GENITOURINARY SYSTEM

Billy Ray A. Marcelo, RN

OVERVIEW

 Promote fluid, e+ & acid-

base balance
 Promote excretion of the
nitrogenous waste products
OVERVIEW

 Kidneys
– A pair of bean-shaped organs located
retroperitoneally at the back of peritoneum
at either side of the vertebral column
– Parts: medulla, cortex & renal pelvis
– Nephrons: basic unit, glomerulus (network
of capillaries)
OVERVIEW

 Kidneys
– Function
 Urine formation
– Stages
 Filtration: GFR: 125 ml/min

 Tubular reabsorption: 124 ml

reabsorbed
 Tubular secretion: 1 ml excreted
OVERVIEW

 Ureters
– 25 cm long, prevent reflux of urine back to the
kidneys
 Bladder
– Behind symphysis pubis, elastic & muscular
tissue that makes it distensible
– Can hold up to 1.2-1.8 L urine
– 250-500 cc of urine can trigger micturition
OVERVIEW

 Urethra- extends to the exterior

surface of the body
– F: 2-5 cm/ 1-1.5 in
– M: 20 cm/ 8 in
– Cathether: Pedia: 8-10F, Adult F
12-14F, Adult M 14-16 F
CYSTITIS (UTI)

 Inflammation of the bladder r/t

microbial invasion
 Predisposing Factors
– Microbial invasion (80%- E. coli)
– Urinary obstruction & stagnation
  estrogen levels
CYSTITIS (UTI): S/Sx

 Flank pain & tenderness

 Urinary frequency & urgency
 Dysuria (painful urination)
 Burning sensation upon urination
 Hematuria
 Fever, chills, A/N/V
CYSTITIS (UTI): Diagnostic Procedure

 Urine
C/S: determines the
causative agent
CYSTITIS (UTI): Nursing Interventions

 Force fluids
 Warm Sitz bath
 Monitor for the color, odor, blood in urine
 Administer meds as ordered
– Systemic Antibiotics (Cephalosporin, Tetracycline,
Ampicillin)
– Sulfonamides (Cotrimoxazole: Bactrim, Gantricin)
– Urinary analgesic: Pyridium
CYSTITIS (UTI): Nursing Interventions

 Acid ash diet

 Health teaching
– Adequate hydration
– For M: instruct to urinate after coitus
– For F: avoid cleaning perineum from back
to front, toilet paper, bubble bath
 Prevent Cx: Pyelonephritis
PYELONEPHRITIS

 Inflammation of 1 or 2 renal pelvis of kidneys

leading to ATN, abscess formation & RF
 Predisposing Factors
– Microbial invasion (E. coli & Streptococcus)
– Urinary retention & obstruction
– DM
– Pregnancy
– Exposure to renal toxins
PYELONEPHRITIS: S/Sx

 Acute
– Costovertebral pain & tenderness
– Fever & chills
– Urinary frequency & urgency
– Hematuria, dysuria, burning sensation upon urination
 Chronic
– A/ wt. loss
– Polyuria, polydipsia
– HTN, HA
PYELONEPHRITIS: Diagnostic
Procedures

 U/A-  CHON, WBC

 Urine C/S: determines the
causative agent
 Cystoscopy: (+) urinary
obstruction
BENIGN PROSTATIC HYPERTROPHY

 Enlargement of the prostate gland

 Predisposing factors
– Male >40 y/o r/t hormonal influences
 S/Sx
– Urinary hesitancy,  urinary stream
– Terminal dribbling
– Backache
– Hematuria
– Dysuria
– Burning sensation upon urination
BENING PROSTATIC HYPERTROPHY

 Diagnostic Procedures
– Digital rectal exam: enlarged
prostate gland
– Cystoscopy: urinary obstruction
– KUB- enlarged prostate gland
– U/A- WBC, RBC
BENING PROSTATIC HYPERTROPHY:
Nursing Interventions

 Limit fluid intake

 Catheterization as ordered
 Prostatic massage
 Administer as ordered
– Terazosin- relaxes urinary sphincters
– Finasteride- promotes atrophy of BPH
BENING PROSTATIC HYPERTROPHY:
Nursing Interventions

 Assist in surgery
– Prostatectomy
– Transurethral Resection of the Prostate (TURP)
 Cystoclysis: continuous bladder irrigation
– Irrigate the tube with pNSS to flush the
clots
– WOF bleeding, hemorrhage
– Strict asepsis
NEPHROLITHIASIS/
UROLITHIASIS

 Formation of stones elsewhere in the urinary tract

 Common type: Ca, Oxalate, uric acid
 Predisposing Factors
  Ca, Oxalate diet (chocolates), purines
– Gout
– Obesity
– Sedentary lifestyle
– Prolonged immobility
– Hyperparathyroidism
NEPHROLITHIASIS/
UROLITHIASIS: S/Sx

 Renal colic
 Cool, moist skin
 N/V
 Polyuria, polydipsia
 Hematuria, dysuria, nocturia, burning
sensation upon urination
NEPHROLITHIASIS/
UROLITHIASIS: Diagnostic Procedures

 KUB- locates stones

 IVP- location & composition of stones
 Cystoscopy: urinary obstruction
 U/A: WBC, RBC
 Stone analysis: type, no. &
composition
NEPHROLITHIASIS/
UROLITHIASIS: Nursing Interventions
 Force fluids
 Strain all urine with gauze
 Warm sitz bath
 Diet: if Ca stone: acid ash
 If Oxalate: alkaline ash (milk & milk products)
 If Uric acid:  purines
 Administer as ordered:
– Narcotic analgesic
– Antibiotics
– Allopurinol
NEPHROLITHIASIS/
UROLITHIASIS: Nursing Interventions

 Assist in surgery
– Nephrectomy: removal of 1 kidney
– Extracorporeal Shockwave
Lithotripsy: if stones are recurrent
 Prevent Cx: ARF
RENAL FAILURE

 Loss of kidney function

 S/Sx r/t retention of waste & fluids & inability to
regulate e+
 Causes
– Prerenal: dehydration, hypovolemic shock
– Intrarenal: ATN, nephrotoxicity, altered renal
blood flow
– Postrenal: obstruction of urine flow
ACUTE RENAL FAILURE

Diuretic Phase
 Oliguric Phase (8- 
 GFR (4-5 L/day)
15 days)  K

 GFR  Na
– Hypovolemia
K – Gradual  BUN, crea

– N or  Na  Recovery (Convalescent)
Phase
– Fluid overload – Stable & N BUN
– Complete recovery: 1-2 yrs
  BUN, crea
CHRONIC RENAL FAILURE

 Stage 1: Diminished Renal Reserve

  renal function
– (-) accumulation of metabolic wastes
– The healthier kidney compensates
– Nocturia & polyuria r/t  ability to
concentrate urine
CHRONIC RENAL FAILURE

 Stage 2: Renal Insufficiency

– Metabolic wastes begins to accumulate
– Oliguria & edema r/t  responsiveness to
diuretics
 Stage 3: End Stage
– Excessive accumulation of metabolic wastes
– Kidneys unable to maintain homeostasis
– Dialysis or other renal replacement therapy is
required
SPECIAL PROBLEMS IN RENAL
FAILURE

 Anemia (Vit. B9/Folic acid instead of iron,

Epogen, BT as ordered)
 GI bleeding (r/t ammonia irritation)
 HTN (Inderal as ordered: renin release),
hypervolemia (diuretics, fluid restriction, Na
diet)
 Infection & injury (minimize urinary
catheterization)
 Insomnia & fatigue
SPECIAL PROBLEMS IN RENAL
FAILURE

 HypoCa, Hyperphosphatemia, HyperK (diet,

dialysis)
 Metabolic acidosis
 Muscle cramps, pruritus (r/t uremic frost- skin
care, avoid soaps, antipruritics as ordered)
 Neuro changes
 Occular irritation (r/t Ca deposits in conjunctiva,
eye drops)
 Psychosocial problems (psychosocial care)
NCLEX/CGFNS QUESTIONS

 The pt who has a hx of gout is also dx with

urolithiasis. The stones are determined to be
uric acid type. The nurse gives the pt
instructions in foods to limit, which include
– Liver
– Apples
– Carrots
– Milk
NCLEX/CGFNS QUESTIONS

 A RN is assessing the patency of an

atriovenous fistula in the L arm of a pt who is
receiving hemodialysis for the tx of chronic
RF. Which finding indicates that the fistula is
patent?
– (-) bruit on auscultation of the fistula
– Palpation of a thrill over the fistula
– Presence of radial pulse in the L wrist
– CRT <3 sec in the nail beds of L hand
NCLEX/CGFNS QUESTIONS

 A pt with chronic RF has completed a

hemodialysis tx. The RN would use which of
the ff standard indicators to evaluate the pt’s
status after dialysis?
– K level & wt
– BUN & crea levels
– VS & BUN
– VS & wt
NCLEX/CGFNS QUESTIONS

 The pt asks about the purpose of the glucose

contained in the peritoneal dialysis. The nurse
bases the response knowing that glucose
– Prevents excess glucose from being removed from
the client
– Decreases the risk of peritonitis
– Increases osmotic pressure to produce ultrafiltration
– Increases the risk of peritonitis
NCLEX/CGFNS QUESTIONS

 A pt newly dx with RF is receiving peritoneal

dialysis. During the infusion of the dialysate,
the pt complains of abdominal pain. Which
action by the RN is most appropriate?
– Slow the infusion
– Decrease the amount to be infused
– Explaining that pain will subside after the 1st few
exchanges
– Stop the dialysis
NCLEX/CGFNS QUESTIONS

 A RN is instructing a pt with DM about

peritoneal dialysis & tells the pt that it is impt
to maintain the dwell time for the dialysis at
the prescribed time because of the risk of
– Infection
– Hyperglycemia
– Fluid overload
– Hyperkalemia