Alterations in Genitourinary Function
STIs (2)
-in children <10 consider sexual abuse -adolescents are at-risk related to inexperience and lack of knowledge about STIs
types of enuresis (4)
-nocturnal: happens at night -diurnal: happens during day; associated with maturational delay, sleep disorders, reduced bladder capacity, overactive bladder -primary: never had a dry night -secondary: reliable dry for at least 6 months begins bedwetting; associated with stress, infections, and sleep disorders, DM, constipation
HUS clinical manifestations (14)
-pallor -bruising -hematuria -proteinuria -oliguria -irritability -fever -abdominal pain -anorexia -vomiting -diarrhea -HTN -uremia -hyperkalemia
chronic renal failure clinical manifestations (9)
-pallor -nausea -anemia (tachycardia, tachypnea) -anorexia -HTN -fractures -growth delay -decreased ability to concentrate -may have oliguria or polyuria
types of acute renal failure (3)
-prerenal -intrarenal or primary -postrenal
chronic renal failure nursing care (5)
-promote F&E balance -promote growth & development -meet nutritional needs -maintain fluid restriction -dialysis
testicular torsion clinical manifestations (4)
-severe pain and erythema in the scrotum -N/V -abdominal pain -scrotal swelling
chronic renal failure treatment (2)
-slow progression, prevent complications, promote growth and development -once ESRD develops: dialysis and/or renal transplant
nephrotic syndrome clinical manifestations (9)
-snug fit clothing or shoes -pallor -HTN -irritability -anorexia -hematuria -decreased UO -malaise -weight gain
polycystic kidney disease treatment (3)
-supportive therapy -dialysis -renal transplant
two examples of obstructive uropathy
-ureteropelvic junction obstruction -posterior urethral valves
obstructive uropathy nursing care (2)
-urethral catheter placement and management -monitor for S/S of infection
things that increase risk of UTI (7)
-urinary stasis: neurogenic bladder -infrequent voiding -poor hygiene and inadequate cleaning after bowel movements -uncircumcised males -constipation -sexual activity in adolescent females -vesicoureteral reflux
What does prune-belly syndrome cause? (5)
-urinary tract anomalies -pulmonary hypoplasia -CV defects -GI defects -MSK defects
When is surgical correction of cryptorchidism indicated?
if the testes have not descended by 6 months of age
cryptorchidism majority
in majority of cases, testes spontaneously descend by 3 months of age
nephrotic syndrome patho
increased glomerular permeability -> albumin excreted in the urine (proteinuria) -> decreased oncotic pressure (hypoalbuminemia, hypoproteinemia) -> edema
pyelonephritis
infection of the ureters, renal pelvis, renal parenchyma
cystitis
infection of the urethra or bladder
acute post-infectious glomerulonephritis patho
inflammation of the glomeruli that typically follows group A strep infection (10-21 days after strep infection) -> glomeruli damage -> decreased GFR and increased vascular permeability -> retention of sodium, water, waste
What is testicular torsion?
medical emergency in which the testis suddenly rotates on its spermatic cord, cutting off blood supply leading to vascular engorgement and ischemia
vesicoureteral reflux nursing care
monitor for S/S of a UTI
What is an inguinal hernia?
painless inguinal or scrotal swelling of variable size that occurs when abdominal tissue extends into the inguinal canal
cryptorchidism clinical manifestations
palpation of the scrotum fails to reveal testes
inguinal hernia clinical manifestation
parents may report an intermittent bulge in the groin or swelling in the scrotum
genetic disorder
polycystic kidney disease
hypospadias/epispadias nursing care
prevent infection and monitor for urethral obstruction following surgery
polycystic kidney disease patho
progressive disease, over time cysts become larger and fibrosis occurs -> the cysts replace the kidney's mass -> reduced kidney function over time -> chronic renal failure
bladder exstrophy nursing care
protect the exposed bladder and prevent infection
testicular torsion nursing management
recognize S/S and necessity of emergency care
What is enuresis?
repeated involuntary voiding by a child who has reached an age at which bladder control is expected, usually about 5-6
prerenal patho and causes (4)
results from decreased perfusion to an otherwise healthy kidney -shock -sepsis -hypovolemia -complication of cardiac surgery
postrenal patho and causes (1)
results from something below the kidney -urologic anatomic anomalies
intrarenal or primary patho and causes (3)
results from something within the kidney -hemolytic uremic syndrome -acute glomerulonephritis -nephrotoxic medications
What is vesicoureteral reflux?
retrograde flow of urine from the bladder into the ureters
HUS nursing care
same as acute post-infectious glomerulonephritis + monitor LOC, assess for signs of bleeding, administer transfusions as ordered
acute post-infectious glomerulonephritis nursing care
same as nephrotic syndrome + monitor BP
What does obstructive uropathy refer to?
structural or functional abnormalities of the urinary system that interfere with urine flow and result in urine backflow into the kidneys
acute renal failure (acute kidney injury)
sudden loss of adequate renal function
inguinal hernia treatment
surgical correction is required to avoid incarceration
testicular torsion treatment
surgical emergency
What is epispadias?
the urethral canal is open on the dorsal surface of the penis
What is hypospadias?
the urethral canal is open on the ventral surface of the penis
When do testicular torsion symptoms start?
typically start while the child is sleeping but they can occur after trauma, sexual activity, or exercise
cryptorchidism
undescended testes
Toilet training regression is commonly seen in what?
urinary tract infections
Which structural defect has an increased risk for infection?
vesicoureteral reflux
paraphimosis
when the foreskin cannot be returned to its normal position, MEDICAL EMERGENCY
cystitis clinical manifestations (5)
-fever -urgency -dysuria -urinary frequency -foul-smelling urine
enuresis treatment approaches (6)
-fluid restriction -bladder exercises (at least 6 months) -timed voiding -enuresis alarms (children over 7, takes 3-4 months for success) -reward system -medications (imipramine, desmopressin, oxybutynin)
What does chronic renal failure result in? (5)
-fluid, electrolyte, acid/base imbalances -osteodystrophy -growth delay -anemia -HTN
pyelonephritis clinical manifestations (6)
-high fever -chills -abdominal pain -N/V -flank pain -dehydration
acute renal failure clinical manifestations (9)
-N/V -edema -gross hematuria -oliguria -HTN -pallor -lethargy -headache -fatigue
acute post-infectious glomerulonephritis clinical manifestations (9)
-TEA COLORED URINE -often asymptomatic -flank or mid-abdominal pain -irritability -malaise -fever -edema -HTN -oliguria
nephrotic syndrome nursing care (5)
-administer meds as ordered -carefully monitor intake and output -prevent infection -prevent skin breakdown -promote rest
factors that increase risk of STI (4)
-avoidance of protective barriers -multiple partners -frequent intercourse -failing to seek treatment until symptoms have advanced
acute post-infectious glomerulonephritis treatment (4)
-bed rest -sodium restriction -diuretics -anti-hypertensives
types of urinary system structural defects (5)
-bladder exstrophy -hypospadias and epispadias -obstructive uropathy -vesicoureteral reflux -prune-belly syndrome
pelvic inflammatory disease (2)
-can occur in females if an STI is left untreated -can lead to infertility, ectopic pregnancy, and chronic pelvic pain
What is chronic renal failure (chronic kidney disease) due to? (5)
-developmental abnormalities of the kidney or urinary tract -obstructive uropathy -severe reflux -hemolytic uremic syndrome -glomerulonephritis
HUS treatment (4)
-dialysis -nutritional therapy -PRBC transfusion -platelet transfusion
diurnal and nocturnal enuresis clinical manifestations
-diurnal: frequency, urgency, dribbling, involuntary loss of urine -nocturnal: bedwetting
What is nephrotic syndrome characterized by? (6)
-edema -massive proteinuria -hypoalbuminemia -hypoproteinemia -hyperlipidemia -altered immunity
UTI nursing care (2)
-education (p. 1052) -administer antibiotics and antipyretics as ordered
polycystic kidney disease newborns
60% of newborns with this die from pulmonary hypoplasia due to oligohydramnios secondary to severe intrauterine kidney disease
most common cause of UTIs
E. coli
acute post-infectious glomerulonephritis acronym
HADSTREP -Hypertension -Acute post-infectious glomerulonephritis -Decreased GFR -Swelling -Tea colored urine -Recent strep -Elevated BUN and creatinine -Proteinuria
UTI treatment
antibiotic therapy
What does obstructive uropathy often result in?
hydronephrosis
hemolytic uremic syndrome (HUS) patho
caused by E. coli toxins that attach to the glomeruli, collecting ducts, and distal tubules -> damage of the glomerular arterioles -> swelling of the glomeruli -> inflammatory response -> glomeruli occlusion with platelets and fibrin -> damaged RBCs -> hemolytic anemia -> platelet clusters -> thrombocytopenia -> decreased GFR -> acute renal failure
When is circumcision contraindicated and why?
contraindicated in hypospadias and epispadias because the foreskin can be used as a source of tissue for repair of the defect
nephrotic syndrome treatment
corticosteroids
obstructive uropathy clinical manifestations
depends on the location and severity of the abnormality
acute renal failure treatment
depends on underlying cause, dialysis
What does gradual loss of kidney function lead to?
end stage renal disease (ESRD)
What is bladder exstrophy?
extrusion of the bladder wall through the abdominal wall that requires surgical intervention
What is prune-belly syndrome?
failure of the abdominal musculature to develop
hydrocele
fluid-filled mass in the scrotum
phimosis
foreskin cannot be retracted (normal finding in uncircumcised infant)
HUS triad
hemolytic anemia, thrombocytopenia, acute renal failure
most common cause of ARF in young children
hemolytic uremic syndrome
What is incarceration?
hernia cannot be reduced and circulation to trapped tissue is impaired - MEDICAL EMERGENCY
