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Nursing Care of the
Child with GU
Disturbance
Topics
GU development
 Nephrotic syndrome
 Glomerulonephritis
 Toilet training
 Enuresis
 UTI

GU Development

Kidney:
 All
nephrons present at birth
 Acid-base balance more efficient by age 2
 Most renal growth during first 5 years
 Kidney & tubular system mature by teen
GU Development

Bladder
 Infant:
increase urine output d/t
• Small bladder size
• ____________ ability to concentrate urine
• & _____________intake
 Less than 2: no bladder control-insufficient
nerve development
Nephrosis/Nephrotic Syndrome
Alternation in kidney function 2nd/to
increased glomerular permeability to
plasma protein
 Result of glomerular injury
 Minimal change nephrotic syndrome
 Secondary nephrotic syndrome
 Recessive gene
Nephrosis

Occurs in children 2-7 years of age
 More

common in boys
Characterized by:
 Edema
 Massive
proteinuria
 Hypoalbuminemia
 Hyperlipidemia
A hydrostatic pressure
caused by a difference in the
amounts of solutes between
solutions that are separated
by a semi-permeable
membrane.
Osmotic pressure reduces
water potential, which is the
tendency of water moving
from one area to another.
Clinical Manifestations

Develops gradually

Weight gain

Edema
 Periorbital
upon arising, becomes
generalized

Pale, irritable, fatigued

 urine output

Muehrcke lines

Labs
Treatment:
Goals:
 decrease
proteinuria
 relieve edema
 manage sx
 improve nutrition
 prevent infection
*Meds –
Corticosteroids

What would you do for nursing care?
Promote Rest
Meet Nutritional
and fluid needs
Prevent Infection
Emotional Support
Administer Meds
Prevent Skin breakdown
The clinical manifestations of nephrosis
include the symptoms of:
1.
2.
3.
4.
Hematuria, bacteriuria &
weight gain.
Gross hematuria,
albuminuria & fever.
HTN, weight loss &
proteinuria.
Massive proteinuria,
hypoalbuminemia &
edema.
0 of 5

The nurse reads the new medication order
for a 4-year-old child with nephrotic
syndrome:
 D/C
prednisolone 40 mg PO daily
 Prednisolone 30 mg PO QOD

The nurse should:
 A.
Discontinue the prednisolone 40 mg & give
the 30 mg dose today.
 B. Check the med record first to see when the
last dose of prednisolone was given.
 C. Start the 30 mg dose tomorrow.
 D. Contact the prescriber for clarification.
Glomerulonephritis (aka acute
postinfectious glomerulonephritis)

Inflammation of the glomeruli

Post-infectious
 Streptococcal
or pneumococcal

Early school-age children

Immune-complex disease

Latent period between streptococcal
infection and onset of symptoms
Pathophysiology
Release of membrane-like material
from organism
 Antigenicantibodies form
 Immune complexes become trapped in
glomerular capillary loop
 Inflammatory response
 Obstruction

Clinical Manifestations
 urine output
 Dark-colored urine

 Tea

or cola colored
Fluid volume excess
 Periorbital
edema
Loss of appetite
 Abrupt flank or midabdominal pain,
fever, irritability
 Mild to moderate hypertension
 Labs


Nursing Care???
Sudden weight loss in the child who has
acute glomerulonephritis most likely results
from the:
1.
2.
3.
4.
Poor appetite
Decreased salt
intake
Reduction of edema
Restriction to
bedrest.
TOILET TRAINING





____________ bowel and bladder elimination
Bowel control usually precedes bladder
“Training” should begin when child shows
____________ and ______________ signs of
readiness
Most American children achieve bowel and
bladder control by age ___________
Use potty training as opportunity to teach
proper _______________
ENURESIS

Repeated _____________ urination

Usually nocturnal; rarely diurnal

Theory: Bladder capacity insufficient to hold urine
produced during the night
 Kawauchi et al., 2003
 ADH
 Genetics

At least 5 years of age

At least 2x/week for 3 months
ENURESIS: MANAGEMENT
R/O organic causes (UTI, diabetes)
 Restrict PM fluids
 Wake child to void
 Bladder capacity training
 Self-hypnosis
 Electrical devices-alarms, watches

Pharmacologic
Management

Anticholinergics- Ditropan

Tricyclic antidepressants- Tofranil

DDAVP nasal spray
Nursing Care
Child and Parent Education
 Lots of sensitivity and positive
reinforcement
 Assess how the child is feeling about this

 Determine
ability to cope
 Wolanczyk et al., 2002
Urinary Tract Infection
E. coli most common bacteria
 Can be first sign of anatomical problems
*causes urinary stasis
 Not easy to diagnose early
S/S UTI

Infants and Young Children
 Typically
non-specific
 Fever
 Irritability,
 Malaise,
 N/V,
anorexia, _________________
 Diarrhea
S/S UTI

Older children
 specific
symptoms are more common
 ___________

Frequency, urgency, burning,
 Pain
in _______________
 Daytime or bedtime wetting
Urinary Tract Infection



Clean-catch, midstream urine specimen (if
carefully done) is sufficient for urine
culture…requires cooperation from the child;
criteria for dx: >100,000 bacterial colonies/ml
Infants: sterile catheterization or suprapubic
needle aspiration is required

Stick-on urine bags are __________________ for
culture….contamination is guaranteed
Pathophysiology of UTI
MECHANISM
CAUSES
INTERVENTIONS
Immature
Allows bacteria to Close monitoring of
kidney
pass the renal
kidney function; high
filtration barrier index of suspicion
“Ascending”
bacteria
Girls: short
urethra, proximity
to anus, exit within
folds of vulva;
intercourse, soaps,
tampons irritate
urethra & increase
susceptibility to
bacteria
Teach parents and
child proper
hygiene; front to
back wiping and
cleaning; void after
intercourse; avoid
bubble baths, harsh
soaps, detergents
Pathophysiology of UTI
MECHANISM
Incomplete
urinary
drainage;
urinary stasis
Urethral
instrumentation
(UTI is most
common
nosocomial
infection)
CAUSES
Obstruction of
urinary flow due
to congenital
anomalies,
stones, strictures,
fibrosis
Mechanical
introduction of
bacteria into
bladder
INTERVENTIONS
High index of
suspicion; observe
quantity, color,
clarity, force of urine
flow
Use sterile technique
during
catheterization and
needle aspiration of
bladder
Education for UTI Prevention
Front to back wiping and cleaning–
females
 Avoid bubblebaths
 Avoid harsh soaps and detergents
 Wear cotton underwear
 Void after intercourse

To prevent UTI in young girls, the
recommendations include:
1.
2.
3.
4.
Clean & wipe front to
back.
Limit bathing as
much as possible.
Increase fluids &
decrease salt intake.
Cleanse perineum
with water after
voiding.
Which finding most likely
indicates a child has a UTI?
1.
2.
3.
4.
He has clear urine
He’s toilet trained but experiences
enuresis.
He drinks a lot of fluids at frequent
intervals.
He urinates once in the morning and once
in the evening
Which of the following orders should a
nurse implement first for a child with a
UTI?
A. Ampicillin 250 mg IV q12 hr
 B. Blood & urine culture
 C. Sitz bath PRN for pain
 D. Voiding cystourethrogram

ATI Review

A nurse is caring for a child. Which of the following are
clinical manifestations of nephrotic syndrome? (Select all
that apply.)

A. Dipstick protein of 1+

B. Edema in the ankles

C. Hyperlipidemia

D. Weight loss

E. Anorexia
ATI Review

A nurse caring for a child recognizes symptoms of
poststreptococcal glomerulonephritis as: (Select all that
apply.)

A. Frothy urine

B. Periorbital edema

C. ill appearance

D. decreased creatinine

E. Hypertension