• Save
Genito Urinary System
Upcoming SlideShare
Loading in...5
×
 

Genito Urinary System

on

  • 58,847 views

Genito Urinary System

Genito Urinary System

Statistics

Views

Total Views
58,847
Slideshare-icon Views on SlideShare
56,636
Embed Views
2,211

Actions

Likes
60
Downloads
0
Comments
31

23 Embeds 2,211

http://philippinenurses.blogspot.com 999
http://www.nursereview.org 867
http://www.slideshare.net 125
http://www.myllps.com 112
https://tasks.crowdflower.com 28
http://www.zeadmph.com 26
http://localhost 24
http://study.myllps.com 7
https://ccc.blackboard.com 4
http://172.16.1.27 2
http://siliconcityurology.com 2
http://translate.googleusercontent.com 2
http://www.freewebs.com 2
http://www.filescon.com 2
http://www.siliconcityurology.com 1
http://72.14.203.104 1
http://66.218.69.11 1
http://www.rapidsharego.com 1
http://192.168.10.100 1
http://209.85.173.132 1
https://imperial.blackboard.com 1
http://bboard-app-sh.hartford.edu 1
http://elearning.kctcs.edu 1
More...

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel

110 of 31 Post a comment

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
  • Very nice presentation.If you can share the same thro mail will highly appreciate.
    Are you sure you want to
    Your message goes here
    Processing…
  • It is a very nice PPT. I will be very happy if I can get a copy through my e-mail ashagremolla@yahoo.com
    Are you sure you want to
    Your message goes here
    Processing…
  • me tooo
    Are you sure you want to
    Your message goes here
    Processing…
  • nice i like it
    Are you sure you want to
    Your message goes here
    Processing…
  • gud day. can u send me a copy on this at my email. tnx. I need it so badly. Gracias and Godbless... jed_xy@yahoo.com
    Are you sure you want to
    Your message goes here
    Processing…

110 of 31

Post Comment
Edit your comment

    Genito Urinary System Genito Urinary System Presentation Transcript

    • The Genito-Urinary System Medical Surgical Nursing Review
    • Outline of review
      • Recall the anatomy and physiology of the Renal System
      • Renal Assessment
      • Renal Laboratory Procedure
      • Common Conditions:
        • UTI
        • Kidney Stones
        • ARF and CRF
    • Outline of review
        • BPH
        • Prostatic cancer
    • Kidney function HYPERKALEMIA Excretes excess POTASSIUM Metabolic ACIDOSIS Produces bicarbonate and secretes acids Calcium and Phosphate imbalances Metabolism of Vitamin D ANEMIA Secretes Erythropoietin to increase RBC Impaired urine production and azotemia The Nephron produces urine to eliminate waste
    • Urological Assessment
      • Nursing History
        • Reason for seeking care
        • Current illness
        • Previous illness
        • Family History
        • Social History
        • Sexual history
    • Urological Assessment
        • Key Signs and Symptoms of Urological Problems
        • EDEMA
          • associated with fluid retention
          • Renal dysfunctions usually produce ANASARCA
    • Urological Assessment
        • Key Signs and Symptoms of Urological Problems
        • PAIN
          • Suprapubic pain= bladder
          • Colicky pain on the flank= kidney
    • Urological Assessment
        • Key Signs and Symptoms of Urological Problems
        • HEMATURIA
          • Painless hematuria may indicate URINARY CANCER!
          • Early-stream hematuria= urethral lesion
          • Late-stream hematuria= bladder lesion
    • Urological Assessment
        • Key Signs and Symptoms of Urological Problems
        • DYSURIA
          • Pain with urination= lower UTI
    • Urological Assessment
        • Key Signs and Symptoms of Urological Problems
        • POLYURIA
          • More than 2 Liters urine per day
        • OLIGURIA
          • Less than 400 mL per day
        • ANURIA
          • Less than 50 mL per day
    • Urological Assessment
        • Key Signs and Symptoms of Urological Problems
        • Urinary Urgency
        • Urinary retention
        • Urinary frequency
    • Urological Assessment
        • PHYSICAL EXAMINATION
        • Inspection
        • Auscultation
        • Percussion
        • Palpation
    • Urological Assessment
        • Laboratory examination
        • Urinalysis
        • BUN and Creatinine levels of the serum
        • Serum electrolytes
    • Urological Assessment
        • Laboratory examination
        • Radiographic
        • IVP
        • KUB x-ray
        • KUB ultrasound
        • CT and MRI
        • Cystography
    • Implementation Steps for selected problems
      • Provide PAIN relief
      • Assess the level of pain
      • Administer medications usually narcotic ANALGESICS
    • Implementation Steps for selected problems
      • Maintain Fluid and Electrolyte Balance
      • Encourage to consume at least 2 liters of fluid per day
      • In cases of ARF, limit fluid as directed
      • Weigh client daily to detect fluid retention
    • Implementation Steps for selected problems
      • Ensure Adequate urinary elimination
      • Encourage to void at least every 2-3 hours
      • Promote measures to relieve urinary retention:
        • Alternating warm and cold compress
        • Bedpan
        • Open faucet
        • Provide privacy
        • Catheterization if indicated
    • Urinary Tract Infection (UTI)
      • Bacterial invasion of the kidneys or bladder (CYSTITIS) usually caused by Escherichia coli
    • Urinary Tract Infection (UTI)
      • Predisposing factors include
      • Poor hygiene
      • Irritation from bubble baths
      • Urinary reflux
      • Instrumentation
      • Residual urine, urinary stasis
    • Urinary Tract Infection (UTI)
      • PATHOPHYSIOLOGY
      • The invading organism ascends the urinary tract, irritating the mucosa and causing characteristic symptoms
        • Ureter= ureteritis
        • Bladder= cystitis
        • Urethra=Urethritis
        • Pelvis= Pyelonephritis
    • Urinary Tract Infection (UTI)
      • Assessment findings
      • Low-grade fever
      • Abdominal pain
      • Enuresis
      • Pain/burning on urination
      • Urinary frequency
      • Hematuria
    • Urinary Tract Infection (UTI)
      • Assessment findings: Upper UTI
      • Fever and CHIILS
      • Flank pain
      • Costovertebral angle tenderness
    • Urinary Tract Infection (UTI)
      • Laboratory Examination
      • Urinalysis
      • Urine Culture
    • Urinary Tract Infection (UTI)
      • Nursing interventions
      • Administer antibiotics as ordered
      • Provide warm baths and allow client to void in water to alleviate painful voiding.
      • Force fluids. Nurses may give 3 liters of fluid per day
      • Encourage measures to acidify urine (cranberry juice, acid-ash diet).
    • Urinary Tract Infection (UTI)
      • Provide client teaching and discharge planning concerning
      • a. Avoidance of tub baths
      • b. Avoidance of bubble baths that might irritate urethra
      • c. Importance for girls to wipe perineum from front to back
      • d. Increase in foods/fluids that acidify urine.
    • Urinary Tract Infection (UTI)
      • Pharmacology
      • 1. Sulfa drugs
        • Highly concentrated in the urine
        • Effective against E. coli!
      • 2. Quinolones
    • Nephrolithiasis/Urolithiasis
      • Presence of stones anywhere in the urinary tract
        • Calcium
        • oxalate
        • and uric acid
    • Nephrolithiasis/Urolithiasis
      • Pathophysiology
      • Predisposing factors
      • a. Diet: large amounts of calcium and oxalate
      • b. Increased uric acid levels
      • c. Sedentary life-style, immobility
      • d. Family history of gout or calculi
      • e. Hyperparathyroidism
    • Nephrolithiasis/Urolithiasis
      • Pathophysiology
      • Supersaturation of crystals due to stasis
      • Stone formation
      • May pass through the urinary tract
      • OBSTRUCTION, INFECTION and HYDRONEPHROSIS
    • Nephrolithiasis/Urolithiasis
      • Assessment findings
      • Abdominal or flank pain
      • Renal colic radiating to the groin
      • 3. Hematuria
      • 4. Cool, moist skin
      • 5. Nausea and vomiting
    • Nephrolithiasis/Urolithiasis
      • Diagnostic tests
      • 1. KUB Ultrasound and X-ray : pinpoints location, number, and size of stones
      • 2. IVP: identifies site of obstruction and presence of non-radiopaque stones
      • 3. Urinalysis : indicates presence of bacteria, increased protein, increased WBC and RBC (hematuria)
    • Nephrolithiasis/Urolithiasis
      • Medical management
      • 1. Surgery
      • a. Percutaneous nephrostomy: tube is inserted through skin and underlying tissues into renal pelvis to remove calculi.
      • b. Percutaneous nephrostolithotomy: delivers ultrasound waves through a probe placed on the calculus.
    • Nephrolithiasis/Urolithiasis
      • Medical management
      • 2. Extracorporeal shock-wave lithotripsy: delivers shock waves from outside the body to the stone, causing pulverization
      • Pain management : Morphine or Meperidine
      • Diet modification
    • Nephrolithiasis/Urolithiasis
      • Nursing interventions
      • 1. Strain all urine through gauze to detect stones and crush all clots.
      • 2. Force fluids (3000—4000 cc/day).
      • 3. Encourage ambulation to prevent stasis.
    • Nephrolithiasis/Urolithiasis
      • Nursing interventions
      • 4. Relieve pain by administration of analgesics as ordered and application of moist heat to flank area.
      • 5. Monitor intake and output
    • Nephrolithiasis/Urolithiasis
      • Nursing interventions
      • 6. Provide modified diet, depending upon stone consistency: Calcium, Oxalate and Uric acid stones
    • Nephrolithiasis/Urolithiasis
      • Nursing interventions
      • Calcium stones
      • limit milk/dairy products; provide acid-ash diet to acidify urine (cranberry or prune juice, meat, eggs, poultry, fish, grapes, and whole grains)
    • Nephrolithiasis/Urolithiasis
      • Nursing interventions
      • Oxalate stones
      • avoid excess intake of foods/ fluids high in oxalate (tea, chocolate, rhubarb, spinach); maintain alkaline-ash diet to alkalinize urine (milk; vegetables; fruits except prunes, cranberries, and plums)
    • Nephrolithiasis/Urolithiasis
      • Nursing interventions
      • Uric acid stones
      • reduce foods high in purine (liver, beans, kidneys, venison, shellfish, meat soups, gravies, legumes); maintain alkaline urine
    • Nephrolithiasis/Urolithiasis
      • Nursing interventions
      • 7. Administer allopurinol (Zyloprim) as ordered, to decrease uric acid production
    • Nephrolithiasis/Urolithiasis
      • 8. Provide client teaching and discharge planning concerning
      • Prevention of Urinary stasis by maintaining increased fluid intake especially in hot weather and during illness; mobility; voiding whenever the urge is felt and at least twice during the night
      • Adherence to prescribed diet
      • Need for routine urinalysis (at least every 3—4 months)
      • Need to recognize and report signs/ symptoms of recurrence (hematuria, flank pain).
    • Acute renal failure
      • Sudden interruption of kidney function to regulate fluid and electrolyte balance and remove toxic products from the body
    • Acute renal failure
      • PATHOPHYSIOLOGY
      • Pre-renal failure
      • Intra-renal failure
      • Post-renal failure
    •  
    • Acute renal failure
      • PATHOPHYSIOLOGY
      • Prerenal CAUSE:
      • Factors interfering with perfusion and resulting in diminished blood flow and glomerular filtrate, ischemia, and oliguria; include CHF, cardiogenic shock, acute vasoconstriction, hemorrhage, burns, septicemia, hypotension, anaphylaxis
    • Acute renal failure
      • PATHOPHYSIOLOGY
      • Intrarenal CAUSE:
      • Conditions that cause damage to the nephrons; include acute tubular necrosis (ATN), endocarditis, diabetes mellitus, malignant hypertension, acute glomerulonephritis, tumors, blood transfusion reactions, hypercalcemia, nephrotoxins (certain antibiotics, x-ray dyes, pesticides, anesthetics)
    • Acute renal failure
      • PATHOPHYSIOLOGY
      • Postrenal CAUSE:
      • Mechanical obstruction anywhere from the tubules to the urethra; includes calculi, BPH, tumors, strictures, blood clots, trauma, and anatomic malformation
    • Acute renal failure
      • Three phases of acute renal failure
      • Oliguric phase
      • Diuretic phase
      • Convalescence or recovery phase
    • Acute renal failure
      • Four phases of acute renal failure (Brunner and Suddarth)
      • Initiation phase
      • Oliguric phase
      • Diuretic phase
      • Convalescence or recovery phase
    • Acute renal failure
      • Assessment findings: The Three Phases of Acute Renal Failure
      • 1. Oliguric phase
      • Urine output less than 400 cc/24 hours
      • duration 1—2 weeks
      • Manifested by dilutional hyponatremia, hyperkalemia , hyperphosphatemia, hypocalcemia , hypermagnesemia, and metabolic acidosis
      • Diagnostic tests: BUN and creatinine elevated
    • Acute renal failure
      • Assessment findings: The Three Phases of Acute Renal Failure
      • 2. Diuretic phase
      • Diuresis may occur (output 3—5 liters/day) due to partially regenerated tubule’s inability to concentrate urine
      • Duration: 2—3 weeks ; manifested by hyponatremia, hypokalemia, and hypovolemia
      • Diagnostic tests: BUN and creatinine slightly elevated
    • Acute renal failure
      • Assessment findings: The Three Phases of Acute Renal Failure
      • 3. Recovery or convalescent phase:
      • Renal function stabilizes with gradual improvement over next 3—12 months
    • Acute renal failure
      • Laboratory findings:
      • Urinalysis: Urine osmo and sodium
      • BUN and creatinine levels increased
      • Hyperkalemia
      • Anemia
      • ABG: metabolic acidosis
    • Acute renal failure
      • Nursing interventions
      • Monitor fluid and Electrolyte Balance
      • Reduce metabolic rate
      • Promote pulmonary function
      • Prevent infection
      • Provide skin care
      • Provide emotional support
    • Acute renal failure
      • Nursing interventions
      • 1. Monitor and maintain fluid and electrolyte balance.
      • Measure l & O every hour. note excessive losses in diuretic phase
      • Administer IV fluids and electrolyte supplements as ordered.
      • Weigh daily and report gains.
      • Monitor lab values; assess/treat fluid and electrolyte and acid-base imbalances as needed
    • Acute renal failure
      • Nursing interventions
      • 2. Monitor alteration in fluid volume.
      • Monitor vital signs, PAP, PCWP, CVP as needed.
      • Weigh client daily.
      • Maintain strict I & O records.
    • Acute renal failure
      • Nursing interventions
      • 2. Assess every hour for hypervolemia
        • Maintain adequate ventilation.
        • Restrict FLUID intake
        • Administer diuretics and antihypertensives
    • Acute renal failure
      • Nursing interventions
      • 3. Promote optimal nutritional status.
      • Weigh daily.
      • Administer TPN as ordered.
      • With enteral feedings, check for residual and notify physician if residual volume increases.
      • Restrict protein intake to 1 g/kg/day
      • Restrict POTASSIUM intake
      • HIGH CARBOHYDRATE DIET, calcium supplements
    • Acute renal failure
      • Nursing interventions
      • 4. Prevent complications from impaired mobility (pulmonary embolism, skin breakdown, and atelectasis)
      • 5. Prevent fever/infection.
        • Assess for signs of infection.
        • Use strict aseptic technique for wound and catheter care.
    • Acute renal failure
      • Nursing interventions
      • 6. Support client/significant others and reduce/ relieve anxiety.
        • Explain pathophysiology and relationship to symptoms.
        • Explain all procedures and answer all questions in easy-to-understand terms
        • Refer to counseling services as needed
      • 7. Provide care for the client receiving dialysis
    • Acute renal failure
      • Nursing interventions
      • 8. Provide client teaching and discharge planning concerning
      • Adherence to prescribed dietary regimen
      • Signs and symptoms of recurrent renal disease
      • Importance of planned rest periods
      • Use of prescribed drugs only
      • Signs and symptoms of UTI or respiratory infection need to report to physician immediately
    • Chronic Renal Failure
      • Gradual, Progressive irreversible destruction of the kidneys causing severe renal dysfunction.
      • The result is azotemia to UREMIA
    • Chronic Renal Failure
      • Predisposing factors:
        • DM= worldwide leading cause
        • Recurrent infections
        • Exacerbations of nephritis
        • urinary tract obstruction
        • hypertension
    • Chronic Renal Failure
      • PATHOPHYSIOLOGY
      • As renal functions decline
      • Retention of end-products of metabolism
    • Chronic Renal Failure
      • PATHOPHYSIOLOGY
      • STAGE 1= reduced renal reserve, 40-75% loss of nephron function
      • STAGE 2= renal insufficiency, 75-90% loss of nephron function
      • STAGE 3= end-stage renal disease, more than 90% loss. DIALYSIS IS THE TREATMENT!
    • Chronic Renal Failure
      • Assessment findings
      • 1. Nausea, vomiting; diarrhea or constipation; decreased urinary output
      • 2. Dyspnea
      • 3. Stomatitis
      • 4. Hypertension (later), lethargy, convulsions, memory impairment, pericardial friction rub
    • Chronic Renal Failure loss of strength, foot drop, osteodystrophy Musculoskeletal Anemia Hema Uremic lungs Pulmo Acute MI, edema, hypertension, pericarditis CVS seizures, altered LOC, anorexia, fatigue CNS dry skin , pruritus, uremic frost Dermatologic
    • Chronic Renal Failure
      • Diagnostic tests:
      • a. 24 hour creatinine clearance urinalysis
      • b. Protein, sodium, BUN, Crea and WBC elevated
      • c. Specific gravity, platelets, and calcium decreased
      • D. CBC= anemia
    • Chronic Renal Failure
      • Medical management
      • 1. Diet restrictions
      • 2. Multivitamins
      • 3. Hematinics and erythropoietin
      • 4. Aluminum hydroxide gels
      • 5. Anti-hypertensive
      • 6. Anti-seizures
      • DIALYSIS
    • Chronic Renal Failure
      • Nursing interventions
      • 1. Prevent neurological complications.
      • Assess every hour for signs of uremia (fatigue, loss of appetite, decreased urine output, apathy, confusion, elevated blood pressure, edema of face and feet, itchy skin, restlessness, seizures).
    • Chronic Renal Failure
      • Nursing interventions
      • 1. Prevent neurological complications.
      • Assess for changes in mental functioning.
      • Orient confused client to time, place, date, and persons; institute safety measures to protect client from falling out of bed.
      • Monitor serum electrolytes, BUN, and creatinine as ordered
    • Chronic Renal Failure
      • Nursing interventions
      • 2. Promote optimal GI function.
      • Assess/provide care for stomatitis
      • Monitor nausea, vomiting, anorexia
      • Administer antiemetics as ordered.
      • Assess for signs of Gl bleeding
    • Chronic Renal Failure
      • Nursing interventions
      • 3. Monitor/prevent alteration in fluid and electrolyte balance
      • 4. Assess for hyperphosphatemia (paresthesias, muscle cramps, seizures, abnormal reflexes), and administer aluminum hydroxide gels (Amphojel) as ordered
    • Chronic Renal Failure
      • Nursing interventions
      • 5. Promote maintenance of skin integrity.
      • Assess/provide care for pruritus.
      • Assess for uremic frost (urea crystallization on the skin) and bathe in plain water
    • Chronic Renal Failure
      • Nursing interventions
      • 6. Monitor for bleeding complications, prevent injury to client.
      • Monitor Hgb, hct, platelets, RBC.
      • Hematest all secretions.
      • Administer hematinics as ordered.
      • Avoid lM injections
    • Chronic Renal Failure
      • Nursing interventions
      • 7. Promote/maintain maximal cardiovascular function.
      • Monitor blood pressure and report significant changes.
      • Auscultate for pericardial friction rub.
      • Perform circulation checks routinely.
    • Chronic Renal Failure
      • Nursing interventions
      • 7. Promote/maintain maximal cardiovascular function.
      • Administer diuretics as ordered and monitor output.
      • Modify drug doses
      • 8. Provide care for client receiving dialysis.
    • DIALYSIS
      • a procedure that is used to remove fluid and uremic wastes from the body when the kidneys cannot function
    • DIALYSIS
      • Two methods
      • 1. Hemodialysis
      • 2. Peritoneal dialysis
    •  
    •  
    • DIALYSIS
      • Diffusion
      • Osmosis
      • Ultrafiltration
    • DIALYSIS
      • Nursing management
      • Meet the patient's psychosocial needs
      • Remember to avoid any procedure on the arm with the fistula (HEMO)
        • Monitor WEIGHT, blood pressure and fistula site for bleeding
    • DIALYSIS
      • Nursing management
      • 3. Monitor symptoms of uremia
      • 4. Detect complications like infection, bleeding (Hepatitis B/C and HIV infection in Hemodialysis)
      • 5. Warm the solution to increase diffusion of waste products (PERITONEAL)
      • 6. Manage discomfort and pain
    • DIALYSIS
      • Nursing management
      • 7. To determine effectiveness, check serum creatinine, BUN and electrolytes
    • Male reproductive disorders
      • BPH
      • Prostatic cancer
    • Male reproductive disorders
      • DIGITAL RECTAL EXAMINATION- DRE
      • Recommended for men annually with age over 40 years
      • Screening test for cancer
      • Ask patient to BEAR DOWN
    •  
    • Male reproductive disorders
      • TESTICULAR EXAMINATION
      • Palpation of scrotum for nodules and masses or inflammation
      • BEGINS DURING ADOLESCENCE
    • Male reproductive disorders
      • Prostate specific antigen (PSA)
      • Elevated in prostate cancer
      • Normal is 0.2 to 4 nanograms/mL
      • Cancer= over 4
    • Male reproductive disorders
      • BENIGN PROSTATIC HYPERPLASIA
      • Enlargement of the prostate that causes outflow obstruction
      • Common in men older than 50 years old
    •  
    • Male reproductive disorders
      • BENIGN PROSTATIC HYPERPLASIA
      • Assessment findings
      • DRE: enlarged prostate gland that is rubbery, large and NON-tender
      • Increased frequency, urgency and hesitancy
      • Nocturia, DECREASE IN THE VOLUME AND FORCE OF URINE STREAM
    • Male reproductive disorders
      • BENIGN PROSTATIC HYPERPLASIA
      • Medical management
      • Immediate catheterization
      • Prostatectomy
      • TRANSURETHRAL RESECTION of the PROSTATE (TURP)
      • Pharmacology: alpha-blockers, alpha-reductase inhibitors. SAW palmetto
    •  
    •  
    • BPH
      • NURSING INTERVENTION
      • Encourage fluids up to 2 liters per day
      • Insert catheter for urinary drainage
      • Administer medications – alpha adrenergic blockers and finasteride
      • Avoid anticholinergics
      • Prepare for surgery or TURP
      • Teach the patient perineal muscle exercises. Avoid valsalva until healing
    • BPH
      • NURSING INTERVENTION: TURP
      • Maintain the three way bladder irrigation to prevent hemorrhage
      • Only initially the drainage is pink-tinged and never reddish
      • Administer anti-spasmodic to prevent bladder spasms
    • Prostate Cancer
      • a slow growing malignancy of the prostate gland
      • Usually an adenocarcinoma
      • This usualy spread via blood stream to the vertebrae
    •  
    • Prostate Cancer
      • Predisposing factor
        • Age
    • Prostate Cancer
      • Assessment Findings
      • DRE: hard, pea-sized nodules on the anterior rectum
      • Hematuria
      • Urinary obstruction
      • Pain on the perineum radiating to the leg
    • Prostate Cancer
      • Diagnostic tests
      • Prostatic specific antigen (PSA)
      • Elevated SERUM ACID PHOSPHATASE indicates SPREAD or Metastasis
    • Prostate Cancer
      • Medical and surgical management
      • Prostatectomy
      • TURP
      • Chemotherapy: hormonal therapy to slow the rate of tumor growth
      • Radiation therapy
    • Prostate Cancer
      • Nursing Interventions
      • Prepare patient for chemotherapy
      • Prepare for surgery
    • Prostate Cancer
      • Nursing Interventions: Post-prostatectomy
      • Maintain continuous bladder irrigation. Note that drainage is pink tinged w/in 24 hours
      • Monitor urine for the presence of blood clots and hemorrhage
      • Ambulate the patient as soon as urine begins to clear in color