This is a comprehensive and detailed note on nursing care of genitourinary and Reproductive disorders in children to r Nur 433.
*Essential Study Material!!
Nursing Care of Genitourinary and Reproductive Disorders in Children
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Enuresis
● Enuresis: is uncontrolled or unintentional urination that occurs after a child is beyond an
age at which bladder control is achieved
● Diagnosis:
○ Occurs at least 2x/week for at least 3 months
○ At least 5 years old
■ There is criteria to follow
○ Rule out ALL organic causes (UTI) prior to dx.
● Two Types:
○ Primary enuresis: A child has never been free of bed-wetting for any extended
periods of time.
○ Secondary enuresis: A child who started bed-wetting after development of urinary
control
○ Cause can be due to sexual abuse
● Expected findings:
○ History of:
■ Alterations in toilet training, voiding/bowel patterns
■ Chronic or acute illness (UTI, DM, sickle cell disease, neurologic deficits)
■ Family disruptions/emotional stressors
■ Family history of enuresis
■ Fluid intake, especially in the evening
○ Complications:
■ Low self-esteem, altered body image, social isolation, fears
■ Early interventions can alleviate long-term emotional issues
● Nursing Care:
○ Evaluate the child’s coping and available support systems.
○ Support the child and family, involve all in teaching
○ Assist them to understand the disorder
○ Allow the child to wear regular sleep wear and avoid diapers.
○ Use positive reinforcement (avoid punishing/scolding following an incident)
○ Assist the child in keeping a calendar of wet and dry days.
○ Have child assist with changing bed linens following accident
○ Make environmental changes (night light, bottom bunk)
○ Refer to appropriate resources (support groups, counseling)
● Intake modifications:
○ Encourage fluids during the day/restrict in evening
○ Avoid holding urine during the day
○ Avoid fruit and fruit drinks after 1600.
○ Avoid caffeinated or carbonated drinks after 1600
○ Avoid constipation: increase fiber in diet
○ Wake the child up during the night to void.
, ○ Administer prescribed medications.
● Medications:
○ Antidiuretic hormone (Desmopressin/DDAVP)
■ Reduces the volume of urine (monitor I&O)
■ Given at bedtime
■ Can be given orally or nasally
○ Tricyclic Antidepressants
■ Inhibits urination
■ Treatment 6-8 weeks
■ Given with food 1 hour before bedtime
■ Educate on adverse reactions (mood changes, suicidality)
■ Avoid sun exposure
○ Anticholinergics
■ Oxybutynin chloride reduces bladder contractions.
Urinary Tract Infections
● UTI: An infection in any portion of the urinary tract. Can be asymptomatic or symp.
○ Terms to know:
■ Bacteriuria: bacteria in the urine
■ Persistent UTI: unresolved bacteriuria with antibiotic therapy
■ Febrile UTI: symptomatic bacteriuria with fever
■ Cystitis: inflammation of the bladder
■ Urethritis: inflammation of the urethra
■ Pyelonephritis: inflammation of the upper urinary tract and the kidneys
■ Urosepsis: bacterial illness
● Risk Factors:
○ Urinary stasis
○ Urinary tract anomalies
○ Reflux within the urinary tract system
○ Constipation
○ Onset of toilet training
○ Uncircumcised males (inadequate hygiene)
○ Females (urethra in close proximity to rectum)
○ Synthetic, tight underwear and wet bathing suits
○ Sexual activity
● Clinical Findings:
○ INFANTS
■ Increase in irritability
■ Screaming or straining with urination
■ Poor feeding, vomiting, or failure to gain weight
■ Increase in thirst
■ Frequent urination
■ Foul-smelling urine
■ Fever
■ Diaper rash
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