NURS 2410 Unit 10 and 11 GU, Endocrine, Integ

1. NURS 2410 Unit 10 and 11GU, Endocrine, Integ Nancy Pares, RN, MSN Metro Community College

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

3. 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

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

6. Ureters • Carry waste fluid from kidneys to bladder

7. 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

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

9. Clinical Manifestations of Genitourinary Problems • Structural defects and various disorders • May result in reduced or obstructed urine flow • Testing

12. 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

13. Figure 31-5 Hypospadias and epispadias. A, In hypospadias, the urethral canal is open on the ventral surface of the penis. B, In epispadias, the urethral canal is open on the dorsal surface.

14. 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

15. 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

16. Structural Defects of Urinary System • Congenital abnormalities involving abnormal location of urethral meatus • Postoperative care • Protect surgical site • Pain management • Double diapering

18. Structural Defects of Urinary System • Obstuctive uropathy and posterior urethral valves • Definition—abnormalities that result in urine backflow into the kidneys • Pathophysiology—caused by several congenital lesions

19. Figure 31-7 Obstruction may occur in either the upper or lower urinary tract. Common sites of obstruction occur at the ureteropelvic valve, the ureterovesicular junction, or the posterior urethral valve. Why would damage from posterior urethral valves potentially be worse than other obstructions? Renal failure is most likely to occur when both kidneys are affected by hydronephrosis.

20. Structural Defects of Urinary System • Obstuctive uropathy and posterior urethral valves • Nursing management • Monitor urine output • Pain management • Monitor for infection • Pre- and postoperative care • Diaper placement • Ostomy care

21. Structural Defects of Urinary System • Vesicoureteral reflux • Definition—retrograde flow of urine from bladder into ureters • Pathophysiology—reflux prevents complete emptying of bladder, reservoir for bacterial growth

22. Structural Defects of Urinary System • Vesicoureteral reflux • Postoperative care • Monitor urine • IV administration • Family teaching • Monitor for infection • Incision care

23. Structural Defects of the Reproductive System • Cryptorchidism • Definition—undescended testes • Pathophysiology—occurs when one or both testes fail to descend through inguinal canal into scrotum

24. 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

25. Urinary Tract Infection • Definition—viral, bacterial, or fungal infection of the lower or upper urinary tract

27. Urinary Tract Infection • Pathophysiology—organism enters genitourinary tract and ascends from the urethra to the bladder toward the kidney

28. Urinary Tract Infection • Assessment • History of UTI • I & O • Physical exam of abdomen and perineal region • Collection of urine

29. Urinary Tract Infection • Nursing diagnosis • Impaired Urinary Elimination • Urinary Retention • Risk for Deficient Fluid Volume • Nursing management • Medication administration • Hydration status • Assess renal function

30. Urinary Tract Infection • Teaching • Prevention

32. Chronic Renal Failure • Slow, irreversible reduction in kidney function over months or years • Caused by congenital defects, cystic and inherited diseases, glomerulonephritis, hereditary disorders, and acquired disorders

33. Chronic Renal Failure • Delay in growth and development is a common outcome • High-quality protein diet is needed to support growth • Optimal intake is 2.5g/kg/day

34. Nursing Management • Monitor height and weight • Assess development • Meet nutritional needs • Provide emotional support

36. LEARNING OUTCOME 5 • Summarize dietary restrictions for the child with a renal disorder.

37. LEARNING OUTCOME 5 • Children with kidney disease—risk for malnutrition

38. LEARNING OUTCOME 5 • Chronic renal failure: • Small frequent meals high in protein (2.5g/kg/day) • High calorie intake • Adequate calcium • May require enteral feedings • Complex carbohydrates • Fruits and vegetables low in potassium

39. LEARNING OUTCOME 5 • Chronic renal failure: • Limit phosphorous, potassium, and sodium • Nephrotic syndrome • Regular protein • Low-sodium diet • Acute glomerulonephritis • Low protein • No-added-salt diet

40. LEARNING OUTCOME 6 • Describe psychosocial issues for the child requiring surgery on the genitourinary tract.

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

42. 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

43. 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

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

45. LEARNING OUTCOME 7 • Develop a nursing care plan for the child with acute and chronic renal failure on peritoneal dialysis.

46. Types of Dialysis • Hemodialysis • Peritoneal

47. Nursing Management • Electrolyte monitoring • Intake and output • Vital signs • Heparin administration • Monitor for bleeding and infection • Complications: hypotension, rapid fluid and electrolyte exchange, and disequilibrium syndrome

48. Sexually Transmitted Infections (STIs) • Pathophysiology: numerous bacterial, parasitic, and viral organisms transmit sexually due to avoidance of protective barriers, multiple sexual partners, frequent sexual activity, failure to seek medical treatment, and sexual abuse

49. Sexually Transmitted Infections (STIs) • Nursing management • Identify signs and symptoms, assess for asymptomatic STI • Symptoms: 75% are asymptomatic • Symptoms may include endocervical discharge, pelvic pain, vaginal spotting, urethritis, dysuria

50. Sexually Transmitted Infections (STIs) • Nursing management • Assess for psychosocial impact • Good communication and nonjudgmental approach • Education and prevention