NR 328 EDAPT NURSING CARE: PEDIATRIC ELIMINATION: URINARY ALTERATIONS
Urinary elimination involves the process of waste formation through the production of
urine. The kidneys, ureters, bladder, and urethra must function for urination to occur. The
type and clinical manifestations of urinary dysfunction change with the age of the child.
Assessment
The nurse is caring for a 6-month-old pediatric client in a healthcare clinic.
Which assessment findings are consistent with the clinical manifestations of
urinary dysfunction? Select all that apply.
Anterior fontanel is sunken
Parent reports increased number of diaper changes
Parent reports infant has decreased interest in eating
Temperature is 100.5º F
Parent reports infant is sleeping more than usual
All these assessment findings are consistent with the clinical manifestations of urinary
dysfunction, including poor feeding, frequent urination, fever, and signs of dehydration.
Because these findings are consistent with other childhood disorders, the nurse should
gather additional information about the history of illness. The healthcare provider may
order additional tests to determine the cause of illness.
Specimen Collection
A urine culture and sensitivity requires the collection of sterile urine collected
by clean-catch, catheterization, or suprapubic aspiration collection. The nurse
is educating a client about how to collect a clean-catch specimen to determine
if the client has a urinary tract infection. Place the steps of collecting a clean-
catch urine in the order performed.
To collect a clean-catch specimen, the urethral meatus is cleaned (for males, clean the
tip of the penis; for females, the perineum is wiped from front to back), then a few
milliliters of urine is voided, and then urine is collected in a sterile specimen cup.
Laboratory and Diagnostic Tests
Match the laboratory or diagnostic test with the description.
• Urine culture and sensitivity: urine test for pathogens and drugs to which they are
sensitive
• Specific gravity: urine test to indicate fluid status
• Ultrasound: provides visualization of structures of the urinary system
• Abdominal x-ray: basic picture of abdomen and pelvis; can be used to identify
stones
• Voiding cystourethrogram (VCUG): provides visualization of bladder outline and
urethra; can show reflux of urine into ureters and bladder emptying
Urinary Function Assessment
Many clinical manifestations of kidney or urinary tract dysfunction are common to a
number of childhood disorders, so it is important to gather further information from the
child’s history, family history, and laboratory studies, in addition to the physical
, examination. The most important basic nursing assessments include accurate
measurement of intake and output, height and weight, and blood pressure.
Age Specific Clinical Manifestations
NEONATE
Birth to 1 month
• poor feeding
• vomiting
• failure to gain weight
• respiratory distress
• dehydration
• jaundice
INFANT
1-24 months
• poor feeding
• vomiting
• failure to gain weight
• excessive thirst
• frequent urination
• fever
• dehydration
CHILD
2-14 years
• poor appetite
• vomiting
• growth failure
• excessive thirst
• enuresis
• frequent urination
• swelling of the face
• blood in urine
• abdominal or back pain
• hypertension
Common Laboratory and Radiologic Tests
• urine culture and sensitivity
• glomerular filtration rate
• generally accepted as best overall indication of kidney function
• creatinine
• blood urea nitrogen (BUN)
• ultrasound
• abdominal x-ray
• voiding cystourethrogram (VCUG)
Urinary elimination involves the process of waste formation through the production of
urine. The kidneys, ureters, bladder, and urethra must function for urination to occur. The
type and clinical manifestations of urinary dysfunction change with the age of the child.
Assessment
The nurse is caring for a 6-month-old pediatric client in a healthcare clinic.
Which assessment findings are consistent with the clinical manifestations of
urinary dysfunction? Select all that apply.
Anterior fontanel is sunken
Parent reports increased number of diaper changes
Parent reports infant has decreased interest in eating
Temperature is 100.5º F
Parent reports infant is sleeping more than usual
All these assessment findings are consistent with the clinical manifestations of urinary
dysfunction, including poor feeding, frequent urination, fever, and signs of dehydration.
Because these findings are consistent with other childhood disorders, the nurse should
gather additional information about the history of illness. The healthcare provider may
order additional tests to determine the cause of illness.
Specimen Collection
A urine culture and sensitivity requires the collection of sterile urine collected
by clean-catch, catheterization, or suprapubic aspiration collection. The nurse
is educating a client about how to collect a clean-catch specimen to determine
if the client has a urinary tract infection. Place the steps of collecting a clean-
catch urine in the order performed.
To collect a clean-catch specimen, the urethral meatus is cleaned (for males, clean the
tip of the penis; for females, the perineum is wiped from front to back), then a few
milliliters of urine is voided, and then urine is collected in a sterile specimen cup.
Laboratory and Diagnostic Tests
Match the laboratory or diagnostic test with the description.
• Urine culture and sensitivity: urine test for pathogens and drugs to which they are
sensitive
• Specific gravity: urine test to indicate fluid status
• Ultrasound: provides visualization of structures of the urinary system
• Abdominal x-ray: basic picture of abdomen and pelvis; can be used to identify
stones
• Voiding cystourethrogram (VCUG): provides visualization of bladder outline and
urethra; can show reflux of urine into ureters and bladder emptying
Urinary Function Assessment
Many clinical manifestations of kidney or urinary tract dysfunction are common to a
number of childhood disorders, so it is important to gather further information from the
child’s history, family history, and laboratory studies, in addition to the physical
, examination. The most important basic nursing assessments include accurate
measurement of intake and output, height and weight, and blood pressure.
Age Specific Clinical Manifestations
NEONATE
Birth to 1 month
• poor feeding
• vomiting
• failure to gain weight
• respiratory distress
• dehydration
• jaundice
INFANT
1-24 months
• poor feeding
• vomiting
• failure to gain weight
• excessive thirst
• frequent urination
• fever
• dehydration
CHILD
2-14 years
• poor appetite
• vomiting
• growth failure
• excessive thirst
• enuresis
• frequent urination
• swelling of the face
• blood in urine
• abdominal or back pain
• hypertension
Common Laboratory and Radiologic Tests
• urine culture and sensitivity
• glomerular filtration rate
• generally accepted as best overall indication of kidney function
• creatinine
• blood urea nitrogen (BUN)
• ultrasound
• abdominal x-ray
• voiding cystourethrogram (VCUG)
