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GENITOURINARY SYSTEM

GENITOURINARY SYSTEM. Michelle Gardner NUR-224. URINARY SYSTEM. ASSESSMENT OF THE URINARY SYSTEM. Subjective Data Good communication skills Avoid medical terminology Anxiety/embarrassment – “forget/deny”-- . ASSESSMENT DATA. Past Health History

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GENITOURINARY SYSTEM

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  1. GENITOURINARY SYSTEM Michelle Gardner NUR-224

  2. URINARY SYSTEM

  3. ASSESSMENT OF THE URINARY SYSTEM Subjective Data • Good communication skills • Avoid medical terminology • Anxiety/embarrassment – “forget/deny”--

  4. ASSESSMENT DATA Past Health History • Presence/history of diseases r/t urologic problems – DM, HTN • Neurologic conditions – back injury, stroke, trauma • Urinary problems – BPH, renal calculi, cancer, infection

  5. ASSESSMENT DATA Medications • Prescription / OTC / Herbs • Nephrotoxic medications -- antibiotics • Quantity & character of urine output –diuretic, anticholinergic, antihistamine • Change in color – Pyridium, Macrodantin

  6. ASSESSMENT DATA Surgery • Previous hospitalizations r/t urologic disease • Pelvic surgeries • Urinary instrumentation • Urinary problems during past pregnancies • Radiation/chemotherapy

  7. ASSESSMENT DATA • Pain • Changes in voiding • Affects of aging on the urinarysystem a. Decrease muscle tone b. Decrease bladder capacity c. Prostate enlargement d. Changes in metabolism

  8. BLOOD CHEMISTRIES Blood Chemistries • Serum Creatinine: 0.6 – 1.2mg/dl • End product of muscle & protein metabolism • Excellent indicator of kidney function • Renal disease results in increase creatinine

  9. BLOOD CHEMISTRIES • BUN/Blood Urea Nitrogen: 7-18mg/dl • Used to identify renal problems • Nonrenal factors may increase BUN a. Fever b. Dehydration c. High protein diet d. Athletic activity e. Drugs and vitamins (acetaminophen, ibuprofen, vitamin D)

  10. DIAGNOSTIC STUDIES • KUB (kidneys, ureters, bladder) • X- ray exam of abdomen & pelvis • Used to detect abnormalities • Urinary calculi • Cysts • Tumors • Hydronephrosis

  11. DIAGNOSTIC STUDIES • IVP (INTRAVENOUS PYLEOGRAM) Urography • Intravenous injection of radiopaque imaging dye • X-ray imaging of dye through upper and lower urinary system

  12. INTRAVENOUS UROGRAPHY

  13. INTRAVENOUS UROGRAPHY • Patient preparation: • Consent form • Cathartic/enema the night before • Identify allergies – shellfish, iodine • Pre-medicate–antihistamine (Benadryl) • NPO 8 hr. before procedure • Transitory effects – contrast medium

  14. INTRAVENOUS UROGRAPHY • Post-procedure • Monitor vital signs • Assess for s/s anaphylactic reactions • Monitor urine output • Force fluids

  15. RENAL ANGIOGRAPHY • RENAL ANGIOGRAM: • Catheter inserted into femoral artery • Contrast material injected through the catheter • Visualize renal blood vessels • Findings : • Renal artery stenosis • Differentiate renal cysts from tumors • Evaluate hypertension

  16. RENAL ANGIOGRAPHY • Patient preparation • Consent form • Cathartic/enema the evening before • Assess allergic reaction • Mark peripheral pulses

  17. RENAL ANGIOGRAPHY • Post-Procedure • Monitor vital signs • Pressure dressing over insertion site • Assess insertion site - • Bedrest with affected leg straight • Palpate peripheral pulses

  18. RENAL BIOPSY • Done as a needle biopsy with needle insertion into lower lobe of the kidney OR open biopsy via small flank incision • Obtain renal tissue to determine type of renal disease • Kidneys are vascular organs – hemorrhage/complication

  19. RENAL BIOPSY Patient preparation • Consent form signed • NPO status 8 hrs. prior to test • Assess baseline coagulation status • Medications that may alter clotting function

  20. RENAL BIOPSY

  21. Post-Procedure Pressure dressing applied Check puncture site – swelling/tenderness Prone position for 30-60 minutes Monitor vital signs Observe for gross bleeding Assess for flank pain, Hgb./Hct. levels Avoid lifting heavy object/strenuous activity – 7 days RENAL BIOPSY

  22. UROLOGIC ENDOSCOPIC PROCEDURES • Visualize/inspect the interior of the urethra and bladder with a tubular lighted scope (cystoscope) • Used to: • Treat bleeding lesions • Insert ureteral catheters • Remove calculi • Obtain biopsy specimens

  23. CYSTOSCOPY • Patient preparation • Signed consent form • NPO prior to the procedure • Local topical anesthetic • Lithotomy position – leg cramps

  24. CYSTOSCOPY • Post-procedure • Expected side effects - burning on urination, blood-tinged urine, urinary frequency • Encourage increased fluids • Warm sitz bath • Mild analgesics

  25. RENAL CALCULI

  26. UROLITHIASIS/NEPHROLITHIASIS • 500,000 people in the U.S. have kidney stone disease • Incidence is highest in Southern & Midwest states. • Occurs between the 3rd-5th decade of life. • Recurrence of stones – 50% of pts. • More common in men than in women

  27. RENAL CALCULI Risk Factors • Family history of stone formation • Dehydration  increase urine concentrations • Excess dietary intake of calcium, oxalate, or proteins • Sedentary lifestyle/immobility • Genetic predisposition

  28. RENAL CALCULI • Stones can be found anywhere from kidney to bladder • Vary in size • Factors that contribute to urolithiasis * supersaturation * nucleation

  29. RENAL CALCULI Pathophysiology • Concentration of an insoluble salt is high in the urine supersaturation • Crystals form from supersaturated urine • Growth continues by aggregation to form larger particles – stone formation

  30. RENAL CALCULI

  31. RENAL CALCULI • 4 Major Categories of Stones • Calcium • Oxalate • Uric acid • Cystine

  32. Calcium Calculi • High concentration of calcium in the blood/urine • 70-80% of kidney stones are calcium stones • Smaller stones maybe trapped in the ureter • Seen more in men

  33. Calcium Calculi (Oxalate) Risk factors • Hypercalciuria/hypercalcemia, immobility, vit.D, urine intoxication, dehydration Management • Thiazide diuretics • Limit foods that acidify urine • Hydration/exercise

  34. Uric Acid Stones

  35. Urine concentration of uric acid is high Common in men Causes: Gout Increased dietary intake of purine Acid urine Reduce dietary purines– sardines, mussels, organ meats, aged cheese Administer allopurinol (Zyloprim) Reduce urinary concentration of uric acid Uric Acid Calculi

  36. Struvite Calculi

  37. Struvite Calculi (Staghorn) • 15-20 % of stones - magnesium/ammonium/phosphate Risk Factors • UTIs, esp Proteus infections • Stones are large fill renal pelvis Management • Antibiotics • Surgical intervention/lithotripsy

  38. Make up 1-2% of all stones Caused by genetic defect Tend to form in acid urine Stones appear during childhood / adolescence Rare in adults Increase hydration Low-protein diet Cystine Calculi

  39. RENAL CALCULI • Clinical Manifestations: • Severe flank pain / renal colic • Abdominal pain • Hematuria • Oliguria/anuria • Nausea /Vomiting/Diarrhea

  40. RENAL CALCULI Diagnostic Studies: • Urinalysis • 24 hr urinary measurement for calcium, uric acid • X-ray - KUB • Renal Ultrasonography • CT Scan

  41. RENAL CALCULIManagement Pain management • Opiod analgesics – Morphine • NSAID Toradal • Comfort measures • Increase fluid intake (oral/intravenous)

  42. RENAL CALCULI • Stones may pass spontaneously • Stones larger than 4mm are unlikely to pass through the ureter • Chemical analysis of the stone to determine the composition of the stone • STRAIN ALL URINE

  43. RENAL CALCULI • THERAPUETIC INTERVENTIONS • ESWL-Extracorporeal shock-wave lithotripsy • Non-invasive procedure • External shock-waves break up the stone • No damage to surrounding tissue • Stones are fragmented into fine sand • Fragments are excreted in the urine • All urine is strained -- chemical analysis • Anesthesia is necessary

  44. RENAL CALCULI • Cystoscopy passed – removes stones located in the ureter close to the bladder • Stone removed -- grasping basket, forceps • Stent may be placed • Foley catheter -- facilitate passage stone fragments • Minimal complications

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