The Child with Genitourinary

Alterations

By Susan Sienkiewicz

1
 Review Quiz: GU System
1 Name the functional unit of the kidney.
2 Name three functions of the kidney.
3 Name two hormones secreted by the kidney and the main
purpose of each.
4 For the following U/A results, indicate which are abnormal:
• trace protein, 1+ glucose, RBC’s: 0-1/HPF, WBC’s: 2-

4/HPF, Ketones: negative, Moderate casts, s.g.: 1.003

5 Name two blood tests that reflect renal function.
6 Name three diagnostic tests that assess the structure of the
urinary system.

2
Urinary Elimination Management
 Perineal Hygiene

wipe front to back

 fluids

do not hold urine

use cotton panties

3
 Skin Care
 Change position Q2H
 Daily bath
 Support edematous extremity
 Bed cradle/loose clothing after orchiopexy
 Incision care
 Protect Skin with Bladder Exstrophy

Preop - cover exposed bladder, use skin prep to
protect from urine leakage

Postop - Bryant’s traction or sidelying position to
protect incision
• Check peripheral circulation
• Skin care for skin traction 4
 Strict I/OFluid Management

Maintain Fluid Restriction
• Divide fluid restriction b/w waking hours
• serve fluids in small cups
• hard candies to keep mouth moist

Or Maintain Maintenance or Hydration
Fluids
• 100 mL/kg/day X 1st 10 kg . . .

1-2 ml/kg/hr u/o

label all tubes (post op)

maintain patency of tubes (ureteral
5
reimplantation for VUR)
Fluid Management, continued

Assess for s/s dehydration

Daily weight (same time,
same scale)

Assess edema

Monitor electrolytes
6
 Body Image Enhancement
 Encourage expression of feelings
 Discuss transient effects of steroids

7
 Infection Protection
  VS & s/s infection
 Frequent diaper changes (orchiopexy,
hydrocelectomy)
 Cover exposed bladder (exstrophy) &
protect surrounding skin with sealant
 Skin care
 Protect A-V shunt (hemodialysis) or
Tenchkoff Catheter (peritoneal dialysis)
 Avoid exposure to infectious individuals
 No live viral vaccines while on steroids 8
Coping Enhancement Strategies
 Allow parents to vent concerns
 Promote bonding

encourage participation in care
 Allow child to vent embarrassment
(enuresis)

extra set of clothes at school
9
 Energy Management
 Promote rest
 cluster care
 limit visitors
 quiet diversion
 quiet play X 2 wks with AGN, no
competitive play X 6-12 wks until
proteinuria resolves
 Fowler’s position to facilitate breathing
(NS, ARF, CRF, HUS)
10
 Patient/Family Education
 Compliance with med regime
 Infection Control
 Perineal Hygiene with UTI
 Use of bedwetting alarms (enuresis)
 Importance of f/u
 S/S to report to MD
 Fluid management
(restriction/hydration)
11
 Pt/Fam Education, continued
 Diet restriction
 Activity Restriction
 Daily Weights (AGN, NS, ARF, CRF,
HUS)
 Urine testing for protein (AGN, NS)
 Monthy STE for cryptorchidism
 Dialysis (ARF, CRF, HUS)
 Post transplantation care (CRF)
 Chemo, radiation (Wilm’s Tumor) 12
 Nutrition Management
 Small meals, preferred foods
 NAS (ARF, CRF, NS, HUS)
  Protein (NS)
  Protein (AGN, ARF, CRF, HUS)
  Na+,  K+ (AGN, ARF, CRF,
HUS)
  Ca++,  PO4- (ARF, CRF) 13
 Pain Management
 Tylenol (15 mg/kg/dose)
 Tylenol #3 (codeine 0.5-1 mg/kg/dose)
for postop pain
 Anticholinergics/Antispasmodics
(Oxybutrin chloride/Ditropan) for
bladder spasms (VUR, hypospadias
repair)
 No straddling on hip or toys
(hypospadias repair, orchiopexy) 14
Vesicoureteral Reflux (VUR)
 Manifestations  Nursing care

recurrent UTI’s 
Education (med

enuresis compliance, f/u)

flank/abd pain

Post op care

grade I-V VCUG • Pain Mgmt
• Fluid Mgmt

15
16
17
18
19
 Hypospadias/Epispadias
 Nursing Care
 Manifestations  Pain Mgmt
 abnormal 
Analgesics
placement of 
Antichol (Ditropan)
urethra 
Maintain tube
 small foreskin patency

no straddling
 short chordee (band

maintain penile
that curves penis  pressure dsg
 Fluid Mgmt
 Educ 20
 Cryptorchidism
 Manifestations  Nursing Care
 testes not palpable  Pain Mgmt
 Infection Protection
 Education

STE

possibility of
infertilty
21
 Hydrocele
 Manifestations  Nursing Care
 painless scrotal  Education
swelling 
infection control
 smooth (fluid- 
no activity
filled) mass restrictions

22
 Inguinal Hernia
 Manifestations  Nursing Care
 groin swelling   Preop
with abd pressure 
 for
 strangulation/incarc strangulation
eration  Postop

redness 
 bldg, drainage

inconsolability 
 recurrence

vomiting  Education

abd dist
 heart rate
23

 Bladder Exstrophy
 Manifestations  Nursing Care

exposed bladder  Infection Protection
mucosa  Skin Care

urine leakage  Postop

bifid clitoris 
Fluid

short stubby Management
penis 
Coping

widened s. pubis Enhancement
 waddling gait 24
 UTI  Children
 Infants

abd pain

fever or  temp 
frequency

irritability 
urgency

poor feeding 
dysuria

vomiting 
enuresis

 in color/odor of urine 
fever > 101

CVAT, (back pain)

n/v with pyelonephritis
• Nursing Care 
hematuria
•Fluid Mgmt
•Fever Mgmt
•Education 25
Perineal Hygiene
(to prevent UTI)

 Wipe front to back

  fluids
 don’t hold urine
 no bubble baths
 cotton panties

26
 Enuresis
 Manifestations  Nursing Care
 dribbling  Education
 urgency  Coping
 infreq/painful vdg Enhancement
 straining
 incontinence

27
 S&S (abrupt)
AGN  Dx Eval

hematuria 
U/A  +RBC’s,casts,

proteinuria prot,  s.g.

dep edema 
urine cx neg

periorbital edema 
 BUN, creatinine

 U/O 
+ antistreptolysin O

fatigue, irritability titer

 B/P
 symptoms appear 10
days after strep
infection
28
 AGN: Nursing Care

 Energy Management
 Fluid Management (restriction)
 Nutrition Management
 Skin Care
 Education

29
 Nephrotic Syndrome
 S&S(insidious)
 Nursing Care

periorbital edema
 Infection Protection

pitting dep edema  Nutrition Mgmt

ascites  Fluid Mgmt

 wt 
Fluid restriction during

nl B/P massive edema

anorexia, fatigue

 abd girth QS

abd pain

 lungs
 Energy Mgmt
 Coping Enhancement
 Education (next slide)
30
 Parent Education for Nephrotic
Syndrome
 side effects of steroids
 daily weights
 urine testing
 infection control
 s/s relapse/worsening dz
 no live virus vaccines while on steroids
31
 Wilm’s Tumor
 Postop Nursing
 S&S

mobile abd mass
Care
 Pain Mgmt
• DO NOT
PALPATE!  Fluid Mgmt

Hematuria 
NGT with cc/cc
replacement

HTN
 Incision Care

Abd pain
 Coping Enhancement

fatigue, malaise, fever
 Education (next slide)
32
 Post Nephrectomy Parent
Education
 Chemo/Radiation
 Skin Care (with RT)
 No contact sports!!!
 Report GU s/s immediately!!

33
CASE STUDY: Urinary Tract Infection

A 10 year old girl is visiting the pediatrician’s

office for the fifth time for UTI. Two of her
past visits resulted in hospitalization for
treatment.
1. Determine necessary assessment data.
2. Determine medications that will be
administered.
3. Develop a treatment/prevention teaching
plan.
34
 CASE STUDY: AGN
Seven year old Jason is hospitalized with AGN. Jason weighs
48 lbs. On admission his blood pressure is 110/60, pulse is 80,
resp rate is 18. His urine is dark brown and contains 3+
protein. Output is 60 mL in 2 hours. Jason’s mother states
that he has “real puffy eyes” in the morning. There is slight
periorbital edema on admission.
1. What other assessments should be made on Jason?
2. Explain the cause of his symptoms.
3. What MD orders should the nurse anticipate?
4. Explain to Jason’s family the course of his illness.
5. What daily assessments should be made?
6. What assessment indicates Jason is improving?
35
THE END

36