Discussion: Diagnosis and Management of Genitourinary Disorders
Many genitourinary (GU) disorders such as kidney disease begin developing during childhood and adolescence (Johns Hopkins Childrens Center 2010). This early onset of disease makes it essential for you as the advanced practice nurse caring for pediatric patients to identify potential signs and symptoms. Although some pediatric GU disorders require long-term treatment and management other disorders such as bedwetting or urinary tract infections are more common and frequently require only minor interventions. In your role with pediatric patients you must evaluate symptoms and determine whether to treat patients or refer them for specialized care. For this Discussion consider potential diagnoses treatment and/or referral options for the patients in the following three case studies.
Case Study 1
You see a 3-year-old with a 2-day history of complaints of dysuria with frequent episodes of enuresis despite potty training about 7 months ago. She is afebrile and denies vomiting. Physical examination is normal. Dipstick voided urine analysis reveals: specific gravity 1.015 Protein 1+ non-hemolyzed blood 1+ nitrites 1+ leukocytes and glucose-negative.
Case Study 2
Mark is a 15-year-old with complaint of acute left scrotal pain with nausea. The pain began approximately 6 hours ago as a dull ache and has gradually worsened to where he can no longer stand without doubling over. He is afebrile and in marked pain. Physical exam is negative except for elevation of the left testicle diffuse scrotal edema and the presence of a blue dot sign.
Case Study 3
Maya is a 5-year-old who presents for a well-child visit. She is a healthy child with no complaints. Physical examination is normal. Routine urinalysis indicates 2+ proteinuria; specific gravity 1.020; negative for glucose blood leukocytes and nitrites. Her blood pressure is normal and she is at the 60th percentile for height and weight.
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