Genitourinary System

GENITOURINARY SYSTEM

Billy Ray A. Marcelo, RN

OVERVIEW Promote

fluid, e+ & acidbase 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/min Tubular reabsorption: 124 ml reabsorbed Tubular 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 & tenderness Urinary frequency & urgency Dysuria (painful urination) Burning sensation upon urination Hematuria Fever, 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 

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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

↑ CHON, ↑WBC Urine C/S: determines the causative agent Cystoscopy: (+) urinary obstruction U/A-

BENIGN PROSTATIC HYPERTROPHY  

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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 intake  Catheterization as ordered  Prostatic massage  Administer 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

colic  Cool, moist skin  N/V  Polyuria, polydipsia  Hematuria, dysuria, nocturia, burning sensation upon urination

NEPHROLITHIASIS/ UROLITHIASIS: Diagnostic Procedures KUB-

locates stones IVP- location & composition of stones Cystoscopy: urinary obstruction U/A: ↑WBC, ↑RBC Stone 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 recurrent Prevent 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

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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