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

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.Diagnosis and Management of Genitourinary Disorders, NURS6541

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 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. Diagnosis and Management of Genitourinary Disorders, NURS6541

ADDITIONAL INFORMATION;

Diagnosis and Management of Genitourinary Disorders

Introduction

The genitourinary (GU) system is a complex network of organs involved in the function and maintenance of body fluids, including urine, blood and semen. GU disorders include many different types of problems that can affect both men and women. They can range from common conditions to rarer diseases.

Diagnosis and Management of Genitourinary Disorders

Genitourinary disorders are common, but they can be complicated. You need to know about genitourinary disorders so you can diagnose and manage them effectively.

Genitourinary disorders include:

• Urinary tract infections (UTIs)

• Kidney stones

Enlarged prostate (BPH) Erectile dysfunction (ED) Prostate cancer Urinary incontinence (UI) Bladder cancer

Nephrotic Syndrome

Nephrotic syndrome is a condition in which protein is present in the urine. There are two types of nephrotic syndrome:

• Primary nephrotic syndrome (PNPS) occurs when your kidneys fail to filter waste products that build up in the blood, leading to excess protein in your urine. This type can be caused by an infection or another illness that damages the kidneys and causes them not to work well enough for filtering purposes.

• Secondary nephrotic syndrome (SNS) develops when there’s damage from high blood pressure or diabetes, which causes thickening of the walls of your blood vessels and reduced flow through them into other parts of your body like muscles and skin.

Urinary Tract Infections in Pediatric Patients

Urinary tract infections (UTIs) are a common health problem that can lead to more serious conditions. They’re often caused by bacteria, but they also can be caused by viruses and even fungi.

Urinary tract infections occur when the kidneys and bladder don’t work properly. The result is a build-up of urine in these organs, which can make you sick if it gets into your bloodstream through an open wound or other type of injury.

If you have an infection, your doctor will likely ask some questions about how long it’s been going on and what symptoms you’ve had:

• Are there any blood or pus in your urine?

• Do you feel tired or weak after urinating?

• Is there burning while passing urine?

If so, this is likely something much more serious than just a UTI! Your child should get checked right away by their pediatrician to determine if his/her kidneys need treatment before anything else happens such as kidney damage due to dehydration caused by having too large amount of fluid inside them (which causes swelling).

Adult Low Male Sexual Desire Disorder

You may have low male sexual desire disorder if your desire to engage in sexual activity is lacking and you can’t remember the last time that you had sex.

The cause of low male sexual desire disorder is not well known, but it’s thought to be due to a number of factors including age and physical health.

Some people who have this condition report that they aren’t interested in having sex because they feel like their partner isn’t attractive enough or doesn’t care enough about them as a person. However, others may just feel tired after having intercourse on a regular basis for many years without stopping for breaks or trying something new like masturbating instead (though this could be considered cheating).

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. It occurs in older men, with a prevalence rate of 3 to 5 percent. BPH can cause problems with urination, such as difficulty starting or stopping urination, and difficulty emptying the bladder.

Acute Uncomplicated Cystitis in Women

Acute uncomplicated cystitis is a condition that causes inflammation and infection in the bladder, affecting approximately 20% of women. The symptoms include:

• Painful urination

• Vomiting

• Fever

Test your knowledge on a variety of Genitourinary disorders.

You’re probably familiar with the term “genitourinary disorders,” but do you know what they are? If not, this section will help clarify how common genitourinary disorders are and what types of tests your doctor might order to help them make a diagnosis.

• Genitourinary disorders are very common in children and adults alike. They can vary widely in severity and impact overall quality of life for an individual patient.

• Some types of genitourinary disorders occur more frequently in women than men: for instance, urinary tract infections (UTIs) tend to be more common among females than males—but also have no gender differences when it comes to prostate cancer risk factors or symptoms associated with early-stage prostate cancer.* Other types aren’t as gender specific: for example, pelvic pain from endometriosis occurs equally among both sexes.*

Conclusion

The diagnosis and management of these disorders is a complex process, but you can use the information in this article to help you understand these issues more deeply. We hope that this article has been helpful for you as you navigate your way through the world of genitourinary medicine.