Alterations in Genitourinary Function Flashcards
Genitourinary Function
All nephrons present at birth (but continue to enlarge)
Most renal growth occurs in first 5 years of life
Efficiency of kidneys increases with age (increases markedly at age 2 years)
Urine output/kg higher in infancy
Bladder capacity at birth approx. 20-50 mL
Shortness of urethra may contribute to UTI
Reproductive system functionally immature until puberty
Hypospadias & Epispadias
Failure of urethral folds to fuse completely over urethral groove
Diagnosis made at birth - careful assessment!
Do not circumcise (not up to us to decide. If wanted, don’t initially circumcise because they need the foreskin for the surgery to correct the urinary stream)
Repaired surgically (usually in 1st year of life)
(placement of urethral meatus at end of glans penis to correct urinary stream. Improve physical appearance, preserve sexually adequate organ by release of chordee to straighten penis)
Hypospadias
Urethral meatus anywhere on ventral side (underside)
Often occurs with congenital chordee
Epispadias
Meatal opening on dorsal surface
Often occurs with exstrophy of bladder
Nursing Management of Hypospadias and Epispadias - Post-op
Protect surgical site from injury (pressure dressing); maintain urethral stent
Fluid intake to maintain urine output & patency of stent; accurate I&O
Pain management; may have bladder spasms
Looking for urine output!
Medications for Hypospadias and Epispadias
Analgesics, anticholinergics, antibiotics
Discharge teaching for Hypospadias and Epispadias
Avoid tub bath until stent removed; antibiotic ointment; catheter care
Bladder Exstrophy
Posterior bladder wall extrudes through lower abdominal wall. Upper urinary tract usually normal.
Bladder mucosa appears as mass of bright red tissue & urine continually leaks from open urethra
this is an emergency
Bladder Exstrophy: Treatment is surgical reconstruction in several stages
- Bladder closure (within 48 hours)
- Esispadias repair (9 months)
- Reconstruction of bladder neck & ureteral reimplantation (3-5 years)
Bladder Exstrophy: Goals of Treatment (5)
Preservation of renal function
Attainment of urinary control
Adequate reconstructive repair for psychologic benefit
Prevention of UTI
Preservation of external genitalia with continence & sexual function
Bladder Exstrophy: Pre-Op Care
- prevention of infection & trauma to exposed bladder
- cover bladder mucosa in sterile plastic wrap
- clean surrounding area & protect from leaking urine
- fluid management is critical!
Bladder Exstrophy: Post-Op Care
- manage pain & agitation
- immobilize wound & pelvis (traction)
- avoid abduction of legs
- maintain proper alignment, monitor peripheral circulation, provide meticulous skin care
- monitor renal functioning
- offer emotional support
Obstructive Uropathy
Structural or functional abnormalities of urinary system that interfere with urine flow
Often causes hydronephrosis which results in:
- cessation of glomerular filtration
- metabolic acidosis
- inability to concentrate urine (polyuria, polydipsia)
- urinary stasis (bacterial growth) -
- restriction of urinary outflow (progressive renal damage)
Most common site of obstruction
UPJ (ureteropelvic junction) is most common site of upper obstruction
Early diagnosis & treatment essential to prevent permanent renal damage
Transient or permanent urinary diversion may be required
Obstructive Uropathy: Surgery to correct or divert urine flow
Pyeloplasty (removal of obstructed segment of ureter & reimplantation into renal pelvis) or valve or reconstruction
Obstructive Uropathy: Post- op
May have urinary incontinence
Monitor for urine retention
Discharge teaching re: dressings, catheters, stents, signs of obstruction or infection, urinary diversion systems
Avoid contact sports
Urinary Tract Infection
Involves lower or upper urinary tract
Acute or chronic (recurrent or persistent)
Uncircumcised males < 3 months & females < 12 months have highest prevalence
Incidence increases in teenage girls who are sexually active
E. coli, Staphylococcus aureus, Klebsiella Proteus, Pseudomonas, Haemophilus
Clinical manifestations of UTI: Infants (11)
(PPUFFR HIVSS)
- poor feeding
- persistent diaper rash
- unexplained fever
- failure to thrive
- fever
- renal tenderness
- hypothermia
- irritability or lethargy
- vomiting & diarrhea
- strong-smelling urine
- sepsis
Clinical Manifestations of UTI: Older Children
(DUI FHEAPS)
- Dysuria
- Urgency or hesitancy
- Increased Frequency
- Fever
- Hematuria
- Enuresis or new-onset incontinence
- Abdominal tenderness or lower abdominal pain
- Poor appetite
- Strong-smelling urine
Etiology and Patho of UTI
Urinary stasis: abnormal anatomic structure or abnormal function. infrequent voiding
Vesicoureteral reflux: back flow of urine from bladder into ureters which creates reservoir for bacteria. Structural anomaly
Kidney Damage
May result from vesicoureteral reflux & recurrent UTIs
Risk increases if:
- < 1 year of age
- delay in effective antibiotics for upper UTI
- anatomic or neurologic obstruction
- recurrent episodes of upper UTI
Diagnosis and Management of UTI
Urine specimen: Dipstick. C&S, midstream, catheter, suprapubic, urine bag
Radiologic studies: renal ultrasound (soon after diagnosis). Voiding cystourethrogram (3-6 weeks after infection cleared if renal ultrasound abnormal or 2nd infection) DMSA
Antibiotic therapy: follow-up cultures - 48-72 hours, monthly for 3 months, q3 months for 6 months and then annually
Nursing Management UTI
Antibiotics & antipyretics
Encourage fluid intake; Document I&O
- infants 2-3 ml/kg/hr; children 1-2 ml/kg/hr
Encourage frequent voiding; post-void catheterization
Child may regress & become incontinent
Prevention (especially girls)
- wear cotton underwear, avoid tight-fitting pants, wipe from front to back after BM, avoid “holding” urine, generous fluid intake
Nephrotic Syndrome
Clinical entity produced by loss of urinary protein
Kidney’s release protein inappropriately that causes a shift in fluid and causes edema
