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Genital-urinary System. Renal System Part 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

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genital urinary system

Genital-urinary System

Renal System

Part 2

behavioral objectives
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
dysfunctional voiding patterns
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)
types of incontinence
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
slide5

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.

types of incontinence6
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
anticholinergic
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
types of incontinence8
Types of Incontinence
  • Reflux incontinence
    • Involuntary loss of urine due to Hyperreflexia in the absence of normal sensation
    • Associated with spinal cord injuries
types of incontinence9
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
behavior therapy management
Behavior Therapy Management
  • Fluid Management
    • Increase fluid
    • Decrease fluid
    • WATER!!!!
  • Standardized voiding frequency
      • Timed voiding
      • Bladder retraining
behavior therapy management11
Behavior Therapy Management
  • Pelvic Muscle Exercises
    • Kegel exercises
      • Goal
        • strengthen voluntary muscles
behavior therapy management12
Behavior Therapy Management
  • Pharmacological Therapy
    • Anticholinergic agents
      • Oxybutynin/Ditropan
        • Action: Inhibits bladder contractions
        • Indications for use: urge incontinence
surgical management
Surgical management
  • Involve lifting and stabilizing the bladder or urethra
nursing management
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
urinary retention
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
urinary retention16
Urinary Retention
  • Assessment
    • Measure post void residual urine
      • Portable bladder scanner
urinary retention17
Urinary Retention
  • Complications
    • Chronic infections 
    • Pyelonephritis 
    • Sepsis 
    • Kidney failure
    • Deathmosis
urinary retention18
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
neurogenic bladder
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
neurogenic bladder management
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
urological surgery
Urological Surgery
  • Drainage tubes
  • Nephrostomy drainage
    • Tube inserted directly into the kidney
nephrostomy drainage
Nephrostomy drainage
  • Nursing management
    • Assess for complications
      • Bleeding
      • Infection
      • Skin
    • Ensure unobstruction
    • Never clamp
    • Irrigate
    • Encourage fluids
    • Aseptic technique
    • Measure I&O
urethral stent
Urethral Stent
  • A tubular device that maintains position & patency of the urethra
nursing process post op urinary surgery
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.
test question
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
nursing process post op urinary surgery26
Nursing Process: post-op urinary surgery
  • Acute pain
    • Assess pain level
    • Assess abd. distention
    • Admin analgesics
    • Moist heat
    • Massage
    • Splint
    • Exercise
nursing process post op urinary surgery27
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
nursing process post op urinary surgery28
Nursing Process: post-op urinary surgery
  • Potential complications
    • Bleeding
    • Pneumonia
    • Infection
    • Fluid disturbances
    • Deep vein thrombosis
urinary tract infections uti
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
urinary tract infections
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
urinary tract infections31
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
defense mechanism
Defense Mechanism
  • Physical barrier
  • Urine flow
  • Enzymes
  • Antibodies
defense mechanism33
Defense Mechanism
  • Who is more likely to get a UTI
    • Male
    • Female
  • Why?
    • Shorter urethra
predisposing factors to uti
Predisposing factors to UTI
  • Factors increasing urinary stasis
  • Foreign bodies
  • Anatomic factors
  • Factors compromising immune system
  • Functional disorders
clinical manifestations lower uti
Clinical Manifestations: Lower UTI
  • Dysuria
  • Burning
  • Frequency
  • Urgency
    • Nocturia
    • Incontinence
    • Pelvic pain
    • Hematuria
    • Cloudy urine
    • Back pain
clinical manifestations upper uti
Clinical Manifestations: Upper UTI
  • Fever & Chills
  • Back pain (flank)
  • N/V
  • H/A
  • Malaise
  • Dysuria
gerontologic considerations
Gerontologic considerations
  • Few S&S
  • Fatigue
  • Alt cognitive function
  • Slight drop in temp
medical management pharmacological therapy
Medical management/pharmacological therapy
  • Antibiotic
    • Cephalosporin
    • Bactrim/Septra
  • Urinary analgesic
    • Phenazopyridine (Pyridium)
      • Urine  orange
nursing process uti
Nursing Process: UTI
  • Assessment
    • S&S
    • Voiding patterns
    • Sexual intercourse
    • Urine
nursing process uti41
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
nursing process uti42
Nursing Process: UTI
  • Diagnosis
    • Deficient knowledge detection, preventions and recurrence and meds
      • Hygiene
      • Fluid intake
      • Voiding habits
nursing process uti43
Nursing Process: UTI
  • Nursing Interventions: Hygiene
    • Shower not bath
    • Front to back
    • Wash after BM w/soap & water
    • No harsh soaps
nursing process uti44
Nursing Process: UTI
  • Nursing Interventions: Fluid Intake
    • Increased
    • Water
    • Avoid irritants
      • Coffee
      • Tea
      • Citrus
      • Spices
      • Cola
      • Alcohol
nursing process uti45
Nursing Process: UTI
  • Nursing Interventions: Voiding habits
    • 2-3 hrs
    • Empty completely
    • Before & after intercourse
pyelonephritis
Pyelonephritis
  • Bacterial infection of the renal pelvis, tubules and interstitial tissue of one or both kidneys.
    • Pathophysiology
      • Lower ascends up
      • Reflux
      • Obstruction
      •  enlarged kidney
pyelonephritis47
Pyelonephritis
  • Clinical manifestations
    • Acutely ill
    • Fever & Chills
    • Pyuria
    • Flank pain
    • Bacteriuria
pyelonephritis48
Pyelonephritis
  • Assessment & Dx:
    • Ultrasound
    • CT
    • UA
      • Pyuria
      • Bacteriuria
      • Hematuria
      • WBC
pyelonephritis49
Pyelonephritis
  • Medical Management
    • Outpatient
    • Dehydration
pyelonephritis50
Pyelonephritis
  • Rx
    • 2 week antibiotics
    • IV
pyelonephritis51
Pyelonephritis
  • Complications
    • End Stage Renal Disease
    • Hypertension
    • Kidney stones
    • Urosepsis
urethritis
Urethritis
  • Pathophysiology
    • Inflammation of the urethra
    • Usually ascending infection
    • STD
urethritis53
Urethritis
  • Clinical manifestations – Men
    • Prostatitis
    • Epididymitis
    • Urethral stricture
    • Sterility
  • Clinical Manifestations - Women
    • Asymptomatic
urethritis54
Urethritis
  • Treatment
    • Tetracycline
    • Partners
nephrotic syndrome
Nephrotic syndrome
  • Pathophysiology
    • Primary glomerular disease characterized by:
      • Marked increase in protein in the urine
        • (proteinuria)
      • Decrease in albumin in the blood
        • (hypoalbuminemia)
      • Edema
      • High serum cholesterol and low-density lipoprotein
nephrotic syndrome56
Nephrotic syndrome
  • Clinical Manifestation
    • #1 – edema
    • Malaise
    • H/A
    • Irritability
    • Fatigue
nephrotic syndrome57
Nephrotic syndrome
  • Assessment and diagnostic findings
    • Proteinuria
    • Hyperlipidemia
    • Hypoalbuminemia
nephrotic syndrome58
Nephrotic syndrome
  • Complications
    • Infections
    • Thromboembolism
    • Pulm. Emboli
    • Renal Failure
nephrotic syndrome59
Nephrotic syndrome
  • Medical Management
    • Diuretic
    • NSAID
    • Diet
      • i Sodium
      • h K+
      • h protein
      • i Fat
nephrotic syndrome60
Nephrotic syndrome
  • Nursing Management - Edema
    • qD weight
    • I&O
    • Abd. Girth
    • Clean skin
    • Avoid people with infections
hydronephrosis
Hydronephrosis
  • Pathophysiology
    • Dilation of the renal pelvis and calyces of one or both kidneys due to an obstruction
hydronephrosis62
Hydronephrosis
  • Clinical Manifestations
    • Aching flank
    • Dysuria
    • Chills & fever
    • Tenderness
    • Pyuria
hydronephrosis63
Hydronephrosis
  • Medical Management
    • Remove obstruction
renal calculi or nephrolithiasis
Renal calculi or nephrolithiasis
  • Pathophysiology
    • Stones are formed in the urinary tract when urinary concentrations of the substances such as calcium oxalate, calcium phosphate and uric acid increase
      • Calculus = Stone
      • Lithiasis = Stone formation
renal calculi or nephrolithiasis65
Renal calculi or nephrolithiasis
  • Certain factors favor the formation of stones:
    • Infection
    • Urinary stasis
    • Immobility
    • Dehydration
renal calculi or nephrolithiasis66
Renal calculi or nephrolithiasis
  • Clinical Manifestations
    • Pain
      • Abd / flank
      • Severe
      • N&V
    • Hematuria
renal calculi or nephrolithiasis67
Renal calculi or nephrolithiasis
  • Assessment and diagnostic findings
    • X-ray
    • Ultrasonography
    • 24-hour urine test
    • Cystoscopy
    • IVP
renal calculi or nephrolithiasis68
Renal calculi or nephrolithiasis
  • Cystoscopy
    • Lighted scope to inspect bladder
    • Gen anesthesia
    • Nrs Management
      • Force fluids
      • Expect burning
      • Pink tinged
      • Frequency
      • Orthostatic hypotension
renal calculi or nephrolithiasis69
Renal calculi or nephrolithiasis
  • IVP
    • intravenous pyelogram
    • X-ray + IV dye
    • Assess for allergies to dye
    • After  push fluids
renal calculi or nephrolithiasis70
Renal calculi or nephrolithiasis
  • Medical management
    • Opioid analgesic
    • Antibiotics
    • NSAIDs
    • Diet
      • Calcium OK
      • Fluids
      • i protein
      • i Sodium
renal calculi or nephrolithiasis71
Renal calculi or nephrolithiasis
  • Surgical Management
    • If > 4mm will not pass through ureter
    • If not pass spontaneously or if complications  surgery
renal calculi or nephrolithiasis72
Renal calculi or nephrolithiasis

Surgical Management

  • Ureteroscopy
    • First visualize the stone
    • Destroy the stone
      • Laser
      • Electrohydraulic lithotriptos
      • Ultrasound
renal calculi or nephrolithiasis73
Renal calculi or nephrolithiasis
  • ESWL - Extracorporeal shock wave lithotripsy
    • Gen / spinal
    • Shock waves  water  stone breaks up
renal calculi or nephrolithiasis74
Renal calculi or nephrolithiasis
  • Nursing Process
    • Diagnosis
      • Acute pain
      • Deficient knowledge to prevent recurrence of renal stone
renal calculi or nephrolithiasis75
Renal calculi or nephrolithiasis
  • Nursing Interventions
    • Admin opioid agents
    • NSAIDS
    • Position of comfort
    • Amb.
    • Heat to flank
    • h fluids
    • Assess urine
    • I&O
    • Strain urine – gauze
    • Avoid dehydration
renal neoplasm s
Renal neoplasm’s
  • Pathophysiology
    • Tobacco leading cause of all UT – Ca
    • Metastasize early
      • Liver
      • Lungs
      • Bone
      • Brain
    • 1/3 have metastasis at time of diagnosis
renal neoplasm s77
Renal neoplasm’s
  • Clinical Manifestations
    • Asymptomatic
    • Painless hematuria
renal neoplasm s78
Renal neoplasm’s
  • Medical treatment
    • Goal:
      • Eradicate before metastasis
      • Nephrorectomy
      • Chemotherapy