Renal/Reproductive

Question 1

Deck Objectives

Answer 1

CARE OF THE CHILD WITH RENAL/REPRODUCTIVE DISORDERS

Entrance expectations:

In preparation for this class day, students are expected to review the following:

Normal anatomy and physiology of the genitourinary system.
Pathophysiology of:
Urinary Tract Infections
Acute Kidney Injury (Acute Renal Failure)
Assessment of:
Hydration status
Normal blood pressure ranges in children
Diagnostic Testing:
Ultrasound
Voiding cystourethrogram
Urine culture
Laboratory values
Drugs that may be used in patients with genitourinary disorders:
Diuretics
Antibiotics
Antihypertensives
Immunosuppressants
Class/Prep Objectives:

Upon completion of this unit, the student should be able to:

Discuss pertinent history and physical assessment findings in a child with a genitourinary disorder:
Urinary tract infection
Vesicoureteral reflux
Hypospadias
Epispadias/ bladder exstrophy
Nephrotic syndrome
Acute kidney injury
Hemolytic uremic syndrome
Acute Glomerulonephritis
Cryptorchidism
Describe the nursing management of children with selected genitourinary diseases.
Discuss child-specific preparation and modification of diagnostic tests utilized in children with selected genitourinary diseases.
Apply the nursing process as a framework for providing individualized nursing care for children with genitourinary disease.
Provide patient and family education aimed at health promotion and health maintenance of patients with genitourinary disorders.

Question 2

Minimum Uop for children

Answer 2

1 mL/kg/hr

Question 3

BUN lab value & what does it indicate if elevated?

Answer 3

7-24
too high: dehydration

Question 4

Creatinine lab value

Answer 4

0.7-1.4 mm/dL
if high, think some sort of renal failure

Question 5

UTI Strategies

Answer 5

PERINEAL HYGIENE-WIPE FROM FRONT TO BACK
 AVOID TIGHT CLOTHING/DIAPERS
 WEAR COTTON UNDERWEAR RATHER THAN NYLON
 AVOID “HOLDING” URINE & EMPTY BLADDER COMPLETELY
 AVOID BUBBLE-BATHS
 AVOID CONSTIPATION (BOWEL/BLADDER PROGRAM)
 ENCOURAGE GENEROUS FLUID INTAKE
 EVALUATE PERINEAL ITCHING & TREAT PINWORM OR VAGINITIS PROMPTLY
 ENCOURAGE TEENAGE GIRLS TO VOID AS SOON AS POSSIBLE AFTER SEXUAL
INTERCOURSE

Question 6

Vesicouteral Reflux

Answer 6

ABNORMAL FLOW OF URINE FROM THE
BLADDER UP THE URETERS TO THE
KIDNEYS
* USUALLY DIAGNOSED IN INFANTS AND
CHILDREN < 3 YEARS
* INCREASES THE RISK OF URINARY TRACT
INFECTIONS WHICH CAN LEAD TO KIDNEY
DAMAGE
* CHILDREN MAY OUTGROW IT
* MAY TREAT WITH MEDICATION OR
SURGERY

Question 7

Bladder Extrophy

Answer 7

ASSOCIATED WITH EPISPADIAS
* CLOSED WITHIN 1-2 DAYS OF BIRTH
* SKIN CARE AND TEMPERATURE ARE PRIORITIES
* LATEX ALLERGIES ARE COMMON

Question 8

Cryptochordism

Answer 8

FAILURE OF TESTES TO DESCEND
* AFTER AGE 1, SURGICAL
CORRECTION (ORCHIOPEXY)
* INCREASED RISK FOR
* TESTICULAR CANCER
* INFERTILITY
* TORSION

Question 9

Postop Hypospadias Repair

Answer 9

DOUBLE DIAPERING PROVIDES ADDED
PROTECTION AND CUSHIONING
FOLLOWING REPAIR WHEN A STENT
AND URINARY CATHETER IS PLACED
* AVOID PRESSURE ON SURGICAL
SITE
* SPONGE BATHS UNTIL STENT IS OUT
* URINE BLOOD TINGED FOR SEVERAL
DAYS
* ENCOURAGE FLUIDS
* PAIN MEDS AND ANTIBIOTICS

Question 10

HYPOSPADIAS REPAIR

Answer 10

USING THE FORESKIN TO CREATE A NEW URETHRAL OPENING AT THE TIP OF THE PENIS

Question 11

Hypospadias vs. Epispadias

Answer 11

Hypospadias is a defect where the opening of the urethra is on the ventral (underside) of the penis instead of the tip.
Treatment of hypospadias is typically done within the first two years of life.
Infants should not be circumcised because the foreskin is used to reconstruct the urethra.

Epispadias is a defect where the opening of the urethra is on the dorsum (top) of the penis instead of the tip.