8/8/2019 Pedi GU (1)

1/36

1

The Child with Genitourinary

Alterations

By Susan Sienkiewicz

8/8/2019 Pedi GU (1)

2/36

2

Review Quiz: GU System

1 Name the functional unit of the kidney.

2 Name three functions of the kidney.

3 Name two hormones secreted by the kidney and the

main purpose of each.

4 For the following U/A results, indicate which areabnormal:

trace protein, 1+ glucose, RBCs: 0-1/HPF,

WBCs: 2-4/HPF, Ketones: negative, Moderate

casts, s.g.: 1.003

5 Name two blood tests that reflect renal function.

6 Name three diagnostic tests that assess the structure

of the urinary system.

8/8/2019 Pedi GU (1)

3/36

3

Urinary Elimination Management

Perineal Hygiene

wipe front to back o fluids

do not hold urine

use cotton panties

8/8/2019 Pedi GU (1)

4/36

4

Skin Care Change position Q2H

Daily bath Support edematous extremity

Bed cradle/loose clothing after orchiopexy

Incision care Protect Skin with Bladder Exstrophy

Preop - cover exposed bladder, use skin prep to

protect from urine leakage Postop - Bryants traction or sidelying position

to protect incision

Check peripheral circulation

Skin care for skin traction

8/8/2019 Pedi GU (1)

5/36

5

Fluid Management Strict I/O

Maintain FluidR

estriction Divide fluid restriction b/w waking hours

serve fluids in small cups

hard candies to keep mouth moist

Or Maintain Maintenance or Hydration

Fluids

100 mL/kg/day X 1st 10 kg . . .

1-2 ml/kg/hr u/o

label all tubes (post op)

maintain patency of tubes (ureteralreimplantation for VUR)

8/8/2019 Pedi GU (1)

6/36

6

Fluid Management, continued

Assess for s/s dehydration

Daily weight (same time,same scale)

Assess edemaMonitor electrolytes

8/8/2019 Pedi GU (1)

7/36

7

Body Image Enhancement

Encourage expression of feelings

Discuss transient effects of steroids

8/8/2019 Pedi GU (1)

8/36

8

Infection Protection

VS & s/s infection

Frequent diaper changes (orchiopexy,

hydrocelectomy)

Cover exposed bladder (exstrophy) &protect surrounding skin with sealant

Skin care

Protect A-V shunt (hemodialysis) orTenchkoff Catheter (peritoneal dialysis)

Avoid exposure to infectious individuals

No live viral vaccines while on steroids

8/8/2019 Pedi GU (1)

9/36

9

Coping Enhancement Strategies

Allow parents to vent concerns

Promote bonding encourage participation in care

Allow child to vent embarrassment

(enuresis)

extra set of clothes at school

8/8/2019 Pedi GU (1)

10/36

10

Energy Management

Promote rest cluster care

limit visitors

quiet diversion

quiet play X 2 wks with AGN, no

competitive play X 6-12 wks until

proteinuria resolves

Fowlers position to facilitate

breathing (NS, AR

F, CR

F, HUS)

8/8/2019 Pedi GU (1)

11/36

11

Patient/Family Education Compliance with med regime

Infection Control

Perineal Hygiene with UTI

Use of bedwetting alarms (enuresis)

Importance of f/u

S/S to report to MD

Fluid management

(restriction/hydration)

8/8/2019 Pedi GU (1)

12/36

12

Pt/Fam Education, continued

Diet restriction

Activity Restriction

Daily Weights (AGN, NS, ARF, CRF,

HUS) Urine testing for protein (AGN, NS)

Monthy STE for cryptorchidism

Dialysis (ARF, CRF, HUS)

Post transplantation care (CRF)

Chemo, radiation (Wilms Tumor)

8/8/2019 Pedi GU (1)

13/36

13

Nutrition Management Small meals, preferred foods

NAS (ARF, CRF, NS, HUS)

o Protein (NS)

q Protein (AGN, ARF, CRF, HUS)

qNa+, q K+ (AGN, ARF, CRF,HUS)

o Ca++, q PO4- (ARF, CRF)

8/8/2019 Pedi GU (1)

14/36

14

Pain Management

Tylenol (15 mg/kg/dose)

Tylenol #3 (codeine 0.5-1 mg/kg/dose)

for postop pain

Anticholinergics/Antispasmodics

(Oxybutrin chloride/Ditropan) for

bladder spasms (VUR, hypospadias

repair)

No straddling on hip or toys

(hypospadias repair, orchiopexy)

8/8/2019 Pedi GU (1)

15/36

15

VesicoureteralR

eflux (VUR

)

Manifestations

recurrent UTIs enuresis

flank/abd pain

grade I-V VCUG

Nursing care

Education (medcompliance, f/u)

Post op care

Pain Mgmt Fluid Mgmt

8/8/2019 Pedi GU (1)

16/36

16

8/8/2019 Pedi GU (1)

17/36

17

8/8/2019 Pedi GU (1)

18/36

18

8/8/2019 Pedi GU (1)

19/36

19

8/8/2019 Pedi GU (1)

20/36

20

Hypospadias/Epispadias

Manifestations

abnormal

placement ofurethra

small foreskin

short chordee (bandthat curves penis q

Nursing Care Pain Mgmt

Analgesics

Antichol (Ditropan)

Maintain tube

patency

no straddling

maintain penilepressure dsg

Fluid Mgmt

Educ

8/8/2019 Pedi GU (1)

21/36

2

1

CryptorchidismManifestations

testes not palpable

Nursing Care

Pain Mgmt

Infection Protection

Education

STEpossibility of

infertilty

8/8/2019 Pedi GU (1)

22/36

22

HydroceleManifestations

painless scrotalswelling

smooth (fluid-

filled) mass

Nursing Care

Education infection control

no activity

restrictions

8/8/2019 Pedi GU (1)

23/36

2

3

Inguinal Hernia

Manifestations groin swelling o

with abd pressure

strangulation/incarceration

redness

inconsolability vomiting

abd dist

o heart rate

Nursing Care Preop

for

strangulation

Postop

bldg, drainage

recurrence

Education

8/8/2019 Pedi GU (1)

24/36

2

4

Bladder ExstrophyManifestations exposed bladder

mucosa urine leakage

bifid clitoris

short stubbypenis

widened s. pubis

pwaddling gait

Nursing Care

Infection Protection

Skin Care

Postop

Fluid

Management

Coping

Enhancement

8/8/2019 Pedi GU (1)

25/36

25

UTI Infants

fever orq temp

irritability

poor feeding

vomiting

( in color/odor of urine

Children

abd pain

frequency

urgency

dysuria

enuresis fever > 101

CVAT, (back pain)

n/v with pyelonephritis

hematuria Nursing Care

Fluid Mgmt

Fever Mgmt

Education

8/8/2019 Pedi GU (1)

26/36

26

Perineal Hygiene

(to prevent UTI)

Wipe front to back

o fluids

dont hold urine

no bubble baths

cotton panties

8/8/2019 Pedi GU (1)

27/36

27

EnuresisManifestations

dribbling

urgency

infreq/painful vdg

straining

incontinence

Nursing Care

Education

Coping

Enhancement

8/8/2019 Pedi GU (1)

28/36

28

AGN S&S(abrupt) hematuria

proteinuria

dep edema

periorbital edema

q U/O

fatigue, irritability

oB/P

symptoms appear 10

days after strep

infection

DxEval

U/Ap +RBCs,casts,

prot, o s.g.

urine cx neg

o BUN, creatinine

+ antistreptolysinO

titer

8/8/2019 Pedi GU (1)

29/36

29

AGN: Nursing Care

Energy Management

Fluid Management (restriction)

Nutrition Management

Skin Care

Education

8/8/2019 Pedi GU (1)

30/36

30

Nephrotic Syndrome

S&S(insidious)

periorbital edema

pitting dep edema

ascites o wt

nl B/P

anorexia, fatigue

abd pain

Nursing Care Infection Protection

Nutrition Mgmt

Fluid Mgmt

Fluid restriction during

massive edema

abd girth QS

lungs

Energy Mgmt

Coping Enhancement

Education (next slide)

8/8/2019 Pedi GU (1)

31/36

31

Parent Education for Nephrotic

Syndrome side effects of steroids

daily weights

urine testing

infection control

s/s relapse/worsening dz

no live virus vaccines while on steroids

8/8/2019 Pedi GU (1)

32/36

32

Wilms Tumor S&S

mobile abd mass

DO NOT

PALPATE!

Hematuria

HTN Abd pain

fatigue, malaise,

fever

PostopNursing

Care

Pain Mgmt Fluid Mgmt

NGT with cc/cc

replacement

Incision Care

Coping Enhancement

Education (next slide)

8/8/2019 Pedi GU (1)

33/36

33

Post Nephrectomy Parent

Education Chemo/Radiation

Skin Care (with

RT)

No contact sports!!!

Report GU s/s immediately!!

8/8/2019 Pedi GU (1)

34/36

34

CASE STUDY: Urinary Tract Infection

A 10 year old girl is visiting the pediatriciansoffice for the fifth time for UTI. Two ofher

past visits resulted in hospitalization for

treatment.

1. Determine necessary assessment data.

2. Determine medications that will be

administered.3. Develop a treatment/prevention teaching

plan.

CASE STUDY AGN

8/8/2019 Pedi GU (1)

35/36

35

CASE STUDY: AGNSeven year old Jason is hospitalized withAGN. Jason weighs

48 lbs. On admission his blood pressure is 110/60, pulse is 80,

resp rate is 18. His urine is dark brow

n and contains 3+protein. Output is 60 mL in 2 hours. Jasons mother states

that he has real puffy eyes in the morning. There is slight

periorbital edema on admission.

1. What other assessments should be made on Jason?

2. Explain the cause ofhis symptoms.

3. What MD orders should the nurse anticipate?

4. Explain to Jasons family the course ofhis illness.

5. What daily assessments should be made?

6. What assessment indicates Jason is improving?

7. Discuss home care needs after dischar e.

8/8/2019 Pedi GU (1)

36/36

36

THE END