Nursing Care of the Child with GU disorders

Renal System Assessment Physical assessment –Palpation, percussion Health history –Previous UTIs, calculi, stasis, retention, pregnancy, STDs, bladder cancer –Meds: antibiotics, anticholinergics, antispasmodics –Urologic instrumentation –Urinary hygiene –Patterns of elimination

Radiography and other tests of urinary system function Urine culture & sensitivity Renal/ bladder US VCUG Imaging studies Testicular US IVPcystoscopy Renal bx,

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

Blood tests of renal function BUN (blood urea nitrogen)BUN (blood urea nitrogen) Uric acidUric acid CreatinineCreatinine

Nursing responsibilities with testing Responsible for preparation and collection of urine or bloodResponsible for preparation and collection of urine or blood Maintains careful intake and outputMaintains careful intake and output Recognizes that renal disease can diminish the glomerular filtration rateRecognizes that renal disease can diminish the glomerular filtration rate

External Defects Hypospadius / Epispadius

Epispadias –Congenital urethral defect in which the uretheral opening is on the upper aspect of the penis and not on the end

Hypospadias –Congenital urethral defect in which the uretheral opening is on the lower aspect of the penis and not on the tip. May have associated chordee.

Hypospadius Occurs from incomplete development of urethra in utero. Occurs in 1 of 100 male children. Increased risk if father or siblings have defect. Ranges from mild to severe. Cyrptorchidism/Undescended testes may be found in conjunction with hypospadias.

Assessment Usually discovered during Newborn Physical Assessment

Interventions Medical Treatment: –Do NOT circumcise infant. May need to use foreskin in reconstruction. Surgery –Reconstructive – repositions uretheral opening at tip of penis

The reason for surgery at about 1 year of age is because: a. children will experience less pain. b. chordee may be reabsorbed. c. the child has not developed body image and castration anxiety. d. the repair is easier before toilet training.

Post –op Nursing Care 1. Assess pressure dressing (use to control bleeding. 2. Maintain urinary drainage. 3. Control bladder spasms. Antispasmotics (relax the bladder muscle) Pro-Banthine (probantheline) Ditropan (oxybutinin) Levsin (hyoscyamine)

A double diapering technique protects the urinary stent after surgery. The inner diaper collects stool and the outer diaper collects urine.

4. Control Pain. 5. Increase fluids intake. 6. Do not allow to play on any straddle toys. 7. Prevent infection. – no bathing or swimming until stents removed. 8. Discharge teaching: When to call doctor. No bathing or swimming until stents removed.

Cryptorchidism Failure of one or both of the testes to descend from abdominal cavity to the scrotum

Etiology and Pathophysiology Testes usually descend into the scrotal sac during the 7-9 gestation They may descend anytime up to 6 weeks after birth. Rarely descend after that time. Cause unknown Theories –Inadequate length of spermatic vessels –Lowered testosterone levels

Assessment

Therapeutic Interventions Surgery –Orchiopexy done via laproscopy –Done around 1 year of age Nursing Care – Post-op –Minimal activity for few day to ensure that the internal sutures remain intact –Allow opportunity to express fears

Why is early surgery important? Morphologic changes to testis from higher temperature in abd cavity Decreased sperm count=infertility? Testicular cancer

Urinary Tract Infections

Urinary tract infections Most common type of bacterial infections occurring in childrenMost common type of bacterial infections occurring in children Bacteria passes up the urethra into the bladderBacteria passes up the urethra into the bladder Most common types of bacteria are those near the meatus…staph as well as e.coliMost 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 infectionsThose with lower resistance, particularly those with recurrent infections Unusual voiding and bowel habits may contribute to UTI in childrenUnusual voiding and bowel habits may contribute to UTI in children “forget to go to bathroom”“forget to go to bathroom” Symptoms vary by age of childSymptoms vary by age of child

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

Therapeutic Interventions Drug Therapy –Antibiotics – specific to causative organism –Analgesics – Nursing Care –Force fluids – childs choice –Dysuria – sit in warm water in bathtub and void into the water

Parent Teaching Change diaper frequently Teach girls to wipe front to back Discourage bubble baths Encourage fluids frequently throughout day Bathe daily Adolescent girls when menstruating are to change of pad every 4 hours

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

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

Nephrotic Syndrome Chronic renal disorder in which the basement membrane surfaces of the glomeruli are affected, cause loss of protein in the urine.

Nephrotic syndrome

Nephrotic syndrome, cont

Contrast of normal gloumerular activity with changes seen in Nephrotic Syndrome

Etiology Insidious onset with periods of remission / exacerbations throughout life- No cure 95% idiopathic, possibly a hypersensitivity reaction. Other causes: post acute glomerulonephritis, sickle cell disease, Diabetes Mellitus, or drug toxicity. Usually seen in preschool yrs (2-4). M>F

Assessment Four most common characteristics: 1.Massive proteinuria 2.Hypoalbuminemia (K + normal, BP normal) 3.Edema – usually starts in periorbital area and dependent areas of the body and progresses to generalized, massive edema. Pitting edema of 4+. Caused by hypo albumin which causes shift of fluids to extracellular space. *There is an insidious weight gain- shoes don't fit, etc 4.Hyperlipidemia * Of note is that there is no hematuria or hypertension

Other signs and symptoms Fatigue Anorexia Weight gain Abdominal pain – from large amount of fluid in abdominal

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

Ask Yourself? Which of the following signs and symptoms are characteristic of minimal change nephrotic syndrome? a. gross hematuria, proteinuria, fever b. hypertension, edema, fatigue c. poor appetite, proteinuria, edema d. body image change, hypotension

Acute Glomerulonephritis Immune-complex disease which causes inflammation of the glomeruli of the kidney as a result of an infection elsewhere in the body.

Acute Glomerulonephritis

Etiology/Pathophysiology Usual organism is Group A beta-hemolytic streptococcus Organism not found in kidney, but the antigen- antibody complexes become trapped in the membrane of the glomeruli causing inflammation, obstruction and edema in kidney The glomeruli become inflamed and scarred, and slowly lose their ability to remove wastes and excess water from the blood to make urine.

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

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

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

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