The document discusses various topics related to the genitourinary system including renal anatomy and physiology, common conditions like urinary tract infections and kidney stones, and nursing considerations for related assessments, procedures, and treatments. Specific conditions covered include acute renal failure, chronic renal failure, nephrolithiasis, urinary tract infections, and dialysis.

1. The Genito-Urinary System Medical Surgical Nursing Review pinoynursing.webkotoh.com

2. 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

3. Outline of review BPH Prostatic cancer

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. Urological Assessment Nursing History Reason for seeking care Current illness Previous illness Family History Social History Sexual history

6. Urological Assessment Key Signs and Symptoms of Urological Problems EDEMA associated with fluid retention Renal dysfunctions usually produce ANASARCA

7. Urological Assessment Key Signs and Symptoms of Urological Problems PAIN Suprapubic pain= bladder Colicky pain on the flank= kidney

8. 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

9. Urological Assessment Key Signs and Symptoms of Urological Problems DYSURIA Pain with urination= lower UTI

10. 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

11. Urological Assessment Key Signs and Symptoms of Urological Problems Urinary Urgency Urinary retention Urinary frequency

12. Urological Assessment PHYSICAL EXAMINATION Inspection Auscultation Percussion Palpation

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

14. Urological Assessment Laboratory examination Radiographic IVP KUB x-ray KUB ultrasound CT and MRI Cystography

15. Implementation Steps for selected problems Provide PAIN relief Assess the level of pain Administer medications usually narcotic ANALGESICS

16. 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

17. 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

18. Urinary Tract Infection (UTI) Bacterial invasion of the kidneys or bladder (CYSTITIS) usually caused by Escherichia coli

19. Urinary Tract Infection (UTI) Predisposing factors include Poor hygiene Irritation from bubble baths Urinary reflux Instrumentation Residual urine, urinary stasis

20. 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

21. Urinary Tract Infection (UTI) Assessment findings Low-grade fever Abdominal pain Enuresis Pain/burning on urination Urinary frequency Hematuria

22. Urinary Tract Infection (UTI) Assessment findings: Upper UTI Fever and CHIILS Flank pain Costovertebral angle tenderness

23. Urinary Tract Infection (UTI) Laboratory Examination Urinalysis Urine Culture

24. 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).

25. 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.

26. Urinary Tract Infection (UTI) Pharmacology 1. Sulfa drugs Highly concentrated in the urine Effective against E. coli! 2. Quinolones

27. Nephrolithiasis/Urolithiasis Presence of stones anywhere in the urinary tract Calcium oxalate and uric acid

28. 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

29. Nephrolithiasis/Urolithiasis Pathophysiology Supersaturation of crystals due to stasis Stone formation May pass through the urinary tract OBSTRUCTION, INFECTION and HYDRONEPHROSIS

30. Nephrolithiasis/Urolithiasis Assessment findings Abdominal or flank pain Renal colic radiating to the groin 3. Hematuria 4. Cool, moist skin 5. Nausea and vomiting

31. 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)

32. 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.

33. 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

34. 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.

35. 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

36. Nephrolithiasis/Urolithiasis Nursing interventions 6. Provide modified diet, depending upon stone consistency: Calcium, Oxalate and Uric acid stones

37. 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)

38. 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)

39. Nephrolithiasis/Urolithiasis Nursing interventions Uric acid stones reduce foods high in purine (liver, beans, kidneys, venison, shellfish, meat soups, gravies, legumes); maintain alkaline urine

40. Nephrolithiasis/Urolithiasis Nursing interventions 7. Administer allopurinol (Zyloprim) as ordered, to decrease uric acid production

41. 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).

42. Acute renal failure Sudden interruption of kidney function to regulate fluid and electrolyte balance and remove toxic products from the body

43. Acute renal failure PATHOPHYSIOLOGY Pre-renal failure Intra-renal failure Post-renal failure

45. 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

46. 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)

47. 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

48. Acute renal failure Three phases of acute renal failure Oliguric phase Diuretic phase Convalescence or recovery phase

49. Acute renal failure Four phases of acute renal failure (Brunner and Suddarth) Initiation phase Oliguric phase Diuretic phase Convalescence or recovery phase

50. 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

51. 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

52. 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

53. Acute renal failure Laboratory findings: Urinalysis: Urine osmo and sodium BUN and creatinine levels increased Hyperkalemia Anemia ABG: metabolic acidosis

54. Acute renal failure Nursing interventions Monitor fluid and Electrolyte Balance Reduce metabolic rate Promote pulmonary function Prevent infection Provide skin care Provide emotional support

55. 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

56. 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.

57. Acute renal failure Nursing interventions 2. Assess every hour for hypervolemia Maintain adequate ventilation. Restrict FLUID intake Administer diuretics and antihypertensives

58. 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

59. 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.

60. 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

61. 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

62. Chronic Renal Failure Gradual, Progressive irreversible destruction of the kidneys causing severe renal dysfunction. The result is azotemia to UREMIA

63. Chronic Renal Failure Predisposing factors: DM= worldwide leading cause Recurrent infections Exacerbations of nephritis urinary tract obstruction hypertension

64. Chronic Renal Failure PATHOPHYSIOLOGY As renal functions decline Retention of end-products of metabolism

65. 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!

66. 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

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

68. 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

69. 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

70. 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).

71. 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

72. 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

73. 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

74. 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

75. 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

76. 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.

77. 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.

78. DIALYSIS a procedure that is used to remove fluid and uremic wastes from the body when the kidneys cannot function

79. DIALYSIS Two methods 1. Hemodialysis 2. Peritoneal dialysis

82. DIALYSIS Diffusion Osmosis Ultrafiltration

83. 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

84. 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

85. DIALYSIS Nursing management 7. To determine effectiveness, check serum creatinine, BUN and electrolytes

86. Male reproductive disorders BPH Prostatic cancer

87. 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

89. Male reproductive disorders TESTICULAR EXAMINATION Palpation of scrotum for nodules and masses or inflammation BEGINS DURING ADOLESCENCE

90. Male reproductive disorders Prostate specific antigen (PSA) Elevated in prostate cancer Normal is 0.2 to 4 nanograms/mL Cancer= over 4

91. Male reproductive disorders BENIGN PROSTATIC HYPERPLASIA Enlargement of the prostate that causes outflow obstruction Common in men older than 50 years old

93. 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

94. 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

97. 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

98. 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

99. Prostate Cancer a slow growing malignancy of the prostate gland Usually an adenocarcinoma This usualy spread via blood stream to the vertebrae

101. Prostate Cancer Predisposing factor Age

102. Prostate Cancer Assessment Findings DRE: hard, pea-sized nodules on the anterior rectum Hematuria Urinary obstruction Pain on the perineum radiating to the leg

103. Prostate Cancer Diagnostic tests Prostatic specific antigen (PSA) Elevated SERUM ACID PHOSPHATASE indicates SPREAD or Metastasis

104. Prostate Cancer Medical and surgical management Prostatectomy TURP Chemotherapy: hormonal therapy to slow the rate of tumor growth Radiation therapy

105. Prostate Cancer Nursing Interventions Prepare patient for chemotherapy Prepare for surgery

106. 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