The Child with Genitourinary Alterations

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The Child with Genitourinary Alterations
By Susan Sienkiewicz
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Review Quiz GU System

• Name the functional unit of the kidney.
• Name three functions of the kidney.
• Name two hormones secreted by the kidney and the
  main purpose of each.
• For the following U/A results, indicate which are
  abnormal
• trace protein, 1 glucose, RBCs 0-1/HPF, WBCs
  2-4/HPF, Ketones negative, Moderate casts, s.g.
  1.003
• Name two blood tests that reflect renal function.
• Name three diagnostic tests that assess the
  structure of the urinary system.

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Urinary Elimination Management

• Perineal Hygiene
• wipe front to back
• ? fluids
• do not hold urine
• use cotton panties

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Skin Care

• Change position Q2H
• Daily bath
• Support edematous extremity
• Bed cradle/loose clothing after orchiopexy
• Incision care
• Protect Skin with Bladder Exstrophy
• Preop - cover exposed bladder, use skin prep to
  protect from urine leakage
• Postop - Bryants traction or sidelying position
  to protect incision
• Check peripheral circulation
• Skin care for skin traction

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Fluid Management

• Strict I/O
• Maintain Fluid Restriction
• Divide fluid restriction b/w waking hours
• serve fluids in small cups
• hard candies to keep mouth moist
• Or Maintain Maintenance or Hydration Fluids
• 100 mL/kg/day X 1st 10 kg . . .
• 1-2 ml/kg/hr u/o
• label all tubes (post op)
• maintain patency of tubes (ureteral
  reimplantation for VUR)

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Fluid Management, continued

• Assess for s/s dehydration
• Daily weight (same time, same scale)
• Assess edema
• Monitor electrolytes

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Body Image Enhancement

• Encourage expression of feelings
• Discuss transient effects of steroids

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Infection Protection

• ? VS s/s infection
• Frequent diaper changes (orchiopexy,
  hydrocelectomy)
• Cover exposed bladder (exstrophy) protect
  surrounding skin with sealant
• Skin care
• Protect A-V shunt (hemodialysis) or Tenchkoff
  Catheter (peritoneal dialysis)
• Avoid exposure to infectious individuals
• No live viral vaccines while on steroids

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Coping Enhancement Strategies

• Allow parents to vent concerns
• Promote bonding
• encourage participation in care
• Allow child to vent embarrassment (enuresis)
• extra set of clothes at school

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Energy Management

• Promote rest
• cluster care
• limit visitors
• quiet diversion
• quiet play X 2 wks with AGN, no competitive play
  X 6-12 wks until proteinuria resolves
• Fowlers position to facilitate breathing (NS,
  ARF, CRF, HUS)

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Patient/Family Education

• Compliance with med regime
• Infection Control
• Perineal Hygiene with UTI
• Use of bedwetting alarms (enuresis)
• Importance of f/u
• S/S to report to MD
• Fluid management (restriction/hydration)

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Pt/Fam Education, continued

• Diet restriction
• Activity Restriction
• Daily Weights (AGN, NS, ARF, CRF, HUS)
• Urine testing for protein (AGN, NS)
• Monthy STE for cryptorchidism
• Dialysis (ARF, CRF, HUS)
• Post transplantation care (CRF)
• Chemo, radiation (Wilms Tumor)

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Nutrition Management

• Small meals, preferred foods
• NAS (ARF, CRF, NS, HUS)
• ? Protein (NS)
• ? Protein (AGN, ARF, CRF, HUS)
• ? Na, ? K (AGN, ARF, CRF, HUS)
• ? Ca, ? PO4- (ARF, CRF)

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Pain Management

• Tylenol (15 mg/kg/dose)
• Tylenol 3 (codeine 0.5-1 mg/kg/dose) for postop
  pain
• Anticholinergics/Antispasmodics (Oxybutrin
  chloride/Ditropan) for bladder spasms (VUR,
  hypospadias repair)
• No straddling on hip or toys (hypospadias repair,
  orchiopexy)

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Vesicoureteral Reflux (VUR)

• Manifestations
• recurrent UTIs
• enuresis
• flank/abd pain
• grade I-V VCUG

• Nursing care
• Education (med compliance, f/u)
• Post op care
• Pain Mgmt
• Fluid Mgmt

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Hypospadias/Epispadias

• Nursing Care
• Pain Mgmt
• Analgesics
• Antichol (Ditropan)
• Maintain tube patency
• no straddling
• maintain penile pressure dsg
• Fluid Mgmt
• Educ

• Manifestations
• abnormal placement of urethra
• small foreskin
• short chordee (band that curves penis ?

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Cryptorchidism

• Manifestations
• testes not palpable

• Nursing Care
• Pain Mgmt
• Infection Protection
• Education
• STE
• possibility of infertilty

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Hydrocele

• Manifestations
• painless scrotal swelling
• smooth (fluid-filled) mass

• Nursing Care
• Education
• infection control
• no activity restrictions

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Inguinal Hernia

• Manifestations
• groin swelling ? with abd pressure
• strangulation/incarceration
• redness
• inconsolability
• vomiting
• abd dist
• ? heart rate

• Nursing Care
• Preop
• ? for strangulation
• Postop
• ? bldg, drainage
• ? recurrence
• Education

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Bladder Exstrophy

• Manifestations
• exposed bladder mucosa
• urine leakage
• bifid clitoris
• short stubby penis
• widened s. pubis ? waddling gait

• Nursing Care
• Infection Protection
• Skin Care
• Postop
• Fluid Management
• Coping Enhancement

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UTI

• Children
• abd pain
• frequency
• urgency
• dysuria
• enuresis
• fever 101
• CVAT, (back pain)
• n/v with pyelonephritis
• hematuria

• Infants
• fever or ? temp
• irritability
• poor feeding
• vomiting
• ? in color/odor of urine

• Nursing Care
• Fluid Mgmt
• Fever Mgmt
• Education

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Perineal Hygiene(to prevent UTI)

• Wipe front to back
• ? fluids
• dont hold urine
• no bubble baths
• cotton panties

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Enuresis

• Manifestations
• dribbling
• urgency
• infreq/painful vdg
• straining
• incontinence

• Nursing Care
• Education
• Coping Enhancement

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AGN

• SS (abrupt)
• hematuria
• proteinuria
• dep edema
• periorbital edema
• ? U/O
• fatigue, irritability
• ? B/P
• symptoms appear 10 days after strep infection

• Dx Eval
• U/A ? RBCs,casts, prot, ?? s.g.
• urine cx neg
• ? BUN, creatinine
• antistreptolysin O titer

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AGN Nursing Care

• Energy Management
• Fluid Management (restriction)
• Nutrition Management
• Skin Care
• Education

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Nephrotic Syndrome

• Nursing Care
• Infection Protection
• Nutrition Mgmt
• Fluid Mgmt
• Fluid restriction during massive edema
• ? abd girth QS
• ? lungs
• Energy Mgmt
• Coping Enhancement
• Education (next slide)

• SS(insidious)
• periorbital edema
• pitting dep edema
• ascites
• ? wt
• nl B/P
• anorexia, fatigue
• abd pain

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Parent Education for Nephrotic Syndrome

• side effects of steroids
• daily weights
• urine testing
• infection control
• s/s relapse/worsening dz
• no live virus vaccines while on steroids

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Wilms Tumor

• Postop Nursing Care
• Pain Mgmt
• Fluid Mgmt
• NGT with cc/cc replacement
• Incision Care
• Coping Enhancement
• Education (next slide)

• SS
• mobile abd mass
• DO NOT PALPATE!
• Hematuria
• HTN
• Abd pain
• fatigue, malaise, fever

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Post Nephrectomy Parent Education

• Chemo/Radiation
• Skin Care (with RT)
• No contact sports!!!
• Report GU s/s immediately!!

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CASE STUDY Urinary Tract Infection
A 10 year old girl is visiting the pediatricians
office for the fifth time for UTI. Two of her
past visits resulted in hospitalization for
treatment. 1. Determine necessary assessment
data. 2. Determine medications that will be
administered. 3. Develop a treatment/prevention
teaching plan.
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CASE STUDY AGN
Seven year old Jason is hospitalized with AGN.
Jason weighs 48 lbs. On admission his blood
pressure is 110/60, pulse is 80, resp rate is 18.
His urine is dark brown and contains 3 protein.
Output is 60 mL in 2 hours. Jasons mother
states that he has real puffy eyes in the
morning. There is slight periorbital edema on
admission. 1. What other assessments should be
made on Jason? 2. Explain the cause of his
symptoms. 3. What MD orders should the nurse
anticipate? 4. Explain to Jasons family the
course of his illness. 5. What daily assessments
should be made? 6. What assessment indicates
Jason is improving? 7. Discuss home care needs
after discharge.
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THE END