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Genitourinary tract dysfunction - Coggle Diagram

- - - - A common and potentially serious problem in children
      - Girls have a two-fold to four-fold higher prevalence than do circumcised boys.
      - Uncircumcised males younger than 3 months old and females younger than 12 months old have the highest baseline prevalence of UTI
    - - • Kidneys (pyelonephritis) tend to present with fever and may be associated
        
        with decrease kidney dysfunction
        
        • Urethra (urethritis)
    - - • Bladder (cystitis)
        • Ureters (ureteritis)
    - - Escherichia coli remains (most common uropathogen)
        
        Proteus mirabilis ,
        
        Pseudomonas aeruginosa
        
        Klebsiella
        
        Enterobacter
        
        • Other gram-negative organisms:
    - - • Female gender
        
        • Uncircumcised males
        
        • Vesicoureteral reflux
        
        • Voiding dysfunction
        
        • Obstructive uropathy
        
        • Urethral instrumentation • tight clothing
        
        • Constipation
        
        • Anatomic abnormal
        
        (Labial adhesion)
        
        • Neuropathic bladder • Sexual activity
        
        • pregnancy
    - - • Newborns may have fever, hypothermia, jaundice, tachypnea or cyanosis, and they appear quite ill.
        
        More than 2 years of age
        
        • enuresis or daytime incontinence in the child who has been toilet trained, fever, foul-smelling urine, increased frequency of urination, dysuria or urgency
        
        In older children and adolescents
        
        • Lower tract infections: frequency and painful urination of a small amount of turbulent urine that may be grossly bloody.
        • Upper tract infection: fever (> 38°C), chills and flank pain-lower tract
      - In older children and adolescents
        
        • Lower tract infections: frequency and painful urination of a small amount of turbulent urine that may be grossly bloody.
        
        • Upper tract infection: fever (> 38°C), chills and flank pain-lower tract.
    - - •Urinary analysis and culture
      - •Urinary analysis and culture
      - •Illness history
    - - Take antibiotic
    - - Encoragement of good toilet habits
        
        Encoragement of dietary intake
        
        Instruct parents about awareness of signs and symptoms of UTI
        
        Teach the parents and children about medication
        
        Encorage brushing the teeth
        Reinforce compliance with medication regimens and complication of therapy
        
        Encorage adequate fluid intake (Holiday segar method)
        
        Avoid bladder irritants (caffeinated, carbonatrred beverage)
        
        IVF if needed
      - Assessment
        
        Laboratory
        
        Urinalysis
        
        proteinnuria
        
        pyuria WBC >5
        
        ้hematuria
        
        Urine culture
        
        Bladder catheization >=10^3
        
        Suprapubic aspiration:Not found
        
        1.Clean-void mid rtream urine >= 10^5 CFU/ml
        
        Radiologic and other test of urinary system function
        
        VCUG
        
        DMSA
        
        Ultrasonnography
    - - Geneally,UTI occures when bacteria adhere to the uroepithelium and induce an inflammatory response
        
        The invasion of uropathogenes may be restrictde to the distal part of the urinary tracted , causing urethritis or cystitis or may reach the upper urinary tract,causing uriteritis and pyelitis or pyelonephritis
        
        Pyelonephritis (กรวยไตอักเสบ)
        
        abdominal , bavk , flank pain
        
        fever>39
        
        malaise
        
        naesea,vomiting
        
        diarrhea
        
        Cyctitis(โรคกระเพาะปัสวะอักเสบ)
        
        dysuria
        
        increase frequency
        
        hematuria
        
        crying while urinating
        
        Cloudy urine
        
        abdominal pain
- - - - Inflammationoftheglomerulus
      - Leadtocomplicationssuchasheartfailure,seizures,acuterenalfailureand
      - hypertensive encephalopathy
      - •Manycasesarepostinfectiousandhavebeenassociatedwithpneumococcal, streptococcal and viral infections.
      - • Postinfectiousdiseasesarepresumedtoresultfromimmune-complexformationand
      - glomerular deposition, and the clinical presentations may be indistinguishable.
    - - • Postinfectious glomerulonephritis, is the most common of the non-infectious renal diseases in childhood
      - APSGN can occur at primarily affects early school- age children, with a median age of onset between 3 and 12 years
    - - • A latent period of 1 to 2 weeks occurs between a streptococcal infection of the throat, or 3 to 6 weeks between a skin infection
      - • Disease secondary to streptococcal pharyngitis is more common in the winter or spring
    - - • Periorbital, gonadal, abdominal or lower extremity oedema
        
        • Loss of appetite
        
        • Decrease urinary out put
        
        • Cola or tea colour urine
      - ์Non-pitting edema
    - - • Urinalysis during the acute phase shows haematuria, proteinuria and increased specific gravity.
        
        • Gross discolouration of urine reflects its red blood cell and haemoglobin content.
        
        • Microscopic examination of the sediment shows many red blood cells, leucocytes, epithelial cells and granular and red blood cell casts.
        • Bacteria are not seen, and urine cultures are negative.
    - - • No specific treatment is available for APSGN.
        
        • Generalsupportivemeasuresandearly recognition and treatment of complications.
        
        • Children who have normal blood pressure and a satisfactory urinary
        
        output can generally be treated at home but must be closely monitored.
        
        • Those with substantial oedema, hypertension, gross haematuria or significant oliguria are often hospitalised because of the unpredictability of complications.
        
        • Short hospitalisation may be necessary in uncomplicated cases
        
        Hypertension
        
        • Need absolute bed rest
        
        • BP taken at least every 4 to 6 hours.
        
        • Antihypertensive drugs, such as calcium channel blockers, beta blockers or angiotensin-converting enzyme inhibitors, may be needed in severe cases
    - - Regular monitoring V/S
        
        • Fluid balance
        
        • Assessmentappearanceforsignsof cerebral complications
        
        • The child with oedema, hypertension and gross haematuria may be subject to complications, and anticipatory preparations are important nursing care responsibilities
        
        • Foods high in sodium and salted treats are eliminated. The nurse should advise parents and friends against bringing items such as potato chips or corn chips
- - - - Proteinuria(3+ to 4+)
    - - Hypercholesterolemia>=250
      - Hypoalbuminia<=2.5 2.5 mg/l
  - - - Reducing fluid retention in the tissue
      - -Restricting salt intake
      - -severe edema : diuretic,give albumin (0.5-1g /kg IV over 1-2 hrs)
  - - - • Teach parents to detect signs of relapse and to notify the healthcare providers
      - • Instruct parents in urine testing for albumin, administration of medications and general care.
      - • Urine is usually tested daily for albumin while the child is receiving medicine for nephrotic syndrome, and twice a week during remission.
      - • Salt is restricted to no additional salt during relapse and steroid therapy, but a regular diet is suitable for the child in remission.
      - • Prevent infection