Bladder Exstrophy

Bladder exstrophy is a congenital anomaly characterized by extrusion of the urinary bladder to the outside of the body through a defect in the lower abdominal wall. The cause of bladder exstrophy is unknown.

Bladder exstrophy needs a surgical management and a series of staged reconstructions. The initial surgery is to close the abdominal defect, and it should be done within the first few day of life. However, the subsequent operation is done to reconstruct the bladder and genitalia and enable child to achieve urinary continence.

Signs and Symptoms of Bladder Exstrophy:

• Esposed bladder mucose
• Widened symphysis pubis
• Defects of the external genitalia

Nursing Interventions:

• Monitor urinary output
• Monitor for signs of urinary tract or wound infections
• Maintain the integrity of the exposed bladder mucose
• Prevent the bladder tissue from drying, while allowing the drainage of urine until surgical closure is done.
• Cover the bladder with sterile, nonadherent clear plastic wrap or a sterile thin film dressing without adhesive
• Petroleum jelly is avoided because it tends to dry out, adhere to the bladder mucose, and damage the delicate tissues when the dressing is remove
• Administer antibiotics as prescribed
• Emotional support to the parents and encourage verbalization of their fears and concerns

Epispadias and Hypospadias

Epispadias is a condition in which the urethral orifice is located on the dorsal surface of the penis (often occurs with exstrophy or the bladder). In hypospadias the urethral orifice is located below the glans penis along the ventral surface.

Surgical intervention is done before the age of toilet training (preferably between 16 and 18 months of age) and the child should not be circumcised because the foreskin may be used in surgical reconstructions.

After surgery, the child will have a pressure dressing and may have some type of urinary diversion or a urinary stent that is used to maintain patency of the urethral opening while healing of the meatus occurs.

Postoperative Nursing Interventions:

• Monitor vital signs
• Encourage child fluid intake to maintain urine output and to maintain patency of the stent
• Monitor intake and output and the urine for cloudiness or a foul odor
• Notify the physician if there is no urinary drainage for 1 hour because it may indicate kinks in the system or obstruction by sediment
• Administer pain killer, anticholinergic and antibiotic as prescribed
• Instruct the parent to avoid giving the child a tub bath until the stent is removed (if any)

Cryptorchidism

Cryptorchidism is a condition in which one or both testes fail to descent through the inguinal canal into the scrotal sac.

Sign of cyptorchidism:
Testes are not palpable or easily guided into the scrotum

Nursing Interventions:

• Observe during the first 12 month of life to determine whether spontaneous descent occurs.
• After age of one year, medical or surgical treatment may be instituted
• Human chorionic gonadotropin may be prescribed
• Surgical corrections (if needed) is done by orchiopexy between 1 and 2 years of age

Enuresis

Enuresis is a condition in which the child is unable to control bladder function even though the child has reached an age at which control of bladder is expected. There are two types of enuresis: primary and secondary (acquired)

Primary Nocturnal Enuresis

• Bed wetting in a child who has never been dry for extended periods
• The child is unable to sense a full bladder and does not awaken to void
• The child may have delayed maturation of the central nervous system

Secondary or Acquired Enuresis

• Bed wetting occurs after a period of established urinary continence
• It may occur during nighttime sleep (nocturnal), only during the waking hours (diurnal), or during both times of the day

Nursing Interventions:

• Obtain urinalysis and urine culture as prescribed
• Limit fluid intake at night, and encourage the child to void just before going to bed
• Involve the child in caring for the wet sheets and changing the bed to assist the child to take ownership of the problems
• Give child rewards as appropriate

Nephrotic Syndrome in Children

Nephrotic syndrome is a kidney disorder that characterized by massive proteinuria, hypoalbuminemia, and edema. The primary treatments are to reduce the excretion of urinary and maintain protein-free urine.

Signs and Symptoms:

• Child body weight is increased
• Periorbital and facial edema (mostly in the morning)
• Urine output is decreased
• Urine is dark and frothy
• Leg, ankle, labial or scrotal edema
• Abdominal swelling
• Blood pressure is normal or slightly decreased

Nursing Interventions:

• Monitor vital signs, intake and output, and daily weights
• Monitor urine for specific gravity and albumin
• Monitor for edema
• A regular diet without added salt is prescribed during remission
• A sodium restriction diet is prescribed during massive edema
• Administer corticosteroid and immunosuppressant as prescribed
• Administer diuretics as prescribed

Glomerulonephritis in Children

Glomerulonephritis is an inflammation of the internal kidney structures (glomeruli). Glomeruli itself has functions to help filter waste and fluids from the blood. This disease leads to proliferative and inflammatory changes within glomerular structure, as well as, destruction, inflammation and sclerosis of the glomeruli of both kidneys.

Inflammation in glumeruli due to an antigen-antibody reaction produced by an infection elsewhere in the body.

Casuse of glomerulonephritis:

• Autoimmune disease
• Immunological disease
• Streptococcal infection, group A beta-hemolytic
• History of pharyngitis or tonsillitis 2-3 week before the symptoms

Complication of Glomerulonephritis:

• Hypertensive encephalopathy
• Renal failure
• Heart failure
• Pulmonary edema

Signs and Symptoms:

• Periorbital and facial edema (more prominent in the morning)
• Decreased urinary output
• Cloudy, smoky, and brown-colored urine
• Anorexia
• Pallor, irritability and lethargy


• Headaches, abdominal or flank pain, dysuria
• Hypertension
• Proteinuria
• Azotemia
• Blood urea nitrogen and creatinine levels are increased
• Antistreptolysin O titer is increase

Nursing Intervention:

1. Monitor vital signs, weight, intake and output, and observe characteristic of urine
2. Limit activity and provide safety
3. In uncomplicated disease, a regular diet is permitted but sodium is restricted
4. For child with hypertension or edema, moderate sodium restriction is prescribed
5. During oliguria period, foods high in potassium are restricted
6. If child has severe azotemia, protein restricted is prescribed
7. Observe the complication of glumerulonephritis
8. Administer diuretics, antihypertensives, and antibiotics as prescribed
9. Initiate seizure precaution and administer anticonvulsant as prescribed
10. Instruct parent to report signs of bloody urine, headache, or edema
11. Inform parent that child needs to obtain treatment for infection