NURSING CARE OF THE CHILD WITH AN ALTERATION IN ELIMINATION/GENITOURINARY DISORDER

LEARNING OBJECTIVES

• Compare Anatomical and Physiological Differences:
    - Distinguish differences in the genitourinary system between infants and children compared to adults.

• Nursing Care for Diagnostic Tests:
    - Describe nursing interventions related to common laboratory and diagnostic tests for pediatric genitourinary and reproductive conditions.

• Alterations in Urinary Elimination:
    - Identify common genitourinary disorders affecting infants, children, and adolescents.

• Nursing Assessments and Interventions:
    - Identify appropriate assessments and interventions related to medications and treatments for genitourinary disorders in children.

• Individualized Nursing Care Plans:
    - Develop nursing care plans or concept maps for children with urinary or genitourinary disorders.

• Psychosocial Impact:
    - Describe the psychosocial impact of chronic genitourinary disorders on children.

• Nutrition Plan:
    - Formulate a nutrition plan for children with abnormal kidney function.

• Family Teaching Plans:
    - Create teaching plans for children and families regarding urinary elimination and genitourinary disorders.

ANATOMY AND PHYSIOLOGY DIFFERENCES

• Kidneys:
    - Large relative to the stomach.
    - Prone to injury due to size.

• Urethra:
    - Shorter in infants, increasing the risk of bacteria entering the bladder.

• Glomerular Filtration Rate:
    - Slower in infants, leading to a higher risk for dehydration.

• Bladder Capacity:
    - Approximately 30 mL in newborns and reaches adult size by 1 year.

• Reproductive Organs:
    - Immature at birth and mature during adolescence.

PAST MEDICAL HISTORY FOR GENITOURINARY DISORDERS

• Past Medical History Includes:
    - Maternal polyhydramnios, oligohydramnios, diabetes, hypertension, or substance abuse (alcohol, cocaine).

• Neonatal History Includes:
    - Presence of a single umbilical artery, abdominal mass, chromosome abnormality, congenital malformation.

• Family History Includes:
    - Renal disease, uropathology, chronic urinary tract infections (UTIs), renal calculi, history of parental enuresis.

SIGNS AND SYMPTOMS OF GENITOURINARY DISORDERS

• Common Symptoms:
    - Burning on urination.
    - Changes in voiding patterns.
    - Foul-smelling or dark-colored urine.
    - Vaginal or urethral discharge.
    - Genital pain, irritation, or discomfort.
    - Hematuria (blood in urine).
    - Edema.
    - Masses in the groin, scrotum, or abdomen.
    - Flank or abdominal pain/cramps.
    - Distention in lower abdomen.
    - Nausea/vomiting.
    - Poor growth or weight gain.
    - Fever.
    - History of infectious exposure.
    - Trauma.

PHYSICAL EXAMINATION

• Inspection and Observation:
    - Observe general appearance of the child.
    - Note presence of edema.

• Auscultation:
    - Carefully listen to heart sounds.

• Percussion:
    - Perform simple percussion if relevant.

• Palpation:
    - Note any tenderness or pain when palpating the abdomen or groin.

COMMON LABORATORY AND DIAGNOSTIC TESTS

• Common Tests Used:
    - Complete blood count (CBC).
    - Blood urea nitrogen (BUN), electrolytes, creatinine, total protein, albumin.
    - Urinalysis using clean catch, suprapubic, or catheterized methods.
    - Urine culture and sensitivity tests.
    - Creatinine clearance tests.
    - Timed urine collections (e.g., 24 hours).
    - Cystoscopy and urodynamic studies.
    - Voiding cystourethrogram (VCUG).
    - Renal ultrasound and intravenous pyelogram (IVP).
    - Renal biopsy.

COMMON MEDICAL TREATMENTS FOR GENITOURINARY DISORDERS

• Interventions Include:
    - Urinary diversion procedures.
    - Use of Foley catheters, ureteral stents, nephrostomy and suprapubic tubes.
    - Bladder augmentation.
    - Dialysis methods (both hemodialysis and peritoneal).

COMMON MEDICATION CLASSES FOR GENITOURINARY DISORDERS

• Medication Types:
    - Antibiotics.
    - Anticholinergics.
    - Desmopressin (DDAVP).
    - Diuretics.
    - Corticosteroids.
    - ACE inhibitors and other antihypertensives.
    - Imipramine (a tricyclic antidepressant for enuresis).
    - Immunosuppressants (post-renal transplants).
    - Albumin (IV).

COLLECTING URINE SPECIMENS IN CHILDREN

• Methods of Collection Based on Age:
    - Suprapubic aspiration.
    - Urinary catheterization.
    - Urine bag methods.
    - Clean catch procedures.

STRUCTURAL DISORDERS

• Examples of Structural Disorders:
    - Hypospadias and epispadias.
    - Obstructive uropathy.
    - Hydronephrosis.
    - Vesicoureteral reflux.

HYPOSPADIAS/EPISPADIAS

• Hypospadias:
    - Defect where urethral opening is located on the ventral side of the penis.

• Epispadias:
    - Defect where urethral opening is on the dorsal surface of the penis.

COMMON SITES OF OBSTRUCTIVE UROPATHY

• Possible Obstruction Locations:
    - Ureteropelvic junction (from pelvis to ureter).
    - Ureterovesical junction (from lower ureter to bladder).
    - Ureterocele (ureter swelling into bladder).
    - Posterior urethral valves (tissue flaps in proximal urethra; males only).

HYDRONEPHROSIS

• Definition:
    - Dilation of the renal pelvis and calyces due to obstruction.

• Causes and Complications:
    - Multiple causes exist; potential complications include renal insufficiency, hypertension, and renal failure.

ACQUIRED/FUNCTIONAL DISORDERS

• Common Disorders Include:
    - Urinary tract infections (UTI).
    - Enuresis.
    - Nephrotic syndrome.
    - Acute glomerulonephritis.
    - Hemolytic uremic syndrome.
    - Renal failure (both acute and chronic).

URINARY TRACT INFECTION (UTI)

• Definition:
    - Infection of the urinary tract, commonly affecting the bladder; more prevalent in females.

• Signs and Symptoms:
    - Fever, nausea/vomiting, chills, abdominal pain, urinary frequency/urgency.
    - Enuresis may occur in previously continent children.

DEFINITIONS RELATED TO ENURESIS

• Enuresis:
    - Urinary incontinence in a child who has never achieved voluntary control.

• Primary Enuresis:
    - No prior bladder control.

• Secondary Enuresis:
    - Loss of bladder control after maintaining it for at least 3 to 6 consecutive months.

• Types of Enuresis:
    - Diurnal enuresis: daytime loss.
    - Nocturnal enuresis: nighttime bedwetting.

NEPHROTIC SYNDROME

• Mechanism:
    - Characterized by abnormal protein loss (albumin) in urine; results from increased glomerular membrane permeability.

• Effects:
    - Hypoalbuminemia causes osmotic pressure changes; fluid shifts into tissues.

• Treatment:
    - Corticosteroids, IV albumin, long-term therapy for remission.

ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS (APSGN)

• Definition:
    - Injury to glomeruli due to immune processes, often following infection.

• Symptoms:
    - Fever, lethargy, headache, decreased urine output (UOP), abdominal pain, vomiting, anorexia.

HEMOLYTIC UREMIC SYNDROME (HUS)

• Characteristics:
    - Usually preceded by diarrheal illness (including hemorrhagic colitis).
    - Damage due to microthrombotic events in kidneys.

• Classic Features:
    - Hemolytic anemia, thrombocytopenia, acute renal failure.

RENAL FAILURE

• Definition:
    - Inability of kidneys to concentrate urine, conserve electrolytes, or excrete waste.

• Types:
    - Acute renal failure (may progress to chronic).
    - Chronic (end-stage renal disease, ESRD).

• Treatment Options:
    - Dialysis or kidney transplantation.

NURSING GOALS FOR CHILDREN WITH ESRD

• Nursing Goals Include:
    - Promoting growth and development.
    - Waste removal and fluid balance via dialysis.
    - Minimizing complications through adequate fluid/nutrition.
    - Supporting psychosocial well-being of the child and family.

RESTORING FLUID AND ELECTROLYTE BALANCE

• Monitoring:
    - Frequent vital signs checks, including urine specific gravity.
    - Ensure diet supports growth and maintenance.
    - Maintain intake/output records.
    - Administer diuretics as ordered.
    - Watch for signs of hyperkalemia and hypocalcemia.
    - Transfuse packed red blood cells if indicated.
    - Dialysis may be necessary.

DIALYSIS METHODS

• Peritoneal Dialysis:
    - A catheter is placed and tunneled under the skin into the peritoneal cavity for solution infusion and drainage.

• Hemodialysis:
    - Involves blood being passed through a machine for filtration.

FEMALE REPRODUCTIVE ORGAN DISORDERS

• Labial Adhesions:
    - Adhesion of labia, common in young girls.

VULVOVAGINITIS

• Causes:
    - Bacterial or yeast overgrowth, chemical irritants (bubble bath, soaps), poor hygiene, tight clothing.

• Assessment Findings:
    - Irritation, discharge, itching, possible signs of UTI.

• Treatment Options:
    - Promote good hygiene; antifungal treatment if indicated; use of probiotics.

MALE REPRODUCTIVE DISORDERS

• Common Disorders Include:
    - Phimosis and paraphimosis.
    - Cryptorchidism.
    - Hydrocele and varicocele.
    - Testicular torsion.
    - Epididymitis and sexually transmitted infections (STIs).

PHIMOSIS AND PARAPHIMOSIS

• Phimosis:
    - Foreskin of the penis cannot be retracted.

• Paraphimosis:
    - Retracted foreskin cannot be returned to its original position.

CIRCUMCISION

• Benefits Include:
    - Decreased incidence of UTIs, STIs, HIV, and penile/cervical cancer.

• Complications:
    - Potential alterations in urinary meatus, excessive foreskin removal, or damage to glans penis.

CRYPTORCHIDISM

• Definition:
    - Undescended testicles; one or both do not descend from abdomen.

• Complications:
    - Risk of sterility and testicular cancer.

• Treatment:
    - Surgical intervention to reposition and anchor the testicle.

HYDROCELE AND VARICOCELE

• Hydrocele:
    - Accumulation of fluid in scrotal sac, typically benign, resolves spontaneously.

• Varicocele:
    - Dilation of veins in the spermatic cord, may lead to reduced sperm count.

TESTICULAR TORSION

• Definition:
    - Abnormal attachment causes spermatic cord twisting; requires urgent surgery.

• Consequences:
    - Ischemia, potential infertility; most common in boys aged 12-18 years.

EPIDIDYMITIS

• Cause:
    - Typically bacterial infection; leads to scrotal pain.

• Management:
    - Eradicate the bacterial infection; untreated cases may result in abscess or infertility.