Nursing Care of the Child with GU disorders by cuiliqing

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									Nursing Care of the Child with
        GU disorders
 External Defects in the Urinary
            System




Extrophy of the bladder
Hypospadias vs epispadius
Cryptorchidism
     Extrophy of the bladder
Posterior bladder wall
extrudes through the
lower abd wall.
Failure of the abd to
close
Pre-op focus of nsg
care
– Prevent trauma
– Prevent infection of
  exposed
   bladder
Post-operative care with surgical
  care of extrophy of bladder
Care of the surgical   Monitoring renal
site with meticulous   function and
wound care             obstruction of tubes
Positioning:
immobilization and     Promoting comfort
avoidance of
abduction of legs      Discharge teaching
Neurovascular
assessment of lower
extremities
 Hypospadias vs Epispadias
Hypospadias             Epispadias
– Congenital urethral   – Congenital urethral
                          defect
 defect                 – Urethral opening is
– Uretheral opening       on the DORSAL
 on VENTRAL (lower)       aspect of the penis

aspect of the penis
 Treatment for hypospadias
DO NOT circumcise infant; may need
the foreskin for reconstruction
Surgery: reconstructive to re-
position the meatus at the tip
Usually done before one year of age
Post-op care:
     Post-op management
Care of the catheter (may be foley,
suprapubic or urethral stent.
Use double diapering
Management of bladder spasms
Prophylactic abx
No bath until stent removed
Increase fluid intake
No play on straddle toys
Call physician for temp > 101º
Cryptorchidism
  Therapeutic interventions for
        cryptorchidism
Orchiopexy done via laproscopy
Nursing care post-op:
– Minimal activity for few days
– Allow opportunity to express fears about
  mutilation or castration
   Critical thinking for client
undergoing urinary tract surgery
David is 5 years old and scheduled for ureter
reimplantation surgery. In addition to discussion
of post-op pain, tubes and dressings, the most
significant other topic would be which of the
following?
 – A. Need to reassure David his genitals are
   intact and will function normally when the
   catheters are removed
 – B. Importance of monitoring the urine
   drainage from stents and urethral catheter
 – C. The need to assess the surgical site for
   bleeding or excessive drainage
 – D. The home care regimen that can be
   anticipated when David is discharged
     Obstructive Uropathy
Stenosis of uteropelvic valve
Stenosis of posterior urethral valve
Stenosis of the uterovesicular
junction otherwise known as
“vesicoureteral reflux”
Hydronephrosis the main problem
with reflux of urine
What is vesicoureteral reflux?
  Therapeutic management
Corticosteroids (prednisone)
Dietary management
Restriction of fluid intake
Prevention of infections
Monitoring for complications:
infections, severe GI upset, ascites,
or respiratory distress
     Physiologic changes r/t
        hydronephrosis
Cessation of glomerular filtration and
cell death
Metabolic acidosis result
Impairment of kidney’s ability to
concentrate urine
Obstruction results in stasis and
infection
Can lead to chronic renal failure
Diagnostic tests for renal/bladder
             function
Urine culture and   Renal/bladder
sensitivity: done   ultrasound
every 2-3 months
                    IVP

VCG: voiding
cystourethrogram    Renal biopsy

                    Cystoscopy
Nursing responsibilities with testing
 Responsible for preparation and
 collection of urine or blood
 Maintains careful intake and output
 Recognizes that renal disease can
 diminish the glomerular filtration
 rate(the amt of plasma from which a
 given substance is totally clear in
 one minute)
Treatment for vesicoureteral reflux
Directed toward preventing UTIs
Managed by time or surgery if a
lower grade
Single doses each day of abx as long
as reflux lasts
Urine cultures done q 6 wks up to 3
months to make sure no “silent
infection”
   Treatment and nsg care for
      obstructive uropathy
Drug therapy              Follow up VCG after
– Penicillin              few months post op
– Cephalosporins          Nsg care:
– Urinary antiseptics     – Teach prevention of UTI
  (Furadantin)
                          – Teach imp of taking all
                            abx
Surgery:                  – Monitor urinary
                            drainage from catheters
– Repair of anatomical
  anomalies/pyeloplasty   – Assess for pain
                          – Teach parents how to
                            change dressings,
                            double-diaper
                          – s/s obstruction or
                            infection
Differences between adult s/s UTI
       and pediatric patient
In children:
 – Unexplained fever
 – Failure to thrive
 – Vomiting
 – Diarrhea
    Urinary tract infections
Most common type of bacterial
infections occurring in children
Bacteria passes up the urethra into
the bladder
Most common types of bacteria are
those near the meatus…staph as well
as e.coli
       Contributing factors

Those with lower resistance,
particularly those with recurrent
infections
Unusual voiding and bowel habits
may contribute to UTI in children
“forget to go to bathroom”
Symptoms:
  Therapeutic management
Eliminate the current infections
Identify contributing factors to
reduce the risk of re-infection
Prevent systemic spread of the
infection
Preserve renal function
                FYI
The single most important host
factor influencing the occurrence of
UTI is urinary stasis
What is the chief cause of urinary
stasis?
Nephrotic syndrome
Nephrotic syndrome, cont
Child with nephrotic syndrome
Treatment of nephrotic syndrome
Varies with degree of severity
Treatment of the underlying cause
Prognosis depends on the cause
Children usually have the “minimal
change syndrome” which responds
well to treatment
Nursing interventions to manage
      nephrotic syndrome
Administer corticosteroids
(prednisone) as ordered
Dietary management
Restriction of fluid intake
Prevention of infections
Monitoring for complications:
infections, severe GI upset, ascites,
or respiratory distress
    Glomerular diseases


Acute glomerulonephritis (AGN)
Nephrotic syndrome (MCNS) or
minimal-change nephrotic syndrome
              AGN
Immune-complex disease causing
inflammation of glomeruli of kidney
Usual organism is group A beta-
hemolytic strep
Decreased glomerular filtration
Common in children (boys > girls)
Assessment/diagnostic tests:
                 AGN
Treatment and nursing care:
Bed rest may be recommended during
acute phase
Record of daily weight is the most useful
means for assessing fluid
balance
Nursing diagnosis for the child with
        glomerulonephritis
 Fluid volume excess r/t to…
 Activity intolerance r/t….
 Altered patterns of urinary
 elimination r/t …
 Altered family process r/t…
Nursing care specific to the child
           with AGN
Allow activities that do not expend
energy
Diet should not have any added salt
Fluid restriction, if prescribed
Monitor weights
Education of the parents

								
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