Chapter 21: Nursing Care of the Child With an Alteration in Urinary Elimination/Genitourinary Disorder

The comprehensive discussion details the nursing care for pediatric patients experiencing genitourinary (GU) disorders and alterations in urinary elimination, beginning with a foundational comparison of anatomic and physiologic differences in infants and children versus adults, highlighting key vulnerabilities such as the kidneys’ lesser protection, the shorter female urethra, and the immature glomerular filtration rate (GFR) in younger toddlers. The chapter outlines the systematic nursing process, emphasizing thorough health history collection—including maternal and family factors—and detailed physical assessment techniques, followed by an explanation of diagnostic procedures and essential laboratory tests used to evaluate renal function, like BUN, serum creatinine, and specialized imaging studies. Structural congenital abnormalities are thoroughly explored, including the management of bladder exstrophy, hypospadias, epispadias, and obstructive uropathy, while stressing the necessity of vigilant monitoring for infection and preventing skin breakdown. Common conditions like urinary tract infection (UTI) and enuresis (diurnal and nocturnal) are addressed with attention to risk factors, hygiene education, and appropriate pharmacological or behavioral interventions. Furthermore, the text delves into serious acquired renal conditions such as minimal change nephrotic syndrome (MCNS), acute poststreptococcal glomerulonephritis (APSGN), and hemolytic uremic syndrome (HUS), detailing their distinct pathophysiologies and the complex nursing management required for fluid volume regulation, electrolyte balance, and infection prophylaxis. The chapter concludes with treatment modalities for acute and end-stage renal disease (ESRD), including the comparison of peritoneal and hemodialysis, the challenges of renal transplantation, and an overview of common reproductive issues in adolescents, such as pelvic inflammatory disease (PID) and testicular torsion.