Nursing Care of the Child with Nursing Care of the Child with GU disordersGU disorders

External Defects in the Urinary External Defects in the Urinary SystemSystem

Extrophy of the bladderExtrophy of the bladder

Hypospadias vs epispadiusHypospadias vs epispadius

CryptorchidismCryptorchidism

Extrophy of the bladderExtrophy of the bladderPosterior bladder wall Posterior bladder wall extrudes through the extrudes through the lower abd wall.lower abd wall.

Failure of the abd to Failure of the abd to closeclose

Pre-op focus of nsg Pre-op focus of nsg carecare– Prevent traumaPrevent trauma– Prevent infection of Prevent infection of

exposedexposedbladderbladder

Post-operative care with surgical Post-operative care with surgical care of extrophy of bladdercare of extrophy of bladder

Care of the surgical Care of the surgical site with meticulous site with meticulous wound carewound care

Positioning: Positioning: immobilization and immobilization and avoidance of avoidance of abduction of legsabduction of legs

Neurovascular Neurovascular assessment of lower assessment of lower extremitiesextremities

Monitoring renal Monitoring renal function and function and obstruction of tubesobstruction of tubes

Promoting comfortPromoting comfort

Discharge teachingDischarge teaching

Hypospadias vs EpispadiasHypospadias vs Epispadias

HypospadiasHypospadias– Congenital urethral Congenital urethral

defectdefect– Uretheral opening Uretheral opening

on VENTRAL (lower) on VENTRAL (lower)

aspect of the penisaspect of the penis

EpispadiasEpispadias– Congenital urethral Congenital urethral

defectdefect– Urethral opening is Urethral opening is

on the DORSAL on the DORSAL aspect of the penisaspect of the penis

Treatment for hypospadiasTreatment for hypospadias

DO NOT circumcise infant; may need DO NOT circumcise infant; may need the foreskin for reconstructionthe foreskin for reconstruction

Surgery: reconstructive to re-position Surgery: reconstructive to re-position the meatus at the tipthe meatus at the tip

Usually done before one year of ageUsually done before one year of age

Post-op care:Post-op care:

Post-op managementPost-op managementCare of the catheter (may be foley, Care of the catheter (may be foley, suprapubic or urethral stent.suprapubic or urethral stent.Use double diaperingUse double diaperingManagement of bladder spasmsManagement of bladder spasmsProphylactic abxProphylactic abxNo bath until stent removedNo bath until stent removedIncrease fluid intakeIncrease fluid intakeNo play on straddle toysNo play on straddle toysCall physician for temp > 101ºCall physician for temp > 101º

CryptorchidismCryptorchidism

Therapeutic interventions for Therapeutic interventions for cryptorchidismcryptorchidism

Orchiopexy done via laproscopyOrchiopexy done via laproscopy

Nursing care post-op:Nursing care post-op:– Minimal activity for few daysMinimal activity for few days– Allow opportunity to express fears about Allow opportunity to express fears about

mutilation or castrationmutilation or castration

Critical thinking for client Critical thinking for client undergoing urinary tract surgeryundergoing urinary tract surgery

David is 5 years old and scheduled for ureter David is 5 years old and scheduled for ureter reimplantation surgery. In addition to discussion of reimplantation surgery. In addition to discussion of post-op pain, tubes and dressings, the most post-op pain, tubes and dressings, the most significant other topic would be which of the significant other topic would be which of the following?following?– A. Need to reassure David his genitals are intact A. Need to reassure David his genitals are intact

and will function normally when the catheters are and will function normally when the catheters are removedremoved

– B. Importance of monitoring the urine drainage B. Importance of monitoring the urine drainage from stents and urethral catheterfrom stents and urethral catheter

– C. The need to assess the surgical site for C. The need to assess the surgical site for bleeding or excessive drainagebleeding or excessive drainage

– D. The home care regimen that can be D. The home care regimen that can be anticipated when David is dischargedanticipated when David is discharged

Obstructive UropathyObstructive Uropathy

Stenosis of uteropelvic valveStenosis of uteropelvic valve

Stenosis of posterior urethral valveStenosis of posterior urethral valve

Stenosis of the uterovesicular Stenosis of the uterovesicular junction otherwise known as junction otherwise known as “vesicoureteral reflux”“vesicoureteral reflux”

Hydronephrosis the main problem Hydronephrosis the main problem with reflux of urinewith reflux of urine

What is vesicoureteral reflux?What is vesicoureteral reflux?

Therapeutic managementTherapeutic management

Corticosteroids (prednisone)Corticosteroids (prednisone)

Dietary managementDietary management

Restriction of fluid intakeRestriction of fluid intake

Prevention of infectionsPrevention of infections

Monitoring for complications: Monitoring for complications: infections, severe GI upset, ascites, infections, severe GI upset, ascites, or respiratory distressor respiratory distress

Physiologic changes r/t Physiologic changes r/t hydronephrosishydronephrosis

Cessation of glomerular filtration and Cessation of glomerular filtration and cell deathcell death

Metabolic acidosis resultMetabolic acidosis result

Impairment of kidney’s ability to Impairment of kidney’s ability to concentrate urineconcentrate urine

Obstruction results in stasis and Obstruction results in stasis and infectioninfection

Can lead to chronic renal failureCan lead to chronic renal failure

Diagnostic tests for renal/bladder Diagnostic tests for renal/bladder functionfunction

Urine culture and Urine culture and sensitivity: done sensitivity: done every 2-3 monthsevery 2-3 months

VCG: voiding VCG: voiding cystourethrogramcystourethrogram

Renal/bladder Renal/bladder ultrasoundultrasound

IVPIVP

Renal biopsyRenal biopsy

Cystoscopy Cystoscopy

Nursing responsibilities with testingNursing responsibilities with testing

Responsible for preparation and Responsible for preparation and collection of urine or bloodcollection of urine or blood

Maintains careful intake and outputMaintains careful intake and output

Recognizes that renal disease can Recognizes that renal disease can diminish the glomerular filtration diminish the glomerular filtration raterate(the amt of plasma from which a (the amt of plasma from which a given substance is totally clear in given substance is totally clear in one minute)one minute)

Treatment for vesicoureteral refluxTreatment for vesicoureteral reflux

Directed toward preventing UTIsDirected toward preventing UTIs

Managed by time or surgery if a Managed by time or surgery if a lower gradelower grade

Single doses each day of abx as long Single doses each day of abx as long as reflux lastsas reflux lasts

Urine cultures done q 6 wks up to 3 Urine cultures done q 6 wks up to 3 months to make sure no “silent months to make sure no “silent infection”infection”

Treatment and nsg care for Treatment and nsg care for obstructive uropathyobstructive uropathy

Drug therapyDrug therapy– PenicillinPenicillin– CephalosporinsCephalosporins– Urinary antiseptics Urinary antiseptics

(Furadantin)(Furadantin)

Follow up VCG after Follow up VCG after few months post opfew months post op

Surgery:Surgery:– Repair of anatomical Repair of anatomical

anomalies/pyeloplastyanomalies/pyeloplasty

Nsg care:Nsg care:– Teach prevention of UTITeach prevention of UTI– Teach imp of taking all Teach imp of taking all

abxabx– Monitor urinary Monitor urinary

drainage from cathetersdrainage from catheters– Assess for painAssess for pain– Teach parents how to Teach parents how to

change dressings, change dressings, double-diaperdouble-diaper

– s/s obstruction or s/s obstruction or infectioninfection

Differences between adult s/s UTI Differences between adult s/s UTI and pediatric patientand pediatric patient

In children:In children:– Unexplained feverUnexplained fever– Failure to thriveFailure to thrive– VomitingVomiting– Diarrhea Diarrhea

Urinary tract infectionsUrinary tract infections

Most common type of bacterial Most common type of bacterial infections occurring in childreninfections occurring in children

Bacteria passes up the urethra into Bacteria passes up the urethra into the bladderthe bladder

Most common types of bacteria are Most common types of bacteria are those near the meatus…staph as those near the meatus…staph as well as e.coliwell as e.coli

Contributing factorsContributing factors

Those with lower resistance, Those with lower resistance, particularly those with recurrent particularly those with recurrent infectionsinfections

Unusual voiding and bowel habits Unusual voiding and bowel habits may contribute to UTI in childrenmay contribute to UTI in children

““forget to go to bathroom”forget to go to bathroom”

Symptoms:Symptoms:

Therapeutic managementTherapeutic management

Eliminate the current infectionsEliminate the current infections

Identify contributing factors to Identify contributing factors to reduce the risk of re-infectionreduce the risk of re-infection

Prevent systemic spread of the Prevent systemic spread of the infectioninfection

Preserve renal functionPreserve renal function

FYIFYI

The single most important host The single most important host factor influencing the occurrence of factor influencing the occurrence of UTI is urinary stasisUTI is urinary stasis

What is the chief cause of urinary What is the chief cause of urinary stasis?stasis?

Nephrotic syndromeNephrotic syndrome

Nephrotic syndrome, contNephrotic syndrome, cont

Child with nephrotic syndromeChild with nephrotic syndrome

Treatment of nephrotic syndromeTreatment of nephrotic syndrome

Varies with degree of severityVaries with degree of severity

Treatment of the underlying causeTreatment of the underlying cause

Prognosis depends on the causePrognosis depends on the cause

Children usually have the “minimal Children usually have the “minimal change syndrome” which responds change syndrome” which responds well to treatmentwell to treatment

Nursing interventions to manage Nursing interventions to manage nephrotic syndromenephrotic syndrome

Administer corticosteroids Administer corticosteroids (prednisone) as ordered(prednisone) as ordered

Dietary managementDietary management

Restriction of fluid intakeRestriction of fluid intake

Prevention of infectionsPrevention of infections

Monitoring for complications: Monitoring for complications: infections, severe GI upset, ascites, infections, severe GI upset, ascites, or respiratory distressor respiratory distress

Glomerular diseasesGlomerular diseases

Acute glomerulonephritis (AGN)Acute glomerulonephritis (AGN)

Nephrotic syndrome (MCNS) or Nephrotic syndrome (MCNS) or minimal-change nephrotic syndromeminimal-change nephrotic syndrome

AGNAGN

Immune-complex disease causing Immune-complex disease causing inflammation of glomeruli of kidneyinflammation of glomeruli of kidney

Usual organism is group A beta-Usual organism is group A beta-hemolytic strephemolytic strep

Decreased glomerular filtrationDecreased glomerular filtration

Common in children (boys > girls)Common in children (boys > girls)

Assessment/diagnostic tests:Assessment/diagnostic tests:

AGNAGNTreatment and nursing care:Treatment and nursing care:

Bed rest may be recommended during Bed rest may be recommended during acute phaseacute phase

Record of daily weight is the most useful Record of daily weight is the most useful means for assessing fluidmeans for assessing fluid

balancebalance

                                                             

Nursing diagnosis for the child with Nursing diagnosis for the child with glomerulonephritisglomerulonephritis

Fluid volume excess r/t to… Fluid volume excess r/t to…

Activity intolerance r/t….Activity intolerance r/t….

Altered patterns of urinary Altered patterns of urinary elimination r/t …elimination r/t …

Altered family process r/t…Altered family process r/t…

Nursing care specific to the child Nursing care specific to the child with AGNwith AGN

Allow activities that do not expend Allow activities that do not expend energyenergy

Diet should not have any added saltDiet should not have any added salt

Fluid restriction, if prescribedFluid restriction, if prescribed

Monitor weightsMonitor weights

Education of the parentsEducation of the parents