GENITOURINARY

ALTERATIONS IN CHLDREN

Heather Buccello

OBJECTIVES

Review anatomy & physiology of

genitourinary system
Discuss stressors and disorders of the
pediatric clients genitourinary system
Discuss nursing implementation and plan
of care with the pediatric clients with
genitourinary disorders

GENITOURINARY
ALTERATIONS

Pediatric Genitourinary Anatomy & Physiology

Newborns bladder is low in the abd. cavity,
gradually sinks into the pelvic cavity (3 yrs. of
age)
Young children have shorter urethras
predispose them to UTIs
Unlike adults most children with ARF regain
normal kidney function
By 6-12 months of age kidney function is nearly
like an adults
Children achieve complete bladder control by 4-5
yrs. of age

Urinary Tract Infection

Infection/Inflammation of any portion of

the urinary tract
Greater in girls than boys
Newborns
2-6 yrs old
During adolescents r/t STIs
Higher in girls than boys

UTIs

Assessment
Fever, chills, pain on urination, bed
wetting
Lethargy, constant squirming
Strong smelling urine, hematuria
Vomiting/diarrhea
Abdominal distention/ flank pain

UTIs

Nursing Intervention:
Antibiotics/analgesics/
I&O/UA/C&S
Assess patterns of urination
Assist with diagnostic procedures
Prevent infections

Vesicoureteral Reflux

ACUTE POSTSTREPTOCCAL
GLOMERULONEPHRITIS

Occurs after a streptococcal infection

Occurs in school age children (5 10 yrs.)
Incidence slightly higher in boys
Occurs soon after a URI or Impetigo
Incidence is higher in winter &
spring/summer

ACUTE POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS

Pathophysiology
The body responds to the STREPTOCCAL
bacteria by forming antibodies
The antibodies interact with the bacterial
antigens forming antigen/antibody complex
Immune complex inflame glomerulus
Causing tissue injury/damage to the capillary
walls
Ineffective filtration causes Na, H20 retention
EDEMA & OLIGURIA

UNHEALTHY KIDNEY

ACUTE POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS
Clinical Manifestations
Onset abrupt
Hematuria cardinal sign
Proteinuria
Oliguria
Mild edema / weight gain
Hypertension

ACUTE POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS

Diagnosis
History, presenting symptoms & laboratory
results
Recent URI (7-14days) or Impetigo (c/in 3
weeks)
BUN/Crt. elevated
Antistreptolysin O titer (ASO) generally
elevated
Urinalysis red blood cells & proteins

ACUTE POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS
Nursing Assessment
Assess for periorbital /lower extremity
edema
Monitor daily weights
Use appropriate size blood pressure cuff
Assess respiratory system
Monitor lab values

ACUTE POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS

Therapeutic Management
No specific therapy for this illness
Course of illness 1-2 weeks
Supportive care/medical management are
associated with the S/S.
Children with renal failure are hospitalized
Antihypertensive therapy
Normal diet limit salt intake

ACUTE POSTSTREPTOCOCCAL
GLOMERULONEPHRITIS

Nursing Interventions
Prevent the consequence of fluid excess
Provide adequate rest periods
Maintain skin integrity
Maintain nutritional status
Administer prescribed medications
Refer family to VNS
Provide family teaching

NEPHROTIC SYNDROME

Nephrosis: altered glomeruliu permeability

due to fusion of the glomeruli membrane
surface
Abnormal loss of protein in the urine
Nephrotic is thought to be cause by
antigen-antibody reaction or an
autoimmune process

NEPHROTIC SYNDROME

Refers to a kidney disorder characterized

by:
proteinuria
hypoalbuminemia
edema, & hyperlipidemia(increased blood
lipid levels)

NEPHROTIC SYNDROME

Pathophysiology
There is damage to the glomeruli membrane
causing increased permeability
Resulting in loss of plasma proteins albumin &
protein
Intravascular fluid shifts into the interstitial spaces
hypovolemia, decreases blood volume
Kidneys conserve Na& H2O edema
Liver increases the productions of lipoproteins to
compensate for protein loss increased lipids in
the blood -- hyperlipidemia

NEPHROTIC SYNDROME
Clinical Manifestations
Proteinuria
Hypoalbuminemia
Edema & ascites
Hyperlipidemia
Hypovolemia (decr. Intravascular volume,
incl.renal blood flow)
Pallor, fatigue, irritable

NEPHROTIC SYNDROME

A.
B.

C.

Classification
Congenital-autosomal recessive disorder
Secondary glomerulonephritis is
associated with a systemic disease,
systemic lupus erythematosus (SLE, and
sickle cell anemia)
Idiopathic (primary) - most common

NEPHROTIC SYNDROME
Incidence
MCN - Minimal change nephrotic syndrome
Occurs most frequently between the ages
2-6 years
Slightly higher in boys
Prognosis is very good children respond
well to therapy

NEPHROTIC SYMDROME
Diagnostic Evaluation
Clinical presentation, age of the child
Laboratory results
- urinalysis marked proteinuria
- serum cholesterol, Hct., Hgb.- increased
- serum albumin decreased
- ESR elevated (erythrocyte sedimentation
rate)

NEPHROTIC SYNDROME

a.
b.
.
.
.

Therapeutic Management
Corticosteriod therapy Prednisone
Educate parents about side effects
cushingoid appearance
Do not stop medication abruptly
Diuretics not commonly used if used check
for hypokalemia
Pain medication -- discomfort
IV albumin correct hypoalbuminemia

NEPHROTIC SYNDROME

NOTE:
BEFORE TREATMENT
TEST THE CHILD FOR EXPOSURE TO
TB & VARICELLA TREATMENT
SUPRESSES THE IMMUNE SYSTEM

NEPHROTIC SYNDROME

Nursing Interventions
Administer medications as ordered
Obtain daily weights; monitor I&O
Change position frequently / HOB elevated
Diet increase protein / K+ intake, avoid
foods high in Sodium
Provide parent support

Nephroblastoma (Wilms Tumor)

A malignant neoplasm of the kidney

Most common cause of renal cancer in
children
Peak > 3 yrs old Boys>girls
Maybe r/t cryptochordism ,hypospadias to
name a few

Wilms Tumor

Wilms Tumor

Probably arise from a malignant cluster of

mesoderm cells during gestation
Tumors are usually encapsulated for
extended periods of time
Rupture of the capsule> spread(seeding)
of tumor into the abdomen
STAGES
Metastasis > to the lungs

Clinical manifestation:

Firm, nontender mass

Abdominal enlargement
Periorbital edema c ecchymosis around
the eyes
Hematuria/Low grade temp/
Anemia r/t decr.erythropoetia production
Respirator involvement SOB

Diagnosis (Wilms Tumor)

IVP
Cat scan, MRI
Treatment:
Surgical removal of tumor ASAP
Radiation and chemotherapy

NEPHROBLASTOMA

Management:
Depends on stage of disease and extent
of metastasis
Stage 1-11 surgery and close observation
Stage 111-1V Chemo/Radiation, then
surgery after tumor has shrunk
Children < 1 yr old good prognosis

Nursing Interventions:

Avoid palpating abdomen

Pre op for surgery
Post op
Assess labs/VS
Strict I & O

HYPOSPADIAS / EPISPADIAS

HYPOSPADIAS

Congenital anomaly in which the actual

opening of the urethral meatus is not at
the end of the penis but on the ventral
aspect of the penis

HYPOSPADIAS
Etiology/Incidence
Anomaly fairly common
Occurs in 1:300 male newborns
Risk if either father /sibling has the
anomaly

HYPOSPADIAS

Pathophysiology
Occurs because of incomplete development of
the urethra in utero
Displacement of the urethral meatus does not
usually interfere with urinary incontinence
Ventral placement might interfere with fertility in
the mature male if left uncorrected

HYPOSPADIAS
Assessment
Male infants need to be inspected @ birth
Male infants have short chordee
Inspect male infants for cryptorchidism
(UNDESCENDED TESTES)

HYPOSPADIAS
Diagnosis
Based on physical exam
There is no laboratory /diagnostic findings
to confirm a diagnosis

HYPOSPADIAS
Therapeutic Management
Correction is done by surgical intervention
Surgeon releases the chordee, lengthens
the urethra, positions the meatus at the
penile tip & reconstructs the penis
Usually done in one stage/outpatient basis
between 6-12 months of age

HYPOSPADIAS
Post-op
Indwelling urinary catheter/urethral stents
in place
May experience painful bladder spasms
antispasmodic Ditropan
analgesic - Tylenol

HYPOSPADIAS

Nursing Interventions
Provide parents with detailed pre/post op
teaching
Parents should be able to demonstrate proper
care of catheter before discharge
Monitor fluid I&O, urinary pattern & encourage
fluids
Teach s/s regarding UTI
Allow parents to verbalize feelings

EPISPADIAS
Congenital anomaly
Urethral opening is located in the dorsal
surface of the glans of the penis
RARE

Critical Thinking

Patient with Pyelonephritis:

To assess the patients renal status, the nurse
should monitor for which lab tests? Select all
that apply:
a. serum sodium and potassium levels
b. arterial blood gases
c.hemoglobin
d. serum blood urea nitrogen
e. creatine levels
f. urinalysis

d,e

Serum BUN and creatinine are the test

most commonly used to assess renal
function with creatinine being the most
reliable
non renal may affect BUN as well as
sodium and potassium. Arterial blood
gases and hemoglobin are not indicators
Urinalysis is a general screening test

needle biopsy? Select all that

apply

1. Assess the biopsy site

2. Take vital signs every hour
3. Assess urine for hematuria
4. Place the pt in prone position
5. assess the pt for chest pain

1, 3, 4

The nurse should assess the site for

bleeding and hematuria. The pt should
remain prone for 8-24. VS s/b q 5-15 mins
first hour then less if stable
A renal biopsy does not pt at risk for chest
pain