Disorders of the Genitourinary System

7/23/2019 Disorders of the Genitourinary System

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DISORDERS OF THEDISORDERS OF THEGENITOURINARYGENITOURINARY

SYSTEMSYSTEM

Annette TomlinsonAnnette Tomlinson


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Anatomy and Physiology idneys

U!ete!s

"ladde! U!eth!a


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URINARY TRA#T

INFE#TION $UTI% "a&te!ial in'asion o( the )idneys o! *ladde! Mo!e &ommon in gi!ls+ ,!es&hool+ and s&hool-

age &hild!en Us.ally &a.sed *y E/ &oli

The in'ading o!ganism as&ends the .!ina!yt!a&t+ i!!itating the m.&osa and &a.sing

&ha!a&te!isti& sym,toms


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UTI Sym,toms Dys.!ia ".!ning

It&hing F!e0.en&y

Odo!o.s1&lo.dy .!ine

Fe'e!

"ed2etting 2hen&hild toilet t!ained


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UTI P!edis,osing Fa&to!s3

4 Poo! hygiene

4 I!!itation (!om *.**le *aths4 U!ina!y !e(l.5


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N.!sing Inte!'entions O*tain .!ine &.lt.!e as o!de!ed Administe! anti*ioti&s as o!de!ed $a(te!

&.lt.!e% P!o'ide 2a!m *aths and allo2 &hild to 'oidin 2ate! to alle'iate ,ain(.l 'oiding

Fo!&e (l.ids

A&idi(y .!ine $&!an*e!!y 6.i&e+ a&id-ashdiet%


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N.!sing Inte!'entions P!o'ide &lient tea&hing and dis&ha!ge,lanning &on&e!ning3

4 A'oidan&e o( t.* *aths $&ontamination o(di!ty 2ate! may allo2 mi&!oo!ganisms tot!a'el ., the .!eth!a%

4 Im,o!tan&e (o! gi!ls to 2i,e ,e!ine.m (!om

(!ont to *a&)4 In&!ease in (oods1(l.ids that a&idi(y .!ine


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7ESI#OURETERA8

REF8U9 Reg.!gitation o( .!ine (!om the *ladde!into the .!ete!s d.e to (a.lty 'al'eme&hanism at the 'esi&o.!ete!al 6.n&tion

P!edis,oses &hild to34 UTIs (!om .!ine stasis

4 Pyelone,h!osis (!om &h!oni& UTIs

4 Hyd!one,h!osis (!om in&!eased ,!ess.!e onthe !enal ,el'is


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N.!sing Inte!'entions Assist 2ith ,!e-o,e!ati'e st.dies P!o'ide ,ost-o,e!ati'e &a!e

4 Monito! d!ains: may ha'e one (!om *ladde!and ea&h .!ete!

4 #he&) o.t,.t (!om all d!ains and !e&o!d

4 O*se!'e d!ainage (!om a*dominal d!essing

4 Administe! medi&ation (o! *ladde! s,asms aso!de!ed


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E9STROPHY OF THE

"8ADDER #ongenital mal(o!mation in 2hi&h non-(.sion o( a*dominal and ante!io!

2alls o( the *ladde! d.!ingem*!yologi& de'elo,ment &a.ses theante!io! s.!(a&e o( the *ladde! to lie

o,en on the a*dominal 2all 7a!ying deg!ees o( de(e&t


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Assessment Asso&iated st!.&t.!al &hanges4 P!ola,sed !e&t.m4 Ing.inal he!nia4 ;idely s,lit sym,hysis4 Rotated hi,s

Asso&iated anomalies

4 E,is,adi.s4 Undes&ended testi&les


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T2o-stage !e&onst!.&ti'e s.!ge!y

Possi*ly 2ith .!ina!y di'e!sion

Us.ally delayed .ntil age


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N.!sing Inte!'entions

P!e-o, P!o'ide *ladde! &a!e: ,!e'ent in(e&tion4 ee, a!ea &lean as ,ossi*le: .!ine on s)in

2ill &a.se i!!itation and .l&e!ation4 #hange dia,e! (!e0.ently: )ee, dia,e!loose-(itting

4 ;ash 2ith mild soa, and 2ate!

4 #o'e! e5,osed *ladde! 2ith 7aseline ga.>e


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N.!sing Inte!'entions

Post-o, Design ,lay a&ti'ities to (oste!toddle!?s need (o! a.tonomy

4 #hild 2ill *e immo*ili>ed (o! ane5tended ,e!iod o( time

P!e'ent t!a.ma

4 As &hild gets olde! and mo!e mo*ile+t!a.ma mo!e li)ely


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HYPOSPADIAS U!ethe!al o,ening lo&ated any2he!e

along the 'ent!al $lo2e!% s.!(a&e o(,enis

#ho!dee $'ent!al &.!'at.!e o( the ,enis%o(ten asso&iated+ &a.sing &onst!i&tion

In e5t!eme &ases+ &hild?s se5 may *e

.n&e!tain


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Epispadias

An epispadiasis a !a!e ty,e o(mal(o!mationo( the ,enisin 2hi&h

the .!eth!ao,ening is on the do!salo! .,,e! s.!(a&e o( the ,enis/
http://en.wikipedia.org/wiki/Congenital_malformationhttp://en.wikipedia.org/wiki/Penishttp://en.wikipedia.org/wiki/Urethrahttp://en.wikipedia.org/wiki/Urethrahttp://en.wikipedia.org/wiki/Penishttp://en.wikipedia.org/wiki/Congenital_malformation


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Assessment U!ina!y meat.s is mis,la&ed Ina*ility to ma)e a st!aight st!eam

o( .!ine


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T!eatment

Minimal de(e&ts need no inte!'ention Neonatal &i!&.m&ision delayed+ tiss.e

may *e needed (o! &o!!e&ti'e s.!ge!y

S.!ge!y ,e!(o!med at age


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NEPHROTI#

SYNDROME $Ne,h!osis% A.toimm.ne ,!o&ess leading to st!.&t.!alalte!ation o( glome!.la! mem*!ane that !es.ltsin in&!eased ,e!mea*ility to ,lasma ,!oteins+

es,e&ially al*.min #o.!se o( the disease &onsists o( e5a&e!*ations

and !emissions o'e! a ,e!iod o( months to yea!s

#ommonly a((e&ts ,!es&hoole!s+ *oys mo!e than

gi!ls


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Patho,hysiology

Glome!.la! mem*!ane *e&omes,e!mea*le to ,!oteins

Res.lts in massi'e ,!otein loss

4 Hy,o,!oteinemia4 P!otein.!ia $massi'e%

4 Hy,o'olemia

4 Edema $massi'e%

4 Hy,oal*.minemia4 Hy,e!li,idemia


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Patho,hysiology De&!eased &a,illa!y osmoti& ,!ess.!e&a.ses (l.id a&&.m.lation in the

inte!stitial s,a&es4 #a.ses hy,o'olemia 2hi&h stim.lates

antidi.!eti& ho!mone se&!etion #a.ses !ea*so!,tion o( sodi.m and 2ate!


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Assessment P!otein.!ia+ hy,o,!oteinemia+hy,e!li,idemia

De,endent *ody edema4 P.((iness a!o.nd eyes in the mo!ning

4 As&ites

4 S&!otal edema4 An)le edema


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Assessment Ano!e5ia+ 'omiting+ dia!!hea Pallo!+ letha!gy

He,atomegaly D!amati& 2eight gain

Hy,e!tension


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T!eatment D!.g the!a,y4 #o!ti&oste!oids to !esol'e edema

4 Anti*ioti&s (o! *a&te!ial in(e&tions4 Thia>ide di.!eti&s in edemato.s stage

"ed !est

Diet modi(i&ation4 8o2 to mode!ate ,!otein+ lo2 sodi.m


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N.!sing Inte!'entions P!o'ide *ed !est4 #onse!'e ene!gy

4 Find a&ti'ities (o! 0.iet ,lay

P!o'ide high-,!otein+ lo2-sodi.m dietd.!ing edema ,hase

O*tain mo!ning .!ine (o! ,!otein st.dies

P!o'ide s&!otal s.,,o!t


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N.!sing Inte!'entions Maintain s)in integ!ity4 Do not .se *and-aids4 A'oid IM in6e&tions $medi&ation is not a*so!*ed

into edemato.s tiss.e%4 T.!n (!e0.ently

Monito! ICO+ 'ital signs+ 2eigh daily Administe! ste!oids to s.,,!ess a.toimm.ne

!es,onse P!ote&t (!om in(e&tion


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N.!sing Inte!'entions Tea&hing and dis&ha!ge ,lanning&on&e!ning3

4 8ong-te!m .se o( &o!ti&oste!oids4 P!e'ention o( in(e&tion

4 U!ine testing

4 Need (o! long-te!m (ollo2-.,


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A#UTE

G8OMERU8ONEPHRITIS Imm.ne &om,le5 disease !es.lting (!oman antigen-anti*ody !ea&tion

Se&onda!y to a *eta-hemolyti&st!e,to&o&&al in(e&tion o&&.!!ingelse2he!e in the *ody

Mo!e (!e0.ent in *oys: .s.ally age =-B

yea!s Us.ally !esol'es in days: sel(-limiting


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Assessment Histo!y o( a ,!e&i,itatingst!e,to&o&&al in(e&tion

Edema+ ano!e5ia+ letha!gy Hemat.!ia o! tea-&olo!ed .!ine

Fe'e!

Hy,e!tension


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Diagnosti&s ASO tite!"UN+ se!.m &!eatinine+ ESR

Hg* C h&t U!inalysis !e'eals3

s,e&i(i& g!a'ity

4 R"#s+ ;"#s+ ,!otein+ &ell.la! &asts


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T!eatment

Anti*ioti&s (o! st!e,to&o&&al in(e&tion Antihy,e!tensi'es i( "P se'e!ely

ele'ated

Digitalis i( &i!&.lato!y o'e!load Fl.id !est!i&tion i( !enal ins.((i&ien&y

Pe!itoneal dialysis i( se'e!e !enal o!

&a!dio,.lmona!y ,!o*lems de'elo,


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N.!sing Inte!'entions St!i&t monito!ing o( ICO+ *lood,!ess.!e+ .!ine: 2eigh daily

Tea&hing and dis&ha!ge ,lanning&on&e!ning34 Medi&ation administ!ation4 P!e'ention o( in(e&tion

4 Signs o( !enal &om,li&ations4 Im,o!tan&e o( long-te!m (ollo2-.,


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;I8M?S TUMOR 8a!ge+ en&a,s.lated t.mo! thatde'elo,s in the !enal ,a!en&hyma+ mo!e

(!e0.ently in the le(t )idney O!iginates d.!ing (etal li(e (!om.ndi((e!entiated em*!yoni& tiss.es

Pea) age3 -< yea!s

P!ognosis good i( no metastases


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Assessment Staging4 Stage I3 limited to )idneys

4 Stage II3 t.mo! e5tends *eyond )idney

4 Stage III3 t.mo! &on(ined to a*domen

4 Stage I73 t.mo! has metastasi>ed to l.ng+li'e!+ *one o! *!ain

4 Stage 73 *ilate!al !enal in'ol'ement atdiagnosis


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Assessment Us.ally mothe! noti&es mass 2hile*athing o! d!essing &hild: non-tende!

.s.ally midline nea! li'e! Hy,e!tension and ,ossi*le hemat.!ia+

anemia+ signs o( metastasis

Diagnosti& test3 I7P !e'eals mass


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T!eatment Ne,h!e&tomy+ 2ith total !emo'al o(t.mo!

Radiation (o! stages II+ III+ I7 Post-s.!gi&al &hemothe!a,y


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N.!sing Inte!'entions Do NOT ,al,ate a*domen to a'oid,ossi*le dissemination o( &an&e! &ells

Handle &hild &a!e(.lly 2hen *athing andgi'ing &a!e

Post-o, &a!e (o! ne,h!e&tomy ,atient:.s.ally ,e!(o!med 2ithin - ho.!s

a(te! diagnosis Administe! &hemothe!a,y

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Disorders of the Genitourinary System