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Urinary System

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  • 1.   ANATOMY AND PHYSIOLOGY OF THE SYSTEM
  • 2. URINARY SYSTEM
    • The major role of the urinary system is to maintain homeostasis by maintaining body fluid composition and volume.
    • The components of the Urinary System are as follows: kidneys, ureters, urinary bladder and urethra.
  • 3. BPH (Benign Prostatic Hyperplasia)
    • *It is gradual enlargement of the prostate gland with hypertrophy and hyperplasia of normal tissues.
    • *The cause is unknown. It usually occurs among men over 50 years of age.
  • 4.
    • Aging process in males results to hormonal imbalance . The estrogen levels become higher than the androgen levels. This cause hyperplasia of the prostate gland.
    • The enlargement causes compression of the urethra and base of the bladder. This leads to urinary obstruction.
    • If untreated, it results to a serious complication – renal failure .
  • 5. Two processes produce this obstruction: hyperplasia and hypertrophy: Enlargement of the prostate (hyperplasia of the prostate gland) Narrowing of the lumen of the segment of the prostate that courses to the prostate (the prostatic urethra ) When it encroaches upon the bladder neck, it reduces its ability to funnel in response to micturition Growth of the so-called median lobe of the prostate extends into the proximal urethra OBSTRUCTION
  • 6. Enlargement of the prostate (hyperplasia of the prostate gland) Accompanied by hypertrophy of the smooth muscle of the gland Mechanically adding to the tissue constricting the urethral lumen that courses to the prostate (the prostatic urethra ) Increased muscle tone in the bladder neck reducing then its ability to funnel in response to micturition Increased muscle tone at the proximal (prostatic) urethra EXACERBATION OF URINARY OBSTRUCTION
  • 7.
    • Nocturia ( frequent voiding at night) the frequent manifestation that occurs.
    • The other manifestations are frequency, urgency, hesitancy (difficulty in initiating urination, takes few minutes before urine flows), decreased caliber of urinary stream and force, increased residual urine, hematuria, UTI.
    • Abdominal straining with urination, volume and force of urinary stream.
    • Sensation that bladder has not completely emptied.
    • Recurrent urinary tract infection
    • It is validated by rectal examination, cystoscopy and ultrasound.
    ASSESSMENT
  • 8. DIAGNOSTICS
    • Digital Rectal Examination (DRE)
    • - reveals a large, rubbery, and non tender prostate gland.
    • Urinalysis and Urodynamic studies
    • - to assess urine flow
    • Renal function tests including serum-creatinine level (complete blood studies)
    • - to determine wether there is renal impairment.
    • Ultrasound
    • Cystoscopy – visualization of urinary bladder
    • Biopsy
  • 9.
    • Preoperative Care
    • Ultrasonography
    • - reassure client that ultrasound is painless and not invasive
    • - fleet enema 45 minutes before procedure
    • Cystoscopy
    • - preop protocol; obtain consent
    • - urine culture or Gram stain must be negative
    • - place client in lithotomy position
    • - urethra is prepared with a water-soluble lubricant containing 2% lidocaine
    • - ext. Genetelia are prepped w/ antiseptic sol’n e.g., povidone/iodine.
    Postoperative Care Cystoscopy – hematuria is expected - instruct client to force fluids - report any frank bleeding or clots in the urine or manifestations of UTI - warm baths and NSAIDS Biopsy – immediately apply pressure to the puncture site - apply sterile dressing - check puncture site for bleeding , V/S - force fluids to promote urination and to prevent clot formation - limited activity for the first 24 hrs.
  • 10. Complications
    • Nursing Diagnosis
    • Urinary elimination, alteration in pattern related to surgery
    • Pain related to bladder spasm
    • Infection/injury (hemorrhage), potential for, related to surgery
    • Sexual dysfunction, potential related to surgery
    • Knowledge deficit (activity restriction, prevention of complications) related to lack of information
    with advanced BPH, urinary tract obstruction may occur as urine is unable to pass through the prostate. Urinary obstruction can lead to UTI’s and, if unrelieved, renal failure
  • 11. Interventions
    • Medical
    • - ongoing assessment of a symptom
    • - reducing urethral obstruction by relaxing smooth muscle w/in the prostate, proximal urethra & bladder neck (Alpha-1-adrenergic blockers)
    • - 5-alpha-reductase (finasteride (Proscar) and dutasteride)
    • Surgical
    • - TURP, Suprapubic Prostatectomy, Retropubic Prostatectomy, and Perineal Prostatectomy
    Nursing Care Promotive - balance and healthy diet - regular exercise - health teachings Preventive - teach men to report any lower urinary tract symptoms that may be indicative of BPH - teach men on how to perform TSE - teach men to practice safer sex to prevent infections of the reproductive organs
  • 12.
    • Curative
    • - Medications that reduces urethral obstruction by relaxing smooth muscle w/in the prostate, proximal urethra & bladder neck (Alpha-1- adrenergic blockers)
    • - Surgery: TURP, Suprapubic Prostatectomy, Retropubic Prostatectomy, and Perineal Prostatectomy
    • Rehabilitative
    • - reassure clients that loss of control in urination is almost always temporary and will resolve
    • - teach and encourage Kegel exercises
  • 13.
    • is an inflammation of the kidney and upper urinary tract that usually results from non contagious bacterial infection of the bladder (cystitis)
    • the cause may be an active infection in the kidney or the remnants of a previous infection
    • There two types: acute and chronic pyelonephritis.
    PYELONEPHRITIS
  • 14.
    • bacteria enters the renal pelvis
    • Inflammation WBCs
    • Edema and swelling of the involved tissue
    • (papillae – cortex)
    • (if treated)
    • Fibrosis and scar tissue may develop
    • (w/ altered tubular
    • reabsorption &
    • secretion)
    • RENAL FUNCTION
  • 15.
    • Acute Pyelonephritis
    • Client seems to be in acute distress
    • fever, chills, nausea, flank pain on the affected side, headache, muscle pain, and in general prostration
    • Dysuria, frequency, urgency
    • Urine is cloudy/bloody, foul-smelling
    ASSESSMENT
    • Chronic Pyelonephritis
    • Discovered incidentally when the client is evaluated for hpn.
    • Hypertension itself is the most frequent manifestation of the disease.
    • Lab results may show azotemia, pyuria, anemia, &proteinuria.
    • Demonstrates poor urine-concentrrating ability
  • 16. DIAGNOSTICS
    • X-ray studies, intravenous pyelography (IVP)
    • cystourethrogram
    • Ultrasound, CT scan, MRI
    • Radionuclide imaging w/ gallium citrate and indium-111 (In 111 )
    • Urine culture and sensitiviy tests
    • IV urogram, measurements of creatinine clearance, BUN & Crea. levels
  • 17. Preoparative Care
    • - screening for allergies or sensitivity
    • - instruct px about necessary bowel prep.
    • - tell client that there is sensation of flushing and warmth, salty taste, nausea. If occurs, take deep, full breath
    Intraoparative Care - assess for allergic reactions immediately after injection of the contrast medium (urticaria, itching, diaphoresis, and resp. distress or failure) - antihistamines, steroids and emergency cart must be ready available
  • 18.
    • Postoperative Care:
    • Monitor hydration status after IVP to reduce the risk of renal failure in susceptible clients
    • If not contraindicated, force fluids to promote renal clearance of the contrast medium.
    • Monitor output
    • Observe for mild reactions for iodine, such as hives, nausea or parotid swelling.
    • Complications
    • End Stage Renal Disease (ESRD) – for Chronic pyelonephritis
    • Hypertension, formation of kidney stones
  • 19. NURSING DIAGNOSIS
    • Risk for Deficient Fluid Volume related to fever, nausea, vomiting, and possible diarrhea
    • Acute pain related to an inflammatory process in the kidney and possible colic.
    • Readiness for enhanced therapeutic regimen management
  • 20. Interventions
    • Medical
    • Prepare client for antibiotic thrapy
    • IV fluid for client w/ severe nausea and vomiting
    • Pain reliever as indicated, antipyretics for fever, urinary analgesics
    • Nursing Care
    • Promotive
    • Healthy lifestyle
    • Health teachings
    • Preventive
    • Provision of information on lifestyle measures:
      • Perineal hygiene-wiping front-back
      • Acidification of the urine(take ascorbic acid and other juice)
      • Ensuring adequate fluid intake
  • 21.
    • Curative
    • Give antibiotics as indicated (2-3 weeks course)
      • Ciprofloxacin (Cipro)
      • Ampicillin (Omnipen)
      • trimethoprim-sulfamethoxazole (Bactrim, Septra
    • May require hospitalization if the patient is severely ill
    • For chronic p., 6 mos course of antibiotics until infection is clear
    • Fluid intake
    • Rehabilitative
    • Health maintenance
      • Importance of completing the course of antibiotics
      • Follow-up cultures to ensure that infection has been eradicated
  • 22. CYSTITIS
    • Is the inflammation of the urinary bladder
    • Sometimes cystitis and urethritis are referred to collectively as a lower urinary tract infection, or UTI
    • Most of the time, the inflammation is caused by a bacterial infection
    • common female problem, esp. to pregnant ones (no prostatic fluid and short urethra)
    • uncommon in younger and middle-aged men, but may occur as complications of bacterial infections of the kidney or prostate gland
    • In children, cystitis is often caused by congenital abnormalities (present at birth) of the urinary tract
  • 23.
    • Ascending and invading Bacteria
    Inflammatory response in the lining of the urinary tract triggers IRRITATION
    • Pain
    • Frequent voiding
    • Other clinical manifestations
  • 24. ASSESSMENT
    • Frequency (voiding at close intervals)
    • Urgency (strong desire to void)
    • Dysuria
    • Foul-smelling urine
    • Suprapubic pain
    • Malaise, fever, chills, nausea and vomiting
    • Low back pain
    • Routine urinalysis and Creatinine and Sensitivity test of urine support presence of UTI (rbc, wbs, pus, and bacteria in the urine
    • For elderly, lethargy, altered sensorium, anorexia, new incontinence, hyperventilation, grade fever
  • 25. DIAGNOSTICS
    • Urinalysis (presence of rbc, wbc, pus and bacteria)
    • Urine cultures
    • Bacterial colony counts
    • Cellular studies
    • Preoperative Care
    • advise client to obtain a urine midstream
    • give adequate instructions to the client regarding antibiotic therapy & dietary & activity restrictions needed during antibiotic therapy
    • for surgery, do preop protocol
  • 26.
    • Postoperative Care
    • Maintain hydration status
      • IV Fluids
      • Adequate fluid intake
      • Complications
      • Urethrovesical reflux
      • Urosepsis
      • Pyelonephritis
  • 27. NURSING DIAGNOSIS
    • Impaired Urinary Elimination
    • Acute Pain related to infection within the urinary tract
    • Deficient Knowledge about factors predisposing the patient to infection and recurrence, detection and prevention of recurrence, and pharmacvologic therapy
  • 28. INTERVENTIONS
    • Medical
        • Acute Pharmacologic Therapy ( Antibacterial agents)
        • Long-term Pharmacologic Therapy (another short course -3 to 4 days of full-dose antimicrobial therapy followed by a regular bedtime dose of an antimicrobial agent may be prescribed)
        • Patient Education
        • Surgical
        • - are performed only to address structural anomalies that cause repeated infections
  • 29. NURSING CARE
    • Promotive
    • Healthy lifestyle
    • Teaching Patients Self Care
    • Preventive
    • Practicing Careful Personal Hygiene
      • Practice “3 W’s”
      • Wash hands before and after using the toilet
      • Wear cotton underwear
      • Wipe perineum from front to back
    • Increasing fluid intake to promote voiding and dilution of urind
    • Urinating regularly and more frequently
    • Drink cranberry juice!
  • 30.
    • Curative
    • Administer medications as prescribed
      • Urinary Tract Analgesics
      • Urinary Antiseptics
      • Fluoroquinolones
      • Sulfonamides
      • Cholinergic
      • Antispasmodics
    • Rehabilitative
    • Recognition of lifestyle changes-to dec. Risk factors
    • Ability to restate the medication protocol
  • 31. WILM’S TUMOR
    • Is the type of childhood cancer that begins in the kidney
    • It is a malignant tumor
    • Most common type of kidney cancer among children
    • Can develop in both (bilateral) or in one (unilateral) kidney.
    • Is only often found after it has grown to a size of 8 oz
    • Risk factor- hemihypertrphy for children
    • It accounts for 6% of all childhood cancers. • It generally grows to a large size before it is diagnosed, usually before the child reaches age 5. • The tumor expands the renal parenchyma, and the capsule of the kidney becomes stretched over the surface of the tumor. • Staging if from I (limited to kidney) to IV (matastasis) and stage V, which indicates bilateral involvement (rare). • The tumor may metastasize to the lymph nodes , lungs, liver, and brain.
  • 32.
    • Undeferentiated cluster of primordial cell
    • grow into
    • Large solitary well-circumscribed mass
    • growth and behavior becomes more aggressive
    • METASTASIZE
    • (occurs via venous or lymphatic routes)
  • 33. ASSESSMENT
    • Firm, non tender abdominal mass
    • Hematuria
    • Low grade fever
    • HPN
    • Possible anemia
    • Weight loss
    • Malaise
    • Anorexia
    • Stomach pain
    • Nausea and vomiting
  • 34. DIAGNOSTICS
    • IVP
    • Chest CT scan
    • Chest MRI
    • Sonogram
    • Chest Xray
  • 35. COMPLICATION
    • Spread of the Tumor to the vitsl organs
    • HPN
    • Kidney damage may occur
  • 36. INTERVENTION
    • Medical
      • IV combination chemo
      • Analgesic for pain
      • Radiotherapy
      • SURGICAL
      • - Nephroureterectomy
      • - resection of involved abdominal structure
      • - kidney transplant
  • 37. NURSING CARE
    • Preventive/Curative/Rehabilitative
    • do not palpate the abdomen as palpation and handling aids in metastasis
    • provide care for a client with nephrectomy
    • provide care for client receiving chemo and radiation therapy
    • continue follow-up care
  • 38.  
  • 39.  

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