Professional Documents
Culture Documents
DEFINITION
Urology is the surgical specialty that focuses on the urinary tracts of males and
females, and on the reproductive system of males. Medical professionals specializing in
the field of urology are called urologists and are trained to diagnose, treat, and manage
patients with urological disorders. The organs covered by urology include the kidneys,
ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas
deferens, seminal vesicles, prostate and penis). Both Urologists and General Surgeons
operate on the adrenal glands.
In men, the urinary system overlaps with the reproductive system, and in women
the urinary tract opens into the vulva. In both sexes, the urinary and reproductive tracts are
close together, and disorders of one often affect the other. Urology combines management
of medical (i.e. non-surgical) problems such as urinary tract infections and benign prostatic
hyperplasia, as well as surgical problems such as the surgical management of cancers, the
correction of congenital abnormalities, and correcting stress incontinence. Urology is
closely related to, and in some cases overlaps with, the medical fields of oncology,
nephrology,
gynecology,
andrology,
pediatric
surgery,
gastroenterology,
and
endocrinology.
The body takes nutrients from food and converts them to energy. After the
body has taken the food that it needs, waste products are left behind in the bowel and in
the blood. The urinary system keeps the chemicals and water in balance by removing a
1
type of waste, called urea, from the blood. Urea is produced when foods containing
protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea
is carried in the bloodstream to the kidneys.
2.1 Two Kidneys
A pair of purplish-brown organs located below the ribs toward the middle of the
back. Their function is to:
o
produce erythropoietin, a hormone that aids the formation of red blood cells.
The kidneys remove urea from the blood through tiny filtering units called
nephrons. Each nephron consists of a ball formed of small blood capillaries, called a
glomerulus, and a small tube called a renal tubule. Urea, together with water and other
waste substances, forms the urine as it passes through the nephrons and down the renal
tubules of the kidney.
kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop.
About every 10 to 15 seconds, small amounts of urine are emptied into the bladder
from the ureters.
2.3 Bladder
A triangle-shaped, hollow organ located in the lower abdomen. It is held in
place by ligaments that are attached to other organs and the pelvic bones. The
bladder's walls relax and expand to store urine, and contract and flatten to empty urine
through the urethra. The typical healthy adult bladder can store up to two cups of
urine for two to five hours.
2.4 Two sphincter muscles
Circular muscles that help keep urine from leaking by closing tightly like a
rubber band around the opening of the bladder.
2.5 Nerves in the bladder
Alert a person when it is time to urinate, or empty the bladder.
2.6 Urethra
The tube that allows urine to pass outside the body. The brain signals the
bladder muscles to tighten, which squeezes urine out of the bladder. At the same time,
the brain signals the sphincter muscles to relax to let urine exit the bladder through the
urethra. When all the signals occur in the correct order, normal urination occurs.
3. PATHOPHYSIOLOGY
3.1 Medical Diagnosis
Chronic kidney failure occurs when disease or dis- order damages the kidneys so
that they can no longer adequately remove fluids and wastes from the body or maintain
proper levels of kidney-regulated chemicals in the bloodstream. Chronic kidney failure,
also known as chronic renal failure, affects over 250,000 Americans annually. It may be
3
caused by a number of diseases and inherited disorders, but the progression (end result) of
chronic kidney failure is always the same.
The kidneys, which serve as the body's natural filtration system, gradually lose their
ability to remove fluids and waste products (urea) from the bloodstream. They also fail to
regulate certain chemicals in the bloodstream and allow protein to leak into the urine.
Chronic kidney failure is irreversible and eventually leads to total kidney failure, known as
end-stage renal disease (ESRD). Without treatment and intervention to remove wastes and
fluids from the bloodstream, ESRD is inevitably fatal.
Diabetes
Decrease of nefron
Hypertension
Glomerulonephritis
.disfunction of glomerulus filtration
Description
GFR*
mL/min/1.73m2
More than 90
60-89
30-59
15-29
Kidney failure
Diabetes. Diabetes mellitus (DM), both insulin dependant (IDDM) and non-insulin
dependant (NIDDM), occurs when the body cannot produce and/or use insulin, the
hormone necessary for the body to process glucose. Long-term diabetes may cause
the glomeruli, the filtering units located in the nephrons of the kidneys, to gradually
lose function.
2.
Hypertension. High blood pressure is both a cause and a result of kidney failure. The
kidneys can become stressed and ultimately sustain permanent damage from blood
pushing through them at excessive pressures over long periods of time.
3.
4.
2. Bad breath or a bad taste in mouth. Urea in the saliva may cause an ammonia-like
taste in the mouth.
3. Bone and joint problems. The kidneys produce vitamin D, which aids in the
absorption of calcium and keeps bones strong. In patients with kidney failure, bones
may become brittle, and in children, normal growth may be stunted. Joint pain may
also occur as a result of unchecked phosphate levels in the blood.
4. Edema. Puffiness or swelling around the eyes and legs.
5. Frequent urination.
6. Foamy or bloody urine. Protein in the urine may cause it to foam significantly. Blood
in the urine may indicate bleeding from diseased or obstructed kidneys, bladder, or
ureters.
7. Headaches. High blood pressure may trigger headaches.
8. Hypertension, or high blood pressure. The retention of fluids and sodium causes blood
volume to increase, which, in turn, causes blood pressure to rise.
9. Increased fatigue. Toxic substances in the blood and the presence of anemia may
cause feelings of exhaustion.
10. Itching. Phosphorus, which is typically eliminated in the urine, accumulates in the
blood of patients with kidney failure. This heightened phosphorus level may cause
itching of the skin.
11. Low back pain. Pain where the kidneys are located, in the small of the back below the
ribs.
12. Nausea, loss of appetite, and vomiting. Urea in the gastric juices may cause upset
stomach. This can lead to malnutrition and weight loss.
5. NURSING PROCESS
5.1 Assessment
a) Interview
Patient Identity
Symptoms : headache.
B4
: Bone (Bone-Muscle-Integument)
(urea nitrogen, and creatinine). The presence of protein in the urine indicates kidney
damage. The amount of creatinine and urea excreted in the urine can be used to
calculate the level of kidney function and the glomerular filtration rate (GFR).
Glomerular filtration rate (GFR): The GFR is a standard means of expressing overall
kidney function. As kidney disease progresses, GFR falls. The normal GFR is about
100-140 mL/min in men and 85-115 mL/min in women. It decreases in most people
with age. The GFR may be calculated from the amount of waste products in the 24hour urine or by using special markers administered intravenously. An estimation of
the GFR (eGFR) can be calculated from the patient's routine blood tests. Patients are
divided into five stages of chronic kidney disease based on their GFR (see Table 1
above).
Blood Tests:
Creatinine and urea (BUN) in the blood: Blood urea nitrogen and serum creatinine
are the most commonly used blood tests to screen for, and monitor renal disease.
Creatinine is a product of normal muscle breakdown. Urea is the waste product of
breakdown of protein. The level of these substances rises in the blood as kidney
function worsens.
Estimated GFR (eGFR): The laboratory or your physician may calculate an estimated
GFR using the information from your blood work. It is important to be aware of your
estimated GFR and stage of chronic kidney disease. Your physician uses your stage of
kidney disease to recommend additional testing and suggestions on management.
Electrolyte levels and acid-base balance: Kidney dysfunction causes imbalances in
electrolytes, especially potassium, phosphorus, and calcium. High potassium
(hyperkalemia) is a particular concern. The acid-base balance of the blood is usually
disrupted as well. Decreased production of the active form of vitamin D can cause
low levels of calcium in the blood. Inability to excrete phosphorus by failing kidneys
causes its levels in the blood to rise. Testicular or ovarian hormone levels may also be
abnormal.
Blood cell counts: Because kidney disease disrupts blood cell production and shortens
the survival of red cells, the red blood cell count and hemoglobin may be low
(anemia). Some patients may also have iron deficiency due to blood loss in their
8
gastrointestinal system. Other nutritional deficiencies may also impair the production
of red cells.
Other tests:
Ultrasound: Ultrasound is often used in the diagnosis of kidney disease. An
which the cause of the kidney disease is unclear. Usually, a biopsy can be collected
with local anesthesia by introducing a needle through the skin into the kidney. This is
usually done as an outpatient procedure, though some institutions may require an
overnight hospital stay.
Accumulation
Goal
Statement Intervention
Rationale
(NOC)
(NIC)
of - Long term goals: - Auskultasi heard - S3/S4
and
toxic substances, in
toxic
sound.
Evaluation
altered pattern of
separated
oedema
urinary elimination.
distribute well in
own
substances,
part
and
after
treatment.
- Short term goals:
water, waste, and
in
of
and
dypsnea.
- Assesst
of
Notice
Hemodialysis
substances,
the
body
separated
and
distribute well in
own part. Give a
comfort condition
to the patient.
tonus
muffled, tachycardia.
irregular
heart
frequency,
tachypnea, dyspnea.
- Hypertension causes
interference
hypertension.
doing
toxic
pulmonary
with
for
postural changes,
of
aldosteron
renin
angiotensin system.
lay, stand.
- Examine
complaints
of
and
location
radiation.
- Evaluate of heart
CRF
patient
causes
can
pericarditis,
tamponade.
- There are suddenly
hypotention,
sounds,
blood
paradoxic
artery,
pressure,
pulse
narrowing
artery
perifer,
congesti
vascular,
temperature
pressure,
decrease
sensory.
- Assest
the
activity,
the
respond
of
- Unbalance
can
activity.
10
- Beware
of
disturb
electrical
laboratory
examination. For
example
identification
Electrolit
and
chest roengten.
- Administer
heart
failure.
- Decrease
vascular
resistance
systemic
antihypertention.
For
decrease myocardial
example:
Prazozin
(minipress).
prevent CRF.
- Electrolyte
- Help
in
pericardiocentesis
suitable
accumulation
pericardium
in
layers
indication.
charge
and
contraction
of
myocardiac
can
for
dyalisis.
- Decrease of ureum
toxin and improve
electrolyte
imbalance and fluid
overbalance
can
prevent
heart
manifestation include
hypertension
2.
Social
pericardial effusion.
- Alert with changes
related to impaired
disturbance
social interaction.
patient
thinking.
more
can
calm
be
and
and
of
give
chance
for
evaluated
and
intervention.
- Give compare
11
for
comfort
after
nurse
give
nearest
explanation about
the condition.
- Short term goals:
Patient
can
rest
after
24
family
development.
to nearest family
about
the
condition
of
- Minimalisation
patient.
- Give
environmental,
the
fact
help in introducesing
- The
potensial
confrontation
- Comunication
with
confusion.
simple
santance.
- Make a scadule
a
good
- Insomnia can disturb
activity.
- Adekuat rest.
cognitive skills.
and
urinary elimination.
toxic
substances,
sound.Mevaluatio
irregular
n of oedema and
frequency,
distribute well in
own
part
after
doing
Hemodialysis
treatment.
- Short term goals:
pulmonary
with
related to altered
and
make
against reaction.
- Can helping decrease
brief.
for
of
environment respons
relaxing.
- Orientation about
separated
the
patient.
- Physical
- Give information
environmental
3.
evaluation
dypsnea.
- Assest
muffled, tachycardia.
heart
tachypnea, dyspnea.
of - Hypertension causes
hypertention.
Notice
tonus
interference
for
postural changes,
aldosteron
of
renin
angiotensin system.
- Hypertension
and
12
substances,
the
body
separated
and
distribute well in
own part. Give a
comfort condition
to the patient.
complaints
of
location
radiation.
- Evaluate of heart
CRF
patient
causes
can
pericarditis,
tamponade.
- There are suddenly
hypotention,
sounds,
blood
paradoxic
artery,
pressure,
pulse
narrowing
artery
perifer,
congesti
vascular,
decrease
temperature
and
sensory.
- Assest
the
activity,
the
respond
of
activity.
- Beware
of
examination. For
example
Electrolit
- Unbalance
disturb
can
electrical
laboratory
and
chest roengten.
- Administer
antihypertention.
For
pressure,
example:
heart
failure.
- Decrease
vascular
resistance
systemic
Prazozin
prevent CRF.
(minipress).
- Electrolyte
- Help
in
accumulation
in
pericardiocentesis
pericardium
layers
suitable
indication.
charge
and
contraction
of
myocardiac
can
13
Decrease
toxin
of
and
electrolyte
ureum
improve
imbalance
prevent
heart
manifestation include
hypertention
4.
Imbalanced
and
pericardial effusion.
- Help in identification
deficiency and diet
programe.
- Anorexia minimilze
and
vomit
related
with uremik.
- Give intervention to
control
in
diet
programe.
- Give a treatment
mouth and refreshing
mouth which often
feel uncomfort.
- Patient fast.
5.4 Evaluation
1. S (Subjective):
Patient has not feel pain.
Patient feel comfort.
2. O (Objective):
The normal GFR is about 100-140 mL/min in men and 85-115 mL/min in women.
Urine test showed that the function of the kidneys was normal.
14
3. A (Assessment):
Goal match: the body can separated and distribute well in own part after doing
Hemodialysis treatment.
Goal not match: the body cant separated and distribute well in own part after
doing Hemodialysis treatment.
Goal parsialy match: The body can separated and distribute not so well in own
part after did Hemodialysis treatment.
New problem: The Chronic Renal Failure causes complication with another organ.
4. P (Planning):
Goal match: We can continue the treatment. If the condition have stabil, we can
stop the treatment (hemodialysis).
Goal not match: We cant do the new treatment because Chronic Renal Failure is
the last desease.
Goal parsialy match: Continue the treatment or modifiy with another treatment.
For example: Did hemodialysis with new equipment.
New problem: Evaluation all of the treatment and make new strategy.
REFERENCES
Doenges, ME. 1999. Rencana Asuhan Keperawatan. Jakarta: EGC
Gibson, John. 1995. Anatomi dan Fisiologi Modern. Jakarta: EGC
Nurjanah, Intansari. 2005. Aplikasi Proses Keperawatan. Yogyakarta: Mocomedia
15
16