PEDS Urinary/Renal/Bladder Disorders Flashcards
What am I:
a congenital condition in which the urethral opening is not located at the tip of the penis but rather along the underside.
HYPOspadias
Hypo= below
Spadias= fissure
What sex is at higher risk for Hypospadias?
men > female
What is the Tx option for HYPOspadias
Surgical Repair: foreskin is preserved
When is the ideal age for surgical repair of hypospadias
between 6 to 24 months.
Why should a child with hypospadias avoid circumcision BEFORE surgery?
the foreskin is needed for tissue preservation during reconstruction
Q: What types of supportive care may be used POST hypospadias surgery?
Supportive care= additional tx or tools
- Urinary diversion
- Urinary stent
Hypospadia Surgery:
Post Op Care
- Keep surgical site clean- prevent infx
- Monitor vital signs
- Encourage fluid intake
- Monitor urine hourly for amount, cloudiness or a foul odor (norm: 1ml/kg/hr urine output)
Hypospadias: Post-Op
When will the HCP remove the dressing post hypospadias surgery?
about 4 days after surgery.
Q: What 2 things should parents do for their child post-Hypospaidas surgery?
- Quiet diversional activities (read, color, puzzles- non strenous)
- Avoid traumatizing the surgical site.
3 types of Meds given post-surgery for Hypospadias?
Antibiotics: penicillin, ceftriaxone, erythromycin, clindamycin
analgesics: tylenol, NSAIDs, opioids, lidocaine)
anti-spasmodics: baclofen
Parent teaching Post surgery for Hypospadias?
- Care of Stent and Surgical Site
- Aware of S/S Infection or Complications
- ** Avoid Bathing – infection risk
- ** Fluids – encourage oral (“If the gut works, use it!”)
- No circumcision – preserve foreskin for reconstruction
- F/U with HCP (dressing removal ~ post-op day 4)
- a type of kidney cancer that primarily affects children, typically under the age of 5
- often forming a large mass
Wilms’ tumor
(also known as nephroblastoma)
Nursing Interventions for WILMS TUMOR:
Whats the #1 most important thing you should NOT DO to a pt with Wilms’ Tumor?
REFRAIN FROM PALPATING MASS!
Why is it important to refrain from palpating the mass in a child with Wilms’ tumor?
Palpation can cause:
* rupture of the protective capsule
* leading to seeding of the tumor
* and potential spread of cancerous cells.
What precaution should be taken to prevent accidental palpation of the abdomen in a child with Wilms’ tumor?
A sign should be placed on the BED warning against palpating the abdomen.
How quickly does surgery typically occur after a Wilms’ tumor diagnosis?
1-2 days AFTER diagnosis.
ITS RAPID!!
Why is pre-op preparation important for Wilms’ tumor surgery
Because of the RAPID timeline of surgery:
* families need extensive education,
* and children require significant emotional support before surgery.
Chemo complications for Wilms’ Tumor
- Vincristine-induced ileus : vincristine is a chemo drug. Causes bowel obstruction due to nerve damage.
- Radiation-induced edema: swelling and discomfort in treated areas.
- Postsurgical intestinal adhesions: bands of scar tissue.
- Hypertension (involves renin system)
- Altered urinary output
- Infection
- Metabolic Alkalosis: tx leads to severe vomit and GI fluid loss removing HCL from stomach.
Wilms’ Tumor surgery:
What should be carefully monitored when it comes to the RENAL system…. POST surgery?
- HOURLY Urine Outputs
- 1ml/kg/hr (Varies with Age)
- S/S Infection
- Hematuria (blood in urine)
- Electrolytes
Wilms’ Tumor surgery:
What should be carefully monitored regarding GI system POST surgery?
- NG Tube
- Bowel Sounds: function return, prevent ileus (stopping of peristalsis) & bowel obstruction.
- Abdominal Distention
What is Enuresis?
children wetting the bed after they can control bladder.
Wetting of bed that occurs ONLY in the day
Diurnal
Wetting of bed that occurs at NIGHT.
Nocturnal
Causes of Enuresis
List 4
- Familial
- Medical: DM, UTIs etc
- Neurogenic: Nervous system doesnt coordinate properly with bladder funciton
- Emotional
- Irritable bladder
- Structural disorders
- Disorders that affect the concentrating ability of kidneys
- Excessive production of urine
- Chronic constipation: pressure on bladder from inflammed intestine.
DX for Enuresis include:
- History & presenting
- Clinical symptoms: day? night?
- Renal Ultrasound: visualize kidneys
- Voiding cystourethrogram (VCUG): imaging that examines bladder and urethra while bladder fills & empties
- UA, C & S, specific gravity
- glucose: indication of DM (polyuria)
- calcium: metabolic issues or kidney stones
- pinworm prep: tape test around the anus- done if suspisiouc of pinworm infx cause itching and nocturnal enuresis.
Name the 3 medications used for Enuresis
- Oxybutynin chloride (Ditropan)
- Imipramine hydrochloride (Tofranil)
- Desmopressin acetate – DDAVP
Enuresis Meds:
Class: Anticholinergic
Oxybutynin chloride (Ditropan)
Enuresis Meds:
Action of Oxybutynin chloride (Ditropan)
Helps to relax the bladder and increase bladder capacity
* making it easier to hold urine and reducing urgency and frequency.
Enuresis Meds:
Class: Tricyclic Antidepressant
Imipramine Hydrochloride (Tofranil)
Enuresis Meds:
Action of Imipramine Hydrochloride (Tofranil)
decreases depth of sleep - insomnia
* decreasing the need to urinate while sleeping
Enuresis Meds:
Class: Synthetic Human Antidiuretic Hormone
Desmopressin Acetate (DDAVP)
Enuresis Meds:
Action of Desmopressin Acetate (DDAVP)
Increasing the concentration of urine
* urine has higher ratio of waste products, low H2O.
* tells kidneys to retain water (hence urine is more concentrated).
* Child produces less urine at night.
Enuresis Meds:
What is the drug of choice for treating enuresis
Desmopressin Acetate (DDAVP)
Which of the following is an important teaching point for parents whose child is being treated for enuresis with medication?
a) The medications will completely cure enuresis.
b) The medications will control symptoms, but the child may need ongoing treatment.
c) The medications are not necessary if the child has no symptoms.
d) The medications will stop enuresis permanently after a short course.
Answer: b) The medications will control symptoms, but the child may need ongoing treatment.
Rationale: Medications for enuresis help manage symptoms, but they do not provide a cure. Ongoing treatment and behavior modification may be required to address the condition in the long term.
Other Treatement options for Enuresis
- Bed wetting alarms
- Motivational therapies
- Bowel programs
- Treat structural anomalies
- Decrease foods irritating to bladder
- Bladder retention exercises (Bladder training)
- Void before bedtime.
- Limit fluid intake before bedtime
What approach should be taken when managing a child with enuresis?
- Child needs support and encouragement.
- Punishment is contraindicated (may exacerbate condition)
What am I:
a rare congenital birth defect where the bladder develops outside the body through an opening in the abdominal wall.
Bladder Extrophy
What is the management for exstrophy in a newborn?
- Cover exposed tissue with non-adhering plastic wrap or dressing to limit risk of contamination.
- Surgical repair of the bladder and genitalia.
Parent teaching for newborns with Extrophy
- Goal is to establish urinary continence (control bladder urination).
- UTI prevention is essential.
- Closely monitor U/O
What is paraphimosis?
A UROLOGIC EMERGENCY!!!
- Occurs when the foreskin is retracted over the glans penis and constricted at the base, leading to edema, swelling, and possible blood flow restriciton
Why does Paraphimosis occur in men?
- Most common in uncircumcised men with poor hygiene or difficulty with self-care.
- uncircumcised male, when the foreskin is retracted to insert an indwelling catheter and the foreskin is not pulled back down.
Paraphimosis:
Manual reduction involves
Gradual application of ice and attempting to return the foreskin to its normal position.
Why is Paraphimosis a urologic emergency?
arterial blood flow to the glans is obstructed, resulting in ulceration/necrosis.
Paraphimosis:
What is the DEFINITIVE treatment?
May require circumcision or a dorsal slit surgical release procedure.
-dorsal=top part of penis
