Paediatric

1. GENITO URINARY DISORDERS
URINARY TRACT INFECTION
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2. UNIT OVERVIEW: 6 HOURS
URINARY TRACT INFECTION.
ACUTE GLOMERULAR NEPHRITIS.
NEPHROTIC SYNDROME.
WILM’S TUMOR.
OBSTRUCTIVE UROPATHY.
EPISPADIASIS & HYPOSPADIASIS
ECTOPIA VESICA
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3. DEFINITION:
 Urinary tract infection is an infection of one or more
structures of the urinary tract.
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4. INCIDENCE:
 Second most common infection in children.
 Common in male neonates than females.
 After 1st year of life, the incidence is more in girls
than boys because of the short female urethra and its
proximity to anal opening.
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5. ETIOLOGY:
 E.coli.
 Klebsiella
 Pseudomonas.
 Enterobacter.
 Proteus species and fungi like candida species.
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6. CLASSIFICATION:
 Classified into 2.
a) LUTI: Lower urinary tract infection includes
infection of urinary bladder (cystitis)and urethra
(urethritis).
b) UUTI: Upper urinary tract infection includes
infection of the kidney-renal pelvis and renal
parenchyma.
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7. RISK FACTORS:
 Urinary stasis.
 Neurogenic bladder associated with spina bifida.
 Vesicoureteral reflux.
 Renal calculi.
 Children on immunosuppressive therapy.
 Instrumentation or catheterization of urinary tract.
 Less water intake and infrequent feeding.
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8. PATHOPHYSIOLOGY:
 During infancy, the bacteria usually enters the urinary tract
through blood and cause infection.
 After infancy, UTI occurs when bacteria enter the urinary
tract by ascending through the urethra.
 When bacteria enter the urinary tract, they produce
inflammatory changes in the urinary tract.
 Thickening and fibrosis of uretero-vesical junction
 incompetence vesicoureteral valve.
 Reflux of urine, allowing the organism to enter the upper
urinary tract and causing infection of renal parenchyma.
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9. CLINICAL FEATURES:
INFANTS PRESCHOOLERS SCHOOLERS
 Foul smelling urine.
 Malaise.
 Irritability.
 Unexplained fever.
 Failure to thrive.
 Poor feeding.
 Burning micturition.
 Vomiting .
 Diarrhoea .
 Foul smelling urine.
 Malaise.
 Hematuria.
 Fever.
 Dysuria.
 Increased frequency.
 Abdominal pain.
 Flank pain.
 Vomiting
 Diarrhoea.
 Foul smelling urine.
 Malaise.
 Hematuria.
 Fever and chills.
 Dysuria.
 Increased frequency.
 Abdominal pain.
 Flank pain.
 Avoiding urination.
 Costovertebral angle
tenderness.
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10. DIAGNOSTIC EVALUATION:
 Urinalysis.
 Urine culture.
 Blood investigations: CBC, Blood culture, Elevated ESR and
C-reactive protein test.
 CT Scan of abdomen.
 Renal ultrasound to identify hydronephrosis.
 Voiding cystourethrogram to identify bladder and uretheral
anomalies.
 Intravenous pyelography.
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11. MEDICAL MANAGEMENT:
 For Mild Bladder and Kidney Infections: oral
antibiotics are prescribed for 7- 14 days. Commonly used
antibiotics include trimethoprimsulfame-thoxazole,
amoxicillin and cephalosporin like ceftriaxone,
doxycycline and fluroquinolones.
 A follow up urine culture is done 48-72 hours after
initiation of treatment.
 To relieve burning pain during urination, Pyridium may
be given.
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12.  For Severe Renal Infections:
 If child is too sick to take oral medications or drink
enough fluid, hospitalization may be required.
 During hospitalization, intravenous antibiotics and fluids
are given.
 In case of chronic or recurrent UTI, longer treatment is
given.
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13. NURSING MANAGEMENT:
 Usually mild UTI can be treated at home with oral
medications and increased fluid . In case of severe UTI
hospitalization may be required.
 Nursing care focuses on:
a) Administration of prescribed medications.
b) Promoting rehydration.
c) Assessing and maintaining renal functions.
d) Educating parents and children regarding prevention of
UTI.
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14. NURSING CARE INCLUDES:
 Complete history of child is collected, including history of urinary
symptoms.
 Thorough P/E is done. Abdomen is palpated for costovertebral and
suprapubic tenderness and distension.
 A “ clean-catch” midstream urine sample is collected for urinalysis
and culture.
 After urine is sent for culture, prescribed antibiotics are
administered.
 Encourage fluid intake to dilute the urine and flush the bladder.
 Document I/0 chart.
 Assess renal function by comparing the child’s output to expected
output of 1ml/kg/hr.
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15.  Weight the child daily.
 Palpate or percuss the bladder after voiding to evaluate bladder
emptying.
 When drugs of sulpha group are administered, encourage fluid intake
to reduce the chances of crystal formation.
 Educate the parents to give slightly acidic fluids to the child like apple
juice, orange juice, lemonade etc, as they make urine acidic, there by
rendering it unsuitable for the growth of micro organisms.
 If the child is having incontinence of urine, reassure the parents and
the child. Tell them that the problem is due to infection and it will
disappear when infection is cured.
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16. PREVENTION:
1. Bathing and Hygiene:
 Shower bath rather than tub bath.
 Maintain personal hygiene.
 Taught about clean habits.
 Taught to keep the genital area clean and should be
washed after urination and defecation.
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17. 2. clothing:
Avoid tight fitting undergarments.
Underwear's should be changed atleast once a day or as soon as it gets
soiled.
Child should be made to wear cotton panties.
3. Dietary and Fluid Intake:
 Encourage the child to drink plenty of fluids.
 Child should be given orange juice, lemonade, apple juice to make the
urine acidic, rendering unsuitable for growth of microorganisms.
 Fluid irritating bladder should be avoided like coffee and tea
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18. 4. Bladder Care:
 Child should be asked not to hold urine for long time.
 Should pass urine as soon as urge is felt.
COMPLICATIONS:
 Sepsis.
 Kidney damage or scarring.
 Kidney Infection.
 Pyelonephritis.
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19. PROGNOSIS:
 Successful prognosis.
 Symptoms usually disappears with in 24-48 hrs after
treatment begins.
 If kidney infection it may take 1 week or longer for the
symptoms to go away.
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