The Child with a Genitourinary Alteration Flashcards
Review of the Genitourinary System
Structure
> Bean-shaped kidneys are located one on each side of the spinal column
> Ureters extend down from the kidney and enter the bladder wall
> The nephron is the kidney’s functional unit
Function
> Maintain fluid and electrolyte balance
Genitourinary System Differences
* Kidneys operate at a functional level appropriate for body size
* Kidneys reach near adult function at __ to __ months of age
* Infants cannot concentrate urine as efficiently as older children or adults
* Shorter urethras predispose children to UTIs
* Achieve complete bladder control by __ to __ years of age
6-12
4-5
Laboratory & Diagnostic Testing
* Urinalysis
> Specific gravity (___ - ___), pH (__-__), protein, glucose, ketones, leukocyte esterase, nitrites, WBCs, RBCs, bacteria, casts
* Urine C&S
* Serum studies (BUN, creatinine, serum osmolality)
* Radiography (KUB)
* Cystoscopy
* Imaging studies (CT scan, voiding cystourethrogram [VCUG])
* Urodynamic studies
- 002 - 1.030
- 5 - 8.0
?
Urgency, frequency, and inappropriate wetting during the day
Diurnal enuresis
?
Difficulty in maintaining bladder control
Enuresis
?
History of bed-wetting
Unable to sense a full bladder
Should not be a concern until greater than 6 years of age
Nocturnal enuresis
Diagnostic evaluation
> Based on history and clinical symptoms
Therapeutic management
> Limiting fluids and altering diet
> Imagery, record-keeping (log)
> Behavioral conditioning with setting alarms to void
> Desmopressin acetate - ADH
> Voiding frequently to keep low urine volume in bladder
?
Characterized by the presence of bacteria in the urine
Usually caused by bacteria ascending from outside the urethra into the bladder and then into upper urinary tract
Fecal bacteria causes most of these - Escherichia coli especially in girls
Urinary tract infections
Conditions that predispose infant or child to UTI’s
* Urinary tract obstructions
* Voiding dysfunction (urinary stasis)
* Anatomic differences (females)
* Individual susceptibility to infection
* Vesicoureteral reflux (VUR)
* Urinary retention usually seen while toilet training
* Bacterial colonization (males)
* Sexual activity during adolescence (females)
Manifestations of UTIs in Infants and Children
Infants
- Nonspecific
- Fever or hypothermia in neonate
- Irritability
- Crying when voiding
- Changes in urine color or odor
- Poor weight gain
- Feeding difficulties
Children
- Abdominal or suprapubic pain
- Voiding frequency/urgency
- Dysuria
- New or increased incidence of enuresis
- Fever
Chidren with ___
> Same symptoms as with children who have uncomplicated UTI’s, plus
- High fever, chills
- Back pain
- CVA tenderness
- N/V
- Ill-looking appearance
pyelonephritis
Management and Prevention of UTI’s - Education for parents and children
- Prescribed medication for the full number of days
- Wipe from front to back
- Avoid “holding of urine”
- Plenty of fluids
- Cotton underwear
- Avoid bubble baths
- Good hygiene for sexually active adolescent girls
Anomalies of the Genitourinary Tract
?
- At least 1 undescended testicle at birth
- Premature infants have a greater risk
Manifestations - nonpalpable testes or not easily guided into scrotum
Therapeutic management - observation for first 6 mos
___ - bring testes down into scrotum and suture in place
Cryptorchidism
orchidopexy
?
The urethral opening is below its normal location on the glans of the penis
Hypospadias
?
The urethral opening is above its normal location on the glans of the penis
Epispadias
Therapeutic management
- Surgery preferably between 6-12 mos
Nursing considerations
- Preoperative teachings
- Decrease edema using a pressure dressing
- Catheter or stent care
- Encourage fluids
- Monitor temperature
- Monitor urine for signs of infection
?
Group of kidney disorders characterized by inflammatory injury in the glomerulus
Glomerulonephritis
?
Most common
Sudden onset of
- Hematuria (cardinal sign) - smokey or tea-colored urine
- Proteinuria
- HTN
- Edema
- Renal insufficiency
- Decreased urine output
- Fever and fatigue
Acute Post-Streptococcal Glomerulonephritis
Therapeutic management
> Supportive care directed to associated S/S
> 10 day course of antibiotic may be needed
> Diuretics and antihypertensives
Acute Post-Streptococcal Glomerulonephritis - Nursing considerations
- Frequent accurate I&O
- With severe renal impairment
> Measure I&O every 1-2 hrs
> If an output is less than 1 mL/kg/hr report to physician
> Daily weights
> Measure BP every 4-8 hrs
> Assess respiratory status (RR, lung sounds, color)
> Limit fluid and salt
Nephrotic Syndrome
Kidney disorder characterized by ___, ___, and ___
Manifestations
* ___ - in periorbital spaces and dependent areas
* Anorexia
* Fatigue
* Abdominal pain
* Increased weight
* Respiratory infection
proteinuria, hypoalbuminemia, edema
edema
Diagnostic evaluation
* Urinalysis (presence of 3+ to 4+ protein and urine dark and frothy)
Therapeutic management
- Palliative treatment
- Hospitalization common
- Remission induction
> Prednisone - No-added salt diet
- Diuretics
- Albumin
Acute Renal Failure
Sudden, severe loss of kidney function
> Kidneys can no longer filter waste products, regulate fluid volume, or maintain chemical balance
Manifestations
- Electrolyte abnormalities
- Fluid volume shifts
- Increased BUN and serum creatinine levels
- Acid-base imbalances
- Poor feeding
- Decreased appetite
- Vomiting
- Lethargy
- Seizures
- Pallor
Diagnostic evaluation
> Past and recent history
> Fluid volume status (edema, crackles, HTN, urine output)
> Laboratory data
- Serum creatinine and BUN increased
- Metabolic acidosis
- Serum potassium increased
- Serum sodium may be increased or decreased
> Physical examination - examine for fluid overload
> Imaging studies - renal ultrasonography
Therapeutic management
> Maintain normal fluid volume
> Maintain electrolyte balance (K+, Na+, acid-base imbalances, nutrition)
Indications for dialysis
> Severe fluid overload
> Pulmonary edema or CHF secondary to fluid overload
> Severe HTN
> Metabolic acidosis or hyperkalemia not responsive to medications
> BUN > 120 mg/dL
?
Permanent irreversible loss of kidney function that treatment can no longer sustain patient’s health and life
End-stage renal disease
?
An irreversible loss of kidney function over months to years
Managed by medications and diet restrictions
___ progresses to ESRD
Chronic kidney disease (CKD)
Manifestations
* Electrolyte abnormalities
* Fluid volume shifts
* Acid-base imbalances
* Renal osteodystrophy (rickets)
* Anemia
* Poor growth
* HTN
* Fatigue, decreased appetite
* Poor feeding, N/V
* Neurological symptoms
Therapeutic management
> CKD
- Diet including reduction of sodium and fluid intake
> Diuretics, antihypertensives, sodium bicarbonate tablets, vitamin D, phosphorous binding medications
> Yearly influenza vaccine
- Families that are affected require multidisciplinary care
- Kidney transplantation for ESRD
?
Occurs when the kidney fails to maintain normal level of calcium and phosphorous in the blood
The abnormal blood level of calcium and phosphorous causes hormonal changes which follows dimineralization of bone
It slows down bone growth and may also lead to other deformities of the bone; an example of such deformity is bowed leg where the legs are bent inwards or outwards
Renal osteodystrophy
