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URINARY SYSTEM

PROBLEMS

FUNCTIONS OF KIDNEY
Urine formation
Eliminates nitrogenous waste products
Maintains acid-base balance
Maintains fluid and electrolyte balance
Secretes erythropoietin
Regulates BP
Metabolizes Vit. D

DIAGNOSTICS
Urinalysis
Blood chemistry

BUN gross glomerular function & excretion of


urea
Creatinine ability of kidney to excrete wastes

IVP
Cytoscopy

PYELONEPHRITIS
Inflammation of kidneys pelvis &
nephrons

Interventions:

Cotrimoxazole
Phenazopyridine

UTI
Increase fluids
Drink acidic fluids

CYSTITIS
E. coli
Empty bladder q2hrs
Cotton undies

UROLITHIASIS
Cause:

Decreased fluid intake


DHN
pH of urine
Increased Ca intake
UTI
Hot climate

Types

Acidic stone

Purine
Alkaline ash
diet

Struvite stone

NH3; staghornlike

Cystine stones
Genetics

Ca oxalate
Ca-P stones

Manifestations

Colicky pain at flank


Hematuria

Interventions
OFI
Strain urine
ESWL

BPH
50 and up
Early: decreased urine stream, hesitancy
Retained urine may dam back
Rectal digital exam

Surgical intervention

Supra-pubic prostatectomy (50g & up)


Lower midline
Whole prostate
Vasectomy
Cx: urinary fistula
Retro-pubic
Perineal

TURP
1st 36 hrs drain pink and red
Hemorrhage increase
Dislodged DOC
Urgency obstruction
Obstructed DOC, irrigate

48H clear remove


Cx

Dribbling (1-2 wks)


Bladder neck stricture
Retrograde ejaculation

BURNS
Thermal

Prevent penetration to deeper tissues


Immerse in cool water

Chemical
Electrical
Irradiation

CLASSIFICATION
Depth
1

st

Superficial partial
Epidermis
Redness, pain

nd

Deep partial
Epidermis & dermis
Blisters, very painful,
edema

3rd

Full thickness
Epidermis, dermis, SQ
Dry and leathery with
little/or pain

4th

Full
Skin, fascia, muscle,
bone

TBSA

Critical

2nd - >30%
3rd - >10%

Major

2nd 15 to 30%
3rd 2 to 10%

Minor

2nd - <15%
3rd - <2%

INTERVENTION
Maintain airway patency
Relieve pain
Fluid replacement
Prevent infection
NGT insertion
Insertion of indwelling catheter

STAGES
Neurogenic shock
Fluid loss shock/emergent phase
1st 48-72 H
PLR
Cimetidine
High everything

Burn slough & Infection


p 48H
Eschar

Open sulfamylon with bed cradle; Hubbard


tank
Semi-open thin dressing; analgesic
Closed bulky dressing; Kerlix

Skin graft

Autologous
Homologous/homograft/allograft
Heterologous/heterograft/xenograft