Nursing Care of the Child with Nursing Care of the Child with GU disordersGU disorders

Revised, Fall 2010Revised, Fall 2010

Enuresis Multitreatment Enuresis Multitreatment approachapproach

Fluid restrictionFluid restriction

Bladder exercisesBladder exercises

Timed voidingTimed voiding

Enuresis alarmsEnuresis alarms

Reward systemReward system

MedicationsMedications

Urinary tract infectionsUrinary tract infections

Most common type of bacterial Most common type of bacterial infections occurring in childreninfections occurring in children

Bacteria passes up the urethra into Bacteria passes up the urethra into the bladderthe bladder

Most common types of bacteria are Most common types of bacteria are those near the meatus…staph as those near the meatus…staph as well as e.coliwell as e.coli

Urinary tract infectionsUrinary tract infections

Most common type of bacterial Most common type of bacterial infections occurring in childreninfections occurring in children

Bacteria passes up the urethra into Bacteria passes up the urethra into the bladderthe bladder

Most common types of bacteria are Most common types of bacteria are those near the meatus…staph as those near the meatus…staph as well as e.coliwell as e.coli

Contributing factorsContributing factors

Those with lower resistance, Those with lower resistance, particularly those with recurrent particularly those with recurrent infectionsinfections

Unusual voiding and bowel habits Unusual voiding and bowel habits may contribute to UTI in childrenmay contribute to UTI in children

““forget to go to bathroom”forget to go to bathroom”

Symptoms:Symptoms:

Therapeutic managementTherapeutic management

Eliminate the current infectionsEliminate the current infections

Identify contributing factors to Identify contributing factors to reduce the risk of re-infectionreduce the risk of re-infection

Prevent systemic spread of the Prevent systemic spread of the infectioninfection

Preserve renal functionPreserve renal function

FYIFYI

The single most important host factor The single most important host factor influencing the occurrence of UTI is influencing the occurrence of UTI is urinary stasisurinary stasis

What is the chief cause of urinary What is the chief cause of urinary stasis?stasis?

Vesicoureteral RefluxVesicoureteral Reflux

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

What is vesicoureteral reflux?What is vesicoureteral reflux?

Treatment for vesicoureteral refluxTreatment for vesicoureteral reflux

Directed toward preventing UTIsDirected toward preventing UTIs

Managed by time or surgery if a Managed by time or surgery if a lower gradelower grade

Single doses each day of abx as long Single doses each day of abx as long as reflux lastsas reflux lasts

Urine cultures done q 6 wks up to 3 Urine cultures done q 6 wks up to 3 months to make sure no “silent months to make sure no “silent infection”infection”

Diagnostics: VCUGDiagnostics: VCUG

Hypo/Epispadias

Bladder Extrophy

External Defects

Crypt-orchidism

Bladder ExstrophyBladder Exstrophy

Exstrophy of the Bladder, cont.Exstrophy of the Bladder, cont.Treatment: surgical reconstruction done Treatment: surgical reconstruction done 11stst 24-48 after birth 24-48 after birth

Goals:Goals:– Bladder/abd wall closureBladder/abd wall closure– Preserve urinary functionPreserve urinary function– Create normal appearingCreate normal appearing

genitaliagenitalia

-improvement of sexual function-improvement of sexual function

Nursing care, cont.Nursing care, cont.Control bladder spasmsControl bladder spasmsControl painControl painIncrease fluid intakeIncrease fluid intakeDo not allow to play on straddle toysDo not allow to play on straddle toysPrevent infection (no bathing or swimming Prevent infection (no bathing or swimming until stents removeduntil stents removedCall dr if: temp >101; anorexia, pus or Call dr if: temp >101; anorexia, pus or bleeding from stent, cloudy or foul bleeding from stent, cloudy or foul smelling urinesmelling urine

Etiology and PathophysiologyEtiology and PathophysiologyHypospadias:occurs from incomplete Hypospadias:occurs from incomplete development of urethra in uterodevelopment of urethra in utero– Defect ranges from mild to severeDefect ranges from mild to severe– Undescended testes may also be presentUndescended testes may also be present– Might interfere with fertility in the mature male Might interfere with fertility in the mature male

if not correctedif not corrected

Epispadias: rare and often associated with Epispadias: rare and often associated with extrophy of bladderextrophy of bladder

EpispadiasEpispadias– Congenital urethral defect in which the Congenital urethral defect in which the

uretheral opening is on the upper aspect uretheral opening is on the upper aspect of the penis and not on the endof the penis and not on the end

AssessmentAssessment

Usually discovered during Newborn Physical Assessment

Ask yourself?Ask yourself?

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

The reason for surgery atAbout 1 year of age is Because:a.Children will experience less painb.Chordee may be reabsorbedc.The child has not developed body image and castration anxietyd. The repair is easier before toilet training

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

outer diaper collects urine.

CryptorchidismCryptorchidism

Defined as failure of one or both Defined as failure of one or both testes to descendtestes to descend

TreatmentTreatment

Objective of treatmentObjective of treatment

Therapeutic interventions for Therapeutic interventions for undescended testesundescended testes

Surgery: Orchiopexy done via Surgery: Orchiopexy done via laproscopy (around 1 yr of age)laproscopy (around 1 yr of age)

Post-op nursing care: minimal Post-op nursing care: minimal activity for few days, allow to activity for few days, allow to express fears about castration, express fears about castration, mutilation by playng with puppets or mutilation by playng with puppets or dollsdolls

Why is it important that theTestes are in the scrotal sac?

Answer Answer

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

Assessment on NB examAssessment on NB exam

Glomerular diseasesGlomerular diseases

Nephrotic syndrome (MCNS) or Nephrotic syndrome (MCNS) or minimal-change nephrotic syndromeminimal-change nephrotic syndrome

Acute glomerulonephritis (AGN)Acute glomerulonephritis (AGN)

AGNAGN

Immune-complex disease causing Immune-complex disease causing inflammation of glomeruli of kidneyinflammation of glomeruli of kidney

Usual organism is group A beta-Usual organism is group A beta-hemolytic strephemolytic strep

Decreased glomerular filtrationDecreased glomerular filtration

Common in children (boys > girls)Common in children (boys > girls)

Assessment/diagnostic tests:Assessment/diagnostic tests:

What’s really happening in What’s really happening in AGN?AGN?

Decreased glomerular filtration leads to inc. Na and H2OProtein molecules filter thru damagedglomeruliDamage leads to hematuriaHigh B/P; heart failure may ensuePhases: edematous (4-10 days); Diuresis phase

AGNAGN

Treatment and nursing care:Treatment and nursing care:

Bed rest may be recommended Bed rest may be recommended during the acute phase of the during the acute phase of the diseasedisease

A record of daily weight is the most A record of daily weight is the most useful means for assessing fluid useful means for assessing fluid balancebalance

Nursing diagnosis for the child with Nursing diagnosis for the child with glomerulonephritisglomerulonephritis

Fluid volume excess r/t to decreased Fluid volume excess r/t to decreased plasma filtrationplasma filtrationActivity intolerance r/t fatigueActivity intolerance r/t fatigueAltered patterns of urinary Altered patterns of urinary elimination r/t fluid retention and elimination r/t fluid retention and impaired filtrationimpaired filtrationAltered family process r/t child with Altered family process r/t child with chronic disease, hospitalizationschronic disease, hospitalizations

Nursing care specific to the child Nursing care specific to the child with AGNwith AGN

Allow activities that do not expend Allow activities that do not expend energyenergy

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

Nephrotic syndromeNephrotic syndrome

Nephrotic syndrome, contNephrotic syndrome, cont

Contrast of normal gloumerular activity with changes seen in Nephrotic Syndrome

Treatment of nephrotic syndromeTreatment 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 Children usually have the “minimal change syndrome” which responds change syndrome” which responds well to treatmentwell to treatment

Child with nephrotic syndromeChild with nephrotic syndrome

Therapeutic managementTherapeutic management

Corticosteroids (prednisone)Corticosteroids (prednisone)

Dietary managementDietary management

Restriction of fluid intakeRestriction of fluid intake

Prevention of infectionsPrevention of infections

Monitoring for complications: Monitoring for complications: infections, severe GI upset, ascites, infections, severe GI upset, ascites, or respiratory distressor respiratory distress

Critical thinking for client Critical thinking for client undergoing urinary tract surgeryundergoing urinary tract surgeryThe Scotts are receiving pre-op instructions The Scotts are receiving pre-op instructions before their son David’s surgery for before their son David’s surgery for reimplantation of the ureters. David is 5 years reimplantation of the ureters. David is 5 years old. In addition to discussion of post-op pain, old. In addition to discussion of post-op pain, tubes and dressings, the most significant other tubes and dressings, the most significant other topic would be which of the following?topic would be which of the following?– A. Need to reassure David his genitals are intact and A. Need to reassure David his genitals are intact and

will function normally when the c atheters are removedwill function normally when the c atheters are removed– B. Important of monitoring the urine drainage from B. Important of monitoring the urine drainage from

stents and urethral catheterstents and urethral catheter– C. Need to assess the surgical site for bleeding or C. Need to assess the surgical site for bleeding or

excessive drainageexcessive drainage– D. The home care regimen that can be anticipated on D. The home care regimen that can be anticipated on

David’s discharge from the hospitalDavid’s discharge from the hospital