Week 12 GU disorders

Urinary function review

Removal, filter, balance

Hormone: renin, calcitrol, Erythropoietin

Monitoring: eGFR, CRE, BUN, urine SG, UA

Enuresis

Night 2x/week-3 months>5 years

Risk: bladder dysfunction, emotional event, behavioral disorder

S/s: Hx alternation in toilet training/void behavior

Dx: pattern, functional bladder capacity screening

Management: bedtime/fluid, positive/avoid, have child Change afterward

Therapeutic measure: behavior therapy, conditioning therapy, retention control

Nursing care: self-esteem, coping, support

Medication: antidiuretics(desmopressin); anticholinergic(oxybutynin)

Complications: emotional disturbances, low, isolation

Urinary tract infection

Cause: bacterial, virus, fungus

Ascending

Risk: urine stasis/reflux, catheterization, hygiene, tight underwear, bubble bath, sex, constipation

S/s

-infants: fever, irritability, poor feeding, vomiting

-children: + above, enuresis, ordor, frequency, urgency, dysuria, blood in urine

Dx: UA(WBC, nitrites, RBC), Urine culture/sensitivity

Nursing care: emptying, monitor I&O

Medication: analgesics, antipyretics, ABX

Education: monitor s/s, prevention

Complications: pyelonephritis, urosepsis

Acute Glomerulonephritis

Glomeruli

Risk: Streptococcal, URI

S/s: decreased UO, cloudy/red/tea color urine, mild-severe HTN, fever, edema

Dx: UA(blood, protein, SG), renal function(BUN/CRE, decrease GFR), antistreptolysin O(ASO) titer

Nursing care: monitor I&O/neurological status, restriction, daily weight, vital sign(BP, Temp)

Medication: diuretics, antihypertensives, ABX

Education: follow-up, monitor BP/weight, avoid

Proteinuria, elevated BUN, Pos ASO titer, Tea-color/red cloudy urine

Nephrotic syndrome

Alternation in glomerular membrane→Protein in urine→decrease osmotic pressure

S/s: weight gain, edema, muehrcke line, irritability, lethargy, urine, BP

Dx: 24 hr Urine

Blood work: hypoalbumineria, hyperlipidemia

Nursing care: protein, strict, weights, BP, ABD girth, Elevate

Medication: steroid, diuretics, plasma expanders(25% albumin)

Education: infection prevention, monitor BP, weight, protein

Proteinuria, high cholesterol, dark frothy urine

Hemolytic uremic syndrome

Actue Rena diseases: renal failure, hemolytic anemia, thrombocytopenia

Toxin→damage of kidney tissues

Platelets→clots renal circulation

Risk: toxin-Ecoli, malignancies genetic disorders

S/s: fever, D/V, irritability, lethargic, edema, bruising/rectal bleeding, Anuria/HTN

Dx: CBC(decrease hgb/hct/platelets), urine(blood,protein), elevated BUN/CRE

Nursing care: I&O, daily weight, replacement(fluid/electrolyte), transfusion, dialysis, NO ABX

Education: avoid undercook/unpasteurized, pubic pools

Proteinuria, elevated BUN, decrease plt, red urine

Vesicoureteral reflux(VUR)

Backflow, bladder→ureters,kidney @ vesicoureteral junction

S/s: recurrent UTI, fever, N/V

Dx: VCUG radiograph

Medication: prophylactic ABX, Grade 1-2(resolve), grade 3(may), Grade 4-5(surgical)

Complications: pyelonephritis, renal scarring

Bladder exstrophy

Anterior bladder→open on ABD wall

Dx: prenatal US

Nursing care: infection prevention, surgery

Phimosis

Narrowing of preputial opening→inability to retract foreskin

Normal→infants

S/s: pain, ABN/intermittent urine stream

Nursing care: do not force retract, low-dose steroid cream

Surgery: circumcision

Hypospadias

Urethane opening, below, behind, above glans penis

Cryptorchidism

Absent/undescended testes

Treatment: surgical @ 6 months

Complication: testicular cancer, infertility

Testicular torsion

Testicle twists

S/s: dusky scrotum, pain

Treatment: surgery→stabilize to prevent recurrence

Nursing care: education, emotional, NPO

Post-op: pain, I&O, catheter, wound/dressing care, infection

Infection: fever, skin inflammation, foul/odor urine, cloudy, frequency

Emotional problem: self-esteem, body image, isolation, play therapy, support group