GENITOURINARY SYSTEM

Function: Promote excretion of nitrogenous waste products Maintain F&E & acid base balance 1. Kidneys - pair of bean shaped organ - Retro peritonially (back of peritoneum) on either side of vertebral column. Encased in Bowmanss capsule. Parts: Renal pelvis pyenophritis inflamed Cortex Medulla Nephrones basic living unit Glomerulus filters blood going to kidneys Function of kidneys: 1.) Urine formation 25% of total CO (Cardiac Output) is received by kidneys 1. Filtration Normal GFR/ min is 125 ml of blood 2. Tubular Reabsorption 124ml of ultra infiltrates (H2O & electrolytes is for reabsorption) 3. Tubular Secretion 1 ml is excreted in urine 2.) Regulation of BP: Predisposing factor: Ex: CS hypovolemia decrease BP going to kidneys Activation of RAAS Release of Renin (hydrolytic enzyme) at juxtaglomerular apparatus Angiotensin I mild vasoconstrictor Angiotensin II vasoconstrictor Adrenal cortex Aldosterone Increase Na & H2O reabsorption Hypervolemia increase CO increase PR Increase BP

2.Ureters 25 35 cm long, passageway of urine to bladder 3.Bladder Muscular & elastic tissue that is distensible located behind symphisis pubis. Function reservoir or urine 1200 1800 ml Normal adult can hold 200 500 ml needed to initiate micturition reflex Color amber Odor aromatic Consistency clear or slightly turbid pH 4.5 8 Specific gravity 1.015 1.030 WBC/ RBC (-) Albumin (-) E coli (-) Mucus thread few Amorphous urate (-) 4.Urethra extends to external surface of body. Passage of urine, seminal & vaginal fluids. - Women 3 5 cm or 1 to 1 - Male 20cm or 8

URINARY TRACT INFECTION

1. CYSTITIS inflammation of bladder Predisposing factors: 1. Microbial invasion E. coli 2. High risk women 3. Obstruction 4. Urinary retention 5. Increase estrogen levels 6. Sexual intercourse Signs & Symptoms: 1. Pain flank area 2. Urinary frequency & urgency 3. Burning upon urination 4. Dysuria & hematuria 5. Fever, chills, anorexia, gen body malaise Diagnostic Exam: 1. Urine culture & sensitivity - (+) to E. coli Nursing Management: 1. Force fluid 2000 ml 2. Warm sitz bath to promote comfort

3. Monitor & assess for gross hematuria 4. Acid ash diet cranberry, vit C -OJ to acidify urine & prevent bacterial multiplication 5. Meds: systemic antibiotics Ampicillin Cephalosporin Sulfonamides cotrimaxazole (Bactrim) - Gantrism (ganthanol) Urinary antiseptics Mitropurantoin (Macrodantin) Urinary analgesic- Pyridum Health Teachings: a.) Importance of Hydration b.) Void after sex c.) Female avoids cleaning back & front Bubble bath, Tissue paper, Powder, perfume d.) Complications: Pyelonephritis

2. PYELONEPHRITIS acute/ chronic inflamation of 1 or 2 renal pelvis of kidneys leading to tubular destruction, interstitial abscess formation. Lead to Renal Failure Predisposing factors: 1. Microbial invasion a.) E. Coli b.) Streptococcus 2. Urinary retention /obstruction 3. Pregnancy 4. DM 5. Exposure to renal toxins Signs & Symptoms: 1.) Acute pyelonephritis a.) Costovertibral angle pain, tenderness b.) Fever, anorexia, gen body malaise c.) Urinary frequency, urgency d.) Nocturia, dsyuria, hematuria e.) Burning on urination 2.) Chronic Pyelonephritis a.) Fatigue, wt loss b.) Polyuuria, polydypsia c.) HPN Diagnostic Exam: 1. Urine culture & sensitivity (+) E. coli & streptococcus 2. Urinalysis Increase WBC, CHON & pus cells 3. Cystoscopic exam urinary obstruction

Nursing Management: 1. Provide CBR acute phase 2. Force fluid 3. Acid ash diet 4. Meds: a.) Urinary antiseptic nitrofurantoin (macrodantin) SE: peripheral neuropathy GI irritation Hemolytic anemia Staining of teeth b.) Urinary analgesic Peridium Complication - Renal Failure

NEPHROLITHIASIS / UROLITHIASIS
- formation of stones at urinary tract - calcium oxalate milk cabbage cranberries nuts tea chocolates uric acid anchovies organ meat nuts sardines

Predisposing factors: 1. Diet increase Ca & oxalate 2. Hereditary gout 3. Obesity 4. Sedentary lifestyle 5. Hyperparathyroidism Signs & Symptoms: 1. Renal colic 2. Cool moist skin (shock) 3. Burning upon urination 4. Hematuria 5. Anorexia, n/v Diagnostic Exam: 1. IVP intravenous pyelography. Reveals location of stone 2. KUB reveals location of stone 3. Cytoscopic exam- urinary obstruction 4. Stone analysis composition & type of stone 5. Urinalysis increase EBC, increase CHON Nursing Management: 1. Force fluid 2. Strain urine using gauze pad 3. Warm sitz bath for comfort 4. Alternate warm compress at flank area 5. Meds a.) Narcotic analgesic- Morphine SO4 b.) Allopurinol (Zyeoprim)

c.) Patent IV line d.) Diet if + Ca stones acid ash diet If + oxalate stone alkaline ash diet - (Ex milk/ milk products) If + uric acid stones decrease organ meat / anchovies sardines Surgery Treatment: Nephectomy removal of affected kidney Litholapoxy removal of 1/3 of stones- Stones will recur. Not advised for pt with big stones Extracorporeal shock wave lithotripsy - Non - invasive - Dissolve stones by shock wave Complications: Renal Failure

BENIGN PROSTATIC HYPERTROPHY

- enlarged prostate gland leading to: a.) Hydro ureters dilation of ureters b.) Hydronephrosis dilation of renal pelvis c.) Kidney stones d.) Renal failure Predisposing factor: 1. High risk 50 years old & above 60 70 (3 to 4 x at risk) 2. Influence of male hormone Signs & Symptoms: 1.Decrease force of urinary stream 2.Dysuria 3.Hematuria 4.Burning upon urination 5.Terminal bubbling 6.Backache 7.Sciatica Diagnostic Exam: 1. Digital rectal exam enlarged prostate gland 2. KUB urinary obstruction 3. Cystoscopic exam obstruction 4. Urinalysis increase WBC, CHON Nursing Management: 1. Prostatic message promotes evacuation of prostatic fluid 2. Limit fluid intake 3. Provide catheterization 4. Meds: a. Terazozine (hytrin) - Relaxes bladder sphincter b. Fenasteride (Proscar) - Atrophy of Prostate Gland Surgery Treatment: *Prostatectomy TURP- Transurethral resection of Prostate- No incision

-Assist in cystoclysis or continuous bladder irrigation. Nursing Management: c. Monitor symptoms of infection d. Monitor symptoms gross/ flank bleeding. Normal bleeding within 24h. 3. Maintain irrigation or tube patent to flush out clots - to prevent bladder spasm & distention

ACUTE RENAL FAILURE

sudden immobility of kidneys to excrete nitrogenous waste products & maintain F&E balance due to a decrease in GFR. (N 125 ml/min)

Predisposing factors: 1. Pre renal cause- decrease blood flow Causes: 1. Septic shock 2. Hypovolemia 3. Hypotension decrease flow to kidneys 4. CHF 5. Hemorrhage 6. Dehydration 2. Intra-renal cause involves renal pathology= kidney problem 1. Acute tubular necrosis2. Pyelonephritis 3. HPN 4. Acute GN 3. Post renal cause involves mechanical obstruction 1. Stricture 2. Urolithiasis 3. BPH

CHRONIC RENAL FAILURE

irreversible loss of kidney function Predisposing factors: 1. DM 2. HPN 3. Recurrent UTI/ nephritis 4. Exposure to renal toxins Stages of CRF 1. Diminished Reserve Volume asymptomatic Normal BUN & Crea, GFR < 10 30% 2. Renal Insufficiency 3. End Stage Renal disease Signs & Symptoms: 1.) Urinary System 2.) Metabolic disturbances

a.) polyuria b.) nocturia c.) hematuria d.) Dysuria e.) oliguria 3.) CNS a.) headache b.) lethargy c.) disorientation d.) restlessness e.) memory impairment 5.) Respiratory a.) Kassmauls resp b.) decrease cough reflex 7.) Fluid & Electrolytes a.) hyperkalemia b.) hypernatermia c.) hypermagnesemia d.) hyperposphatemia e.) hypocalcemia f.) met acidosis

a.) azotemia (increase BUN & Crea) b.) hyperglycemia c.) hyperinulinemia 4.) GIT a.) n/v b.) stomatitis c.) uremic breath d.) diarrhea/ constipation 6.) Hematological a.) Normocytic anemia bleeding tendencies 8.) Integumentary a.) itchiness/ pruritus b.) uremic frost

Nursing Management: 1. Enforce CBR 2. Monitor VS, I&O 3. Meticulous skin care. Uremic frost assist in bathing pt 4. Meds: a.) Na HCO3 due Hyperkalemia b.) Kagexelate enema c.) Anti HPN hydralazine d.) Vit & minerals e.) Phosphate binder (Amphogel) Al OH gel - S/E constipation f.) Decrease Ca Ca gluconate 5. Assist in hemodialysis 1.) Consent/ explain procedure 2.) Obtain baseline data & monitor VS, I&O, wt, blood exam 3.) Strict aseptic technique 4.) Monitor for signs of complications: B bleeding E embolism D disequilibrium syndrome S septicemia S shock decrease in tissue perfusion Disequilibrium syndrome from rapid removal of urea & nitrogenous waste prod leading to: a.) n/v b.) HPN

c.) Leg cramps d.) Disorientation e.) Paresthesia 2. Avoid BP taking, blood extraction, IV, at side of shunt or fistula. Can lead to compression of fistula. 3. Maintain patency of shunt by: i. Palpate for thrills & auscultate for bruits if (+) patent shunt! ii. Bedside- bulldog clip - If with accidental removal of fistula to prevent embolism. - Infersole (diastole) common dialisate used Complication - Peritonitis - Shock Surgery Treatment: *Renal transplantation Complication rejection. Reverse isolation