Genitourinary Disorders

NUR2310
T. McDonald

Urinary System
Maintains balance of fluid and
electrolytes
Removal of waste products
Functionally immature until puberty

Kidneys
Function through filtration,
reabsorption, and secretion
Nephrons
The kidney's functional unit

Filtration occurs at the glomerulus,

Bowman's capsule, and the
basement membrane

Kidneys
As child grows, concentration of
urine becomes more efficient
Under 2 years old, kidneys less
efficient

Ureters
Carry waste fluid from kidneys to
bladder

Bladder
Stores urine
Bladder capacity in ounces estimated
by adding 2 to child's age
Muscular organ
Contraction of detrusor and relaxation of
sphincters result in bladder emptying

Urethra
Excretes urine
Urine excretion occurs around the
12th week of gestation

Urinary Tract Infection

Definition
Viral, bacterial, or fungal infection of the
lower or upper urinary tract

Clinical Manifestations of Urinary

Tract Infection

Urinary Tract Infection

Pathophysiology
Organism enters genitourinary tract and
ascends from the urethra to the bladder
toward the kidney

Urinary Tract Infection

Assessment
History of UTI
I & O
Physical exam of abdomen and perineal
region
Collection of urine

Urinary Tract Infection

Nursing diagnosis
Impaired Urinary Elimination
Urinary Retention
Risk for Deficient Fluid Volume

Nursing management
Medication administration [antibiotics]
Hydration status
Assess renal function [monitor I/O]

Urinary Tract Infection

Teaching
Prevention [wipe from front to back,
cotton, wash hands, no bubble bath]

Structural Defects of Urinary

System
Congenital abnormalities involving
abnormal location of urethral meatus
Hypospadias
Urethral meatus located on ventral surface

Epispadias
Urethral opening located on dorsal surface
[not as common]

A, In hypospadias the urethral canal is open on the ventral

surface of the penis.
B, In epispadias the canal is open on the dorsal surface.

A double-diapering technique protects the urinary stent after

surgery for hypospadias or epispadias repair. The inner diaper
collects stool; the outer diaper, urine.

Milestones in the Development of Bladder Control

Structural Defects of Urinary

System
Congenital abnormalities involving
abnormal location of urethral meatus
Pathophysiology
Result from failure of urethral folds to fuse
completely over urethral groove

Structural Defects of Urinary

System
Congenital abnormalities involving
abnormal location of urethral meatus
Nursing management
Preoperative teaching
Fluid intake and output documentation
Education
Catheter and stent care
Incision and penis care

Structural Defects of Urinary

System
Congenital abnormalities involving
abnormal location of urethral meatus
Postoperative care
Protect surgical site
Pain management
Double diapering

Structural Defects of Urinary

System
Vesicoureteral reflux
Definition
Retrograde flow of urine from bladder into
ureters [main cause for UTI]

Pathophysiology
Reflux prevents complete emptying of
bladder, reservoir for bacterial growth

Structural Defects of Urinary

System
Vesico-uretral reflux
Postoperative care
Monitor urine
IV administration

Family teaching
Monitor for infection
Incision care

Structural Defects of the

Reproductive System
Inguinal hernia and hydrocele
Definition
Painless inguinal or scrotal swelling

Pathophysiology
Peritoneal sac precedes the testicles'
descent into scrotum

Genitourinary Surgery
Nonemergent vs. Emergencies
Infancy vs. older child
Parental concerns
Injury, infection, disfigurement, and
preservation of renal and reproductive
function

Genitourinary Surgery
Nonemergent vs. Emergencies
Parental teaching
Bladder elimination procedures, special
dressing and diapering, bathing,
hydration assessment, wound care, and
infection control

Assess family coping mechanisms

and support systems

Genitourinary Surgery
Nonemergent vs. Emergencies
Assess level of understanding of the
surgery and concerns
Provide parents with the opportunity
to discuss concerns
Psychological counseling may be
beneficial

Nursing Management
Reduce postoperative complications
Reduce parental and child stress
Promote positive body image

Nephrotic Syndrome

Nephrotic Syndrome

This boy has generalized edema, a

characteristic finding in nephrotic syndrome.

Acute Postinfectious Glomerulonephritis

Wilms Tumor
[Wilms tumor= parents find it at bath
time, DO NOT PALPATE; put sign on the
childs bed and chart to alert health care
providers not to palpate b/c it can cause
a metastasis (spreading), it can affect
the kidneys, nephrectomy- affects labs,
I/O; chemo- immuno compromised, keep
kids away from toddlers, as the nurse
give lots of support and teaching, teach
with dolls and drawings]