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Tuesday, October 30, 2007

Genito Urinary System :: Medical Surgical Nursing :: Review For Nursing Licensure Examination

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Genito Urinary System :: Medical Surgical Nursing :: Review For Nursing Licensure Examination Slide Transcript
Slide 1: The Genito-Urinary System Medical Surgical Nursing Review

Slide 2: Outline of review  Recall the anatomy and physiology of the Renal System  Renal Assessment  Renal Laboratory Procedure  Common Conditions:  UTI  Kidney Stones  ARF and CRF

Slide 3: Outline of review  BPH  Prostatic cancer

Slide 4: Kidney function Impaired urine production The Nephron produces and azotemia urine to eliminate waste Secretes Erythropoietin ANEMIA to increase RBC Metabolism of Vitamin D Calcium and Phosphate imbalances Produces bicarbonate Metabolic ACIDOSIS and secretes acids Excretes excess HYPERKALEMIA POTASSIUM

Slide 5: Urological Assessment  Nursing History  Reason for seeking care  Current illness  Previous illness  Family History  Social History  Sexual history

Slide 6: Urological Assessment Key Signs and Symptoms of Urological Problems EDEMA associated with fluid retention Renal dysfunctions usually produce ANASARCA

Slide 7: Urological Assessment Key Signs and Symptoms of Urological Problems PAIN  Suprapubic pain= bladder  Colicky pain on the flank= kidney

Slide 8: Urological Assessment Key Signs and Symptoms of Urological Problems HEMATURIA  Painless hematuria may indicate URINARY CANCER!  Early-stream hematuria= urethral lesion  Late-stream hematuria= bladder lesion

Slide 9: Urological Assessment Key Signs and Symptoms of Urological Problems DYSURIA  Pain with urination= lower UTI

Slide 10: Urological Assessment Key Signs and Symptoms of Urological Problems POLYURIA  More than 2 Liters urine per day OLIGURIA  Less than 400 mL per day ANURIA  Less than 50 mL per day

Slide 11: Urological Assessment Key Signs and Symptoms of Urological Problems Urinary Urgency Urinary retention Urinary frequency

Slide 12: Urological Assessment PHYSICAL EXAMINATION Inspection Auscultation Percussion Palpation

Slide 13: Urological Assessment Laboratory examination 2. Urinalysis 3. BUN and Creatinine levels of the serum 4. Serum electrolytes

Slide 14: Urological Assessment Laboratory examination Radiographic  IVP  KUB x-ray  KUB ultrasound  CT and MRI  Cystography

Slide 15: Implementation Steps for selected problems Provide PAIN relief  Assess the level of pain  Administer medications usually narcotic ANALGESICS

Slide 16: Implementation Steps for selected problems Maintain Fluid and Electrolyte Balance  Encourage to consume at least 2 liters of fluid per day  In cases of ARF, limit fluid as directed  Weigh client daily to detect fluid retention

Slide 17: Implementation Steps for selected problems Ensure Adequate urinary elimination  Encourage to void at least every 2-3 hours  Promote measures to relieve urinary retention:  Alternating warm and cold compress  Bedpan  Open faucet  Provide privacy  Catheterization if indicated

Slide 18: Urinary Tract Infection (UTI) Bacterial invasion of the kidneys or bladder (CYSTITIS) usually caused by Escherichia coli

Slide 19: Urinary Tract Infection (UTI)  Predisposing factors include 2. Poor hygiene 3. Irritation from bubble baths 4. Urinary reflux 5. Instrumentation 6. Residual urine, urinary stasis

Slide 20: Urinary Tract Infection (UTI) PATHOPHYSIOLOGY  The invading organism ascends the urinary tract, irritating the mucosa and causing characteristic symptoms  Ureter= ureteritis  Bladder= cystitis  Urethra=Urethritis  Pelvis= Pyelonephritis

Slide 21: Urinary Tract Infection (UTI) Assessment findings  Low-grade fever  Abdominal pain  Enuresis  Pain/burning on urination  Urinary frequency  Hematuria

Slide 22: Urinary Tract Infection (UTI) Assessment findings: Upper UTI  Fever and CHIILS  Flank pain  Costovertebral angle tenderness

Slide 23: Urinary Tract Infection (UTI) Laboratory Examination 2. Urinalysis 3. Urine Culture

Slide 24: Urinary Tract Infection (UTI) Nursing interventions  Administer antibiotics as ordered  Provide warm baths and allow client to void in water to alleviate painful voiding.  Force fluids. Nurses may give 3 liters of fluid per day  Encourage measures to acidify urine (cranberry juice, acid-ash diet).

Slide 25: Urinary Tract Infection (UTI)  Provide client teaching and discharge planning concerning a. Avoidance of tub baths b. Avoidance of bubble baths that might irritate urethra c. Importance for girls to wipe perineum from front to back d. Increase in foods/fluids that acidify urine.

Slide 26: Urinary Tract Infection (UTI) Pharmacology  1. Sulfa drugs  Highly concentrated in the urine  Effective against E. coli!  2. Quinolones

Slide 27: Nephrolithiasis/Urolithiasis  Presence of stones anywhere in the urinary tract  Calcium  oxalate  and uric acid

Slide 28: Nephrolithiasis/Urolithiasis Pathophysiology  Predisposing factors a. Diet: large amounts of calcium and oxalate b. Increased uric acid levels c. Sedentary life-style, immobility d. Family history of gout or calculi e. Hyperparathyroidism

Slide 29: Nephrolithiasis/Urolithiasis Pathophysiology Supersaturation of crystals due to stasis Stone formation May pass through the urinary tract OBSTRUCTION, INFECTION and HYDRONEPHROSIS

Slide 30: Nephrolithiasis/Urolithiasis Assessment findings 2. Abdominal or flank pain 3. Renal colic radiating to the groin 3. Hematuria 4. Cool, moist skin 5. Nausea and vomiting

Slide 31: Nephrolithiasis/Urolithiasis Diagnostic tests 1. KUB Ultrasound and X-ray: pinpoints location, number, and size of stones 2. IVP: identifies site of obstruction and presence of non-radiopaque stones 3. Urinalysis: indicates presence of bacteria, increased protein, increased WBC and RBC (hematuria)

Slide 32: Nephrolithiasis/Urolithiasis Medical management 1. Surgery  a. Percutaneous nephrostomy: tube is inserted through skin and underlying tissues into renal pelvis to remove calculi.  b. Percutaneous nephrostolithotomy: delivers ultrasound waves through a probe placed on the calculus.

Slide 33: Nephrolithiasis/Urolithiasis Medical management 2. Extracorporeal shock-wave lithotripsy: delivers shock waves from outside the body to the stone, causing pulverization 3. Pain management : Morphine or Meperidine 4. Diet modification

Slide 34: Nephrolithiasis/Urolithiasis Nursing interventions  1. Strain all urine through gauze to detect stones and crush all clots.  2. Force fluids (3000—4000 cc/day).  3. Encourage ambulation to prevent stasis.

Slide 35: Nephrolithiasis/Urolithiasis Nursing interventions  4. Relieve pain by administration of analgesics as ordered and application of moist heat to flank area.  5. Monitor intake and output

Slide 36: Nephrolithiasis/Urolithiasis Nursing interventions  6. Provide modified diet, depending upon stone consistency: Calcium, Oxalate and Uric acid stones

Slide 37: Nephrolithiasis/Urolithiasis Nursing interventions Calcium stones  limit milk/dairy products; provide acid-ash diet to acidify urine (cranberry or prune juice, meat, eggs, poultry, fish, grapes, and whole grains)

Slide 38: Nephrolithiasis/Urolithiasis Nursing interventions Oxalate stones  avoid excess intake of foods/ fluids high in oxalate (tea, chocolate, rhubarb, spinach); maintain alkaline- ash diet to alkalinize urine (milk; vegetables; fruits except prunes, cranberries, and plums)

Slide 39: Nephrolithiasis/Urolithiasis Nursing interventions Uric acid stones  reduce foods high in purine (liver, beans, kidneys, venison, shellfish, meat soups, gravies, legumes); maintain alkaline urine

Slide 40: Nephrolithiasis/Urolithiasis Nursing interventions  7. Administer allopurinol (Zyloprim) as ordered, to decrease uric acid production

Slide 41: Nephrolithiasis/Urolithiasis 8. Provide client teaching and discharge planning concerning  Prevention of Urinary stasis by maintaining increased fluid intake especially 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 urinalysis (at least every 3 —4 months)  Need to recognize and report signs/ symptoms of recurrence (hematuria, flank pain).

Slide 42: Acute renal failure  Sudden interruption of kidney function to regulate fluid and electrolyte balance and remove toxic products from the body

Slide 43: Acute renal failure PATHOPHYSIOLOGY 2. Pre-renal failure 4. Intra-renal failure 6. Post-renal failure

Slide 45: Acute renal failure PATHOPHYSIOLOGY Prerenal CAUSE:  Factors interfering with perfusion and resulting in diminished blood flow and glomerular filtrate, ischemia, and oliguria; include CHF, cardiogenic shock, acute vasoconstriction, hemorrhage, burns, septicemia, hypotension, anaphylaxis

Slide 46: Acute renal failure PATHOPHYSIOLOGY Intrarenal CAUSE:  Conditions that cause damage to the nephrons; include acute tubular necrosis (ATN), endocarditis, diabetes mellitus, malignant hypertension, acute glomerulonephritis, tumors, blood transfusion reactions, hypercalcemia, nephrotoxins (certain antibiotics, x-ray dyes, pesticides, anesthetics)

Slide 47: Acute renal failure PATHOPHYSIOLOGY Postrenal CAUSE:  Mechanical obstruction anywhere from the tubules to the urethra; includes calculi, BPH, tumors, strictures, blood clots, trauma, and anatomic malformation

Slide 48: Acute renal failure Three phases of acute renal failure 3. Oliguric phase 5. Diuretic phase 7. Convalescence or recovery phase

Slide 49: Acute renal failure Four phases of acute renal failure (Brunner and Suddarth) 2. Initiation phase 3. Oliguric phase 4. Diuretic phase 5. Convalescence or recovery phase

Slide 50: Acute renal failure Assessment findings: The Three Phases of Acute Renal Failure 1. Oliguric phase  Urine output less than 400 cc/24 hours  duration 1—2 weeks  Manifested by dilutional hyponatremia, hyperkalemia, hyperphosphatemia, hypocalcemia, hypermagnesemia, and metabolic acidosis  Diagnostic tests: BUN and creatinine elevated

Slide 51: Acute renal failure Assessment findings: The Three Phases of Acute Renal Failure 2. Diuretic phase  Diuresis may occur (output 3—5 liters/day) due to partially regenerated tubule’s inability to concentrate urine  Duration: 2—3 weeks; manifested by hyponatremia, hypokalemia, and hypovolemia  Diagnostic tests: BUN and creatinine slightly elevated

Slide 52: Acute renal failure Assessment findings: The Three Phases of Acute Renal Failure 3. Recovery or convalescent phase:  Renal function stabilizes with gradual improvement over next 3—12 months

Slide 53: Acute renal failure Laboratory findings: 2. Urinalysis: Urine osmo and sodium 3. BUN and creatinine levels increased 4. Hyperkalemia 5. Anemia 6. ABG: metabolic acidosis

Slide 54: Acute renal failure Nursing interventions  Monitor fluid and Electrolyte Balance  Reduce metabolic rate  Promote pulmonary function  Prevent infection  Provide skin care  Provide emotional support

Slide 55: Acute renal failure Nursing interventions 1. Monitor and maintain fluid and electrolyte balance.  Measure l & O every hour. note excessive losses in diuretic phase  Administer IV fluids and electrolyte supplements as ordered.  Weigh daily and report gains.  Monitor lab values; assess/treat fluid and electrolyte and acid-base imbalances as needed

Slide 56: Acute renal failure Nursing interventions 2. Monitor alteration in fluid volume.  Monitor vital signs, PAP, PCWP, CVP as needed.  Weigh client daily.  Maintain strict I & O records.

Slide 57: Acute renal failure Nursing interventions 2. Assess every hour for hypervolemia  Maintain adequate ventilation.  Restrict FLUID intake  Administer diuretics and antihypertensives

Slide 58: Acute renal failure Nursing interventions 3. Promote optimal nutritional status.  Weigh daily.  Administer TPN as ordered.  With enteral feedings, check for residual and notify physician if residual volume increases.  Restrict protein intake to 1 g/kg/day  Restrict POTASSIUM intake  HIGH CARBOHYDRATE DIET, calcium supplements

Slide 59: Acute renal failure Nursing interventions 4. Prevent complications from impaired mobility (pulmonary embolism, skin breakdown, and atelectasis) 5. Prevent fever/infection.  Assess for signs of infection.  Use strict aseptic technique for wound and catheter care.

Slide 60: Acute renal failure Nursing interventions 6. Support client/significant others and reduce/ relieve anxiety.  Explain pathophysiology and relationship to symptoms.  Explain all procedures and answer all questions in easy-to-understand terms  Refer to counseling services as needed 7. Provide care for the client receiving dialysis

Slide 61: Acute renal failure Nursing interventions 8. Provide client teaching and discharge planning concerning  Adherence to prescribed dietary regimen  Signs and symptoms of recurrent renal disease  Importance of planned rest periods  Use of prescribed drugs only  Signs and symptoms of UTI or respiratory infection need to report to physician immediately

Slide 62: Chronic Renal Failure  Gradual, Progressive irreversible destruction of the kidneys causing severe renal dysfunction.  The result is azotemia to UREMIA

Slide 63: Chronic Renal Failure Predisposing factors:  DM= worldwide leading cause  Recurrent infections  Exacerbations of nephritis  urinary tract obstruction  hypertension

Slide 64: Chronic Renal Failure PATHOPHYSIOLOGY As renal functions decline Retention of end-products of metabolism

Slide 65: Chronic Renal Failure PATHOPHYSIOLOGY STAGE 1= reduced renal reserve, 40- 75% loss of nephron function STAGE 2= renal insufficiency, 75- 90% loss of nephron function STAGE 3= end-stage renal disease, more than 90% loss. DIALYSIS IS THE TREATMENT!

Slide 66: Chronic Renal Failure Assessment findings  1. Nausea, vomiting; diarrhea or constipation; decreased urinary output  2. Dyspnea  3. Stomatitis  4. Hypertension (later), lethargy, convulsions, memory impairment, pericardial friction rub

Slide 67: Chronic Renal Failure dry skin, pruritus, uremic Dermatologic frost seizures, altered LOC, CNS anorexia, fatigue Acute MI, edema, CVS hypertension, pericarditis Pulmo Uremic lungs Hema Anemia loss of strength, foot Musculoskeletal drop, osteodystrophy

Slide 68: Chronic Renal Failure Diagnostic tests:  a. 24 hour creatinine clearance urinalysis  b. Protein, sodium, BUN, Crea and WBC elevated  c. Specific gravity, platelets, and calcium decreased  D. CBC= anemia

Slide 69: Chronic Renal Failure Medical management  1. Diet restrictions  2. Multivitamins  3. Hematinics and erythropoietin  4. Aluminum hydroxide gels  5. Anti-hypertensive  6. Anti-seizures  DIALYSIS

Slide 70: Chronic Renal Failure Nursing interventions 1. Prevent neurological complications.  Assess every hour for signs of uremia (fatigue, loss of appetite, decreased urine output, apathy, confusion, elevated blood pressure, edema of face and feet, itchy skin, restlessness, seizures).

Slide 71: Chronic Renal Failure Nursing interventions 1. Prevent neurological complications.  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

Slide 72: Chronic Renal Failure Nursing interventions 2. Promote optimal GI function.  Assess/provide care for stomatitis  Monitor nausea, vomiting, anorexia  Administer antiemetics as ordered.  Assess for signs of Gl bleeding

Slide 73: Chronic Renal Failure Nursing interventions  3. Monitor/prevent alteration in fluid and electrolyte balance  4. Assess for hyperphosphatemia (paresthesias, muscle cramps, seizures, abnormal reflexes), and administer aluminum hydroxide gels (Amphojel) as ordered

Slide 74: Chronic Renal Failure Nursing interventions 5. Promote maintenance of skin integrity.  Assess/provide care for pruritus.  Assess for uremic frost (urea crystallization on the skin) and bathe in plain water

Slide 75: Chronic Renal Failure Nursing interventions 6. Monitor for bleeding complications, prevent injury to client.  Monitor Hgb, hct, platelets, RBC.  Hematest all secretions.  Administer hematinics as ordered.  Avoid lM injections

Slide 76: Chronic Renal Failure Nursing interventions 7. Promote/maintain maximal cardiovascular function.  Monitor blood pressure and report significant changes.  Auscultate for pericardial friction rub.  Perform circulation checks routinely.

Slide 77: Chronic Renal Failure Nursing interventions 7. Promote/maintain maximal cardiovascular function.  Administer diuretics as ordered and monitor output.  Modify drug doses 8. Provide care for client receiving dialysis.

Slide 78: DIALYSIS  a procedure that is used to remove fluid and uremic wastes from the body when the kidneys cannot function

Slide 79: DIALYSIS  Two methods  1. Hemodialysis  2. Peritoneal dialysis

Slide 82: DIALYSIS  Diffusion  Osmosis  Ultrafiltration

Slide 83: DIALYSIS Nursing management 2. Meet the patient's psychosocial needs 3. Remember to avoid any procedure on the arm with the fistula (HEMO)  Monitor WEIGHT, blood pressure and fistula site for bleeding

Slide 84: DIALYSIS Nursing management 3. Monitor symptoms of uremia 4. Detect complications like infection, bleeding (Hepatitis B/C and HIV infection in Hemodialysis) 5. Warm the solution to increase diffusion of waste products (PERITONEAL) 6. Manage discomfort and pain

Slide 85: DIALYSIS Nursing management 7. To determine effectiveness, check serum creatinine, BUN and electrolytes

Slide 86: Male reproductive disorders  BPH  Prostatic cancer

Slide 87: Male reproductive disorders DIGITAL RECTAL EXAMINATION- DRE  Recommended for men annually with age over 40 years  Screening test for cancer  Ask patient to BEAR DOWN

Slide 89: Male reproductive disorders TESTICULAR EXAMINATION  Palpation of scrotum for nodules and masses or inflammation  BEGINS DURING ADOLESCENCE

Slide 90: Male reproductive disorders Prostate specific antigen (PSA)  Elevated in prostate cancer  Normal is 0.2 to 4 nanograms/mL  Cancer= over 4

Slide 91: Male reproductive disorders BENIGN PROSTATIC HYPERPLASIA  Enlargement of the prostate that causes outflow obstruction  Common in men older than 50 years old

Slide 93: Male reproductive disorders BENIGN PROSTATIC HYPERPLASIA Assessment findings 3. DRE: enlarged prostate gland that is rubbery, large and NON-tender 4. Increased frequency, urgency and hesitancy 5. Nocturia, DECREASE IN THE VOLUME AND FORCE OF URINE STREAM

Slide 94: Male reproductive disorders BENIGN PROSTATIC HYPERPLASIA Medical management 3. Immediate catheterization 4. Prostatectomy 5. TRANSURETHRAL RESECTION of the PROSTATE (TURP) 6. Pharmacology: alpha-blockers, alpha- reductase inhibitors. SAW palmetto

Slide 97: BPH NURSING INTERVENTION 2. Encourage fluids up to 2 liters per day 3. Insert catheter for urinary drainage 4. Administer medications – alpha adrenergic blockers and finasteride 5. Avoid anticholinergics 6. Prepare for surgery or TURP 7. Teach the patient perineal muscle exercises. Avoid valsalva until healing

Slide 98: BPH NURSING INTERVENTION: TURP  Maintain the three way bladder irrigation to prevent hemorrhage  Only initially the drainage is pink- tinged and never reddish  Administer anti-spasmodic to prevent bladder spasms

Slide 99: Prostate Cancer  a slow growing malignancy of the prostate gland  Usually an adenocarcinoma  This usualy spread via blood stream to the vertebrae

Slide 101: Prostate Cancer  Predisposing factor  Age

Slide 102: Prostate Cancer  Assessment Findings 2. DRE: hard, pea-sized nodules on the anterior rectum 3. Hematuria 4. Urinary obstruction 5. Pain on the perineum radiating to the leg

Slide 103: Prostate Cancer  Diagnostic tests 2. Prostatic specific antigen (PSA) 3. Elevated SERUM ACID PHOSPHATASE indicates SPREAD or Metastasis

Slide 104: Prostate Cancer Medical and surgical management 2. Prostatectomy 3. TURP 4. Chemotherapy: hormonal therapy to slow the rate of tumor growth 5. Radiation therapy

Slide 105: Prostate Cancer Nursing Interventions 2. Prepare patient for chemotherapy 3. Prepare for surgery

Slide 106: Prostate Cancer Nursing Interventions: Post- prostatectomy 2. Maintain continuous bladder irrigation. Note that drainage is pink tinged w/in 24 hours 3. Monitor urine for the presence of blood clots and hemorrhage 4. Ambulate the patient as soon as urine begins to clear in color





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