomerulonephritis pg 1571 occurs following an upper respiratory or skin infection causing injury to the glomeruli in the kidneys. vHemolytic uremic syndrome pg 1572 is a condition that can occur when the small blood vessels in you kidneys become damaged and inflamed. vRenal failure (acute and chronic) pg 1573-1574 Copyright © 2021 Wolters Kluwer. All Rights Reserved Urinary Tract Infections (UTI) vCaused by bacterium, virus, or fungus vMost often start distally and ascend at urethral area, causing urethritis or cystitis vIf origin in upper tract, ureteritis and pyelitis or pyelonephritis may result vMost common organism is E. Coli ( found in stool) vRisk factors include: gender, age, sexual activity, structural abnormalities, etc. Copyright © 2021 Wolters Kluwer. All Rights Reserved UTI signs and Symptoms vFever vChills, vAbdominal, back or flank pain vLethargy vPoor feeding/appetite vUrinary urgency or frequency vDysuria vFoul smelling urine vTreatment and Education Copyright © 2021 Wolters Kluwer. All Rights Reserved Renal Failure vCondition in which the kidneys cannot concentrate urine, conserve electrolytes, or excrete waste products vMay be acute or chronic: When acute renal failure continues to progress, it becomes chronic (also known as end-stage renal disease [ESRD]). vA common complication is hypertension vTreatment modalities for ESRD o Dialysis o Kidney transplantation Copyright © 2021 Wolters Kluwer. All Rights Reserved Female Reproductive Organ Disorders pg 1579 vLabial adhesions Fig 43.10 pg 1580 vVulvovaginitis pg 1580 vPelvic inflammatory disease We will discuss during Week 13 vSexually transmitted infections We will discuss during Week 13 vMenstrual disorders We will discuss during Week 13 o Primary and secondary amenorrhea o Mittelschmerz and dysmenorrhea o Menorrhagia and metrorrhaghia Copyright © 2021 Wolters Kluwer. All Rights Reserved Labial adhesions Copyright © 2021 Wolters Kluwer. All Rights Reserved Vulvovaginitis Causes Associated Factors vBacterial or yeast overgrowth vTight clothing may cause a heat rash in the perineal area vChemical factors (bubble bath, soaps, perfumes) vPersistent scratching of the irritated area may result in the vPoor hygiene complication of superficial skin infection Copyright © 2021 Wolters Kluwer. All Rights Reserved  Vulvovaginitis Copyright © 2021 Wolters Kluwer. All Rights Reserved Male Reproductive Disorders vPhimosis and paraphimosis Fig 43.11 pg 1581 vCircumsion pg 1581 vCryptorchidism pg 1582 vHydrocele and varicocele pg 1583 vTesticular torsion pg 1583 vEpididymitis pg 1583 vSexually transmitted infections We will discuss during Week 13 Copyright © 2021 Wolters Kluwer. All Rights Reserved Phimosis and paraphimosis Copyright © 2021 Wolters Kluwer. All Rights Reserved Circumcision pg 1581 Benefits Complications vDecreased incidence: vAlterations in the urinary o UTI meatus o Sexually transmitted infections vUnintentional removal of excessive amounts of foreskin o HIV infection o Penile cancer vDamage to the glans penis o Cervical cancer in female partners Copyright © 2021 Wolters Kluwer. All Rights Reserved  Cryptorchidism Copyright © 2021 Wolters Kluwer. All Rights Reserved Hydrocele and varicocele Copyright © 2021 Wolters Kluwer. All Rights Reserved Testicular Torsion vA testicle is abnormally attached to the scrotum and twisted vRequires immediate surgery because ischemia can result if the torsion is left untreated, leading to infertility Also an increased risk of testicular cancer vMay occur at any age but most commonly occurs in boys aged 12 to 18 years vDx: first by nurse assessment then inguinal /abdominal ultrasound vCorrected surgically after 4 months of age Copyright © 2021 Wolters Kluwer. All Rights Reserved Testicular torsion Copyright © 2021 Wolters Kluwer. All Rights Reserved Epididymitis (Inflammation of the Epididymis) vCaused by infection with bacteria vMost common cause of pain in the scrotum vRarely occurs before puberty vTherapeutic management o Eradicate bacteria, give antibiotic , hygiene o If left untreated, a scrotal abscess, testicular infarction, or infertility may occur Copyright © 2021 Wolters Kluwer. All Rights Reserved  Epididymitis Copyright © 2021 Wolters Kluwer. All Rights Reserved Past Medical History for Genitourinary Disorders vPast medical history: maternal polyhydramnios, oligohydramnios, diabetes, hypertension, or alcohol or cocaine ingestion vNeonatal history: presence of a single umbilical artery, abdominal mass, chromosome abnormality, or congenital malformation vFamily history: renal disease or uropathology, chronic urinary tract infections, renal calculi, or a history of parental enuresis Copyright © 2021 Wolters Kluwer. All Rights Reserved Signs and Symptoms of Genitourinary Disorders #1 vBurning on urination vChanges in voiding patterns vFoul-smelling or dark-colored urine vVaginal or urethral discharge vGenital pain, irritation, or discomfort vBlood in the urine vEdema Copyright © 2021 Wolters Kluwer. All Rights Reserved Signs and Symptoms of Genitourinary Disorders #2 vMasses in the groin, scrotum, or abdomen vFlank or abdominal pain; cramps vDistention in lower abdomen vNausea and/or vomiting vPoor growth; weight gain vFever vInfectious exposure vTrauma Copyright © 2021 Wolters Kluwer. All Rights Reserved Question #1 The nurse is percussing the abdomen of a child and notes a dull sound indicating a full bladder. At what anatomic location would this sound be heard? a. Over the spleen b. At the right costal margin c. Over the kidneys d. Above the symphysis pubis Copyright © 2021 Wolters Kluwer. All Rights Reserved Answer to Question #1 d. Above the symphysis pubis When percussing the abdomen a dull sound over the symphysis pubis indicates a full bladder. Dullness is usually heard over the spleen at the right costal margin, over the kidneys, and 1 to 3 cm below the left costal margin. A full bladder may yield dullness above the symphysis pubis. Copyright © 2021 Wolters Kluwer. All Rights Reserved Common Medication Classes for Genitourinary Disorders Pg 1558-1559 drug guide 43.1 vAntibiotics vAnticholinergics (ex Oxybutynin for enuresis) vDesmopressin (DDAVP) (ex Oxybutynin for enuresis) vDiuretics vCorticosteroids vACE inhibitors and other antihypertensives vImipramine (tricyclic antidepressants for enuresis) vImmunosuppressants (for renal transplants) vAlbumin (IV) Copyright © 2021 Wolters Kluwer. All Rights Reserved Common Medical Treatments for Genitourinary Disorders vUrinary diversion vFoley catheter vUreteral stent vNephrostomy tube vSuprapubic tube vVesicostomy vAppendicovesicostomy vBladder augmentation vDialysis (hemodialysis and peritoneal) Copyright © 2021 Wolters Kluwer. All Rights Reserved Hemolytic Uremic Syndrome (HUS) pg 1572 vTypically preceded by diarrheal illness including hemorrhagic colitis vDamage is due to microthrombotic events in kidneys vCharacterized by: pg 1572 o 1.Hemolytic anemia o 2.Thrombocytopenia o 3. Acute renal failure (as evidenced by oliguria and/or anuria) Copyright © 2021 Wolters Kluwer. All Rights Reserved Nursing Goals for the Child with End-Stage Renal Disease (ESRD) vPromoting growth and development vRemoving waste products and maintaining fluid balance via dialysis vMinimize complications by maintaining adequate fluid and nutrition vEncouraging psychosocial well-being vSupporting and educating the family Copyright © 2021 Wolters Kluwer. All Rights Reserved Question #2 Is the following statement true or false? The nurse auscultates the fistula for the presence of a bruit in a child receiving chronic hemodialysis. This is a desired normal finding. Copyright © 2021 Wolters Kluwer. All Rights Reserved Answer to Question #2 True In the child who receives chronic hemodialysis, the nurse should auscultate the fistula for presence of a bruit, which is a desired normal finding. If the child undergoes hemodialysis, the nurse should assess the fistula or graft site for the presence of a bruit and a thrill. The nurse should notify the physician or nurse practitioner immediately if either is absent. Copyright © 2021 Wolters Kluwer. All Rights Reserved Definitions Related to Enuresis vPrimary enuresis: enuresis in the child who has never achieved voluntary bladder control vSecondary enuresis: urinary incontinence in the child who previously demonstrated bladder control over a period of at least 3 to 6 consecutive months vDiurnal enuresis: daytime loss of urinary control vNocturnal enuresis: nighttime bedwetting Copyright © 2021 Wolters Kluwer. All Rights Reserved Restoring Fluid and Electrolyte Balance vMonitor vital signs frequently and assess urine specific gravity vEnsure diet meets required guidelines to support growth vMaintain strict records of intake and output vAdminister diuretics as ordered vWhen urine output is restored, diuresis may be significant vMonitor for signs of hyperkalemia and hypocalcemia vAdminister packed red blood cell transfusions as ordered vDialysis may become necessary Copyright © 2021 Wolters Kluwer. All Rights Reserved