Chp 21

TEACHING GUIDELINES Hygiene in the Uncircumcised Male

. The foreskin does not normally retract in the newbor boy , so do not force it to do so . Change the diaper frequently and wash the penis daily with water and mild soap . . When the infant is older and the foreskin easily retracts , gently the glans with water and mild soap once a week . retract the foreskin and clean around Try the area prior to replacing the foreskin. Always replace the foreskin after attraction. Teach the preschool age boy to retract the foreskin and clean the penis during each bath or shower.

What is the expected your an output in the infant and child?

0.5 to 2 mL per kilogram per hour; the average one-year-old avoids about 400 to 500 mL a day off. Infants and toddlers may void as often as nine or ten times per day.

Bladder capacity in a newborn bladder capacity ; one year of age

30 mL; 270 mL

Birth to 2 years old 2 to 5 years old 5 to 10 years old 10 to 16 years old catheter sizes:

6 French 6 to 8 French • 8 to 10 French • 10 to 12 French

This is a condition in which immune processes injure the glomeruli due to inflammation that causes altered, glomerular structure and function both kidneys. It occurs following infection.

Acute poststreptococcal glomerulonephritis

Nursing management for labial adhesion

Administer topical estrogen cream as prescribed once or twice daily. Teach the parents to continue the cream application until the labia separate. Encourage use of petroleum jelly daily for one month following leave y'all separation to prevent reoccurrence of adhesion.

Calcium channel blocker, nifedipine nursing implications

Administer with food ; avoid grapefruit juice Insoluble shell of extended - release tablet may pass in stool Use caution when administering liquid - filled capsule sublingually or by bite - and - swallow method , as significant hypotension may occur

Diuretics, furosemide and hydrochlorothiazide nursing implications

Administer with food or milk to decrease Gl upset Monitor blood pressure , renal function , and electrolytes ( particularly potassium ) May cause photosensitivity

Corticosteroid, nursing implications

Administer with food to decrease G.I. upset. May mess signs of infection. Do not stop treatment a properly or acute adrenal insufficiency may occur monitor for Cushing syndrome.

Corticosteroids actions/indications

Anti-inflammatory an immuno, suppressive action to induce remission and promote diuresis and nephrotic syndrome. High-dose IV therapy used when nephrotic syndrome is resistant to conventional doses.

Nursing management for pelvic inflammatory disease

Antibiotics, hydration, and analgesics, semi fowler position to promote pelvic drainage, education to prevent reoccurrence

Actions Indications Desmopressin

Antidiuretic hormone effects by causing renal tubule to absorb more water , decreasing volume of urine in children with nocturnal enuresis

Treatment Candida albicans

Antifungal cream or vaginal suppository, prevent by ingesting probiotics, daily and supplementing with a probiotic, such as like to next when taking antibiotics

Nursing management for acute poststreptococcal glomerulonephritis

Antihypertensive, such as labetalol or nifedipine, diuretics, sodium and fluid restrictions, daily weights, input and output, monitor blood pressure

This uses the appendix to create a stoma on the abdominal wall that allows for catheterization of the bladder

Appendicovesicostomy

ESRD Purpose Medication Multivitamin

Augment nutritional status

Why should a child not receive any live vaccines if they have had a kidney transplant?

Because they will be on cortical steroids, and have an immuno suppressed status

This is a piece of stomach or intestine and large bladder capacity

Bladder augmentation

This deformity occurs during the embryonic period of gestation, and leaves the bladder open exposed outside of the abdomen

Bladder exstrophy

Actions / Indications Immunosuppressant drugs ( cyclosporine A [ CyA ] , azathioprine , tacrolimus , mycophenolate )

Cause immune suppression to prevent rejection of renal transplants . CyA and tacrolimus may be used for steroid - dependent nephrotic syndrome

Actions Indications Anticholinergic agents

Cause smooth muscle relaxation of the bladder , used for urinary tract spasms or contractions related to surgical procedure or use of catheters . Control of nocturnal enuresis

What are the most common causes of pelvic inflammatory disease?

Chlamydia, trachomatis, and nessieria gonorrhea

Used Purpose Medication bicitra or sodi bicarbonate tablets

Correction acidosis

What type of medication's may be prescribed for nephrotic syndrome

Cortical steroids, which should be tapered when it is time to stop and diuretics usually furosemide. Watch for hypokalemia. Patient then may be prescribed potassium supplements. In severe hypoalbuminemia albumin may be administered if this is administered furosemide should be given immediately after.

This occurs when one or both testicles do not to sign into the scrotal sac

Cryptochidism

The kidneys, less able to concentrate, urine and reabsorb amino acids, placing the infants and young toddler at increased risk for what

Dehydration during times of fluid loss or decrease fluid intake

daytime loss of urinary control

Diurnal enuresis

Nursing implications of Cytotoxic drugs cyclophosphamide and chlorambucil

Doses may be tapered over time. Monitor for hypertension during infusion. Causes bone marrow suppression. Monitor for signs of infection. Cyclophosphamide administerein the morning. Provide with adequate hydration and have child void frequently during and after infusion to decrease risk of hemorrhagic cystitis. Chlorambucil administer with non-spicy, non-acidic foods; rarely seizures occur.

What diaper method may be used after surgery for hypospadia's and epispadias

Double diapering, which is where the inner diaper collect stool in the outer diaper collects urine. When the child is wet, change the outer diaper when the child has a bowel movement. Change both diapers.

Pain associated with menstruation , usually abdominal cramps ranging from mild to severe

Dysmenorrhea

Nephrotic syndrome, hypoalbuminemia results in a change in osmotic pressure and fluid chips from the bloodstream into the interstitial tissue, which causes

Edema

Promoting grills for eSRD includes

Encourage the child to choose foods that are within the imposed dietary restrictions. Protein requirements for adequate growth range from .9 to 1.5 g of protein per kilogram of weight. Sodium or potassium restrictions may be necessary. Fluid restrictions may need to be enforced. medication, such as erythropoietin growth, hormone and vitamin and mineral supplements to augment nutritional status and promote growth.

This is the most common cause of pain in the scrotum

Epididymitis

This is a urethral defect in which the opening is on the dorsal surface of the penis

Epispadias

Vulvovaginitis Assessment Findings Trichomonas vaginalis

Foul yellow - gray or green vaginal discharge

Educating of the parent after circumcision

Give sponge baths until the circumcision is healed. Teach parents to apply ointment or petroleum jelly if indicated. Instruct the parents to call the physician or NP if any of the following occur: the infant does not urinate within 68 hours after the procedure heavy bleeding occurs there is purulent or serous drainage from the circumcised area. There is redness or swelling of the penile shaft.

Treatment Unhygienic practices

Good hygiene. Sometimes a mild, inflammatory cream is prescribed, assess for signs and symptoms of UTI, which may occur as a complication.

For patients with acute poststreptococcal glomerulonephritis what is typically present in urine

Hematuria and protein

This syndrome is defined by hemolytic, anemia, thrombocytopenia, and acute renal failure

Hemolytic uremic syndrome

Fluid in the scrotal sac

Hydrocele

Nephrotic syndrome, results in what loss in the blood by which lab value an excess of what in the urine

Hypoalbuminemia in the blood; excess loss of protein albumin in the urine protein uria

This is a urethra defect and watch the opening is on the ventral surface of the penis rather than at the end of the penis

Hypospadia's

Postop care for VUR surgical correction.

IV. Fluids should be at 1.5 times maintenance to encourage high urinary output. Monitor output. Urine is typically bloody initially and clears within 2 to 3 days. Administer analgesics, and anti-spasmodic's. Encourage ambulation. Teach parents that prophylactic antibiotics will be given 1 to 2 months after surgery.

What is the most common type of nephrotic syndrome in children?

Idiopathic nephrotic syndrome also called minimal change, nephrotic syndrome

Nursing Implications Anticholinergic

Increase fluid intake ( limit to during the day in the child with nocturnal enuresis ) Avoid use in febrile child

Actions / Indications Imipramine ( tricyclic antidepressant )

Increases the synaptic concentration of serotonin and / or norepinephrine . Treatment of enuresis

Cause of epididymitis

Infection with bacteria

Preventing Pelvic Inflammatory Disease

Insist that sexual partners use condoms . Do not use a vaginal douche routinely , as this may lead to bacterial overgrowth . • Get screened regularly for sexually transmitted infections . • Make sure that each sexual partner also receives antibiotic treatment .

Cytotoxic drugs cyclophosphamide and chlorambucil indications

Interfere with normal function of DNA by alkylation. Used to induce, prolonged remission in nephrotic syndrome.

Vulvovaginitis Assessment Findings Unhygienic practices

Irritation of labia and vaginal opening with bacteria from rectum May have foul brownish - green discharge if infected

Common ways to prevent infection and skin breakdown of bladder exstrophy

Keep the infant in supine position, keep the bladder moist and cover it with a sterile, plastic bag. Change soil diapers immediately to prevent contamination of the bladder with feces. Sponge bath, the infant, rather than immersing him or her in the water to prevent pathogens in the bathwater from entering the bladder. Prevent breakdown of the surrounding abdominal skin by applying protective barrier creams.

This is partial or complete adherence of the labia menorah

Labial adhesion

Children with congenital, urologic malformations are at high risk for which allergy

Latex

Complications of varicocele

Low sperm, count or reduce sperm motility, which can result in infertility

Therapeutic management of hemolytic uremic syndrome

Maintaining fluid balance, correct, in hypertension, acidosis, and electrolyte abnormalities, replenishing, circulating red blood cells, and providing dialysis if needed. Monoclonal antibodies, eculizumab maybe given but note that patients receiving this med all right high risk for meningococcal infection so they should receive the meningococcal vaccine

Treatment for acute poststreptococcal glomerulonephritis is aimed at

Maintaining fluid, volume and managing. Hypertension as there is no specific medical treatment. If there is current infection, antibiotic therapy is necessary.

Nursing management for renal failure

Manage hypertension with antihypertensives like nifedipine or labetalol. restore fluid and electrolyte balance: maintain strict records of intake and output, administer diuretics as ordered. Monitor for hyperkalemia, and hypocalcemia. administer polystyrene sulfonate to decrease potassium levels by exchanging potassium for sodium. Potassium will then be eliminated in the feces. Dialysis if necessary. Educate the family about the plan of care and the need for fluid restriction. Educate about dialysis if relevant.

Vasodilators, hydralazine, minoxidil, nursing implications

May cause fluid retention Hydralazine : administer with food . Monitor heart rate and blood pressure ( closely with intravenous use ) Minoxidil : may be administered without regard to food . May cause dizziness

Albumin, nursing implications

May require a filter depending on brand used Rapid infusion can result in vascular overload Monitor vital signs ; observe for pulmonary edema and cardiac failure

YExcessive menstrual bleeding

Menorrhagia

Trichomonas, vaginalis treatment

Metronet dazzle orally. Sexually transmitted, so can be prevented with the use of condoms.

Bordetella gardnerella treatment

Metronidazole orally

Bleeding between menstrual periods

Metrorrhagia

Abdominal pain , usually habille unilateral , that varies from agen few sharp cramps to several hours of crampy pain

Mittelschmerz

Ace inhibitors nursing implications catopril and enalapril

Monitor blood pressure frequently . May cause cough , hyperkalemia Captopril : administer on empty stomach art vionA Enalapril : administer without regard to food

Nursing implication Immunosuppressant drugs Cause ( cyclosporine A [ CyA ] , azathioprine , tacrolimus , mycophenolate )

Monitor complete blood count , serum creatinine , potassium , and magnesium Monitor blood pressure and observe for signs of infection Blood levels should be drawn prior to morning dose CyA : do not give with grapefruit juice Azathioprine and mycophenolate : give on empty stomach ; do not open capsule or crush tablet Tacrolimus : give on empty stomach ; assess for development of hyperglycemia Relapse of nephrotic syndrome may occur after withdrawal of CyA or tacrolimus therapy

Nursing implication myromonab cd3

Monitor for development of pulmonary edema First - dose effect may cause fever , chills , chest tightness , wheezing , nausea , and vomitingped aninu iliw

Indications hcg

Monitor for signs of precocious puberty if used long term

Imipramine tricyclic anti-depressant, nursing implications

Monitor for urinary retention . May cause decreased appetite

What type of drug should be avoided in children with questionable renal function?

NSAIDs

Indications desmopressin

Nasal spray may cause nasal irritation , nausea , flushing headache Administer at bedtime ; alternate nares . Associated with a high relapse rate

Should parents use petroleum jelly if the plaster Bell is used for circumcision

No, because it can cause the ring to be dislodged.

nighttime bedwetting

Nocturnal enuresis

Therapeutic management for cryptochidism

Orchiopexy is performed to release the spermatic cord, and the testes are then pulled into the scrotum and tacked into place

Retraction of the the phimotic prepuse causes a constricting band behind the glands of the penis, and result in incarceration, if left untreated

Paraphimosis

This is inflammation of the Efird, female, genital, tract and nearby structures, such as the fallopian tubes, ovaries, or peritoneum

Pelvic inflammatory disease

The foreskin of the penis cannot be retracted

Phimosis

Flaps of tissue in the proximal urethra

Posterior urethral valves in males only

After Surgical correction of a urinary obstruction IV fluids, maybe started without added potassium why?

Potassium is withheld from the intravenous fluid until adequate urine output is established postoperatively to avoid the development of hyperkalemia should the kidneys failed to function properly

Actions / Indications Angiotensin - converting enzyme ( ACE ) inhibitors captopril , enalapril )

Potent vasoconstrictor , prevent conversion of angiotensin I to angiotensin II . Used to treat renal causes of hypertension

Lack of menarche within 2 years of reaching Tanner stage 4 breast development or by 16 years of age

Primary amenorrhea

enuresis in the child who has never achieved voluntary bladder control

Primary enuresis

Nursing management for the child with ESRD

Promoting growth, removing waste products and maintain, include balance via dialysis, encouraging, psychosocial, well-being, and supporting and educating the family

Tips for preventing hemolytic, uremic syndrome

Proper handwashing after using the bathroom before eating and after petting farm animals. Use of swim diapers to contain feces for children who are not toilet trained. Teach parents to cook all meats to a temperature of 155 Fahrenheit. Wash all fruits and vegetables. Ensure that drinking water and water use for recreation are treated appropriately. Avoid unpasteurized dairy products and fruit juices including cider.

ESRD Purpose Medication vitamin D and calcium

Purpose Correction of hypocalcemia and hyperphosphatemia

Vulvovaginitis Assessment Findings Candida albicans

Red bumpy perineal rash in infants White cottage - cheese - like discharge Intense itching

Paraphimosis requires what for treatment

Reduction of the pre-Pousse, or a small, dorsal incision to release the foreskin

Encouraging psychosocial will be in an ESRD

Refer children to social worker or counselor as needed for depression or anxiety. Introduce the child to other children with ESRD. Provide referral to websites with forums for children and teens with kidney failure.

Actions / Indications Muromonab CD3

Removal of all CD3 molecules from T - lymphocyte surface so it has inability to act . Used for treatment of acute renal transplant rejection

Nursing management for epididymitis

Rest in bed with the scrotum elevated. Ice packs to the scrotum. NSAIDs or other analgesics administer antibiotics as prescribed.

This occurs when the testis may be brought back into the scrotum, remains for a time, and then retracts back up the inguinal canal.

Retractile testis

Absence of menses for 6 months in the girl who has been menstruating regularly

Secondary amenorrhea

: urinary incontinence in the child who previously demonstrated bladder control over a period of at least 3 to 6 consecutive months

Secondary enuresis

Blood flow through the kidneys is slower or faster in the infants and young toddler compared with the adult

Slower

Complication of crypticchidism

Sterility in an increased risk of testicular cancer

ESRD Purpose medication Growth hormo

Stimulate growth in stature

Treat ESRD Purpose Medication Erythropoietin

Stimulate red blood cell growth

Actions Indications Human chorionic gonadotropin ( hCG

Stimulates production of gonadal steroids to precipitate testicular descent

This is where a sterile needle is inserted into the bladder of a neonate, or Youngin fit through the anterior wall of the abdomen in the urine is aspirated.

Super pubic aspiration

Nursing management for testicular torsion

Surgical correction. Pain medication prior to surgery. Postoperative care.

Urinary diversion

Surgical diversion of ureters to the abdominal wall. Continent diversion uses a piece of intestine to create a bladder that could be catheterize. Non-continent diversion involves a stoma on the abdominal wall that requires use of an ostomy pouch.

Tips to prevent infection with vesicoureteral reflux

Teach the child to empty the bladder completely. Teach the child and parents appropriate perineal hygiene. Teach parents about the antibiotic therapy prescribed since the child will be maintained on a low daily dose to prevent UTI. It should be given at bedtime because of urinary stasis overnight.

A testicle is abnormally attached to the scrotum and twisted

Testicular torsion

How many varicocele present

There will be a mass on one or both sides of the scrotum and bluish discoloration. The spermatic vein may feel wormlike on palpation, and the boy with varicocele may have pain.

Vulvovaginitis Assessment Findings Bordetella Gardnerella

Thin gray vaginal discharge with fishy odor

And hemolytic uremic syndrome, what leads to renal failure

Thrombotic events in the small blood vessels of the glomerulus lead to inclusions of the glomerular, capillary loops and glomerulosclerosis resulting in renal failure

What is prescribed for phimosis?

Topical steroid cream twice a day

Purpose Medication Ferrous sulfate

Treatment of anemia

This is where unilateral hydronephrosis a narrowing of the UPJ occurs. It occurs at the junction of the upper ureter with the renal pelvis of the kidney.

Ureteral pelvic Junction obstruction

Junction of the lower ureter and the bladder; the urinary tract has unilateral hydronephrosis with dilated ureters with narrowing of the UVJ on that side

Ureteral vesicle Junction obstruction

Ureter swells into the bladder

Uretocele

This is a stoma in the abdominal wall to the bladder

Vesicostomy

This is a condition in which urine from the bladder flows back up the ureters

Vesicoureteral reflux

A Venus varicosity along the spermatic cord

Viricocele

This is inflammation of the vulva and vagina

Vulvovaginitis typically as a result of bacterial or yeast, overgrowth or from chemical factors, such as bubble bath, soaps, or perfumes found in personal care products. Poor hygiene. They also contribute to this or tight clothing

Medical management of minimal change nephrotic syndrome includes

You sub, cortical, steroids, intravenous albumin in the edematous child, diuretics and sometimes immuno suppressive therapy, such as cyclophosphamide, cyclosporine, a or mycophenolate Mofetil

Children with nephrotic syndrome, are at increased risk for

thromboembolism