At the end of the session, students will be able to:
 Define Urinary tract infection
 Explain the causes
 Identify the clinical manifestations seen in different age groups
 Explain the treatment
 Define the glomerulonephritis
 Identify the clinical manifestations and treatment
 Define nephrotic syndrome
 Explain the pathophysiology
 Identify the clinical manifestations
 Explain the nursing care and therapeutic management
 Define inguinal hernia
 Identify clinical manifestation and treatment
 Define hydrocele and identify the therapeutic management
 Define undescended testes and identify the clinical manifestation
 Discuss the therapeutic management of this condition
 Define hypospadias and identify the therapeutic management
 Define epispadias and identify the therapeutic management
 UTI
is a clinical condition that may involve
lower urinary tract and upper urinary tract
 UTI
is applied to presence of a significant
number of micro-organisms anywhere within
the urinary tract except to distal 1/3 of urethra

Urinary tract infections (UTI) is common
in the pediatric age group

Early recognition and prompt treatment of
UTI are important to prevent progression of
infection
• To pyelonephritis or urosepsis and
• To avoid late sequelae such as renal
scarring or renal failure.
 UTI
generally begins in the bladder due to ascending
infection from perineal contaminants, usually bowel
flora such as Escherichia coli.
 In
neonates, infection of the urinary tract is assumed
to be due to hematogenous rather than ascending
infection.
 This
etiology may explain the nonspecific symptoms
associated with UTI in these patients.
 Infants
and young children with UTI may present
with few specific symptoms.
 Older
pediatric patients are more likely to have
symptoms and findings
Newborn and children below 2

Resemble GI disorders: failure to thrive, feeding problems,
vomiting, diarrhea, abdominal distention and jaundice

Newborns may have fever, hypothermia or sepsis.

Frequent or infrequent voiding, constant squirming and
irritability, strong smelling urine, and abnormal stream.
Children more than 2 years of age:
 Enuresis,
or daytime incontinence – toilet trained
children
 Fever
 Strong
or foul smelling urine
 Increased
frequency or urination, dysuria or urgency
 Abdominal
 May
pain
have hematuria
 Antibiotic
therapy
 Prophylactic
antibiotic for recurrent UTI
 Ultrasound
 Voiding
Cystogram:

It is the inflammation of the tiny filters in
the kidney (glomeruli)

Most cases are post infectious:
pneumococcal, streptococcal and viral
infections

Presumed as a result from immune complex
formation and glomerular disposition
 Impairment
of selective filtering properties of the
kidney leading to a decreased GFR
 Molecules
normally not filtered such as constituents
of the blood, pass into the urine and are excreted

Oliguria

Periorbital Oedema (worse in the morning)

Loss of appetite

Dark coloured urine

Antecedent streptococcal infection

Hypertension

Circulatory congestion

Haematuria

Proteinuria

Decreased urine output
 Hypertensive
encephalopathy
 Acute cardiac de-compensation
 Acute renal failure
 Maintenance
of fluid balance
Vital signs, body weight and I/O
 Management
of hypertension
Loop diuretics
Calcium channel blockers
Beta blockers
 Nutrition
Depends on stage / edema
Sodium intake is limited
Potassium intake is restricted during oliguria
 Antibiotics
 Variety
of disease processes where there is
direct attack on the kidney or secondary the
previously damaged glomeruli
 Treatment
 Some
of underlying disease
form of CGN treated with corticosteroids
and cytotoxic agents
 In
case of renal failure: dialysis and renal
transplantation
 Defined
as massive proteinuria, hypoalbunemia,
hyperlipidemia and oedema
 Increased
glomerular permeability to plasma
protein resulting in massive protein loss
 Minimal
change nephrotic syndrome; most common
form of primary disease
 Secondary
nephrotic syndrome: associated with
another disease
 Congenital
nephrotic syndrome: hereditary form

The glomerular membrane becomes permeable to protein specially
albumin, which leak through the membrane and is lost in urine
(hyperalbuminuria)

Reduces serum albumin – Hypoalbuminemia

Increased hepatic synthesis of protein and lipids –
hyperlipidemia

Fluid accumulate in the interstitial spaces (edema) and body
cavities e.g. ascites

Sudden weight gain

Puffiness of the face especially around the eyes

Generalized oedema (anasarca)

Skin pallor, changes in nail colour

Rapid weight gain

Labial or scrotal swelling

Decreased urine output
Evaluate a child who exhibits the following for the
possibility of nephrotic syndrome:
 Periorbital,
 Weight
gonadal or lower extremity edema.
gain greater than that expected based on
previous pattern.
 Decreased
 Pallor
urinary output.
fatigue.

History

Clinical manifestations

Urinalysis

Total serum protein

Renal biopsy
 General
measures
 Diet
 Corticosteroid
therapy
 Immunosuppressant
 Prevention
 Family
therapy
of infection
support and home care
 Most
cases of minimal change disease
eventually remit permanently.

Inguinal hernia is when persistence of all parts or part of
processus vaginalis during the 8th month of gestation.

The upper part of processus vaginalis does not atrophy.

Therefore abdominal fluid or abdominal structure can
be forced into it creating a palpable bulge or mass

A painless inguinal swelling that disappears during period of
rest or is reduced by gentle compression.

Appears when infant cries or strains.

In older children: it appears when strains, coughs or stands for
a long time.

Symptoms appears when abdominal content or loop of
intestines become partially obstructed – irritability, tenderness,
anorexia, abdominal distention, difficulty defecation.
 Prompt
elective surgery
Nursing care
 Pre-operative and post operative care for
general abdominal surgeries
 It
is the presence of fluid in the processus
vaginalis and or result of same developmental
defect as in inguinal hernia
It can be
 Non-communicating
 Communicating
 Prompt
elective surgery
Nursing care
 Pre-operative and post operative care for
general abdominal surgeries
 It
is failure of one or both testes to descend
normally through the inguinal canal into the
scrotum
Therapeutic management
If the testes do not descend between 1 an 2 years
of age orchiopexy is performed
 Urethral
opening is located below the glans
penis or any where along ventral surface of the
penile shaft
 Surgical
correction of the deformity
Objectives are
 Enhance child’s ability to void in standing position
 Improve physical appearance of genitalia
 Preserve a sexually adequate organ
 Usually
presented with bladder exstrophy
 In epispadiasis there is failure of urinary
canalization and urethral opening seen on dorsal
surface of penile shaft
 Preservation
 Attainment
 Adequate
of renal function
of urinary control
reconstructive repair
 Prevention
of UTI
 Preservation
of maximum external genitalia
with continence and sexual function