The child with Genitourinary dysfunction

Question 1

Development of the GU system

Answer 1

• All nephrons are present at birth, the ureters or short, and the tubules have a smaller surface area, resulting in diminished water reabsorption. Nephrons grow in size, and the kidneys and the tubule system gradually develop during childhood to reach adult size during adolescence.
• Glomerular filtration rate is at 30%-50% of adult levels throughout first year of life. Glomerular filtration rate increases during childhood.
• Kidneys are less efficient at regulating electrolyte and acid, base, balance, and less able to concentrate urine. Diarrhea, infection, and improper feeding may lead to severe acidosis and fluid imbalance. Efficiency of the kidneys in regulating electrolytes and acid base balance increases after two years of age.
• Average daily urine output ranges from 15–50 milliliters at birth to 400 mL at two months of age. Average daily urine output increases during childhood and reaches 700–1500 mL during adolescence.
• Reproductive system immature.
• Reproductive system matures after puberty

Question 2

UTI- Urinary tract infections

Answer 2

Cystitis
Pyelonephritis

Question 3

Cystitis

Answer 3

lower UTI (urethra or bladder)

Question 4

Pyelonephritis

Answer 4

upper UTI (ureters & kidney)

Question 5

UTI- Urinary tract infection

Causes

Answer 5

Uncircumcision
Poor hygiene
Urinary stasis (holding in urine, neurogenic bladder, abnormal anatomic structure
Vesicoureteral Reflux (Backflow of urine from bladder to ureters or causes incomplete emptying of bladder)

Question 6

UTI- Urinary tract infection
Clinical manifestations:

Answer 6

• Fever
• chills
• n/v
• decreased appetite
• hematuria
• foul smelling urine
• dysuria
• frequency
• mass

Question 7

UTI- Urinary tract infection
Diagnostic Tests

Answer 7

• Urinalysis
• Culture and Sensitivity (in & out Cath)
• VCUG (voiding cystourethrogram)
• renal and bladder ultrasound

Question 8

Nephrotic syndrome
Clinical State characterized by:

Answer 8

• Edema
• Proteinuria
• Hypoalbuminemia
• Hypoproteinemia
• Hyperlipidemia
• Decreased Immunity
  — Cause unknown, may be immune mediated
  — Occurs in kids 2-7 yrs old
  — Most common in male Hispanic or African American

Question 9

Nephrosis Clinical manifestations:

Answer 9

• Periorbital edema
• Acities
• Lower extremities
• Anasarca
• Genital swelling
• Weight gain
• Extreme skin pallor
• Respiratory Distress
• Diarrhea
• Anorexia
• Irritability
• Fatigue
• Urine volume decreased & frothy/foamy

Question 10

Treatment of Nephrosis:

Answer 10

• Preserve renal function and excretion of protein
• Reduce edema
• Prednisone
• Prevent Infection
• Bed Rest
• Skin Care

Question 11

Acute Glomerulonephritis (AGN)

Answer 11

Inflammation of the glomeruli
- Can be caused by different orgnanisms; Especially Group A Beta- Hemolytic Strep
- Develops 10-21 days after infection

Question 12

Acute Glomerulonephritis (AGN) Clinical Manifestations

Answer 12

• Flank or mid-abdominal pain
• Irritability
• Malaise
• Fever
• Hematuria
• Oliguria
• Protienuria
• Edema (periorbital)
• Hypertension

Question 13

Acute Glomerulonephritis (AGN) pathophysiology

Answer 13

Infection from group A beta-hemolytic Streptococcus leads to an immune response that causes inflammation and damage to the glomeruli. Protein and red blood cells are allowed to pass through the glomeruli. Blood flow to the glomeruli is reduced due to obstruction with damaged cells and renal insufficiency results, leading to the retention of sodium, water, and waste.

Question 14

Glomerulonephritis s/s:

Answer 14

• headache
• Increased blood pressure
• Facial/Peri orbital edema
• Malaise
• Low-grade fever
• Weight gain
• Proteinuria/hematuria/oliguria
• Inflammation
• Decreased glomerular filtration rate

Question 15

Glomerulonephritis Complications:

Answer 15

• Acute Renal Failure
• Hypertensive Encephalopathy(headache, N/V,seizures)
• Pulmonary Effusion (dyspnea, cough, crackles)

Question 16

Glomerulonephritis treatment:

Answer 16

• Bedrest
• Sodium Restriction & Diuretics
• Antihypertensives
• Antibiotics

Question 17

Glomerulonephritis nursing Considerations:

Answer 17

• Restful Environment
• Monitor I & O and BP
• Prevent Skin Breakdown
• Daily Weights