PEDS Urinary/Renal/Bladder Disorders

Question 1

What am I:

a congenital condition in which the urethral opening is not located at the tip of the penis but rather along the underside.

Answer 1

HYPOspadias

Hypo= below
Spadias= fissure

Question 2

What sex is at higher risk for Hypospadias?

Answer 2

men > female

Question 3

What is the Tx option for HYPOspadias

Answer 3

Surgical Repair: foreskin is preserved

Question 4

When is the ideal age for surgical repair of hypospadias

Answer 4

between 6 to 24 months.

Question 5

Why should a child with hypospadias avoid circumcision BEFORE surgery?

Answer 5

the foreskin is needed for tissue preservation during reconstruction

Question 6

Q: What types of supportive care may be used POST hypospadias surgery?

Supportive care= additional tx or tools

Answer 6

1. Urinary diversion
2. Urinary stent

Question 7

Hypospadia Surgery:

Post Op Care

Answer 7

• Keep surgical site clean- prevent infx
• Monitor vital signs
• Encourage fluid intake
• Monitor urine hourly for amount, cloudiness or a foul odor (norm: 1ml/kg/hr urine output)

Question 8

Hypospadias: Post-Op

When will the HCP remove the dressing post hypospadias surgery?

Answer 8

about 4 days after surgery.

Question 9

Q: What 2 things should parents do for their child post-Hypospaidas surgery?

Answer 9

• Quiet diversional activities (read, color, puzzles- non strenous)
• Avoid traumatizing the surgical site.

Question 10

3 types of Meds given post-surgery for Hypospadias?

Answer 10

Antibiotics: penicillin, ceftriaxone, erythromycin, clindamycin
analgesics: tylenol, NSAIDs, opioids, lidocaine)
anti-spasmodics: baclofen

Question 11

Parent teaching Post surgery for Hypospadias?

Answer 11

• Care of Stent and Surgical Site
• Aware of S/S Infection or Complications
• ** Avoid Bathing – infection risk
• ** Fluids – encourage oral (“If the gut works, use it!”)
• No circumcision – preserve foreskin for reconstruction
• F/U with HCP (dressing removal ~ post-op day 4)

Question 12

• a type of kidney cancer that primarily affects children, typically under the age of 5
• often forming a large mass

Answer 12

Wilms’ tumor
(also known as nephroblastoma)

Question 13

Nursing Interventions for WILMS TUMOR:

Whats the #1 most important thing you should NOT DO to a pt with Wilms’ Tumor?

Answer 13

REFRAIN FROM PALPATING MASS!

Question 14

Why is it important to refrain from palpating the mass in a child with Wilms’ tumor?

Answer 14

Palpation can cause:
* rupture of the protective capsule
* leading to seeding of the tumor
* and potential spread of cancerous cells.

Question 15

What precaution should be taken to prevent accidental palpation of the abdomen in a child with Wilms’ tumor?

Answer 15

A sign should be placed on the BED warning against palpating the abdomen.

Question 16

How quickly does surgery typically occur after a Wilms’ tumor diagnosis?

Answer 16

1-2 days AFTER diagnosis.

ITS RAPID!!

Question 17

Why is pre-op preparation important for Wilms’ tumor surgery

Answer 17

Because of the RAPID timeline of surgery:
* families need extensive education,
* and children require significant emotional support before surgery.

Question 18

Chemo complications for Wilms’ Tumor

Answer 18

• Vincristine-induced ileus : vincristine is a chemo drug. Causes bowel obstruction due to nerve damage.
• Radiation-induced edema: swelling and discomfort in treated areas.
• Postsurgical intestinal adhesions: bands of scar tissue.
• Hypertension (involves renin system)
• Altered urinary output
• Infection
• Metabolic Alkalosis: tx leads to severe vomit and GI fluid loss removing HCL from stomach.

Question 19

Wilms’ Tumor surgery:

What should be carefully monitored when it comes to the RENAL system…. POST surgery?

Answer 19

• HOURLY Urine Outputs
• 1ml/kg/hr (Varies with Age)
• S/S Infection
• Hematuria (blood in urine)
• Electrolytes

Question 20

Wilms’ Tumor surgery:
​
What should be carefully monitored regarding GI system POST surgery?

Answer 20

• NG Tube
• Bowel Sounds: function return, prevent ileus (stopping of peristalsis) & bowel obstruction.
• Abdominal Distention

Question 21

What is Enuresis?

Answer 21

children wetting the bed after they can control bladder.

Question 22

Wetting of bed that occurs ONLY in the day

Answer 22

Diurnal

Question 23

Wetting of bed that occurs at NIGHT.

Answer 23

Nocturnal

Question 24

Causes of Enuresis

List 4

Answer 24

• Familial
• Medical: DM, UTIs etc
• Neurogenic: Nervous system doesnt coordinate properly with bladder funciton
• Emotional
• Irritable bladder
• Structural disorders
• Disorders that affect the concentrating ability of kidneys
• Excessive production of urine
• Chronic constipation: pressure on bladder from inflammed intestine.

Question 25

**DX** for **Enuresis** include:

Answer 25

* **History & presenting** * **Clinical symptoms**: *day? night?* * **Renal Ultrasound**: *visualize kidneys* * **Voiding cystourethrogram (VCUG)**: *imaging that examines bladder and urethra while bladder fills & empties* * **UA, C & S, specific gravity** * **glucose**: indication of DM (polyuria) * **calcium**: metabolic issues or kidney stones * **pinworm prep**: tape test around the anus- done if suspisiouc of pinworm infx cause itching and nocturnal enuresis.

Question 26

Name the 3 **medications** used for **Enuresis**

Answer 26

1. Oxybutynin chloride (Ditropan) 2. Imipramine hydrochloride (Tofranil) 3. Desmopressin acetate – DDAVP

Question 27

*Enuresis Meds*: Class: **Anticholinergic**

Answer 27

Oxybutynin chloride (Ditropan)

Question 28

*Enuresis Meds*: **Action** of Oxybutynin chloride (Ditropan)

Answer 28

Helps to **relax the bladder and increase bladder capacity** * making it easier to **hold** urine and reducing urgency and frequency.

Question 29

*Enuresis Meds*: Class: **Tricyclic Antidepressant**

Answer 29

Imipramine Hydrochloride (Tofranil)

Question 30

*Enuresis Meds*: **Action** of Imipramine Hydrochloride (Tofranil)

Answer 30

**decreases** depth of sleep - insomnia * decreasing the need to urinate while sleeping

Question 31

*Enuresis Meds*: Class: **Synthetic Human Antidiuretic Hormone**

Answer 31

Desmopressin Acetate (DDAVP)

Question 32

*Enuresis Meds*: **Action** of Desmopressin Acetate (DDAVP)

Answer 32

**Increasing** the **concentration** of urine * urine has higher ratio of waste products, low H2O. * tells kidneys to retain water (hence urine is more concentrated). * Child produces less urine at **night**.

Question 33

*Enuresis Meds*: What is the **drug of choice** for treating enuresis

Answer 33

Desmopressin Acetate (DDAVP)

Question 34

**Which of the following is an important teaching point for parents whose child is being treated for enuresis with medication?** a) The medications will completely cure enuresis. b) The medications will control symptoms, but the child may need ongoing treatment. c) The medications are not necessary if the child has no symptoms. d) The medications will stop enuresis permanently after a short course.

Answer 34

**Answer: b) The medications will control symptoms, but the child may need ongoing treatment.** **Rationale**: *Medications for enuresis help manage symptoms, but they **do not provide a cure**. Ongoing treatment and behavior modification may be required to address the condition in the long term.*

Question 35

Other Treatement options for **Enuresis**

Answer 35

* Bed wetting alarms * Motivational therapies * Bowel programs * Treat structural anomalies * Decrease foods irritating to bladder * Bladder retention exercises (Bladder training) * Void before bedtime. * Limit fluid intake before bedtime

Question 36

What approach should be taken when managing a child with enuresis?

Answer 36

* Child needs support and encouragement. * Punishment is contraindicated *(may exacerbate condition)*

Question 37

What am I: a rare congenital birth defect where the **bladder develops outside the body** through an opening in the abdominal wall.

Answer 37

Bladder Extrophy

Question 38

What is the management for **exstrophy** in a newborn?

Answer 38

* Cover exposed tissue with non-adhering plastic wrap or dressing to limit risk of contamination. * Surgical repair of the bladder and genitalia.

Question 39

Parent teaching for newborns with **Extrophy**

Answer 39

* Goal is to establish urinary continence (control bladder urination). * UTI prevention is essential. * Closely monitor U/O

Question 40

What is **paraphimosis**?

Answer 40

**A UROLOGIC EMERGENCY!!!** * Occurs when the foreskin is retracted over the glans penis and constricted at the base, leading to edema, swelling, and possible blood flow restriciton

Question 41

Why does **Paraphimosis** occur in **men**?

Answer 41

* Most common in **uncircumcised** men with **poor hygiene** or difficulty with self-care. * uncircumcised male, when the foreskin is retracted to insert an **indwelling catheter** and the foreskin is not pulled back down.

Question 42

*Paraphimosis*: **Manual** reduction involves

Answer 42

**Gradual application** of **ice** and attempting to return the foreskin to its normal position.

Question 42

Why is Paraphimosis a **urologic emergency**?

Answer 42

arterial blood flow to the glans is obstructed, resulting in ulceration/necrosis.

Question 43

*Paraphimosis*: What is the DEFINITIVE treatment?

Answer 43

May require **circumcision** or a **dorsal slit surgical release** procedure. -dorsal=top part of penis