The document summarizes the structure and function of the genitourinary tract. It discusses the kidneys, ureters, bladder, and urethra. It describes urine formation and the roles of the kidneys in regulating blood pressure and fluid/electrolyte balance. Common genitourinary disorders are also outlined, including urinary tract infections like cystitis and pyelonephritis. Acute and chronic renal failure are summarized as well as conditions like nephrolithiasis. Nursing management of related issues is briefly discussed.
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Genito Urinary Nursing
1. Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
B. Structure
1. Renal pelvis
2. Renal colic
3. Renal medulla
C. Nephron glomerulus
D. Functions
1. Urine formation
2. Regulates BP
E. Urine Formation (Normal GFR: 125 ml of blood is
MEDICAL AND SURGICAL NURSING filtered in the glomerulus per minute)
1. Filtration
Genito-Urinary Tract Disorder 2. Tubular Reabsorption – 124 ml of ultrafiltrates are
reabsorbed back into the blood
Lecturer: Mark Fredderick R. Abejo RN,MAN 3. Tubular Secretion – 1 ml excreted in the urine; ¼ of
________________________________________________ total cardiac output is received by kidneys
II. Ureters – 20-30 mm long – serves as a passageway of urine
III. Bladder
OVERVIEW OF THE STRUCTURE AND FUNCTION OF A. Located behind the symphysis pubis
THE GENITO-URINARY TRACT B. Made up of muscular and elastic tissues distensible
reservoir of urine
- Promotes excretion of nitrogenous waste products C. Max: 1, 200 -1,800 ml of urine
- Maintain fluid electrolytes and acid-base balance D. Initiates urination: 250-500 cc ml
E. Normal urine:
1. amber, aromatic, turbid/clear, pH 4-8
2. spec gravity: 1.015-1.030
3. WBC, CHON none
4. (-) E. coli
5. mucus threads few
6. (-) amorphous urates
IV. Urethra
A. Serves as a passageway for urine, vaginal/seminal fluids
B. Length
1. F: 3-5 cm or 1-1/2 inches
2. M: 20 cm or 8 inches
C. Catheter
1. Pedia: 8-10 fr
2. F: 12-14 fr
3. M: 16-18 fr
URINARY TRACT INFECTIONS
I. CYSTITIS – inflammation of bladder caused by bacterial
infection
I. Kidneys A. PREDISPOSING FACTORS
A. Location – a pair of bean shaped organs located 1. High risk: women
retroperitoneally (behind peritoneum) on either side of 2. Microbial Invasion (E. Coli)
the verbral column 3. Increased estrogen levels, estrogen therapy
4. Sexual intercourse
MS Abejo
2. Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
Void after sexual intercourse
5. Urinary retention Instruct female client to:
6. Incontinence Proper perineal hygiene
7. Urinary obstruction Front to back cleaning
8. Poor perineal hygiene Avoid tissue use
Bubble bath
B. S/SX (-) talcum powder, perfume
1. Urinary frequency and urgency
2. Flank pain 7. Prevent complications
3. Fever, chills, anorexia, generalized body malaise Pyelonephritis
4. Dysuria – burning upon urination
5. Hematuria II. PYELONEPHRITIS – acute or chronic inflammation of
renal pelvis leading to tubular destruction, intestinal abscesses
C. DX and renal failure
1. Urine culture and sensitivity
(+) E. Coli 90%
2. Urinalysis
Increased WBC
Increased CHON
Increased pus cells
D. NSG MGMT
1. Forced fluids (2-3 L/d)
2. Provide warm sitz bath to promote comfort
3. Provide acid-ash diet: cranberries, grape juice,
plums
A. PREDISPOSING FACTORS
1. Microbial invasion
E. coli
Streptococcus
2. Urinary retention/ stagnation
3. pregnancy
4. DM
5. Exposure to renal toxins/ use of nephrotoxic agents
6. Obesity
4. Monitor for gross hematuria, color, odor of urine
B. S/SX
5. Administer meds as ordered
1. Acute Pyelonephritis
Systemic antibiotics
Urinary frequency and urgency
Penicillins
Costovertebral angle pain and tenderness
Cephalosporins (SE: nephrotoxicity,
Fevers and chills, anorexia, general body
hepatotoxicity)
malaise
Tetracycline (staining of teeth,
Burning upon urination
photosensitivity)
Dysuria, nocturia, hematuria
Sulfonamides
2. Chronic Pyelonephritis
Co-trimoxazole (Bactrim)
Fatigue and/or weakness
Gantricin
Weight loss
Sulfisoxazole
Polyuria
Urinary antiseptics
Polydypsia
Nitrofurantoin (Macrodantin)
HPN
Furadantoin
Urinary analgesics
C. DIAGNOSTICS
Pyridium – decreases pain, promotes
1. Urine CS: (+) cultured microorganisms (E.coli and
relaxation of sphincter
strep)
6. Discharge teaching
2. Urinalysis: elevated WBC, CHON, pus cells
Importance of hydration
3. Cystoscopic exam: (+) urinary obstruction
MS Abejo
3. Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
4. Strain all urine using gauze pad
D. NURSING MANAGEMENT 5. Warm sitz bath for comfort
1. Provide CBR especially during acute attack 6. Meds as ordered
2. Forced fluids Narcotic analgesics – morphine
3. Provide an acid ash in the diet Allopurinol (zyloprim)
4. Provide warm sitz bath for comfort 7. Provide dietary intake:
5. Administer medications as ordered If (+) to ca stones: acid ash
Nitrofurantoin If (+) to oxalate stones: alkaline ash (milk,
SE: GIT irritation, give with food, tea, vegetables)
peripheral neuropathy, hemolytic anemia If (+) to uric acid: avoid purine rich food
(initial sx: fever), discoloration of teeth like anchovies, legumes, organ meat, nuts
Urinary analgesics 8. Assist
Pyridium Litholapoxy – surgical removal of 2/3 stone
6. prevent complications Nephrectomy – removal of kidney
renal failure stagnation
Lithotripsy – extracorporeal shockwave
III. NEPHROLITHIASIS/UROLITHIASIS – formation of No incision, early discharge
stones elsewhere in the urinary tract Too costly
Stones can recur
Post-op: strain urine
9. Prevent complications renal failure
IV. ACUTE RENAL FAILURE (ARF) – sudden inability of the
kidneys to excrete nitrogenous waste products, leads to
azotemia
A. PREDISPOSING FACTORS
1. Pre-renal : involves decrease in GFR
(n=125ml/hr)
Hemorrhage
Shock
Chronic diarrhea (dehydration)
CHF
A. TYPES OF STONES
Hypotension
1. calcium
Septicemia
2. oxalate
2. Intrarenal – involves renal pathology
3. uric acid
Pyelonephritis
DM
B. PREDISPOSING FACTORS
AGN
1. diet high in calcium and oxalate
Acute tubular necrosis: common SE post-
2. hereditary (like gout)
hemolytic BT
3. hyperparathyroidism (Hypercalcemia)
3. Post-renal – (+) mechanical obstruction
4. obesity
BPH
5. sedentary lifestyle
Nephro/urolithiasis
Tumor
C. S/SX
Urinary strictures
1. Renal colic
2. Cool, moist skin
3. Burning upon urination
4. Dysuria, Nocturia
5. Hematuria
D. DIAGNOSTICS
1. Urinalysis – (+) RBC, WBC, Pus cells
2. KUB: reveal site or location of stones
3. Stone analysis: reveals composition of stone
4. Cystoscopic exam: urinary obstruction
5. IVP: reveals obstruction
E. NURSING MANAGEMENT
1. Forced fluids to prevent further crystallization
2. Alternate warm and cold compress
3. Administer isotonic fluids as ordered
MS Abejo
4. Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
Anorexia
B. STAGES N&V
Diarrhea and/or constipation
1. Oliguric phase – passage of urine (1-2 weeks) Stomatitis
UO: <400 ml/cc Uremic breath
Hyperkalemia 7. Integumentary
Hypernatremia Pruritus
Hyperphosphatemia Uremic frost
HYPOCALCEMIA 8. Metabolic/Electrolyte imbalance
Hypermagnesemia Hyperkalemia
Metabolic acidosis Hyperphosphatemia
Elevated BUN, Crea Metabolic acidosis
2. Diuretic Phase (2-3 weeks) 9. Endo
Increased passage of urine Gynecomastia
Hyperkalemia Hyperthyroidism
Hyponatremia
Metabolic acidosis D. NURSING MANAGEMENT
3. Convalescent phase (3-12 months) 1. Enforce CBR
Improvement in passage of urine 2. Admin oxygen inhalation as ordered
Characterized by complete diuresis 3. High CHO diet low CHON, fats, High vit and
minerals
V. CHRONIC RENAL FAILURE (CRF) – irreversible loss of 4. Provide meticulous skin care
kidney function Wash with warm water
Soap irritates and dries skin
A. PREDISPOSING FACTORS 5. Meds as ordered
1. DM and HPN (common causes) anti-HPN agents
2. Recurrent pyelonephritis Hydralazine (appresoline)
3. Exposure to renal toxins SE: orthostatic hypotension
4. Tumor NaHCO3
Kayexelate enema
B. STAGES Hematinics
1. Diminished renal reserve volume – asymptomatic, Antibiotics
normal BUN and CREA Supplementary vitamins and minerals
2. Renal insufficiency Phosphate binders
3. End-stage renal disease (ESRD) – presence of Calcium gluconate
oliguria, azotemia
6. Assist in hemodialysis
C. S/SX
1. Uro
Azotemia (elevated BUN and crea)
Oliguria
Nocturia
Hematuria
Dysuria
2. Neuro
Lethargy
Headache
Disorientation (initial sign of disequilibrium
syndrome) and confusion, restlessness
Memory impairment
Decreased LOC
3. Respi
Depressed or diminished cough reflex
Kussmaul’s respirations
4. Hema
Anemia
Leukopenia
Bleeding tendencies (thrombocytopenia) Secure consent and explain procedure to client
All blood cells decreased Maintain strict aseptic technique
Increased susceptibility to infection Obtain baseline data – before and q30 during
5. CV changes procedure
Pulmo HPN VS
CHF Wt
Pericarditis Blood exams – secure all pre-procedure
6. GIT distress I/O
MS Abejo
5. Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
Most common complication is
Have client void pre-procedure PERITONITIS and shock
Inform pt about bleeding (blood is heparinized) First sign: cloudy dialysate return
Monitor for signs of complications Most common dialysate:
(BEDSSH) INFERSOL
Bleeding Infusion time: 10-20 minutes
Embolism Dwelling time: 30-45 minutes
DISEQUILIBRIUM SYNDROME –
results from rapid loss of nitrogenous What determines effectiveness of dialysis?
waste products particularly UREA from Weight of patient
the brain
HPN 7. Assist in surgical procedure: KIDNEY
Disorientation – initial sign TRANSPLANTATION
Nausea and vomiting
anorexia
Headache
Paresthesia, peripheral
Numbness
Septicemia
Shock
Hepatitis
Avoid BP taking, phlebotomy, IV meds at the
site of fistula, blood extraction to prevent
compression
Maintain patency of shunt/fistula:
Palpate for thrills, auscultate for bruits
Instruct that minimal bleeding is expected
since blood is heparinized
Avoid use vasodilators, sedatives, and
tranquilizers to prevent hypotension unless
ordered
Prepare at bedside bulldog clips to prevent Meds: steroids, immunosuppressants, anti
embolism lymphocyte globulin…
Auscultate for bruits and palpate for thrills
(if (+) patent) Feared complication: rejection, characterized
by hypertension, headache, dizziness,
PERITONEAL DIALYSIS decreased CBC
2 TYPES OF REJECTION
Acute – 6 to 10 months
Chronic – 5-10 years
1. Oliguria
2. Disorientation
3. Decreased LOC
MS Abejo
6. Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
MS Abejo
7. Medical and Surgical Nursing
Genito-Urinary Tract
Prepared by: Mark Fredderick R. Abejo RN,MAN
MS Abejo