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Chapter 29
The Child with a Genitourinary
Condition
Urinary System
• Consists of 2 kidneys, 2 ureters, the bladder, &
urethra
• Function is to rid body of waste & maintain body
fluid homeostasis
• Produce a substance (ESF) that stimulates RBC
formation in bone marrow and renin, which
regulates blood pressure
• Kidneys produce substances that stimulate RBC
production
• The functional unit of the kidney is the nephron
• The kidney & ear develops from the same tissue
Sexual Abuse in Children
• May be manifested by behaviors, such as
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Urinary frequency
Excessive masturbation
Encopresis (fecal soiling beyond 4 years old)
Severe nightmare
Bedwetting
Irritation or pain in genital area
Decrease in physical or emotional development
Assessment of Urinary Function
• Urological diagnostic procedures
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UA
Ultrasound
IV pyelogram
CT scan of kidneys
Biopsy
Uroflow
Cystoscopy
Voiding cystourethrography
Cystometrogram
Urethral pressure
Terms Commonly Used to
Describe Urinary Dysfunction
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Dysuria
Frequency
Urgency
Nocturia
Enuresis
Polyuria
Oliguria
Phimosis
• A narrowing of the
• Forcible retraction of
preputial opening of the
tight foreskin is avoided
foreskin
• Foreskin cannot be
– Prevents foreskin from
returned to its normal
being retracted over
position
penis
• Swelling and impaired
– Normal in newborn,
circulation caused by
disappears by age 3
– Corrected by circumcision constriction
Epispadias and Hypospadias
• Epispadias
• In mild cases surgery
– Urinary meatus is on the
is not indicated
upper surface of the penis • Surgery is usually
• Hypospadias
performed before 18
– Congenital defect in which
months of age
the urinary meatus is
located on the lower portion • Routine circumcision
is avoided in these
of the shaft
children, because
– May be accompanied by
chordee, a downward
foreskin may be
curvature of the penis from
useful in the repair
a fibrous band of tissue
Acute Urinary Tract Infection (UTI)
• More common in girls
– Girls have a shorter
urethra, location of
urethra is near anus,
wearing of close-fitting
nylon underwear, bubble
baths, retention of urine,
and vaginitis
• Most caused by E. coli
• Tx – antibiotics, fluids
• Normal urine is acidic
– Alkaline urine favors
pathogens
• S & S older children –
urgency, painful
urination, bedwetting
• S& S infants – fever,
freq urination, foulsmelling urine,
persistent diaper rash
Health Promotion
• Interventions to prevent UTI
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Cleanse perineum with each diaper change
Wipe perineum front to back
Avoid bubble baths
Have child urinate immediately after a bath
Use white cotton underwear
Use loose-fitting pants
Offer adequate fluid intake
Nephrotic Syndrome (Nephrosis)
• A number of different types of kidney
conditions distinguished by the presence of
marked amounts of protein in the urine,
edema, and hypoalbuminemia
– More common in boys
– Seen more in children 2 to 7 years of age
• S & S: Generalized edema, wt gain, pale,
listless, poor appetite, normal BP,
• Urine exam reveals massive albumin and a
few RBCs
Nephrotic Syndrome (Nephrosis)
(cont.)
• Treatment
– Steroids to reduce proteinuria and edema
• Steroids mask infection; therefore, it is important to
monitor the child for signs of infection
– Prevent medication toxicity
– Diuretics have not been effective in reducing
nephrotic edema
– Avoid adding salt to foods whenever edema is
present
– Fluids generally are not restricted except when
massive edema is present
– Tx lasts long time
Nephrotic Syndrome (Nephrosis)
(cont.)
• Nursing care
– Supportive care to parents and child
– Parent instructed to keep daily record of the child’s
weight, urinary protein levels, and medications
– No vaccinations or immunizations should be
administered while the disease is active or during
immunosuppressive therapy
– Positioning
– Strict monitoring of I&O
– Daily weight and protection from infection
Acute Glomerulonephritis
• Allergic reaction (antigen-antibody) to group A
beta-hemolytic streptococcal infection
• Mild cases generally recover within a couple of
weeks
• S&S: periorbital edema, urine is brown/bloody
• High BUN, creatine, and sed rate
• N.I.: rest with only quiet activities until hematuria
subsides
– Prevention of becoming overly tired, chilled, or
exposed to infection
Wilms’ Tumor (Nephroblastoma)
• One of the most common malignancies of
early life, usually before age 3
• Few or no symptoms during the early stages of
growth
• Abdominal mass usually found by parent or
during routine health checkup
• Tx: surgery to remove kidney & tumor,
radiation & chemo
• N.I.: avoid unnecessary handling of the
abdomen because can cause the tumor to be
spread. NO ABDOMINAL PALPATION
Cryptorchidism
• Testes fail to descend into the scrotum
• Unilateral form is more common
• Testes are warmer in abdomen, sperm cells
begin to deteriorate
• If both testes are involved, sterility can result
• Often accompanied by inguinal hernia
• Testes continue to secrete hormones directly
into the bloodstream, so secondary sex
characteristics are not affected
• Tx: HCG or orchioplexy
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