NUR_372_Genitourinary_System

NURSING CARE OF GENITOURINARY AND REPRODUCTIVE DISORDERS IN CHILDREN

Enuresis and Urinary Tract Infections

  • Enuresis: Uncontrolled or unintentional urination after bladder control is typically expected.

  • Urinary Tract Infection (UTI): An infection affecting any portion of the urinary tract.

Enuresis

  • Diagnostic Criteria:

    • Occurs at least twice a week for a minimum of three months.

    • Child must be at least 5 years old for diagnosis consideration.

    • Rule out organic causes related to genitourinary dysfunction prior to diagnosis.

  • Types:

    • Primary Enuresis: Bed-wetting in a child who has never been dry for extended periods.

    • Secondary Enuresis: Bed-wetting in a child who previously had bladder control.

Expected Findings in Enuresis

  • Toilet training and voiding behavior history.

  • Chronic illness history (e.g., UTI, diabetes).

  • Family disruptions or emotional stress history.

  • Family history of enuresis.

  • Fluid intake patterns, especially in the evening.

Nursing Care for Enuresis

  • Assess self-esteem and coping strategies of the child.

  • Encourage voiding before bedtime; regulate fluid intake (restrict in the evening).

  • Avoid fruit drinks and caffeinated beverages post-1600 hours.

  • Promote regular sleepwear, avoiding diapers, and use positive reinforcement.

  • Assist child in maintaining a calendar for wet/dry days.

  • Environmental adjustments to facilitate bathroom access at night.

  • Encourage regular bowel movements and change bed linens post-incident.

  • Nighttime waking for voiding and advocacy for prescribed medications.

Medications for Enuresis

  • Desmopressin (DDAVP):

    • Reduces urine volume; can be oral or nasal.

    • Monitor intake and output; restrict fluid intake after dinner.

    • Store nasal spray refrigerated; inform family of potential side effects.

  • Tricyclic Antidepressants (Imipramine):

    • Inhibits urination; need supervision for mood changes.

    • Administer 1 hour before bed with food; monitor for side effects.

  • Anticholinergics (Oxybutynin Chloride):

    • Reduces bladder contractions.

Complications of Enuresis

  • Emotional Issues: Low self-esteem, altered body image, social isolation, and fears.

  • Family support is crucial; involve child and family in management and education.

  • Early intervention may alleviate long-term psychological effects.

Urinary Tract Infections Overview

  • Components:

    • Bacteriuria: Presence of bacteria in urine.

    • Types of UTIs: Asymptomatic vs. symptomatic; febrile UTI+symptomatic with fever, cystitis (bladder inflammation), urethritis (urethra inflammation), pyelonephritis (kidney inflammation), and urosepsis (systemic infection).

Risk Factors for UTIs

  • Urinary stasis, anomalies in urinary tract, constipation, toilet training onset, poor hygiene in uncircumcised males, close proximity of rectum to urethra in females, synthetic underwear, and sexual activity.

Clinical Findings in Infants and Children

  • Infants: Irritability, screaming with urination, poor feeding, increased thirst, foul-smelling urine, fever, diaper rash, pallor, dehydration.

  • Children: Abdominal/back pain, pain on urination, vomiting, nocturia, possible edema, and hypertension.

Nursing Care for UTIs

  • Enhance fluid intake, encourage frequent complete voiding, and prepare for diagnostic tests.

  • Administer mild analgesics for pain; monitor urine output.

Antibiotic Treatment for UTIs

  • Prescribe antibiotics based on urine culture and monitor for allergies.

  • Educate families on completing the full course of antibiotics.

Education for UTI Prevention

  • Teach perineal hygiene, voiding habits, and avoid bubble baths.

  • Promote frequent voiding, and hydration, especially post-intercourse for sexually active adolescents.

Renal Disorders Overview

  • Key types: Acute glomerulonephritis, nephrotic syndrome, hemolytic uremic syndrome, acute renal failure, and chronic renal failure.

Acute Glomerulonephritis

  • Symptoms include oliguria, edema, hypertension, hematuria, and proteinuria; commonly due to post-streptococcal infections in children aged 5-8.

Nursing Care in Glomerulonephritis

  • Home management if stable; monitor input/output, weights, vital signs, and neurological status. Restrict sodium and fluid intake as needed.

Nephrotic Syndrome

  • Defined by proteinuria due to alterations in the glomerular membrane; may be primary, secondary, or congenital. Symptoms include weight gain, edema, and decreased urine output.

Nursing Care for Nephrotic Syndrome

  • Focus on monitoring and managing nutrition, weights, and preventing infections.

  • May require corticosteroids and diuretics.

Hemolytic Uremic Syndrome (HUS)

  • Characterized by acute renal failure, hemolytic anemia, and thrombocytopenia; commonly linked to E. coli infections.

Acute Renal Failure Overview

  • Impaired kidney function leads to waste retention; requires careful monitoring of body functions and potential fluid replacements.

Chronic Renal Failure Overview

  • Begins when kidneys can no longer maintain bodily fluid chemistry; presents with fatigue, growth delays, and various systemic impacts families must manage.

Structural Disorders of the Genitourinary Tract

  • Various defects may be present at birth affecting function; surgery is often needed to correct them and minimize emotional impact.

Post-Operative Nursing Actions

  • Focus on pain management, monitoring for signs of infection, and patient education regarding post-surgery recovery and hygiene.