Transcript Nursing Care of the Child with GU disorders

Nursing Care of the Child with
GU disorders
Revised, Fall 2010
Enuresis Multitreatment
approach
Fluid restriction
Bladder exercises
Timed voiding
Enuresis alarms
Reward system
Medications
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
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”
Diagnostics: VCUG
External
Defects
Cryptorchidism
Hypo/
Epispadias
Bladder
Extrophy
Bladder Exstrophy
Exstrophy of the Bladder, cont.
Treatment: surgical reconstruction done
1st 24-48 after birth
Goals:
– Bladder/abd wall closure
– Preserve urinary function
– Create normal appearing
genitalia
-improvement of sexual function
Nursing care, cont.
Control bladder spasms
Control pain
Increase fluid intake
Do not allow to play on straddle toys
Prevent infection (no bathing or swimming
until stents removed
Call dr if: temp >101; anorexia, pus or
bleeding from stent, cloudy or foul
smelling urine
Etiology and Pathophysiology
Hypospadias:occurs from incomplete
development of urethra in utero
– Defect ranges from mild to severe
– Undescended testes may also be present
– Might interfere with fertility in the mature male
if not corrected
Epispadias: rare and often associated
with extrophy of bladder
Epispadias
– Congenital urethral defect in which the
uretheral opening is on the upper aspect
of the penis and not on the end
Assessment
Usually discovered during
Newborn Physical Assessment
Ask yourself?
Why would the nurse question an
order to prepare the infant for a
circumcision?
The reason for surgery at
About 1 year of age is
Because:
a.Children will experience less pain
b.Chordee may be reabsorbed
c.The child has not developed body image and
castration anxiety
d. The repair is easier before toilet training
A double diapering technique protects the urinary stent
after surgery. The inner diaper collects stool and the
outer diaper collects urine.
Cryptorchidism
Defined as failure of one or both
testes to descend
Treatment
Objective of treatment
Therapeutic interventions for
undescended testes
Surgery: Orchiopexy done via
laproscopy (around 1 yr of age)
Post-op nursing care: minimal
activity for few days, allow to
express fears about castration,
mutilation by playng with puppets or
dolls
Why is it important that the
Testes are in the scrotal sac?
Answer
The higher temperatures in the
abdomen than in the scrotum results
in morphologic changes to the
testes-mainly concerned with lower
sperm counts at sexual maturity
Assessment on NB exam
Glomerular diseases
Nephrotic syndrome (MCNS) or
minimal-change nephrotic syndrome
Acute glomerulonephritis (AGN)
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:
What’s really happening in
AGN?
Decreased glomerular filtration leads to
inc. Na and H2O
Protein molecules filter thru damaged
glomeruli
Damage leads to hematuria
High B/P; heart failure may ensue
Phases: edematous (4-10 days);
Diuresis phase
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
Contrast of normal gloumerular activity with
changes seen in Nephrotic Syndrome
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
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