Title: Nursing Care of the Child with GU disorders
1Nursing Care of the Child with GU disorders
2Enuresis
3Enuresis Multitreatment approach
- Fluid restriction
- Bladder exercises
- Timed voiding
- Enuresis alarms
- Reward system
- Medications
4Urinary tract infections
- Most common type of bacterial infections
occurring in children - Bacteria passes up the urethra into the bladder
- Most common types of bacteria are those near the
meatusstaph as well as e.coli
5Urinary tract infections
- Most common type of bacterial infections
occurring in children - Bacteria passes up the urethra into the bladder
- Most common types of bacteria are those near the
meatusstaph as well as e.coli
6Contributing factors
- Those with lower resistance, particularly those
with recurrent infections - Unusual voiding and bowel habits may contribute
to UTI in children - forget to go to bathroom
- Symptoms
7Therapeutic management
- Eliminate the current infections
- Identify contributing factors to reduce the risk
of re-infection - Prevent systemic spread of the infection
- Preserve renal function
8FYI
- The single most important host factor influencing
the occurrence of UTI is urinary stasis - What is the chief cause of urinary stasis?
9Obstructive Uropathy
10Vesicoureteral Reflux
- Approximately 20 of children that have UTIs will
be found to have vesicoureteral reflux on xray
11What is vesicoureteral reflux?
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13Treatment for vesicoureteral reflux
- Directed toward preventing UTIs
- Managed by time or surgery if a lower grade
- Single doses each day of abx as long as reflux
lasts - Urine cultures done q 6 wks up to 3 months to
make sure no silent infection
14Diagnostics VCUG
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16Bladder Exstrophy
17Exstrophy of the Bladder, cont.
- Treatment surgical reconstruction done 1st
24-48 after birth - Goals
- Bladder/abd wall closure
- Preserve urinary function
- Create normal appearing
- genitalia
- -improvement of sexual function
18Nursing care, cont.
- Control bladder spasms
- Control pain
- Increase fluid intake
- Do not allow to play on straddle toys
- Prevent infection (no bathing or swimming until
stents removed - Call dr if temp gt101 anorexia, pus or bleeding
from stent, cloudy or foul smelling urine
19Etiology and Pathophysiology
- Hypospadiasoccurs from incomplete development of
urethra in utero - Defect ranges from mild to severe
- Undescended testes may also be present
- Might interfere with fertility in the mature male
if not corrected - Epispadias rare and often associated with
extrophy of bladder
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21- Epispadias
- Congenital urethral defect in which the uretheral
opening is on the upper aspect of the penis and
not on the end
22Assessment
Usually discovered during Newborn
Physical Assessment
23Ask yourself?
- Why would the nurse question an order to prepare
the infant for a circumcision?
24- The reason for surgery at
- About 1 year of age is
- Because
- Children will experience less pain
- Chordee may be reabsorbed
- The child has not developed body image and
- castration anxiety
- d. The repair is easier before toilet training
25A double diapering technique protects the urinary
stent after surgery. The inner diaper collects
stool and the outer diaper collects urine.
26Cryptorchidism
27Cryptorchidism
- Defined as failure of one or both testes to
descend - Treatment
- Objective of treatment
28Therapeutic interventions for undescended testes
- Surgery Orchiopexy done via laproscopy (around
1 yr of age) - Post-op nursing care minimal activity for few
days, allow to express fears about castration,
mutilation by playng with puppets or dolls
29Why is it important that the Testes are in the
scrotal sac?
30Answer
- The higher temperatures in the abdomen than in
the scrotum results in morphologic changes to the
testes-mainly concerned with lower sperm counts
at sexual maturity
31Assessment on NB exam
32Glomerular diseases
- Nephrotic syndrome (MCNS) or minimal-change
nephrotic syndrome - Acute glomerulonephritis (AGN)
33AGN
- Immune-complex disease causing inflammation of
glomeruli of kidney - Usual organism is group A beta-hemolytic strep
- Decreased glomerular filtration
- Common in children (boys gt girls)
- Assessment/diagnostic tests
34Whats really happening in AGN?
Decreased glomerular filtration leads to inc. Na
and H2O Protein molecules filter thru
damaged glomeruli Damage leads to hematuria High
B/P heart failure may ensue Phases edematous
(4-10 days) Diuresis phase
35AGN
- Treatment and nursing care
- Bed rest may be recommended during the acute
phase of the disease - A record of daily weight is the most useful means
for assessing fluid balance
36Nursing diagnosis for the child with
glomerulonephritis
- Fluid volume excess r/t to decreased plasma
filtration - Activity intolerance r/t fatigue
- Altered patterns of urinary elimination r/t fluid
retention and impaired filtration - Altered family process r/t child with chronic
disease, hospitalizations
37Nursing care specific to the child with AGN
- Allow activities that do not expend energy
- Diet should not have any added salt
- Fluid restriction, if prescribed
- Monitor weights
- Education of the parents
38Nephrotic syndrome
39Nephrotic syndrome, cont
40Contrast of normal gloumerular activity with
changes seen in Nephrotic Syndrome
41Treatment of nephrotic syndrome
- Varies with degree of severity
- Treatment of the underlying cause
- Prognosis depends on the cause
- Children usually have the minimal change
syndrome which responds well to treatment
42Child with nephrotic syndrome
43Therapeutic management
- Corticosteroids (prednisone)
- Dietary management
- Restriction of fluid intake
- Prevention of infections
- Monitoring for complications infections, severe
GI upset, ascites, or respiratory distress
44Critical thinking for client undergoing urinary
tract surgery
- The Scotts are receiving pre-op instructions
before their son Davids surgery for
reimplantation of the ureters. David is 5 years
old. In addition to discussion of post-op pain,
tubes and dressings, the most significant other
topic would be which of the following? - A. Need to reassure David his genitals are
intact and will function normally when the c
atheters are removed - B. Important of monitoring the urine drainage
from stents and urethral catheter - C. Need to assess the surgical site for bleeding
or excessive drainage - D. The home care regimen that can be anticipated
on Davids discharge from the hospital