Pediatric GU Dysfunction

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Pediatric GU Dysfunction

• Assessment of pediatric renal function
• Signs and symptoms
• Laboratory tests
• Radiological tests
• Nursing considerations
• Psychosocial and developmental considerations

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GU Disorders and Defects

• Urinary Tract Infection (UTI)
• Vesicoureteral Reflux
• Hypospadias
• Nephrotic Syndrome
• Acute Glomerular Nephritis
• Hemolytic Uremic Syndrome
• Wilms Tumor

3
Renal Failure

• Acute
• Chronic
• Kidney transplantation

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Urinary Tract Disorders Signs and Symptoms

• Newborn
• Poor feeding
• Vomiting
• Poor weight gain
• Rapid respirations
• Respiratory distress
• Frequent voiding
• Crying w/voiding

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Urinary Tract Disorders Signs and Symptoms

• Newborn (continued)
• Jaundice
• Spontaneous pneumothorax or pneumomediastinum
• Seizures
• Dehydration
• Other anomalies
• Enlarged kidneys or bladder

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Urinary Tract Disorders Signs and Symptoms

• Infant toddler
• Poor feeding, vomiting
• Poor weight gain
• Increased thirst
• Frequent voiding
• Crying with voiding
• Foul-smelling urine
• Pallor
• Fever

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Urinary Tract Disorders Signs and Symptoms

• Infant toddler (continued)
• Persistent diaper rash
• Seizures
• Dehydration
• Enlarged kidneys or bladder

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Urinary Tract Disorders Signs and Symptoms

• Childhood
• Poor appetite
• Vomiting
• Growth failure
• Excessive thirst
• Enuresis, incontinence, frequent urination
• Painful urination
• Swelling of the face

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Urinary Tract Disorders Signs and Symptoms

• Childhood (continued)
• Seizures or tetany
• Pallor
• Fatigue
• Blood in urine
• Abdominal or back pain
• Edema
• Hypertension

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Urinary Tract Infection

• Infection in the upper or lower tract
• Females 10-30x risk of males
• Urinalysis
• Leukocyte esterase, nitrites, WBC and RBC counts,
  bacteria
• Culture and Sensitivity
• E. coli 80 of cases

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Urine Collection
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Anatomic and Physical Factors

• Shorter urethra in females
• 2 6 years of age
• Adolescents
• Urinary stasis
• Reflux
• Anatomic abnormalities
• Bladder compression
• Dysfunctional voiding

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Vesicoureteral Reflux
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Vesicoureteral Reflux

• Retrograde flow of urine from the bladder up the
  ureters
• Conservative management - prophylactic
  antibiotics, routine urine cultures
• Surgical management - reimplants

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Radiological Tests

• Renal/Bladder Ultrasound
• Voiding Cystourethrogram (VCUG)

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Nursing Diagnoses

• High risk for injury related to possibility of
  kidney damage from chronic infection
• Anxiety related to unfamiliar procedures
• Altered family processes related to illness of a
  child

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Nursing Interventions

• Administration of antibiotics
• Education
• Prevention
• Perineal hygiene
• Complete bladder emptying
• Acidify urine

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Hypospadias/Epispadias

• Location of the urinary meatus behind the glans
  penis or anywhere on the penile shaft

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Hypospadias/Epispadias

• Circumcision delayed
• Surgical correction by 1 year old
• To enable voiding in standing position
• Improve physical appearance
• Sexual adequacy

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Psychosocial Considerations

• Body image
• Birth defects
• Ages 3 to 6
• Phallic-oedipal period
• Fear body mutilation
• ? punishment

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Nephrotic Syndrome

• Primary - Minimal Change Nephrotic Syndrome
• 80 of all cases
• Good prognosis
• Secondary to another disorder
• Congenital

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Nephrotic Syndrome
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Nephrotic Syndrome

• Goals
• Reduce urinary protein excretion
• Reduce tissue fluid retention
• Prevent infection
• Minimize complication
• Therapeutic Management
• Low salt diet
• Corticosteroids
• Albumin and lasix
• Immunosuppressants

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Acute Glomerulonephritis

• Clinical Manifestations
• Orbital edema (worse in AM)
• Loss of appetite
• Decreased urine output
• Tea-colored urine
• Antecedent streptococcal infection
• Hypertension
• Proteinuria

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Acute Glomerulonephritis

• Nursing Interventions
• No added salt diet
• Fluid restriction
• Q4h BP
• Daily weights
• Close follow-up

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Hemolytic Uremic Syndrome

• Age 6 months 5 years
• Presents as viral illness followed by sudden
  onset of hemolysis and anemia
• Anemia, thrombocytopenia and renal failure HUS
• 95 recovery rate with prompt treatment
• Can progress to chronic renal failure

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Wilms Tumor

• Abdominal swelling or mass
• Usually 1 kidney (favors left)
• Encapsulated for long period
• Can become quite large
• Treatment surgical removal and chemotherapy

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Wilms Tumor

• DO NOT
• PALPATE
• ABDOMEN !

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Wilms Tumor Post-op CareMonitor for

• Edema
• Bowel sounds
• Bowel movements
• Abd. distention
• Vomiting

• Pain
• Blood pressure
• Urine output
• Signs of infection

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Wilms Tumor

• Psychosocial support
• Play therapy
• Avoid contact sports

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Acute Renal Failure

• Oliguria
• Nausea
• Vomiting
• Drowsiness
• Edema
• Hypertension

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Acute Renal FailureResulting from

• Severe dehydration
• Poor renal perfusion
• Acute renal injury
• Glomerulonephritis
• HUS

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ARF Nursing Interventions

• Vital signs
• Strict I O, daily weights
• Fluid restriction
• Monitor electrolytes
• Minimize risk of infection
• Provide comfort and stability

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Chronic Renal Failure

• Uremia
• Retention of waste products
• Water and sodium restriction
• Hyperkalemia
• Metabolic acidosis
• Anemia
• Calcium phosphorus disturbances
• Growth disturbance

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Chronic Renal Failure

• Calcium and Vitamin D
• Antihypertensives
• Diuretics
• Bicarbonate
• Antiepileptics
• Antihistamines
• Epo

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Treatment of CRF

• Peritoneal DialysisCAPD continuous
  ambulatoryCCPD continuous cyclic

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Treatment of CRF

• Hemodialysis

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Treatment of CRF

• Kidney Transplantation
• LRD living related donor
• CAD cadaver donor

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Renal Transplantation

• Watch for
• Fever
• Swelling and tenderness over graft area
• Decreased urine output
• Elevated blood pressure