Nursing Care of the Child with an Alteration in Urinary Elimination/GU Disorder: Chapter 43: PrepU

The caregiver of a 1-year-old boy calls the nurse, upset that his wife has just told him that their son is being given a hormone. His wife says that the pediatrician called it human chorionic gonadotropic hormone but that is all she understood. The nurse most accurately clarifies the caregiver's question by making which statement regarding the son's treatment?

"The doctor is hoping that the hormone will cause your son's undropped testes to move into their proper place." Shortly before or soon after birth, the male gonads (testes) descend from the abdominal cavity into their normal position in the scrotum. Occasionally one or both of the testes do not descend, which is a condition called cryptorchidism. The testes are usually normal in size; the cause for failure to descend is not clearly understood. A surgical procedure called orchiopexy is used to bring the testes down into the scrotum and anchor them there. Some physicians prefer to try medical treatment such as injections of human chorionic gonadotropic hormone before doing surgery. If this is unsuccessful in bringing down the testes, orchiopexy is performed. If both testes remain undescended, the male will be sterile. If the processus does not close, fluid from the peritoneal cavity passes through, causing hydrocele. If the hydrocele remains by the end of the first year, corrective surgery is performed.

A single male caregiver of a 14-year-old girl accompanies his daughter to her pre-high school physical. In the course of discussion about how his daughter is developing, he remarks, "She's terrific most of the time. Of course when she gets her period, she's miserable and mean, but I tell her that's just what it's like to be a woman." What would be the most appropriate response by the nurse?

"There are nutritional and medical things she can do to lessen the symptoms; I'll give both of you information about some strategies and we'll track her for a few months." Women of all ages are subject to the discomfort of premenstrual syndrome (PMS), but the symptoms may be alarming to the adolescent. Symptoms include edema (resulting in weight gain), headache, increased anxiety, mild depression, and mood swings. Generally the discomforts of PMS are minor and can be relieved by reducing salt intake during the week before menstruation, taking mild analgesics, and applying local heat. When symptoms are more severe, the physician may prescribe a mild diuretic to be taken the week before menstruation to relieve edema; occasionally oral contraceptive pills are prescribed to prevent ovulation.

The nurse is caring for a child on a pediatric unit who has hemodialysis 3 times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child?

Grilled chicken, half of a banana, and flavored water Since hemodialysis is usually performed only every other day, larger amounts of waste products build up in the child's blood; therefore, the child must follow a stricter diet between hemodialysis treatments, though dietary restrictions are usually lifted while the child is actually undergoing the treatment. Since the kidneys are not functioning, foods high in sodium, protein, and potassium must be avoided.

The nurse is reviewing lab work prior to shift handoff on a client with a subnormal urine output. Which is the nurse most correct to report?

Oliguria A subnormal urine output is termed as oliguria. Polyuria is the excessive or abnormally large production of urine. Pyuria is the presence of pus in the urine. Glycosuria is the excretion of glucose in the urine.

The mother of 6-month-old girl is concerned about her daughter getting a urinary tract infection. What should the nurse mention to the mother to help prevent this condition?

Report any abnormally colored urine to the child's primary care provider. Several important interventions can help prevent urinary and renal disease in children. The first intervention is to educate parents and caregivers about wiping from front to back (not back to front) when changing diapers of female infants. Remind parents of simple ways to prevent UTI, such as not allowing children to bathe with bubble bath. Teach parents to recognize that abnormally colored urine (red, black, or cloudy) should not be dismissed as this could be the beginning of a UTI or kidney disease. Educating parents about the importance of giving the full course of antibiotics prescribed for UTIs can help prevent return reinfection; giving the full course of antibiotics after a streptococcal infection can help prevent acute glomerulonephritis.

The nurse knows this is a description of peritoneal dialysis when compared to hemodialysis:

The child can live a more normal lifestyle. The child can live a more normal lifestyle with peritoneal dialysis. This is a 7-day-a-week procedure, but there are less diet restrictions and more freedom with this type of procedure. Peritoneal dialysis can be performed at home.

The location of the kidneys in the child in relationship to the location of the kidneys in the adult makes which fact a greater likelihood in the child?

The child has a greater risk for trauma to the kidney. The kidneys in children are located lower in relationship to the ribs than in adults. This placement and the fact that the child has less of a fat cushion around the kidneys cause the child to be at greater risk for trauma to the kidneys. The location of the kidneys does not affect the urges to empty the bladder nor the retaining of fluids.

The nurse is caring for a child who has a urinary tract infection. How can the nurse best promote normal urinary elimination?

Encourage fluid intake Adequate fluid intake is necessary, and there is no need to avoid milk. Avoiding fluids in the evening may reduce bedwetting but this action does not help the child maintain normal urinary elimination during a urinary tract infection. Diuretics are not usually prescribed.

An 8-year-old develops balanoposthitis. A finding of this is

denuded, reddened surface of the glans of the penis. Balanoposthitis is inflammation of the glans and prepuce of the penis. These appear reddened and are painful.

A 4-year-old boy with nephrotic syndrome has extensive edema. The best implementation to reduce periorbital edema would be to

elevate the head of the bed. Because edema tends to be dependent, elevating an edematous body part usually reduces swelling in that part.

An adolescent is diagnosed as having gonorrhea. You can anticipate that her management will include

identification of sexual contacts. Gonorrhea is a reportable contagious disease. Individuals diagnosed with the disease will be asked to identify their sexual contacts so they can receive therapy also.

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." Many different bacteria may infect the urinary tract, and intestinal bacteria, particularly Escherichia coli, account for about 80% of acute episodes. The female urethra is shorter and straighter than the male urethra, so it is more easily contaminated with feces.

A child in kidney failure has had a kidney transplantation. You would prepare the child for which of the following to occur postoperatively?

Infection-control precautions that may cause him to be lonely Children may be isolated following a transplant to help them resist infection during the time their immune system response is lowered to help them avoid transplant rejection.

A pediatric client is scheduled for an intravenous pyelogram (IVP) of the kidney this afternoon. Which of these actions by the nurse would require immediate attention?

The child does not have intravenous access. An intravenous pyelogram is an X-ray study of the upper urinary tract in which a radio opaque dye is injected into a peripheral vein, requiring intravenous access. The other choices are not a priority for this client.

A female preschool patient with a urinary tract infection is scheduled to have a voiding cystourethrogram. What should the nurse include when teaching the patient about this procedure?

The patient will be expected to void during the procedure. A voiding cystourethrogram is a study of the lower urinary tract and looks at the structure of the urethra and bladder and the presence of reflux into the ureters. After bladder catheterization, a radiopaque dye is injected into the bladder, and the catheter is then removed. The child is asked to void into a bedpan while serial X-ray films are taken. Being asked to void while being observed may be the most stressful part of the procedure for children because they have been taught voiding is a private act. Be sure children are told in advance that they will be asked to do this, and that it is alright if a stranger watches them. A headache is not a common occurrence after this procedure. A local anesthetic is not needed for this procedure. The patient will not be asked to drink water during the procedure.

A child is having their urine checked for a routine well visit. When analyzing the results, what would positive leukocytes indicate?

This may indicate a urinary tract infection. Positive leukocytes may indicate a urinary tract infection. The urine would also need to be cultured to determine the type and amount of bacteria growth.

The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea?

"Emotional stress can be a cause of this disorder." Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.

Which clinical manifestation should a nurse recognize as most significant when assessing a client who is suspected of having female circumcision?

missing clitoris Clients who are assessed with a missing clitoris should receive further workup for female circumcision. Redness, swelling, and vaginal discharge can be indicated for infection. Menses is not affected in clients with female circumcision.

The first method of choice for obtaining a urine specimen from a 3-year-old child with a possible urinary tract infection is:

obtaining a clean catch voided urine. 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.

A 4-year-old girl with a urinary tract infection is scheduled to have a voiding cystourethrogram. When preparing her for this procedure, the nurse would want to prepare her to:

void during the procedure. A voiding cystourethrogram requires the child to void during the procedure so that bladder emptying and urethra flow can be assessed.

A client's mother asks the nurse, "When should my daughter have a pelvic examination?" Which response by the nurse is most appropriate?

"A pelvic exam is necessary at 18 to 20 years of age." A pelvic exam is unnescessary for girls who have not yet reached adolescence. A pelvic exam should be part of routine health care around the age of 18 to 20 years or at the point when she becomes sexually active.

The nurse is discussing recommended immunizations with the mother of an adolescent female. Which immunization would be important for the nurse to include during this discussion?

Gardasil The vaccine Gardasil is recommended as part of routine administration to both early teenage girls and boys to prevent human papillomavirus infections. The nurse should approach the subject of immunization with parents and teenagers with sensitivity because some parents and children are not ready to admit they might be or will soon become sexually active. Influenza vaccination should already be a part of the adolescent's routine vaccinations. Hepatitis B vaccination should have been completed at birth and during the first year of life. Pneumonia vaccination is indicated for those in high-risk groups with respiratory illnesses.

When providing care to a child with vesicoureteral reflux (VUR), which nursing diagnosis would be the priority?

Risk for infection When vesicoureteral reflux is present, the primary goal is to avoid urine infection so that infected urine cannot gain access to the kidneys. Fluid volume typically is not a problem associated with VUR. Nutritional problems are not associated with VUR. Activity intolerance is not associated with VUR.

Which nursing diagnosis would be the priority when caring for a child in renal failure following a kidney transplant?

Risk for infection related to immunocompromised state Children are administered anti-immune therapies to lower immune system response and help prevent rejection following a transplant; this leaves them susceptible to infection.

A 16-year-old tells you she has terrible dysmenorrhea. Which action would be the best health teaching measure regarding this?

Take over-the-counter ibuprofen for its prostaglandin action. An anti-inflammatory medication is most helpful in reducing the discomfort of dysmenorrhea.

A baby is born with ambiguous genitalia. What should the nurse emphasize when discussing this with the parents?

The child's true sex can be determined by a genetic karyotype. If there is any question about a child's gender, karyotyping or DNA analysis establishes whether the child is genetically male or female. Ambiguous genitalia do not result from hypothalamus stimulation. Ambiguous genitalia do not develop fully with estrogen therapy. Ambiguous genitalia can occur in either gender.

The nurse is discussing urinary tract infections (UTI's) in children with a group of peers. Which fact is the most accurate regarding urinary tract infection seen in children?

The most common age for UTIs in children is 2 to 6 years of age. Urinary tract infections (UTIs) are fairly common in the "diaper age," in infancy, and again between the ages of 2 and 6 years. Older school-aged and adolescent girls are not as prone to UTIs.

An adolescent comes to the clinic reporting vaginal discharge. When assessing the vaginal discharge, what would lead the nurse to suspect that the adolescent has candidiasis?

Thick, white cheese-like discharge With candidiasis, the vaginal discharge is thick, white, and cheese-like. A frothy, gray-green discharge is noted with trichomoniasis. A milky, gray discharge with a fishy odor suggests gardnerella. A yellow-green vaginal discharge suggests gonorrhea.

The nurse is conducting a follow-up visit for a 13-year-old girl who has been treated for pelvic inflammatory disease. Which remark indicates a need for further teaching?

"I cannot have unprotected sex again until my partner is treated." The girl's partner should be treated, but she must strongly encourage the girl to require her partner to wear a condom every time they have sex, even after he undergoes antibiotic therapy. The other statements are accurate.

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 In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child's problem. Therefore, measures to address stress and promote coping would be appropriate.

The nurse is caring for a child diagnosed with hydronephrosis. Which manifestation is consistent with complications of the disorder?

Hypertension Complications of hydronephrosis include renal insufficiency, hypertension, and eventually renal failure. Hypotension, hypothermia, and tachycardia are not associated with hydronephrosis.

The nurse is caring for a child who is being evaluated for a possible nephroblastoma. Which nursing intervention would be important for this child?

Protect the child from having the abdomen palpated. When the child is being evaluated and treated, abdominal palpation should be avoided because cells may break loose and spread the tumor.

The nurse is collecting data on a 2-year-old child admitted with a diagnosis of urinary tract infection. When interviewing the caregivers, which question would be most important for the nurse to ask?

"Has your child complained of pain?" Gather information about the current illness: when the fever started and its course thus far, signs of pain or discomfort on voiding, recent change in feeding pattern, presence of vomiting or diarrhea, irritability, lethargy, abdominal pain, unusual odor to urine, chronic diaper rash, and signs of febrile convulsions. Toilet training and bathing habits would be of importance, but they are not the most important to ask. Temperatures in other children in the family would not be related to this child's current situation.

An 8-year-old child is diagnosed with balanoposthitis. What will the nurse most likely assess in this disorder?

Denuded, reddened surface of the glans of the penis Balanoposthitis is inflammation of the glans and prepuce of the penis. The prepuce and glans appear red and swollen; there may be a purulent discharge. The nurse is unable to determine sperm production without a sperm count. The child may have difficulty voiding because of crusting at the meatal opening and because acidic urine touching the denuded surface of the glans causes pain. A bloody urethral discharge is not associated with this disorder.

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 client remains continent throughout the night. 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 newborn is diagnosed with hypospadias and the parents want him to be circumcised. What would be the best response by the nurse?

The foreskin is needed for repair. A child's foreskin is not removed since it is needed to help repair a hypospadias. Once the hypospadias is repaired, a circumcision can be performed at the same time. Meatal stenosis has to do with the urethral opening diameter, not the placement.

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:

acute glomerulonephritis. Acute glomerulonephritis is a condition that appears to be an allergic reaction to specific infections, most often group A beta-hemolytic streptococcal infections such as rheumatic fever. Presenting symptoms appear 1 to 3 weeks after the onset of a streptococcal infection such as strep throat, otitis media, tonsillitis, or impetigo. Usually the presenting symptom is grossly bloody urine. Periorbital edema may accompany or precede hematuria. Fever may be 103℉ to 104℉ (39.4℃ to 40℃) at the onset, but decreases in a few days to about 100℉ (37.8℃). Slight headache and malaise are usual, and vomiting may occur.

Urinary tract infections are usually successfully treated by what means?

Administering antibiotics UTIs may be treated with antibiotics (usually sulfamethoxazole or ampicillin) at home. Fluids are encouraged, but they do not treat the infection. Bladder irrigations and diuretics are not used in the treatment of urinary tract infections.

The nurse is teaching the parent of a child with chronic renal failure on high-potassium foods that should be restricted. Which foods will the nurse include in this teaching? (Select all that apply.)

Bananas, carrots, nuts, and milk Foods that are high in potassium include bananas, carrots, nuts, and milk. Broccoli, wheat, bran, chicken, fish, and green beans are not high in potassium and do not need to be restricted.

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?

Creatinine clearance rate 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.

The nurse is providing discharge teaching to an adolescent who has been treated for pelvic inflammatory disease (PID). What would the nurse include as a preventive measure?

Insisting that sexual partners use condoms PID is a sexually transmitted infection; use of condoms prevents PID. Using a vaginal douche routinely leads to bacterial overgrowth and increases the risk for PID. Sexual partners should also receive treatment with antibiotics. Oral contraceptives prevent pregnancy, not PID.

The nurse is caring for a child recovering from a kidney transplant. Which nursing diagnosis should the nurse identify as the priority to guide the care for this patient?

Risk for infection related to immunocompromised state After renal transplantation, children are cared for in an environment that is as sterile as possible as they are placed on immunosuppressive therapy to reduce the possibility of kidney rejection. Immunosuppressive therapy increases the patient's risk of developing an infection. The priority nursing diagnosis at this time is the risk for infection. Tissue rejection would not be immediate. The patient's pain would be from the surgical site. There is no information to support that the patient's medication will cause constipation. It is unlikely that the patient will be on a fluid restriction after surgery since there is a need to evaluate the functioning of the transplanted kidney.

The nurse is working with a child with altered genitourinary status. Which intervention would be included in the plan of care with excess fluid volume?

Weigh the child twice a day on the same scale. A child with a renal problem needs to be weighed on the same scale for accurate weights. The frequency is important to ensure the child is not retaining fluid.

In caring for a child with nephrotic syndrome, which interventions will be included in the child's plan of care?

Weighing on the same scale each day The child with nephrotic syndrome is weighed every day using the same scale to accurately monitor the child's fluid gain and loss.

To determine if ascites is increasing in amount in a child with nephrotic syndrome, which measurements would be most appropriate?

Abdominal circumference Ascites is accumulation of fluid in the abdominal cavity. Increasing abdominal size reveals this.

A nurse is performing an assessment on a child. What would be indicative of a potential for a urinary tract infection?

Holding urine while at school UTIs are often caused by children who do not urinate frequently at school. It is important for a child to avoid using towelettes and soap in the genital area because this can increase the chance of a UTI. Washing the genital area with water daily does not increase the chance of a UTI.

The nurse is assessing a male neonate and notes that the urethral opening is on the ventral aspect of the penis. Which finding is documented?

Hypospadias Hypospadias is a condition in which the urethral opening in on the ventral surface of the penis. Epispadias is present when the urethral opening is on the dorsal surface of the penis. Patent urachus refers to a fistula between the bladder and umbilicus. Bladder exstrophy involves the bladder lying open and exposed on the abdomen.

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?

Blood pressure 136/84 Hypertension appears in 60% to 70% of clients during the first 4 or 5 days with a diagnosis of acute glomerulonephritis. The pulse of 112 would be a little high for a child this age, but not a concern with this diagnosis. The other vital signs are within normal limits for this age child.

A 15-year-old girl who is sexually active comes to a health care facility because she is concerned that she has contracted gonorrhea from a partner who has the disease. Upon history of present illness, which symptom is anticipated?

No noticeable symptoms Gonorrhea often produces no acute symptoms in females, which is why it is spread so easily among sexual partners.

The nurse is providing a child with oxybutynin (Ditropan) as prescribed following surgical repair of a hypospadias. What should the nurse teach the patient about the purpose of this medication?

Relieves bladder spasms The child may notice painful bladder spasms as long as the catheter is in place after surgical repair of a hypospadias. An anticholinergic medication, which relieves bladders spasms such as oxybutynin (Ditropan), may be prescribed for pain relief. Oxybutynin (Ditropan) does not acidify the urine, stimulate kidney function, or prevent nausea and vomiting.