GENITOURINARY SYSTEM PEDATRICS

GENITOURINARY SYSTEM

•       Nephrons continue to develop after birth

•       GFR is 30% below adult level at birth

•        reaches normal level by age 2 years

•        tubular function immature at birth;  reach adult level

            by age 2 years

•        urethra shorter in children and more prone to ascending

            infection

UNDESCENDED TESTES (Cryptorchidism)

•        unilateral or bilateral absence of testes in scrotal sac

•        testes normally descend at 8 months of gestation

•        increased incidence in those  with genetic disorder

•        75% will descend spontaneously by age 1 year

Assessment:

•        unable to palpate testes in scrotal sac

Management:

•        if testes remains in abdomen, damage to testes is possible because of increased

•        chorionic gonadotropin

•        orchipexy:  surgical procedure to retrieve and secure testes placement; performed between ages 1-3 yrs

Nursing Management:

•        provide treatment options

•        support parents if surgery will be done

•        post op:  avoid disturbing the tension mechanism

•        avoid contamination of incision

HYPOSPADIAS

•        urethral opening located anywhere along the ventral surface of penis

Assessment:

•        urinary meatus misplaced

•        inability to make straight stream of urine

Management:

•        minimal defects – no intervention

•        neonatal circumcision delayed, tissue maybe needed for corrective repair

•        surgery at age 3-9 months

Nursing Intervention:

•        diaper normally

•        provide support for parents

•        post op: check pressure pressure dressing

•        monitor catheter drainage

PHIMOSIS

•        an abnormal narrowing of the foreskin so that it cannot  be retracted over the glans penis

•        may be present at birth or may develop as a result of poor hygiene with accumulation of smegma

Management:

•        Prevention – regular pulling the foreskin back and cleaning

•        circumcision

Nursing intervention:

•        circumcision care:

1. Close observation for bleeding
2. Ice application
3. Administration of analgesics

ENURESIS

•        involuntary passage of urine after the age of control is expected (4 years)

•        types:

1. Primary – in children who have never achieved control
2. Secondary:  in children who have developed complete

            control

•      May occur anytime but most frequent at night

•      More common in boys

•      No organic cause

•      Etiologic possibilities:

1. Sleep disturbances
2. Delayed neurologic development
3. Immature development of bladder
4. Psychologic problems

Assessment:

•      PE normal

•      History of repeated voluntary urination management:

•        bladder retention exercises

•        drug therapy

1. TCA – imipramine
2. Anticholinergics

Nursing Intervention:

•        Provide information/counseling to family:

1. Confirm that this not conscious behavior and that the     child is not purposely misbehaving

2. Assure parents that they are not responsible and that this is a relatively common problem

•      Involve child in care; give praises and support with small accomplishments

1. Age 5-6 years – can strip wet beddings
2. Age 10-12 years – can do laundry and change bed

•      Avoid scolding and belittling the child

EXSTROPHY OF THE BLADDER

•        congenital malformation ; nonfusion of abdominal

            and anterior walls of the bladder during embryologic

            development

•        anterior surface of bladder lie open on abdominal wall

Assessment:

•        Associated structural changes

1. Prolapsed rectum
2. Inguinal hernia
3. Widely split symphysis
4. Rotated hips

•      Associated anomalies

1. Epispadias
2. Cleft scrotum or clitoris
3. Undescended testes
4. Chordee (downward deflection of the penis)

Management:

•        reconstructive surgery

•        urinary diversion

•        delayed until 3-6 months

Nursing intervention: Preop:

•        Provide bladder care; prevent infection

1. Keep area as clean as possible
2. Change diaper frequently; keep loose fitting
3. Wash with mild soap and water
4. Cover exposed bladder with vaseline gauze

Postop:

•       Design play activities to foster toddler’s need for autonomy

            -  child will be immobilized for extended period of time

•      Prevent trauma; as child gets older and more mobile,

            trauma is more likely

NEPHROTIC SYNDROME         

•        autoimmune process

•        structural alteration of glomerular membrane

•        results in increased permeabilityb to plasma proteins

•        course:  exacerbations and remissions over a period of months to years

•        commonly affects preschoolers; boys>girls

Assessment:

1. Proteinuria
2. Hypoproteinemia
3. Hyperlipidemia
4. Dependent edema

•      Puffiness around the eyes in morning

•      Ascites

•      Scrotal edema

•      Ankle edema

5. anorexia, vomiting, diarrhea
6. Pallor, lethargy
7. Hepatomegaly

Management:

•        drug therapy

1. Corticosteroids
2. Antibiotics
3. Thiazide diuretics

Nursing Intervention:

•      Provide bed rest

1. Conserve energy
2. Find activities for quiet play

•      Provide high protein, low sodium diet – during edema phase

•      Maintain skin integrity

•      Avoid IM injections – meds not absorbed in edematous tissues

•      Obtain morning urine for protein studies

•      Provide scrotal support

•      Monitor I and O, vital signs

•      Daily weight

•      Administer as ordered

•      Protect from sources of infection

ACUTE GLOMERULONEPHRITIS

•        immune complex disease

•        beta hemolytic strep

•        More frequently in boys; 6-7 years

•        resolves in 14 days

•        self limiting

Assessment:

1. History of strep infection (URTI or impetigo)
2. Edema, anorexia, lethargy
3. Hematuria or dark colored urine
4. Fever
5. Hypertension
6. Diagnostic tests:

•      Urinalysis – rbc,wbc,protein, cellular casts

•      Urine specific gravity increased

•      BUN, crea increased

•      ESR elevated

•      Hgb, Hct decreased

Management:

•        antibiotics

•        Antihypertensives

•        digitalis – if with CHF

•        fluid restriction

•        peritoneal dialysis – if severe renal complication occurs

Nursing Management:

1.  Monitor I and O, BP

2. Weigh daily
3. Provide diversional activity
4. Provide client teaching and discharge planning

•      Medication administration

•      Prevention of infection

•      Signs of renal complications

•      Importance of long term follow up

WILM’S TUMOR (NEPHROBLASTOMA)

•         large, encapsulated tumor that develops in the renal parenchyma,

•         more frequently in left kidney

•         originates during fetal life

•         peak age : 1-3 years

Assessment:

•         non tender mass, usually midline near liver

•         hypertension

•         hematuria

•         test: IVP

Nursing intervention:

1. Do not palpate abdomen – to avoid dissemination of CA cells
2. Handle child carefully when bathing and giving care
3. Provide care for the client with a nephrectomy
4. Provide care for the child receiving chemotherapy