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Genito Urinary System

Genito Urinary System

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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