Nursing Care of the Child with Alteration in Genitourinary Function

After a surgical repair of a hypospadias, a 12 month old child returns to the nursing unit with an intravenous line, a urethral catheter, and a suprapubic catheter in place. Which of the following would the nurse explain to the parents is the primary purpose for the suprapubic catheter? A. To ensure an accurate measurement of urine output. B. To provide an alternative urinary elimination route. C. To provide an entry port for bladder irrigation. D. To allow assessment for blood clots in the urine.

B. To provide an alternative urinary elimination route.

How much does bladder of infant hold? Adult?

Bladder of infant holds 20-50 ml. Adult 700 ml.

What can Vesicoureteral Reflux (VUR) do to the kidneys?

Can cause renal scarring and hydronephrosis.

Children less than __ ______ may be unable to have bladder control due to immature nerve function

Children less than 2 years may be unable to have bladder control due to immature nerve function

A school-age boy is admitted for treatment of a urinary tract infection. Which of the following activities would be best for a diversional activity? A.Putting a puzzle together with his mother. B.Playing a video game with a 4 year old. C.Watching a movie with his sister. D.Playing a card game with another child the same age.

D.Playing a card game with another child the same age.

How is Vesicoureteral Reflux (VUR) diagnosed?

Diagnosed with VCUG

Location of the urethral opening is on the dorsal of the shaft.

Epispadius

Immune complex disease that occurs after a pneumococcal, streptococcal or viral infection. Immune complexes deposit in the glomerular membrane. Decreased filtration

Acute Postinfectious Glomeronephritis

A school age child with acute post streptococcal glomerulonephritis who has a fluid restriction of 1,000 ml/day, which of the following fluids would the nurse consider as most appropriate for the child's condition and effective for preventing excessive thirst? A. Diet cola B. Ice chips C. Lemonade D. Water

B. Ice chips

The urinalysis of a toddler with nephrotic syndrome reveals +4 for protein. The nurse interprets this result as indicating which of the following A. Decreased secretion of aldosterone B. Increased glomerular permeability C. Inhibited tubular reabsorption of sodium and water D. Loss of red blood cells

B. Increased glomerular permeability

The toddler with nephrotic syndrome responds to treatment and is ready to go home. When helping the family plan for home care, which of the following instructions would the nurse include in the teaching? A. Administer pain medication as needed. B. Keep the child away from others with an infection. C. Notify the physician if there is an increase in the child's urine output. D. Administer acetaminophen daily

B. Keep the child away from others with an infection.

Which of the following statements by the mother of a toddler diagnosed with nephrotic syndrome indicates that the mother has understood the nurse's teaching about the disease? A. "My child really likes chips and bologna. I guess we'll have to find something else". B. "We'll have to encourage lots of liquids. Did you say about 4 liters everyday?" C. "We worry about surgery. Do you think we should do direct donation of blood?" D. " We understand the need for antibiotics. I just wish the antibiotics could be given by mouth?"

A. "My child really likes chips and bologna. I guess we'll have to find something else"

Which of the following would not be an appropriate part of a treatment plan for a preschooler hospitalized with acute Hemolytic Uremic Syndrome (HUS)? A. Low protein diet B. Aspirin prn for discomfort C. Neurological Checks D. Fluid restrictions

B. Aspirin prn for discomfort

The mother of a preschooler with nephrotic syndrome asks the nurse what can be done about the child's swollen eyes. Which of the following would the nurse suggest? A. Applying cool compresses to the child's eyes B. Elevating the head of the child's bed C. Applying eye drops every 8 hours D. Limiting the child's television watching

B. Elevating the head of the child's bed

An acute renal disease caused by bacteria, chemicals or viruses. Toxin damaged glomeruli lining swells and occludes with clots.

Hemolytic Uremic Syndrome (HUS)

Location of the urethral opening is on the ventral side of the shaft.

Hypospadius

Infants and Toddlers tend to have what types of symptoms that indicate urinary tract infection?

Infants and Toddlers tend to have non- classic symptoms such as fever, poor feeding and vomiting.

________ less efficient at regulating fluid and electrolyte balance and acid base balance in infants and children.

Kidneys less efficient at regulating fluid and electrolyte balance and acid base balance in infants and children.

What is the treatment for renal failure?

Management- Fluid therapy, diuretics, Diet low in NA, K and Phos. Ace inhibitors, Epogen prevent infection, dialysis, electrolytes

In what age Hemolytic Uremic Syndrome (HUS) most common?

Most common < 5 yrs

What age is Nephrotic Syndrome most common?

Most common between 2 and 7 years.

A clinical state that includes massive proteinuria, hypoalbuminemia, hyperlipidemia and edema. Increased glomerular permeability to plasma protein

Nephrotic Syndrome

What is the nursing management for Acute Postinfectious Glomeronephritis?

Nursing - Daily weights, Intake and Output, Possible fluid restrictions and low salt diet

What is the nursing care for Nephrotic Syndrome?

Nursing care includes administering corticosteroids, low salt diet, possible diuretics and fluid restrictions, skin care, strict I and O

How is Vesicoureteral Reflux (VUR) treated?

Others treated by prophylactic antibiotics, polymer injection, or reconstructive surgery (ureteral reimplantation)

What is post op care for Hypospadius/Epispadius?

Post-op Care - Maintain Stint, double diaper, limit activity, hydration, hourly I and O, anticholenergics for spasms, pain meds.

What happens to RBCs and platelets in patients with Hemolytic Uremic Syndrome (HUS)?

RBCs become damaged and platelets are drawn to the area of damage

When a child has a urinary tract infection what test might be done to rule out structural defect?

Renal Scan or Voiding Cystourethrogram (VCUG)

What are the symptoms of Acute Postinfectious Glomeronephritis?

Symptoms - Edema, anorexia, cola colored urine, oliguria, pale, elevated BP, hematuria, proteinuria. Possible vomiting, HA or abdominal discomfort

What types of things does teaching for UTI include?

Teaching - caffeine, carbonated drinks and bubble bath may irritate bladder mucosa, teach front to back cleaning for girls, increase PO fluids, complete course of antibiotics, void frequently, cotton instead of nylon

What is the treatment for Hemolytic Uremic Syndrome (HUS)?

Tx- dialysis, blood transfusions, fluid restrictions, monitor vs and neuro symptoms

Abnormal retrograde flow of bladder urine into the ureters.

Vesicoureteral Reflux (VUR)

What type of renal failure might HUS, poisoning or obstructive disorders cause?

acute renal failure

What are the symptoms of Hemolytic Uremic Syndrome (HUS)?

anemia, vomiting, renal injury, thrombocytopenia, oliguria, high BUN & creatinine, petechiae and CNS symptoms.

What type of kidney failure mightonic Polycystic Kidney Disease, reflux, congenital anomalies cause?

chronic kidney failure

Do you you lose red blood cells in Nephrotic Syndrome?

no

What is typically the first sign of Nephrotic Syndrome?

periorbital edema, that is often mistaked for an allergy

What are general symptoms of renal failure?

polyuria, oliguria, pallor, dizziness, fatigue, headache nausea, hypertension, edema, hyperkalemia, hyponatremia and hypocalcaemia. Delayed growth.

Can children with Vesicoureteral Reflux (VUR) outgrow the condition?

yes