FINALS Topic: GENITOURINARY DISORDERS by Wong

D/O-Illness Causative Agent/ Signs & Symptoms Diagnostic Evaluation Therapeutic Nursing Care
Synonyms Etiologic Agent Management Management
Urinary  Caused by  Depends on child’s  Urine Culture  Antibiotic therapy  Identification of
Tract microorganisms age guided by laboratory children with UTI and
Infection such as:  Newborn infants & culture & sensitivity education of parents
(UTI) -Escherichia coli children < 2 y/o signs test. & children regarding
(80% of the are characteristically  Common anti- prevention &
cases) nonspecific. They infective agents used treatment of infection.
-Proteus more resemble GIT for UTI include the  A careful history
-Pseudomonas d/o such as: penicillins, regarding voiding
-Klebsiella -Failure to thrive sulphonamide habits, stooling
-Staphylococcus -Feeding problems (including pattern, & episodes of
aureus -Vomiting trimethoprim & unexplained
-Haemophilus -Diarrhea sulfamethoxazole in irritability may assist
-Coagulase- -Abdominal combination), the in detecting less
negative distension cephalosporins, obvious cases of UTI.
staphylococci -Jaundice nitrofurantoin,, & the  Collecting an
 Anatomic &  Newborns may have tetracyclines. appropriate specimen
Physical factors: fever, hypothermia, or is essential when
-Short urethra of sepsis. infection is suspected.
female than male:  Other evidence  Nurse’s responsibility
2cm (0.75 inch) includes frequent or is to take every
in young girls & infrequent voiding, precaution to obtain
4cm (1.5 inches) constant squirming, acceptable, clean-
in mature women. and irritability, voided specimens in
-Uncircumcised strong-smelling urine, order to avoid using
infants less than 1 & an abnormal other collecting
y/o. stream. procedures except
-Urinary stasis  A persistent diaper when absolutely
-Improper rash may also be a indicated.
catheterization helpful clue.  Teach the patient &
-Administration  Classic symptoms of parents the
of antimicrobial UTI are often appropriate dosage &
drugs observed in children > scheduling & provide
-Tight Clothing or 2 y/o includes: suggestions for
diapers -Enuresis or daytime administering
-Poor hygiene incontinence on the medications.
-Local child who has been  Provide adequate
inflammation toilet trained. fluid intake.
such as vaginitis, -Fever
masturbation, or -Strong or foul-
pinworm smelling urine
infestation. -Inc. frequency of
-Bubble baths, hot urination
tub, whirlpool -Dysuria
baths. -Urgency
-Sexual  Children may also
intercourse. complain of
abdominal pain or
costovertebral angle
tenderness (flank
pain)
 Some will be seen w/
hematuria.
 Preschoolers may
vomit
 There is a high
frequency of
obstructive uropathy
in young infants &
boys w/c is
characterized by
dribbling of urine,
straining with
 urination, or a
decreased in the force
& size of the urinary
stream.
 High fever & chills
accompanied by flank
pain, severe
abdominal pain, and
leukocytosis suggest
pyelonephritis.
 Manifestations in
adolescents are more
specific.
 Lower tract infection:
-Frequency & painful
in urination of a small
amt. of turbulent urine
that may be grossly
bloody.
-Fever is usually
absent.
 Upper tract infection:
-Fever
-Chills
-Flank pain
-Lower tract
symptoms w/c may
appear 1-2 days after
the upper tract
symptoms.
 Previously well child
begins to gain weight
Nephrotic 3 classification  Puffiness of the face  Diagnosis of MCNS  Primary objective is  Daily monitoring of
syndrome  Minimal Change especially around the in children is made on to reduce excretion of intake and output:
Nephrotic eyes the basis of the history urinary protein & strict and accurate
Syndrome  Generalized edema & clinical maintain protein-free measurement.
- 80% of cases (anasarca) manifestations urine.  Other methods of
- can be seen at  Abdominal swelling (edema, proteinuria,  Prevention or monitoring progress
any age but is fro ascites. hypoalbuminemia, & treatment of acute include examination
predominantly a  Labial or scrotal hypercholesterolemia infection. of the urine for
disease of the swelling in the absence of  Control of edema. albumin, daily
preschooler.  Edema of the intestinal hematuria &  Establishment of weight, &
- Rare in children mucosa may cause hypertension good nutrition. measurement of
< 6 mos old, diarrhea, loss of  If renal biopsy is  Readjustment of any abdominal girt.
uncommon in appetite, & poor performed, it provides disturbed metabolic  Assessment of edema
infants < 1 y/o, & intestinal absorption information regarding processes. such as increased or
unusual after age  Decreased volume of the glomerular status decreased swelling
of 8 yrs. urine & appears darkly & type of nephritic around the eyes &
- Males opalescent & frothy. syndrome, the dependent areas, the
outnumber  Child often has response to drugs, & degree of pitting (if
females 2:1. extreme skin pallor the probable course of noted), & the color
- In adolescence and has a tendency the disease. and texture of the
the ratio is 1:1 toward skin skin are part of
- Also known as: breakdown during nursing care.
Idiopathic periods of edema.  Vital signs are
nephrosis, monitored to detect
 Irritable & may be
minimal lesion any early signs of
more easily fatigue or
nephrosis, nil complication such as
lethargic but does not
disease, childhood shock or an infectious
appear seriously ill.
nephrosis, lipoid process.
 Changes in the nails
nephrosis, or  In children
appear as white
uncomplicated hospitalized w/
(Muercke) lines
nephrosis. MCNS, elevating
parallel to the lanula,
 Secondary edematous parts may
w/c are caused by
Nephrotic prolonged be helpful to shift
Syndrome hypoalbuminemia. fluid to more
- May occur after  BP is usually normal comfortable
or in association or slightly decreased. distributions, but
w/ glomerular  Susceptible to dieresis w/
damage of known infection, especially medications and salt
or presumed cellulitis, pneumonia, & water restriction to
cause. peritonitis, or sepsis. remove edema fluid
- Prominent  Children w/ MCNS in are the best therapy.
among causes of rare instances have  Protect from contact
glomerular significant or w/ infected person
damage is AGN persistent because of
or CGN. hypertension, gross or vulnerability to upper
- Less commonly, persistent hematuria, respiratory tract
2⁰ nephritic significant or infection.
syndrome occurs persistent azotemia  Family support and
during the course (presence of increased home care.
of collagen nitrogenous products - Parents are taught to
vascular diseases in the blood), or detect signs of relapse
(e.g. disseminated depression of serum & to bring the child
lupus B1C globulin. for treatment at the
erythematosus & earliest indications.
anaphylactoid - Parents are
purpura) or as a instructed in urine
result of toxicity testing for albumin,
to drugs (e.g. administration of
trimethadione & medications, &
heavy metals), general care.
sting, or venom.
- Nephrotic
syndrome is the
major presenting
symptom of renal
 disease in
pediatric patients
w/ acquired
immunodeficiency
syndrome.
- Diverse, rare
causes are sickle
cell disease,
hepatitis, malaria,
cyanotic heart
disease,
tuberculosis,
infected
ventriculojugular
shunts, renal vein
thrombosis, or
malignancies.
 Congenital
Nephrotic
Syndrome
- Hereditary form
of nephritic
syndrome is
caused by a
recessive on an
autosome.

Acute  Most cases are  Common features  Urinalysis  No specific treatment  Careful assessment of
Glumerulo- post-infectious includes:  Cultures of the is available for AN, the disease status, w/
nephritis and have been -Oliguria pharynx are positive but recovery is regular monitoring of
(AGN) associated w/ -Edema for streptococci in spontaneous and vital signs (including
pneumococcal, -Hypertension & only a few cases. uneventful in most frequent measurement
 streptococcal, & circulatory congestion  Serologic test cases. of BP), fluid balance,
viral infections. -Hematuria  Fluid balance & behaviour.
 All post- -Proteinuria - Regular  Volume & character
infectious disease  APSGN measurement of V/S, of urine are noted, &
are presumed to - Elevated body weight, and the child is weighed
result from streptococcal antibody I&O is essential to daily.
immune complex titers monitor the disease’s  Assessment of the
formation & - Elevated BP progress & detect child’s appearance for
glomerular - Primarily periorbital complications. signs of cerebral
deposition. & peripheral edema  Acute hypertension complications.
 Acute post- - Circulatory must be anticipated &  Child w/ edema,
streptococcal congestion identified early. hypertension, & gross
glomerulo- - Mild to moderate - BP measurements hematuria may be
nephritis proteinuria are taken every 4 - 6 subjected to
(APSGN) is the - Gross or microscopic hours complications, &
most common of hematuria -significant but not anticipatory
the non-infectious - Red blood cell casts severe hypertension is preparations such as
renal diseases in - Azotemia controlled w/ loop seizure precautions &
childhood & the -Normal or increased diuretics. IV access are
one for w/c a serum potassium level. - Other included in the
cause can be - Minimum reduction antihypertensive nursing care plan.
established in the of serum protein levels drugs, such as
majority of cases. - Normal serum lipid calcium channel
- can occur at any level. blockers, beta
age but primarily blockers, or ACE
affects earlt inhibitors, may be
school-age needed in severe
children, with a cases.
peak age of onset - seizure activity
of 6-7 years. associated w/
hypertensive
encephalopathy
requires
 anticonvulsant
therapy &
antihypertensive
agents.
 Nutrition
- Dietary restrictions
depend on the stage
and severity of the
disease, especially the
extent of the edema.
- Regular diet is
permitted in
uncomplicated cases,
but sodium intake is
usually limited (no
salt is added to
foods).
-Moderate sodium
restriction is usually
instituted for children
w/ hypertension or
edema.
- Foods w/ substantial
amounts of potassium
are generally
restricted during the
period of oliguria.
- Protein restriction is
reserved only for
children w/ severe
azotemia resulting
from prolonged
oliguria.
  Antibiotic therapy is
indicated only for
those children w/
evidence of persistent
streptococcal
infections.
 Major goal is
Acute Renal  Prerenal cause  Prime manifestation is  Careful history taking  The MOST effective reestablishment of
Failure - Dehydration oliguria, generally a to reveal symptoms management is renal function (w/
secondary to urinary output of less that may be related to PREVENTION. emphasis on
diarrheal disease than 1 ml/kg/hr. glomerulonephritis;  Development of ARF providing an adequate
or persistent  Anuria (no urinary obstructive uropathy; is known risk in caloric intake to
vomiting. output in 24 hours) is or exposure to certain situations. minimize reduction of
- Surgical shock uncommon except in nephritic chemicals, This should be protein stores);
& trauma obstructive disorders. such as ingestion of anticipated & prevention of
(including burns).  Edema heavy metals or recognized, & complications; &
- Hypovolemia &  Drowsiness inhalation of carbon adequate therapy monitoring of fluid
decreased renal  Circulatory congestion tetrachloride or other should be balance, laboratory
perfusion cause a  Cardiac arrhythmia organic solvents or implemented (e.g. data, & physical
decreased from hyperkalemia drugs (e.g. methicillin, fluid therapy for manifestations.
glomerular  Seizure may be caused sulphonamides, children w/  Major nursing task in
filtration rate & by hyponatremia or neomycin, polymyxin, hypovolemia in the care of the infant
stimulate the hypocalcemia & kanamycin). conditions such as or child w/ ARF is
secretion of
 Tachypnea from  Laboratory data dehydration, burns, & monitoring &
rennin, reflect the kidney hemorrhage). assessing fluid &
metabolic acidosis.
aldosterone, & dysfunction –  Nephrotoxic drugs electrolyte balance.
Antidiuretic hyperkalemia, should be used w/  The nurse must be
hormone, w/c hyponatremia, caution or avoided in continually alert for
further diminish metabolic acidosis, children w/ renal behaviour changes
urine flow. hypocalcemia, disease, & all that indicate the onset
-Extended & anemia, or azotemia. personnel should be of complications.
severe knowledgeable about  Family support
hypoperfusion precautions related to
 (secondary to their administration.
procedures such  Treatment of ARF is
as cardiac directed toward:
surgery) can 1) treatment of the
produce cortical underlying cause
or tubular 2) management of the
necrosis. complications of
-Renal artery renal failure
stenosis, altered 3) and provision of
peripheral supportive therapy
vascular w/in the constraints
resistance related imposed by the renal
to sepsis, & failure.
hepatorenal  Treatment of poor
syndrome are less perfusion resulting
common causes. from dehydration
 Intrinsic Renal consists of volume
Causes: restoration. If oliguria
- include diseases persists after
& nephrotoxic restoration of fluid
agents that volume or if the renal
damage the failure is caused by
glomeruli, intrinsic renal
tubules, or renal damage, the
vasculature. physiologic &
-Glomerular biochemical
disease is the abnormalities that
most common have resulted from
cause og kidney dysfunction
glomerular must be corrected or
damage, whereas controlled.
tubular  Central venous
destruction is pressure monitoring
 more often caused is usually
by ischemia or implemented.
nephrotoxins.  Initially, foley
-Vascular damage catheter is inserted to
is uncommon rule out urine
cause of renal retention, to collect
failure in available urine for
childhood. electrolytes &
 Postrenal Causes analysis, & to
- Obstructive monitor the result of
uropathy is diuretic
uncommon except administration.
during the first  When there is
year of life. persistent oliguria in
the presence of
adequate hydration &
no lower tract
obstruction, mannitol,
furosemide, or both
may be administered
rapidly as a test to
provoke a flow of
urine.
 Reduce serum
potassium
concentration in
hyperkalemia
through:
-Calcium gluconate
-Na+ bicarbonate
-Glucose 50% &
insulin
 When there is a threat
 of hypertensive
encephalopathy,
labetalol (a beta &
alpha blocker) may be
administered
intravenously as
bolus infusions or a
continuous drip.
 Oral drugs used for
acute hypertension
include nifedipine,
captopril, minoxidil,
hydralazine,
propanolol, or
furosemide.