Genito Urinary System


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Genito Urinary System

  1. 1. The Genito-Urinary System Medical Surgical Nursing Review
  2. 2. Outline of review <ul><li>Recall the anatomy and physiology of the Renal System </li></ul><ul><li>Renal Assessment </li></ul><ul><li>Renal Laboratory Procedure </li></ul><ul><li>Common Conditions: </li></ul><ul><ul><li>UTI </li></ul></ul><ul><ul><li>Kidney Stones </li></ul></ul><ul><ul><li>ARF and CRF </li></ul></ul>
  3. 3. Outline of review <ul><ul><li>BPH </li></ul></ul><ul><ul><li>Prostatic cancer </li></ul></ul>
  4. 4. 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
  5. 5. Urological Assessment <ul><li>Nursing History </li></ul><ul><ul><li>Reason for seeking care </li></ul></ul><ul><ul><li>Current illness </li></ul></ul><ul><ul><li>Previous illness </li></ul></ul><ul><ul><li>Family History </li></ul></ul><ul><ul><li>Social History </li></ul></ul><ul><ul><li>Sexual history </li></ul></ul>
  6. 6. Urological Assessment <ul><ul><li>Key Signs and Symptoms of Urological Problems </li></ul></ul><ul><ul><li>EDEMA </li></ul></ul><ul><ul><ul><li>associated with fluid retention </li></ul></ul></ul><ul><ul><ul><li>Renal dysfunctions usually produce ANASARCA </li></ul></ul></ul>
  7. 7. Urological Assessment <ul><ul><li>Key Signs and Symptoms of Urological Problems </li></ul></ul><ul><ul><li>PAIN </li></ul></ul><ul><ul><ul><li>Suprapubic pain= bladder </li></ul></ul></ul><ul><ul><ul><li>Colicky pain on the flank= kidney </li></ul></ul></ul>
  8. 8. Urological Assessment <ul><ul><li>Key Signs and Symptoms of Urological Problems </li></ul></ul><ul><ul><li>HEMATURIA </li></ul></ul><ul><ul><ul><li>Painless hematuria may indicate URINARY CANCER! </li></ul></ul></ul><ul><ul><ul><li>Early-stream hematuria= urethral lesion </li></ul></ul></ul><ul><ul><ul><li>Late-stream hematuria= bladder lesion </li></ul></ul></ul>
  9. 9. Urological Assessment <ul><ul><li>Key Signs and Symptoms of Urological Problems </li></ul></ul><ul><ul><li>DYSURIA </li></ul></ul><ul><ul><ul><li>Pain with urination= lower UTI </li></ul></ul></ul>
  10. 10. Urological Assessment <ul><ul><li>Key Signs and Symptoms of Urological Problems </li></ul></ul><ul><ul><li>POLYURIA </li></ul></ul><ul><ul><ul><li>More than 2 Liters urine per day </li></ul></ul></ul><ul><ul><li>OLIGURIA </li></ul></ul><ul><ul><ul><li>Less than 400 mL per day </li></ul></ul></ul><ul><ul><li>ANURIA </li></ul></ul><ul><ul><ul><li>Less than 50 mL per day </li></ul></ul></ul>
  11. 11. Urological Assessment <ul><ul><li>Key Signs and Symptoms of Urological Problems </li></ul></ul><ul><ul><li>Urinary Urgency </li></ul></ul><ul><ul><li>Urinary retention </li></ul></ul><ul><ul><li>Urinary frequency </li></ul></ul>
  12. 12. Urological Assessment <ul><ul><li>PHYSICAL EXAMINATION </li></ul></ul><ul><ul><li>Inspection </li></ul></ul><ul><ul><li>Auscultation </li></ul></ul><ul><ul><li>Percussion </li></ul></ul><ul><ul><li>Palpation </li></ul></ul>
  13. 13. Urological Assessment <ul><ul><li>Laboratory examination </li></ul></ul><ul><ul><li>Urinalysis </li></ul></ul><ul><ul><li>BUN and Creatinine levels of the serum </li></ul></ul><ul><ul><li>Serum electrolytes </li></ul></ul>
  14. 14. Urological Assessment <ul><ul><li>Laboratory examination </li></ul></ul><ul><ul><li>Radiographic </li></ul></ul><ul><ul><li>IVP </li></ul></ul><ul><ul><li>KUB x-ray </li></ul></ul><ul><ul><li>KUB ultrasound </li></ul></ul><ul><ul><li>CT and MRI </li></ul></ul><ul><ul><li>Cystography </li></ul></ul>
  15. 15. Implementation Steps for selected problems <ul><li>Provide PAIN relief </li></ul><ul><li>Assess the level of pain </li></ul><ul><li>Administer medications usually narcotic ANALGESICS </li></ul>
  16. 16. Implementation Steps for selected problems <ul><li>Maintain Fluid and Electrolyte Balance </li></ul><ul><li>Encourage to consume at least 2 liters of fluid per day </li></ul><ul><li>In cases of ARF, limit fluid as directed </li></ul><ul><li>Weigh client daily to detect fluid retention </li></ul>
  17. 17. Implementation Steps for selected problems <ul><li>Ensure Adequate urinary elimination </li></ul><ul><li>Encourage to void at least every 2-3 hours </li></ul><ul><li>Promote measures to relieve urinary retention: </li></ul><ul><ul><li>Alternating warm and cold compress </li></ul></ul><ul><ul><li>Bedpan </li></ul></ul><ul><ul><li>Open faucet </li></ul></ul><ul><ul><li>Provide privacy </li></ul></ul><ul><ul><li>Catheterization if indicated </li></ul></ul>
  18. 18. Urinary Tract Infection (UTI) <ul><li>Bacterial invasion of the kidneys or bladder (CYSTITIS) usually caused by Escherichia coli </li></ul>
  19. 19. Urinary Tract Infection (UTI) <ul><li>Predisposing factors include </li></ul><ul><li>Poor hygiene </li></ul><ul><li>Irritation from bubble baths </li></ul><ul><li>Urinary reflux </li></ul><ul><li>Instrumentation </li></ul><ul><li>Residual urine, urinary stasis </li></ul>
  20. 20. Urinary Tract Infection (UTI) <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>The invading organism ascends the urinary tract, irritating the mucosa and causing characteristic symptoms </li></ul><ul><ul><li>Ureter= ureteritis </li></ul></ul><ul><ul><li>Bladder= cystitis </li></ul></ul><ul><ul><li>Urethra=Urethritis </li></ul></ul><ul><ul><li>Pelvis= Pyelonephritis </li></ul></ul>
  21. 21. Urinary Tract Infection (UTI) <ul><li>Assessment findings </li></ul><ul><li>Low-grade fever </li></ul><ul><li>Abdominal pain </li></ul><ul><li>Enuresis </li></ul><ul><li>Pain/burning on urination </li></ul><ul><li>Urinary frequency </li></ul><ul><li>Hematuria </li></ul>
  22. 22. Urinary Tract Infection (UTI) <ul><li>Assessment findings: Upper UTI </li></ul><ul><li>Fever and CHIILS </li></ul><ul><li>Flank pain </li></ul><ul><li>Costovertebral angle tenderness </li></ul>
  23. 23. Urinary Tract Infection (UTI) <ul><li>Laboratory Examination </li></ul><ul><li>Urinalysis </li></ul><ul><li>Urine Culture </li></ul>
  24. 24. Urinary Tract Infection (UTI) <ul><li>Nursing interventions </li></ul><ul><li>Administer antibiotics as ordered </li></ul><ul><li>Provide warm baths and allow client to void in water to alleviate painful voiding. </li></ul><ul><li>Force fluids. Nurses may give 3 liters of fluid per day </li></ul><ul><li>Encourage measures to acidify urine (cranberry juice, acid-ash diet). </li></ul>
  25. 25. Urinary Tract Infection (UTI) <ul><li>Provide client teaching and discharge planning concerning </li></ul><ul><li>a. Avoidance of tub baths </li></ul><ul><li>b. Avoidance of bubble baths that might irritate urethra </li></ul><ul><li>c. Importance for girls to wipe perineum from front to back </li></ul><ul><li>d. Increase in foods/fluids that acidify urine. </li></ul>
  26. 26. Urinary Tract Infection (UTI) <ul><li>Pharmacology </li></ul><ul><li>1. Sulfa drugs </li></ul><ul><ul><li>Highly concentrated in the urine </li></ul></ul><ul><ul><li>Effective against E. coli! </li></ul></ul><ul><li>2. Quinolones </li></ul>
  27. 27. Nephrolithiasis/Urolithiasis <ul><li>Presence of stones anywhere in the urinary tract </li></ul><ul><ul><li>Calcium </li></ul></ul><ul><ul><li>oxalate </li></ul></ul><ul><ul><li>and uric acid </li></ul></ul>
  28. 28. Nephrolithiasis/Urolithiasis <ul><li>Pathophysiology </li></ul><ul><li>Predisposing factors </li></ul><ul><li>a. Diet: large amounts of calcium and oxalate </li></ul><ul><li>b. Increased uric acid levels </li></ul><ul><li>c. Sedentary life-style, immobility </li></ul><ul><li>d. Family history of gout or calculi </li></ul><ul><li>e. Hyperparathyroidism </li></ul>
  29. 29. Nephrolithiasis/Urolithiasis <ul><li>Pathophysiology </li></ul><ul><li>Supersaturation of crystals due to stasis </li></ul><ul><li>Stone formation </li></ul><ul><li>May pass through the urinary tract </li></ul><ul><li>OBSTRUCTION, INFECTION and HYDRONEPHROSIS </li></ul>
  30. 30. Nephrolithiasis/Urolithiasis <ul><li>Assessment findings </li></ul><ul><li>Abdominal or flank pain </li></ul><ul><li>Renal colic radiating to the groin </li></ul><ul><li>3. Hematuria </li></ul><ul><li>4. Cool, moist skin </li></ul><ul><li>5. Nausea and vomiting </li></ul>
  31. 31. Nephrolithiasis/Urolithiasis <ul><li>Diagnostic tests </li></ul><ul><li>1. KUB Ultrasound and X-ray : pinpoints location, number, and size of stones </li></ul><ul><li>2. IVP: identifies site of obstruction and presence of non-radiopaque stones </li></ul><ul><li>3. Urinalysis : indicates presence of bacteria, increased protein, increased WBC and RBC (hematuria) </li></ul>
  32. 32. Nephrolithiasis/Urolithiasis <ul><li>Medical management </li></ul><ul><li>1. Surgery </li></ul><ul><li>a. Percutaneous nephrostomy: tube is inserted through skin and underlying tissues into renal pelvis to remove calculi. </li></ul><ul><li>b. Percutaneous nephrostolithotomy: delivers ultrasound waves through a probe placed on the calculus. </li></ul>
  33. 33. Nephrolithiasis/Urolithiasis <ul><li>Medical management </li></ul><ul><li>2. Extracorporeal shock-wave lithotripsy: delivers shock waves from outside the body to the stone, causing pulverization </li></ul><ul><li>Pain management : Morphine or Meperidine </li></ul><ul><li>Diet modification </li></ul>
  34. 34. Nephrolithiasis/Urolithiasis <ul><li>Nursing interventions </li></ul><ul><li>1. Strain all urine through gauze to detect stones and crush all clots. </li></ul><ul><li>2. Force fluids (3000—4000 cc/day). </li></ul><ul><li>3. Encourage ambulation to prevent stasis. </li></ul>
  35. 35. Nephrolithiasis/Urolithiasis <ul><li>Nursing interventions </li></ul><ul><li>4. Relieve pain by administration of analgesics as ordered and application of moist heat to flank area. </li></ul><ul><li>5. Monitor intake and output </li></ul>
  36. 36. Nephrolithiasis/Urolithiasis <ul><li>Nursing interventions </li></ul><ul><li>6. Provide modified diet, depending upon stone consistency: Calcium, Oxalate and Uric acid stones </li></ul>
  37. 37. Nephrolithiasis/Urolithiasis <ul><li>Nursing interventions </li></ul><ul><li>Calcium stones </li></ul><ul><li>limit milk/dairy products; provide acid-ash diet to acidify urine (cranberry or prune juice, meat, eggs, poultry, fish, grapes, and whole grains) </li></ul>
  38. 38. Nephrolithiasis/Urolithiasis <ul><li>Nursing interventions </li></ul><ul><li>Oxalate stones </li></ul><ul><li>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) </li></ul>
  39. 39. Nephrolithiasis/Urolithiasis <ul><li>Nursing interventions </li></ul><ul><li>Uric acid stones </li></ul><ul><li>reduce foods high in purine (liver, beans, kidneys, venison, shellfish, meat soups, gravies, legumes); maintain alkaline urine </li></ul>
  40. 40. Nephrolithiasis/Urolithiasis <ul><li>Nursing interventions </li></ul><ul><li>7. Administer allopurinol (Zyloprim) as ordered, to decrease uric acid production </li></ul>
  41. 41. Nephrolithiasis/Urolithiasis <ul><li>8. Provide client teaching and discharge planning concerning </li></ul><ul><li>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 </li></ul><ul><li>Adherence to prescribed diet </li></ul><ul><li>Need for routine urinalysis (at least every 3—4 months) </li></ul><ul><li>Need to recognize and report signs/ symptoms of recurrence (hematuria, flank pain). </li></ul>
  42. 42. Acute renal failure <ul><li>Sudden interruption of kidney function to regulate fluid and electrolyte balance and remove toxic products from the body </li></ul>
  43. 43. Acute renal failure <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>Pre-renal failure </li></ul><ul><li>Intra-renal failure </li></ul><ul><li>Post-renal failure </li></ul>
  44. 45. Acute renal failure <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>Prerenal CAUSE: </li></ul><ul><li>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 </li></ul>
  45. 46. Acute renal failure <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>Intrarenal CAUSE: </li></ul><ul><li>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) </li></ul>
  46. 47. Acute renal failure <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>Postrenal CAUSE: </li></ul><ul><li>Mechanical obstruction anywhere from the tubules to the urethra; includes calculi, BPH, tumors, strictures, blood clots, trauma, and anatomic malformation </li></ul>
  47. 48. Acute renal failure <ul><li>Three phases of acute renal failure </li></ul><ul><li>Oliguric phase </li></ul><ul><li>Diuretic phase </li></ul><ul><li>Convalescence or recovery phase </li></ul>
  48. 49. Acute renal failure <ul><li>Four phases of acute renal failure (Brunner and Suddarth) </li></ul><ul><li>Initiation phase </li></ul><ul><li>Oliguric phase </li></ul><ul><li>Diuretic phase </li></ul><ul><li>Convalescence or recovery phase </li></ul>
  49. 50. Acute renal failure <ul><li>Assessment findings: The Three Phases of Acute Renal Failure </li></ul><ul><li>1. Oliguric phase </li></ul><ul><li>Urine output less than 400 cc/24 hours </li></ul><ul><li>duration 1—2 weeks </li></ul><ul><li>Manifested by dilutional hyponatremia, hyperkalemia , hyperphosphatemia, hypocalcemia , hypermagnesemia, and metabolic acidosis </li></ul><ul><li>Diagnostic tests: BUN and creatinine elevated </li></ul>
  50. 51. Acute renal failure <ul><li>Assessment findings: The Three Phases of Acute Renal Failure </li></ul><ul><li>2. Diuretic phase </li></ul><ul><li>Diuresis may occur (output 3—5 liters/day) due to partially regenerated tubule’s inability to concentrate urine </li></ul><ul><li>Duration: 2—3 weeks ; manifested by hyponatremia, hypokalemia, and hypovolemia </li></ul><ul><li>Diagnostic tests: BUN and creatinine slightly elevated </li></ul>
  51. 52. Acute renal failure <ul><li>Assessment findings: The Three Phases of Acute Renal Failure </li></ul><ul><li>3. Recovery or convalescent phase: </li></ul><ul><li>Renal function stabilizes with gradual improvement over next 3—12 months </li></ul>
  52. 53. Acute renal failure <ul><li>Laboratory findings: </li></ul><ul><li>Urinalysis: Urine osmo and sodium </li></ul><ul><li>BUN and creatinine levels increased </li></ul><ul><li>Hyperkalemia </li></ul><ul><li>Anemia </li></ul><ul><li>ABG: metabolic acidosis </li></ul>
  53. 54. Acute renal failure <ul><li>Nursing interventions </li></ul><ul><li>Monitor fluid and Electrolyte Balance </li></ul><ul><li>Reduce metabolic rate </li></ul><ul><li>Promote pulmonary function </li></ul><ul><li>Prevent infection </li></ul><ul><li>Provide skin care </li></ul><ul><li>Provide emotional support </li></ul>
  54. 55. Acute renal failure <ul><li>Nursing interventions </li></ul><ul><li>1. Monitor and maintain fluid and electrolyte balance. </li></ul><ul><li>Measure l & O every hour. note excessive losses in diuretic phase </li></ul><ul><li>Administer IV fluids and electrolyte supplements as ordered. </li></ul><ul><li>Weigh daily and report gains. </li></ul><ul><li>Monitor lab values; assess/treat fluid and electrolyte and acid-base imbalances as needed </li></ul>
  55. 56. Acute renal failure <ul><li>Nursing interventions </li></ul><ul><li>2. Monitor alteration in fluid volume. </li></ul><ul><li>Monitor vital signs, PAP, PCWP, CVP as needed. </li></ul><ul><li>Weigh client daily. </li></ul><ul><li>Maintain strict I & O records. </li></ul>
  56. 57. Acute renal failure <ul><li>Nursing interventions </li></ul><ul><li>2. Assess every hour for hypervolemia </li></ul><ul><ul><li>Maintain adequate ventilation. </li></ul></ul><ul><ul><li>Restrict FLUID intake </li></ul></ul><ul><ul><li>Administer diuretics and antihypertensives </li></ul></ul>
  57. 58. Acute renal failure <ul><li>Nursing interventions </li></ul><ul><li>3. Promote optimal nutritional status. </li></ul><ul><li>Weigh daily. </li></ul><ul><li>Administer TPN as ordered. </li></ul><ul><li>With enteral feedings, check for residual and notify physician if residual volume increases. </li></ul><ul><li>Restrict protein intake to 1 g/kg/day </li></ul><ul><li>Restrict POTASSIUM intake </li></ul><ul><li>HIGH CARBOHYDRATE DIET, calcium supplements </li></ul>
  58. 59. Acute renal failure <ul><li>Nursing interventions </li></ul><ul><li>4. Prevent complications from impaired mobility (pulmonary embolism, skin breakdown, and atelectasis) </li></ul><ul><li>5. Prevent fever/infection. </li></ul><ul><ul><li>Assess for signs of infection. </li></ul></ul><ul><ul><li>Use strict aseptic technique for wound and catheter care. </li></ul></ul>
  59. 60. Acute renal failure <ul><li>Nursing interventions </li></ul><ul><li>6. Support client/significant others and reduce/ relieve anxiety. </li></ul><ul><ul><li>Explain pathophysiology and relationship to symptoms. </li></ul></ul><ul><ul><li>Explain all procedures and answer all questions in easy-to-understand terms </li></ul></ul><ul><ul><li>Refer to counseling services as needed </li></ul></ul><ul><li>7. Provide care for the client receiving dialysis </li></ul>
  60. 61. Acute renal failure <ul><li>Nursing interventions </li></ul><ul><li>8. Provide client teaching and discharge planning concerning </li></ul><ul><li>Adherence to prescribed dietary regimen </li></ul><ul><li>Signs and symptoms of recurrent renal disease </li></ul><ul><li>Importance of planned rest periods </li></ul><ul><li>Use of prescribed drugs only </li></ul><ul><li>Signs and symptoms of UTI or respiratory infection need to report to physician immediately </li></ul>
  61. 62. Chronic Renal Failure <ul><li>Gradual, Progressive irreversible destruction of the kidneys causing severe renal dysfunction. </li></ul><ul><li>The result is azotemia to UREMIA </li></ul>
  62. 63. Chronic Renal Failure <ul><li>Predisposing factors: </li></ul><ul><ul><li>DM= worldwide leading cause </li></ul></ul><ul><ul><li>Recurrent infections </li></ul></ul><ul><ul><li>Exacerbations of nephritis </li></ul></ul><ul><ul><li>urinary tract obstruction </li></ul></ul><ul><ul><li>hypertension </li></ul></ul>
  63. 64. Chronic Renal Failure <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>As renal functions decline </li></ul><ul><li>Retention of end-products of metabolism </li></ul>
  64. 65. Chronic Renal Failure <ul><li>PATHOPHYSIOLOGY </li></ul><ul><li>STAGE 1= reduced renal reserve, 40-75% loss of nephron function </li></ul><ul><li>STAGE 2= renal insufficiency, 75-90% loss of nephron function </li></ul><ul><li>STAGE 3= end-stage renal disease, more than 90% loss. DIALYSIS IS THE TREATMENT! </li></ul>
  65. 66. Chronic Renal Failure <ul><li>Assessment findings </li></ul><ul><li>1. Nausea, vomiting; diarrhea or constipation; decreased urinary output </li></ul><ul><li>2. Dyspnea </li></ul><ul><li>3. Stomatitis </li></ul><ul><li>4. Hypertension (later), lethargy, convulsions, memory impairment, pericardial friction rub </li></ul>
  66. 67. 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
  67. 68. Chronic Renal Failure <ul><li>Diagnostic tests: </li></ul><ul><li>a. 24 hour creatinine clearance urinalysis </li></ul><ul><li>b. Protein, sodium, BUN, Crea and WBC elevated </li></ul><ul><li>c. Specific gravity, platelets, and calcium decreased </li></ul><ul><li>D. CBC= anemia </li></ul>
  68. 69. Chronic Renal Failure <ul><li>Medical management </li></ul><ul><li>1. Diet restrictions </li></ul><ul><li>2. Multivitamins </li></ul><ul><li>3. Hematinics and erythropoietin </li></ul><ul><li>4. Aluminum hydroxide gels </li></ul><ul><li>5. Anti-hypertensive </li></ul><ul><li>6. Anti-seizures </li></ul><ul><li>DIALYSIS </li></ul>
  69. 70. Chronic Renal Failure <ul><li>Nursing interventions </li></ul><ul><li>1. Prevent neurological complications. </li></ul><ul><li>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). </li></ul>
  70. 71. Chronic Renal Failure <ul><li>Nursing interventions </li></ul><ul><li>1. Prevent neurological complications. </li></ul><ul><li>Assess for changes in mental functioning. </li></ul><ul><li>Orient confused client to time, place, date, and persons; institute safety measures to protect client from falling out of bed. </li></ul><ul><li>Monitor serum electrolytes, BUN, and creatinine as ordered </li></ul>
  71. 72. Chronic Renal Failure <ul><li>Nursing interventions </li></ul><ul><li>2. Promote optimal GI function. </li></ul><ul><li>Assess/provide care for stomatitis </li></ul><ul><li>Monitor nausea, vomiting, anorexia </li></ul><ul><li>Administer antiemetics as ordered. </li></ul><ul><li>Assess for signs of Gl bleeding </li></ul>
  72. 73. Chronic Renal Failure <ul><li>Nursing interventions </li></ul><ul><li>3. Monitor/prevent alteration in fluid and electrolyte balance </li></ul><ul><li>4. Assess for hyperphosphatemia (paresthesias, muscle cramps, seizures, abnormal reflexes), and administer aluminum hydroxide gels (Amphojel) as ordered </li></ul>
  73. 74. Chronic Renal Failure <ul><li>Nursing interventions </li></ul><ul><li>5. Promote maintenance of skin integrity. </li></ul><ul><li>Assess/provide care for pruritus. </li></ul><ul><li>Assess for uremic frost (urea crystallization on the skin) and bathe in plain water </li></ul>
  74. 75. Chronic Renal Failure <ul><li>Nursing interventions </li></ul><ul><li>6. Monitor for bleeding complications, prevent injury to client. </li></ul><ul><li>Monitor Hgb, hct, platelets, RBC. </li></ul><ul><li>Hematest all secretions. </li></ul><ul><li>Administer hematinics as ordered. </li></ul><ul><li>Avoid lM injections </li></ul>
  75. 76. Chronic Renal Failure <ul><li>Nursing interventions </li></ul><ul><li>7. Promote/maintain maximal cardiovascular function. </li></ul><ul><li>Monitor blood pressure and report significant changes. </li></ul><ul><li>Auscultate for pericardial friction rub. </li></ul><ul><li>Perform circulation checks routinely. </li></ul>
  76. 77. Chronic Renal Failure <ul><li>Nursing interventions </li></ul><ul><li>7. Promote/maintain maximal cardiovascular function. </li></ul><ul><li>Administer diuretics as ordered and monitor output. </li></ul><ul><li>Modify drug doses </li></ul><ul><li>8. Provide care for client receiving dialysis. </li></ul>
  77. 78. DIALYSIS <ul><li>a procedure that is used to remove fluid and uremic wastes from the body when the kidneys cannot function </li></ul>
  78. 79. DIALYSIS <ul><li>Two methods </li></ul><ul><li>1. Hemodialysis </li></ul><ul><li>2. Peritoneal dialysis </li></ul>
  79. 82. DIALYSIS <ul><li>Diffusion </li></ul><ul><li>Osmosis </li></ul><ul><li>Ultrafiltration </li></ul>
  80. 83. DIALYSIS <ul><li>Nursing management </li></ul><ul><li>Meet the patient's psychosocial needs </li></ul><ul><li>Remember to avoid any procedure on the arm with the fistula (HEMO) </li></ul><ul><ul><li>Monitor WEIGHT, blood pressure and fistula site for bleeding </li></ul></ul>
  81. 84. DIALYSIS <ul><li>Nursing management </li></ul><ul><li>3. Monitor symptoms of uremia </li></ul><ul><li>4. Detect complications like infection, bleeding (Hepatitis B/C and HIV infection in Hemodialysis) </li></ul><ul><li>5. Warm the solution to increase diffusion of waste products (PERITONEAL) </li></ul><ul><li>6. Manage discomfort and pain </li></ul>
  82. 85. DIALYSIS <ul><li>Nursing management </li></ul><ul><li>7. To determine effectiveness, check serum creatinine, BUN and electrolytes </li></ul>
  83. 86. Male reproductive disorders <ul><li>BPH </li></ul><ul><li>Prostatic cancer </li></ul>
  84. 87. Male reproductive disorders <ul><li>DIGITAL RECTAL EXAMINATION- DRE </li></ul><ul><li>Recommended for men annually with age over 40 years </li></ul><ul><li>Screening test for cancer </li></ul><ul><li>Ask patient to BEAR DOWN </li></ul>
  85. 89. Male reproductive disorders <ul><li>TESTICULAR EXAMINATION </li></ul><ul><li>Palpation of scrotum for nodules and masses or inflammation </li></ul><ul><li>BEGINS DURING ADOLESCENCE </li></ul>
  86. 90. Male reproductive disorders <ul><li>Prostate specific antigen (PSA) </li></ul><ul><li>Elevated in prostate cancer </li></ul><ul><li>Normal is 0.2 to 4 nanograms/mL </li></ul><ul><li>Cancer= over 4 </li></ul>
  87. 91. Male reproductive disorders <ul><li>BENIGN PROSTATIC HYPERPLASIA </li></ul><ul><li>Enlargement of the prostate that causes outflow obstruction </li></ul><ul><li>Common in men older than 50 years old </li></ul>
  88. 93. Male reproductive disorders <ul><li>BENIGN PROSTATIC HYPERPLASIA </li></ul><ul><li>Assessment findings </li></ul><ul><li>DRE: enlarged prostate gland that is rubbery, large and NON-tender </li></ul><ul><li>Increased frequency, urgency and hesitancy </li></ul><ul><li>Nocturia, DECREASE IN THE VOLUME AND FORCE OF URINE STREAM </li></ul>
  89. 94. Male reproductive disorders <ul><li>BENIGN PROSTATIC HYPERPLASIA </li></ul><ul><li>Medical management </li></ul><ul><li>Immediate catheterization </li></ul><ul><li>Prostatectomy </li></ul><ul><li>TRANSURETHRAL RESECTION of the PROSTATE (TURP) </li></ul><ul><li>Pharmacology: alpha-blockers, alpha-reductase inhibitors. SAW palmetto </li></ul>
  90. 97. BPH <ul><li>NURSING INTERVENTION </li></ul><ul><li>Encourage fluids up to 2 liters per day </li></ul><ul><li>Insert catheter for urinary drainage </li></ul><ul><li>Administer medications – alpha adrenergic blockers and finasteride </li></ul><ul><li>Avoid anticholinergics </li></ul><ul><li>Prepare for surgery or TURP </li></ul><ul><li>Teach the patient perineal muscle exercises. Avoid valsalva until healing </li></ul>
  91. 98. BPH <ul><li>NURSING INTERVENTION: TURP </li></ul><ul><li>Maintain the three way bladder irrigation to prevent hemorrhage </li></ul><ul><li>Only initially the drainage is pink-tinged and never reddish </li></ul><ul><li>Administer anti-spasmodic to prevent bladder spasms </li></ul>
  92. 99. Prostate Cancer <ul><li>a slow growing malignancy of the prostate gland </li></ul><ul><li>Usually an adenocarcinoma </li></ul><ul><li>This usualy spread via blood stream to the vertebrae </li></ul>
  93. 101. Prostate Cancer <ul><li>Predisposing factor </li></ul><ul><ul><li>Age </li></ul></ul>
  94. 102. Prostate Cancer <ul><li>Assessment Findings </li></ul><ul><li>DRE: hard, pea-sized nodules on the anterior rectum </li></ul><ul><li>Hematuria </li></ul><ul><li>Urinary obstruction </li></ul><ul><li>Pain on the perineum radiating to the leg </li></ul>
  95. 103. Prostate Cancer <ul><li>Diagnostic tests </li></ul><ul><li>Prostatic specific antigen (PSA) </li></ul><ul><li>Elevated SERUM ACID PHOSPHATASE indicates SPREAD or Metastasis </li></ul>
  96. 104. Prostate Cancer <ul><li>Medical and surgical management </li></ul><ul><li>Prostatectomy </li></ul><ul><li>TURP </li></ul><ul><li>Chemotherapy: hormonal therapy to slow the rate of tumor growth </li></ul><ul><li>Radiation therapy </li></ul>
  97. 105. Prostate Cancer <ul><li>Nursing Interventions </li></ul><ul><li>Prepare patient for chemotherapy </li></ul><ul><li>Prepare for surgery </li></ul>
  98. 106. Prostate Cancer <ul><li>Nursing Interventions: Post-prostatectomy </li></ul><ul><li>Maintain continuous bladder irrigation. Note that drainage is pink tinged w/in 24 hours </li></ul><ul><li>Monitor urine for the presence of blood clots and hemorrhage </li></ul><ul><li>Ambulate the patient as soon as urine begins to clear in color </li></ul>