Transcript Nursing Care of the Child with GU disorders

Nursing Care of the Child with
GU disorders
Radiography and other tests of
urinary system function
Urine
Renal/bla
culture & dder US
sensitivity
VCG
Imaging
studies
Testicular Scout film
US
IVP
Whitaker perfusion
test
Renal bx,
cysto
Physical tests for Gu function
Volume for polyuria, oliguria
Specific gravity
Osmolality
Appearance
Chemistries on urine (√ for blood,
WBCs, bacteria, casts)
Blood tests of renal function
BUN (blood urea nitrogen_
Uric acid
Creatinine
Nursing responsibilities with testing
Responsible for preparation and
collection of urine or blood
Maintains careful intake and output
Recognizes that renal disease can
diminish the glomerular filtration
rate(the amt of plasma from which a
given substance is totally clear in
one minute)
Urinary tract infections
Most common type of bacterial
infections occurring in children
Bacteria passes up the urethra into
the bladder
Most common types of bacteria are
those near the meatus…staph as well
as e.coli
Contributing factors
Those with lower resistance,
particularly those with recurrent
infections
Unusual voiding and bowel habits
may contribute to UTI in children
“forget to go to bathroom”
Symptoms:
Therapeutic management
Eliminate the current infections
Identify contributing factors to
reduce the risk of re-infection
Prevent systemic spread of the
infection
Preserve renal function
FYI
The single most important host
factor influencing the occurrence of
UTI is urinary stasis
What is the chief cause of urinary
stasis?
Vesicoureteral Reflux
Approximately 20% of children that
have UTIs will be found to have
vesicoureteral reflux on xray
What is vesicoureteral reflux?
Treatment for vesicoureteral reflux
Directed toward preventing UTIs
Managed by time or surgery if a
lower grade
Single doses each day of abx as long
as reflux lasts
Urine cultures done q 6 wks up to 3
months to make sure no “silent
infection”
Tests specific to reflux
Kidney ultrasound
VCUG
Renal SPECT
RCG (radionucleaotide cystogram)
Hypospadias/Epispadias
Congential defect with urethral
defect
Meatus on lower aspect
(hypospadias)
Meatus on dorsal aspect (epispadias)
May have a fibrous band that cuases
the penis to curve downward
Treatment for hypospadias
DO NOT circumcise infant; may need
the foreskin for reconstruction
Surgery: reconstructive to reposition the meatus at the tip
Usually done before one year of age
Post-op care:
Glomerular diseases
Acute glomerulonephritis (AGN)
Nephrotic syndrome (MCNS) or
minimal-change nephrotic syndrome
AGN
Immune-complex disease causing
inflammation of glomeruli of kidney
Usual organism is group A betahemolytic strep
Decreased glomerular filtration
Common in children (boys > girls)
Assessment/diagnostic tests:
AGN
Treatment and nursing care:
Bed rest may be recommended
during the acute phase of the
disease
A record of daily weight is the most
useful means for assessing fluid
balance
Nursing diagnosis for the child with
glomerulonephritis
Fluid volume excess r/t to decreased
plasma filtration
Activity intolerance r/t fatigue
Altered patterns of urinary
elimination r/t fluid retention and
impaired filtration
Altered family process r/t child with
chronic disease, hospitalizations
Nursing care specific to the child
with AGN
Allow activities that do not expend
energy
Diet should not have any added salt
Fluid restriction, if prescribed
Monitor weights
Education of the parents
Nephrotic syndrome
Nephrotic syndrome, cont
Treatment of nephrotic syndrome
Varies with degree of severity
Treatment of the underlying cause
Prognosis depends on the cause
Children usually have the “minimal
change syndrome” which responds
well to treatment
Child with nephrotic syndrome
Therapeutic management
Corticosteroids (prednisone)
Dietary management
Restriction of fluid intake
Prevention of infections
Monitoring for complications:
infections, severe GI upset, ascites,
or respiratory distress
Cryptorchidism
Defined as failure of one or both
testes to descend
Treatment
Objective of treatment
Critical thinking for client
undergoing urinary tract surgery
The Scotts are receiving pre-op instructions
before their son David’s surgery for
reimplantation of the ureters. David is 5 years
old. In addition to discussion of post-op pain,
tubes and dressings, the most significant other
topic would be which of the following?
– A. Need to reassure David his genitals are intact and
will function normally when the c atheters are removed
– B. Important of monitoring the urine drainage from
stents and urethral catheter
– C. Need to assess the surgical site for bleeding or
excessive drainage
– D. The home care regimen that can be anticipated on
David’s discharge from the hospital