Nursing care of the child with genitourinary disturbances

differences in anatomy and physiology

vulnerable to fluid and electrolyte imbalance

• higher percentage of body weight composed of H20

  • increase extracellular fluid

    • decrease with age

  • intracellular fluid increase with age

Nephrotic syndrome patho

increase permeability of glomerular membrane

• changing amount going in

• excretion of albumin and proteins in urine

decrease oncotic pressure

• development of edema

Liver stimulated to synthesis of cholestrol 

loss of immunoglobins 

Nephrotic syndrome characteristics

occurs in children 3-9 years of age

edema

massive proteinuria

hypoalbuminemia

hyperchloesterolemia

nephrotic syndrome clinical manifestations

develops gradually

weight gain

edema

pale, irritable, fatigued

decreased urine output

nephrotic syndrome nursing care

generally supportive

administer medications 

• prednisone 

  • every day for 6 weeks

  • every other day for 6 weeks 

nutritional management 

• regular protein, low salt diet

prevent infection

monitor fluid balance

• I and O 

• daily weight 

• assess edema

Promote periods of rest

Nephrotic syndrome education

steriods

• side effects and taper off

Monitor protein in urine 

signs of relpase

prevention of infection

• withhold immunizations for 6 months

Glomerulonephritis

inflammation of the glomeruli

post infection ALWAYS 

• strep

Early school age children 

immune complex disease

latent period between streptococcal infection and onset of symptoms

Glomerulonephritis clinical manifestations

decrease urine output

dark colored urine

periorbital edema

• worse in AM

generalized edema

mild to moderate hypertension HALLMARK

Glomerulonephritis pharmacolgic interventions

diuretics

antihypertensives

Glomerulonephritis nursing care

monitor blood pressure

low sodium diet

monitor I and O

urine testing for RBC’s and. proteins

UTI

E. coli most common

can be first sign of anatomical or structure abnormality 

not easy to diagnose early 

• kids cannot verbalize 

single most important host factor: urinary stasis

• kids dont want to stop and use the restroom

s/s of a UTI in infants and young children

typically non-specific

fever

irritability 

GI

• nausea, vomit, feeding problems 

• diarrhea

UTI s/s in older children

specific symptoms are more common

dysuria

• frequent, urgent, burning

abdominal pain

new-onset urinary incontinence

• if they were potty trained it may stop because they cannot hold it as well

UTI diagnosis

clean catch, midstream urine speciman

infant

• sterile cath or suprapubic needle aspiration required

• stick on-urine bags are unacceptable for culture because contamination is guaranteed

UTI patho

Bacterial invasion

• irritation

• inflammation

Infant boys > girls

• reflux

• uncircumcised 

Childhood girls > boys 

• E. coli

• withholding

• sexual activity

UTI nursing management

diagnostic testing

• urine analysis vs culture

treatment

• antibiotic therapy 

• increase fluids 

  • avoid caffeine/ carbonated bevs

• encourage voiding

• reduce risk of future infections

Toilet training

voluntary bowel and bladder elimination

bowel control usually precedes bladder

“training” should begin when child shoes pysical and psychosocial signs of readiness 

2-4 yrs

use potty training as opportunity to teach proper hygiene

Do’s of potty training

praise childs successes

make the switch from diapers to cotton underwear a “special moment”

Don’t of potty training

dont rush the process

dont humiliate or punish the child

Enuresis

bed wetting

usually nocturnal, rarely diurnal 

at least 5 years of age

2x week for 3 months

urgency, discomfort, restlessness, frequency

Enuresis management 

rule out organic causes (UTI, diabetes)

restrict PM fluids

• watch hydration levels

wake child to void 

alarm therapy 

bladder capacity training

• make child not go as frequent so it stretches the bladder

Enuesis pharm management

desmopressin

anticholinergics

tricyclic antidepressants

Enuresis nursing care

child and parent education

lots of sensitivity and postitive reinforcement 

assess how the child is feeling about this 

• determine ability to cope

Hypospadias 

congenital anomaly of the male urethra that results in abnormal ventral placement of the urethral opening on the underside of the penis 

one of the most common congenital anomalies

more distal the opening, the more severe the curvature of the penis 

• more extensive surgical intervention necessary

Surgical correction of Hypospadias 

goals

• engance ability to void in standing position with straight stream

• improve physical appearance

• preserve sexual function

6 to 12 months 

2 types of repair, dependent on severity 

avoid circumcision at birth