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

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Presentation on theme: "Nursing Care of the Child with GU disorders Revised, Fall 2010."— Presentation transcript:

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

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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 meatus…staph 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 meatus…staph 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?

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10 Vesicoureteral Reflux Approximately 20% of children that have UTIs will be found to have vesicoureteral reflux on xray

11 What is vesicoureteral reflux?

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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

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16 Bladder Exstrophy

17 Exstrophy of the Bladder, cont. Treatment: surgical reconstruction done 1 st after birth Goals: –Bladder/abd wall closure –Preserve urinary function –Create normal appearing genitalia 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 >101; anorexia, pus or bleeding from stent, cloudy or foul smelling urine

19 Etiology and Pathophysiology Hypospadias:occurs 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

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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: a.Children will experience less pain b.Chordee may be reabsorbed c.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.

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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 > girls) Assessment/diagnostic tests:

34 What’s 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 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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