Alterations in Genitourinary Function

STIs (2)

-in children <10 consider sexual abuse -adolescents are at-risk related to inexperience and lack of knowledge about STIs

types of enuresis (4)

-nocturnal: happens at night -diurnal: happens during day; associated with maturational delay, sleep disorders, reduced bladder capacity, overactive bladder -primary: never had a dry night -secondary: reliable dry for at least 6 months begins bedwetting; associated with stress, infections, and sleep disorders, DM, constipation

HUS clinical manifestations (14)

-pallor -bruising -hematuria -proteinuria -oliguria -irritability -fever -abdominal pain -anorexia -vomiting -diarrhea -HTN -uremia -hyperkalemia

chronic renal failure clinical manifestations (9)

-pallor -nausea -anemia (tachycardia, tachypnea) -anorexia -HTN -fractures -growth delay -decreased ability to concentrate -may have oliguria or polyuria

types of acute renal failure (3)

-prerenal -intrarenal or primary -postrenal

chronic renal failure nursing care (5)

-promote F&E balance -promote growth & development -meet nutritional needs -maintain fluid restriction -dialysis

testicular torsion clinical manifestations (4)

-severe pain and erythema in the scrotum -N/V -abdominal pain -scrotal swelling

chronic renal failure treatment (2)

-slow progression, prevent complications, promote growth and development -once ESRD develops: dialysis and/or renal transplant

nephrotic syndrome clinical manifestations (9)

-snug fit clothing or shoes -pallor -HTN -irritability -anorexia -hematuria -decreased UO -malaise -weight gain

polycystic kidney disease treatment (3)

-supportive therapy -dialysis -renal transplant

two examples of obstructive uropathy

-ureteropelvic junction obstruction -posterior urethral valves

obstructive uropathy nursing care (2)

-urethral catheter placement and management -monitor for S/S of infection

things that increase risk of UTI (7)

-urinary stasis: neurogenic bladder -infrequent voiding -poor hygiene and inadequate cleaning after bowel movements -uncircumcised males -constipation -sexual activity in adolescent females -vesicoureteral reflux

What does prune-belly syndrome cause? (5)

-urinary tract anomalies -pulmonary hypoplasia -CV defects -GI defects -MSK defects

When is surgical correction of cryptorchidism indicated?

if the testes have not descended by 6 months of age

cryptorchidism majority

in majority of cases, testes spontaneously descend by 3 months of age

nephrotic syndrome patho

increased glomerular permeability -> albumin excreted in the urine (proteinuria) -> decreased oncotic pressure (hypoalbuminemia, hypoproteinemia) -> edema

pyelonephritis

infection of the ureters, renal pelvis, renal parenchyma

cystitis

infection of the urethra or bladder

acute post-infectious glomerulonephritis patho

inflammation of the glomeruli that typically follows group A strep infection (10-21 days after strep infection) -> glomeruli damage -> decreased GFR and increased vascular permeability -> retention of sodium, water, waste

What is testicular torsion?

medical emergency in which the testis suddenly rotates on its spermatic cord, cutting off blood supply leading to vascular engorgement and ischemia

vesicoureteral reflux nursing care

monitor for S/S of a UTI

What is an inguinal hernia?

painless inguinal or scrotal swelling of variable size that occurs when abdominal tissue extends into the inguinal canal

cryptorchidism clinical manifestations

palpation of the scrotum fails to reveal testes

inguinal hernia clinical manifestation

parents may report an intermittent bulge in the groin or swelling in the scrotum

genetic disorder

polycystic kidney disease

hypospadias/epispadias nursing care

prevent infection and monitor for urethral obstruction following surgery

polycystic kidney disease patho

progressive disease, over time cysts become larger and fibrosis occurs -> the cysts replace the kidney's mass -> reduced kidney function over time -> chronic renal failure

bladder exstrophy nursing care

protect the exposed bladder and prevent infection

testicular torsion nursing management

recognize S/S and necessity of emergency care

What is enuresis?

repeated involuntary voiding by a child who has reached an age at which bladder control is expected, usually about 5-6

prerenal patho and causes (4)

results from decreased perfusion to an otherwise healthy kidney -shock -sepsis -hypovolemia -complication of cardiac surgery

postrenal patho and causes (1)

results from something below the kidney -urologic anatomic anomalies

intrarenal or primary patho and causes (3)

results from something within the kidney -hemolytic uremic syndrome -acute glomerulonephritis -nephrotoxic medications

What is vesicoureteral reflux?

retrograde flow of urine from the bladder into the ureters

HUS nursing care

same as acute post-infectious glomerulonephritis + monitor LOC, assess for signs of bleeding, administer transfusions as ordered

acute post-infectious glomerulonephritis nursing care

same as nephrotic syndrome + monitor BP

What does obstructive uropathy refer to?

structural or functional abnormalities of the urinary system that interfere with urine flow and result in urine backflow into the kidneys

acute renal failure (acute kidney injury)

sudden loss of adequate renal function

inguinal hernia treatment

surgical correction is required to avoid incarceration

testicular torsion treatment

surgical emergency

What is epispadias?

the urethral canal is open on the dorsal surface of the penis

What is hypospadias?

the urethral canal is open on the ventral surface of the penis

When do testicular torsion symptoms start?

typically start while the child is sleeping but they can occur after trauma, sexual activity, or exercise

cryptorchidism

undescended testes

Toilet training regression is commonly seen in what?

urinary tract infections

Which structural defect has an increased risk for infection?

vesicoureteral reflux

paraphimosis

when the foreskin cannot be returned to its normal position, MEDICAL EMERGENCY

cystitis clinical manifestations (5)

-fever -urgency -dysuria -urinary frequency -foul-smelling urine

enuresis treatment approaches (6)

-fluid restriction -bladder exercises (at least 6 months) -timed voiding -enuresis alarms (children over 7, takes 3-4 months for success) -reward system -medications (imipramine, desmopressin, oxybutynin)

What does chronic renal failure result in? (5)

-fluid, electrolyte, acid/base imbalances -osteodystrophy -growth delay -anemia -HTN

pyelonephritis clinical manifestations (6)

-high fever -chills -abdominal pain -N/V -flank pain -dehydration

acute renal failure clinical manifestations (9)

-N/V -edema -gross hematuria -oliguria -HTN -pallor -lethargy -headache -fatigue

acute post-infectious glomerulonephritis clinical manifestations (9)

-TEA COLORED URINE -often asymptomatic -flank or mid-abdominal pain -irritability -malaise -fever -edema -HTN -oliguria

nephrotic syndrome nursing care (5)

-administer meds as ordered -carefully monitor intake and output -prevent infection -prevent skin breakdown -promote rest

factors that increase risk of STI (4)

-avoidance of protective barriers -multiple partners -frequent intercourse -failing to seek treatment until symptoms have advanced

acute post-infectious glomerulonephritis treatment (4)

-bed rest -sodium restriction -diuretics -anti-hypertensives

types of urinary system structural defects (5)

-bladder exstrophy -hypospadias and epispadias -obstructive uropathy -vesicoureteral reflux -prune-belly syndrome

pelvic inflammatory disease (2)

-can occur in females if an STI is left untreated -can lead to infertility, ectopic pregnancy, and chronic pelvic pain

What is chronic renal failure (chronic kidney disease) due to? (5)

-developmental abnormalities of the kidney or urinary tract -obstructive uropathy -severe reflux -hemolytic uremic syndrome -glomerulonephritis

HUS treatment (4)

-dialysis -nutritional therapy -PRBC transfusion -platelet transfusion

diurnal and nocturnal enuresis clinical manifestations

-diurnal: frequency, urgency, dribbling, involuntary loss of urine -nocturnal: bedwetting

What is nephrotic syndrome characterized by? (6)

-edema -massive proteinuria -hypoalbuminemia -hypoproteinemia -hyperlipidemia -altered immunity

UTI nursing care (2)

-education (p. 1052) -administer antibiotics and antipyretics as ordered

polycystic kidney disease newborns

60% of newborns with this die from pulmonary hypoplasia due to oligohydramnios secondary to severe intrauterine kidney disease

most common cause of UTIs

E. coli

acute post-infectious glomerulonephritis acronym

HADSTREP -Hypertension -Acute post-infectious glomerulonephritis -Decreased GFR -Swelling -Tea colored urine -Recent strep -Elevated BUN and creatinine -Proteinuria

UTI treatment

antibiotic therapy

What does obstructive uropathy often result in?

hydronephrosis

hemolytic uremic syndrome (HUS) patho

caused by E. coli toxins that attach to the glomeruli, collecting ducts, and distal tubules -> damage of the glomerular arterioles -> swelling of the glomeruli -> inflammatory response -> glomeruli occlusion with platelets and fibrin -> damaged RBCs -> hemolytic anemia -> platelet clusters -> thrombocytopenia -> decreased GFR -> acute renal failure

When is circumcision contraindicated and why?

contraindicated in hypospadias and epispadias because the foreskin can be used as a source of tissue for repair of the defect

nephrotic syndrome treatment

corticosteroids

obstructive uropathy clinical manifestations

depends on the location and severity of the abnormality

acute renal failure treatment

depends on underlying cause, dialysis

What does gradual loss of kidney function lead to?

end stage renal disease (ESRD)

What is bladder exstrophy?

extrusion of the bladder wall through the abdominal wall that requires surgical intervention

What is prune-belly syndrome?

failure of the abdominal musculature to develop

hydrocele

fluid-filled mass in the scrotum

phimosis

foreskin cannot be retracted (normal finding in uncircumcised infant)

HUS triad

hemolytic anemia, thrombocytopenia, acute renal failure

most common cause of ARF in young children

hemolytic uremic syndrome

What is incarceration?

hernia cannot be reduced and circulation to trapped tissue is impaired - MEDICAL EMERGENCY