Nursing Care of the Child with GU disorders

Radiography and other tests of urinary system function Urine culture & sensitivity Renal/bla dder US VCG Imaging studies Testicular US Scout film IVP Renal bx, cysto Whitaker perfusion test

Physical tests for Gu function Volume for polyuria, oliguria Specific gravity OsmolalityAppearance Chemistries on urine ( √ for blood, WBCs, bacteria, casts)

Blood tests of renal function BUN (blood urea nitrogen_ Uric acid Creatinine

Nursing responsibilities with testing Responsible for preparation and collection of urine or blood Maintains careful intake and output Recognizes that renal disease can diminish the glomerular filtration rate(the amt of plasma from which a given substance is totally clear in one minute)

Urinary tract infections Most common type of bacterial infections occurring in children Bacteria passes up the urethra into the bladder Most common types of bacteria are those near the meatus…staph as well as e.coli

Contributing factors Those with lower resistance, particularly those with recurrent infections Unusual voiding and bowel habits may contribute to UTI in children “forget to go to bathroom” Symptoms:

Therapeutic management Eliminate the current infections Identify contributing factors to reduce the risk of re-infection Prevent systemic spread of the infection Preserve renal function

FYI The single most important host factor influencing the occurrence of UTI is urinary stasis What is the chief cause of urinary stasis?

Vesicoureteral Reflux Approximately 20% of children that have UTIs will be found to have vesicoureteral reflux on xray

What is vesicoureteral reflux?

Treatment for vesicoureteral reflux Directed toward preventing UTIs Managed by time or surgery if a lower grade Single doses each day of abx as long as reflux lasts Urine cultures done q 6 wks up to 3 months to make sure no “silent infection”

Tests specific to reflux Kidney ultrasound VCUG Renal SPECT RCG (radionucleaotide cystogram)

Hypospadias/Epispadias Congential defect with urethral defect Meatus on lower aspect (hypospadias) Meatus on dorsal aspect (epispadias) May have a fibrous band that cuases the penis to curve downward

Treatment for hypospadias DO NOT circumcise infant; may need the foreskin for reconstruction Surgery: reconstructive to re- position the meatus at the tip Usually done before one year of age Post-op care:

Glomerular diseases Acute glomerulonephritis (AGN) Nephrotic syndrome (MCNS) or minimal-change nephrotic syndrome

AGN Immune-complex disease causing inflammation of glomeruli of kidney Usual organism is group A beta- hemolytic strep Decreased glomerular filtration Common in children (boys > girls) Assessment/diagnostic tests:

AGN Treatment and nursing care: Bed rest may be recommended during the acute phase of the disease A record of daily weight is the most useful means for assessing fluid balance

Nursing diagnosis for the child with glomerulonephritis Fluid volume excess r/t to decreased plasma filtration Activity intolerance r/t fatigue Altered patterns of urinary elimination r/t fluid retention and impaired filtration Altered family process r/t child with chronic disease, hospitalizations

Nursing care specific to the child with AGN Allow activities that do not expend energy Diet should not have any added salt Fluid restriction, if prescribed Monitor weights Education of the parents

Nephrotic syndrome

Nephrotic syndrome, cont

Treatment of nephrotic syndrome Varies with degree of severity Treatment of the underlying cause Prognosis depends on the cause Children usually have the “minimal change syndrome” which responds well to treatment

Child with nephrotic syndrome

Therapeutic management Corticosteroids (prednisone) Dietary management Restriction of fluid intake Prevention of infections Monitoring for complications: infections, severe GI upset, ascites, or respiratory distress

Cryptorchidism Defined as failure of one or both testes to descend Treatment Objective of treatment

Critical thinking for client undergoing urinary tract surgery The Scotts are receiving pre-op instructions before their son David’s surgery for reimplantation of the ureters. David is 5 years old. In addition to discussion of post-op pain, tubes and dressings, the most significant other topic would be which of the following? –A. Need to reassure David his genitals are intact and will function normally when the c atheters are removed –B. Important of monitoring the urine drainage from stents and urethral catheter –C. Need to assess the surgical site for bleeding or excessive drainage –D. The home care regimen that can be anticipated on David’s discharge from the hospital