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

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 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. Evaluation and Management of Renal and Genitourinary Disorders, NURS 6541 Week 9

 

 

MORE INFO 

Evaluation and Management of Renal and Genitourinary Disorders

Introduction

Renal and genitourinary disorders are common and often severe, with a wide range of symptoms. They are often not diagnosed until the patient has already developed complications. Renal disorders can be divided into acute (overdose or other causes) and chronic (end-stage renal disease).

Renal failure

Renal failure is a catastrophic event in which the kidneys lose the ability to filter blood effectively. It can be caused by several medical conditions and is often associated with other organ damage. Renal failure usually occurs when your kidneys are unable to remove toxins from your body, but it may also occur as part of a more general condition such as heart failure or sepsis (severe infection).

The most common causes of renal failure include:

• Chronic hypertension (high blood pressure)

• Diabetes mellitus type 1 or 2

• Endocrine disorders (such as hyperthyroidism)

Symptoms include: cravings for salt, increased thirst and urination, weight loss due to fluid loss through urination/defecation, pale skin tone

Hematuria

Hematuria is defined as the presence of red blood cells in urine, and it can be classified as microscopic or macroscopic. Microscopic hematuria is when there are fewer than 3 RBCs per high power field. Macroscopically visible hematuria refers to more than 10 RBCs in a single urine specimen, while gross hematuria occurs when there are more than 25 RBCs per high power field.

Proteinuria

Proteinuria is the presence of protein in your urine. It can be caused by inflammation or injury to the kidneys and can be dangerous if left untreated.

Hypertension

Hypertension is a major risk factor for cardiovascular disease. Hypertension is often asymptomatic in the early stages, but it can lead to stroke, heart failure and kidney failure. It should be treated with medication if it does not resolve itself on its own.

Urinary tract infection

Urinary tract infection is another common condition that can be caused by bacteria, viruses or fungi. Symptoms include frequent urination, burning sensation when urinating and pain in the lower back, groin or abdomen. Treatment involves antibiotics to kill the bacteria causing the infection.

Lower urinary tract symptoms (urinary frequency, nocturia, urinary urgency and bladder pain, incontinence)

Lower urinary tract symptoms (LUTS) are a common problem, affecting up to 50% of men and 30% of women. LUTS are usually caused by the loss of bladder control, which may be due to:

• Age – As people age, they tend to lose sensation in their lower urinary tract. This can cause them to have difficulty urinating or make it painful for them when they do urinate.

• Medications – Certain medications can also cause LUTS such as antihistamines and diuretics; however these are not always present in all cases where there is pain with urination or difficulty starting the stream/flow rate of urine flow

Chronic kidney disease

• What is chronic kidney disease?

Chronic kidney disease (CKD) is a term used to describe a group of medical conditions that cause the kidneys to lose their ability to function properly. CKD can develop over time, but it most often occurs when there are two or more risk factors for chronic kidney disease. Risk factors include diabetes, high blood pressure, and high cholesterol levels. Some people with no known health problems may be at higher risk for developing an abnormal amount of protein in the urine if they eat certain foods or take certain medicines that affect how their bodies process these substances.

• How do you diagnose chronic kidney disease?

If you have any symptoms related to your kidneys—such as nausea after eating or feeling tired during the day—your doctor will ask about them first before determining whether it’s possible that you have CKD (chronic kidney disease). If he suspects that he has found something wrong with one of his patients’ kidneys because they appear abnormally large compared with other parts like legs or arms which contain many small bones rather than being made completely out of muscle tissue then this could mean there may be something wrong within those organs themselves.”

Kidney stones

Kidney stones are hard masses that form in the kidneys. They can cause pain and blood in the urine, which is why they’re called a “renal” problem. Kidney stones are more common in men than women, but it’s not clear why this is so. The most common type of kidney stone is calcium oxalate (also called struvite), which makes up about 75% of all cases.

Kidney stones form when there’s an imbalance between chemical reactions within your body’s urine that causes certain substances to crystallize together into these mineralized deposits inside your kidneys or ureters—the tubes that connect to each kidney and carry urine away from them through large veins near their bases into your bladder (urine). If left untreated for too long, these crystals will build up until they become large enough to block one or both urination ducts entirely; this can happen without warning since no symptoms usually appear until later stages when some type of pain signals from affected areas begin getting worse due either directly over time due increased pressure generated by larger clumps forming within existing structures

Sexual dysfunction (erectile and orgasmic difficulties)

If you have erectile dysfunction, it means that your ability to get an erection may be impaired. Erectile dysfunction is common in older men.

Orgasmic difficulties are the inability to reach orgasm with sexual stimulation or stimulation of other parts of the body (such as genitalia). This can be caused by physical factors such as pain or numbness and sometimes psychological causes, including depression.

Peyronie’s disease (induration of the penis associated with pain during erection)

Peyronie’s disease (induration of the penis associated with pain during erection) is an inflammatory disorder of the penis. It is characterized by a buildup of scar tissue that causes the penis to bend or curve during erection.

Peyronie’s disease may be treated with medications that thinned out scar tissue and improved blood flow.

Takeaway:

Takeaway:

The main takeaway from this article is that renal and genitourinary disorders can be managed by a multidisciplinary team.

Conclusion

We’ve been talking about a lot of topics in this article. We hope you enjoyed learning about them, and that they were helpful to you. If you have any questions or comments, please leave them below!