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DISORDERS OF THE

GENITOURINARY
SYSTEM
Annette Tomlinson

Anatomy and Physiology

Kidneys
Ureters
Bladder
Urethra

URINARY TRACT
INFECTION (UTI)
Bacterial invasion of the kidneys or bladder
More common in girls, preschool, and schoolage children
Usually caused by E. coli
The invading organism ascends the urinary
tract, irritating the mucosa and causing
characteristic symptoms

UTI Symptoms

Dysuria
Burning
Itching
Frequency
Odorous/cloudy urine
Fever
Bedwetting when
child toilet trained

UTI
Predisposing Factors:
Poor hygiene
Irritation from bubble baths
Urinary reflux

Nursing Interventions
Obtain urine culture as ordered
Administer antibiotics as ordered (after
culture)
Provide warm baths and allow child to void
in water to alleviate painful voiding
Force fluids
Acidify urine (cranberry juice, acid-ash
diet)

Nursing Interventions
Provide client teaching and discharge
planning concerning:
Avoidance of tub baths (contamination of
dirty water may allow microorganisms to
travel up the urethra)
Importance for girls to wipe perineum from
front to back
Increase in foods/fluids that acidify urine

VESICOURETERAL
REFLUX
Regurgitation of urine from the bladder
into the ureters due to faulty valve
mechanism at the vesicoureteral junction
Predisposes child to:
UTIs from urine stasis
Pyelonephrosis from chronic UTIs
Hydronephrosis from increased pressure on
the renal pelvis

Nursing Interventions
Assist with pre-operative studies
Provide post-operative care
Monitor drains; may have one from bladder
and each ureter
Check output from all drains and record
Observe drainage from abdominal dressing
Administer medication for bladder spasms as
ordered

EXSTROPHY OF THE
BLADDER
Congenital malformation in which nonfusion of abdominal and anterior
walls of the bladder during
embryologic development causes the
anterior surface of the bladder to lie
open on the abdominal wall
Varying degrees of defect

Assessment
Associated structural changes

Prolapsed rectum
Inguinal hernia
Widely split symphysis
Rotated hips

Associated anomalies

Epispadius
Undescended testicles

Treatment
Two-stage reconstructive surgery
Possibly with urinary diversion
Usually delayed until age 3-6 months

Nursing Interventions
Pre-op
Provide bladder care; prevent infection
Keep area clean as possible; urine on skin
will cause irritation and ulceration
Change diaper frequently; keep diaper
loose-fitting
Wash with mild soap and water
Cover exposed bladder with Vaseline gauze

Nursing Interventions
Post-op
Design play activities to foster
toddlers need for autonomy
Child will be immobilized for an
extended period of time

Prevent trauma
As child gets older and more mobile,
trauma more likely

HYPOSPADIAS
Uretheral opening located anywhere
along the ventral (lower) surface of
penis
Chordee (ventral curvature of the penis)
often associated, causing constriction
In extreme cases, childs sex may be
uncertain

Epispadias
An epispadias is a rare type of
malformation of the penis in which
the urethra opening is on the dorsal
or upper surface of the penis.

Assessment
Urinary meatus is misplaced
Inability to make a straight stream
of urine

Treatment
Minimal defects need no intervention
Neonatal circumcision delayed, tissue
may be needed for corrective surgery
Surgery performed at age 3-9
months; 2 years of age for complex
repairs however surgical repair can be
performed up to 7 years of life.

NEPHROTIC
SYNDROME (Nephrosis)
Autoimmune process leading to structural
alteration of glomerular membrane that results
in increased permeability to plasma proteins,
especially albumin
Course of the disease consists of exacerbations
and remissions over a period of months to years
Commonly affects preschoolers, boys more than
girls

Pathophysiology
Glomerular membrane becomes
permeable to proteins
Results in massive protein loss

Hypoproteinemia
Proteinuria (massive)
Hypovolemia
Edema (massive)
Hypoalbuminemia
Hyperlipidemia

Pathophysiology
Decreased capillary osmotic pressure
causes fluid accumulation in the
interstitial spaces
Causes hypovolemia which stimulates
antidiuretic hormone secretion
Causes reabsorption of sodium and water

Assessment
Proteinuria, hypoproteinemia,
hyperlipidemia
Dependent body edema

Puffiness around eyes in the morning


Ascites
Scrotal edema
Ankle edema

Assessment

Anorexia, vomiting, diarrhea


Pallor, lethargy
Hepatomegaly
Dramatic weight gain
Hypertension

Treatment
Drug therapy
Corticosteroids to resolve edema
Antibiotics for bacterial infections
Thiazide diuretics in edematous stage

Bed rest
Diet modification
Low to moderate protein, low sodium

Nursing Interventions
Provide bed rest
Conserve energy
Find activities for quiet play

Provide high-protein, low-sodium diet


during edema phase
Obtain morning urine for protein studies
Provide scrotal support

Nursing Interventions
Maintain skin integrity

Do not use band-aids


Avoid IM injections (medication is not absorbed
into edematous tissue)
Turn frequently

Monitor I&O, vital signs, weigh daily


Administer steroids to suppress autoimmune
response
Protect from infection

Nursing Interventions
Teaching and discharge planning
concerning:

Long-term use of corticosteroids


Prevention of infection
Urine testing
Need for long-term follow-up

ACUTE
GLOMERULONEPHRITIS
Immune complex disease resulting from
an antigen-antibody reaction
Secondary to a beta-hemolytic
streptococcal infection occurring
elsewhere in the body
More frequent in boys; usually age 6-7
years
Usually resolves in 14 days; self-limiting

Assessment
History of a precipitating
streptococcal infection
Edema, anorexia, lethargy
Hematuria or tea-colored urine
Fever
Hypertension

Diagnostics
+ ASO titer
BUN, serum creatinine, ESR
Hgb & hct
Urinalysis reveals:
specific gravity
RBCs, WBCs, protein, cellular casts

Treatment
Antibiotics for streptococcal infection
Antihypertensives if BP severely
elevated
Digitalis if circulatory overload
Fluid restriction if renal insufficiency
Peritoneal dialysis if severe renal or
cardiopulmonary problems develop

Nursing Interventions
Strict monitoring of I&O, blood
pressure, urine; weigh daily
Teaching and discharge planning
concerning:

Medication administration
Prevention of infection
Signs of renal complications
Importance of long-term follow-up

WILMS TUMOR
Large, encapsulated tumor that
develops in the renal parenchyma, more
frequently in the left kidney
Originates during fetal life from
undifferentiated embryonic tissues
Peak age: 1-3 years
Prognosis good if no metastases

Assessment
Staging
Stage I: limited to kidneys
Stage II: tumor extends beyond kidney
Stage III: tumor confined to abdomen
Stage IV: tumor has metastasized to lung,
liver, bone or brain
Stage V: bilateral renal involvement at
diagnosis

Assessment
Usually mother notices mass while
bathing or dressing child; non-tender
usually midline near liver
Hypertension and possible hematuria,
anemia, signs of metastasis
Diagnostic test: IVP reveals mass

Treatment
Nephrectomy, with total removal of
tumor
Radiation for stages II, III, IV
Post-surgical chemotherapy

Nursing Interventions
Do NOT palpate abdomen to avoid
possible dissemination of cancer cells
Handle child carefully when bathing and
giving care
Post-op care for nephrectomy patient;
usually performed within 24-48 hours
after diagnosis
Administer chemotherapy