THE GENITOURINARY SYSTEM

FUNCTIONS OF THE KIDNEYS

NEPHRONS – basic functional unit of the Kidney.

INTRAVENOUS PYELOGRAM
POSITION PRE POST COMPLICATION

SITE:

INCREASE ORAL
FLUIDS
Consent

Assess:

X-ray test which uses NPO 6-8 hours

Iodine Base
contrast agent

ACCEPT what is, let go of what was, have faith in what will be.
 DISORDERS OF THE KIDNEY

Causes of Renal Failure

Pre-Renal Intra-Renal Post-Renal

POOR PERFUSION WITHIN THE KIDNEYS OBSTRUCTION
Hypovolemia Nephrotic syndrome BPH
Dehydration Nephrotoxic drugs Renal calculi / stones
Burns

ACUTE RENAL FAILURE

OLIGURIC PHASE DIURETIC PHASE

RECOVERY PHASE

CHRONIC RENAL FAILURE

REDUCED RENAL RESERVE RENAL INSUFFICIENCY END STAGE RENAL DISEASE

ACCEPT what is, let go of what was, have faith in what will be.
 DIALYSIS
HEMODIALYSIS PERITONEAL DIALYSIS

Permanent Access

AV Fistula AV Graft

Temporary Access
PERFORMING THE EXCHANGE:
Venous Catheter AV Shunt
INFUSION - 2L OF DIALYSATE SOLUTION (5-
10MINUTES)

DWELLING – TIME FOR THE SOLUTION TO STAY IN

THE PATIENTS PERITONEUM (30-45MINS)

TOO MUCH DWELLING:

DIALYSIS DISEQUILIBRIUM SYNDROME (DDS) ANTIDOTE:

-During the first few days of dialysis sessions
DRAINING - TIME FOR THE SOLUTION TO BE
S/SX: Altered L.O.C. DRAINED OUT (10-30MINS)
Nausea & vomiting
Seizure TOO SLOW DRAINING:
Restlessness

DISORDERS OF THE NEPHRONS

NEPHROTIC Syndrome NEPHRITIC Syndrome

Autoimmune Acute Glomerulonephritis
Diffuse damage to glomerular lining Common Causative Agent: GABHS
Inflammation of glomeruli due to an antigen-antibody reaction

ACCEPT what is, let go of what was, have faith in what will be.
RENAL CALCULI
NEPHROLITHIASIS UROLITHIASIS

Location: kidneys & renal pelvis Location: ureters

EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY (ESWL)

-Uses shockwave to break the stones in fragments

POSITION PRE POST COMPLICATION

Obstruction

Supine NPO 6 – 8 hours Hydronephrosis

UTI

PAIN

IV sedation **BRUISING

BENIGN PROSTATIC HYPERPLASIA

RISK FACTORS:

MALE
AGE 50 Y.O AND ABOVE
DIHYDROTESTOSTERONE – male hormone

DIAGNOSTIC TEST:
1.Digital Rectal Exam (DRE)

LABORATORY CHECKS:
1.Prostate Specific Antigen (PSA) – Normal: <4ng/ml
2.Erythrocyte Sedimentation Rate (ESR) Normal: 0-15mm/hr (male)

ACCEPT what is, let go of what was, have faith in what will be.
MANAGEMENT:

1.Saw Palmetto (herbal medication)

to improve urinary symptoms
2. Finasteride (Proscar)

3. Terazosin (Hytrin) – (Antihypertensive drug) to relax the muscles around the urethra
WOF:
Check:

4. Phenazopyridine (Pyridium) – Urinary Analgesic: to decrease pain upon urination

TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)

-Insertion of a resectoscope to remove obstructing prostate tissue

POSITION PRE POST COMPLICATIONS

NPO 6 – 8 hours CBI - Continuous Bladder Perforation

Irrigation
Gen. Anesthesia

Lithotomy Infection

**HEALTH TEACHING:

Clot formation

CONTINUOUS BLADDER IRRIGATION (CBI)

INFLOW OUTFLOW BALLOON INFLATION

ACCEPT what is, let go of what was, have faith in what will be.
BURNS

The Rule of 9’s

Stages of Burns

EMERGENT PHASE DIURETIC PHASE RECOVERY PHASE

ACCEPT what is, let go of what was, have faith in what will be.
 THE GASTROINTESTINAL SYSTEM

Procedure Contrast PRE- POST- COMPLICATION/S

Medium
“Radiographic”
Chalk-like stools Anaphylactic
UPPER GI SERIES NPO 6-8 reaction
High Fowlers

Management:
LOWER GI SERIES 1-3days: Bowel 1.Increase Fluids
Preparation - clear 2.Increase Fiber
fluids 3.Administer
Laxative
NPO 6-8
Left side lying

“Scopy” Perforation
NPO 6-12
Local Anesthesia

UPPER GI
Atropine
Bleeding

Midazolam
(Versed)

Shock
LOWER GI NO NPO
Cleansing enema 1
hour before

ACCEPT what is, let go of what was, have faith in what will be.
 GASTROINTESTINAL DISORDERS

UPPER GI DISORDERS
CAUSES: AGE, CAFFEINE, ALCOHOL, SMOKING, HOT AND SPICY FOODS, HIATAL HERNIA,

GASTROESOPHAGEAL REFLUX DISEASE (GERD) – Stomach contents leak toward the esophagus
causing irritation
Problems:

1. HCl acid back flow

2. Feeling of fullness - bloated

3. Nausea and vomiting

4. Dysphagia – difficulty swallowing

5. Ptyalism – excessive salivation

The fundus of the stomach is wrapped

around the esophagus to strengthen the
sphincter

PEPTIC ULCER DISEASE

Commonly caused by: Helicobacter Pylori infection - Management: 2 Antibiotics

1 PPI
GASTRIC ULCER DUODENAL ULCER
Other causes: Long term use of NSAIDs and Stress
Hcl acid production: normal or hyposecretion HCL acid production: hypersecretion

PAIN PAIN

RELIEVED: RELIEVED:

BLEEDING: BLEEDING:

Management: AVOID Caffeine - Chocolate

Alcohol Monitor: Hemoglobin & Hematocrit
Smoking
Hot and spicy foods
Dairy products Give: Antacids, H2 Receptor Blockers, Proron Pump
Inhibitors, Sucralfate, Cytotec (AHPSC)

ACCEPT what is, let go of what was, have faith in what will be.
 COMPLICATION OF GASTRIC SURGERY

DUMPING SYNDROME PERNICIOUS ANEMIA

PROBLEM: Rapid gastric emptying PROBLEM:

Feeling of fullness
Nausea and vomiting
Increased peristalsis –

Undigested carbohydrate –

Diet:

Avoid:

Position: During meals

After meals

DISORDERS OF THE ACCESSORY ORGANS

Liver Cirrhosis
Functions of the liver:
Bile production
Vitamins A D E K absorption
Synthesis of clotting factor
Making and storing glucose

WHAT TO ASSESS: LIVER CIRRHOSIS

1. ALT – Alanine Transaminase
Men: 10-55 U/L Women: 7-30 U/L
2. AST – Aspartate Transaminase
Men: 10-40 U/L Women: 9-25 U/L
EARLY SIGNS AND SYMPTOMS:
Fever, Anorexia, Nausea, Vomiting

ACCEPT what is, let go of what was, have faith in what will be.
 ESOPHAGEAL VARICES
Severe dilation of esophageal veins

Rupture

Bleeding

AVOID: straining, valsalva maneuver

coughing, sneezing,vomiting, heavy weight lifting
wearing tight clothing
ASCITES
-Fluid accumulation in the peritoneum.
Paracentesis: Removal of excessive peritoneal fluid.
Normal to drain at least 2-3 L/ doctor’s order
PROCEDURE: Paracentesis – Removal of excessive fluid in the abdomen
Before: Neomycin – Antibiotic prophylaxis: to decrease GI bacteria
Position:
During: Attach a BP cuff in the patients arm WOF:
After: Albumin IV (plasma protein) –

HEPATIC ENCEPHALOPATHY
-Increase ammonia level in the blood
Hallmark sign:

Management:
1. Lactulose (Chronulac) - Osmotic Laxative
- To excrete ammonia via stool

2. Neomycin: Antibiotic prophylaxis – to decrease GI bacteria that produces ammonia

Pancreatitis

Chronic pancreatitis – occurs after an episode of acute pancreatitis

Acute pancreatitis – sudden inflammation occurs over a short period of time

DOC FOR PAIN:

 Steatorrhea due to malabsorption
 Hypocalcemia due to lipolysis –
 Bleeding:

ACCEPT what is, let go of what was, have faith in what will be.
DIET:

PANCREATIC ENZYMES: SERUM LIPASE : 12-70 U/L SERUM AMYLASE: 25-125 U/L

DIAGNOSTIC TEST: Endoscopic Retrograde Cholangiopancreatography(ERCP) - Visualization of the

common bile duct, pancreas and gallbladder using an endoscope and contrast medium

POINTS TO REMEMBER:
DIVERTICULAR DISEASE

DIVERTICULOSIS DIVERTICULITIS

THERE IS AN OUTPOUCHING IN THE THE OUTPOUCHING MUCOSA (Diverticulosis)

MUCOSA AND SUBMUCOSAL LAYERS OF THE BECOMES IRRITATED WHICH CAUSES
COLON WHICH CAUSES HIGH INFLAMMATION
INTRALUMINAL PRESSURE

Appropriate Diet:
CAUSES:
Low residue (fiber) diet/Limit fat
Low fiber diet 0 – milk (zero)
Age (colon gets weak) Real meat (avoid fried foods)
Seeds Eggs boiled
Trapped foods (solid particles) Strain foods and fluids (no solids)

AVOID: High residue diet

Signs and symptoms:

Appropriate Diet: High Fiber diet
Cramps, LLQ pain, diarrhea, fever
AVOID: Low fiber diet

RENAL BIOPSY

Normal position: Prone

Patient with renal transplant

Position: Supine

ACCEPT what is, let go of what was, have faith in what will be.
 Inflammatory Bowel Disease (IBD)

Comparison CROHN’S DISEASE ULCERATIVE COLITIS

(Regional Enteritis)

LOCATION SMALL & LARGE INTESTINES LARGE INTESTINES

Presenting s/sx FISTULA ULCERATION

Common Site ILEUM RECTAL

Stools per day 5-6 x per day 10-20 x per day

Cancer Potential COLON CANCER COLON CANCER

Bleeding: NO BLEEDING HEMATOCHEZIA

(Fresh blood in stool)
Diet for both: Avoid oily, fatty, hot and spicy foods

DOC for both: Corticosteroids

Atropine – (SNS) decreases gastric
motility & peristalsis

KIDNEY TRANSPLANT

NEW LOCATION: ILIAC FOSSA

REJECTION: Fever, chills, oliguria, flank pain

MEDICATIONS TO PREVENT REJECTION: IMMUNOSUPPRESSANTS

Cyclosporine (Sandimmune) – Do not take it with grapefruit juice (might cause toxicity)
Chocolate milk and orange juice okay

Tacrolimus (Prograf)
Azathioprine (Imuran)
Prednisone (Deltasone)

HOW TO AVOID DISPLACEMENT:

Avoid contact sports
Avoid sitting for long hours

LIVER BIOPSY: Removal of a small liver tissue to detect the presence of damage or a disease.
PRE-PROCEDURE: Assess PT (for bleeding)
DURING: Supine with the right hand under the head or
Left side lying
PROCEDURE: Inhale, Exhale and hold breath for 5-10 secs to prevent puncturing the lungs
AFTER: Right side lying
Put pressure to prevent bleeding

ACCEPT what is, let go of what was, have faith in what will be.