N220 Exam 1 OLOL - Genitourinary Disorders in the Pediatric Client

* the function of the GU system is to:
- regulate the body's fluid and electrolyt status
- remove metabolic waste products and toxins from the body

* The infant's kidneys and renal system are immature
- inefficient regulation and concentration of solutes and waste products

-

-

Disorders of the GU system cause:
-Fluid and electrolyte (LISTEN TO TAPE)

-

-

-definition

-definition

-
--replace foreskin after stretching
--stretch several times a day & replace

-constriction of the tight band of foreskin
-obstructs blood supply to penis
-medical emergency

Very Important
-Teach child how to clean self

-A failure of one or both testes to descend normally through the inguinal canal into the scrotum
--descending normally occurs around 7 to 9 months of gestation

-common

-affects 3-4:100 males

-affected side looks empty
--not full, does not have rugae (wrinkles)
--empty to palpation

-Need to differentiate between retractile (stimulated) and undescended testicle
-Diagnosis: Manual examination of scrotal contents first 2 years of life

-self correction
--spontaneously by 1 year of age if retractile
--true undescended rarely have spontaneous correction

-Surgial correction
--orchioplexy between age 1 and 2
--varies from simple to complicated
--hormone trials to induce leutenizing and HCG hoemones - usually try before surgery

-Nursing: wound care & education

-a congenital anomaly in which the urinary meatus in male is located on the VENTRAL (underside, towards scrotum) aspect of the penis

-common
--1:150 incidence
--familial tendency
--varying degrees of severity

-varying degrees
-may be just below the tip of the penis in mild cases
-In severe cases may be located on the scrotum
-Associated with chordae:
--penis curves downward because of fibrous band of tissue)

-associated with Cryptorchidism

-surgical intervention 6-18 months
-before child has mutilation fears
--worse time is preschool age/mutilation fears

-goals:
--to increase ability to stand and void
--normalize appearance of penis
--maintain potential sexual fx
--**avoid circumcision - may need skin to repair

The same as hypospadias, except the meatus is on the dorsal (top) and is way less common
-care is the same

-Pre-operative
-Post-operative
-Nursing Implications
-Discharge Instructions

-

-

-

-Home care includes teaching:
--no sand, dirt
--no riding toys

-

-primary enuresis
-secondary enuresis
-diagnosis
-treatment

-child has never achieved complete bladder control

-child has achieved a period of bladder control

-Determine cause
---listen to tape

-Ditropan: relaxes the smooth muscles of the bladder
-Tofranil: ....
-remind child to use toilet every 2 hours
-decrease fluids after 5 pm
-emotional support

-A twisting of the testicle upon the spermatic cord
-most frequently occurs in 10-14 years old and after trauma

-Emergency

-Sudden onset of:

-recognition is essential
--school nurse, ED nurse must recognize

-Surgical Emergency

-a group of diseases (immune mediated diseases) presumed to be a result of immune complex formation and glomerular deposition
-ranges from mild to severe
-peak onset: early school age, uncommon in younger
-highest in children who are 6-7 years
-2:1 males

-most common cause is post-streptococcal
-only certain strains of streptococcal organisms (Group A Beta hemolytic) are associated with AGN
--strep pharyngitis - winterm early spring
-strep impetigo - ... (listen to tape)

-group A beta-hemolytic streptococcal infection
-APSGN develops 1-2 weeks later
-antibody-antigen complexes becomes lodged in the glomeruli
--leads to inflammation and obstruction

-damaged glomerular membrane allows RBCs to be excreted

-sodium and water are retained
--expands the intravascular and interstitial compartments
--leads to edema

-gross hematuria
-edema: face, periorbital, abdomen, lymphs
-pallor, lethargy
-irritability
-headache
-abdominal pain
-costovertebral tenderness
-anorexia
-painful urination
-elevated blood pressure, mild to moderate
-urine: smoky, cloudy, brown, reduced volume, coke or tea colored

-acute phase (previous manifestations)
--4-10 days, can last 2-3 weeks

-diuresis: 1st sign of improvement
--massive diuresis
--feels better
--decreased HTN & hematuria
--microscopic hematuria for several months

-convalescence
--weeks to months

-Encephaly
-cardiac decompensation
-acute renal failure
-skin breakdown from edema
-chronic renal disease

-

-

-

-Urinalysis
--hamaturia
--proteinuria: 3-4+
--increased SPGR

-increase BUN, Increase CRT

-normal electrolytes unless progressed to renal failure

-serologic testing for antecedent streptococcal infection
--ASO titer: antistreptolycin titer to detect strep
--sed rate: nonspecific

-Anemia (hemodilution_

-

-

-genitourinary
-cardiovascular
-neurologic
-gastrointestinal
-EENT
-Hematologic
-Integumentary

-

-

-

-

-

-

-

-See Slide

Should be 1 to 2 ml/kg per hour

-

-

-

-

-

-

-

-

-

-Insiduous
-gradual, over days to weeks, sometimes missed

-morning periorbital/sacral shifts to scrotal/labial during day
-causes (...LISTEN TO TAPE)

----(...LISTEN TO TAPE)

-

-

-

-History and S&S
-UA findings:
---(...LISTEN TO TAPE)
-Serum findings
---(...LISTEN TO TAPE)

(...LISTEN TO TAPE)

(...LISTEN TO TAPE)

DAILY WEIGHTS required to assess edema

see slide

-

-

-

-

-Training depends on the toddler's emotional readiness
--the toddler acts to please others
--trusts enough to give up body products, and begins autonomous behavior
--the parents must be committed to establishing a toileting pattern and must communicate well with the toddler, offering praise for success but no punishment for failure

-Training also depends on the toddler's physical readiness
--

-Toilet sitting begins at age 18 months, once every 2 waking hours
--

-