Chapter 44 The Child with a Genitourinary Alteration

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Chapter 44 The Child with a Genitourinary Alteration Elsevier items and derived items ©

Chapter 44 The Child with a Genitourinary Alteration Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Genitourinary System Differences in Children Structure Ø The infant kidney is small; however, it

Genitourinary System Differences in Children Structure Ø The infant kidney is small; however, it is proportionately larger than the adult's. Function Kidneys reach near adult function at 6 -12 months of age. Ø Infants cannot concentrate urine as efficiently as older children or adults. Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 2

Enuresis: Nursing Diagnosis Situational low self-esteem related to bedwetting or urinary incontinence Impaired social

Enuresis: Nursing Diagnosis Situational low self-esteem related to bedwetting or urinary incontinence Impaired social interaction related to bedwetting 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 Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 3

Conditions that Predispose Infants and Children to Urinary Tract Infections Urinary tract obstructions Voiding

Conditions that Predispose Infants and Children to Urinary Tract Infections Urinary tract obstructions Voiding dysfunction (urinary stasis) Anatomic differences Individual susceptibility to infection Reflux Urinary retention while toilet-training Bacterial colonization of the prepuce of uncircumcised infants Sexual activity during adolescence (girls) Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 4

Manifestations of Urinary Tract Infections Vary widely in relation to the following: Age Ø

Manifestations of Urinary Tract Infections Vary widely in relation to the following: Age Ø Gender Ø Underlying anatomic or neurologic abnormalities Ø Frequency of recurrence Ø Vesicoureteral reflux (VUR) Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 5

Prevention of Urinary Tract Infections Nursing education to parents and children Personal hygiene Ø

Prevention of Urinary Tract Infections Nursing education to parents and children Personal hygiene Ø Increased fluid intake Ø Regular emptying of the bladder Ø Wearing cotton underwear Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 6

Disorders and Anomalies of the Genitourinary Tract Cryptorchidism Hypospadias and epispadias Hydrocele Phimosis Testicular

Disorders and Anomalies of the Genitourinary Tract Cryptorchidism Hypospadias and epispadias Hydrocele Phimosis Testicular torsion Bladder exstrophy Disorders of sex development Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 7

Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of

Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 8

Acute Post-Streptococcal Glomerulonephritis Manifestations Hematuria Ø Proteinuria Ø Hypertension Ø Edema Ø Renal insufficiency

Acute Post-Streptococcal Glomerulonephritis Manifestations Hematuria Ø Proteinuria Ø Hypertension Ø Edema Ø Renal insufficiency Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 9

Nephrotic Syndrome Manifestations Edema Ø Anorexia Ø Fatigue Ø Abdominal pain Ø Increased weight

Nephrotic Syndrome Manifestations Edema Ø Anorexia Ø Fatigue Ø Abdominal pain Ø Increased weight Ø Respiratory infection Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 10

Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of

Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 11

Acute Renal Failure Indications for dialysis Severe fluid overload Ø Pulmonary edema or congestive

Acute Renal Failure Indications for dialysis Severe fluid overload Ø Pulmonary edema or congestive heart failure secondary to fluid overload Ø Severe hypertension Ø Metabolic acidosis or hyperkalemia not responsive to medications Ø Blood urea nitrogen greater than 120 mg/d. L Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 12

Question What best describes acute glomerulonephritis? Occurs after a urinary tract infection B. Occurs

Question What best describes acute glomerulonephritis? Occurs after a urinary tract infection B. Occurs after a streptococcal infection C. Associated with renal vascular disorders D. Associated with structural anomalies of genitourinary tract A. Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 13

Chronic Renal Failure An irreversible loss of kidney function over months to years Families

Chronic Renal Failure An irreversible loss of kidney function over months to years Families that are affected require multidisciplinary care. Kidney transplantation Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 14