Nursing Care of the Child with GU disorders

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Nursing Care of the Child with GU disorders

• Revised, Fall 2010

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Enuresis
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Enuresis Multitreatment approach

• Fluid restriction
• Bladder exercises
• Timed voiding
• Enuresis alarms
• Reward system
• Medications

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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
  meatusstaph as well as e.coli

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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
  meatusstaph as well as e.coli

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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

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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

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FYI

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

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Obstructive Uropathy
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Vesicoureteral Reflux

• Approximately 20 of children that have UTIs will
  be found to have vesicoureteral reflux on xray

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What is vesicoureteral reflux?
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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

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Diagnostics VCUG
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Bladder Exstrophy
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Exstrophy of the Bladder, cont.

• Treatment surgical reconstruction done 1st
  24-48 after birth
• Goals
• Bladder/abd wall closure
• Preserve urinary function
• Create normal appearing
• genitalia
• -improvement of sexual function

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Nursing care, cont.

• Control bladder spasms
• Control pain
• Increase fluid intake
• Do not allow to play on straddle toys
• Prevent infection (no bathing or swimming until
  stents removed
• Call dr if temp gt101 anorexia, pus or bleeding
  from stent, cloudy or foul smelling urine

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Etiology and Pathophysiology

• Hypospadiasoccurs from incomplete development of
  urethra in utero
• Defect ranges from mild to severe
• Undescended testes may also be present
• Might interfere with fertility in the mature male
  if not corrected
• Epispadias rare and often associated with
  extrophy of bladder

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

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Assessment
Usually discovered during Newborn
Physical Assessment
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Ask yourself?

• Why would the nurse question an order to prepare
  the infant for a circumcision?

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• The reason for surgery at
• About 1 year of age is
• Because
• Children will experience less pain
• Chordee may be reabsorbed
• The child has not developed body image and
• castration anxiety
• d. The repair is easier before toilet training

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

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

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Therapeutic interventions for undescended testes

• Surgery Orchiopexy done via laproscopy (around
  1 yr of age)
• Post-op nursing care minimal activity for few
  days, allow to express fears about castration,
  mutilation by playng with puppets or dolls

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Why is it important that the Testes are in the
scrotal sac?
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Answer

• The higher temperatures in the abdomen than in
  the scrotum results in morphologic changes to the
  testes-mainly concerned with lower sperm counts
  at sexual maturity

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Assessment on NB exam
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Glomerular diseases

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

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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 gt girls)
• Assessment/diagnostic tests

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Whats really happening in AGN?
Decreased glomerular filtration leads to inc. Na
and H2O Protein molecules filter thru
damaged glomeruli Damage leads to hematuria High
B/P heart failure may ensue Phases edematous
(4-10 days) Diuresis phase
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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

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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

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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

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Nephrotic syndrome
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Nephrotic syndrome, cont
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Contrast of normal gloumerular activity with
changes seen in Nephrotic Syndrome
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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

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Child with nephrotic syndrome
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Therapeutic management

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

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Critical thinking for client undergoing urinary
tract surgery

• The Scotts are receiving pre-op instructions
  before their son Davids 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 Davids discharge from the hospital