Genital-urinary System

1. Genital-urinary System Renal System Part 2

2. Behavioral Objectives • Identify and describe the etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following: • Urinary retention • Urinary incontinence • Urinary suppression • Residual urine • Discuss common pharmacological interventions appropriate in treatment of patient with GU disorders • Describe general nursing consideration and intervention in pre and post-operative care of patients undergoing urological surgery • Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for the following GU disorders: • Pyelonephritis • Cystitis • Urinary tract infections (UTI) • Urethritis • Nephritic syndrome • Hydronephrosis • Renal calculi • Renal neoplasm’s

3. Dysfunctional Voiding Patterns • Urinal Incontinence • Pathophysiology • Unplanned loss of urine that is sufficient to be considered a problem • Continence requires intact urinary, neurologic and muscular-skeletal systems • Any break in communication between these systems can lean to incontinence (or residual)

4. Types of Incontinence • Stress Incontinence • Involuntary loss of urine through an intact urethra due to a sudden h in intra-abd. pressure • Treatment-mild: Biofeedback & bladder drills • Treatment-moderate to severe: surgery

5. Pelvic Floor Training and the role of Biofeedback:  Health Care Professionals usually advise Pelvic Floor Training as a first line treatment or an adjunct therapy for urine leakage that occurs during coughing, laughing or on exertion. Pelvic floor exercises are effective, but only if carried out regularly and diligently. The lack of feedback on progress may lead to frustration and the discontinuation of an exercise routine, hence, it is prudent to choose devices/exercisers with biofeedback function, such as Peritron Perineometer and PFX range of pelvic floor exercisers with pressure biofeedback. The challenge is to motivate and encourage the workout and simultaneously ensure exercising of the correct muscles. Appropriate feedback will stimulate discipline and step-wise progress. PFX is available in 2 versions - vaginal for women only and anal that can used by both men and women. PFX and Peritron Perineometer products can help people, who wish to monitor the effectiveness of their exercising efforts, because of the valuable biofeedback that they generate. Pelvic floor exercises should become routine events in women's lives, but especially before and after childbirth, hysterectomy and the menopause.

6. Types of Incontinence • Urge Incontinence • Involuntary loss of urine associated with a strong urge to void that cannot be suppressed. • Treatment- • Biofeedback • Pelvic floor nerve stimulation • Bladder drill • Anticholinergics

7. anticholinergic • An anticholinergic agent blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. • An example dicyclomine. • Decreased the effects mediated by acetylcholine on acetylcholine receptors

8. Types of Incontinence • Reflux incontinence • Involuntary loss of urine due to Hyperreflexia in the absence of normal sensation • Associated with spinal cord injuries

9. Types of Incontinence • Overflow incontinence • Involuntary loss of urine due to over-distention of the bladder • Bladder is unable to empty normally • over distended • frequent urination (just over flow)  • Incontinence • Treatment: • Catheterization

10. Behavior Therapy Management • Fluid Management • Increase fluid • Decrease fluid • WATER!!!! • Standardized voiding frequency • Timed voiding • Bladder retraining

11. Behavior Therapy Management • Pelvic Muscle Exercises • Kegel exercises • Goal • strengthen voluntary muscles

12. Behavior Therapy Management • Pharmacological Therapy • Anticholinergic agents • Oxybutynin/Ditropan • Action: Inhibits bladder contractions • Indications for use: urge incontinence

13. Surgical management • Involve lifting and stabilizing the bladder or urethra

14. Nursing Management • h fluids • No diuretics after 4PM • Avoid bladder irritants • Caffeine • Alcohol • Aspartame (nutrasweet) • High fiber meals • Void regularly • Enc pelvic floor exercises • Stop smoking

15. Urinary Retention • Pathophysiology • Urinary Retention • The inability to empty the bladder completely • Residual urine • urine that remains in the bladder after voiding • Assoc. with • post-op d/t reflux spasm of sphincters • Diabetes • Prostatic enlargement • Urethral pathology • Trauma • Pregnancy • Neurologic disorders

16. Urinary Retention • Assessment • Measure post void residual urine • Portable bladder scanner

17. Urinary Retention • Complications • Chronic infections  • Pyelonephritis  • Sepsis  • Kidney failure • Deathmosis

18. Urinary Retention • Nursing Management • Promoting normal urinary eliminations • Provide privacy • Commode • Male stand • Sitz bath • Hot tea • Water faucet on • Tapping pubic area • Dipping hand in warm water • Promoting urinary elimination • Catheterization

19. Neurogenic Bladder • A dysfunction d/t a lesion of the nervous system • Two types of neurogenic bladder • Spastic bladder / reflex bladder • Empties on reflex • Flaccid bladder • Bladder becomes distended  • Overflow incontinence  • Bladder does not contract • Can not feel discomfort

20. Neurogenic Bladder: Management • Catheterization • Obstruction • Post-op • Monitor output with critical • Neurogenic bladder or urinary retention • Stage III or IV decubitus ulcers • Indwelling devices • Drainage bag below the level of the bladder • Tubing not kinked and no too long • Increase fluids • Suprapubic catheterization

21. Urological Surgery • Drainage tubes • Nephrostomy drainage • Tube inserted directly into the kidney

22. Nephrostomy drainage • Nursing management • Assess for complications • Bleeding • Infection • Skin • Ensure unobstruction • Never clamp • Irrigate • Encourage fluids • Aseptic technique • Measure I&O

23. Urethral Stent • A tubular device that maintains position & patency of the urethra

24. Nursing Process: post-op urinary surgery • Ineffective airway clearance r/t the surgical incision • Ineffective breathing pattern r/t to surgical incision & general anesthesia • Assess resp status • Auscultation • Admin analgesics • Splint • Change position frequently • Incentive spirometer • Amb.

25. Test Question! • Which of the following is appropriate nursing interventions for a patient with a nursing diagnosis of ineffective breathing patterns following renal surgery? • Have the patient lay on affected side most of the time • Encourage short breaths so not to strain incision site • Bed rest • Administer analgesics • None of the above

26. Nursing Process: post-op urinary surgery • Acute pain • Assess pain level • Assess abd. distention • Admin analgesics • Moist heat • Massage • Splint • Exercise

27. Nursing Process: post-op urinary surgery • Urine retention r/t pain, immobility and anesthesia • Asses I&0 • Assess drainage & drainage system • Aseptic technique • Maintain closed system • Irrigate? • Enc pt to move – assist to move • Anchor cath • Fluids

28. Nursing Process: post-op urinary surgery • Potential complications • Bleeding • Pneumonia • Infection • Fluid disturbances • Deep vein thrombosis

29. Urinary tract infections (UTI) • Describe etiology, Pathophysiology, clinical manifestations, nursing management and patient education for Urinary tract infections (UTI) • Pathophysiology • UTI’s are caused by pathogenic micro-organisms in the urinary tract • Bacteria in bladder  attach to the bladder  colonizes in the epithelium • E. Coli

30. Urinary tract infections • Reflux • Backward flow of urine from the urethra to the bladder • Cough  • increase bladder pressure  • urine forced into urethra  • stop coughing  • decreased pressure  • urine flows back into bladder

31. Urinary tract infections • Types of UTI’s • Cystitis – • Inflammation of the bladder • Prostatitis – • Inflamation of the prostate gland • Urethritis – • Inflammation of the urethra • Pyelonephritis – • Inflammation of the renal pelvis parenchyma • Interstitial nephritis – • Inflammation of the kidney

32. Defense Mechanism • Physical barrier • Urine flow • Enzymes • Antibodies

33. Defense Mechanism • Who is more likely to get a UTI • Male • Female • Why? • Shorter urethra

34. Predisposing factors to UTI • Factors increasing urinary stasis • Foreign bodies • Anatomic factors • Factors compromising immune system • Functional disorders

35. Clinical Manifestations: Lower UTI • Dysuria • Burning • Frequency • Urgency • Nocturia • Incontinence • Pelvic pain • Hematuria • Cloudy urine • Back pain

36. Clinical Manifestations: Upper UTI • Fever & Chills • Back pain (flank) • N/V • H/A • Malaise • Dysuria

37. Gerontologic considerations • Few S&S • Fatigue • Alt cognitive function • Slight drop in temp

38. Assessment & Dx findings • UA • Culture

39. Medical management/pharmacological therapy • Antibiotic • Cephalosporin • Bactrim/Septra • Urinary analgesic • Phenazopyridine (Pyridium) • Urine  orange

40. Nursing Process: UTI • Assessment • S&S • Voiding patterns • Sexual intercourse • Urine

41. Nursing Process: UTI • Diagnosis • Acute pain related to inflammation of the urinary tract • Assess pain • Admin. Analgesics • Tell pt  orange • Teach non-Rx • Heating pad • Warm showers • Admin antispasmodics

42. Nursing Process: UTI • Diagnosis • Deficient knowledge detection, preventions and recurrence and meds • Hygiene • Fluid intake • Voiding habits

43. Nursing Process: UTI • Nursing Interventions: Hygiene • Shower not bath • Front to back • Wash after BM w/soap & water • No harsh soaps

44. Nursing Process: UTI • Nursing Interventions: Fluid Intake • Increased • Water • Avoid irritants • Coffee • Tea • Citrus • Spices • Cola • Alcohol

45. Nursing Process: UTI • Nursing Interventions: Voiding habits • 2-3 hrs • Empty completely • Before & after intercourse

46. Pyelonephritis • Bacterial infection of the renal pelvis, tubules and interstitial tissue of one or both kidneys. • Pathophysiology • Lower ascends up • Reflux • Obstruction •  enlarged kidney

47. Pyelonephritis • Clinical manifestations • Acutely ill • Fever & Chills • Pyuria • Flank pain • Bacteriuria

48. Pyelonephritis • Assessment & Dx: • Ultrasound • CT • UA • Pyuria • Bacteriuria • Hematuria • WBC

49. Pyelonephritis • Medical Management • Outpatient • Dehydration

50. Pyelonephritis • Rx • 2 week antibiotics • IV