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Nursing Care of the Child with GU disorders

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Slide 12 Treatment for vesicoureteral reflux Diagnostics: VCUG Slide 15 Bladder Exstrophy Exstrophy of the Bladder, cont. Nursing care, cont ... – PowerPoint PPT presentation

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Title: Nursing Care of the Child with GU disorders


1
Nursing Care of the Child with GU disorders
  • Revised, Fall 2010

2
Enuresis
3
Enuresis Multitreatment approach
  • Fluid restriction
  • Bladder exercises
  • Timed voiding
  • Enuresis alarms
  • Reward system
  • Medications

4
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
    meatusstaph as well as e.coli

5
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
    meatusstaph as well as e.coli

6
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

7
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

8
FYI
  • The single most important host factor influencing
    the occurrence of UTI is urinary stasis
  • What is the chief cause of urinary stasis?

9
Obstructive Uropathy
10
Vesicoureteral Reflux
  • Approximately 20 of children that have UTIs will
    be found to have vesicoureteral reflux on xray

11
What is vesicoureteral reflux?
12
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13
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

14
Diagnostics VCUG
15
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16
Bladder Exstrophy
17
Exstrophy of the Bladder, cont.
  • Treatment surgical reconstruction done 1st
    24-48 after birth
  • Goals
  • Bladder/abd wall closure
  • Preserve urinary function
  • Create normal appearing
  • genitalia
  • -improvement of sexual function

18
Nursing care, cont.
  • Control bladder spasms
  • Control pain
  • Increase fluid intake
  • Do not allow to play on straddle toys
  • Prevent infection (no bathing or swimming until
    stents removed
  • Call dr if temp gt101 anorexia, pus or bleeding
    from stent, cloudy or foul smelling urine

19
Etiology and Pathophysiology
  • Hypospadiasoccurs from incomplete development of
    urethra in utero
  • Defect ranges from mild to severe
  • Undescended testes may also be present
  • Might interfere with fertility in the mature male
    if not corrected
  • Epispadias rare and often associated with
    extrophy of bladder

20
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21
  • Epispadias
  • Congenital urethral defect in which the uretheral
    opening is on the upper aspect of the penis and
    not on the end

22
Assessment
Usually discovered during Newborn
Physical Assessment
23
Ask yourself?
  • Why would the nurse question an order to prepare
    the infant for a circumcision?

24
  • The reason for surgery at
  • About 1 year of age is
  • Because
  • Children will experience less pain
  • Chordee may be reabsorbed
  • The child has not developed body image and
  • castration anxiety
  • d. The repair is easier before toilet training

25
A double diapering technique protects the urinary
stent after surgery. The inner diaper collects
stool and the outer diaper collects urine.
26
Cryptorchidism
27
Cryptorchidism
  • Defined as failure of one or both testes to
    descend
  • Treatment
  • Objective of treatment

28
Therapeutic interventions for undescended testes
  • Surgery Orchiopexy done via laproscopy (around
    1 yr of age)
  • Post-op nursing care minimal activity for few
    days, allow to express fears about castration,
    mutilation by playng with puppets or dolls

29
Why is it important that the Testes are in the
scrotal sac?
30
Answer
  • The higher temperatures in the abdomen than in
    the scrotum results in morphologic changes to the
    testes-mainly concerned with lower sperm counts
    at sexual maturity

31
Assessment on NB exam
32
Glomerular diseases
  • Nephrotic syndrome (MCNS) or minimal-change
    nephrotic syndrome
  • Acute glomerulonephritis (AGN)

33
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 gt girls)
  • Assessment/diagnostic tests

34
Whats really happening in AGN?
Decreased glomerular filtration leads to inc. Na
and H2O Protein molecules filter thru
damaged glomeruli Damage leads to hematuria High
B/P heart failure may ensue Phases edematous
(4-10 days) Diuresis phase
35
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

36
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

37
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

38
Nephrotic syndrome
39
Nephrotic syndrome, cont
40
Contrast of normal gloumerular activity with
changes seen in Nephrotic Syndrome
41
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

42
Child with nephrotic syndrome
43
Therapeutic management
  • Corticosteroids (prednisone)
  • Dietary management
  • Restriction of fluid intake
  • Prevention of infections
  • Monitoring for complications infections, severe
    GI upset, ascites, or respiratory distress

44
Critical thinking for client undergoing urinary
tract surgery
  • The Scotts are receiving pre-op instructions
    before their son Davids 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 Davids discharge from the hospital
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