genito urinary nursing

Medical and Surgical Nursing

Genito-Urinary Tract

Prepared by: Mark Fredderick R. Abejo RN,MAN

MS Abejo

MEDICAL AND SURGICAL NURSING

Genito-Urinary Tract Disorder

Lecturer: Mark Fredderick R. Abejo RN,MAN

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OVERVIEW OF THE STRUCTURE AND FUNCTION OF

THE GENITO-URINARY TRACT

- Promotes excretion of nitrogenous waste products

- Maintain fluid electrolytes and acid-base balance

I. Kidneys

A. Location – a pair of bean shaped organs located

retroperitoneally (behind peritoneum) on either side of

the verbral column

B. Structure

1. Renal pelvis

2. Renal colic

3. Renal medulla

C. Nephron glomerulus

D. Functions

1. Urine formation

2. Regulates BP

E. Urine Formation (Normal GFR: 125 ml of blood is

filtered in the glomerulus per minute) 1. Filtration

2. Tubular Reabsorption – 124 ml of ultrafiltrates are

reabsorbed back into the blood

3. Tubular Secretion – 1 ml excreted in the urine; ¼ of

total cardiac output is received by kidneys

II. Ureters – 20-30 mm long – serves as a passageway of urine

III. Bladder

A. Located behind the symphysis pubis

B. Made up of muscular and elastic tissues distensible

reservoir of urine

C. Max: 1, 200 -1,800 ml of urine

D. Initiates urination: 250-500 cc ml

E. Normal urine:

1. amber, aromatic, turbid/clear, pH 4-8

2. spec gravity: 1.015-1.030

3. WBC, CHON none

4. (-) E. coli

5. mucus threads few

6. (-) amorphous urates

IV. Urethra

A. Serves as a passageway for urine, vaginal/seminal fluids

B. Length

1. F: 3-5 cm or 1-1/2 inches

2. M: 20 cm or 8 inches

C. Catheter

1. Pedia: 8-10 fr

2. F: 12-14 fr

3. M: 16-18 fr

URINARY TRACT INFECTIONS

I. CYSTITIS – inflammation of bladder caused by bacterial

infection

A. PREDISPOSING FACTORS

1. High risk: women

2. Microbial Invasion (E. Coli)

3. Increased estrogen levels, estrogen therapy

4. Sexual intercourse




MS Abejo

5. Urinary retention

6. Incontinence

7. Urinary obstruction

8. Poor perineal hygiene

B. S/SX

1. Urinary frequency and urgency

2. Flank pain

3. Fever, chills, anorexia, generalized body malaise

4. Dysuria – burning upon urination

5. Hematuria

C. DX

1. Urine culture and sensitivity

(+) E. Coli 90%

2. Urinalysis

Increased WBC

Increased CHON

Increased pus cells

D. NSG MGMT

1. Forced fluids (2-3 L/d)

2. Provide warm sitz bath to promote comfort

3. Provide acid-ash diet: cranberries, grape juice,

plums

4. Monitor for gross hematuria, color, odor of urine

5. Administer meds as ordered

Systemic antibiotics

Penicillins

Cephalosporins (SE: nephrotoxicity,

hepatotoxicity)

Tetracycline (staining of teeth,

photosensitivity)

Sulfonamides

Co-trimoxazole (Bactrim)

Gantricin

Sulfisoxazole

Urinary antiseptics

Nitrofurantoin (Macrodantin)

Furadantoin

Urinary analgesics

Pyridium – decreases pain, promotes

relaxation of sphincter

6. Discharge teaching

Importance of hydration

Void after sexual intercourse

Instruct female client to:

Proper perineal hygiene

Front to back cleaning

Avoid tissue use

Bubble bath

(-) talcum powder, perfume

7. Prevent complications

Pyelonephritis

II. PYELONEPHRITIS – acute or chronic inflammation of

renal pelvis leading to tubular destruction, intestinal abscesses

and renal failure


1. Microbial invasion

E. coli

Streptococcus

2. Urinary retention/ stagnation

3. pregnancy

4. DM

5. Exposure to renal toxins/ use of nephrotoxic agents

6. Obesity

B. S/SX

1. Acute Pyelonephritis

Urinary frequency and urgency

Costovertebral angle pain and tenderness

Fevers and chills, anorexia, general body

malaise

Burning upon urination

Dysuria, nocturia, hematuria

2. Chronic Pyelonephritis

Fatigue and/or weakness

Weight loss

Polyuria

Polydypsia

HPN

C. DIAGNOSTICS

1. Urine CS: (+) cultured microorganisms (E.coli and

strep)

2. Urinalysis: elevated WBC, CHON, pus cells

3. Cystoscopic exam: (+) urinary obstruction




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D. NURSING MANAGEMENT

1. Provide CBR especially during acute attack

2. Forced fluids

3. Provide an acid ash in the diet

4. Provide warm sitz bath for comfort

5. Administer medications as ordered

Nitrofurantoin

SE: GIT irritation, give with food,

peripheral neuropathy, hemolytic anemia

(initial sx: fever), discoloration of teeth

Urinary analgesics

Pyridium

6. prevent complications

renal failure

III. NEPHROLITHIASIS/UROLITHIASIS – formation of

stones elsewhere in the urinary tract

A. TYPES OF STONES

1. calcium

2. oxalate

3. uric acid

B. PREDISPOSING FACTORS

1. diet high in calcium and oxalate

2. hereditary (like gout)

3. hyperparathyroidism (Hypercalcemia)

4. obesity

5. sedentary lifestyle

C. S/SX

1. Renal colic

2. Cool, moist skin

3. Burning upon urination

4. Dysuria, Nocturia

5. Hematuria

D. DIAGNOSTICS

1. Urinalysis – (+) RBC, WBC, Pus cells

2. KUB: reveal site or location of stones

3. Stone analysis: reveals composition of stone

4. Cystoscopic exam: urinary obstruction

5. IVP: reveals obstruction

E. NURSING MANAGEMENT

1. Forced fluids to prevent further crystallization

2. Alternate warm and cold compress

3. Administer isotonic fluids as ordered

4. Strain all urine using gauze pad

5. Warm sitz bath for comfort

6. Meds as ordered

Narcotic analgesics – morphine

Allopurinol (zyloprim)

7. Provide dietary intake:

If (+) to ca stones: acid ash

If (+) to oxalate stones: alkaline ash (milk,

tea, vegetables)

If (+) to uric acid: avoid purine rich food

like anchovies, legumes, organ meat, nuts

8. Assist

Litholapoxy – surgical removal of 2/3 stone

Nephrectomy – removal of kidney

stagnation

Lithotripsy – extracorporeal shockwave

No incision, early discharge

Too costly

Stones can recur

Post-op: strain urine

9. Prevent complications renal failure

IV. ACUTE RENAL FAILURE (ARF) – sudden inability of the

kidneys to excrete nitrogenous waste products, leads to

azotemia


1. Pre-renal : involves decrease in GFR

(n=125ml/hr)

Hemorrhage

Shock

Chronic diarrhea (dehydration)

CHF

Hypotension

Septicemia

2. Intrarenal – involves renal pathology

Pyelonephritis

DM

AGN

Acute tubular necrosis: common SE post-

hemolytic BT

3. Post-renal – (+) mechanical obstruction

BPH

Nephro/urolithiasis

Tumor

Urinary strictures




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B. STAGES

1. Oliguric phase – passage of urine (1-2 weeks)

UO: <400 ml/cc

Hyperkalemia

Hypernatremia

Hyperphosphatemia

HYPOCALCEMIA

Hypermagnesemia

Metabolic acidosis

Elevated BUN, Crea

2. Diuretic Phase (2-3 weeks)

Increased passage of urine

Hyperkalemia

Hyponatremia

Metabolic acidosis

3. Convalescent phase (3-12 months)

Improvement in passage of urine

Characterized by complete diuresis

V. CHRONIC RENAL FAILURE (CRF) – irreversible loss of

kidney function


1. DM and HPN (common causes)

2. Recurrent pyelonephritis

3. Exposure to renal toxins

4. Tumor

B. STAGES

1. Diminished renal reserve volume – asymptomatic,

normal BUN and CREA

2. Renal insufficiency

3. End-stage renal disease (ESRD) – presence of

oliguria, azotemia

C. S/SX

1. Uro

Azotemia (elevated BUN and crea)

Oliguria

Nocturia

Hematuria

Dysuria

2. Neuro

Lethargy

Headache

Disorientation (initial sign of disequilibrium

syndrome) and confusion, restlessness

Memory impairment

Decreased LOC

3. Respi

Depressed or diminished cough reflex

Kussmaul’s respirations

4. Hema

Anemia

Leukopenia

Bleeding tendencies (thrombocytopenia)

All blood cells decreased

Increased susceptibility to infection

5. CV changes

Pulmo HPN

CHF

Pericarditis

6. GIT distress

Anorexia

N&V

Diarrhea and/or constipation

Stomatitis

Uremic breath

7. Integumentary

Pruritus

Uremic frost

8. Metabolic/Electrolyte imbalance

Hyperkalemia

Hyperphosphatemia

Metabolic acidosis

9. Endo

Gynecomastia

Hyperthyroidism

D. NURSING MANAGEMENT

1. Enforce CBR

2. Admin oxygen inhalation as ordered

3. High CHO diet low CHON, fats, High vit and

minerals

4. Provide meticulous skin care

Wash with warm water

Soap irritates and dries skin

5. Meds as ordered

anti-HPN agents

Hydralazine (appresoline)

SE: orthostatic hypotension

NaHCO3

Kayexelate enema

Hematinics

Antibiotics

Supplementary vitamins and minerals

Phosphate binders

Calcium gluconate

6. Assist in hemodialysis

Secure consent and explain procedure to client

Maintain strict aseptic technique

Obtain baseline data – before and q30 during

procedure

VS

Wt

Blood exams – secure all pre-procedure

I/O




MS Abejo

Have client void pre-procedure

Inform pt about bleeding (blood is heparinized)

Monitor for signs of complications

(BEDSSH)

Bleeding

Embolism

DISEQUILIBRIUM SYNDROME –

results from rapid loss of nitrogenous

waste products particularly UREA from

the brain

HPN

Disorientation – initial sign

Nausea and vomiting

anorexia

Headache

Paresthesia, peripheral

Numbness

Septicemia

Shock

Hepatitis

Avoid BP taking, phlebotomy, IV meds at the

site of fistula, blood extraction to prevent

compression

Maintain patency of shunt/fistula:

Palpate for thrills, auscultate for bruits

Instruct that minimal bleeding is expected

since blood is heparinized

Avoid use vasodilators, sedatives, and

tranquilizers to prevent hypotension unless

ordered

Prepare at bedside bulldog clips to prevent

embolism

Auscultate for bruits and palpate for thrills

(if (+) patent)

PERITONEAL DIALYSIS

Most common complication is

PERITONITIS and shock

First sign: cloudy dialysate return

Most common dialysate:

INFERSOL

Infusion time: 10-20 minutes

Dwelling time: 30-45 minutes

What determines effectiveness of dialysis?

Weight of patient

7. Assist in surgical procedure: KIDNEY

TRANSPLANTATION

Meds: steroids, immunosuppressants, anti

lymphocyte globulin…

Feared complication: rejection, characterized

by hypertension, headache, dizziness,

decreased CBC

2 TYPES OF REJECTION

Acute – 6 to 10 months

Chronic – 5-10 years

1. Oliguria

2. Disorientation

3. Decreased LOC




MS Abejo

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