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MS Genito Urinary System
MS Genito Urinary System
KIDNEY
Bean-shaped organ
Highly vascular
Has exocrine and endocrine functions
Weight: 150 g
Length: 4.5 inches (11.4 cm)
Width: 2.5 inches (6.4 cm)
Location: Retroperitoneal
Supine: T12-L3
Trendelenburg: 10th-11th ICS
Standing: Down the iliac crest
1 contains about million nephrons.
NEPHRON
2 sections:
1. Bowman's capsules - outer cortex region
2. Renal tubules - from the cortex into the darker medulla.
Filtration:
Blood flows to the glomerulus (from the renal artery)
Pressure in the glomerulus forces: water, glucose, urea, salts through the capillary wall and tubule (Protein & blood cells remain)
Glucose, most of the water and salts are absorbed back into the blood in the nearby capillaries. (TRR – 124 cc/min)
They pass down the tubule and eventually reach the bladder.
(Blood flows out of the kidney to the renal vein.)
URETERS
Length: 10-12 inches (25-30 cm)
Diameter: 2-8 mm
Major function: Channel urine down to the bladder by peristaltic waves (1-5x/min)
Ureterovesical valve – prevents reflux of urine
URINARY BLADDER
Hollow, spherical, muscular organ
Anterior and inferior to the pelvic cavity
Posterior to Symphysis Pubis
Elastic as it stores urine
a. First Urge: 200-300 cc
b. Moderately full: 500-600 cc
c. Maximum capacity: 1000-1800 cc (Rises up to the Symphisis Pubis
Effects of:
a. Parasympathetic Nerves: Contract
b. Sympathetic Nerves: Relax
URETHRA
Anterior to the vagina (female) – behind symphisis pubis
Length
a. Female: 3-5 cm
b. Male: 20 cm
ROUTINE URINALYSIS
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Blood Tests:
BUN : 10-20 mg/dL
Serum Creatinine : .4-1.2 mg/dL
Serum Uric Acid : 2.5-8 mg/dL
Albumin : 3.2-5.5 mg/dL
RBC : 4.5-5.5 mg/dL
Hematocrit : 38-54 vol%
Serum Electrolytes:
Potassium : 3.5-5 mEq/L
Sodium : 135-145 mEq/L
Calcium : 4.5-5.5 mEq/L
Magnesium : 1.5-2.5 mEq/L
Phosphorus : 3.5-5.5 mEq/L
Chloride : 98-108 mEq/L
DIAGNOSTIC STUDIES
CYSTOSCOPY
Provides a means of direct visualization of the urethra, bladder, and urethral orifices
The Cystoscope (an instrument with lighted lens) is inserted into the urethra
Biopsy specimens, lesions, small stones and small foreign bodies can be removed by this means.
After Cystoscopy:
BR until VS are stable
Blood-tinged (pink) witihin 24-48 hours is normal
Due to irritation:
a. Dysuria c. Hematuria
b. Frequency
Assess for:
a. Urinary retention c. Prolonged / excessive hematuria
b. Signs of infection
Monitor VS and I&O
Force fluids
Before IVP . . .
Secure written consent
NPO 6-8 hours
Bowel preparation
Check for hypersensitivity to iodine (sea foods)
Emergency drug: Epinephrine (for possible anaphylactic shock)
Inform: warm flushing sensation on IV injection site is normal
Before RPG:
Written consent
Check for iodine / dye allergy
Inform: discomfort of the procedure
Emergency drug: Epinephrine (for possible anaphylactic shock)
After RPG:
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Monitor VS
Increase fluid intake flush the dye
Inform: Burning sensation during urination may be experienced
Assess: Late allergic reactions
RENAL ARTERIOGRAM
Provides x-ray pictures of the blood vessels supplying the kidney.
Introduction of a radiopaque dye directly into the renal artery.
Most common site is the femoral artery
Used in evaluating persons suspected of having renal artery stenosis, abnormalities on the renal blood vessels or vascular damages.
Before RA
Cleanse bowel(Laxative)
Shave catheter insertion site
After RA
VS until stable
Cold puncture on the puncture site
Check for swelling / edema
Assess peripheral pulses
Check for color and temperature of the skin
Bedrest for 24 hours, no sitting
Measure I and O
ULTRASOUND
Detects tumors, cyst obstructions and abscesses
Nursing Interventions:
Cleanse the bowel
Force fluids
Withhold voiding
RENAL BIOPSY
To determine malignancies
Nursing Interventions
NPO 6-8 hours
Check PTT, PT (Bleeding is usual)
Mild Sedation
Local anesthesia
Hold breath during insertion of needle
UTZ to locate kidneys
A reversible condition characterized by a sudden reduction or cessation of renal function retention of waste compounds increase in
urea and creatinine
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a. Etiology:
Prerenal
Prolonged deficit in renal blood (renal artery disease , hypovolemia, aortic stenosis, hypotension)
Intrarenal
Damage to the renal parenchyma (glomerulonephritis, acute tubular necrosis [ATN], diabetic nephropathy, pyelonephritis, drug induced).
Diagnostic tests requiring the use of dye (nephrotoxic.)
Postrenal
Obstruction to urine outflow (renal stones, tumors, ureteral kinks, instrumentation).
Assessment of CRF:
1. Inability of the kidneys to excrete metabolic waste products of protein through urine formation
Oliguria
Increased BUN, s. creatinine (AZOTEMIA)
Uriniferous odor of breath
Stomatitis and G.I. Bleeding – urea is converted back into ammonia which
irritates mucous membrane
Destruction of rbc, wbc, platelets
Renal encepalopathy
Uremic frost (pruritis and dryness of skin)
Decreased libido, impotence, infertility (hormonal imbalances)
2. Inability of the kidneys to maintain fluid – electrolyte, acid – base balance.
Edema
Hyperkalemia
Hypo / hypernatremia
Hypermagnesemia
Metabolic acidosis
3. Inability of the kidneys to secrete Erythropoietin (Renal Erythropoetic Factor) Anemia
4. Inability of the kidneys to metabolize Vitamin D.
Hypocalcemima
Hyperphosphatemia
Renal osteodystrophy
5. Altered biochemical environment
Glucose intolerance
1. Conservative Management
Fluid Control
Electrolyte Control
Hyperkalemia
Metabolic acidosis
Hypocalcemia / hyperphosphatemia
Dietary Control
2. Treatment of intercurrent Disorders
Anemia
Gastrointestinal Disturbance
Hypertension, CHF, pulmonary edema, hypocalcemia, hyperphosphatemia, etc.
Guidelines for the Care of the Person with Chronic Renal Failure
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MEDICAL MANAGEMENT:
Hemodialysis
Alternates to the excretory but not on the endocrine function of the kidneys
Practice ARM PRECAUTION
Assess for patency: auscultate for bruit, palpate for thrill
Tourniquet be always available if A – V shunts is present.
• A – V shunt may be used immediately
• A – V fistula may be used after 4-6 weeks wait for healing. It can be used for 3-4 years.
Vascular access:
• Arteriovenous fistula.
• Arteriovenous graft.
• External arteriovenous shunt.
• Femoral vein catheterization.
• Subclavian vein catheterization.
Peritoneal Dialysis
Advantages:
Steady state of blood chemistries.
Patient can dialyze alone in any location without need for machinery.
Patient can readily be taught the process.
Patient has few dietary restrictions; because of loss of CHON in daily dialysate, the patient is usually placed on a high CHON diet.
Patient has much more control over daily life.
Peritoneal dialysis can be used for patients that are hemodynamically unstable.
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a. Etiology
Bacteria, usually E. Coli.
Pyelonephritis spread of bacteria into the bloodstream, urinary reflux, obstruction or ascending UTI.
Cystitis:
a. BPH
b. Occurs more commonly in women
c. Uretheritis - bacterial and viral infections
Other factors include:
a. Stasis
b. Urinary retention and bladder distention.
c. Instrumentation
d. Poor hygiene
e. Fecal incontinence
f. Sexual transmission of bacteria
c. Nursing interventions:
C AND S before antibiotic therapy
Fluid intake (3 – 5 L/day)
Acidity
Hot Sitz bath
3 W’s: wash, wear, wipe
Empty bladder every 2-3hours
Empty bladder immediately after sexual intercourse
Analgesic: PYRIDIUM (Phenazopyridine) - Causes red – orange discoloration of body secretions
Urinary Antiseptic
Cinoxacin (Cinobac)
Nalidixic (Noroxin)
Nitrofurantoin (Macrodatin)
Metheranime Mandelate (mandelamine)
Sulfonamides
Co-trimoxazole (Bactrim)
Sulfisoxazole (Gantrisin)
Cholinergics (to relieve urinary retention)
Bethanechol chloride (Urecholine)
Anticholinergics (to decrease bladder muscle spasms)
Propantheline Bromide (Pro-Banthine)
Antibiotics
Ciprofloxacin (Cipro)
Cephalexin (Keflex)
a. Etiology
Urinary pH influences stone formation
Low calcium and phosphate stone formation
High uric acid stone formation
Other factors are:
Excessive calcium and protein intake
Urinary stasis
Dehydration
c. Nursing Interventions
Increase fluid intake 1 to 3 L daily
Strain urine to determine type of stone
Encourage patient to ambulate to facilitate passage of stones.
Administer analgesics for pain
Provide dietary counseling to prevent recurrent stone formation:
a. Acid-ash diet for calcium and phosphate stones
b. Alkaline ash and low purine diet for uric acid stones
Prepare for surgery for stone removal:
a. Nephrolithotomy – kidney stone
b. Pyelolithotomy – renal pelvis
c. Ureterolithotomy – ureters
d. Cystostomy – bladder calculi
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BLADDER CANCER
More common in males
Cause: unknown
a. Risks Factors
Exposure to cigarette smoke
Pelvic radiation
Use of cyclophosphamide
Chronic cystitis
Bladder calculi
Schistosomiasis
b. Assessment
Painless hematuria (first sign)
Dysuria
Gross hematuria
Obstruction to urine flow
Development of fistula (urine from the vagina, fecal material in the urine)
c. Collaborative Management
Chemotherapy
Thiotepa
Mitomycin C
Doxorubicin (Adriamycin)
Cyclophosphamide (cytoxan)
Cisplatin (Platinol)
Methotrexate
Radiation
Surgery - Urinary Diversion Surgeries
a. Ileal Conduit
For CA Bladder
Adult Neurogenic Bladder
Insterstitial Cystitis
Irreparable Trauma
Important!
External collection device needed
Proper fitting to prevent urine leak to the skin
Skin care with warm water and mild soap
Complications:
Obstruction to the urine flow via small intestines secondary to edema
Infection
Stoma prolapse
Calculi
Electrolyte imbalances
b. Ureterostomy
Either or both ureters are out to the abdominal wall
Ureteral stoma is created
External collection device is needed
Infection is a potential hazard
Increase fluid intake
c. Nephrostomy
To drain the urine while ureteral inflammation from trauma or calculus is present
Complications:
Infection (Pyelonephritis)
Blockage of the catheter
Important!
DO NOT IRRIGATE!!!
d. Ureterosigmoidostomy
No external collection device
Passage of flatus includes leak of urine
Infection is possible
c. Assessment
Rectal Examination (Digital Examination)
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Cystoscopy
Nocturia
Hesitancy
Residual urine
Hematuria
UTI
d. Management
1. TURP (Transurethral Resection of the Prostate)
No incision
Continuous bladder irrigation (CBI) or dystoclysis I done postpop
This is to irrigate the bladder and remove blood clots
No incontenence, no impotence postop.
2. Suprapublic Prostatectomy
Incision over lower abdomen and bladder
With cystostomy tube and 2-way foley chatter postop
No incontenence, no impotence post
3. Retropublic Prostatectomy
Incision over the abdomen
No incontenence, no impotence postop
Postoperative Care
Client Teaching
After removal of catheter: observe for urinary retention/dribbling
Dribbling: KEGEL’s exercise to strengthen pubococcygeal muscle and help regain control voiding
Avoid the following
1. Vigorous exercise
2. Having lifting sexual intercourse 3 weeks after the discharge
3. Driving 2 weeks after discharge
4. Straining with defection
5. Prolonged sitting / standing
6. Crossing the legs
7. Long trips
PROSTATE CANCER
Most common male cancer
Androgen – dependent adenocarcinomas
a. Predisposing Factors
50 years of age
Genetic tendency
Hormonal factors
Late puberty
High frequency of sexual experience
History of multiple sexual partners
High fertility
Diet
↑fat (alters cholesterol and steroid metabolism)
Chemical carcinogens
Air pollution
Occupation-related; industries – fertilizer, rubber, textile; batteries containing Cadmium
Viruses
b. Assessment
Hesistancy
Hematuria
Urinary retention
Stool changes
Pain radiating down hips and legs
Cytitis
Dribbling
Nocturia
Hard, enlarged prostate
Pain on defaction
High level of acid phospatase
Pain on defection
Elevated PSA (Prostatic Specific Antigen)
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c. Nursing Interventions
Early detection of tumor
Ultrasound
MRI
X-ray
CT Scan
Radiation therapy
Endocrine therapy - DES (diethylstilbestrol) decreases testosterome level)
Surgery: Prostatectomy
NEPHROTIC SYNDROME
A group of symptoms associated with the protein loss that occurs with various renal disorders.
a. Etiology:
Presence of other primary diseases, such as diabetes, and systemic lupus erythematosus (SLE).
c. Nursing interventions:
1. Provide the patient with a high-protein, low-salt, diet.
2. Administer diuretics, as ordered.
3. Observe carefully for signs of hypovolemia and hypokalemia.
4. Observe for and treat symptoms of renal failure.
GLOMERULONEPHRITIS
Glomerulonephritis is an inflammatory disorder involving the glomerulus.
Types of glomerulonephritis include:
a. Acute poststreptococcal: Onset is abrupt, typically occurring 7 to 10 days after a streptococcal throat or skin infection.
b. Chronic glomerulonephritis: Occurs when glomerular disease leads to chronic renal failure
c. Glomerular lesions may assume any shape or form; the type of lesions present often determines the course and severity of the
disease.
a. Etiology:
Glomerulonephritis is caused by an immune reaction to the presence of an infectious organism, usually group A beta-hemolytic
Streptococcus.
Manifestations include:
Acute onset of hematuria
Red blood cell casts
Proteinuria
Decreased (GFR)
Oliguria
Edema
Hypertension
c. Nursing interventions:
1. Assess and monitor renal functions - serum creatinine (BUN) tests.
2. Observe for signs and symptoms of infection; avoid exposing the patient to persons with infections.
3. Limit sodium, potassium, fluid, and protein intake.
4. Prepare for dialysis, as indicated.
PYELONEPHRITIS
Infection of the kidney tissue and pelvis that occurs from several sources; may be acute or chronic.
a. Etiology:
1. Typically is caused by bacteria, but may result from fungi or viruses.
2. Acute pyelonephritis results
From bacterial contamination by way of the urethra or from instrumentation.
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c. Nursing interventions:
1. Administer antimicrobial agents, as ordered.
2. Avoid exposing the patient to persons with infections.
3. High normal fluid intake, 2 to 3 L daily
4. CBR to reduce the metabolic rate and rest the kidneys.
5. Analgesics PRN
6. Monitor I & O, weight, temperature, PR, and BP to assess volume status.
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