NURS 6541: Primary Care of Adolescents and Children | Week 9

The care of genitourinary (GU) disorders can range from primary care diagnosis and treatment to referral for specialized care, making it essential for you to identify when a patient’s needs fall within your scope of practice. Consider Hannah, who received specialized treatment for a GU disorder. When Hannah was born, her bladder was misshapen and located outside of her body, requiring immediate surgery. Although the surgery was a success, she began to present with complications at age 2. As is common among children with her condition, bladder exstrophy, she suffered from frequent urinary tract infections (Miami Children’s Hospital, 2012). Although you might not treat bladder exstrophy as an advanced practice nurse, you must be able to treat resulting complications that present later in the patient’s life. In your role, you will care for pediatric patients with GU disorders, and like Hannah, some of these patients will have unique needs, requiring long-term treatment and management.

This week you explore genitourinary disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives – Evaluation and Management of Renal and Genitourinary Disorders, NURS 6541 Week 9 Case Study: Maya is a 5-year-old who presents for a well-child visit

By the end of this week, students will:

• Analyze treatment and management plans for pediatric patients with genitourinary disorders
• Analyze strategies for educating patients and families on the treatment and management of genitourinary disorders
• Evaluate the impact of culture on the treatment and management of genitourinary disorders
• Understand and apply key terms, principles, and concepts related to genitourinary disorders in pediatric patients
• Evaluate diagnoses for pediatric patients
• Evaluate treatment and management plans
• Assess pediatric patients with signs of hematologic and metabolic disorders*
• Assess pediatric patients with signs of gastrointestinal disorders*

*These Learning Objectives support assignments that are due this week but were assigned in Weeks 8 and 9.

Discussion: Diagnosis and Management of Genitourinary Disorders, NURS6541

Many genitourinary (GU) disorders such as kidney disease begin developing during childhood and adolescence (Johns Hopkins Children’s Center, 2010). This early onset of disease makes it essential for you, as the advanced practice nurse caring for pediatric patients, to identify potential signs and symptoms. Although some pediatric GU disorders require long-term treatment and management, other disorders such as bedwetting or urinary tract infections are more common and frequently require only minor interventions. In your role with pediatric patients, you must evaluate symptoms and determine whether to treat patients or refer them for specialized care. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following three case studies.

Discussion board posting assignments are assigned alphabetically by FIRST NAME to ensure all cases are covered and discussed.

• Case Study 1: A-F
• Case Study 2: G-M
• Case Study 3: N-T
• Case Study 4: U-Z

Case Study 1

HPI: This is a 3 year old girl with a 2-day history of complaints of dysuria with frequent episodes of enuresis despite potty training about 7 months ago. She is afebrile and denies vomiting.

PMH: Last UTI, 6 months ago.
PE: Dipstick voided urine analysis reveals: specific gravity 1.015, Protein 1+ non-hemolyzed blood, 1+ nitrites, 1+ leukocytes, and glucose-negative.

Case Study 2Jacob is a 1.5 week old brought in by his distressed mother. While changing his diaper last night, she noted that his penis was edematous and erythematous. He has been crying and fussy. Per mom, no other complaints. He’s been breastfeeding every 1-2 hours without any issues.

PE: Stable VS and growth patterns. Essentially a normal examination with the exception of a slightly erythematous and edematous glans penis with retracted prepuce.

Case Study 3

HPI: Mark is a 15-year-old with complaint of acute left scrotal pain with nausea. The pain began approximately 6 hours ago after a wrestling match. He describes the pain as a dull ache and has gradually worsened to where he can no longer stand without doubling over. He is afebrile and in marked pain.

PE: Physical exam is negative except for elevation of the left testicle, diffuse scrotal edema, and the presence of a blue dot sign.

Case Study 4

HPI: Maya is a 5-year-old who presents for a well-child visit. She is a healthy child with no complaints.

PE: VS stable; Height and weight within the 60th percentile. Head to toe examination is normal.
Diagnostics: Routine urinalysis indicates 2+ proteinuria; specific gravity 1.020; negative for glucose, blood, leukocytes, and nitrites. 60th percentile for height and weight.

To prepare:

• Review “Genitourinary Disorders” in the Burns et al. text.
• Review and select one of the three provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
• Consider strategies for educating patients and families on the treatment and management of the genitourinary disorder.

ORDER INSTRUCTION-COMPLIANT PAPERSBy Day 3

Post an analysis of your assigned case by responding to the following:

• What additional questions will you ask?
  • Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).
• What additional examinations or diagnostic tests, if any will you conduct?
• What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.
• What is your most likely diagnosis and why?
• How will you treat this child?
  • Provide medication treatment and symptomatic care.
  • Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
• Patient Education, Health Promotion & Anticipatory guidance:
  • Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
  • Include any socio-cultural barriers that might impact the treatment and management plans.
  • Health Promotion:
    • What immunizations should this child have had?
    • Based on the child’s age, when is the next well visit?
    • At the next well visit, what are the next set of immunizations?
    • What additional anticipatory guidance should be provided today?

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Describe how culture might impact the diagnosis, management, and follow-up care of patients with the genitourinary disorders your colleagues discussed.
• Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives. Diagnosis and Management of Genitourinary Disorders, NURS6541 Case Study: Maya is a 5-year-old who presents for a well-child visit

 

 

MORE INFO 

Diagnosis and Management of Genitourinary Disorders

Introduction

The genitourinary system is responsible for many important functions, including urination, sexual function and fertility. This article discusses the diagnosis and management of genitourinary disorders.

A. Incontinence

Incontinence is a condition in which the bladder or bowels fail to function normally. The symptoms of incontinence include leakage of urine or stool at inappropriate times (e.g., while lying down).

There are many causes of urinary incontinence, including:

• Aging – as we age our muscles lose their tone and strength, which can make them less able to hold up under pressure. This may lead to leakage even when you’re not trying!

• Pelvic floor disorders – these conditions affect how your pelvic organs work together so that they don’t act like they should anymore; this makes it harder for your bladder and bowels to empty properly when needed. If left untreated long enough these conditions can become chronic (ongoing) problems which require treatment from a doctor who specializes in treating these types of medical issues such as urologists or gynecologists

B. Overactive Bladder Syndrome

Overactive bladder syndrome (OAB) is a common condition that affects both men and women. It’s characterized by the frequent urinary urgency, frequency, and nocturia (having to get up to go to the bathroom at night).

The symptoms of OAB include:

• Having to urinate often or urgently; you may have trouble starting or controlling your urine stream. This can be painful because it causes pressure in your bladder as well as other areas of your body where there are nerve endings that send signals from one nerve ending (the root) down through one spinal cord segment into another nerve ending located somewhere along that segment; this makes those same signals more intense than usual so they can cause pain when tried out during an episode.

C. Benign Prostatic Hypertrophy

There are several types of benign prostate hypertrophy. The most common is chronic prostatitis, which produces pain and discomfort in the lower abdomen and pelvic region. The other forms include:

• Benign prostate hyperplasia: This type causes an increase in size but no symptoms, so it can be diagnosed by a regular physical exam or imaging like an ultrasound or x-ray.

• Prostatic carcinoma: This form causes more serious problems with urinary obstruction, pain from the enlarged gland, and difficulty urinating due to tumor growth blocking out urine flow into the bladder (known as cystoscopy). Treatment for this condition includes surgery to remove the cancerous tissue; radiation therapy; chemotherapy; hormone therapy; cryotherapy (freezing); radioactive seeds inserted into each side of your prostate (transurethral resection); laser therapy

D. Erectile Dysfunction

Erectile dysfunction (ED) is a condition in which a man cannot get an erection. It can happen because of physical or psychological causes.

The signs and symptoms of ED include:

• inability to get an erection for any reason, including sexual excitement, fatigue or stress;

• trouble getting an erection during sexual activity with your partner;

• pain during intercourse; and/or erectile dysfunction is associated with other health problems such as diabetes mellitus (diabetes), atherosclerosis (hardening of the arteries), cancer and heart disease.

Takeaway:

You may be wondering whether you should seek treatment for your genitourinary disorder. The answer is yes! Genitourinary disorders can have a significant impact on quality of life, and they are common—so common that many people are unaware that they have one.

However, it’s important to note that there are two types of genitourinary disorders:

• Primary: These occur when the problem originates in the body itself (e.g., an infection).

• Secondary: These occur after an injury or medical condition has occurred (e.g., urinary tract infections).

Conclusion

According to the American Urological Association website, the most common genitourinary disorders are urinary incontinence and overactive bladder syndrome. These conditions can be treated by physical therapy, medications or surgery. If you have any questions about what is causing your symptoms, it is best to consult with a doctor who specializes in treating these issues.