GENITOURINARY SYSTEM
Billy Ray A. Marcelo, RN
OVERVIEW
Promote fluid, e+ & acid-base balance
Promote excretion of the nitrogenous waste products
OVERVIEW
Kidneys– A pair of bean-shaped organs located
retroperitoneally at the back of peritoneum at either side of the vertebral column
– Parts: medulla, cortex & renal pelvis– Nephrons: basic unit, glomerulus (network
of capillaries)
OVERVIEW
Kidneys– Function
Urine formation– Stages
Filtration: GFR: 125 ml/minTubular reabsorption: 124 ml
reabsorbedTubular secretion: 1 ml excreted
OVERVIEW
Ureters– 25 cm long, prevent reflux of urine back to
the kidneys Bladder
– Behind symphysis pubis, elastic & muscular tissue that makes it distensible
– Can hold up to 1.2-1.8 L urine– 250-500 cc of urine can trigger micturition
OVERVIEW
Urethra- extends to the exterior surface of the body– F: 2-5 cm/ 1-1.5 in– M: 20 cm/ 8 in– Cathether: Pedia: 8-10F, Adult F
12-14F, Adult M 14-16 F
CYSTITIS (UTI)
Inflammation of the bladder r/t microbial invasion
Predisposing Factors– Microbial invasion (80%- E. coli)– Urinary obstruction & stagnation estrogen levels
CYSTITIS (UTI): S/Sx
Flank pain & tendernessUrinary frequency & urgencyDysuria (painful urination)Burning sensation upon urinationHematuriaFever, chills, A/N/V
CYSTITIS (UTI): Diagnostic Procedure
Urine C/S: determines the causative agent
CYSTITIS (UTI): Nursing Interventions
Force fluids Warm Sitz bath Monitor for the color, odor, blood in urine Administer meds as ordered
– Systemic Antibiotics (Cephalosporin, Tetracycline, Ampicillin)
– Sulfonamides (Cotrimoxazole: Bactrim, Gantricin)– Urinary analgesic: Pyridium
CYSTITIS (UTI): Nursing Interventions
Acid ash diet Health teaching
– Adequate hydration– For M: instruct to urinate after coitus– For F: avoid cleaning perineum from back
to front, toilet paper, bubble bath Prevent Cx: Pyelonephritis
PYELONEPHRITIS
Inflammation of 1 or 2 renal pelvis of kidneys leading to ATN, abscess formation & RF
Predisposing Factors– Microbial invasion (E. coli & Streptococcus)– Urinary retention & obstruction– DM– Pregnancy– Exposure to renal toxins
PYELONEPHRITIS: S/Sx
Acute– Costovertebral pain & tenderness– Fever & chills– Urinary frequency & urgency– Hematuria, dysuria, burning sensation upon urination
Chronic– A/ wt. loss– Polyuria, polydipsia– HTN, HA
PYELONEPHRITIS: Diagnostic Procedures
U/A- CHON, WBCUrine C/S: determines the
causative agentCystoscopy: (+) urinary
obstruction
BENIGN PROSTATIC HYPERTROPHY
Enlargement of the prostate gland Predisposing factors
– Male >40 y/o r/t hormonal influences S/Sx
– Urinary hesitancy, urinary stream– Terminal dribbling– Backache– Hematuria– Dysuria– Burning sensation upon urination
BENING PROSTATIC HYPERTROPHY
Diagnostic Procedures– Digital rectal exam: enlarged
prostate gland– Cystoscopy: urinary obstruction– KUB- enlarged prostate gland– U/A- WBC, RBC
BENING PROSTATIC HYPERTROPHY: Nursing Interventions
Limit fluid intakeCatheterization as orderedProstatic massageAdminister as ordered
– Terazosin- relaxes urinary sphincters– Finasteride- promotes atrophy of BPH
BENING PROSTATIC HYPERTROPHY: Nursing Interventions
Assist in surgery– Prostatectomy– Transurethral Resection of the Prostate (TURP)
Cystoclysis: continuous bladder irrigation– Irrigate the tube with pNSS to flush the
clots– WOF bleeding, hemorrhage– Strict asepsis
NEPHROLITHIASIS/UROLITHIASIS
Formation of stones elsewhere in the urinary tract Common type: Ca, Oxalate, uric acid Predisposing Factors
Ca, Oxalate diet (chocolates), purines– Gout– Obesity– Sedentary lifestyle– Prolonged immobility– Hyperparathyroidism
NEPHROLITHIASIS/UROLITHIASIS: S/Sx
Renal colicCool, moist skinN/VPolyuria, polydipsiaHematuria, dysuria, nocturia, burning
sensation upon urination
NEPHROLITHIASIS/UROLITHIASIS: Diagnostic Procedures
KUB- locates stonesIVP- location & composition of stonesCystoscopy: urinary obstructionU/A: WBC, RBCStone analysis: type, no. &
composition
NEPHROLITHIASIS/UROLITHIASIS: Nursing Interventions
Force fluids Strain all urine with gauze Warm sitz bath Diet: if Ca stone: acid ash If Oxalate: alkaline ash (milk & milk products) If Uric acid: purines Administer as ordered:
– Narcotic analgesic– Antibiotics– Allopurinol
NEPHROLITHIASIS/UROLITHIASIS: Nursing Interventions
Assist in surgery– Nephrectomy: removal of 1 kidney– Extracorporeal Shockwave
Lithotripsy: if stones are recurrentPrevent Cx: ARF
RENAL FAILURE
Loss of kidney function S/Sx r/t retention of waste & fluids & inability to
regulate e+ Causes
– Prerenal: dehydration, hypovolemic shock– Intrarenal: ATN, nephrotoxicity, altered renal
blood flow– Postrenal: obstruction of urine flow
ACUTE RENAL FAILURE
Oliguric Phase (8-15 days) GFR K– N or Na– Fluid overload BUN, crea
Diuretic Phase GFR (4-5 L/day) K Na– Hypovolemia– Gradual BUN, crea
Recovery (Convalescent) Phase– Stable & N BUN– Complete recovery: 1-2
yrs
CHRONIC RENAL FAILURE
Stage 1: Diminished Renal Reserve renal function– (-) accumulation of metabolic
wastes– The healthier kidney compensates– Nocturia & polyuria r/t ability to
concentrate urine
CHRONIC RENAL FAILURE
Stage 2: Renal Insufficiency– Metabolic wastes begins to accumulate– Oliguria & edema r/t responsiveness to
diuretics Stage 3: End Stage
– Excessive accumulation of metabolic wastes– Kidneys unable to maintain homeostasis– Dialysis or other renal replacement therapy is
required
SPECIAL PROBLEMS IN RENAL FAILURE
Anemia (Vit. B9/Folic acid instead of iron, Epogen, BT as ordered)
GI bleeding (r/t ammonia irritation) HTN (Inderal as ordered: renin release),
hypervolemia (diuretics, fluid restriction, Na diet)
Infection & injury (minimize urinary catheterization)
Insomnia & fatigue
SPECIAL PROBLEMS IN RENAL FAILURE
HypoCa, Hyperphosphatemia, HyperK (diet, dialysis)
Metabolic acidosis Muscle cramps, pruritus (r/t uremic frost- skin
care, avoid soaps, antipruritics as ordered) Neuro changes Occular irritation (r/t Ca deposits in conjunctiva,
eye drops) Psychosocial problems (psychosocial care)
NCLEX/CGFNS QUESTIONS
The pt who has a hx of gout is also dx with urolithiasis. The stones are determined to be uric acid type. The nurse gives the pt instructions in foods to limit, which include– Liver– Apples– Carrots– Milk
NCLEX/CGFNS QUESTIONS
A RN is assessing the patency of an atriovenous fistula in the L arm of a pt who is receiving hemodialysis for the tx of chronic RF. Which finding indicates that the fistula is patent?– (-) bruit on auscultation of the fistula– Palpation of a thrill over the fistula– Presence of radial pulse in the L wrist– CRT <3 sec in the nail beds of L hand
NCLEX/CGFNS QUESTIONS
A pt with chronic RF has completed a hemodialysis tx. The RN would use which of the ff standard indicators to evaluate the pt’s status after dialysis?– K level & wt– BUN & crea levels– VS & BUN– VS & wt
NCLEX/CGFNS QUESTIONS
The pt asks about the purpose of the glucose contained in the peritoneal dialysis. The nurse bases the response knowing that glucose– Prevents excess glucose from being removed from
the client– Decreases the risk of peritonitis– Increases osmotic pressure to produce ultrafiltration– Increases the risk of peritonitis
NCLEX/CGFNS QUESTIONS
A pt newly dx with RF is receiving peritoneal dialysis. During the infusion of the dialysate, the pt complains of abdominal pain. Which action by the RN is most appropriate?– Slow the infusion– Decrease the amount to be infused– Explaining that pain will subside after the 1st few
exchanges– Stop the dialysis
NCLEX/CGFNS QUESTIONS
A RN is instructing a pt with DM about peritoneal dialysis & tells the pt that it is impt to maintain the dwell time for the dialysis at the prescribed time because of the risk of– Infection– Hyperglycemia– Fluid overload– Hyperkalemia
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