Nursing Genito-Urinary System

The Genito-Urinary The Genito-Urinary SystemSystem

Medical Surgical Nursing Medical Surgical Nursing ReviewReview

Outline of reviewOutline of review

Recall the anatomy and physiology of the Recall the anatomy and physiology of the Renal SystemRenal System

Renal Assessment Renal Assessment Renal Laboratory ProcedureRenal Laboratory Procedure Common Conditions:Common Conditions:

UTIUTI Kidney StonesKidney Stones ARF and CRFARF and CRF

Outline of reviewOutline of review BPHBPH Prostatic cancerProstatic cancer

Urological Assessment Urological Assessment Nursing HistoryNursing History

Reason for seeking careReason for seeking care Current illnessCurrent illness Previous illnessPrevious illness Family HistoryFamily History Social HistorySocial History Sexual historySexual history

Urological Assessment Urological Assessment

Key Signs and Symptoms of Key Signs and Symptoms of Urological ProblemsUrological Problems

EDEMAEDEMAassociated with fluid retentionassociated with fluid retentionRenal dysfunctions usually Renal dysfunctions usually

produce ANASARCAproduce ANASARCA

PAINPAINSuprapubic pain= bladderSuprapubic pain= bladderColicky pain on the flank= kidneyColicky pain on the flank= kidney

HEMATURIAHEMATURIAPainless hematuria may indicate Painless hematuria may indicate

URINARY CANCER!URINARY CANCER!Early-stream hematuria= urethral Early-stream hematuria= urethral

lesionlesionLate-stream hematuria= bladder Late-stream hematuria= bladder

lesionlesion

DYSURIADYSURIAPain with urination= lower UTIPain with urination= lower UTI

POLYURIAPOLYURIAMore than 2 Liters urine per dayMore than 2 Liters urine per day

OLIGURIAOLIGURIALess than 400 mL per dayLess than 400 mL per day

ANURIAANURIALess than 50 mL per dayLess than 50 mL per day

Urinary UrgencyUrinary Urgency

Urinary retentionUrinary retention

Urinary frequencyUrinary frequency

PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONInspectionInspectionAuscultationAuscultationPercussionPercussionPalpationPalpation

Laboratory examinationLaboratory examination1.1. UrinalysisUrinalysis2.2. BUN and Creatinine levels of the BUN and Creatinine levels of the

serumserum3.3. Serum electrolytesSerum electrolytes

Laboratory examinationLaboratory examinationRadiographicRadiographic IVP IVP KUB x-rayKUB x-ray KUB ultrasoundKUB ultrasound CT and MRICT and MRI CystographyCystography

Implementation Steps for selected Implementation Steps for selected problemsproblems

Provide PAIN reliefProvide PAIN relief Assess the level of painAssess the level of pain Administer medications usually Administer medications usually

narcotic ANALGESICSnarcotic ANALGESICS

Maintain Fluid and Electrolyte BalanceMaintain Fluid and Electrolyte Balance Encourage to consume at least 2 liters Encourage to consume at least 2 liters

of fluid per dayof fluid per day In cases of ARF, limit fluid as directedIn cases of ARF, limit fluid as directed Weigh client daily to detect fluid Weigh client daily to detect fluid

retentionretention

Ensure Adequate urinary eliminationEnsure Adequate urinary elimination Encourage to void at least every 2-3 Encourage to void at least every 2-3

hourshours Promote measures to relieve urinary Promote measures to relieve urinary

retention:retention: Alternating warm and cold compressAlternating warm and cold compress Bedpan Bedpan Open faucet Open faucet Provide privacyProvide privacy Catheterization if indicatedCatheterization if indicated

Urinary Tract Infection (UTI)Urinary Tract Infection (UTI)

Bacterial invasion of the Bacterial invasion of the kidneys or bladder kidneys or bladder (CYSTITIS) usually (CYSTITIS) usually caused by caused by Escherichia Escherichia colicoli

Predisposing factors includePredisposing factors include1.1. Poor hygienePoor hygiene2.2. Irritation from bubble bathsIrritation from bubble baths3.3. Urinary refluxUrinary reflux4.4. InstrumentationInstrumentation5.5. Residual urine, urinary stasisResidual urine, urinary stasis6.6. DehydrationDehydration

PATHOPHYSIOLOGYPATHOPHYSIOLOGY The invading organism ascends the The invading organism ascends the

urinary tract, irritating the mucosa and urinary tract, irritating the mucosa and causing characteristic symptomscausing characteristic symptoms Ureter= ureteritisUreter= ureteritis Bladder= cystitisBladder= cystitis Urethra=UrethritisUrethra=Urethritis Pelvis= PyelonephritisPelvis= Pyelonephritis

Assessment findingsAssessment findings Low-grade feverLow-grade fever Abdominal painAbdominal pain EnuresisEnuresis Pain/burning on urinationPain/burning on urination Urinary frequencyUrinary frequency HematuriaHematuria

Assessment findings: Upper UTIAssessment findings: Upper UTI Fever and CHIILSFever and CHIILS Flank painFlank pain Costovertebral angle tendernessCostovertebral angle tenderness

Laboratory ExaminationLaboratory Examination1.1. UrinalysisUrinalysis2.2. Urine CultureUrine Culture

Urinary Tract Infection (UTI)Urinary Tract Infection (UTI)Nursing interventionsNursing interventions Administer antibiotics as orderedAdminister antibiotics as ordered Provide warm baths and allow client to Provide warm baths and allow client to

void in water to alleviate painful void in water to alleviate painful voiding.voiding.

Force fluids. Nurses may give 3 liters of Force fluids. Nurses may give 3 liters of fluid per dayfluid per day

Encourage measures to Encourage measures to acidify urineacidify urine (cranberry juice, acid-ash diet).(cranberry juice, acid-ash diet).

Urinary Tract Infection (UTI)Urinary Tract Infection (UTI) Provide client teaching and discharge Provide client teaching and discharge

planning concerningplanning concerninga. Avoidance of tub baths a. Avoidance of tub baths b. Avoidance of bubble baths that b. Avoidance of bubble baths that might irritate urethramight irritate urethrac. Importance for girls to wipe c. Importance for girls to wipe perineum from front to backperineum from front to backd. Increase in foods/fluids that acidify d. Increase in foods/fluids that acidify urine.urine.

Urinary Tract Infection (UTI)Urinary Tract Infection (UTI)PharmacologyPharmacology 1. Sulfa drugs1. Sulfa drugs

Highly concentrated in the urineHighly concentrated in the urine Effective against E. coli!Effective against E. coli! Can cause CRYSTALLURIACan cause CRYSTALLURIA

2. Quinolones2. Quinolones Not given to less than 18 because they can cause Not given to less than 18 because they can cause

cartilage degradationcartilage degradation

3. Pyridium= urinary antiseptic3. Pyridium= urinary antiseptic Can cause urine discolorationCan cause urine discoloration

Nephrolithiasis/UrolithiasisNephrolithiasis/Urolithiasis

Presence of stones Presence of stones anywhere in the urinary tract anywhere in the urinary tract CalciumCalciumoxalateoxalateand uric acidand uric acid

Nephrolithiasis/UrolithiasisNephrolithiasis/Urolithiasis PathophysiologyPathophysiology Predisposing factorsPredisposing factors

a. Diet: large amounts of calcium and a. Diet: large amounts of calcium and oxalateoxalateb. Increased uric acid levelsb. Increased uric acid levelsc. Sedentary life-style, immobilityc. Sedentary life-style, immobilityd. Family history of gout or calculid. Family history of gout or calculie. Hyperparathyroidisme. Hyperparathyroidism

Nephrolithiasis/UrolithiasisNephrolithiasis/Urolithiasis PathophysiologyPathophysiology

Supersaturation of crystals due to stasisSupersaturation of crystals due to stasis

Stone formationStone formation

May pass through the urinary tractMay pass through the urinary tract

OBSTRUCTION, INFECTION and OBSTRUCTION, INFECTION and HYDRONEPHROSISHYDRONEPHROSIS

Nephrolithiasis/UrolithiasisNephrolithiasis/Urolithiasis Assessment findingsAssessment findings1.1. Abdominal or flank painAbdominal or flank pain2.2. Renal colic radiating to the Renal colic radiating to the

groingroin3. Hematuria3. Hematuria4. Cool, moist skin4. Cool, moist skin5. Nausea and vomiting5. Nausea and vomiting

Nephrolithiasis/UrolithiasisNephrolithiasis/Urolithiasis Diagnostic testsDiagnostic tests 1. 1. KUB Ultrasound and X-rayKUB Ultrasound and X-ray: pinpoints : pinpoints

location, number, and size of stoneslocation, number, and size of stones 2. 2. IVP:IVP: identifies site of obstruction identifies site of obstruction

and presence of non-radiopaque and presence of non-radiopaque stonesstones

3. 3. UrinalysisUrinalysis: indicates presence of : indicates presence of bacteria, increased protein, increased bacteria, increased protein, increased WBC and RBC (hematuria)WBC and RBC (hematuria)

Nephrolithiasis/UrolithiasisNephrolithiasis/UrolithiasisMedical managementMedical management1. Surgery1. Surgery a. Percutaneous nephrostomy: tube is a. Percutaneous nephrostomy: tube is

inserted through skin and underlying inserted through skin and underlying tissues into renal pelvis to remove tissues into renal pelvis to remove calculi.calculi.

b. Percutaneous nephrostolithotomy: b. Percutaneous nephrostolithotomy: delivers ultrasound waves through a delivers ultrasound waves through a probe placed on the calculus.probe placed on the calculus.

Nephrolithiasis/UrolithiasisNephrolithiasis/UrolithiasisMedical managementMedical management2.2. Extracorporeal shock-wave Extracorporeal shock-wave

lithotripsy: delivers shock waves from lithotripsy: delivers shock waves from outside the body to the stone, causing outside the body to the stone, causing pulverizationpulverization

3.3. Pain management : Morphine or Pain management : Morphine or MeperidineMeperidine

4.4. Diet modificationDiet modification

Nursing interventionsNursing interventions 1. 1. Strain all urine through gauze to Strain all urine through gauze to

detect stones and crush all clots.detect stones and crush all clots. 2. Force fluids (3000—4000 cc/day).2. Force fluids (3000—4000 cc/day). 3. Encourage ambulation to prevent 3. Encourage ambulation to prevent

stasis.stasis.

Nursing interventionsNursing interventions 4. Relieve pain by administration of 4. Relieve pain by administration of

analgesics as ordered and analgesics as ordered and application of moist heat to flank application of moist heat to flank area.area.

5. Monitor intake and output5. Monitor intake and output

Nephrolithiasis/UrolithiasisNephrolithiasis/UrolithiasisNursing interventionsNursing interventions 6. Provide modified diet, 6. Provide modified diet,

depending upon stone depending upon stone consistency: Calcium, Oxalate consistency: Calcium, Oxalate and Uric acid stonesand Uric acid stones

Nephrolithiasis/UrolithiasisNephrolithiasis/UrolithiasisNursing interventionsNursing interventionsCalcium stonesCalcium stones limit milk/dairy productslimit milk/dairy products provide acid-ash diet to acidify provide acid-ash diet to acidify

urineurine (cranberry or prune juice, (cranberry or prune juice, meat, eggs, poultry, fish, grapes, meat, eggs, poultry, fish, grapes, and whole grains)and whole grains)

Nephrolithiasis/UrolithiasisNephrolithiasis/UrolithiasisNursing interventionsNursing interventionsOxalate stonesOxalate stones avoid excess intake of foods/ fluids avoid excess intake of foods/ fluids

high in oxalate (tea, chocolate, high in oxalate (tea, chocolate, rhubarb, spinach)rhubarb, spinach)

maintain alkaline-ash diet to maintain alkaline-ash diet to alkalinize urinealkalinize urine (milk; vegetables; (milk; vegetables; fruits except prunes, cranberries, fruits except prunes, cranberries, and plums)and plums)

Nephrolithiasis/UrolithiasisNephrolithiasis/UrolithiasisNursing interventionsNursing interventionsUric acid stonesUric acid stones reduce foods high in purinereduce foods high in purine

(liver, beans, kidneys, venison, (liver, beans, kidneys, venison, shellfish, meat soups, gravies, shellfish, meat soups, gravies, legumes)legumes)

maintain alkaline urinemaintain alkaline urine

Nursing interventionsNursing interventions 7. Administer allopurinol (Zyloprim) as 7. Administer allopurinol (Zyloprim) as

ordered, to decrease uric acid ordered, to decrease uric acid productionproduction Allopurinol Allopurinol

RashesRashes Nasal congestionNasal congestion

8. 8. Provide client teaching and discharge Provide client teaching and discharge planning concerningplanning concerning

Prevention of Urinary stasis by Prevention of Urinary stasis by maintaining increased fluid intakemaintaining increased fluid intake especially in hot weather and during especially in hot weather and during illness; mobility; voiding whenever illness; mobility; voiding whenever the urge is felt and at least twice the urge is felt and at least twice during the nightduring the night

8. 8. Provide client teaching and discharge Provide client teaching and discharge planning concerning: planning concerning:

Adherence to prescribed dietAdherence to prescribed diet Need for routine urinalysis (at least Need for routine urinalysis (at least

every 3—4 months)every 3—4 months) Need to recognize and report signs/ Need to recognize and report signs/

symptoms of recurrence (hematuria, symptoms of recurrence (hematuria, flank pain).flank pain).

Acute renal failureAcute renal failure

Sudden interruption of Sudden interruption of kidney function to regulate kidney function to regulate fluid and electrolyte balance fluid and electrolyte balance and remove toxic products and remove toxic products from the bodyfrom the body

Most important Most important manifestation: OLIGURIAmanifestation: OLIGURIA

Kidney functionKidney functionThe Nephron produces The Nephron produces urine to eliminate wasteurine to eliminate waste

Impaired urine production Impaired urine production and azotemiaand azotemia

Secretes Erythropoietin Secretes Erythropoietin to increase RBCto increase RBC

ANEMIAANEMIA

Metabolism of Vitamin DMetabolism of Vitamin D Calcium and Phosphate Calcium and Phosphate imbalancesimbalances

Produces bicarbonate Produces bicarbonate and secretes acidsand secretes acids

Metabolic ACIDOSISMetabolic ACIDOSIS

Excretes excess Excretes excess POTASSIUMPOTASSIUM

HYPERKALEMIAHYPERKALEMIA

PATHOPHYSIOLOGYPATHOPHYSIOLOGY1.1. Pre-renal failurePre-renal failure

2.2. Intra-renal failureIntra-renal failure

3.3. Post-renal failurePost-renal failure

PATHOPHYSIOLOGYPATHOPHYSIOLOGYPrerenal CAUSE: Prerenal CAUSE: Factors interfering with perfusion Factors interfering with perfusion

and resulting in diminished blood and resulting in diminished blood flow and glomerular filtrate, flow and glomerular filtrate, ischemia, and oliguria; include ischemia, and oliguria; include CHF, cardiogenic shock, acute CHF, cardiogenic shock, acute vasoconstriction, hemorrhage, vasoconstriction, hemorrhage, burns, septicemia, hypotension, burns, septicemia, hypotension, anaphylaxisanaphylaxis

PATHOPHYSIOLOGYPATHOPHYSIOLOGYIntrarenal CAUSE:Intrarenal CAUSE: Conditions that cause damage to the Conditions that cause damage to the

nephrons; nephrons; includeinclude acute tubular acute tubular necrosis (ATN), endocarditis, diabetes necrosis (ATN), endocarditis, diabetes mellitus, malignant hypertension, mellitus, malignant hypertension, acute glomerulonephritis, tumors, acute glomerulonephritis, tumors, blood transfusion reactions, blood transfusion reactions, hypercalcemia, nephrotoxinshypercalcemia, nephrotoxins (certain (certain antibiotics, x-ray dyes, pesticides, antibiotics, x-ray dyes, pesticides, anesthetics)anesthetics)

Acute renal failureAcute renal failurePATHOPHYSIOLOGYPATHOPHYSIOLOGYPostrenal CAUSE: Postrenal CAUSE: Mechanical obstruction anywhere Mechanical obstruction anywhere

from the tubules to the urethra; from the tubules to the urethra; includes includes calculi, BPH, tumors, calculi, BPH, tumors, strictures, blood clots, trauma, and strictures, blood clots, trauma, and anatomic malformationanatomic malformation

Three phases of acute renal failureThree phases of acute renal failure

1.1. Oliguric phaseOliguric phase

2.2. Diuretic phaseDiuretic phase

3.3. Convalescence or recovery phaseConvalescence or recovery phase

Four phases of acute renal failure Four phases of acute renal failure (Brunner and Suddarth)(Brunner and Suddarth)

1.1. Initiation phaseInitiation phase2.2. Oliguric phaseOliguric phase3.3. Diuretic phaseDiuretic phase4.4. Convalescence or recovery phaseConvalescence or recovery phase

Acute renal failureAcute renal failureAssessment findings: The Three Phases of Acute Renal Assessment findings: The Three Phases of Acute Renal

FailureFailure1. 1. Oliguric phaseOliguric phase Urine output less than 400 cc/24 hoursUrine output less than 400 cc/24 hours duration 1—2 weeksduration 1—2 weeks Manifested by Manifested by dilutional hyponatremia,dilutional hyponatremia,

hyperkalemiahyperkalemia, hyperphosphatemia, , hyperphosphatemia, hypocalcemiahypocalcemia, hypermagnesemia, and , hypermagnesemia, and metabolic acidosismetabolic acidosis

Diagnostic tests: BUN and creatinine Diagnostic tests: BUN and creatinine elevatedelevated

Acute renal failureAcute renal failureAssessment findings: The Three Phases of Assessment findings: The Three Phases of

Acute Renal FailureAcute Renal Failure2. Diuretic phase2. Diuretic phase Diuresis may occur (output 3—5 Diuresis may occur (output 3—5

liters/day) due to partially regenerated liters/day) due to partially regenerated tubule’s inability to concentrate urinetubule’s inability to concentrate urine

Duration: Duration: 2—3 weeks2—3 weeks; manifested by ; manifested by hyponatremia, hypokalemia, and hyponatremia, hypokalemia, and hypovolemiahypovolemia

Diagnostic tests: BUN and creatinine Diagnostic tests: BUN and creatinine slightly elevatedslightly elevated

Assessment findings: The Three Assessment findings: The Three Phases of Acute Renal FailurePhases of Acute Renal Failure

3. Recovery or convalescent phase: 3. Recovery or convalescent phase: Renal function stabilizes with gradual Renal function stabilizes with gradual

improvement over next 3—12 monthsimprovement over next 3—12 months

Laboratory findings:Laboratory findings:1.1. Urinalysis: Urine osmo and sodiumUrinalysis: Urine osmo and sodium2.2. BUN and creatinine levels increasedBUN and creatinine levels increased3.3. HyperkalemiaHyperkalemia4.4. AnemiaAnemia5.5. ABG: metabolic acidosisABG: metabolic acidosis

Nursing interventionsNursing interventions Monitor fluid and Electrolyte BalanceMonitor fluid and Electrolyte Balance Reduce metabolic rateReduce metabolic rate Promote pulmonary functionPromote pulmonary function Prevent infectionPrevent infection Provide skin careProvide skin care Provide emotional supportProvide emotional support

Nursing interventionsNursing interventions1. Monitor and maintain fluid and 1. Monitor and maintain fluid and

electrolyte balance.electrolyte balance. Measure l & O every hour. note Measure l & O every hour. note

excessive losses in diuretic phaseexcessive losses in diuretic phase Administer IV fluids and electrolyte Administer IV fluids and electrolyte

supplements as ordered.supplements as ordered. Weigh daily and report gains.Weigh daily and report gains. Monitor lab values; assess/treat fluid Monitor lab values; assess/treat fluid

and electrolyte and acid-base and electrolyte and acid-base imbalances as needed imbalances as needed

Nursing interventionsNursing interventions2. Monitor alteration in fluid volume.2. Monitor alteration in fluid volume. Monitor vital signs, PAP, PCWP, Monitor vital signs, PAP, PCWP,

CVP as needed.CVP as needed. Weigh client daily.Weigh client daily. Maintain strict I & O records.Maintain strict I & O records.

Nursing interventionsNursing interventions2. Assess every hour for 2. Assess every hour for hypervolemiahypervolemia

Maintain adequate ventilation.Maintain adequate ventilation. Restrict FLUID intakeRestrict FLUID intake Administer diuretics and Administer diuretics and

antihypertensives antihypertensives

Acute renal failureAcute renal failureNursing interventionsNursing interventions3. Promote optimal nutritional status.3. Promote optimal nutritional status. Administer TPN as ordered.Administer TPN as ordered. With enteral feedings, check for With enteral feedings, check for

residual and notify physician if residual and notify physician if residual volume increases.residual volume increases.

Restrict protein intake to 1 g/kg/dayRestrict protein intake to 1 g/kg/day Restrict POTASSIUM intakeRestrict POTASSIUM intake HIGH CARBOHYDRATE DIET, calcium HIGH CARBOHYDRATE DIET, calcium

supplementssupplements

Nursing interventionsNursing interventions4. Prevent complications from 4. Prevent complications from

impaired mobility (pulmonary impaired mobility (pulmonary embolism, skin breakdown, and embolism, skin breakdown, and atelectasis) atelectasis)

5. Prevent fever/infection.5. Prevent fever/infection. Assess for signs of infection.Assess for signs of infection. Use strict aseptic technique for wound Use strict aseptic technique for wound

and catheter care.and catheter care.

Nursing interventionsNursing interventions6. Support client/significant others and 6. Support client/significant others and

reduce/ relieve anxiety.reduce/ relieve anxiety. Explain pathophysiology and relationship Explain pathophysiology and relationship

to symptoms.to symptoms. Explain all procedures and answer all Explain all procedures and answer all

questions in easy-to-understand termsquestions in easy-to-understand terms Refer to counseling services as neededRefer to counseling services as needed

7. Provide care for the client receiving 7. Provide care for the client receiving dialysis dialysis

Acute renal failureAcute renal failureNursing interventionsNursing interventions8. Provide client teaching and discharge 8. Provide client teaching and discharge

planning concerningplanning concerning Adherence to prescribed dietary regimenAdherence to prescribed dietary regimen Signs and symptoms of recurrent renal Signs and symptoms of recurrent renal

diseasedisease Importance of planned rest periodsImportance of planned rest periods Use of prescribed drugs onlyUse of prescribed drugs only Signs and symptoms of UTI or respiratory Signs and symptoms of UTI or respiratory

infection need to report to physician infection need to report to physician immediatelyimmediately

Chronic Renal FailureChronic Renal Failure

Gradual, Progressive Gradual, Progressive irreversible destruction of the irreversible destruction of the kidneys causing severe renal kidneys causing severe renal dysfunction. dysfunction.

The result is azotemia to The result is azotemia to UREMIAUREMIA

Predisposing factors: Predisposing factors: DM= DM= worldwide leading causeworldwide leading causeRecurrent infectionsRecurrent infectionsExacerbations of nephritisExacerbations of nephritisurinary tract obstructionurinary tract obstructionhypertensionhypertension

PATHOPHYSIOLOGYPATHOPHYSIOLOGYAs renal functions declineAs renal functions decline

Retention of end-products of Retention of end-products of metabolismmetabolism

PATHOPHYSIOLOGYPATHOPHYSIOLOGYSTAGE 1= reduced renal reserve, 40-STAGE 1= reduced renal reserve, 40-

75% loss of nephron function75% loss of nephron functionSTAGE 2= renal insufficiency, 75-STAGE 2= renal insufficiency, 75-

90% loss of nephron function90% loss of nephron functionSTAGE 3= end-stage renal disease, STAGE 3= end-stage renal disease,

more than 90% loss. more than 90% loss. DIALYSIS IS DIALYSIS IS THE TREATMENT! THE TREATMENT!

Assessment findingsAssessment findings 1. Nausea, vomiting; diarrhea or 1. Nausea, vomiting; diarrhea or

constipation; decreased urinary constipation; decreased urinary outputoutput

2. Dyspnea2. Dyspnea 3. Stomatitis3. Stomatitis 4. 4. HypertensionHypertension (later), lethargy, (later), lethargy,

convulsions, memory impairment, convulsions, memory impairment, pericardial friction rubpericardial friction rub

DermatologicDermatologic dry skindry skin, pruritus, uremic , pruritus, uremic frostfrost

CNSCNS seizures, altered LOC, seizures, altered LOC, anorexia, fatigueanorexia, fatigue

CVSCVS Acute MI, edema, Acute MI, edema, hypertension, pericarditishypertension, pericarditis

PulmoPulmo Uremic lungsUremic lungs

HemaHema AnemiaAnemia

MusculoskeletalMusculoskeletal loss of strength, foot loss of strength, foot drop, osteodystrophydrop, osteodystrophy

Chronic Renal FailureChronic Renal FailureDiagnostic tests: Diagnostic tests: a. a. 24 hour creatinine clearance24 hour creatinine clearance

urinalysisurinalysis b. Protein, sodium, BUN, Crea b. Protein, sodium, BUN, Crea

and WBC elevatedand WBC elevated c. Specific gravity, platelets, and c. Specific gravity, platelets, and

calcium decreasedcalcium decreased D. CBC= anemiaD. CBC= anemia

Medical managementMedical management 1. Diet restrictions1. Diet restrictions 2. Multivitamins2. Multivitamins 3. Hematinics and erythropoietin3. Hematinics and erythropoietin 4. Aluminum hydroxide gels4. Aluminum hydroxide gels 5. Anti-hypertensive5. Anti-hypertensive 6. Anti-seizures6. Anti-seizures DIALYSISDIALYSIS

Nursing interventionsNursing interventions1. Prevent neurological 1. Prevent neurological

complications.complications. Assess every hour for signs of Assess every hour for signs of

uremia (fatigue, loss of appetite, uremia (fatigue, loss of appetite, decreased urine output, apathy, decreased urine output, apathy, confusion, elevated blood confusion, elevated blood pressure, edema of face and feet, pressure, edema of face and feet, itchy skin, restlessness, seizures).itchy skin, restlessness, seizures).

Nursing interventionsNursing interventions1. Prevent neurological complications.1. Prevent neurological complications. Assess for changes in mental Assess for changes in mental

functioning.functioning. Orient confused client to time, place, Orient confused client to time, place,

date, and personsdate, and persons Institute safety measures to protect Institute safety measures to protect

client from falling out of bed.client from falling out of bed.

Nursing interventionsNursing interventions2. Promote optimal GI function.2. Promote optimal GI function. Assess/provide care for stomatitisAssess/provide care for stomatitis Monitor nausea, vomiting, anorexiaMonitor nausea, vomiting, anorexia Administer antiemetics as ordered.Administer antiemetics as ordered. Assess for signs of Gl bleedingAssess for signs of Gl bleeding

Nursing interventionsNursing interventions 3. Monitor/prevent alteration in fluid 3. Monitor/prevent alteration in fluid

and electrolyte balanceand electrolyte balance 4. Assess for hyperphosphatemia 4. Assess for hyperphosphatemia

(paresthesias, muscle cramps, (paresthesias, muscle cramps, seizures, abnormal reflexes), and seizures, abnormal reflexes), and administer administer aluminum hydroxidealuminum hydroxide gels gels (Amphojel) as ordered(Amphojel) as ordered

Nursing interventionsNursing interventions5. Promote maintenance of skin 5. Promote maintenance of skin

integrity.integrity. Assess/provide care for pruritus.Assess/provide care for pruritus. Assess for uremic frost (urea Assess for uremic frost (urea

crystallization on the skin) and bathe crystallization on the skin) and bathe in plain waterin plain water

Nursing interventionsNursing interventions6. Monitor for bleeding complications, 6. Monitor for bleeding complications,

prevent injury to client.prevent injury to client. Monitor Hgb, hct, platelets, RBC.Monitor Hgb, hct, platelets, RBC. Hematest all secretions.Hematest all secretions. Administer hematinics as ordered.Administer hematinics as ordered. Avoid lM injectionsAvoid lM injections

Nursing interventionsNursing interventions7. Promote/maintain maximal 7. Promote/maintain maximal

cardiovascular function.cardiovascular function. Monitor blood pressure and report Monitor blood pressure and report

significant changes.significant changes. Auscultate for pericardial friction Auscultate for pericardial friction

rub.rub. Perform circulation checks routinely.Perform circulation checks routinely.

Nursing interventionsNursing interventions7. Promote/maintain maximal 7. Promote/maintain maximal

cardiovascular function.cardiovascular function. Administer diuretics as ordered and Administer diuretics as ordered and

monitor output.monitor output. Modify drug dosesModify drug doses8. Provide care for client receiving 8. Provide care for client receiving

dialysis.dialysis.

Important DrugsImportant DrugsAluminum hydroxide Aluminum hydroxide (Amphogel)(Amphogel)

Binds with Binds with PHOSPHATE to PHOSPHATE to decrease phosphorusdecrease phosphorus

KayexalateKayexalate Binds with Binds with POTASSIUM to POTASSIUM to manage hyperkalemiamanage hyperkalemia

DiureticsDiuretics To decrease edemaTo decrease edema

Erythropoietin Erythropoietin (Epogen)(Epogen)

To increase RBCTo increase RBC

Anti-HypertensivesAnti-Hypertensives To manage To manage HypertensionHypertension

DIALYSISDIALYSIS

a procedure that is used to remove a procedure that is used to remove fluid and uremic wastes from the fluid and uremic wastes from the body when the kidneys cannot body when the kidneys cannot functionfunction

DIALYSISDIALYSIS

Two methodsTwo methods

1. Hemodialysis1. Hemodialysis

2. Peritoneal dialysis2. Peritoneal dialysis

DIALYSISDIALYSIS

DiffusionDiffusion OsmosisOsmosis UltrafiltrationUltrafiltration

DIALYSISDIALYSIS

Nursing managementNursing management1.1. Meet the patient's psychosocial Meet the patient's psychosocial

needsneeds2.2. Remember to avoid any Remember to avoid any

procedure on the arm with the procedure on the arm with the fistula (HEMO)fistula (HEMO)

Monitor WEIGHT, blood pressure Monitor WEIGHT, blood pressure and fistula site for bleedingand fistula site for bleeding

DIALYSISDIALYSISNursing managementNursing management3. Monitor symptoms of uremia3. Monitor symptoms of uremia4. Detect complications like infection, 4. Detect complications like infection,

bleeding (Hepatitis B/C and HIV bleeding (Hepatitis B/C and HIV infection in Hemodialysis) Peritonitis infection in Hemodialysis) Peritonitis in peritoneal dialysisin peritoneal dialysis

5. Warm the solution to increase 5. Warm the solution to increase diffusion of waste products diffusion of waste products (PERITONEAL)(PERITONEAL)

6. Manage discomfort and pain6. Manage discomfort and pain

DIALYSISDIALYSIS

Nursing managementNursing management7. To determine effectiveness, check 7. To determine effectiveness, check

serum creatinine, BUN and serum creatinine, BUN and electrolyteselectrolytes

Male reproductive disordersMale reproductive disorders BPHBPH Prostatic cancerProstatic cancer

Male reproductive disordersMale reproductive disorders

DIGITAL RECTAL EXAMINATION- DREDIGITAL RECTAL EXAMINATION- DRE Recommended for men annually with Recommended for men annually with

age over 40 yearsage over 40 years Screening test for cancerScreening test for cancer Ask Ask patient to BEAR DOWNpatient to BEAR DOWN

TESTICULAR EXAMINATIONTESTICULAR EXAMINATION Palpation of scrotum for nodules and Palpation of scrotum for nodules and

masses or inflammationmasses or inflammation BEGINS DURING ADOLESCENCEBEGINS DURING ADOLESCENCE

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

BENIGN PROSTATIC HYPERPLASIA Enlargement of the prostate that

causes outflow obstruction

Common in men older than 50 years old

BENIGN PROSTATIC HYPERPLASIAAssessment findings1. DRE: enlarged prostate gland that is

rubbery, large and NON-tender2. Increased frequency, urgency and

hesitancy 3. Nocturia, DECREASE IN THE VOLUME

AND FORCE OF URINE STREAM

Male reproductive disordersMale reproductive disordersBENIGN PROSTATIC HYPERPLASIAMedical management1. Immediate catheterization2. Prostatectomy3. TRANSURETHRAL RESECTION of the

PROSTATE (TURP)4. Pharmacology: alpha-blockers, alpha-

reductase inhibitors. SAW palmetto

BPHBPH

NURSING INTERVENTIONNURSING INTERVENTION1.1. Encourage fluids up to 2 liters per dayEncourage fluids up to 2 liters per day2.2. Insert catheter for urinary drainageInsert catheter for urinary drainage3.3. Administer medications – alpha adrenergic Administer medications – alpha adrenergic

blockers and finasterideblockers and finasteride4.4. Avoid anticholinergicsAvoid anticholinergics5.5. Prepare for surgery or TURPPrepare for surgery or TURP6.6. Teach the patient perineal muscle Teach the patient perineal muscle

exercises. Avoid valsalva until healingexercises. Avoid valsalva until healing

BPHBPH

NURSING INTERVENTION: TURPNURSING INTERVENTION: TURP Maintain the three way bladder Maintain the three way bladder

irrigation to prevent hemorrhageirrigation to prevent hemorrhage Only initially the drainage is pink-Only initially the drainage is pink-

tinged and never reddishtinged and never reddish Administer anti-spasmodic to prevent Administer anti-spasmodic to prevent

bladder spasmsbladder spasms

Prostate CancerProstate Cancer

a slow growing malignancy of the a slow growing malignancy of the prostate glandprostate gland

Usually an Usually an adenocarcinomaadenocarcinoma This usualy spread via blood stream to This usualy spread via blood stream to

the vertebraethe vertebrae

Predisposing factor Age

Assessment Findings1. DRE: hard, pea-sized nodules on the

anterior rectum2. Hematuria3. Urinary obstruction4. Pain on the perineum radiating to the

Diagnostic tests1. Prostatic specific antigen (PSA)2. Elevated SERUM ACID

PHOSPHATASE indicates SPREAD or Metastasis

Medical and surgical management1. Prostatectomy2. TURP3. Chemotherapy: hormonal therapy to

slow the rate of tumor growth4. Radiation therapy

Nursing Interventions1. Prepare patient for chemotherapy2. Prepare for surgery

Nursing Interventions: Post-prostatectomy

1. Maintain continuous bladder irrigation. Note that drainage is pink tinged w/in 24 hours

2. Monitor urine for the presence of blood clots and hemorrhage

3. Ambulate the patient as soon as urine begins to clear in color

Nursing Genito-Urinary System

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