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Children and Genitourinary NursingUrinary Tract InfectionInfoBroad term for infection anywhere in the urinary tractIncidencePediatrics2 to 6 Years-OldSexually Active GirlsFemales More Often Than MalesExcept in Neonate PeriodFemalesShorter Urethra Than MalesUrethra Is In Close Proximity To AnusSingle most important factorUrine StasisExcellent Culture MediumVoiding Removes Bacteria From The Bladder And Allows More Efficient Destruction Of Bacteria Remaining On The Bladder WallExamplesVesicoureteral RefluxNeurogenic BladderSome kind of CNS problem, the impulses to go pee aren’t getting sent from the brain so the bladder never wants to contract and empty. Seen in accidents and shitBladder CompressionUA with Culture and SensitivityCotton Ball In DiaperIs ok for the UA but not for the culture and sensitivity (because it can be contaminated by skin or poop)Bagged SpecimensAgain, ok for a UA but not for C&SMidstream Clean CatchOlder Child can do it because they can follow directionsSterile Catheter SpecimenThe Very Young & Others (best for C&S)100,000 Organisms/ml usually needed for diagnosisGram Negative BacteriaFalse-PositiveContaminated With Organisms From Perineal/Perianal AreasFalse-NegativeChildren Given Large Volume Of FluidFirst Morning Void Is Most Accurate Other TestsTo Detect Anomalies Or Renal ScarringRenal And Bladder UltrasoundVoiding Cystoureteral Gram (VCUG) S/SBased on Age Of ChildLocation Of The InfectionCystitisUrethra Or BladderPyelonephritis Ureters Or Kidney Neonate and Infant S/SFeverPoor FeedingVomiting And/Or DiarrheaFailure To ThriveStrong Smelling UrinePersistent Diaper RashCystitis after Infancy S/SFrequency & UrgencyEnuresisBedwetting or incontinence in a toilet trained childStrong Smelling UrineDysuria Burning sensation when you voidInfants And Very Young Children Cannot Verbalize Discomfort Of VoidingPyelnonephritis after infancyHigh Fever & ChillsCostovertebral Angle TendernessPersistent VomitingModerate To Severe DiarrheaDysuria Frequency & UrgencyDesired outcomesEliminate Current InfectionAntibioticsEventually Based On Sensitivity CulturesTeach The Importance Of Taking All The AntibioticEncourage FluidsFlush Out PathogensCarbonated Or Caffeinated Liquids May Irritate BladderVoid FrequentlyIdentify Contributing FactorsIs There An Anatomical Anomalie Resulting In Urine Stasis?Good Perineal HygieneWiping Front To BackAvoid IrritantsBubble Baths/Shampoos, can irritate stuffCotton UnderwearAllows Air Through Fabric, doesn’t have to be all cotton, crotch is most importantIncreased Fluid IntakePromotes Flushing Of The Normal BladderLowers Concentration Of OrganismsVoid RegularlyEveryoneSexually Active Females Acidify UrineMost Pathogens Favor An Alkaline MediumVegetarian Diet Increases Urine AlkalinityTo Acidify UrineApple JuiceVitamin CIncreased ProteinCranberry Juice Helps Prevent Bacteria Adhering To Bladder Wall Preserve Renal FunctionRenal Scarring Can Occur From First InfectionProgressive Renal Injury Is Greatest In Children Under 2 Year-Of-AgeVesicoureteral Reflux Reflux of urine up the uretersTypes of RefluxPrimary RefluxAbnormal Insertion Of Ureters Into BladderSecondary RefluxAcquiredEdema Caused By InfectionNeurogenic BladderThese Children Have Frequent Kidney Infections (Pyelonephritis) (Biggest indicator for this, frequent UTI’s)Voiding Cystoureterogram (VCUG)Contrast Medium Is Injected Into The Bladder Through A CatheterPictures Are Taken Before, During, And After VoidingYou tell them to pee on the table and everyone is standing around and taking pictures of them… Very embarrassing for adolescents and confusing for kids who are being potty trained Shows Urine ReflexGrading System 1 to 5One is barely up the ureturs, five is everything, super severeInterventionsDaily Low-Dose Antibiotic TherapyNot Associated With Candida Infections Or OvergrowthExamplesNitrofurantoin Bactrim Liberal FluidsRegular Voiding & Double VoidingUreteral ReimplantationHigh Grade RefluxNoncompliance With Antibiotic TherapyInfrequent Access To Health Care SystemGlomerular Filtration MembranePathoWalls Of Glomerulus Composed Of 3 LayersMiddle Layer Is Glomerular Filtration MembraneFilters Blood Resulting In Formation Of UrineLarge Molecules Such As Blood and Plasma Proteins Do Not Pass Through The MembraneNephrotic SyndromeIncreased permeability of glomerular filtration membrane TypesPrimary DiseaseUnknown EtiologyMinimal Change Nephrotic SyndromeSecondary DiseaseA Result Of Damage To The Glomerulus Onset Of Nephrotic SyndromeOften Preceded By A Viral IllnessRelapsing Course Throughout ChildhoodClinical State characterized byMassive Proteinuria Hypoalbuminemia EdemaHyperlidpidemia What Happens in the bodyIncreased Permeability Of The Glomerular Filtration Membrane To Plasma Protein, Especially AlbuminMassive Proteinuria Hypoalbuminemia Two reasons for edemaDecrease In Plasma Osmotic PressureFluid Moves From Intravascular Space Into Interstitial SpaceHypovolemia Renin-Angiotensogen MechanismWhat else happens in the bodyAs The Liver Rapidly Manufacturers Replacement Proteins, Large Amounts Of Lipids Are Created As WellHyperlipidemia At Risk For InfectionImmunoglobulins Are Lost. Resulting In Altered ImmunityAt Risk For Venous ThrombosisHypovolemia Loss Of Antithrombin IIINephrotic Syndrome : EdemaGeneralized EdemaMay Develop Gradually Or RapidlyEventually Brings Child Into Health Care SystemPatternFacial Edema Especially Around The Eyes In The MorningPeripheralLabial Or Scrotal SwellingMay Be Gaining Weight But Losing True Body WeightIntestinal SwellingAbdominal PainDiarrheaAscites Pleural EffusionRespiratory DifficultyNS : UrineDecreased VolumeDark And FrothyProteinuria Greater Than 3+May Have A Few RBCsNS : CorticosteroidsInitial TreatmentPrednisone 4 – 6 Weeks (DOC)Positive Response In 7 To 21 DaysZero To Trace Urine Protein For A Week (this is a positive response)RelapseIncrease Urine ProteinRepeat Course Of Steroid Therapy (prednisone)Children Who Do Not Respond To Steroids Other Immunosuppressants (Cyclosporine)NS : NursingIntake And Output Plus Daily Weight (weight is best way to assess edema)Assessment Of Edema“Hide The Salt Shaker” During Acute Edematous PhaseNo Foods With High Salt Content May Be Fluid Restriction During This PhaseNS : Home CareTesting Urine For AlbuminMedication AdministrationRisk For InfectionPrognosisRenal Function Can Be Normal Or Near Normal As Adult With Early Detection And Prompt Treatment In ChildhoodHemolytic – Uremic SyndromeClassic TriadHemolytic AnemiaThrombocytopeniaAcute Renal FailureInfoGenerally Seen In Children Less Than 4 Years-Of-AgeOften Linked To A Strain Of E. coliRaw Hamburger MeatUnpasteurized MilkPathoToxin From Bacteria Damages Lining Of Glomerular Arterioles Glomerular Arterioles Become Swollen & Occluded With Platelets & Fibrin Clots RBCs Are Damaged As They Pass Through The Narrowed Arterioles Damaged RBCs Removed By Spleen Acute Hemolytic Anemia Platelets clustering within damaged vesselsPlus removal of damaged platelets by spleenThrobocytopeniaDamage to renal tubular cellsAcute tubular necrosisAcute renal failureIn some chronic renal failureHUS : AssessmentPreceded By IllnessDiarrhea & VomitingRespiratory InfectionAnorexia, Irritability, LethargyPallorBruisingPurpura Rectal BleedingOliguriaTo Anuria Hematuria Proteinuria Possibly Central Nervous System InvolvementPossibly Signs Of Acute Heart FailureHUS : NursingHemodialysis Fluid Replacement If Needed, But Managed With Great CareBlood Transfusion If Needed, But Done With Great CautionPlasma Infusion May Be NeededHUS : TeachingCook All Meat ThoroughlyScrub Fruits & VegetablesConsume Only Pasteurized Milk & Dairy ProductsDrink Only Water That Has Been Properly TreatedDon’t Swim In Sewage Contaminated WaterGood Handwashing Acute Poststreptococcal GlomerulonephritisInfoIncreased Permeability Of The Glomerular Filtration Membrane Caused By Damage From Immune Complexes As A Result Of Group A β-Hemolytic StreptococcusPathoGroup A β Hemolytic Infection Immune Complexes formedImmune complexes injure basement membraneBasement membrane capillaries occluded by inflamed tissue and leukocytesCirculatory congestionAGN : AssessmentPrimarily School-Age ChildrenPeak 6 – 7 Years-Of-AgeMore Often In BoysHistory Of Infection – Usually StrepAGN : EdemaPeriorbital And DependentMild To ModerateMay Progress In SeverityAcute Edematous Phase Lasts 4 – 10 DaysAGN : UrinalysisRed Blood Cells, “Tea Or Cola”LeukocytesCastsHardened material that assumes the shape of the vessel that it’s in. Can be RBC casts or WBC casts, generally3+ To 4+ Proteinuria Usually not as high as those seen in Nephrotic SyndromeElevated Specific GravityOliguria May Or May Not Be PresentAGN : Other SignsSudden Elevation Of Blood PressureIf they say they have a HA, check the BP before you do ANYTHING else, before meds or anything like that. You need to see what their BP is! Elevated Antistreptolysin O Titer (ASO Titer)Measures Antibodies From A Recent Strep InfectionElevation In 1 Week To 1 MonthAnorexia, Fatigue, Irritability AGN : ComplicationsHypertensive EncephalopathyHyperfusion Of The Brain With EdemaCardiac DecompositionDuring Acute Edematous PhasePulmonary EdemaRenal FailureAGN : NursingSupportive Measures & Early Identification Of ComplicationsChildren With Normal Blood Pressure And Adequate Urine Output Can Generally Be Treated At HomeIntake And OutputAcute Edematous PhaseUsually 4 – 10 DaysChild Will Generally Put Themselves On Bedrest Elevated Blood PressureAntihypertensive Medication (on a PRN basis, because it’s not constantly high BP, just spikes)Diuretic (PRN and maybe SCH)NutritionMost Children Regular Diet With No Added SaltDiet Restriction Depends Upon Severity Of Edema And HypertensionRestrict Foods With High Potassium For Child With Oliguria AGN : Signs of ImprovementSmall Increase In Urine Output With Corresponding Decrease In Body WeightFollowed In 1 – 2 Days By Copious Diuresis Reduction In Blood Pressure With Reduction In EdemaAGN : Discharge teachingTeach ParentsMedicationsDietary RestrictionsSigns & Symptoms Of ComplicationsHow ToCheck Blood PressureCheck UrineFollow For At Least One YearAnomalies of the Genitourinary TractGeneral Interventions related to Surgical RepairBefore Child Has Developed Body Image And Castration AnxietyBefore Preschool PeriodKeep Dressing Clean And DryChange Diapers When DampSponge BathCatheter Or Stent CareLimit Activity To Promote HealingUndescended Testes (cryptorchidism)PathoReview: Normally Testes Descend7 to 9 Months Intrauterine LifeUp to 6 Weeks After BirthCryptorchidism May Be Bilateral Or UnilateralScrotum Will Appear Small And MisshapenRetractile Testes Is Not Cryptorchidism Testes That Move Out Of The Scrotum Into Inguinal CanalTreatmentIn Majority Of Infants With Cryptorchidism (~75%) Testes Will Descend By 1 Year-Of-AgeChorionic Gonadotropin HormoneGynecomastia Precocious PubertyOrchiopexyPreferred Treatment6 – 24 Months-Of-AgeMaintain Future FertilityDecreases Incidence Of Tumor FormationInguinal HerniaProtrusion Of Abominal Contents Through Inguinal Canal Into ScrotumPainless Inguinal Swelling Of Variable SizeInfantAppears During Crying Or StrainingChildAppears During Crying, Straining, Or Standing For A Long PeriodIncarcerated inguinal HerniaLoop Of Bowel Becomes TrappedIntestinal ObstructionGangrene HydroceleFluid In The ScrotumCommon In NewbornsOften Resolves Spontaneously As Fluid Is Gradually AbsorbedSurgical Repair Required If Hydrocele Is Not Absorbed By 1-Year-Of-Age HypospadiasUrinary Opening on Underside of PenisEpispadias Urinary Opening On Dorsal Surface Of PenisFamilial10% - 15% Have A First-Degree Relative With Same ConditionFrequently Associated withChordee Ventral Curvature Of The PenisReplacement Of Normal Skin With Fibrous Band Of TissueCryptorchidism (Undescended Testes)Hypospadias RepairStaged Surgical RepairVariety Of Possible Procedures Based On Severity Of ConditionNo Circumcision At Birth – Skin Needed For RepairPreferred Age Is 6 – 18 MonthsDesired OutcomesChild Is Able To Void In Standing Position And Direct Stream Voluntarily In Usual MannerImprove Appearance Of GenitaliaProduce Sexually Active OrganPrepare ParentsMay Expect A Perfect Penis After SurgeryTemporary Urinary Diversion While Reconstructed Urethra Is HealingStent Or CatheterExcessively Restless Child May Need SedationPostoperative Epidural Pain Management May Be Needed ................
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