Genitourinary Disorders Flashcards
Assessment Parameters for GU Disorder
- burning
- changes in voiding pattern
- foul-smelling urine
- discharge
- pain, irritation, discomfort
- blood in urine
- edema
- masses
- flank/abdominal pain; cramps
- n/v, fever, trauma
What is the bladder capacity of a newborn?
30 mL
At what age does a child’s bladder become adult sized?
1 year
At what anatomic location would a dull sound indicating a full bladder be heard?
above the symphysis pubis
Important Past Medical Hx for GU Disorder
- maternal polyhydramnios
- oligohydramnios
- diabetes
- hypertension
- alcohol/cocaine ingestion
Important Neonate hx for GU
- presence of single umbilical artery
- abdominal mass
- chromosome abnormality
- congenital malformation
Important Family hx for GU
- renal disease or uropathology
- chronic UTI’s
- renal calculi
- history of parental enuresis
Lab/Diagnostic Tests for GU
- urinalysis
- urine culture
- renal ultrasound
- VCUG
VCUG’s are not usually performed until when?
Until the child has been treated w/ antibiotics for at least 48 hours
What is the expected urine output in the infant and child?
0.5-2 mL/kg/hr
What is necessary for accurate urine culture results?
obtaining a clean or sterile urine specimen
What is a critical component of nursing care related to renal disorders?
Close monitoring of serum blood counts and electrolytes
What is Suprapubic Aspiration used for?
obtaining a sterile urine specimen from the neonate or young infant
Anticholinergic Agents
- used for UT spasms or contractions; control nocturnal enuresis
- increase fluid intake
- avoid in febrile child
Desmopressin
- decreases volume of urine in child w/ nocturnal enuresis
- nasal spray
- administer at bedtime; alternate nares
Desmopressin may cause what?
Nasal irritation
Nausea
Flushing
Headaches
Corticosteroids
- administer w/ food
- may mask signs of infection
- do NOT stop abruptly
- monitor for Cushing syndrome
Furosemide (Lasix):Diuretics
- administer w/ food or milk do decrease GI upset
- monitor BP, renal function, and electrolytes
- may cause photosensitivity
Bladder Exstrophy
congenital defect resulting in bladder being open and exposed outside of the abdomen
Postop Care for Bladder Exstrophy
- prevent infection
- keep infant supine
- quickly change diapers
Catheterizing if Bladder Tissue is present
If tissue is present, surgery reconstruction of bladder w/in pelvis and reconstruction of urethra-INDWELLING catheter and medications for bladder spasms
What medications are used for bladder spasms?
Oxybutynin
Belladonna
Opioid suppository
Catheterizing if Bladder Tissue is NOT present
- Bladder is removed and a continent urinary reservoir is created
- Stoma is created on abdominal wall w/ access to reservoir
- Catheterization about 4x/day
- urine is often cloudy due to location
- HIGH RISK for latex allergy
Hypospadias
urethral defect in which the opening of the penis is on the ventral surface
Epispadias
urethral defect where opening is on the dorsal surface of the penis
When is Hypospadias/Epispadias usually repaired?
by 1 year of age
Complications of Hypospadias/Epispadias if not corrected
- not capable of aiming correctly when standing
- infertility
- body image/self esteem issues
What to assess for w/ Hypospadias/Epispadias?
- Chordee
- Cryptorchidism
- hydrocele
- inguinal hernia
Chordee
fibrous band causing the penis to curve downward
Cryptorchidism
undescended testicles
- can lead to sterility and increased risk of testicular cancer
- requires surgery
- if not descended by 6 months-surgery
Hydronephrosis
condition in which the pelvis and calyces of the kidneys are dilated
What are some causes of Hydronephrosis?
- congenital defect
- result of obstructive uropathy
- secondary to vesicoureteral reflux
S/S of Hydronephrosis reported in Health History
- failure to thrive
- intermittent hematuria
- abdominal mass
- s/s of UTI
Vesicoureteral Reflux
condition in which urine from the bladder flows back up the ureters
If the urine if infected and the kidney’s are exposed to bacteria then vesicoureteral reflux could lead to?
Pyelonephritis
Primary VUR results from what?
Congenital abnormality at the vesicoureteral junction that results in incompetence of the valve
Secondary VUR is related to what?
Other structural or functional problems such as neurogenic bladder, bladder dysfunction, or bladder outlet obstruction
How is VUR graded?
according to severity
The goal of therapeutic management for VUR is what?
preventing pyelonephritis, renal scarring, and development of HTN later in life
Which grades of VUR usually warrant surgery?
III, IV, V
Teaching for Preventing Infection for VUR
- empty bladder completely
- perineal hygiene
- toileting hygiene
- antibiotic therapy as prescribed
- give meds at bedtime b/c of urinary stasis overnight
UTI
infection of the urinary tract most commonly affecting the bladder
What is most often the cause of an UTI?
Most often occurs as a result of bacteria ascending to the bladder via the urethra
UTI is most often cause by which bacteria?
E.coli
S/S of UTI
- jaundice
- increased RR
- perineal redness/irritation
- blood,dark, cloudy, mucus, foul odor in urine
- pallor
- edema
- elevated BP
- distended bladder
- abdominal mass
- tenderness
Lab/Diagnostic Tests for UTI
- urinalysis
- urine culture
- renal ultrasound
- VCUG
Enuresis
continued incontinence of urine past the age of toilet training
Nocturnal Enuresis usually resolves by what age?
6
Enuresis may occur secondary to what physical disorders?
- diabetes mellitus or insipidus
- sickle cell anemia
- ectopic ureter
- urethral obstruction
What are the most frequent causes of daytime enuresis?
dysfunctional voiding or holding of urine
What are the most frequent causes of nocturnal enuresis?
- high fluid intake in evening
- obstructive sleep apnea
- sexual abuse
- family hx
- inappropriate family expectations
Nephrotic Syndrome
occurs as a result of increased glomerular basement membrane permeability, which allows abnormal loss of protein in the urine
What is key to look for in nephrotic syndrome?
periorbital edema
Nursing Management of Nephrotic Syndrome
- promote diuresis; administer corticosteroids/furosemide
- watch for hypokalemia
- weigh daily
- prevent infection
- monitor temp
- administer PCV vaccine
- notify if exposed to chickenpox
How long do you have to wait to deliver live vaccines if child is taking corticosteroids?
2 weeks
Acute Post-streptococcal Glomerulonephritis
immune processes injure the glomeruli
- occurs following an infection
- occurs b/t ages 5-12
- progresses to uremia and renal failure
What will urine reveal w/ APSG?
proteinuria and hematuria
- tea colored or cola colored or even dirty green
- elevated ASO titer
Hemolytic-Uremic Syndrome is defined by what 3 features?
- hemolytic anemia
- thrombocytopenia
- acute renal failure
Therapeutic Management for Hemolytic Uremic Syndrome
- maintain fluid balance
- correct HTN, acidosis, electrolyte imbalances
- replenish circulating RBC
- provide dialysis
S/S of Hemolytic Uremic Syndrome
- pallor
- toxic appearance
- edema
- oliguria
- anuria
Causes of HUS
- antecedent diarrheal illness
- idiopathic
- inherited
- drug related
- malignancies
- transplantation
- malignant HTN
Renal Failure
condition in which the kidneys cannot concentrate urine, conserve electrolytes, or excrete waste products
-acute or chronic
Acute Renal Failure
- sudden, often reversible, decline in renal function that results in the accumulation of metabolic toxins as well as fluid/electrolyte imbalance
- when it continues to progress it becomes chronic
End-Stage Renal Disease (ESRD)
chronic renal failure requiring long term dialysis or renal transplantation
Nursing Goals for Child w/ ESRD
- promoting growth and development
- removing waste products and maintaining fluid balance
- encourage psychosocial well-being
- supporting/educating family
Peritoneal Dialysis
uses abdominal cavity as a semipermeable membrane to help remove excess fluid and waste products
Hemodialysis
removes toxins and excess fluid from the blood by pumping the child’s blood through a hemodialysis machine and then reinfusing the blood into the child
Female Reproductive Organ Disorders
- labial adhesions
- vulvovaginitis
- pelvic inflammatory disease
- menstrual disorders
Labial Adhesions
“Labial fusion”
partial or complete adherence of the labia minora
Vulvovaginitis
inflammation of the vulva and vagina
Causes of Vulvovaginitis
- bacterial or yeast overgrowth
- chemical factors: bubble baths, soaps, perfumes
- poor hygiene
- tight clothing
- persistent scratching
Pelvic Inflammatory Disease (PID)
inflammation of the upper female genital tract and nearby structures
What are the 2 most common causes of PID?
gonorrhea and chlamydia
Phimosis
foreskin of the penis cannot be retracted
- normal in the newborn
- topical steroid BID x 1 month
Paraphimosis
more serious disorder characterized by retraction of the phimotic prepuce which causes a constricting band behind the gland of the penis and results in incarceration if left untreated
Treatment for Paraphimosis
- reduction of the prepuce of a small dorsal incision to release foreskin
- circumcision
What is considered a medical emergency for males?
swollen reddened penis and can quickly result in necrosis
Hygiene for Uncircumcised Male
- foreskin does NOT normally retract in newborn
- change diaper frequently and wash penis daily
- older infant foreskin retracts clean around glans once a week
- dry area prior to replacing foreskin
- always replace foreskin
- teach preschool age to retract foreskin and clean during bath
Benefits of Circumcision
decreased incidence of UTI’s, STI’s, AIDS, and penile cancer and in female partners a decreased occurrence of cervical cancer
Complications of Circumcision
alterations in meatus, unintentional removal of excessive amounts of foreskin, or damage to the glans penis
Hydrocele
fluid in the scrotal sac
- benign/self limiting
- spontaneously resolves by age 1
Variocele
venous varicosity along the spermatic cord
- swollen scrotal sac
- mass on one or both sides and bluish discoloration
- spermatic veins feel worm-like
Testicular Torsion
a testicle is abnormally attached to the scrotum and twisted
- requires immediate surgery
- most common in boys ages 12-18 yrs
Testicular Torsion can result in what if left untreated?
ischemia leading to infertility
Epididymitis
inflammation of the epididymis
- caused by infection w/ bacteria
- rarely occurs before puberty
What is the most common cause of pain in the scrotum?
Epididymitis
If Epididymitis occurs before puberty it may be a result of what?
urethral or bladder infection related to urogenital anomaly
Therapeutic Management of Epididymitis
directed toward eradicating bacteria
- encourage rest w/ scrotum elevated
- ice packs
- analgesics/antibiotics
What can Epididymitis cause if left untreated?
Scrotal abscess
Testicular infarction
Infertility
