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The Genito -Urinary System Medical Surgical Nursing

The Genito -Urinary System Medical Surgical Nursing

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The Genito -Urinary System Medical Surgical Nursing

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  1. The Genito-Urinary System Medical Surgical Nursing

  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 • BPH • Prostatic cancer

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

  4. Urological Assessment Key Signs and Symptoms of Urological Problems • EDEMA • associated with fluid retention • Renal dysfunctions usually produce ANASARCA • PAIN • Suprapubic pain= bladder • Colicky pain on the flank= kidney • HEMATURIA • Painless hematuria may indicate URINARY CANCER! • Early-stream hematuria= urethral lesion • Late-stream hematuria= bladder lesion

  5. DYSURIA • Pain with urination= lower UTI • POLYURIA • More than 2 Liters urine per day • OLIGURIA • Less than 400 mL per day • ANURIA • Less than 50 mL per day

  6. Urinary Urgency • Urinary retention • Urinary frequency

  7. PHYSICAL EXAMINATION • Inspection • Auscultation • Percussion • Palpation

  8. Laboratory examination • Urinalysis • BUN and Creatinine levels of the serum • Serum electrolytes

  9. Radiographic • IVP • KUB x-ray • KUB ultrasound • CT and MRI • Cystography

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

  11. 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 • Provide privacy • Catheterization if indicated

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

  13. Predisposing factors include • Poor hygiene • Irritation from bubble baths • Urinary reflux • Instrumentation • Residual urine, urinary stasis

  14. 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

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

  16. Assessment findings: Upper UTI • Fever and CHIILS • Flank pain • Costovertebral angle tenderness

  17. Laboratory Examination • Urinalysis • Urine Culture

  18. 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).

  19. 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.

  20. Pharmacology 1. Sulfa drugs • Highly concentrated in the urine • Effective against E. coli! 2. Quinolones

  21. Nephrolithiasis/Urolithiasis Presenceof stones anywhere in the urinary tract • Calcium • oxalate • and uric acid

  22. 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

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

  24. 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)

  25. Medical management 1. Surgery a. Percutaneousnephrostomy: tube is inserted through skin and underlying tissues into renal pelvis to remove calculi. b. Percutaneousnephrostolithotomy: delivers ultrasound waves through a probe placed on the calculus. 2. Extracorporeal shock-wave lithotripsy: delivers shock waves from outside the body to the stone, causing pulverization

  26. Pain management : Morphine or Meperidine Diet modification

  27. 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. 4.Relieve pain by administration of analgesics as ordered and application of moist heat to flank area. 5. Monitor intake and output . 6.Provide modified diet, depending upon stone consistency: Calcium, Oxalate and Uric acid stones

  28. 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) • )

  29. 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

  30. Uric acid stones • reduce foods high in purine (liver, beans, kidneys, venison, shellfish, meat soups, gravies, legumes); maintain alkaline urine

  31. 7. Administer allopurinol (Zyloprim) as ordered, to decrease uric acid production • 8. Provide client teaching and discharge planning concerning

  32. 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).

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

  34. PATHOPHYSIOLOGY • Pre-renal failure • Intra-renal failure • Post-renal failure

  35. 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

  36. 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)

  37. Postrenal CAUSE: • Mechanical obstruction anywhere from the tubules to the urethra; includes calculi, BPH, tumors, strictures, blood clots, trauma, and anatomic malformation

  38. Three phases of acute renal failure • Oliguric phase • Diuretic phase • Convalescence or recovery phase

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

  40. 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 dilutionalhyponatremia, hyperkalemia , hyperphosphatemia, hypocalcemia , hypermagnesemia, and metabolic acidosis • Diagnostic tests: BUN and creatinine elevated

  41. 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

  42. 3. Recovery or convalescent phase: • Renal function stabilizes with gradual improvement over next 3—12 months

  43. Laboratory findings: • Urinalysis: Urine osmo and sodium • BUN and creatinine levels increased • Hyperkalemia • Anemia • ABG: metabolic acidosis

  44. Nursing interventions 1.Monitor fluid and Electrolyte Balance • Reduce metabolic rate • Promote pulmonary function • Prevent infection • Provide skin care • Provide emotional support

  45. 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

  46. 2. Monitor alteration in fluid volume. • Monitor vital signs, PAP, PCWP, CVP as needed. • Weigh client daily. • Maintain strict I & O records.

  47. 2. Assess every hour for hypervolemia • Maintain adequate ventilation. • Restrict FLUID intake • Administer diuretics and antihypertensives