Chapter 43: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is: -performing a suprapubic aspiration. -placing a cotton ball in the underwear to catch urine. -placing an indwelling urinary catheter. -obtaining a clean catch voided urine.

-placing a cotton ball in the underwear to catch urine. Rationale: In the cooperative, toilet-trained child, a clean midstream urine may be used successfully to obtain a "clean catch" voided urine. If a culture is needed, the child may be catheterized, but this is usually avoided if possible. A suprapubic aspiration also may be done to obtain a sterile specimen. In the toilet-trained child, using a cotton ball to collect the urine would not be appropriate.

The nurse is reinforcing teaching with the caregiver of 5-year-old twins regarding urinary tract infections (UTIs). The caregiver is puzzled about why her daughter has had three urinary tract infections but her son has had none. She reports that their diets and fluid intake is similar. Which statement would be accurate for the nurse to tell this mother? "A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily." "Girls tend to urinate less frequently than boys, making them more susceptible to UTI's." "Girls need more vitamin C than boys to keep their urinary tract healthy, so your daughter may be deficient in vitamin C." "It is unlikely that your daughter is practicing good cleaning habits after she voids."

"A girl's urethra is much shorter and straighter than a boy's, so it can be contaminated fairly easily."

The nurse is caring for a pediatric client who is scheduled for the surgical removal of a Wilms tumor. Which is contraindicated in the client's care? -Intravenous fluids -Abdominal palpation -Foley catheter placement -Supine positioning

Abdominal palpation

To prevent further urinary tract infections in a preschooler, what measures would you teach her mother? -Encourage her to be more ambulatory to increase urine output. -Teach her to take frequent tub baths to clean her perineal area. -Suggest she drink less fluid daily to concentrate urine. -Teach her to wipe her perineum front to back after voiding.

-Teach her to wipe her perineum front to back after voiding.

A child is hospitalized with nephrotic syndrome. Which measurement is best for the nurse to determine the child's edema? weight, daily urine output, every shift amount of protein in the urine abdominal circumference

weight, daily Rationale: The classic sign of nephrotic syndrome is edema. It is usually generalized, but may be manifested as ascites or be periorbital depending on the seriousness of the disease. The easiest way to determine edema is by weighing the child. The child should be weighed on the same scale, at the same time daily, and with the same amount of clothing.

The nurse is caring for a child admitted with acute glomerulonephritis. Which clinical manifestation would likely have been noted in the child with this diagnosis? -Loose, dark stools -Tea-colored urine -Strawberry red tongue -Jaundiced skin

-Tea-colored urine Rationale: The presenting symptom in acute glomerulonephritis is grossly bloody urine. The caregiver may describe the urine as tea or cola colored.

The nurse is concerned about the pediatric client's immune system after taking corticosteroids. Which laboratory study is the nurse most correct to assess? red blood count leukocyte count eosinophils basophils

Leukocyte count Rationale: Since the nurse is concerned about the client's immune system. it is most correct to assess the client's WBCs or cells of the immune system called leukocytes.

The nurse is caring for an 8-year-old child hospitalized with nephrotic syndrome. Which nursing intervention would be appropriate for this child? Measure the abdominal girth daily. Weigh the child once a week. Test the urine for ketones twice a day. Administer antipyretics as needed.

Measure the abdominal girth daily Rationale: Measure the child's abdomen daily at the level of umbilicus, and make certain that all staff personnel measure at the same level. Weigh the child at the same time every day on the same scale in the same clothing.

The nurse is collecting data for a child diagnosed with acute glomerulonephritis. What would the nurse likely find in this child's history? The child has a sibling with the same diagnosis. The child had a congenital heart defect. The child recently had an ear infection. The child is being treated for asthma.

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.

Which laboratory test result would be most important for the nurse to assess in a child who is suspected of having a urinary tract infection? urinalysis chemical reagent strip testing urine specific gravity level serum blood urea nitrogen (BUN) level

urinalysis

The nurse is preparing a 7-year-old girl for discharge after treatment for nephrotic syndrome. Which instructions would the nurse include in the discharge teaching plan for the parents? -"Let's meet with the dietitian and plan some meals." -"She must severely restrict her sodium intake." -"She should try to avoid protein." -"Here is some written information from the dietitian."

-"Let's meet with the dietitian and plan some meals." Consultation with a dietitian would be most helpful for meal planning because so many of children's favorite foods are high in sodium. Restricting sodium may not be necessary if the child is not edematous; in addition, the statement does not teach. Protein-rich snacks should be encouraged. The nurse needs to provide the parents with specific instructions, assistance, and resources in addition to simple written instructions

The nurse is caring for a 10-year-old child experiencing nocturnal enuresis with no physiologic cause. The child states, "I am embarrassed and I wish I could stop this right now!" How will the nurse respond? -"You will grow out of this eventually; you just need to be patient. -"There are several things we can do to help you achieve this goal. -"You are not alone. There are almost 5 million people that have enuresis." -"You can wear pull-ups to bed and, since they look like underwear, no one will know."

"There are several things we can do to help you achieve this goal." The child wants to stop this problem immediately, so the nurse's most therapeutic response is to assure the child that enuresis is indeed solvable. For some children, learning about the high prevalence of the problem may provide consolation. However, this may not alleviate the child's embarrassment and it does not address the desire for solutions. Telling the child that he or she will "grow out of this" downplays the embarrassment and does not address the desire to solve the problem. Pull-ups conceal the consequences of enuresis but do not provide a solution.

A newborn is diagnosed with hypospadias and the parents want the newborn to be circumcised. What would be the best response by the nurse? -The foreskin is needed for repair. -Circumcision is usually performed after 1 year of age. -Circumcision with a hypospadias will cause meatal stenosis. -The circumcision may predispose the newborn to renal failure.

-The foreskin is needed for repair. Hypospadias occurs when the meatal opening is on the ventral surface of the penis rather than at the end of the penis. The newborn with this condition is not circucised at birth because the excess skin may be needed to reconstruct the meatus during surgical repair. Once the hypospadias is repaired, a circumcision can be performed as part of the procedure. Hypospadias repair is usually done after the newborn is 1 year or older. Meatal stenosis has to do with the urethral opening diameter, not the placement. Circumcision or hypospadias repair does not affect the functioning of the renal system so neither would predispose the newborn to renal failure.

In caring for a child with nephrotic syndrome, which intervention will be included in the child's plan of care? -Weighing on the same scale each day -Ambulating 3 to 4 times a day -Increasing fluid intake by 50 ml per hour -Testing the urine for glucose levels regularly

-Weighing on the same scale each day

Which instruction should a nurse give to a client who has a history of urinary tract infection to prevent recurrence? -Wipe from front to back. -Use bubble bath to wash. -Encourage fluids throughout the day. -Finish all antibiotic prescribed. -Limit bathing to once a week.

-Wipe from front to back -Encourage fluids throughout the day -Finish all antibiotic prescribed

A 2-year-old has a history of fever and fussiness. Which additional symptoms would make the nurse suspect a urinary tract infection? -Swollen lymph nodes -Skin rash -Increased thirst -Abdominal pain

Abdominal pain The symptoms of urinary tract infection can vary depending on the age of the child. Abdominal pain is a common symptom in children of a UTI. Swollen lymph nodes, skin rash, and thirst are not the common symptoms associated with a UTI.

A client has just been admitted to the unit with a history of recent strep infection, hematuria, and proteinuria. Based on these findings, the nurse would suspect which condition? renal failure urinary tract infection prune belly syndrome acute glomerulonephritis

Acute glomerulonephritis

Urinary tract infections are usually successfully treated by what means? Increasing fluids, such as cranberry juice Administering antibiotics Performing bladder irrigations Administering diuretics

Administering diuretics

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? Pulse rate 112 bpm Pulse oximetry 93% on room air Respirations 24 per minute Blood pressure 136/84

Blood pressure 136/84

A child needs to collect urine for 24 hours. The nurse explains to the parents and child that this test assesses glomerular filtration rate and how the kidneys are functioning. What results would be expected in this type of test? creatinine clearance culture and sensitivity casts and bacteria red blood cell (RBC) casts

Creatinine clearance

A child is being evaluated for renal and urinary tract disease. What would the nurse expect to be ordered to evaluate the child's glomerular filtration rate? Urinalysis Creatinine clearance rate Kidneys, ureter, and bladder x-ray Computed tomography scan

Creatinine clearance rate Rationale: The glomerular filtration rate is measured by creatinine clearance rate, or the amount of creatinine excreted in 24 hours as determined by a 24-hour urine sample along with a venous blood sample and compared with the urine findings. Urinalysis provides general information about kidney function. A kidneys, ureters, and bladder x-ray provides information about the size and contour of the kidneys. A computed tomography reveals the size and density of kidney structures and adequacy of urine flow.

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? Demonstrate love and acceptance at home. Discuss how the child can continue to go to the bathroom instead of in his or her underwear. Take away a toy every time the child urinates in his or her pants. Demonstrate how to urinate in the bathroom every time the child has an occurrence.

Demonstrate love and acceptance at home. Rationale: Enuresis is the continued incontinence of urine past the age of toilet training. It is a source of shame and embarrassment. It affects the child's life emotionally, behaviorally, and socially. It causes the child to have low self-esteem. Demonstrating love and acceptance at home will help counteract the ridicule the child is getting at school

The nurse is caring for a child with nephrotic syndrome. The child is noted to have edema. The edema would most likely be seen where on this child? Eyes Fingers Abdomen Sacrum

Eyes Rationale: The sx of nephrotic syndrome include perorbital edema upon awakening with progressive edema throughout the day in all extremities and abdomen.

A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure? Encouraging fluid intake after dinner Practicing bladder-stretching exercises Giving desmopressin intranasally Engaging the child in stress-reduction measures

Encouraging fluid intake after dinner

An infant is diagnosed with a urinary tract infection (UTI). What corroborating finding would the nurse expect on assessment? Failure to thrive Abdominal pain Urinary urgency Dysuria

Failure to thrive Rationale Sx of infant UTI: Irritability, vomiting, failure to thrive, jaundice. Sx of Children UTI: Dysuria, frequency, hesitancy, urgency, pain

Which is a priority for the nurse caring for a client with bladder exstrophy? -increasing fluid intake -encouraging voiding -preventing skin breakdown -placing the child in prone position

Prevent skin breakdown Rationale: Prevention of skin breakdown is the priority to prevent infection and the surface from drying out.

The parent of 6-month-old girl is concerned about the child getting a urinary tract infection. What should the nurse mention to the parent regarding this concern? Report any abnormally colored urine to the child's primary care provider. Wipe from back to front when changing the girl's diaper. Discontinue prescribed antibiotics once symptoms of UTI have disappeared. Bathe the child with bubble bath once a week.

Report any abnormally colored urine to the child's primary care provider.

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant? Deficient fluid volume related to fluid intake restrictions postoperatively Risk for infection related to immunocompromised state Constipation related to effects of administered drugs Pain related to tissue rejection

Risk for infection related to immunocompromised state Rationale: Children are administered immunosuppressants following a transplant. These drugs lower the immune system response and help prevent rejection following the transplant. As a result, this leaves them susceptible to infection.

The caregiver of a child being treated at home for acute glomerulonephritis calls the nurse reporting that her daughter has just had a convulsion. The child is resting comfortably but the caregiver would like to know what to do. The nurse would instruct the caregiver to take which action? -Weigh the child in the same clothes she had been weighed in the day before and report the two weights to the nurse while the nurse is on the phone. -Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. -Give the child a diuretic and report back to the nurse in a few hours -Give the child fluids and report back to the nurse in a few hours.

Take the child's blood pressure and report the findings to the nurse while the nurse is still on the phone. Blood pressure should be monitored regularly using the same arm and a properly fitting cuff. If hypertension develops, a diuretic may help reduce the blood pressure to normal levels. An antihypertensive drug may be added if the diastolic pressure is 90 mm Hg or higher. The concern is immediate so reporting the findings in a few hours could delay needed treatment. The child should be weighed daily in the same clothes and using the same scale, but the blood pressure is the priority in this situation.

A caregiver brings her 7-year-old son to the pediatrician's office, concerned about the child's bedwetting after being completely toilet trained even at night for over 2 years. The caregiver further reports that the child has wet the bed every night since returning home from a 1-week fishing trip. The child refuses to talk about the bedwetting. The nurse notes the child is shy, skittish, and will not make eye contact. Further evaluation needs to be done to rule out what possible explanation for the bedwetting? The child has a urinary tract infection due to not bathing while on the fishing trip. The child is out of the habit of waking himself up during the night to void. The child did not want to go on the fishing trip and is now retaliating against being made to go. The child has been sexually abused, maybe on the fishing trip.

The child has been sexually abused, maybe on the fishing trip.

Which goal of therapy would be appropriate for a nurse to establish with a client's family and a client who has a diagnosis of enuresis? The child wakes up once during the night for a glass of water. The client wets only when involved in an activity. The client remains continent throughout the night. The parent takes the client to the bathroom at night.

The client remains continent throughout the night. Rationale: The goal of therapy is for the client to be continent of urine throughout the night. The nurse should encourage the child to awaken and void and not have any fluids before bedtime. During an activity, the child should be encouraged to void before and after the activity to prevent incontinence.

A nurse is conducting a discussion group with parents of children who have genitourinary disorders. As part of the discussion, the nurse reviews the major functions of the kidneys. The nurse determines that the teaching was successful based on which statement by the group? "Problems with the kidneys raise the risk for infection because there is a problem with producing white blood cells." "The kidneys help get rid of carbon dioxide from the body, so kidney problems can affect our child's breathing." "We should expect problems with too much fluid in the brain because the kidneys are not able to keep the fluid in balance." "The kidneys help control blood pressure, so our child's blood pressure needs to be checked often."

The kidneys help control blood pressure, so our child's blood pressure needs to be checked often."

A 4-year-old child with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing the child for this procedure, the nurse would want to prepare the child to: -have a local anesthetic injected prior to the procedure. -drink three glasses of water during the procedure. -void during the procedure. -anticipate a headache afterward

void during the procedure. At the start of the voiding cystourethrogram, a catheter is inserted into the bladder. The contrast medium is inserted through the catheter into the bladder. Fluroscopy is performed to demonstrate the filling of the bladder and the collapsing of the bladder upon emptying. The assessment of emptying requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed. No anesthetic is required for this procedure. The fluid filling the bladder is inserted via the catheter so no drinking of water is required. A headache following the procedure would not be expected.

The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine "looks funny." He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have: -a urinary tract infection. -lipoid nephrosis (idiopathic nephrotic syndrome). -acute glomerulonephritis. -rheumatic fever.

-acute glomerulonephritis.

The home care nurse is conducting an in-home visit for a child who had corrective surgery for hypospadias 3 days prior. What would alert the home care nurse to provide additional teaching? -The mother indicates the child is fussy, but calms down when she holds him on her hip. -The mother states, "I can't wait until I can bath him the tub again...he enjoys it so much. "-The mother expresses relief that the child was not also diagnosed with cryptorchidism at birth. -The mother states, "I have had to buy more diapers since having to double diaper him."

-The mother indicates the child is fussy, but calms down when she holds him on her hip. Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Surgical repair involves a catheter or stent left in place for 3-7 days postoperatively. Activities or play that involves straddling (such a being carried on mom's hip) are discouraged to prevent trauma to the surgical site and catheter/stent. The child should be double diapered to prevent stool from contaminating the catheter/stent and operative site and causing an infection. The child should not be bathed in a tub until the catheter/stent is removed. Crypotoorchidism is a common diagnosis along with hypospadias.

A nurse is performing postoperative care on a child with a ureteral stent. Which intervention will help manage tube patency? -Monitor output. -Allow tubes to dangle freely to encourage flow. -Maintain fluid restriction. -Provide a low-sodium diet.

Monitor output. Rationale: A ureteral stint is placed in the ureter temporarily to aid in the drainage of urine. It is removed via cystoscopy when it is time for discontinuation. The nurse should monitor output cafefully when a ureteral stint is in place. This is an indication that the stent is patent and functioning properly. The tubes are inserted into the ureter so they would not dangle on the outside of the body. There is no need to maintain fluid restriction or a low-sodium diet just because of the stent. This would only be necessary if there were other disease processes affecting the child.