1. Nursing Care of the Child with GU disorders

2. External Defects in the Urinary System
Extrophy of the bladder
Hypospadias vs epispadius
Cryptorchidism

3. Extrophy of the bladder
Posterior bladder wall extrudes through the lower abd wall.
Failure of the abd to close
Pre-op focus of nsg care
Prevent trauma
Prevent infection of exposed bladder

4. Post-operative care with surgical care of extrophy of bladder
Care of the surgical site with meticulous wound care
Positioning: immobilization and avoidance of abduction of legs
Neurovascular assessment of lower extremities
Monitoring renal function and obstruction of tubes
Promoting comfort
Discharge teaching

5. Hypospadias vs Epispadias
Congenital urethral
defect
Uretheral opening
on VENTRAL (lower)
aspect of the penis
Epispadias
Congenital urethral defect
Urethral opening is on the DORSAL aspect of the penis

6. 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:

7. Post-op management
Care of the catheter (may be foley, suprapubic or urethral stent.
Use double diapering
Management of bladder spasms
Prophylactic abx
No bath until stent removed
Increase fluid intake
No play on straddle toys
Call physician for temp > 101º

8. Cryptorchidism

9. Therapeutic interventions for cryptorchidism
Orchiopexy done via laproscopy
Nursing care post-op:
Minimal activity for few days
Allow opportunity to express fears about mutilation or castration

10. Critical thinking for client undergoing urinary tract surgery
David is 5 years old and scheduled for ureter reimplantation surgery. 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 catheters are removed
B. Importance of monitoring the urine drainage from stents and urethral catheter
C. The need to assess the surgical site for bleeding or excessive drainage
D. The home care regimen that can be anticipated when David is discharged

11. Obstructive Uropathy Stenosis of uteropelvic valve
Stenosis of posterior urethral valve
Stenosis of the uterovesicular junction otherwise known as “vesicoureteral reflux”
Hydronephrosis the main problem with reflux of urine

12. What is vesicoureteral reflux?

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

15. Physiologic changes r/t hydronephrosis
Cessation of glomerular filtration and cell death
Metabolic acidosis result
Impairment of kidney’s ability to concentrate urine
Obstruction results in stasis and infection
Can lead to chronic renal failure

16. Diagnostic tests for renal/bladder function
Urine culture and sensitivity: done every 2-3 months
VCG: voiding cystourethrogram
Renal/bladder ultrasound
IVP
Renal biopsy
Cystoscopy

17. 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)

18. 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”

19. Treatment and nsg care for obstructive uropathy
Drug therapy
Penicillin
Cephalosporins
Urinary antiseptics (Furadantin)
Follow up VCG after few months post op
Nsg care:
Teach prevention of UTI
Teach imp of taking all abx
Monitor urinary drainage from catheters
Assess for pain
Teach parents how to change dressings, double-diaper
s/s obstruction or infection
Surgery:
Repair of anatomical anomalies/pyeloplasty

20. Differences between adult s/s UTI and pediatric patient
In children:
Unexplained fever
Failure to thrive
Vomiting
Diarrhea

21. 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

22. 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:

23. 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

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

25. Nephrotic syndrome

26. Nephrotic syndrome, cont

27. Child with nephrotic syndrome

28. 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

29. Nursing interventions to manage nephrotic syndrome
Administer corticosteroids (prednisone) as ordered
Dietary management
Restriction of fluid intake
Prevention of infections
Monitoring for complications: infections, severe GI upset, ascites, or respiratory distress

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

31. 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:

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

33. Nursing diagnosis for the child with glomerulonephritis
Fluid volume excess r/t to…
Activity intolerance r/t….
Altered patterns of urinary elimination r/t …
Altered family process r/t…

34. 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