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Nursing Care of the Child with GU disorders

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					Nursing Care of the Child with
        GU disorders
   Radiography and other tests of
      urinary system function
Urine       Renal/bla   Testicular Scout film
culture & dder US       US
sensitivity
VCG         Imaging
            studies
                        IVP        Renal bx,
                                   cysto

Whitaker perfusion
test
Physical tests for Gu function
Volume for polyuria, oliguria
Specific gravity
Osmolality
Appearance
Chemistries on urine (√ for blood,
WBCs, bacteria, casts)
 Blood tests of renal function
BUN (blood urea nitrogen_
Uric acid
Creatinine
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)
    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?
      Vesicoureteral Reflux
Approximately 20% of children that
have UTIs will be found to have
vesicoureteral reflux on xray
What is vesicoureteral reflux?
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”
    Tests specific to reflux
Kidney ultrasound
VCUG
Renal SPECT
RCG (radionucleaotide cystogram)
  Hypospadias/Epispadias
Congential defect with urethral
defect
Meatus on lower aspect
(hypospadias)
Meatus on dorsal aspect (epispadias)
May have a fibrous band that cuases
the penis to curve downward
 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:
    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 the acute phase of the
disease
A 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 decreased
 plasma filtration
 Activity intolerance r/t fatigue
 Altered patterns of urinary
 elimination r/t fluid retention and
 impaired filtration
 Altered family process r/t child with
 chronic disease, hospitalizations
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
Nephrotic syndrome
Nephrotic syndrome, cont
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
Child with nephrotic syndrome
  Therapeutic management
Corticosteroids (prednisone)
Dietary management
Restriction of fluid intake
Prevention of infections
Monitoring for complications:
infections, severe GI upset, ascites,
or respiratory distress
         Cryptorchidism
Defined as failure of one or both
testes to descend
Treatment
Objective of treatment
   Critical thinking for client
undergoing urinary tract surgery
The Scotts are receiving pre-op instructions
before their son David’s surgery for
reimplantation of the ureters. David is 5 years
old. 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 c atheters are removed
– B. Important of monitoring the urine drainage from
  stents and urethral catheter
– C. Need to assess the surgical site for bleeding or
  excessive drainage
– D. The home care regimen that can be anticipated on
  David’s discharge from the hospital

				
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posted:9/15/2012
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