Peds - Urinary System

Functional unit of the kidney

Nephron

Urinary system function

Removes waste and maintains fluid balance in the body

Normal pediatric urine output

Varies by age but should be adequate with no signs of oliguria

Four urologic diagnostic procedures

Urinalysis, ultrasound, CT scan, IV pyelogram

Urinalysis (UA)

Test that checks urine for protein, glucose, infection, and abnormalities

Ultrasound

First-line imaging in children because it is safe and has no radiation

IV pyelogram

Test using dye to evaluate kidney function and detect obstruction

CT scan

Detailed imaging used for tumors or trauma but may require sedation

Biopsy

Test used to confirm kidney disease

Uroflow

Test that measures urine flow rate to detect obstruction

Cystoscopy

Scope inserted into bladder to visualize abnormalities

VCUG

Test used to detect urine flowing backward (reflux)

Cystometrogram

Test that evaluates bladder function

Dysuria

Painful urination

Frequency

Urinating often

Urgency

Inability to hold urine

Nocturia

Urinating at night

Enuresis

Bedwetting (normal until age 5)

Polyuria

Excessive urine output

Oliguria

Low urine output and considered an emergency

Phimosis

Tight foreskin that cannot be retracted

Paraphimosis

Foreskin stuck and cannot return causing swelling and emergency

Hypospadias

Urinary opening on underside of penis

Epispadias

Urinary opening on upper side of penis

Chordee

Curved penis due to fibrous tissue

Bladder exstrophy

Bladder exposed outside the body causing continuous urine leakage

Nursing care for bladder exstrophy

Cover bladder, prevent infection, position for drainage

Obstructive uropathy

Blockage of urine flow causing kidney damage

Hydronephrosis

Swelling of kidney due to urine backup

Polycystic kidney disease

Multiple cysts replace normal kidney tissue

Hydrocele

Fluid buildup around testicle causing swelling

Cryptorchidism

Testes do not descend into scrotum

UTI cause in children

E. coli bacteria

Why UTIs are more common in girls

Short urethra and proximity to anus

UTI symptoms in infants

Fever, foul-smelling urine, diaper rash

UTI symptoms in older children

Pain, frequency, bedwetting

UTI treatment

IV antibiotics for infants, oral antibiotics for older children

UTI teaching

Increase fluids and wipe front to back

Nephrotic syndrome definition

Kidney disorder with protein loss, edema, and low albumin

Nephrotic syndrome symptoms

Edema, weight gain, irritability

Nephrotic syndrome treatment

Steroids and monitoring for infection

Nephrotic syndrome diet

Low sodium diet

Why diuretics are ineffective in nephrotic syndrome

Edema is caused by protein loss not fluid overload

Acute glomerulonephritis cause

Post-strep immune reaction

Acute glomerulonephritis symptoms

Bloody urine, edema, hypertension, decreased urine

Difference between nephrotic syndrome and glomerulonephritis

Nephrotic is protein problem, glomerulonephritis is inflammation problem

Wilms tumor

Kidney tumor in young children

Wilms tumor key sign

Abdominal mass

Critical nursing action for Wilms tumor

Do NOT palpate abdomen

Wilms tumor treatment

Surgery, chemotherapy, radiation

Impact of undescended testes

Risk for infertility and cancer

Treatment for cryptorchidism

Hormone therapy or surgery

Impact of GU surgery on preschool child

Confusion about body and fear

Impact of GU surgery on school-age child

Embarrassment and body image issues

Impact of GU surgery on adolescent

Sexual identity concerns

Why is oliguria an emergency

It may indicate kidney failure

What happens if urine flows backward

Increased risk of infection

Why should foreskin not be forced back

It can cause paraphimosis

Why is fever concerning in infant with UTI

Risk of rapid decline and seizures

Why must fluids be increased with UTI

Helps flush bacteria

Why are steroids used in nephrotic syndrome

Reduce protein loss and swelling

Why are children with nephrotic syndrome at risk for infection

Immune suppression from steroids

Why should abdomen not be palpated in Wilms tumor

It can rupture tumor and spread cancer

Why is early treatment of cryptorchidism important

Prevents infertility

Why is bladder exstrophy high risk for infection

Bladder is exposed to outside environment

Why is ultrasound preferred in children

It is safe and has no radiation

Priority nursing action for decreased urine output

Notify provider immediately

Priority nursing care for bladder exstrophy

Protect bladder and prevent infection

Priority teaching for parents of UTI children

Fluids and hygiene

Priority assessment in nephrotic syndrome

Daily weight and edema monitoring

Priority intervention for urinary obstruction

Relieve obstruction to prevent kidney damage