Child with Renal or Urinary tract

Glomerulonephritis Causes:
a. Immunological diseases
Disorders b. Autoimmune diseases
c. Antecedent group A beta-hemolytic
Topics included: streptococcal infection of the
 Glomerulonephritis pharynx or skin
 Nephrotic Syndrome d. History of pharyngitis or tonsillitis 2
 Enuresis to 3 weeks before symptoms
 Cryptorchidism
 Epispadias and Hypospadias
 Bladder Exstrophy
 UTI

Glomerulonephritis Types:
a. Acute:
 Occurs 2 to 3 weeks after a
streptococcal infection
b. Chronic:
“Glomerulonephritis”  May occur after the acute
phase or slowly over time
 Glomerulonephritis refers to a group
of kidney disorders characterized by
inflammatory injury in the
glomerulus, most of which are
caused by an immunological
reaction (streptococcal infections )
 The disorder results in proliferative
and inflammatory changes within
the glomerular structure.
 Destruction, inflammation, and
sclerosis of the glomeruli of the Glomerulonephritis Complications
kidneys occur. a. Kidney failure
 Inflammation of the glomeruli b. Hypertensive encephalopathy
results from an antigen- antibody  decreased alertness, impaired
reaction produced by an infection cognitive function, delirium, and in
elsewhere in the body. some cases, generalized seizures
 Loss of kidney function develops. c. Pulmonary edema
d. Heart failure
e. Seizures
  Increased anti-streptolysin O titer –
used to diagnose disorders caused by
streptococcal infections

Glomerulonephritis Interventions
Glomerulonephritis Assessment: Monitor vital signs, intake and output, and
 Periorbital and facial edema that is characteristics of urine
more prominent in the morning  Measure daily weights at the same
 Anorexia time of day, using the same scale
 Decreased urinary output  Limit activity; provide safety
 Cloudy, smoky, brown-colored urine measures.
(hematuria)  Diet restrictions of sodium
 Pallor, irritability, lethargy (edema)in addition, potassium may be
restricted during periods of oliguria.
 Administer medications as
prescribed:
 Diuretics - if significant
edema and fluid overload are present
 Antihypertensive - for
hypertension
 Antibiotics - to a child with
evidence of persistent streptococcal
infections
 Anticonvulsants as
prescribed for seizures associated
Glomerulonephritis with hypertensive encephalopathy
 In older child: headache, abdominal PS: Instruct parents that the child needs to
or flank pain, dysuria obtain appropriate and immediate
 Hypertension treatment for infections, sore throats, upper
 Proteinuria that produces a persistent respiratory infections, and skin infections.
and excessive foam in the urine
 Azotemia “Nephrotic Syndrome”
 elevation of Blood Urea Nitrogen
(BUN-usually ranging 7 to 21  Nephrotic syndrome is a kidney
mg/dL), creatinine in the blood, and disorder characterized by massive
other secondary waste products proteinuria, hypoalbuminemia
within the body (hypoproteinemia), and edema
Nephrotic Syndrome Assessment
 Child gains weight( anasarca) Nephrotic Syndrome Interventions
 Periorbital and facial edema most The primary objectives of
prominent in the morning therapeutic management are to:
 Leg, ankle, labial, or scrotal edema  reduce the excretion of
 Urine output decreases; urine dark urinary protein
and frothy (proteinuria)  maintain protein-free urine
 Ascites (fluid in abdominal cavity  reduce edema,
 Blood pressure normal or slightly  prevent infection
decreased  minimize complications
 Lethargy, anorexia, and pallor  Monitor vital signs, intake and
 Decreased serum protein output, and daily weights.
(hypoproteinemia) and elevated  Monitor urine for specific
serum lipid levels gravity and protein.
 Monitor for edema.
 A regular diet without added
salt
 Medication as prescribed
 Corticosteroid therapy
 Immunosuppressant
therapy
 Diuretics

“Enuresis”

 Enuresis refers to a condition in

which a child is unable to control
bladder function, even though the
child has reached an age at which
control of voiding is expected or the
child has successfully completed a
bladder control program.

Types:
 Primary enuresis: Wetting that
occurs in a child that has not fully
Nephrotic Syndrome VS AGN mastered toilet training.
  Daytime (diurnal) enuresis:  Perform urinalysis and urine culture
Wetting that occurs during the as prescribed to rule out infection or an
day existing disorder.
 Nighttime (nocturnal)  Assist the family with identifying a
enuresis- is bedwetting in a treatment plan that best fits the needs of
child who has never been dry the child.
for extended periods  Limit fluid intake at night and
 The condition is common in encourage the child to void just before
children, and most children going to bed.
eventually outgrow Enuresis
bedwetting without  Involve the child in caring for the
therapeutic intervention. wet sheets and changing the bed to assist
 The child is unable to sense a the child to take ownership of the problem.
full bladder and does not  Provide reward systems as
awaken to void. appropriate for the child.
 The child may have delayed  Incorporate behavioral conditioning
maturation of the central technique
nervous system.  Medication as prescribed:
 The child should be evaluated  Desmopressin may reduce
for any pathological causes urine production at night;
before the diagnosis of  anticholinergics may reduce
nighttime (nocturnal) enuresis bladder contractions and increase
is made. bladder capacity
 Secondary enuresis  Encourage follow-up to determine
 The onset of wetting occurs the effectiveness of the treatment
after a period of established
urinary continence.
 If the child complains of
dysuria, urgency, or frequency
the child should be assessed
for urinary tract infections.

Assessment:
 A child older than 5 years wets their
bed or their clothes 2 times a week or
more, for at least 3 months.
Interventions
“Cryptorchidism”
 Cryptorchidism is a condition in
which one or both testes fail to descend Cryptorchidism Interventions:
through the inguinal canal into the scrotal  ORCHIOPEXY
sac.  is a procedure in which a
surgeon fastens an
undescended testicle inside
the scrotum, usually with
absorbable sutures

Cryptorchidism Assessment:
 Testes are not palpable or easily
guided into the scrotum.

 Instruct parents in
postoperative home care
measures, including
Cryptorchidism Interventions preventing infection, pain
 Monitor during the first 6 months of control, and activity
life to determine whether spontaneous restrictions.
descent occurs.  Provide an opportunity for
 Surgical correction is commonly parental counseling if the
done at 6 months of age and before 12 parents are concerned about
months, depending on the pediatric the future fertility of the child.
surgeon's preference.
 Monitor for bleeding and infection “Epispadias and Hypospadias”
postoperatively.
 Epispadias and hypospadias are
congenital defects involving
abnormal placement of the urethral
orifice of the penis.
 These anatomical defects can lead to
the easy entry of bacteria into the
urine.
Epispadias and Hypospadias
 age, depending on the pediatric surgeon's
preference.
 Circumcision may not be performed
on a newborn with epispadias or
hypospadias.
 Although there are other surgical
techniques used to repair these defects, the
pediatric surgeon may prefer using the
foreskin for surgical reconstruction

Assessment Postoperative interventions

Epispadias:  The child has a pressure dressing
 The urethral orifice is located on the and may have some type of urinary
dorsal surface of the penis; diversion or a urinary stent (used to
maintain patency of the urethral opening)
while the meatus is healing.

 Monitor vital signs.

 Encourage fluid intake to maintain
adequate urine output and maintain
patency of the stent if a stent was placed.
 Monitor intake and output and the
urine for cloudiness or a foul odor.

Postoperative interventions
 Notify the pediatric surgeon if there
is no urinary output for 1 hour, because
 the condition often occurs with this may indicate kinks in the urinary
exstrophy of the bladder- diversion or stent or obstruction by
 bladder exposed to the outside sediment
skin  Medication as prescribed
Hypospadias:  Anticholinergic- to relieve
 Urethral orifice is located below the bladder spasms
glans penis along the ventral surface.  antibiotics – prevent infection

Postoperative interventions
 Instruct parents in the care of the
child who has a urinary diversion or stent.
 Instruct parents to avoid giving the
child a tub bath until the stent, if present, is
removed.
 Instruct parents about fluid intake,
medication administration, signs and
symptoms of infection, and need for
follow-up for dressing removal after
Surgical interventions surgery as prescribed
 Surgery is done before the age of
toilet training, between 6 and 12 months of
 “Bladder Exstrophy” “Urinary tract infections (UTI)”

 Bladder exstrophy is a congenital  Urinary pathogens seem to enter the

anomaly characterized by extrusion of the urinary tract most often as an ascending
urinary bladder to the outside of the body infection from the perineum and are gram-
through a defect in the lower abdominal negative rods such as Escherichia coli.
 The cause is unknown; it is possibly
a combination of genetic and
environmental risk factors during
pregnancy.

Assessment
 Exposed bladder mucosa and
epispadias in males
 Defects of the abdominal wall
 Vesicoureteral reflux
 Defects of the rectum and anus

Interventions Risks for UTI

 Prevent the bladder tissue from  A health care-acquired infection in
drying, while allowing the drainage of children who have urinary catheters.
urine, until surgical closure is performed.  Occur more often in girls than boys
 Immediately after birth, as because the urethra is shorter in
prescribed, the exposed bladder is covered girlsbacteria can easily spread to the
with a sterile, non adherent dressing to urethra.
protect it until closure can be performed.  Frequent use of products such as
 Applying petroleum jelly to the bubble bath, feminine hygiene sprays, and
bladder mucosa is avoided because it tends hot tubs.
to dry out

Interventions
 Monitor urinary output.
 Monitor for signs of urinary tract or
wound infection.
 Maintain the integrity of the exposed
bladder mucosa.

 Monitor laboratory values and

urinalysis to assess renal function.
 Administer antibiotics as prescribed.
 Provide emotional support to the
parents and encourage verbalization of
their fears and concerns. Assessment
 pain on urination
 frequency, burning, and hematuria
 Fever
 Urine for culture positive for  Treatment with antibiotics must be
bacteriuria continued for the full prescription or the
 Presence of either red or white blood infection will return.
cells  A child needs to drink a large
quantity of fluid to "flush" the infection out
of the urinary tract
 Cranberry juice to acidify urine and
making it more resistant to bacterial
growth.

 if infection is confined to the bladder

(cystitis), the child may have a low-grade
fever, mild abdominal pain, and day- or  Avoid fluids with artificial coloring
nighttime enuresis. and carbonation should because they
 If the infection progresses to irritate the bladder and can cause further
pyelonephritis,the symptoms are generally discomfort
more acute, with high fever, abdominal or
flank pain, vomiting, and malaise. Interventions
 If the child experiences moderate to
severe pain on urination that interferes
with the ability to void, suggest the child
sit in a bathtub of warm water and void
into the water.
 Changing diapers frequently can
help reduce the risk for infection in infants.
 Girls should be taught early (when
they are toilet-trained) to wipe themselves
from front to back after voiding and
defecating to avoid contaminating the
urethra.
 A repeat clean-catch urine sample
obtained after approximately 7 days of
antibiotic dosing is indicated for some
children who have had multiple recurrent
Interventions UTIs.
 Broad-spectrum antibiotic
 This is referred to as a "test of cure," system because it is not a system that
and the goal is to confirm that the bacterial receives much discussion
infection has been obliterated and is not  Nurses should be knowledgeable
simply being partially suppressed resources, explaining anatomy, tests and
procedures, and the rationale for various
ASSESSMENT testing.
 Because the symptoms of many  In addition, nurses should be patient
urinary tract and renal disorders, such as advocates and facilitate opportunities for
mild abdominal pain, slowly increasing family/provider discussions when
edema, or low-grade fever, are subtle, indicated.
school nurses play an important role in
recognizing the seriousness of such minor End of Concept
symptoms and making referrals for care.
 Refer immediately

NURSING DIAGNOSIS
1. Pain related to bladder irritation from
urinary tract infection
2. Excess fluid volume related to decreased
kidney function and fluid accumulation
3. Imbalanced nutrition, less than body
requirements, related to effects of dietary
restrictions
4. Interrupted family processes related to
the stress of a child's chronic illness
5. Compromised family coping related to
the chronic nature of a child's illness

Nursing Process
OUTCOME AND PLANNING
 Be certain that outcomes established
for care are relevant to a child's age and
condition.
 If renal disease becomes chronic,
expected outcomes may need to be
modified frequently to meet the evolving
needs of both the child and the family unit.
 Planning for a child with a urinary
tract or renal disorder often involves
helping parents develop a reliable system
to remember to give medicine.
IMPLEMENTATION
 Neither parents nor children may
fully understand the function of the urinary