Genitourinary System

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