Genito Urinary Tract

Genito - Urinar y
Tract
Urinary System
•
•Functions:
•Helps to clean the body, disposing of waste
products, & excess ions
•Regulates blood volume & RBC production
thru Erythropoeitin
•Regulates Blood pressure thru Renin
•Consists of :
•Kidneys
•Ureters
•Urinary bladder
•Urethra
Floating
Ribs
Iliac Crest
Renal Calyx
Urine Formation
•
•Nephrons – structural and functional units of the

kidneys responsible for the production of urine
•Consists of:
• Glomerulus – which is a knot of capillaries
• Renal Tubule
• Glomerular or Bowman’s Capsule
• Proximal Convoluted Tubule
• Loop of Henle
• Distal Convoluted Tubule
•Collecting ducts receive the formed urine and sending
it to the Renal Calyces and Renal pelvis
•Urine Formation has three processes
1. Filtration – at the glomerular capsule & renal
tubule
2. Reabsorption – at the renal tubules
3. Secretion – at the tubules into the collecting
ducts
Urine
•
•generally clear & pale to deep yellow

•Color due to Urochrome – from hemoglobin destruction
•Is sterile & becomes odorous once bacteria acts on the urine solutes
•Specific gravity – the term used to compare how much heavier urine
is to distilled water
•Normally : Specific Gravity is 1.001 – 1.035
•Solutes found normally in the urine : Sodium, Potassium, Urea, Uric
Acid, Creatinine, Ammonia & bicarbonate ions
•Glucose (Glycosuria) – indicates excessive intake of sugar-foods or
DM
•Proteins (Albuminuria) – Indicates Pregnancy, Glomerulonephritis or
Hypertension
•Pus (Pyuria) – indicates UTI
•RBC’s (Hematuria) – indicates bleeding in the urinary tract
•Hemoglobin (Hemoglobinuria) – indicates transfusion reaction or
Hemolytic anemia
•Bile pigment (Bilirubinuria) – indicates liver disease such as hepatitis
or Liver cirrhosis
Micturation
•
•The bladder is capable of holding more than 1000ml of

urine
•When about 200cc of urine is accumulated, the
micturation reflex is initiated
•If ignored, the urge disappears, but if another 200-300cc
of urine is collected, the micturation reflex occurs again
•An average minimum of 30cc/hr is considered normal
•Oliguria is abnormally low urine output – about 100cc –
400cc/day
•Anuria is urine output of less than 100cc/day
•
LABORATORY/DIAGNOSTIC TESTS
URINE STUDIES
1. URINALYSIS
- examination to assess the nature of the urine produced.
a. Evaluates color, pH, and specific gravity
COLOR: pale to amber
VOLUME: 30 ml/hour
APPEARANCE: Clear
ODOR: aromatic then strong ammoniacal odor
SPECIFIC GRAVITY:
- measures the kidney’s ability to concentrate urine.
1.015-1.025 (24 hr urine collection)
1.003-1.030 (random specimen)
pH:4.8-8.0
pH:
b. Determines the presence of glucose, protein, ketones and blood.
c. Analyzes sediment for cells
- presence of WBC, bacteria, crystals
URINE STUDIES
2. URINE CULTURE and SENSITIVITY
- diagnoses bacterial infections of the urinary tract.
VOIDED SPECIMEN (CLEAN CATCH)
- bacterial count >100,000 organisms/ml
STERILE, CATHETERIZED URINE SPECIMEN
- > 10,000 organisms/ml
3. RESIDUAL URINE
- amount of urine left in the bladder after voiding measured via
catheter (permanent or temporary) in bladder.
4. CREATININE CLEARANCE TEST

- measures the volume of blood cleared of creatinine in 1 min.
- measures overall renal function; measures GFR
- most sensitive indication of early renal disease.
Normal: 100-120 ml/min or 120-125 ml/min
URINE COLLECTION METHODS
1. ROUTINE URINALYSIS
•Wash perineal area if soiled.
•Obtain first voided morning specimen.
•Send to lab immediately.
- should be examined within 1 hour of voiding

2. CLEAN CATCH (MIDSTREAM)
SPECIMEN for URINE CULTURE
•Cleanse perineal area.
FEMALE
Spread labia and cleanse meatus front to back using antiseptic
sponges.
MALE
Retract foreskin (if uncircumcised) and cleanse glans with
antiseptic sponges.

3. 24-hour URINE SPECIMEN
- preferred method for creatinine clearance test.
•Have client void and discard specimen; note time.
•Collect all subsequent urine specimens for 24 hours.
•If specimen is accidentally discarded, the test must be
restarted.
•Record exact start and finish of collection; include date
and time.
BLOOD STUDIES
•BICARBONATE
- 22-26 mEq/L
•BUN
- measures renal ability to excrete urea nitrogen
- Normal: 5-20 mg/dl
•CALCIUM
- 9.0-10.5 mg/dl
•SERUM CREATININE
- Specific tests for renal disorders
- Reflects ability of kidneys to excrete creatinine
- 0.7-1.5 mg/dl
•PHOSPORUS
- 2.5-4.5 mg/dl
•Sodium
- 136-145 mEq/L
KUB (PLAIN FILM)

•An x-ray film that views the urinary system & adjacent
structures.
•May identify the number and size of kidneys with tumors,
malformations, and calculi.
•Requires no special preparation.
KUB
INTRAVENOUS PYELOGRAM
(IVP)
•Fluoroscopic visualization of the urinary tract after injection with a
radiopaque dye.
NURSING CARE (PRE-TEST)

•Obtain consent.
•Assess for allergies to iodine, seafood & radiopaque dyes.
•Inform client he will lie on a table throughout procedure.
•Administer laxatives or enema the night before.
•Keep the client NPO for 8 hours pretest.
•Inform client about possible throat irritations, flushing of the face,
warmth or a salty taste that may be experienced during the test.
NURSING CARE (POST-TEST)

•Force fluids at least 1L unless contraindicated.
•Assess venipuncture site for bleeding.
•Monitor V/S & urinary output.
CYSTOSCOPY
•The bladder mucosa is examined for inflammation, calculi or tumors
by means of a cystoscope; biopsy may be obtained.

•Obtain consent.
•Explain to client that the procedure will be done under general/local
anesthesia.
•Administer enemas/laxatives as prescribed.
•Administer sedatives 1 hour before test, as ordered.
•General anesthesia:
anesthesia Keep client on NPO after midnight before he
test.
•Local anesthesia:
anesthesia offer liquid breakfast.
CYSTOSCOPY

•Monitor V/S and I&O.
•Monitor for postural hypotension.
•Force fluids as prescribed.
•Encourage DBE to relieve bladder spasms.
•Administer analgesics.
•Administer sitz baths for back and abdominal pain.
•Legs cramps are common.
•Assess urine color & consistency.
Pink tinged or Tea-colored urine is expected.
Bright red urine or presence of large clots are not normal & should
be immediately reported to MD.
RENAL ANGIOGRAPHY
•The injection of a radiopaque dye through a catheter for examination
of the renal arterial supply.

•Obtain consent.
•Assess client for allergies to iodine, seafood & radiopaque dyes.
•Inform about possible burning feeling of heat along the vessel when
the dye is injected.
•NPO postmidnight before the test.
•Instruct client to void immediately before the procedure.
•Shave injection sites as prescribed.
•Assess & mark the peripheral pulses.

•Assess V/S & peripheral pulses..
•Provide bedrest and use of sandbag at the insertion site
for 4-8 hrs.
•NPO postmidnight before the test.
•Assess color & temp. of the involved extremity.
•Force fluids unless C/I.
•Monitor urinary output.
DISORDERS OF THE
GENITO-URINARY SYSTEM
CYSTITIS
GENERAL INFORMATION
•Inflammation of the bladder due to bacterial infection
or obstruction of the urethra.
•More common in women.
•“Honeymooner’s Cystitis”
•Most common causative agents are:
•E. Coli,Pseudomonas & Serratia
PREDISPOSING FACTORS
•Stagnation of urine
•Obstruction of free flow of urine
•Urinary reflux and Sex
CYSTITIS
CLINICAL FINDINGS
•Urgency & frequency
•Burning in urination / dysuria – initial manifestation
•Voiding in small amounts
•Inability to void & incomplete emptying of the bladder
•Suprapubic or flank pain
•Cloudy, dark, foul smelling urine
•Hematuria
•Bladder spasms
•N & V, malaise, chills & fever
DIAGNOSTIC TESTS
CYSTITIS
NURSING INTERVENTIONS
•Obtain specimen for urine culture & sensitivity test.
•Force fluids up to 3L esp. if client is taking Sulfonamides.
•Administer medications as prescribed such as
analgesics, antiseptics, antispasmodics & antimicrobials.
•Maintain an acid urine pH (5.5).
•Consume an acid ash diet.
•Observe strict aseptic technique when inserting catheter.
•Observe meticulous perineal care for the client with FBC.
•Discourage caffeine products such as coffee, tea & cola.
•Instruct client to avoid alcohol.
•Provide heat to abdomen or sitz bath for comfort.
•Instruct strict compliance of antibiotics. ( 10-14 days)
CYSTITIS
PREVENTION OF CYSTITIS
•Teach good perineal hygiene (wipe from front to back).
•Instruct female client to avoid bubble baths, tub baths and
avoid vaginal deodorants or sprays.
•Instruct to void every 2-3 hours.
•Teach female client to void and drink a glass of H2O after sex.
•Wear cotton pants & underwear and avoid tight fitting clothes
or pantyhose
•avoid sitting in a wet bathing suit for prolonged periods of time.
•Teach pregnant women to void every 2 hours.
•Encourage menopausal women to use estrogen vaginal creams
to restore pH.
•Instruct client to use water-soluble lubricants for coitus,
especially after menopause.
Medications commonl y used:
•Antibiotics
•Co-Trimoxazole (Bactrim, Septra, Triglobe)
•Quinolones (Ciprofloxacin)
•Nalidixic Acid
•Nitrofurantoin (Macrodantin)
•Phenazopyridine (Pyridium) – a urinary analgesic
•
Herbal Alert:
•CRANBERRY – for UTI
•SAW PALMETTO - treats UTI & urinary problems, a
diuretic and urinary antiseptic to prevent bladder
infections
•UVA URSI – for UTI and is a Diuretic
PYELONEPHRITIS
•Inflammation of the renal pelvis & parenchyma, commonly caused

by bacterial invasion
•Acute Infection
- usually ascends from the lower urinary tract or following an
invasive procedure of the urinary tract
- can progress to bacteremia or chronic pyelonephritis
ASSESSMENT
•Fever & Chills

•N/V
•CVA tenderness, flank pain on the affected side
•Headache, muscular pain, dysuria
PYELONEPHRITIS
Chronic Infection
- Major cause is ureterovesical reflux
- Result of recurrent infections is eventual parenchymal
deterioration and possible renal failure
ASSESSMENT
•Client usually unaware of the disease
•May have bladder irritability
•Chronic fatigue
•Slight dull ache over the kidneys
•Eventually develops hypertension, atrophy of the
PYELONEPHRITIS
MEDICAL MANAGEMENT
ACUTE INFECTION
•Antibiotics
•Antispasmodics
•Surgical removal of any obstruction
CHRONIC INFECTION
•Antibiotics and urinary antiseptics
- Sulfonamides , Nitrofurantoin
•Surgical correction of structural abnormality if possible
PYELONEPHRITIS
NURSING CARE
•Monitor I & O
•Encourage fluids
•Encourage adequate rest
•Administer antibiotics, analgesics as ordered.
•Support client and significant others and explain
the possibility of dialysis, transplant options if
significant renal deterioration.
•
•Provide client teaching and discharge planning:
- Medication regimen
- Diet: high calorie, low protein
Nephrolithiasis/Urolithiasis
GENERAL INFORMATION
•
•Presence of stones anywhere in the renal &
urinary tract.
•Frequent compositions of stones:
•calcium phosphate, calcium oxalate, uric
acid, struvite and cystine (rare) stones
•Most often occurs in men age 20-55 years
•All are radiopaque except Uric acid stones
•Calcium stone – 80 %
•Stones
< 6mm usually pass out spontaneously
•
•Diet: large amount of calcium, oxalate
•Increased uric acid levels
•Sedentary lifestyles, immobility
•Family history of gout or calculi
•Hyperparathyroidism
•Purine metabolism disorder
•Obstruction & urinary stasis
•Infection ( Proteus vulgaris)
•Dehydration & urine concentration
•Immobilization
•Excess vitamin D, milk
•Hyperuricemia & hypercalcemia
•High intake of salt, calcium, protein, tea & fruit juices
CLINICAL FINDINGS
•Abdominal pain or flank pain – severe, sudden
onset
•Renal colic
- severe pain in the kidney area radiating down
the flank to the pubic area
•Hematuria, frequency, urgency, nausea
•History of prior associated health problems
•gout, parathyroidism, immobility,
dehydration, UTI
•Diaphoresis
•Pallor
•Grimacing
MEDICAL MANAGEMENT
1.SURGERY
A. PERCUTANEOUS NEPHROSTOMY
- Tube is inserted through skin and underlying tissues into
renal pelvis to remove calculi.
B. PERCUTANEOUS NEPHROLITHOTOMY
- Delivers U/S waves thorough a probe placed on the
calculus
2. PERCUTANEOUS ULTRASONIC LITHOTRIPSY (PUL) -

Nephroscope is inserted through skin into kidney. -
Ultrasonic waves disintegrate stones that are then removed by
MEDICAL MANAGEMENT
3. EXTRACORPOREAL SHOCK - WAVE
LITHOTRIPSY (ESWL)
- Client is placed in water and exposed to

shock waves that disintegrate stones so that they
can be passed with urine.
- This procedure is non-invasive.

Management
Immediate analgesia & hydration
Avoidance of dietary excess :
Calcium stones – low calcium diet, acid ash diet:
cranberry juice, prune juice, meat, eggs, fish,

poultry
Uric acid stone– low purine diet : liver, kidney,
shellfish, meat, legumes

Alkaline ash diet– milk, vegetables & fruits except
prune & cranberry

Management
Struvite stones – alkaline ash diet
Cystine stones – limit protein food - (low
methionine) meat, milk, eggs, cheese, Alkaline
ash diet
Morphine, Meperidine, Acetaminophen with
Codiene
Antispasmodic – Buscopan
Allopurinol - reduce urine Uric excretion
Antibiotics for infections
Thiazide diuretics - reduce urine Ca excretion

•Strain all urine through gauze to detect stones and crush
all clots.
•Force fluids (3000 – 4000 ml/day).
•Encourage ambulation to prevent stasis.
•Relieve pain by administration of analgesics as ordered
and application of moist heat to flank area.
•Monitor I & O.
•Provide modified diet, depending upon stone
consistency.
DIET ALTERED ACCORDING TO TYPE
OF STONE
CALCIUM PHOSPHATE STONES
•Caused by supersaturation of urine with Ca & Phosphate
•Stone: Alkaline chemistry
•Diet: Acid ash diet, low Ca foods
•
CALCIUM OXALATE STONE
•Caused by supersaturation of urine with Ca & Oxalate
•Stone: Alkaline chemistry
•Diet: Acid ash diet, low Ca foods
•Avoid the following oxalate food sources:
- tea, almonds, cashews, chocolate, cocoa, beans, spinach and
rhubarb
DIET ALTERED ACCORDING TO TYPE OF
STONE
STRUVITE STONES
•Also called as Triple Phosphate stones; composed of Mg and
Ammonium phosphate
•Caused by urea splitting by bacteria
•Stone: tend to form in alkaline urine
•Diet: Limit foods high in phosphate foods such as dairy
products, red & organ meats, whole grains
URIC ACID STONES

•Caused by excess dietary purine or gout
•Stone: tend to form in acidic urine
•Diet: Alkaline ash foods
•Avoid the following purine food sources:
- organ meats, gravies, red wines, sardines, Liver, brains, kidneys,
venison, shellfish,
•Allopurinol (Zyloprim) may be prescribed to lower uric acid levels
DIET ALTERED ACCORDING TO
TYPE OF STONE
CYSTINE STONES
•Caused by cystine crystal formation
• Stone: tend to form in acidic urine
• Diet: Alkaline ash foods
• Encourage fluid intake of 3L/day
• Low methionine
- Methionine is the essential amino acid from which the
non-essential amino acid cystine is formed
ACID ASH DIET
OUTCOME
•Decreases the pH
•makes the urine more acidic
FOODS TO INCLUDE
•Cheese, eggs
•Meat, fish, oysters, poultry
•Bread, cereal, whole grains
•Pastries
•Cranberries, prunes, plums, tomatoes
•Corn & legumes
ALKALINE ASH DIET
OUTCOME
•Increases the pH
•Reduces the acidity of the urine
FOODS TO INCLUDE
•Milk
•Fruits except cranberries, plums, prunes
•Rhubarb
•Most vegetables
•Small amounts of beef, halibut, veal, trout, & salmon
•
•Encourage daily weight-bearing exercise to prevent hypercalcinuria

caused by release of calcium from the bones when not contraindicated.
•Provide client teaching and discharge planning concerning:
•Prevention of urinary stasis by maintaining increased fluid
intake esp. in hot weather and during illness
•mobility
•voiding whenever the urge is felt and at least twice during the
night.
- Adherence to prescribed diet.
- Need for routine U/A (at least every 3-4 months)
- Need to recognize and report S/S of recurrence
- hematuria, flank pain
RENAL FAILURE
Prerenal Causes Intrarenal Causes
Acute tubular Postrenal Causes
necrosis
Hypotension (ATN) Calculi
- ischemia /
Shock Diabetes Tumors
toxins
mellitus Blood clots
CHF Malignant
hypertension BPH
Acute
Hemorrhage
glomeruloneph Strictures
Burns ritis
Tumors Trauma
Septicemia
Impaired Allergic Anatomic
Cardiac Reactions malformation
Output Nephrotoxins
Clinical manifestations
Nausea & vomiting, diarrhea
Dryness of mucous membrane
Decrease skin turgor
Fever
Skin rashes
Edema
Difficulty in voiding
Changes in urine flow
Azotemia – retention of nitrogenous wastes
 (BUN > 20mg/dL)

ACUTE RENAL FAILURE
CLINICAL FINDINGS
OLIGURIC PHASE - Caused by reduction in GFR
•Urine less than 400 ml/24 hours
-duration: 1-2 weeks (8-15 days)
-Urine SG is 1.010 – 1.016
-Anorexia, N&V, hypertension, decreased skin turgor, pruritus,
-Tingling of the extremities, drowsiness progressing to coma
-Edema, Dysrhymias, CHF & pulmonary edema
DIAGNOSTIC TESTS
Elevated BUN Elevated creatinine
MANIFESTATIONS
Na level normal/decreased Hypermagnesemia Hyperphosphatemia
GFR decreases Hyperkalemia Hypocalcemia

Metabolic acidosis Fluid overload
ACUTE RENAL FAILURE
CLINICAL FINDINGS
- Slow, gradual increase in daily urine output
DIURETIC PHASE
•Diuresis may occur
- output: 3-5 L/day
vdue to partially regenerated tubule’s inability to concentrate
urine
-duration: 2-3 weeks
-Hypotension, tachycardia & improvement in LOC
DIAGNOSTIC TESTS
Gradual decline in BUN & creatinine
MANIFESTATIONS
Hyponatremia Hypokalemia Hypovolemia GFR begins to increase
ACUTE RENAL FAILURE
CLINICAL FINDINGS
RECOVERY / CONVALESCENT PHASE
-Slow process; complete recovery may take 1-2

years
-Urine volume is normal
-Increase in strength
-Increase in LOC
-BUN stable and normal
-Client may develop CRF
Diagnostic evaluation
Urinalysis : proteinuria, hematuria
Serum creatinine, blood urea nitrogen
Renal ultrasonography
Serum (K, Na, Ca, Mg & Phosphates)
Electrocardiogram
Chest PA view
Central Venous pressure

Management
• Diet : low salt, low potassium, low
phosphate, low protein, moderate Ca &
carbohydrates
• Correct reversible cause of ARF
• Relieve renal obstruction
• Intravenous hydration to improve renal
perfusion
• Dopamine, diuretic (Furosemine & mannitol)
• Correction of electrolyte problems
• Hemodialysis & peritoneal dialysis
ACUTE RENAL FAILURE
NURSING CARE
•Monitor fluid and electrolyte balance / I & O
•Monitor alteration in fluid volume.
•Promote optimal nutritional status
•Prevent complications from impaired mobility
•Prevent fever and infection
•Support client/S.O. & reduce/relieve anxiety

CHRONIC RENAL FAILURE
GENERAL INFORMATION
•Progressive, irreversible destruction of the kidneys that continues until
nephrons are replaced by scar tissue.
•Loss of renal function is gradual.
•Progressive deterioration of renal function is often asymptomatic until
severe renal insufficiency develops
•Recurrent infections
•Exacerbations of nephritis
•Urinary tract obstructions
•Diabetes mellitus
•Hypertension
CLINICAL FINDINGS
STAGE 1 STAGE 2 STAGE 3

Diminished Renal Renal
Renal Insufficiency Failure
Reserve
STAGE 4
End Stage
Renal
Disease
Nausea and vomiting Uremic Fetor , Uremic Frost
Decreased urinary output Dyspnea
Azotemia / Uremia Hypotension (early)
Hypertension (later) Lethargy
Convulsions Memory impairment
Pericardial friction rub CHF

Confusion -- Apathy --
Anemia Coma
Management
• Dietary modification : low protein, low salt, low
potassium, low phosphate
• Fluid restriction
• NaHCO3 for acidosis
• Hyperphosphatemia - phosphate binders
• Anemia – iron supplement and erythropoietin (EPO,
Epogen, Eprex (CAN), Procrit )

• Hypocalcemia - CaCo3
• Symptomatic Hyperuricemia - Allopurinol
• Antihypertensive medication
• Dialysis & Renal Transplantation
NURSING CARE:
•Prevent neurologic complications.
•Promote optimal GI function.
•Monitor/prevent alteration in F/E.

•
•Promote maintenance of skin integrity.
•Monitor for bleeding complications, and prevent

injury.
•Prevent neurologic complications .
- Assess every hour for signs of uremia.
üFatigue
üLoss of appetite
üDecreased urine output
üApathy
üConfusion
üElevated BP
üEdema of the face and feet
üItchy skin
üRestlessness and seizures
- Assess for changes in mental functioning.
- Orient confused client to time, place, date, and persons.
- Institute safety measures to protect client from falling out of bed.
- Monitor serum electrolytes, BUN, and creatinine as ordered.
•Promote optimal GI function .
- Assess/provide care for stomatitis.
- Monitor nausea, vomiting and anorexia.
- Administer antiemetics as ordered.
- Assess for signs of GI bleeding.
•Monitor / prevent alteration in fluid and

electrolyte balance .
•Assess for hyperphosphatemia .
- Paresthesias
- Muscle cramps
- Seizures
- Abnormal reflexes
- Administer Aluminum hydroxide gels as ordered.
- Amphogel, AlternaGEL
•Promote maintenance of skin integrity .
- Assess/provide care for pruritus.
- Assess for uremic frost and bathe in plain water.
vurea crystallization on the skin
•Monitor for bleeding complications and
prevent injury .
- Monitor Hgb, Hct, platelets, RBC.
- Hematest all secretions.
- Administer Hematinics (drugs that stimulate blood cell
production) as ordered.
- Avoid IM injections.
•Promote / maintain maximal cardiovascular
function .
- Monitor blood pressure and report significant changes.
- Auscultate for pericardial friction rub.
- Perform circulation checks routinely.
- Administer diuretics as ordered and monitor output.
- Modify digitalis dose as ordered.
•Provide care for client receiving

dialysis .
GENERAL INFORMATION
•Removal by artificial means of metabolic wastes, excess
electrolytes and excess fluid from clients with renal
failure.
PURPOSES
•Remove the end products of protein metabolism from
the blood
•Maintain safe levels of electrolytes.
•Correct acidosis and replenish the blood bicarbonate
system
•Remove excess fluid from the blood.
TYPES
•Hemodialysis
•Peritoneal dialysis
HEMODIALYSIS
GENERAL INFORMATION
•Client is attached to a dialysis machine via a surgically
created AV shunt
•4 hours, 3 times per week
ACCESS ROUTES
1. EXTERNAL AV SHUNT
- one cannula inserted into an artery and the other
into a vein.
- both are brought out to the skin surface and
connected by a U-shaped shunt.
EXTERNAL AV SHUNT
HEMODIALYSIS
NURSING CARE :
( EXTERNAL AV SHUNT)
•Auscultate for a bruit and palpate for a thrill to ensure
patency.
•Assess for clotting (color change of blood, absence of
pulsations in tubing).
•Change sterile dressings over shunt daily.
•Avoid venipuncture, administering IV infusions, or taking
BP with a cuff on the shunt arm.
HEMODIALYSIS
ACCESS ROUTES
2 . AV FISTULA
- internal anastomosis of an artery to an adjacent
vein in a sideways position.
- fistula is accessed for hemodialysis by
venipuncture.
- takes 4-6 weeks to be ready for use.
AV FISTULA
HEMODIALYSIS
NURSING CARE: (AV

FISTULA)
•Auscultate for a bruit and palpate for a thrill to ensure
patency.
•Report bleeding, skin discoloration, drainage, and pain.
•Avoid restrictive clothing/dressings over site.
•Avoid administering IV infusions, giving injections or
taking BP with a cuff on the shunt arm.
HEMODIALYSIS
ACCESS ROUTES
3 . FEMORAL SUBCLAVIAN CANNULATION
- insertion of a catheter into one of these large
veins for easy access to circulation.
- procedure is similar to insertion of a CVP line.
- it is only for temporary use.
FEMORAL VEIN
CATHETERIZ ATION
HEMODIALYSIS
NURSING CARE:
(FEMORAL/SUBCLAVIAN
CANNULATION )
•Palpate peripheral pulses in cannulized extremity.
•Observe for bleeding/hematoma formation.
•Position catheter properly to avoid dislodgement
during dialysis.
SUBCLAVIAN CATHETERIZATION
HEMODIALYSIS
NURSING CARE:
(BEFORE and DURING
HEMODIALYSIS)
•Have client void.
•Chart client’s weight.
•Assess vital signs before and every 30 mins. during procedure.
•Withhold antihypertensives, sedatives, and vasodilators.
- to prevent hypotensive episode (unless ordered otherwise).
•Ensure bed rest with frequent position changes for comfort.
•Inform client that headache and nausea may occur.
•Monitor closely for signs of bleeding since blood has been
heparinized for procedure.
HEMODIALYSIS
NURSING CARE: (POST- DIALYSIS)

•Assess for complications.
A . HYPOVOLEMIC SHOCK
- may occur as a result of rapid removal or ultrafiltration
of fluid from the intravascular compartment.
B . DIALYSIS DISEQUILIBRIUM SYNDROME

- Urea is removed more rapidly from the blood than from
the brain.
- Assess for nausea, vomiting, elevated BP, restlessness,
disorientation, leg cramps, and peripheral paresthesias, confusion &
seizure.
- Management: Prepare to dialyze the client for a shorter
period at a reduced blood flow rates
PERITONEAL DIALYSIS
GENERAL INFORMATION
•Introduction of a specially prepared
dialysate solution into the abdominal
cavity
•where the peritoneum acts as a semi -
permeable membrane between the dialysate
and blood into the abdominal vessels .
•4 exchanges a day , 7 days a week
•
PERITONEAL DIALYSIS
NURSING CARE
•Assess vital signs before, every 15 minutes during first exchange,
and every hour thereafter.
•Assemble specially prepared dialysate solution with added
medications.
•Have client void.
•Warm dialysate solution to body temperature.
•Assist physician with trocar insertion.
•Inflow: Allow 1 - 2 Liters of dialysate to flow unrestricted into
peritoneal cavity.
- 10-20 minutes
•Dwell: Allow fluid to remain in peritoneal cavity for prescribed period
- 20-30 minutes
•Outflow: Fluid drains out of the body by gravity into the
drainage bag.
- about 20-30 mins
PERITONEAL DIALYSIS
NURSING CARE
•Observe characteristics of dialysate outflow.
a. CLEAR PALE YELLOW or COLORLESS

- normal
b . CLOUDY
- infection, peritonitis
c . BROWNISH
- bowel perforation
d . BLOODY
- common during first few exchanges
- ABNORMAL: if continuous
e . SAME COLOR AS URINE
- indicates bladder perforation
PERITONEAL DIALYSIS
NURSING CARE
•Monitor total I & O and maintain records.
•Assess for complications.
A . PERITONITIS
ØResulting from contamination of solution or tubing during
exchange.
ØAssess for S/S such as:
- Severe abdominal pain
- Rebound tenderness
- Muscle rigidity
- Absent bowel sounds
- Abdominal distention
- Anorexia, nausea, vomiting
- Shallow respirations
- Decreased urinary output
- Weak, rapid pulse
- Elevated temperature
PERITONEAL DIALYSIS
NURSING CARE
•
B . ABDOMINAL PAIN
vPain during inflow is common during the first few
exchanges.
- usually caused by peritoneal irritation.
vCold temperature of the dialysate aggravates the condition.
- dialysate should be warmed before use with a special
dialysate warmer pad.
vPlace a heating pad on the abdomen during the inflow to
relieve discomfort.
PERITONEAL DIALYSIS
NURSING CARE
•
C . INSUFICIENT OUTFLOW
§May be caused by catheter migration out of the
peritoneal area.
- if this occurs, catheter must be repositioned by
the MD.
§Can also be caused by a full colon.
§Change the client’s outflow position by turning or
ambulating.
§Check for kinks in the tubings.
§Encourage stool softeners & high fiber diet.
PERITONEAL DIALYSIS
NURSING CARE
•
D . PROTEIN LOSS
- Most
serum proteins pass through the peritoneal
membrane and are lost in the dialysate fluid.
- Monitor serum protein levels closely.
KIDNEY TRANSPLANTATION
GENERAL INFORMATION
•Transplantation of a kidney from a donor to recipient to prolong the
life of person with renal failure.
SOURCES OF DONOR SELECTION

•Living relative with compatible serum and tissue studies, free from
systemic infection and emotionally stable.
•Cadavers with good serum and tissue crossmatching, free from
renal disease, neoplasms and sepsis, absence of ischemia or
trauma.
(PRE-OPERATIVE CARE)
•Provide routine pre-op care.
•Discuss the possibility of post-op dialysis /
immunosuppressive drug therapy with client and
significant others.
(POST-OPERATIVE CARE)
•Provide routine post-op care.
•Monitor fluid and electrolyte balance carefully.
- Monitor I & O hourly and adjust IV fluid administration
accordingly.
- Anticipate possible massive diuresis.
•Encourage frequent and early ambulation.
•Monitor V/S esp. temperature and report significant changes.
•Provide mouth care and Nystatin (Myostatin) mouthwashes for
Candidiasis.
( POST-OPERATIVE CARE)
•Administer immunosuppressive agents as ordered.
A . CYCLOSPORINE ( SANDIMMUNE )
- does not cause significant bone marrow depression.
Assess for:
- Hypertension
- Hypermagnesemia
- Hyperkalemia
- Decreased bicarbonate
- Neurologic functioning
C . CYCLOPHOSPHAMIDE ( CYTOXAN )
Assess for:
- Alopecia
- Hypertension
- Kidney/Liver toxicity
- Leukopenia
D . ANTILYMPHOCYTIC GLOBULIN ( ALG )

ANTITHYMOCYTIC GLOBULIN ( ATG )
Assess for:
- Fever
- Chills
- Anaphylactic shock
- Hypertension
- Rash
- Headache
E . CORTICOSTEROIDS ( PREDNISONE ,
METHYLPREDNISOLONE Na SUCCINNATE
[ SOLU - MEDROL ])
Assess for:
- PUD and GI bleeding
- Na/water retention
- Muscle weakness
- Delayed wound healing
- Mood alterations
- Hyperglycemia
- Acne
NURSING
INTERVENTIONS
( POST-OPERATIVE
CARE)
•Assess for signs of rejection.
Note for:
- Decreased urine output
- Fever/pain over transplant site
- Edema
- Sudden weight gain
- Increasing BP
- Generalized malaise
- Rise in serum creatinine
NURSING
INTERVENTIONS
( POST-OPERATIVE
CARE)
•Provide client teaching and discharge planning
concerning:
- Medication regimen
- S/S of tissue rejection and the need to
report it immediately to the physician
- Dietary restrictions
- Restricted Na and calories
- Increase CHON
- Daily weights
- Daily measurements of I & O
MALE
REPRODUCTIVE
DISORDERS
BENIGN PROSTATIC HYPERTROPHY
GENERAL INFORMATION
•Mild to moderate glandular enlargement, hyperplasia,
and overgrowth of the smooth muscles and connective
tissue
•As the gland enlarges, it compresses the urethra,
resulting in urinary retention.
•Most common problem of the male reproductive system
- occurs in 50% of men over age 50
- 75% of men over age 75
CLINICAL FINDINGS
•Nocturia
•Frequency
•Retention & dribbling
•
•Decreased force and amount of urinary stream

•Hesitancy
- difficulty in starting voiding
•Hematuria
•Urinary stasis & UTIs
•Enlargement of prostate gland upon palpation by digital rectal
exam
•Reduction in size and force of urinary stream – initial manifestation
DIAGNOSTIC TESTS
•Urinalysis
- alkalinity increased
- specific gravity normal or increased
•BUN and creatinine elevated
- if long standing BPH
•Prostate-specific antigen (PSA) elevated
- Normal: <4 ng/ml
•Cystoscopy
- reveals enlargement of gland and obstruction of urine flow
•Administer antibiotics as ordered.
•Provide client teaching concerning medications
- Terazocin (Hytrin)
- relaxes bladder spincter and makes it easier to urinate
- may cause hypotension and dizziness
- Finasteride (Proscar)
- shrinks enlarged prostate
•Force fluids (3-5L/day).
•Prepare for bladder drainage via urinary catheterization for
distention.
•Avoid administering medications such as anticholinergics,
antihistamines & decongestants.
•Prepare client for surgery as prescribed.
GENERAL INFORMATION
•Indicated for benign prostatic hypertrophy and prostatic
cancer
TYPES
1 . TRANSURETHRAL RESECTION
PROSTATECTOMY ( TURP )
2 . SUPRAPUBIC PROSTATECTOMY
3 . RETROPUBIC PROSTATECTOMY
4 . RADICAL PERINEAL PROSTATECTOMY
TYPES
1 . TRANSURETHRAL
RESECTION / TRANSURETHRAL
PROSTATECTOMY ( TUR or TURP )
- insertion of a resectoscope into the urethra to excise
prostatic tissue
- good for poor surgical risks
- does not require an incision
- most common type of surgery for BPH

TRANSURETHRAL PROSTATECTOMY
TYPES
2 . SUPRAPUBIC PROSTATECTOMY
- the prostate is approached by a low abdominal incision
into the bladder to the anterior aspect of the prostate
- for large tumors obstructing the urethra

SUPRAPUBIC PROSTATECTOMY
TYPES
3 . RETROPUBIC PROSTATECTOMY
- to remove a large mass high in the pelvic area
- involves a low midline incision below the bladder and into

the prostatic capsule
RETROPUBIC PROSTATECTOMY
TYPES
4 . RADICAL PERINEAL
PROSTATECTOMY
- often used for prostatic cancer
- the incision is made through the perineum, which
facilitates radical surgery if a malignancy is found
RADICAL PERINEAL PROSTATECTOMY
NURSING INTERVENTIONS:
(PRE-OPERATIVE CARE)
•Provide routine pre-op care.
•Institute and maintain urinary drainage.
•Force fluids, administer antibiotics, acid-ash diet to eradicate
UTI.
•Reinforce what surgeon has told client/significant others
regarding effects of surgery on sexual function.
•Provide routine post-op care.
•Ensure patency of 3-way Foley.
•Monitor continuous bladder irrigations with sterile saline
solution and control rate to keep urine light pink changing
to clear.
- removes clotted blood from bladder
•Expect hematuria for 2-3 days.
•Irrigate catheter with normal saline as ordered.
•Control/treat bladder spasms.
•Encourage short, frequent walks.
•Decrease rate of continuous bladder irrigations.
- if urine is not red and is without clots
•Administer anticholinergics (Probantheline bromide [Pro-
Banthine] or antispasmodics (B&O suppositories) as
ordered.
•Prevent hemorrhage.
- Administer stool softeners to discourage straining at
stool.
- Avoid rectal temperatures and enemas.
- Monitor Hgb and Hct.
•Report bright, red, thick blood in the catheter; persistent
clots, persistent drainage on dressings.
•Provide for bladder re-training after Foley removal.
- Instruct client to perform perineal exercises to
improve sphincter control.
- stopping and starting stream during voiding
- pressing buttocks together then relaxing muscles
- Limit liquid intake in evening.
- Restrict caffeine-containing beverages.
- Withhold anticholinergics and antispasmodics if
permitted.
- these drugs relax bladder and increase the chance
of incontinence.
•Provide client teaching and discharge planning
concerning:
- Continued increased fluid intake.
- Signs of UTI and the need to report them.
- Avoidance of heavy lifting, straining during defecation,
and prolonged travel (at least 8-12 weeks).
- Measures that promote urinary continence.
- Possible impotence
- discuss ways of expressing sexuality
- massaging, cuddling
- suggest alternative methods of sexual gratification
and use of assistive aids
- Discuss possibility of penile prosthesis with physician.
UNDESCENDED TESTICLES
(CRYPTORCHIDISM)
GENERAL INFORMATION
•Occurs when one or both testes fail to descend through the
inguinal canal into the scrotal sac
•Testes normally descend at 8 months of gestation
- will normally be absent in premature infants
•Incidence increased in children having genetically transmitted
diseases.
•Unilateral cryptorchidism most common
•75% will descend spontaneously by age 1 year
Cryptorchidism
•Undescended testes
•Assesment:
•empty scrotum (one or both)
•80% of undescended testes will be in the scrotum by 1
year of age
•Surgery should be done ideally at 1 to 3 years of age
•If not corrected by surgery before puberty:
•increased risk of testicular cancer
•decreased or absent sperm production – leading to
infertility
•androgen production is still OK
HYPOSPADIAS/EPISPADIAS
GENERAL INFORMATION
•Congenital defects involving abnormal placement of the urethral
orifice of the penis
ASSESSMENT
HYPOSPADIAS
- urethral orifice located below the glans penis along the ventral
surface
EPISPADIAS
- Urethral orifice located on the dorsal surface of the penis
- often occurs with exostrophy of the bladder
MEDICAL
MANAGEMENT
•Minimal defects needs no intervention.
•Neonatal circumcision is delayed.
- tissue may be needed for corrective repair.
•Surgery performed before the age of toilet training
- preferably between 16-18 months of age
NURSING
INTERVENTIONS
•Diaper normally.
•Provide support for the parents.
•Provide support for child at time of surgery.
Post-op
•Check pressure dressings.
•Monitor catheter drainage.
•Assess for pain.
NEPHROTIC SYNDROME
GENERAL INFORMATION
•Autoimmune process leading to structural alteration of
glomerular membrane that results in increased
permeability to plasma proteins, particularly albumin.
•Prominent symptoms: massive proteinuria,
hypoalbuminemia, hyperlipemia and edema
•
•Course of the disease consists of exacerbations and

remissions over a period of months to years.
•Commonly affects preschoolers.
- boys more often than girls
•Prognosis is good unless edema does not respond to
steroids.
NEPHROTIC SYNDROME
(NEPHROSIS)
Plasma CHON enter the renal tubule
Excreted in urine
PROTEINURIA
ÜOncotic pressure
ÜPlasma volume
HYPOVOLEMIA
Release of RENIN & ANGIOTENSIN êBP
éSecretion of aldosterone Release of ADH

Reabsorption of General shift of
Reabsorption of H2O & Na in distal tubule H2O plasma into
interstitial
spaces
MASSIVE EDEMA
NEPHROTIC SYNDROME
CLINICAL FINDINGS
•Periorbital Edema – initial manifestation
•Proteinuria, hypoproteinemia, hyperlipidemia
•Dependent body edema
- puffiness around eyes in morning
- ascites
- scrotal edema
- ankle edema
•Pale, irritable & fatigued child
•Decreased urine output
•Dark, frothy urine
•Anorexia, anemia
•amenorrhea or abnormal menses
NEPHROTIC SYNDROME
MEDICAL MANAGEMENT
•Drug therapy
- CORTICOSTEROIDS
- to resolve edema
- continued until the urine is free from CHON & remains normal
for 10 days – 2 weeks then tapered to D/C
- If relapse occurs: Low steroid dose OD may be
prescribed for 6 mos. – 1 year
- Immunosuppressant therapy with steroids
- to reduce relapse & induce long-term remission
- Plasma volume expenders
- Salt-poor human albumin & DEXTRAN, to severely edematous
child to raise the osmotic pressure
- Antibiotics
- for bacterial infections
- Thiazide / Loop diuretics
- edematous stage esp. if child has difficulty in
breathing
NEPHROTIC SYNDROME
•Provide bed rest.
- Conserve energy.
- Find activities for quiet play.
•Diet:
- Regular diet with regular CHON intake is prescribed if the
child is in remission.
- Provide high CHON, low sodium diet during edema
phase only.
•Maintain skin integrity.
- Don’t use Band-Aids.
- Avoid IM injections
- medication is not absorbed in edematous tissue.
•Obtain morning urine for CHON studies.
•Provide scrotal support.
•Monitor I & O, V/S and weigh daily.
•Administer steroids to suppress autoimmune response as ordered.
•Protect from known sources of infection.
ACUTE
GLOMERULONEPHRITIS
GENERAL INFORMATION
•Immune complex disease resulting from an antigen -
antibody reaction.
•Occurs more frequently in boys, usually between ages 6-7
years
•Usually resolves in about 14 days
•Self-limiting
•
CAUSES
•Immunological diseases
•Autoimmune diseases
•Streptococcal infection, group A beta-hemolytic
•History of pharyngitis or tonsilitis 2-3 weeks prior to
symptoms
ACUTE
GLOMERULONEPHRITIS
TYPES
ACUTE
•Occurs 2-3 weeks after a streptococcal infection
CHRONIC
•Can occur after the acute phase or slowly overtime
COMPLICATIONS
•Renal failure
•Hypertensive encephalopahy
•Pulmonary edema
•Heart failure
ACUTE GLOMERULONEPHRITIS
CLINICAL FINDINGS
•Gross hematuria or dark smoky, cola-colored
or red-brown urine
•Proteinuria that produces a persistent & excessive foam
in the urine
•Oliguria or anuria
•Azotemia
•Abdominal/flank pain
•Edema in the face & periorbital area, feet, or generalized
•Hypertension
•Headache, fever, chills, anorexia, N & V
DIAGNOSTIC FINDINGS
•U/A
- reveals RBCs, WBCs, CHON, cellular casts
•Urine specific gravity increased
•Low urinary pH
•BUN and serum creatinine increased
•ESR elevated
•Increased antistreptolysin O titer
•Hgb and Hct decreased
•Monitor I & O, BP, urine and weigh daily.
•Limit activity, bedrest & provide diversional therapy.
•Nutrition:
A. UNCOMPLICATED CASES
- Regular diet permitted but Na is restricted to no added
salt to foods
B. CHILD WITH HYPERTENSION/ EDEMA/ OLIGURIA
- Moderate Na restriction
- K & Fluid intake restrictions, if oliguria present
- CHON restrictions during azotemia
•Administer diuretics, antihypertensives, anticonvulsants, antibiotics
•Monitor for edema, fluid overload, ascites, pulmonary edema &
CHF
•Monitor for signs of renal failure & hypertensive encephalopathy
HYDRONEPHROSIS
GENERAL INFORMATION
•Distention of the renal pelvis & calices, caused by an
obstruction of normal urine flow
•Urine becomes trapped proximal to the obstruction
•
CAUSES
•Calculus
•Tumors
•Scar tissue & kinks in the ureter
HYDRONEPHROSIS
CLINICAL FINDINGS
•Hypertension
•Headache
•Flank pain
•Fluid & electrolyte imbalances
•Fluctuating mass in the region of the kidney
MEDICAL MANAGEMENT
•Surgery to correct or remove obstruction
HYDRONEPHROSIS
•Prepare child for multiple urologic studies:
a. IVP
- is the intravenous injection of a radiopaque
contrast medium followed by x-ray imaging of
the kidneys and ureters as the contrast agent
passes through.
b. Voiding cystourethrogram
- consists of serial x-rays of the bladder and
urethra after intravesicular infusion of an
iodine-bound contrast medium.
c. Cystoscopy
- is the evaluation of the urinary tract using direct
visualization via a metal tube or flexible sheath
and fiber technology.
HYDRONEPHROSIS
•Monitor V/S frequently.
•Monitor for fluid & electrolyte imbalances including
dehydration after the obstruction is relieved.
•Monitor diuresis which could lead to fluid depletion.
•Monitor daily weights.
•Monitor urine for specific gravity, albumin & glucose.
•Administer fluid replacement as prescribed.
Genito-urinary
medications
Urinary tract antiseptics- inhibit the
growth of bacteria in the urine

Side effects and nursing considerations


Nitrofurantoin

• gastrointestinal effects such as anorexia,

nausea, vomiting and diarrhea, administration
with milk or meals will minimize
gastrointestinal distress
• pulmonary reactions such as dyspnea,
chest pain, chills, cough and alveolar
infiltrates, these resolves in 2 to 4 days
following cessation of treatment
•
•
• hematological effects such as
agranulocytosis, luekopenia,
thrombocytopenia, and megaloblastic
anemia
• peripheral neuropathy such as muscle
weakness, tingling sensations, and numbness
•
• nuerological effects such as headache, vertigo,
drowsiness, nystagmus
•
• imparts a harmless brown color to the urine
•
• instruct the client in the expected side effects
and those warranting notifying the physician
METHENAMINE
• relatively safe and well tolerated
•
• may cause gastric distress
•
• chronic-high dose therapy can cause bladder
irritation
•
• can cause crystalluria and should not be used in
clients with renal impairment
• decomposition of medication generates
ammonia
•
• requires acidic urine with pH of 5.5 or less

• ingestion of large amounts of fluid will

reduce antibacterial effects by diluting
the medication and raising the urinary
Ph
•
• clients receiving this medication should
not be given alkalinizing agents
NALIXIDIC ACID
• gastrointestinal disturbances: nausea,
vomiting and abdominal discomfort
•
• Rash
•
• visual disturbances
•
• photosensitivity reactions
• may produce intracranial hypertension in
pediatric clients and should not be
administered to children under age 3
months
•
• when used for more than 2 weeks, complete
blood cell counts and liver function tests
should be performed
•
• can intensify the effects of oral
anticoagulants
•
• contraindicated in clients with a history of
convulsive disorders
CINOXACIN
• side effects are similar to those of nalixidic
acid
•
• dosage should be reduced in clients with
renal impairment, failure to do so could
result in accumulation of medication to
toxic levels
NORFLOXACIN
• can cause fatigue, headache, nausea,
constipation, rash and elevated liver
function tests
• encourage the clients to consume a high
fluid intake
• advise the client to take medication 1 hour
before or 2 hours after meals because
food may hamper absorption
SULFONAMIDES
suppress bacterial growth by inhibiting the
synthesis
Side effects and
 of folic acid
nursing considerations

• hypersensitivity reactions: rash, fever, and

photosensitivity
•
• Steven- Johnson’s syndrome, the most severe
hypersensitivity response, producing symptoms that
include widespread lesions of the skin and mucous
membranes, with fever, malaise and toxemia
•
• Should be discontinued if rash is observed
•
• Can case hemolytic anemia, agranulocytosis,
luekopenia, and thrombocytopenia
• Instruct the client to take medication on an
empty stomach with a full glass of water
•
• Instruct the client to avoid prolonged
exposure to sunlight, wear protective
clothing, and apply sunscreen to exposed
skin

• Adults should maintain a daily urine output of

1200 ml by consuming 8 to 10 glasses of
water each day to minimize the risk of renal
damage from the medication
 Can intensify the effects of
warfarin sodium Coumadin ),
phenytoin ( Dilantin ), and
oral hypoglycemics
•
 Administer with caution in
clients with renal impairment
•
 Contraindicated if a
hypersensitivity exists to
sulfonamides , sulfonyureas ,
or thiazide or loop diuretics
TRIMETHOPRIM ( proloprim,
trimpex)
• active against a broad spectrum of microbes
• suppresses bacterial synthesis of DNA, RNA,
and proteins
•
Side effects and nursing considerations
• itching and rash are the most frequent side

effects
• GI reactions such as such as epigastric
distress, nausea and vomiting, glossitis and
stomatitis occur occasionally
• Megaloblastic anemia, thrombocytopenia,
and nuetropenia may occur, such as
sore throat, fever or pallor, a CBC
should be performed
•
• Contraindicated in women who are
pregnant or are breast feeding
•
• Contraindicated in clients with folate
deficiency
CHOLINERGIC

• used to treat nonobstructive urinary retention

and nuerogenic bladder
• used to increase bladder tone and function
•
Side effects
• headache
• hypotension
• flushing and sweating
• increased salivation
•
• abdominal cramps
•
• nausea and vomiting
•
• Diarrhea
•
• urinary urgency
•
• bronchoconstriction
Nursing considerations
• do not administer if the client has a urinary
obstruction
•
• never administer by the intramuscular (IM) or
intravenous route
•
• monitor intake and output
•
• monitor for increased bladder tone and function
•
• monitor for cholinergic overdose
•

 Example: bethanecol
chloride ( Urecholine)
ANTISPASMODICS

•
• oxybutynin chloride ( Ditropan) relaxes
smooth muscles of the urinary tract
•
• propantheline bromide ( Pro-banthine)
decreases bladder muscle spasm
OXYBUTYNIN CHLORIDE
( Ditropan)
 Side effects

• luekopenia
• anxiety
• anorexia, nausea and vomiting
• palpitations
• sinus bradycardia

• do not administer to clients with known

hypersensitivity, GI or genitourinary
obstruction, glaucoma, severe colitis or
myasthenia gravis
•
• instruct the client to avoid hazardous
activities
Propantheline bromide ( pro-

bathine)

Side effects

• Palpitations

• blurred vision
– confusion in elderly clients
– Tachycardia
– Constipation
– dry mouth
– urinary hesitancy and urgency
– decreased sweating
• monitor intake and output
•
• provide gum or hard candy for dry mouth

• do not administer to clients with narrow

angle glaucoma, obstructive uropathy,
GI disease or ulcerative colitis
URINARY ANALGESIC
used for pain from urinary tract irritation
or infection
Side effects

• Nausea
•
• Headache

• Vertigo


instruct the client that the urine will turn


red or orange

contraindicated in renal or hepatic disease


 example: phenazopyridine hydrochloride

HEMATOPOIETIC GROWTH
FACTOR

used to stimulate red blood cell production


example: Epoetin alfa ( Epogen, procrit)


• monitor the CBC
•
• monitor vital signs, especially the blood pressure for
hypertension
•
• the extent for hypertension is directly related to the rate
of rise in hematocrit
•
• contraindicated in clients with uncontrolled hypertension

• used with caution in clients with cancers of myeloid origin

Preventing organ
rejection
• cyclosporine acts on T lymphocytes to suppress
production of interleukin-2, gamma interferon,
and other cytokines
•
• Azathioprine (Imuran) suppresses cell- mediated
and humoral immune responses by inhibiting
the proliferation of B and T lymphocytes
•
• Mycophenolate mofentil causes

selective inhibition of b and T
lymphocyte proliferation
•
•
• Therapeutic effect of anti-
thymocyte globulin results from a
decrease in the number and
activity of thymus- derived
lymphocytes
IMMUNOSUPPRESSANTS
Cyclosporine ( Sandimmune, Neoral)
Tracolimus ( Prograf)
 CYTOTOXIC MEDICATIONS

Azathioprine ( Imuran)
Mycophenolate Mofetil ( Cellcept)
GLUCOCORTICOID
Prednisolone ( Deltasone)

ANTIBODIES

• Anti- thymocyte globulin ( Atgam)

• Basiliximab (Simulect)
• Daclizumab ( Zenapax)
• Muromonab-CD3 ( Orthoclene OKT3)
THANK YOU

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Genito - Urinar y

•Nephrons – structural and functional units of the

•generally clear & pale to deep yellow

•The bladder is capable of holding more than 1000ml of

4. CREATININE CLEARANCE TEST

URINE COLLECTION METHODS

URINE COLLECTION METHODS

URINE COLLECTION METHODS

KUB (PLAIN FILM)

NURSING CARE (PRE-TEST)

NURSING CARE (POST-TEST)

NURSING CARE (PRE-TEST)

NURSING CARE (POST-TEST)

NURSING CARE (PRE-TEST)

NURSING CARE (POST-TEST)

•Inflammation of the renal pelvis & parenchyma, commonly caused

•Fever & Chills

•Provide client teaching and discharge planning:

2. PERCUTANEOUS ULTRASONIC LITHOTRIPSY (PUL) -

- Client is placed in water and exposed to

- This procedure is non-invasive.

Calcium stones – low calcium diet, acid ash diet:

cranberry juice, prune juice, meat, eggs, fish,

shellfish, meat, legumes

prune & cranberry

Allopurinol - reduce urine Uric excretion

Antibiotics for infections

Thiazide diuretics - reduce urine Ca excretion

URIC ACID STONES

•Encourage daily weight-bearing exercise to prevent hypercalcinuria

Decrease skin turgor

Changes in urine flow

Azotemia – retention of nitrogenous wastes

 (BUN > 20mg/dL)

GFR decreases Hyperkalemia Hypocalcemia

-Slow process; complete recovery may take 1-2

Serum (K, Na, Ca, Mg & Phosphates)

Central Venous pressure

•Monitor alteration in fluid volume.

•Promote optimal nutritional status

•Prevent complications from impaired mobility

•Prevent fever and infection

•Support client/S.O. & reduce/relieve anxiety

STAGE 1 STAGE 2 STAGE 3

Nausea and vomiting Uremic Fetor , Uremic Frost

Decreased urinary output Dyspnea

Azotemia / Uremia Hypotension (early)

Hypertension (later) Lethargy

Convulsions Memory impairment

Pericardial friction rub CHF

Epogen, Eprex (CAN), Procrit )

•Promote optimal GI function.

•Monitor/prevent alteration in F/E.

•Monitor for bleeding complications, and prevent

•Monitor / prevent alteration in fluid and

•Provide care for client receiving

NURSING CARE: (AV

NURSING CARE: (POST- DIALYSIS)

B . DIALYSIS DISEQUILIBRIUM SYNDROME

a. CLEAR PALE YELLOW or COLORLESS

SOURCES OF DONOR SELECTION

D . ANTILYMPHOCYTIC GLOBULIN ( ALG )

•Decreased force and amount of urinary stream