Académique Documents
Professionnel Documents
Culture Documents
Etiology
Bacteria ascending from the urethra into the
bladder and to the upper urinary tract Escherichia coli: predominate organism Candida rarely causes infection Obstruction Voiding dysfunction Constipation Vesicoureteral Reflux (VUR) Intercourse
Manifestations
Often vague and nonspecific Fever: 100.4 or higher without evidence of
infection in children age 2-24 months Irritability New or increased enuresis Dysuria Poor weight gain
Diagnostic Evaluation
Urinalysis: hematuria, WBCs, nitrites Urine culture: single-strain of bacteria in a clean
catch urine Use a urine bag to collect sample Consider catheterization for sample May see a suprapubic aspiration for culture Refrigerate urine if it is not processed within 1015 minutes of collection
Nursing Management
Obtain history including elimination patterns VS: particular attention to blood pressure Assess for CVA tenderness Assess for phimosis Antibiotic instructions
3-5 day course Take single dose course at night Prophylaxis in recurrent cases (VUR)
Accurate I and O Encourage fluid intake (PO or IV) Education regarding effects of untreated UTI in children Review symptoms with caregiver Follow-up diagnostic evaluation to confirm treatment efficacy Additional education and evaluation for those who are sexually active
Cryptorchidism
Undescended or hidden testes Begin descent at 26-28 weeks gestation Premature infants have higher incidence Occurs in 5% of healthy full term males Etiology unknown
Associated Risks
Most testes spontaneously descend within
the first year of life If remains undescended:
Increased risk of malignancy Sperm production decreased Inguinal hernia more common
Nursing Interventions
Assessment/Identification!!
Assess in a warm environment Examine the older child sitting and in a frog leg position Milk the testis downward from the groin Assess for a hernia Assess the abdomen
Nursing Interventions
Parental education/reassurance Review the risks of an undescended testes If surgically corrected, postoperative care
Assess site Incentive spirometry Skin integrity Increase activity
Additional Information
Rare: bilaterally undescended testes Elevated FSH and LH with absent
testosterone = absent testes May use CT or MRI to determine location Treatment of choice is surgical correction
2/500 males Increased risk if father or sibling affected Testes undescended in 10% of those affected Assess for stenosis
Manifestations
Altered placement of urethral opening Altered urinary stream Chordee (downward curvature of penis) Assess for obstruction of urine outflow
Therapeutic Management
No circumcision Correction requires surgical intervention Done between 6-12 months of age (ideally
before toilet training) Goal of surgery:
Normalize urinary function Normalize sexual function Cosmetic
Nursing Interventions
Identification through assessment Obtain history:
Urinary tract infection Quality of urine stream Incontinence Family History
Nursing Interventions
Post-operative care:
Pressure dressing for 4 days Stent or catheter for urine drainage Hydration (IV the PO) Assess urine color, odor, clarity Monitor temperature Prophylactic antibiotics Quiet, diversional play Pain management
Nursing Interventions
Extensive family education Restrict activity for 1-2 weeks Continued monitoring for UTI
Glomerulonephritis
Inflammatory injury in the glomerulus Infection, Lupus, Schonlein-Henoch
purpura, vasculitis Sudden onset, self-limiting, resolve Poststreptococcal is the most common
Pathophysiology
Antigen-antibody complex formed Become trapped in the glomerulus Activation of inflammatory response Damage to capillary walls Decrease in GFR; renal insufficiency Large molecules are allowed to pass to
urine
Incidence
Group A beta-hemolytic streptococcal
infection (throat or skin) Young school age children Higher incidence in winter and summer Symptoms appear 8-21 days after infection
Manifestations
Hematuria (smoky, tea colored urine) Edema (orbital, worse in a.m.) Decreased urinary output Hypertension
renal insufficiency Dilutional anemia C3 (serum complement) low Antistreptolysin (ASO) titer elevated (only useful for recent infection where the child has not received antibiotics)
Nursing Management
Strict, accurate I and O (hourly) Report oliguria Accurate daily weights Monitor for hypertension Antihypertensive medication if necessary Astute respiratory assessment Fluid restriction (monitor for signs of dehydration) Low-sodium diet Cluster care to provide rest Reassurance the illness is self-limiting
Nephrotic Syndrome
Primary (MCNS): most common Secondary: acquired from systemic
disease (lupus, hepatitis, cancer) Arises from one of 4 types of renal lesions which all affect the basement membrane of the glomerulus
Incidence:
Children ages 2-6 years Slightly higher in boys Prognosis for MCNS is good Symptoms decrease with age
Pathophysiology
Insult to glomerular basement membrane Increased permeability resulting in loss of
plasma proteins Fluid shift to interstitial space Hypovolemia and decreased renal blood flow Renin production stimulated Reabsorption of sodium and water Edema
Pathophysiology (contd)
IgG levels decreased Cholesterol and triglycerides elevated Hypercoagulable
Manifestations
Proteinuria* (frothy urine) Hypoalbuminemia* Edema* (orbital, worse during day) Normotensive Increased weight Respiratory infection Abdominal pain (fluid in peritoneal space)
Manifestations
Often misdiagnosed as allergic rhinitis due to respiratory symptoms and orbital edema
Diagnostic Evaluation
3+ - 4+ urine protein Dark, frothy urine Decreased serum albumin Increased Hgb and Hct Increased serum cholesterol Increased serum triglycerides Negative ASO Evaluate for underlying etiology
Management
Prednisone Diuretics Albumin Antibiotics No-added-salt diet
Nursing Interventions
Assess VS (hypovolemia) Strict I and O Assess for dehydration Daily weights Assess exposure to communicable disease Prophylactic Penicillin Follow labs closely (risk of venous thrombus) Measure abdominal girth Astute assessment of pulmonary status No salt added diet Consider fluid restriction if becomes hypervolemic
hypotension, shock, renal artery obstruction, aminoglycosides, contrast dye Postrenal causes: structural abnormalities (tumor, ureterovesical obstruction, neurogenic bladder) Rare in children
Manifestations
Electrolyte and fluid imbalance Increased BUN and creatinine Acid-base imbalance (acidosis) Oliguria (urine output <1cc/kg/hr) Poor feeding Lethargy Seizures
Nursing Goals
Monitoring and maintaining fluid and
electrolyte balance Prevention of Infection Adequate nutrition Parental education (decreasing parent an child anxiety)
Manifestations
All associated with acute renal failure Renal bone disease Poor growth (FTT) Chronic hypertension Neurologic symptoms
Nursing Goals
Adequate nutrition
Na and fluid restriction Protein restriction Potassium restriction Phosphorus restriction Vitamin D High calorie foods
Nursing Goals
Prevention of infection Skin integrity Family education Developmental activites based on childs
age Multidisciplinary approach
Dialysis in children
Hemodialysis 3-4 treatments per week Maintain access (prevent infection, obstruction) Children are more susceptible to fluid shifts Interferes significantly with daily routine Requires a multidisciplinary approach for education and promoting optimal growth and development
The End