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
________________________________________________



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; 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
Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
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



A. PREDISPOSING FACTORS
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
Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
MS Abejo

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

A. PREDISPOSING FACTORS
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


Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
MS Abejo

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

A. PREDISPOSING FACTORS
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
Kussmauls 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
Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
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

Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
MS Abejo
Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
MS Abejo