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: Teenage patient with acute left scrotal pain with nausea

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

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 1HPI: 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 2

Jacob 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. Case Study: Teenage patient with acute left scrotal pain with nausea

 

 

 

MORE INFO 

Evaluation and Management of Renal and Genitourinary Disorders

Introduction

Renal and genitourinary disorders must be managed with an in-depth evaluation. The clinician’s role is to establish the diagnosis, severity, stage of the disease, risk factors for complications, comorbidities and potential side effects of therapy. Treatment decisions must be made based on a thorough understanding of the patient’s history and current state of health as well as their preferences for care.

CLINICIAN TASKS

The clinician must first establish a diagnosis. This is done by obtaining an extensive history and conducting a physical examination, including laboratory tests to determine kidney function.

The severity and stage of disease are also evaluated, as well as risk factors for complications and comorbidities. Based on these factors, treatment decisions can be made at this time to address any immediate needs (such as pain control) or help prevent further progression of disease (such as infection).

1. Establish a diagnosis.

Establishing a diagnosis is the first step in the process of care. A diagnosis is the identification of the nature of a disease or injury. It may include information about how long it has been present and whether there are other symptoms associated with it.

The purpose of establishing a diagnosis is to determine what treatment will be most appropriate for each patient and how much additional information you need from them before proceeding with therapy, such as laboratory tests or imaging studies (e.g., X-rays).

2. Establish severity and stage of disease.

The second step is to understand the severity of your disease, its stage, and any comorbidities.

• Identify the type of kidney disease: This can be done by inspecting your medical history, including previous treatment and medications you may have taken in the past. If there has been any damage to your kidneys or other organs due to acute or chronic conditions such as diabetes or hypertension (high blood pressure), this may also be noted. In some cases it may be necessary for doctors to perform an imaging test called sonography which uses sound waves instead of light waves like CT scans do; this allows them see inside your body more clearly so they can determine what kind of problem there might be with one specific organ—such as whether it’s blocked off completely or just partially damaged from something like small stones lodged inside them – without having surgery immediately afterwards.”

3. Identify risk factors for complications and comorbidities.

Risk factors for complications and comorbidities should be identified in the medical record, care plan, and discharge plan.

Risk factors include:

• Age

• Sex

• Race/ethnicity (e.g., Asian American)

In addition to these clinical risk factors, there are social and economic ones that affect your patient’s health status. For example, poverty can lead to poor nutrition, lack of access to healthcare resources and services such as immunizations that could prevent an infection from becoming serious or requiring hospitalization until it resolves on its own; these are known as “population-level” determinants of health.

4. Make the initial treatment decisions based on risk stratification and patient preferences.

• Assess the patient’s risk of developing complications.

• Assess the patient’s preferences for treatment options.

• Consider the patient’s age, gender and comorbidities when making treatment decisions.

• Consider your ability to manage their care if they are unable or unwilling to comply with recommended medications or follow-up appointments.

5. Prepare the patient for the course of treatment, including anticipatory guidance and individualized care plans for self-monitoring or home care.

The treatment plan for renal and genitourinary disorders should be discussed with the patient, who will need to understand the goals of therapy and how to monitor his or her condition. The doctor may recommend that you take medications orally, either as pills or liquids (e.g., in a drink). You may also have an appointment with a urologist separately from your primary care doctor if you have further questions about this type of treatment plan. If you experience side effects during treatment for renal disease or genitourinary disorder, tell your doctor right away so he can adjust your dosage accordingly.

If any problems arise while taking medications prescribed by a urologist, it’s important that you contact them immediately so they can help figure out what went wrong and provide additional help if necessary—and even get back into touch with them sooner rather than later!

6. Confirm medication effectiveness and adherence.

• Review the medications the patient is taking, and make sure they are appropriate.

• Check for adherence to medication.

• Check for side effects, interactions between medications (especially if you’re prescribing multiple medications), tolerance to certain drugs or combinations of drugs, etc.

7. Monitor for complications of therapy through systematic assessments of symptoms, adverse effects, laboratory values, tolerability, response rates, functional status, quality of life, and other clinical outcomes.

• Monitor for complications of therapy through systematic assessments of symptoms, adverse effects, laboratory values, tolerability, response rates and other clinical outcomes.

The use of POCT to monitor for complications of therapy has been shown to be beneficial in the treatment of urological disorders [5]. To improve the monitoring process and provide additional information about your condition during treatment with POCTs in general please see our post on how to use POCTs effectively on our blog here: https://www.medicalartworkonline.com/blog/how-to-use-a-positron emission tomography (PET)/computed tomography scan machine

8. Document the steps in the out-of-office Point-of-Care Testing (POCT) process as per relevant guidelines including federal requirements as they apply to Medicare patients (42 CFR Part 493).

• Document the steps in the out-of-office Point-of-Care Testing (POCT) process as per relevant guidelines including federal requirements as they apply to Medicare patients (42 CFR Part 493).

• Utilize standardized documentation templates for POCTs, including:

• Basic data elements for specific types of POCTs;

• Consent documents for patients receiving consent; and

• Discharge summaries for patients who have been discharged from your practice.

Conclusion

With the increasing number of kidney and genital disease cases, medical professionals must be prepared to provide accurate diagnoses, treat patients appropriately, and communicate with patients about their treatment. In today’s healthcare world with rising costs, it is critical for physicians to focus on quality care delivery rather than cost savings. By implementing these guidelines for managing renal and genitourinary disorders at every visit, both physicians and nurses can improve patient outcomes while reducing costs.