Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder
fever, abdominal pain, pain withintercourse, painful menstrual cycles and abnormal uterine bleeding
manifestations of Pelvic Inflammatory disease (PID)
fever, irritability, vomiting, failure to thrive or jaundice, dysuria, frequency, hesitancy, urgency and pain
manifestations of UTI in infants
retraction of the phimotic prepuce which causes aconstricting band behind the glans of the penis and results inincarceration if left untreated.
what is Paraphimosis
Paraphimosis and Phimosis
Circumcision maybe used to treat which conditions
nitrites, leukocyte esterase
Urine dipstick will show what if patient has UTI
circumcision
a child with a Hypospadias/Epispadias should not have what done?
yes
can constipation increase the risk to UTI?
yes because it makes a breeding ground for bacteria
can holding pee increase the risk to UTI?
diabetes or sickle cell anemia, UTI, constipation and emotional distress
causes of Enuresis
UTI may result from urinary stasis behind the labia
complication of Labial adhesion
one or both of the testes do not descend
cryptorchidism
prematurity, firstborn child, C-section birth, low birthweight, and hypospadias
risk factor associated with Cryptorchidism
The foreskin is needed for repair.
A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse?
"She can eat whatever she wants on dialysis days."
A nurse is caring for a 12-year-old girl recently diagnosed with end-stage kidney disease. The nurse is discussing dietary restrictions with the girl's mother. Which response indicates a need for further teaching?
Demonstrate love and acceptance at home.
A parent is asking how to help the child deal with the peer ridicule at school in regards to enuresis. What is the best response by the nurse?
A congenital defect resulting in the bladder beingopen and exposed outside of the abdomen may have bladder spasms
Bladder Exstrophy
high fluid intake in the evening, obstructive sleep apnea,sexual abuse, a family history or inappropriate family expectations
Nocturnal enuresis may be due to what?
Most often results from congenital structural defects such as an obstructive uropathy
End Stage Renal Disease in the pediatric population is commonly caused by what?
Caused by infection with bacteria is the most common cause of pain in the scrotum and it rarely occurs before puberty but if it does it may occur as a result of a urethral or bladder infection related to a urogenital anomaly
Epididymitis
Treatment may include scrotal elevation, bed rest, and ice packs to the scrotum. Pharmacotherapy may include antibiotics, pain medications, and nonsteroidal anti-inflammatory drugs (NSAIDs)
Epididymitis is caused by a bacterial infection. Treatment may include what
venous varicosity along the spermatic cord, isoften noted as a swelling of the scrotal sac complicationsinclude low sperm count or reduce sperm motility which canresult in infertility
Varicocele
diarrheal illness
Hemolytic Uremic Syndrome (HUS) is usually preceded by what?
hypertension
Hemolytic Uremic Syndrome (HUS) will affect blood pressure in what way
fluid in the scrotal sac, is usually a benign andself-limiting disorder it is noted early in infancy and oftenspontaneously resolves by one year of age
Hydrocele
toilet training and self esteem
Hypospadias/Epispadias can affect what?
referred for surgical repair
If testes are not descended by six months of age the infant should be
Weighing on the same scale each day
In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care?
two years after breast development starts on average at around 12 to13 years of age
Menstruation begins in most girls about
testicle is abnormally attached to the scrotum andtwisted it requires immediate attention becauseischemia can result if the torsion is left untreatedleading to infertility
Testicular Torsion
White cottage cheese-like discharge
The nurse is caring for a 2-year-old girl with suspected vulvovaginitis. The nurse suspects the cause as Candida albicans based on which finding?
hypertension
The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?
intravenous pyelogram (IVP) voiding cystourethrogram (VCUG) renal ultrasound
The nurse is caring for a child who has been admitted to the acute care facility with manifestations consistent with hydronephrosis. Which tests will confirm the diagnosis? Select all that apply.
The child recently had an ear infection. In the child with acute glomerulonephritis, presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection, such as strep throat, otitis media, tonsillitis, or impetigo.
The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history?
blood pressure 136/84
The nurse is collecting data on a 6-year-old child admitted with acute glomerulonephritis. Which vital sign would the nurse anticipate with this child's diagnosis?
Sleeping too soundly
The nurse recognizes that what would be a likely physiologic cause for a child to have enuresis?
Risk for infection
When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?
a catheter
a child with a Hypospadias/Epispadias will have what after surgery
diuretics but must monitor for hypotension teach patients: eat potassium and monitor weight IV albumin if severe hypoalbuminemia occurs
a treatment for Nephrotic Syndrome
bubbly/frothy urine to show proteinuria hematuria (may be microscopic)
manifestations of Acute Post Strep Glomerulonephritis
Uremia, hypocalcemia, hyperkalemia and metabolic acidosis occurs
manifestations of End Stage Renal Disease
Scrotum will appear swollen with erythema gently palpate the scrotum for a harden and tender epididymis and check for inguinal lymph nodes that are enlarged
manifestations of Epididymitis
Urinalysis may be positive for bacteria and white blood cells The culture of the urethral discharge may be positive for sexuallytransmitted infection such as gonorrhea or chlamydi
diagnosis of Epididymitis
proteinuria (bubbly/frothy)
hallmark manifestation of Nephrotic Syndrome
relieve abdomen or flank pain
how to relieve pain associated pain in pediatric patient with UTI
sterility and an increase risk for testicular cancer in adolescence and young adulthood
if Cryptorchidism is left untreated what happens
YES immediately because this is a medical emergency
is surgery necessary for Testicular Torsion
May be from an acquired problem such as glomerulonephritis orfollowing an infectious process such as pyelonephritis or HUS
other causes of End Stage Renal Disease
Rest in bed with scrotum elevated using ice packs and administering NSAIDs Administer antibiotic
treatment for Epididymitis
aimed at maintaining fluid balance, correcting hypertension,acidosis and electrolyte abnormalities, and replacing red blood cells
treatment for Hemolytic Uremic Syndrome (HUS)
Administer topical estrogen cream usually once or twice a day until the labia separate then use petroleum jelly daily for one month following separation to prevent reoccurrence of adhesion
treatment of Labial adhesion
Reduction of the prepuce or a small dorsal incision to release the foreskin
treatment of Paraphimosis
IV or oral antibiotics
treatment of Pelvic Inflammatory disease (PID)
topical steroid cream applied BID for a month
treatment of Phimosis
bubble baths, soaps or perfumes found in personal care products
what are chemical factors that may cause Vulvovaginitis
range from 0.9 to 1.5 g of protein per kilogram of weight
what are the Protein requirements for adequate growth
supine
what child position is best for one with Bladder Exstrophy
kidneys become affected from previous strep pharyngitis
what is Acute Post Strep Glomerulonephritis
Undescended testicles occurs when one or both testicles do not to sendinto the scrotal sac
what is Cryptorchidism
Chronic renal failure requiring long-term dialysis or renal transplant
what is End Stage Renal Disease
Continued incontinence of urine past the age of toilet training
what is Enuresis
a urethral defect in which the opening is on the dorsal surface of the penis
what is Epispadias
Defined by three features, hemolytic anemia, thrombocytopenia and acute renal failure
what is Hemolytic Uremic Syndrome (HUS) defined by
a urethral defect in which the opening is on the ventralsurface of the penis rather than at the end of the penis
what is Hypospadias
labial fusion is partial or complete adherence of the labiaminora
what is Labial adhesion
when the urine has too much protein/albumin
what is Nephrotic Syndrome
an inflammation of the upper female genital trackand nearby structures
what is Pelvic Inflammatory disease (PID)
the foreskin of the penis cannot be retracted local irritation or UTI may occur
what is Phimosis
a condition in which urine from the bladder flows back up the ureters and occurs during the bladder contraction with voiding, can occur in one or both ureters
what is Vesicoureteral Reflux
formation of the vulva and vagina occurring as a result of bacterialor yeast overgrowth or from chemical factors
what is Vulvovaginitis
recurrent UTI that may develop into pyelonephritis which can result in scarring possible hypertension
what is a manifestation of Vesicoureteral Reflux
Idiopathic nephrotic syndrome
what is the most commonly occurring type in children and is also called minimal change nephrotic syndrome (MCNS)
boys age 12 to 18
when does Testicular Torsion occur
generally subsides by six if it does not further investigation and treatment may be warranted
when does nocturnal Enuresis usually stop
Sodium and or potassium
which electrolytes may need to be restricted in End Stage Renal Disease
mainly higher than 2
which grades of Vesicoureteral Reflux require surgery
oxybutynin
which medicine is used to manage bladder spasm in Bladder Exstrophy