genito urinary system

The Genito-Urinary The Genito-Urinary SystemSystem

Medical Surgical Nursing Medical Surgical Nursing ReviewReview

Outline of reviewOutline of review

Recall the anatomy and physiology of the Recall the anatomy and physiology of the Renal SystemRenal System

Renal Assessment Renal Assessment Renal Laboratory ProcedureRenal Laboratory Procedure Common Conditions:Common Conditions:

UTIUTI Kidney StonesKidney Stones ARF and CRFARF and CRF

Outline of reviewOutline of review

BPHBPH Prostatic cancerProstatic cancer

Kidney functionKidney function

The Nephron produces The Nephron produces urine to eliminate wasteurine to eliminate waste

Impaired urine production Impaired urine production and azotemiaand azotemia

Secretes Erythropoietin Secretes Erythropoietin to increase RBCto increase RBC

ANEMIAANEMIA

Metabolism of Vitamin DMetabolism of Vitamin D Calcium and Phosphate Calcium and Phosphate imbalancesimbalances

Produces bicarbonate Produces bicarbonate and secretes acidsand secretes acids

Metabolic ACIDOSISMetabolic ACIDOSIS

Excretes excess Excretes excess POTASSIUMPOTASSIUM

HYPERKALEMIAHYPERKALEMIA

Urological Assessment Urological Assessment

Nursing HistoryNursing History Reason for seeking careReason for seeking care Current illnessCurrent illness Previous illnessPrevious illness Family HistoryFamily History Social HistorySocial History Sexual historySexual history


Key Signs and Symptoms of Key Signs and Symptoms of Urological ProblemsUrological Problems

EDEMAEDEMAassociated with fluid retentionassociated with fluid retentionRenal dysfunctions usually Renal dysfunctions usually

produce ANASARCAproduce ANASARCA



PAINPAINSuprapubic pain= bladderSuprapubic pain= bladderColicky pain on the flank= kidneyColicky pain on the flank= kidney



HEMATURIAHEMATURIAPainless hematuria may indicate Painless hematuria may indicate

URINARY CANCER!URINARY CANCER!Early-stream hematuria= urethral Early-stream hematuria= urethral

lesionlesionLate-stream hematuria= bladder Late-stream hematuria= bladder

lesionlesion



DYSURIADYSURIAPain with urination= lower UTIPain with urination= lower UTI



POLYURIAPOLYURIAMore than 2 Liters urine per dayMore than 2 Liters urine per day

OLIGURIAOLIGURIALess than 400 mL per dayLess than 400 mL per day

ANURIAANURIALess than 50 mL per dayLess than 50 mL per day



Urinary UrgencyUrinary Urgency

Urinary retentionUrinary retention

Urinary frequencyUrinary frequency


PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

InspectionInspection

AuscultationAuscultation

PercussionPercussion

PalpationPalpation


Laboratory examinationLaboratory examination

1.1. UrinalysisUrinalysis

2.2. BUN and Creatinine levels of the BUN and Creatinine levels of the serumserum

3.3. Serum electrolytesSerum electrolytes


Laboratory examinationLaboratory examination

RadiographicRadiographic IVP IVP KUB x-rayKUB x-ray KUB ultrasoundKUB ultrasound CT and MRICT and MRI CystographyCystography

Implementation Steps for selected Implementation Steps for selected problemsproblems

Provide PAIN reliefProvide PAIN relief Assess the level of painAssess the level of pain Administer medications usually Administer medications usually

narcotic ANALGESICSnarcotic ANALGESICS


Maintain Fluid and Electrolyte BalanceMaintain Fluid and Electrolyte Balance Encourage to consume at least 2 liters Encourage to consume at least 2 liters

of fluid per dayof fluid per day In cases of ARF, limit fluid as directedIn cases of ARF, limit fluid as directed Weigh client daily to detect fluid Weigh client daily to detect fluid

retentionretention


Ensure Adequate urinary eliminationEnsure Adequate urinary elimination Encourage to void at least every 2-3 Encourage to void at least every 2-3

hourshours Promote measures to relieve urinary Promote measures to relieve urinary

retention:retention: Alternating warm and cold compressAlternating warm and cold compress Bedpan Bedpan Open faucet Open faucet Provide privacyProvide privacy Catheterization if indicatedCatheterization if indicated

Urinary Tract Infection (UTI)Urinary Tract Infection (UTI)

Bacterial invasion of the Bacterial invasion of the kidneys or bladder kidneys or bladder (CYSTITIS) usually (CYSTITIS) usually caused by caused by Escherichia Escherichia colicoli


Predisposing factors includePredisposing factors include

1.1. Poor hygienePoor hygiene

2.2. Irritation from bubble bathsIrritation from bubble baths

3.3. Urinary refluxUrinary reflux

4.4. InstrumentationInstrumentation

5.5. Residual urine, urinary stasisResidual urine, urinary stasis


PATHOPHYSIOLOGYPATHOPHYSIOLOGY The invading organism ascends the The invading organism ascends the

urinary tract, irritating the mucosa and urinary tract, irritating the mucosa and causing characteristic symptomscausing characteristic symptoms Ureter= ureteritisUreter= ureteritis Bladder= cystitisBladder= cystitis Urethra=UrethritisUrethra=Urethritis Pelvis= PyelonephritisPelvis= Pyelonephritis


Assessment findingsAssessment findings Low-grade feverLow-grade fever Abdominal painAbdominal pain EnuresisEnuresis Pain/burning on urinationPain/burning on urination Urinary frequencyUrinary frequency HematuriaHematuria


Assessment findings: Upper UTIAssessment findings: Upper UTI Fever and CHIILSFever and CHIILS Flank painFlank pain Costovertebral angle tendernessCostovertebral angle tenderness


Laboratory ExaminationLaboratory Examination

1.1. UrinalysisUrinalysis

2.2. Urine CultureUrine Culture


Nursing interventionsNursing interventions Administer antibiotics as orderedAdminister antibiotics as ordered Provide warm baths and allow client to Provide warm baths and allow client to

void in water to alleviate painful void in water to alleviate painful voiding.voiding.

Force fluids. Nurses may give 3 liters of Force fluids. Nurses may give 3 liters of fluid per dayfluid per day

Encourage measures to Encourage measures to acidify urineacidify urine (cranberry juice, acid-ash diet).(cranberry juice, acid-ash diet).


Provide client teaching and discharge Provide client teaching and discharge planning concerningplanning concerning

a. Avoidance of tub baths a. Avoidance of tub baths

b. Avoidance of bubble baths that b. Avoidance of bubble baths that might irritate urethramight irritate urethra

c. Importance for girls to wipe c. Importance for girls to wipe perineum from front to backperineum from front to back

d. Increase in foods/fluids that acidify d. Increase in foods/fluids that acidify urine.urine.


PharmacologyPharmacology 1. Sulfa drugs1. Sulfa drugs

Highly concentrated in the urineHighly concentrated in the urine Effective against E. coli!Effective against E. coli!

2. Quinolones2. Quinolones

Nephrolithiasis/UrolithiasisNephrolithiasis/Urolithiasis

Presence of stones Presence of stones anywhere in the urinary tract anywhere in the urinary tract CalciumCalciumoxalateoxalateand uric acidand uric acid

Nephrolithiasis/UrolithiasisNephrolithiasis/Urolithiasis PathophysiologyPathophysiology Predisposing factorsPredisposing factors

a. Diet: large amounts of calcium and a. Diet: large amounts of calcium and oxalateoxalate

b. Increased uric acid levelsb. Increased uric acid levels

c. Sedentary life-style, immobilityc. Sedentary life-style, immobility

d. Family history of gout or calculid. Family history of gout or calculi

e. Hyperparathyroidisme. Hyperparathyroidism

Nephrolithiasis/UrolithiasisNephrolithiasis/Urolithiasis PathophysiologyPathophysiology

Supersaturation of crystals due to stasisSupersaturation of crystals due to stasis

Stone formationStone formation

May pass through the urinary tractMay pass through the urinary tract

OBSTRUCTION, INFECTION and OBSTRUCTION, INFECTION and HYDRONEPHROSISHYDRONEPHROSIS


Assessment findingsAssessment findings

1.1. Abdominal or flank painAbdominal or flank pain

2.2. Renal colic radiating to the Renal colic radiating to the groingroin

3. Hematuria3. Hematuria

4. Cool, moist skin4. Cool, moist skin

5. Nausea and vomiting5. Nausea and vomiting

Nephrolithiasis/UrolithiasisNephrolithiasis/Urolithiasis Diagnostic testsDiagnostic tests

1. 1. KUB Ultrasound and X-rayKUB Ultrasound and X-ray: pinpoints : pinpoints location, number, and size of stoneslocation, number, and size of stones

2. 2. IVP:IVP: identifies site of obstruction identifies site of obstruction and presence of non-radiopaque and presence of non-radiopaque stonesstones

3. 3. UrinalysisUrinalysis: indicates presence of : indicates presence of bacteria, increased protein, increased bacteria, increased protein, increased WBC and RBC (hematuria)WBC and RBC (hematuria)


Medical managementMedical management1. Surgery1. Surgery a. Percutaneous nephrostomy: tube is a. Percutaneous nephrostomy: tube is

inserted through skin and underlying inserted through skin and underlying tissues into renal pelvis to remove tissues into renal pelvis to remove calculi.calculi.

b. Percutaneous nephrostolithotomy: b. Percutaneous nephrostolithotomy: delivers ultrasound waves through a delivers ultrasound waves through a probe placed on the calculus.probe placed on the calculus.


Medical managementMedical management

2.2. Extracorporeal shock-wave Extracorporeal shock-wave lithotripsy: delivers shock waves from lithotripsy: delivers shock waves from outside the body to the stone, causing outside the body to the stone, causing pulverizationpulverization

3.3. Pain management : Morphine or Pain management : Morphine or MeperidineMeperidine

4.4. Diet modificationDiet modification


Nursing interventionsNursing interventions 1. 1. Strain all urine through gauze to Strain all urine through gauze to

detect stones and crush all clots.detect stones and crush all clots. 2. Force fluids (3000—4000 cc/day).2. Force fluids (3000—4000 cc/day). 3. Encourage ambulation to prevent 3. Encourage ambulation to prevent

stasis.stasis.


Nursing interventionsNursing interventions 4. Relieve pain by administration of 4. Relieve pain by administration of

analgesics as ordered and analgesics as ordered and application of moist heat to flank application of moist heat to flank area.area.

5. Monitor intake and output5. Monitor intake and output


Nursing interventionsNursing interventions 6. Provide modified diet, 6. Provide modified diet,

depending upon stone depending upon stone consistency: Calcium, Oxalate consistency: Calcium, Oxalate and Uric acid stonesand Uric acid stones


Nursing interventionsNursing interventionsCalcium stonesCalcium stones limit milk/dairy products; limit milk/dairy products; provide provide

acid-ash diet to acidify urineacid-ash diet to acidify urine (cranberry or prune juice, meat, (cranberry or prune juice, meat, eggs, poultry, fish, grapes, and eggs, poultry, fish, grapes, and whole grains)whole grains)


Nursing interventionsNursing interventionsOxalate stonesOxalate stones avoid excess intake of foods/ fluids avoid excess intake of foods/ fluids

high in oxalate (tea, chocolate, high in oxalate (tea, chocolate, rhubarb, spinach); rhubarb, spinach); maintain maintain alkaline-ash diet to alkalinize urinealkaline-ash diet to alkalinize urine (milk; vegetables; fruits except (milk; vegetables; fruits except prunes, cranberries, and plums)prunes, cranberries, and plums)


Nursing interventionsNursing interventionsUric acid stonesUric acid stones reduce foods high in purinereduce foods high in purine

(liver, beans, kidneys, venison, (liver, beans, kidneys, venison, shellfish, meat soups, gravies, shellfish, meat soups, gravies, legumes); legumes); maintain alkaline urinemaintain alkaline urine


Nursing interventionsNursing interventions 7. Administer allopurinol (Zyloprim) as 7. Administer allopurinol (Zyloprim) as

ordered, to decrease uric acid ordered, to decrease uric acid productionproduction


8. 8. Provide client teaching and discharge Provide client teaching and discharge planning concerningplanning concerning

Prevention of Urinary stasis by maintaining Prevention of Urinary stasis by maintaining increased fluid intakeincreased fluid intake especially in hot especially in hot weather and during illness; mobility; weather and during illness; mobility; voiding whenever the urge is felt and at voiding whenever the urge is felt and at least twice during the nightleast twice during the night

Adherence to prescribed dietAdherence to prescribed diet Need for routine urinalysis (at least every 3Need for routine urinalysis (at least every 3

—4 months)—4 months) Need to recognize and report signs/ Need to recognize and report signs/

symptoms of recurrence (hematuria, flank symptoms of recurrence (hematuria, flank pain).pain).

Acute renal failureAcute renal failure

Sudden interruption of Sudden interruption of kidney function to regulate kidney function to regulate fluid and electrolyte balance fluid and electrolyte balance and remove toxic products and remove toxic products from the bodyfrom the body


PATHOPHYSIOLOGYPATHOPHYSIOLOGY1.1. Pre-renal failurePre-renal failure

2.2. Intra-renal failureIntra-renal failure

3.3. Post-renal failurePost-renal failure


PATHOPHYSIOLOGYPATHOPHYSIOLOGYPrerenal CAUSE: Prerenal CAUSE: Factors interfering with perfusion Factors interfering with perfusion

and resulting in diminished blood and resulting in diminished blood flow and glomerular filtrate, flow and glomerular filtrate, ischemia, and oliguria; include ischemia, and oliguria; include CHF, cardiogenic shock, acute CHF, cardiogenic shock, acute vasoconstriction, hemorrhage, vasoconstriction, hemorrhage, burns, septicemia, hypotension, burns, septicemia, hypotension, anaphylaxisanaphylaxis


PATHOPHYSIOLOGYPATHOPHYSIOLOGYIntrarenal CAUSE:Intrarenal CAUSE: Conditions that cause damage to the Conditions that cause damage to the

nephrons; nephrons; includeinclude acute tubular acute tubular necrosis (ATN), endocarditis, diabetes necrosis (ATN), endocarditis, diabetes mellitus, malignant hypertension, mellitus, malignant hypertension, acute glomerulonephritis, tumors, acute glomerulonephritis, tumors, blood transfusion reactions, blood transfusion reactions, hypercalcemia, nephrotoxinshypercalcemia, nephrotoxins (certain (certain antibiotics, x-ray dyes, pesticides, antibiotics, x-ray dyes, pesticides, anesthetics)anesthetics)


PATHOPHYSIOLOGYPATHOPHYSIOLOGYPostrenal CAUSE: Postrenal CAUSE: Mechanical obstruction anywhere Mechanical obstruction anywhere

from the tubules to the urethra; from the tubules to the urethra; includes includes calculi, BPH, tumors, calculi, BPH, tumors, strictures, blood clots, trauma, and strictures, blood clots, trauma, and anatomic malformationanatomic malformation


Three phases of acute renal failureThree phases of acute renal failure

1.1. Oliguric phaseOliguric phase

2.2. Diuretic phaseDiuretic phase

3.3. Convalescence or recovery phaseConvalescence or recovery phase


Four phases of acute renal failure Four phases of acute renal failure (Brunner and Suddarth)(Brunner and Suddarth)

1.1. Initiation phaseInitiation phase2.2. Oliguric phaseOliguric phase3.3. Diuretic phaseDiuretic phase4.4. Convalescence or recovery phaseConvalescence or recovery phase


Assessment findings: The Three Phases of Acute Assessment findings: The Three Phases of Acute Renal FailureRenal Failure

1. 1. Oliguric phaseOliguric phase Urine output less than 400 cc/24 hoursUrine output less than 400 cc/24 hours duration 1—2 weeksduration 1—2 weeks Manifested by Manifested by dilutional hyponatremia,dilutional hyponatremia,

hyperkalemiahyperkalemia, hyperphosphatemia, , hyperphosphatemia, hypocalcemiahypocalcemia, hypermagnesemia, and , hypermagnesemia, and metabolic acidosismetabolic acidosis

Diagnostic tests: BUN and creatinine Diagnostic tests: BUN and creatinine elevatedelevated


Assessment findings: The Three Phases of Assessment findings: The Three Phases of Acute Renal FailureAcute Renal Failure

2. Diuretic phase2. Diuretic phase Diuresis may occur (output 3—5 Diuresis may occur (output 3—5

liters/day) due to partially regenerated liters/day) due to partially regenerated tubule’s inability to concentrate urinetubule’s inability to concentrate urine

Duration: Duration: 2—3 weeks2—3 weeks; manifested by ; manifested by hyponatremia, hypokalemia, and hyponatremia, hypokalemia, and hypovolemiahypovolemia

Diagnostic tests: BUN and creatinine Diagnostic tests: BUN and creatinine slightly elevatedslightly elevated


Assessment findings: The Three Assessment findings: The Three Phases of Acute Renal FailurePhases of Acute Renal Failure

3. Recovery or convalescent phase: 3. Recovery or convalescent phase: Renal function stabilizes with gradual Renal function stabilizes with gradual

improvement over next 3—12 monthsimprovement over next 3—12 months


Laboratory findings:Laboratory findings:1.1. Urinalysis: Urine osmo and sodiumUrinalysis: Urine osmo and sodium2.2. BUN and creatinine levels increasedBUN and creatinine levels increased3.3. HyperkalemiaHyperkalemia4.4. AnemiaAnemia5.5. ABG: metabolic acidosisABG: metabolic acidosis


Nursing interventionsNursing interventions Monitor fluid and Electrolyte BalanceMonitor fluid and Electrolyte Balance Reduce metabolic rateReduce metabolic rate Promote pulmonary functionPromote pulmonary function Prevent infectionPrevent infection Provide skin careProvide skin care Provide emotional supportProvide emotional support


Nursing interventionsNursing interventions1. Monitor and maintain fluid and 1. Monitor and maintain fluid and

electrolyte balance.electrolyte balance. Measure l & O every hour. note Measure l & O every hour. note

excessive losses in diuretic phaseexcessive losses in diuretic phase Administer IV fluids and electrolyte Administer IV fluids and electrolyte

supplements as ordered.supplements as ordered. Weigh daily and report gains.Weigh daily and report gains. Monitor lab values; assess/treat fluid Monitor lab values; assess/treat fluid

and electrolyte and acid-base and electrolyte and acid-base imbalances as needed imbalances as needed


Nursing interventionsNursing interventions2. Monitor alteration in fluid volume.2. Monitor alteration in fluid volume. Monitor vital signs, PAP, PCWP, Monitor vital signs, PAP, PCWP,

CVP as needed.CVP as needed. Weigh client daily.Weigh client daily. Maintain strict I & O records.Maintain strict I & O records.


Nursing interventionsNursing interventions2. Assess every hour for 2. Assess every hour for hypervolemiahypervolemia

Maintain adequate ventilation.Maintain adequate ventilation. Restrict FLUID intakeRestrict FLUID intake Administer diuretics and Administer diuretics and

antihypertensives antihypertensives


Nursing interventionsNursing interventions3. Promote optimal nutritional status.3. Promote optimal nutritional status. Weigh daily.Weigh daily. Administer TPN as ordered.Administer TPN as ordered. With enteral feedings, check for residual With enteral feedings, check for residual

and notify physician if residual volume and notify physician if residual volume increases.increases.

Restrict protein intake to 1 g/kg/dayRestrict protein intake to 1 g/kg/day Restrict POTASSIUM intakeRestrict POTASSIUM intake HIGH CARBOHYDRATE DIET, calcium HIGH CARBOHYDRATE DIET, calcium

supplementssupplements


Nursing interventionsNursing interventions4. Prevent complications from 4. Prevent complications from

impaired mobility (pulmonary impaired mobility (pulmonary embolism, skin breakdown, and embolism, skin breakdown, and atelectasis) atelectasis)

5. Prevent fever/infection.5. Prevent fever/infection. Assess for signs of infection.Assess for signs of infection. Use strict aseptic technique for wound Use strict aseptic technique for wound

and catheter care.and catheter care.


Nursing interventionsNursing interventions6. Support client/significant others and 6. Support client/significant others and

reduce/ relieve anxiety.reduce/ relieve anxiety. Explain pathophysiology and relationship Explain pathophysiology and relationship

to symptoms.to symptoms. Explain all procedures and answer all Explain all procedures and answer all

questions in easy-to-understand termsquestions in easy-to-understand terms Refer to counseling services as neededRefer to counseling services as needed

7. Provide care for the client receiving 7. Provide care for the client receiving dialysis dialysis


Nursing interventionsNursing interventions8. Provide client teaching and discharge 8. Provide client teaching and discharge

planning concerningplanning concerning Adherence to prescribed dietary regimenAdherence to prescribed dietary regimen Signs and symptoms of recurrent renal Signs and symptoms of recurrent renal

diseasedisease Importance of planned rest periodsImportance of planned rest periods Use of prescribed drugs onlyUse of prescribed drugs only Signs and symptoms of UTI or respiratory Signs and symptoms of UTI or respiratory

infection need to report to physician infection need to report to physician immediatelyimmediately

Chronic Renal FailureChronic Renal Failure

Gradual, Progressive Gradual, Progressive irreversible destruction of the irreversible destruction of the kidneys causing severe renal kidneys causing severe renal dysfunction. dysfunction.

The result is azotemia to The result is azotemia to UREMIAUREMIA


Predisposing factors: Predisposing factors: DM= DM= worldwide leading causeworldwide leading causeRecurrent infectionsRecurrent infectionsExacerbations of nephritisExacerbations of nephritisurinary tract obstructionurinary tract obstructionhypertensionhypertension


PATHOPHYSIOLOGYPATHOPHYSIOLOGY

As renal functions declineAs renal functions decline

Retention of end-products of Retention of end-products of metabolismmetabolism


PATHOPHYSIOLOGYPATHOPHYSIOLOGYSTAGE 1= reduced renal reserve, 40-STAGE 1= reduced renal reserve, 40-

75% loss of nephron function75% loss of nephron functionSTAGE 2= renal insufficiency, 75-STAGE 2= renal insufficiency, 75-

90% loss of nephron function90% loss of nephron functionSTAGE 3= end-stage renal disease, STAGE 3= end-stage renal disease,

more than 90% loss. more than 90% loss. DIALYSIS IS DIALYSIS IS THE TREATMENT! THE TREATMENT!


Assessment findingsAssessment findings 1. Nausea, vomiting; diarrhea or 1. Nausea, vomiting; diarrhea or

constipation; decreased urinary constipation; decreased urinary outputoutput

2. Dyspnea2. Dyspnea 3. Stomatitis3. Stomatitis 4. 4. HypertensionHypertension (later), lethargy, (later), lethargy,

convulsions, memory impairment, convulsions, memory impairment, pericardial friction rubpericardial friction rub


DermatologicDermatologic dry skindry skin, pruritus, uremic , pruritus, uremic frostfrost

CNSCNS seizures, altered LOC, seizures, altered LOC, anorexia, fatigueanorexia, fatigue

CVSCVS Acute MI, edema, Acute MI, edema, hypertension, pericarditishypertension, pericarditis

PulmoPulmo Uremic lungsUremic lungs

HemaHema AnemiaAnemia

MusculoskeletalMusculoskeletal loss of strength, foot loss of strength, foot drop, osteodystrophydrop, osteodystrophy


Diagnostic tests: Diagnostic tests: a. a. 24 hour creatinine clearance24 hour creatinine clearance

urinalysisurinalysis b. Protein, sodium, BUN, Crea b. Protein, sodium, BUN, Crea

and WBC elevatedand WBC elevated c. Specific gravity, platelets, and c. Specific gravity, platelets, and

calcium decreasedcalcium decreased D. CBC= anemiaD. CBC= anemia


Medical managementMedical management 1. Diet restrictions1. Diet restrictions 2. Multivitamins2. Multivitamins 3. Hematinics and erythropoietin3. Hematinics and erythropoietin 4. Aluminum hydroxide gels4. Aluminum hydroxide gels 5. Anti-hypertensive5. Anti-hypertensive 6. Anti-seizures6. Anti-seizures DIALYSISDIALYSIS


Nursing interventionsNursing interventions1. Prevent neurological 1. Prevent neurological

complications.complications. Assess every hour for signs of Assess every hour for signs of

uremia (fatigue, loss of appetite, uremia (fatigue, loss of appetite, decreased urine output, apathy, decreased urine output, apathy, confusion, elevated blood confusion, elevated blood pressure, edema of face and feet, pressure, edema of face and feet, itchy skin, restlessness, seizures).itchy skin, restlessness, seizures).


Nursing interventionsNursing interventions1. Prevent neurological complications.1. Prevent neurological complications. Assess for changes in mental Assess for changes in mental

functioning.functioning. Orient confused client to time, place, Orient confused client to time, place,

date, and persons; institute safety date, and persons; institute safety measures to protect client from measures to protect client from falling out of bed.falling out of bed.

Monitor serum electrolytes, BUN, and Monitor serum electrolytes, BUN, and creatinine as orderedcreatinine as ordered


Nursing interventionsNursing interventions2. Promote optimal GI function.2. Promote optimal GI function. Assess/provide care for stomatitisAssess/provide care for stomatitis Monitor nausea, vomiting, anorexiaMonitor nausea, vomiting, anorexia Administer antiemetics as ordered.Administer antiemetics as ordered. Assess for signs of Gl bleedingAssess for signs of Gl bleeding


Nursing interventionsNursing interventions 3. Monitor/prevent alteration in fluid 3. Monitor/prevent alteration in fluid

and electrolyte balanceand electrolyte balance 4. Assess for hyperphosphatemia 4. Assess for hyperphosphatemia

(paresthesias, muscle cramps, (paresthesias, muscle cramps, seizures, abnormal reflexes), and seizures, abnormal reflexes), and administer aluminum hydroxide gels administer aluminum hydroxide gels (Amphojel) as ordered(Amphojel) as ordered


Nursing interventionsNursing interventions5. Promote maintenance of skin 5. Promote maintenance of skin

integrity.integrity. Assess/provide care for pruritus.Assess/provide care for pruritus. Assess for uremic frost (urea Assess for uremic frost (urea

crystallization on the skin) and bathe crystallization on the skin) and bathe in plain waterin plain water


Nursing interventionsNursing interventions6. Monitor for bleeding complications, 6. Monitor for bleeding complications,

prevent injury to client.prevent injury to client. Monitor Hgb, hct, platelets, RBC.Monitor Hgb, hct, platelets, RBC. Hematest all secretions.Hematest all secretions. Administer hematinics as ordered.Administer hematinics as ordered. Avoid lM injectionsAvoid lM injections


Nursing interventionsNursing interventions7. Promote/maintain maximal 7. Promote/maintain maximal

cardiovascular function.cardiovascular function. Monitor blood pressure and report Monitor blood pressure and report

significant changes.significant changes. Auscultate for pericardial friction Auscultate for pericardial friction

rub.rub. Perform circulation checks routinely.Perform circulation checks routinely.


Nursing interventionsNursing interventions7. Promote/maintain maximal 7. Promote/maintain maximal

cardiovascular function.cardiovascular function. Administer diuretics as ordered and Administer diuretics as ordered and

monitor output.monitor output. Modify drug dosesModify drug doses8. Provide care for client receiving 8. Provide care for client receiving

dialysis.dialysis.

DIALYSISDIALYSIS

a procedure that is used to remove a procedure that is used to remove fluid and uremic wastes from the fluid and uremic wastes from the body when the kidneys cannot body when the kidneys cannot functionfunction

DIALYSISDIALYSIS

Two methodsTwo methods

1. Hemodialysis1. Hemodialysis

2. Peritoneal dialysis2. Peritoneal dialysis

DIALYSISDIALYSIS

DiffusionDiffusion OsmosisOsmosis UltrafiltrationUltrafiltration

DIALYSISDIALYSIS

Nursing managementNursing management1.1. Meet the patient's psychosocial Meet the patient's psychosocial

needsneeds2.2. Remember to avoid any Remember to avoid any

procedure on the arm with the procedure on the arm with the fistula (HEMO)fistula (HEMO)

Monitor WEIGHT, blood pressure Monitor WEIGHT, blood pressure and fistula site for bleedingand fistula site for bleeding

DIALYSISDIALYSIS

Nursing managementNursing management3. Monitor symptoms of uremia3. Monitor symptoms of uremia4. Detect complications like infection, 4. Detect complications like infection,

bleeding (Hepatitis B/C and HIV bleeding (Hepatitis B/C and HIV infection in Hemodialysis)infection in Hemodialysis)

5. Warm the solution to increase 5. Warm the solution to increase diffusion of waste products diffusion of waste products (PERITONEAL)(PERITONEAL)

6. Manage discomfort and pain6. Manage discomfort and pain

DIALYSISDIALYSIS

Nursing managementNursing management

7. To determine effectiveness, check 7. To determine effectiveness, check serum creatinine, BUN and serum creatinine, BUN and electrolyteselectrolytes

Male reproductive disordersMale reproductive disorders

BPHBPH Prostatic cancerProstatic cancer


DIGITAL RECTAL EXAMINATION- DREDIGITAL RECTAL EXAMINATION- DRE Recommended for men annually with Recommended for men annually with

age over 40 yearsage over 40 years Screening test for cancerScreening test for cancer Ask Ask patient to BEAR DOWNpatient to BEAR DOWN


TESTICULAR EXAMINATIONTESTICULAR EXAMINATION Palpation of scrotum for nodules and Palpation of scrotum for nodules and

masses or inflammationmasses or inflammation BEGINS DURING ADOLESCENCEBEGINS DURING ADOLESCENCE


Prostate specific antigen (PSA)Prostate specific antigen (PSA) Elevated in prostate cancer Normal is 0.2 to 4 nanograms/mL Cancer= over 4


BENIGN PROSTATIC HYPERPLASIA Enlargement of the prostate that

causes outflow obstruction

Common in men older than 50 years old


BENIGN PROSTATIC HYPERPLASIA

Assessment findings

1. DRE: enlarged prostate gland that is rubbery, large and NON-tender

2. Increased frequency, urgency and hesitancy

3. Nocturia, DECREASE IN THE VOLUME AND FORCE OF URINE STREAM


BENIGN PROSTATIC HYPERPLASIA

Medical management

1. Immediate catheterization

2. Prostatectomy

3. TRANSURETHRAL RESECTION of the PROSTATE (TURP)

4. Pharmacology: alpha-blockers, alpha-reductase inhibitors. SAW palmetto

BPHBPH

NURSING INTERVENTIONNURSING INTERVENTION

1.1. Encourage fluids up to 2 liters per dayEncourage fluids up to 2 liters per day

2.2. Insert catheter for urinary drainageInsert catheter for urinary drainage

3.3. Administer medications – alpha adrenergic Administer medications – alpha adrenergic blockers and finasterideblockers and finasteride

4.4. Avoid anticholinergicsAvoid anticholinergics

5.5. Prepare for surgery or TURPPrepare for surgery or TURP

6.6. Teach the patient perineal muscle Teach the patient perineal muscle exercises. Avoid valsalva until healingexercises. Avoid valsalva until healing

BPHBPH

NURSING INTERVENTION: TURPNURSING INTERVENTION: TURP Maintain the three way bladder Maintain the three way bladder

irrigation to prevent hemorrhageirrigation to prevent hemorrhage Only initially the drainage is pink-Only initially the drainage is pink-

tinged and never reddishtinged and never reddish Administer anti-spasmodic to prevent Administer anti-spasmodic to prevent

bladder spasmsbladder spasms

Prostate CancerProstate Cancer

a slow growing malignancy of the a slow growing malignancy of the prostate glandprostate gland

Usually an Usually an adenocarcinomaadenocarcinoma This usualy spread via blood stream to This usualy spread via blood stream to

the vertebraethe vertebrae


Predisposing factor Age


Assessment Findings

1. DRE: hard, pea-sized nodules on the anterior rectum

2. Hematuria

3. Urinary obstruction

4. Pain on the perineum radiating to the leg


Diagnostic tests

1. Prostatic specific antigen (PSA)

2. Elevated SERUM ACID PHOSPHATASE indicates SPREAD or Metastasis


Medical and surgical management

1. Prostatectomy

2. TURP

3. Chemotherapy: hormonal therapy to slow the rate of tumor growth

4. Radiation therapy


Nursing Interventions

1. Prepare patient for chemotherapy

2. Prepare for surgery


Nursing Interventions: Post-prostatectomy

1. Maintain continuous bladder irrigation. Note that drainage is pink tinged w/in 24 hours

2. Monitor urine for the presence of blood clots and hemorrhage

3. Ambulate the patient as soon as urine begins to clear in color

Date post:	12-Nov-2014
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