Acute Glomerulonephritis, Hypospadias, Epispadias, Enuresis

Glomerulonephritis:

inflammation of the glomeruli (tubules of the kidney)

Causes of glomerulonephritis:

streptococcus organisms, infections

S/S of acute glomerulonephritis:

↓ urine output, HTN, tea-colored urine, headaches, periorbital edema, ↑ abd girth, swelling of labia or scrotum, hematuria (macro- or microscopic), proteinuria, abnormal BUN and creatinine

Dx of glomerulonephritis:

serum ASO if the child has been dx w/ a strep infection in the previous 2 weeks; serum complement (C3) can be positive; urine microscopic hematuria can be observed for up to a yr after the disease resolves; BUN and creatinine to assess renal function

If children don’t fully recover from glomerulonephritis, they can develop:

nephrotic syndrome (NS) and require a renal biopsy

Nursing care for glomerulonephritis:

closely monitor for HTN, urine output, renal status, dietary restrictions (Na, K+, fluid intake)

Medical care for glomerulonephritis:

antibiotic therapy if infection of strep is still found, I&O monitoring, diuretics (furosemide), antihypertensives, severe forms may require PD/HD/plasma exchange

Education/discharge for glomerulonephritis:

take antibiotics as directed and for the full length of tx

Hypospadias:

meatus is inferior to the usual position

Epispadias:

meatus is superior to the usual position

S/S of hypospadias:

opening of urethra below tip on bottom side of penis, incomplete foreskin, curvature of penis during erection, abnormal position of the scrotum

S/S of epispadias:

opening of urethra above tip of penis, curvature of penis, urinary incontinence, may not be able to urinate standing, may have cryptorchidism

Dx of hypo- and epispadias:

pt hx, physical exam findings, radiography, ultrasound

Prevention of hypo- and epispadias:

potential voiding dysfunction and chordee issues

Nursing care for hypo- and epispadias:

help parents w/ coping and counseling

Surgery for epispadias:

surgical correction and possible penile urethral lengthening

Surgery for hypo- and epispadias:

usually done after 6m and before toilet training, circumcision cannot be done before surgical correction bc foreskin may be used during surgical repair

Potential surgical complications after hypo- and epispadias surgery:

urethral fistula, stenosis, return of the meatus to its original position, and strictures

Education/discharge for hypo- and epispadias:

watch for UTIs, child will probably have acute pain r/t bladder spasms/incisional pain/pain r/t infection

Med that can be used to relieve bladder spasms:

oxybutynin

Dysfunctional elimination syndrome/enuresis:

voiding dysfunction, abnormal but common in peds elimination → bladder and bowel withholding and incontinence

S/S of enuresis:

patterns of urinary urgency, crossed legs, jiggling behaviors, holding genitals; foul-smelling urine odor, behavior problems/developmental delays/ADHD, encopresis, DM, OSA, psychological stress, signs of sexual abuse

Dx of enuresis:

pt hx and physical exam to rule out other conditions

Prevention of enuresis:

sometimes genetic and can’t be prevented; some conditions causing it can prevent enuresis w/ meds

Nursing care for enuresis:

not considered abnormal until after 5-6y/o → educate parents of this; other pt/parent education → bed alarms used to wake child up to void and then eventually the child’s body/mind will understand and do this own it’s own (takes about 12 weeks); if caused by psych issues → acupressure, massage therapy in some cases; motivational therapy → uses rewards for dry nights or days

Medical care for enuresis:

extreme cases → meds → most common is **desmopressin (DDAVP)** which lowers the incidence of nocturnal urinary production → children who have HTN or have risk for fluid and electrolyte imbalances cannot take the oral tabs