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

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

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

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

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

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

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

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

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

Key Signs and Symptoms of Urological Problems

Urinary Urgency

Urinary retention

Urinary frequency

Urological Assessment PHYSICAL EXAMINATION Inspection Auscultation Percussion Palpation

PHYSICAL EXAMINATION

Inspection

Auscultation

Percussion

Palpation

Urological Assessment Laboratory examination Urinalysis BUN and Creatinine levels of the serum Serum electrolytes

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

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

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

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

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

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

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

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

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

Assessment findings: Upper UTI

Fever and CHIILS

Flank pain

Costovertebral angle tenderness

Urinary Tract Infection (UTI) Laboratory Examination Urinalysis Urine Culture

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).

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.

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

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

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

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

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

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)

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.

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

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.

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

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

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)

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)

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

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

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).

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

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

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

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)

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

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

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

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

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

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

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

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

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

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.

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

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

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.

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

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

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

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

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

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!

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

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

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

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).

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

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

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

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

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

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.

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.

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

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

Two methods

1. Hemodialysis

2. Peritoneal dialysis

DIALYSIS Diffusion Osmosis Ultrafiltration

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

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

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

Nursing management

7. To determine effectiveness, check serum creatinine, BUN and electrolytes

Male reproductive disorders BPH Prostatic cancer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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