Providing Patient Centered Care for the Child Experiencing a Genitourinary Disorder Marlene Meador RN, MSN, CNE - PowerPoint PPT Presentation

Loading...

PPT – Providing Patient Centered Care for the Child Experiencing a Genitourinary Disorder Marlene Meador RN, MSN, CNE PowerPoint presentation | free to download - id: 50add7-OWYyO



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Providing Patient Centered Care for the Child Experiencing a Genitourinary Disorder Marlene Meador RN, MSN, CNE

Description:

... tablet or nasal ... urinary tract usually normal 1:400,000 live births Treatment is surgical reconstruction in stages Goals of Surgical Reconstruction ... – PowerPoint PPT presentation

Number of Views:119
Avg rating:3.0/5.0
Slides: 62
Provided by: acc149
Learn more at: http://www.austincc.edu
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Providing Patient Centered Care for the Child Experiencing a Genitourinary Disorder Marlene Meador RN, MSN, CNE


1
Providing Patient Centered Care for the Child
Experiencing a Genitourinary Disorder Marlene
Meador RN, MSN, CNE
2
Pediatric Differences in the Urinary Tract
  • Kidney function
  • Bladder capacity
  • Bladder control
  • Recovery

3
Enuresis
  • Difficulty with urination control
  • Nocturnal Enuresis at night
  • Diurnal Enuresis during the day
  • Primary Never having experienced a period of
    dryness
  • Secondary Occurs when a 6-12 month of dryness
    has preceded the onset of enuresis

4
Possible Cause
  • Physical
  • Bladder capacity
  • Urinary tract abnormality
  • Neurologic alterations
  • Obstructive sleep apnea
  • Constipation
  • UTI
  • Pinworm infestation
  • Diabetes mellitus
  • Voiding dysfunction

5
Treatment
  • Limit fluids after supper and void before bed
  • Imagery
  • Let child keep record of progress
  • Rewards can be used
  • Behavioral use of alarm that detects moisture
  • Imipramine HCL Tricyclic Antidepressant
  • Despropressin acetate tablet or nasal spray
    which has antidiuretic effect
  • Address the emotional side with all involved

6
Risk Factors
  • Emotional
  • Family disruption
  • Inappropriate pressure during training
  • Inadequate attention to voiding cues
  • Decreased self-esteem
  • Sexual abuse

7
Diagnosis
  • Diagnosis is based on history and symptoms
  • Repeated involuntary voiding or incontinence past
    the age of toilet training.
  • Urinalysis and culture are done
  • Measurement of urine flow and bladder capacity
    with voiding cystourethrogram

8
Treatment
  • Limit fluids after supper and void before bed
  • Imagery
  • Let child keep record of progress
  • Rewards can be used
  • Behavioral use of alarm that detects moisture
  • Imipramine HCL Tricyclic Antidepressant
  • Despropressin acetate tablet or nasal spray
    which has antidiuretic effect
  • Address the emotional side with all involved

9
Nursing Diagnoses
  • Situational low self-esteem related to bed-
    wetting or urinary incontinence
  • Impaired social interaction related to bed-
    wetting or urinary incontinence
  • Compromised family coping related to negative
    social stigma and increased laundry load
  • Risk for impaired skin integrity related to
    prolonged contact with urine

10
Urinary Tract Infections
  • Etiology and Pathophysiology
  • Why are girls more likely to have a UTI than
    boys?
  • What is the most common causative pathogen?
  • May be bacterial, viral or fungal infection

11
Assessment
  • Typical symptoms of older children adults
  • Dysuria
  • Frequency urgency
  • Burning
  • Hematuria (usually older child)
  • Symptoms for infants and young children can be
    vague and nonspecific
  • Fever
  • Mild abdominal pain
  • Enuresis
  • If severe High fever, flank pain, vomiting,
    malaise

12
Diagnostic Tests
  • Urine for culture and sensitivity
  • Clean catch
  • Suprapubic aspiration
  • Catheterization
  • Positive Urinalysis
  • Bacteria colony count of more than 100,000/ml.
  • Presence of protein

13
Therapeutic Interventions
  • Drug Therapy
  • Antibiotics
  • Analgesics Tylenol
  • Antipyretic
  • Nursing Care
  • Force fluids for rehydration
  • Prescribed antibiotics
  • Promote comfort

14
Therapeutic Interventions
  • Parent Teaching
  • Change diaper frequently
  • Teach girls to wipe front to back
  • Discourage bubble baths
  • Encourage children to drink periodically during
    the day
  • Bathe daily
  • Adolescent start menstruating encourage change
    of pad every 4 hours
  • When girls become sexually active teach to
    urinate immediately after intercourse

15
Evaluation
  • Follow up
  • Return for repeat urinalysis usually after 72
    hours of treatment to be sure treatment is
    working
  • Girls who have more than three UTIs, and boys
    with first UTI should be referred to urologist
    for further evaluation.

16
Vesicoureteral Reflux
17
Pathophysiology
  • Urinary Reflux defective ureterovesicular valve
    that guards the entrance from the bladder to the
    ureter
  • Primary reflux congenital abnormality
  • Secondary reflux repeated UTIs
  • Neurogenic bladder stronger than usual bladder
    pressure.
  • Backflow while voiding when bladder contracts,
    urine is swept up the ureters
  • Stasis of urine in ureters or kidneys which in
    turn leads to hydronephrosis

18
Assessment
  • Fever
  • Vomiting
  • Chills
  • Straining or crying on urination, poor urine
    stream
  • Enuresis (bedwetting), incontinence in a toilet
    trained child, frequent urination
  • Strong smelling urine
  • Abdominal or back/flank pain

19
Diagnostic Tests
  • Urine culture
  • Voiding Cystourethrogram
  • Renal ultrasound

20
Therapeutic Interventions
  • Drug Therapy
  • Antibiotics
  • Penicillin
  • Cephalosporins
  • Urinary Antiseptics
  • Nitrofurantoin
  • Surgery
  • Repair of significant anatomical anomalies,
    uretheral implantation

21
Nursing Care
  • Keep accurate record of intake and output
  • Secure stents and catheter
  • Assess vital signs
  • Assess comfort level
  • Patient Teaching

22
Evaluation
  • Follow-up
  • Repeat VCUG (voiding cystourethrogram) after a
    few months

23
Test Yourself
  • Which of the following organisms is the most
    common cause of UTI in children?
  • a. staphylococcus
  • b. klebsiella
  • c. pseudomonas
  • d. escherichia coli

24
Bladder Exstrophy
  • A rare defect in which the bladder wall extrudes
    through the lower abdominal wall
  • Due to failure of abdominal wall to close in
    fetal development
  • Upper urinary tract usually normal
  • 1400,000 live births
  • Treatment is surgical reconstruction in stages

25
Goals of Surgical Reconstruction
  • Bladder and abdominal wall closure
  • Urinary continence, with preservation of renal
    function
  • Creation of functional and normal appearing
    gentitalia
  • Improvement of sexual functioning

26
Nursing Care
  • Pre-op focus-prevent infection
  • Post-operative focus Immobilize to promote
    healing of surgical site
  • Monitor renal function assess IO and urine
    chemistries to detect renal damage
  • Maintain patency of drainage tubes
  • Analgesics
  • Antibiotics as ordered
  • Emotional support of parents

27
Epispadias
Hypospadias
28
Etiology and Pathophysiology
  • Epispadias rare and often associated with
    extrophy of bladder.
  • Hypospadias
  • Occurs from incomplete development of urethra in
    utero.
  • Occurs in 1 of 100 male children. Increased risk
    if father or siblings have defect.

29
  • Hypospadias

30
Assessment
When is this anomaly typically diagnosed?
31
Interventions
  • Medical Treatment
  • Do NOT circumcise infant. May need to use
    foreskin in reconstruction.
  • Surgery
  • Reconstructive repositions uretheral opening at
    tip of penis
  • Chordee released and urethra lengthened.

32
Clinical Judgment
  • What is the rationale for the corrective surgery
    occurring prior to the childs first birthday?
  • a. the procedure is less painful for a child
  • b. chordee may be reabsorbed
  • c. the child has not developed body image
  • and castration anxiety
  • d. the repair increases the ease of toilet
    training

33
Postoperative Nursing Care
  • Assess bleeding
  • Maintain urinary drainage
  • Control Bladder Spasms
  • Prophylactic antibiotics
  • Control Pain
  • Increase fluid intake

34
  • Do not allow to play on any straddle toys.
  • Prevent infection
  • Call Dr if
  • temp is over 101
  • loss of appetite
  • pus or increased bleeding from stent
  • cloudy or foul smelling urine

35
Cryptorchidism
  • Failure of one or both of the testes to descend
    from abdominal cavity to the scrotum

36
Therapeutic Interventions
  • Surgery
  • Orchiopexy done via laproscopy
  • Done around 1 year of age
  • Nursing Care Post-op
  • Assess from bleeding and S/S of infection.
  • Minimal activity for few day to ensure that the
    internal sutures remain intact
  • Allow opportunity to express fears about
    mutilation or castration by playing with puppets
    or dolls.

37
Acute Glomerulonephritis
38
Etiology and Pathophysiology
  • Usual organism Group A beta-hemolytic
    streptococcus
  • Organism not found in kidney
  • Glomeruli become inflamed
  • and scarred

39
  • Edema renal capillary permeability with renal
    vascular spasms
    glomerular filtration
  • accumulation of Na and H2O in the blood stream
    causing increased intravascular and interstitial
    fluid volume
  • Proteinuria Protein molecules filter through
    the damaged glomeruli
  • Hematuria RBCs can pass through to the urine

40
Manifestations
  • Common in boy 5-10 years old. Occurs 1-2 weeks
    after a respiratory infection or after impetigo.
  • Has 2 phases
  • Edematous phase 4-10 days
  • Diuresis phase- self limiting

41
Assessment
  • 1. Renal
  • a. Moderate proteinuria
  • b. Sudden onset of hematuria (tea-colored,
    reddish-brown, or smoky) and next develops
    oliguria
  • c. Excessive foaming of urine

42
Assessment Cont
  • 2. Cardiovascular
  • a.  Edema-usually eyes, hands, feet, not
    generalized (dependent edema)
  • b.  Hypertension from hypervolemia which can lead
    to
  • c.  Cardiac involvement CHF- orthopnea / dyspnea,
    cardiac enlargement, pulmonary edema

43
Assessment cont
  • 3.Neuro
  • a. Encephalopathy
  • headache
  • irritability
  • convulsions
  • coma-from cerebral edema

44
Test Yourself
  • A 6 year old is admitted with R/O acute
    glomerular nephritis which of the following
    symptoms is the child most likely have?
  • a. normal blood pressure, diarrhea
  • b. periorbital edema, grossly bloody urine
  • c. severe, generalized edema, ascites
  • d. severe flank pain, vomiting

45
Diagnostic Tests
  • Urinalysis- protein (moderate), RBC's, WBC's,
    Specific Gravity elevated.
  • All children should have a urinalysis 2 wks
    after strep infection.
  • Blood-
  • ASO titer (antistreptolysin O) (antibody
    formation against Streptococcus) is elevated,
    indicating a recent streptococcal infection
  • ESR (erythrocyte sedimentation rate) elevated
    showing inflammatory process
  • BUN (urea nitrogen) creatinine elevated
    indicating glomerular damage
  • CBCWBCs normal range, HH decreased.
  • Lytes elevated potassium, low serum bicarbonate

46
Therapeutic Interventions
  • 1. Depends on the severity of the disease.
  • No specific treatment, supportive care.
  • 2. Treat at home if normal BP adequate
    output.
  • 3. Must be hospitalized if
  • BP increases
  • gross hematuria
  • oliguria present.
  • To monitor for complications
  • Rarely develops into acute renal failure

47
Main Goals Relieve Hypertension and
Re-establish fluid and electrolyte balance
  • Keep accurate record of IO.
  • Record characteristics of urine output
  • Check and record specific gravity with each
    voiding
  • Monitor vital signs and neuro vital signs
  • Monitor and record amount of edema at least once
    a shift.

48
  • Interventions cont
  • Daily weights
  • Bed rest for 4-10 days during acute phase
  • Oxygen therapy
  • Diet therapy
  • Drug therapy

49
Clinical Judgment
  • A child is admitted and diagnosed with having
    AGN. Prioritize the following nursing
    diagnoses.
  • a. fluid volume excess
  • b. risk for impaired skin integrity
  • c. anxiety
  • d. activity intolerance

50
Clinical Judgment
  • When teaching parents about known
  • antecedent infections in acute
  • glomerulonephritis, which of the following
  • should the nurse cover?
  • a. Herpes simplex
  • b. Streptococcus
  • c. Varicella
  • d. Impetigo

51
Nephrotic Syndrome
  • Chronic renal disorder in which the basement
    membrane surfaces of the glomeruli are affected,
    causing loss of protein in the urine.

52
Etiology and Pathophysiology
  • Insidious onset with periods of remission /
    exacerbations throughout life- No cure
  • Idiopathic cause (95) immune response is
    strongly suspected.
  • Other causes may develop after acute
    glomerulonephritis, sickle cell disease, Diabetes
    Mellitus, or drug toxicity.
  • Age of onset preschool yrs.- 2-4 yrs, males more
    common
  • Increased permeability which allows protein to
    leak into the urine (proteinuria).
  • Shift of protein out of the vascular system
    causes fluid from the plasma to seep into the
    interstitial spaces and body cavities,
    particularly the abdomen (ascites). Edema and
    hypovolemia

53
Nephrotic Syndrome Assessment Findings
  • Four most common characteristics
  • Massive proteinuria
  • Low serum albumin (K normal)
  • Edema
  • Malnourishment

54
Assessment
  • Hyperlipidemia
  • Shiny, pale skin
  • Brittle hair
  • Hypercoagulability (increased risk for
    thrombosis)
  • Fatigue
  • Abdominal pain (ascites)

55
Ask Yourself?
  • Which of the following signs and symptoms are
    characteristic of minimal change nephrotic
    syndrome?
  • a. gross hematuria, proteinuria, fever
  • b. hypertension, edema, fatigue
  • c. poor appetitie, proteinuria, edema
  • d. body image change, hypotension

56
Diagnostics
  • Based on history
  • Characteristic symptoms
  • Lab findings with serum albumin and sodium
    decreased
  • BUN, Cholesterol and Electrolytes may be ordered
  • Urinalysis reveals massive proteinuria (50
    mg/kg/day) (primary indicator of nephrotic
    syndrome)

57
Therapeutic Interventions
  • Reduce edema
  • Keep accurate record of IO. Measure abdominal
    girth, weigh daily
  • Test urine for protein and specific gravity to
    see if tx is effective
  • Diet
  • Normal diet for childs age recommended
  • No salt added
  • High caloric
  • Possible fluid restrictions

58
Treatment
  • Diuretics-cautious use
  • Antihypertensive
  • Antibiotic
  • Analgesics
  • Albumin if resistant to diuretic
  • Protective Isolation

59
Interventions
  • Provide good skin care edematous tissue fragile
  • Child / Parent teaching measures to prevent
    infections, medication administration, monitoring
    of intake and output
  • Provide rest periods

60
Prognosis
  • Usually spontaneous resolution even with relapses
    (by age 30)
  • 20 may develop chronic renal failure

61
If you have any questions or concerns regarding
this presentation please contact Marlene Meador
RN, MSN, CNE mmeador_at_austincc.edu
About PowerShow.com