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Genitourinary disorders. Islamic University Nursing College . Genitourinary Tract. Main function of GU is Maintaining the composition and volume of the body fluids in equilibrium Production of certain hormonal substance (e.g., erythropoietin) Remove wastes from bloodstream.

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Genitourinary disorders

Genitourinary disorders

Islamic University Nursing College

Genitourinary tract
Genitourinary Tract

  • Main function of GU is

    • Maintaining the composition and volume of the body fluids in equilibrium

    • Production of certain hormonal substance (e.g., erythropoietin)

    • Remove wastes from bloodstream

Genitourinary tract1
Genitourinary Tract

  • The nephrons increase in number throughout gestation and reach their full complement by birth but still immature and less effective

  • Glomerular filtration and absorption are relatively low at birth and do not reach adult values until 1-2 years

Genitourinary tract2
Genitourinary Tract

  • Loop of Henle (site of the urine concentrating mechanism) is short in the newborn which reduces the ability of the newborn to reabsorb sodium and water . Concentrating ability reaches adult levels by around 3rd month of age

  • Amount of urine excreted in 24 hours depends on : fluid intake, state of kidney health, and age

Gu diagnostic tests
GU: Diagnostic tests

  • Urine Culture (suprapubic aspiration)

  • Glomerular filtration rate: measured by the creatinine clearance test (100ml/min)

  • BUN:

    • is used to measure the amount of urea nitrogen in the blood

    • tests glomerular function (N= 5 – 20 mg/ 100ml)

  • Serum creatinine: 0.7 – 1.5 mg/ 100ml

Gu diagnostic tests1
GU: Diagnostic tests

  • Sonography & MRI

    • To visualize the sizes of kidneys, ureters

    • differentiate between solid or cystic masses.

  • X-ray: KUB

  • IVP: intravenous pyelogram

  • CT scan: size & density of kidneys, adequacy of urine flow

  • Cystoscopy : evaluate stenosis

  • Voiding Cystourethrogram (VCUG): evaluate reflux in ureters

  • Renal biopsy

Genitourinary tract assessment
Genitourinary Tract: Assessment

  • Chief concern:

    • Burning or cries during urination

    • Blood in urine/ Frequency of urination

    • Abdominal pain/ Flank pain

    • Enuresis

    • Periorbital edema

    • Poor appetite

    • Strong urine odor

    • Diaper rash

  • Family history (Renal disease)

  • Pregnancy history(Nephrotoxic drugs)

  • Past illnesses (Recurrent UTI)

Urinary tract infection uti
Urinary Tract Infection (UTI)

  • UTI is the presence of significant numbers of microorganisms anywhere within the urinary tract

    • May present without clinical manifestations

    • Peak incidence between 2-6 years of age

    • Female has greater risk of developing UTI

    • The likelihood of reoccurrence in female is 50%

    • Prevalence of UTI in infants is 2% in boys and 3.7% in girls

Urinary tract infection uti1
Urinary Tract Infection (UTI)

  • Escherichia coli (80% of cases) and other gram-negative enteric-organisms are most commonly causative agents

  • A number of factors contribute to the development of UTI including:

    • Anatomy of UT

    • Physical properties of UT

    • Chemical conditions properties of the host’s urinary tract

Factors contributing to uti
Factors contributing to UTI

  • Shorter urethra in females

  • Uncircumcised males

  • Incomplete bladder emptying (reflux, stenosis)

  • Altered urine and bladder chemistry/ sterility:

    • Adequate fluid intake promote urine sterility

    • Use of cranberry juice increased urine acidity and so prevent UTI

  • Extrinsic factors:

    • Poor hygiene, use of bubble bath, hot tubs

    • Bladder neck obstruction, chronic constipation, tight clothing/ diapers

    • Altered Normal. flora: antimicrobial agents

    • Catheters

Uti assessment
UTI: Assessment

  • Any child with fever, dysuria, urgency should be evaluated for UTI

  • Clean – catch urine for culture & sensitivity

  • UTI, urine is positive for proteinuria due to bacterial growth

  • Hematuria due to mucosal irritation

  • Increase WBC

  • Urine pH is more alkaline (>7)

Gastrointestinal tract clinical manifestation
Gastrointestinal Tract: clinical manifestation

  • Cystitis (infection of bladder):

    • low grade fever (LGF)

    • Mild abdominal pain

    • Enuresis (preschooler)

  • Pyelonephritis (kidneys):

    • Symptoms are more acute

    • High fever

    • Flank or abdominal pain

    • Vomiting

    • Malaise

Uti management
UTI: Management

  • Identify contributing factors to

    • eliminate the infection

    • reduce the risk of recurrence

    • Prevent urosepsis

    • Preserve renal function

  • 7-10 days antibiotics matching organism sensitivity (penicillins, sulfonamide, cephalosporins, tetracyclines)

  • Mild analgesics/ antipyretics

  • Increase fluid intake: flush out infection

  • Clean – catch urine after 72 hrs to assess effectiveness

  • For recurrent UTI, prophylactic antibiotics for 6 months

Uti nursing care
UTI: Nursing Care

  • Education regarding prevention & treatment

  • Instruct parents to observe for clues that suggest UTI:

    • Incontinence in a toilet-trained child

    • Strong-smelling urine

    • Frequency

Cryptorchidism crptorchism
Cryptorchidism (Crptorchism)

  • is failure of one or both testes to descend normally through the inguinal canal into the scrotum

  • Absence of testes within the scrotum can be a result of

    • Undescended (cryptorchid) testes,

    • Retractile testes (withdrawal of the testes)

    • Anorchia (absence of testes)

    • Actopic : emerges outside the inguinal ring

Cryptorchidism crptorchism1
Cryptorchidism (Crptorchism)

  • Cryptorchid testes are often accompanied by congenital hernias and abnormal testes, and they are at risk for subsequent torsion

  • Unknown cause, but this problem is believed to be partly inherited

    Risk Factors

    • Prematurity; Low birth weight; Twin

    • Down syndrome (fetus); Hormonal abnormalities (fetus)

    • Toxic exposures in the mother

    • Mother younger than 20 or older than 35 years of age

    • A family history of undescended testes

Cryptorchidism crptorchism2
Cryptorchidism (Crptorchism)

  • CM

    • Non-palpable testes

    • Affected hemiscrotum will appear smaller than the other

    • In retractile testes :Intermittently observing the testes in the scrotum , thus hands should be warm when examining the baby in a warm room

  • Management

    • Retractile testis can be manipulated into the scrotum.

    • By 1 year of age, cryptorchid testes will descend spontaneously in approximately 75% of cases in both full-term and preterm infants

    • In true undescended testes rarely descend spontaneously after 1 year of age and need a surgery

Cryptorchidism crptorchism3
Cryptorchidism (Crptorchism)

  • Surgical repair is done to

    • prevent damage to the undescended testicle & decrease the incidence of tumor formation,

    • avoid trauma and torsion & prevent the cosmetic and psychologic handicap of an empty scrotum

  • Postoperative care:

    • prevention of infection

    • instructing parents in home care of the child about:

      • pain control; carefully cleansing the operative site of stool and urine

      • Observation of the wound for complications; Activity restriction

Vesicoureteral reflux vur
Vesicoureteral Reflux (VUR)

  • Retrograde flow of urine from the bladder up the ureters and possibly to the kidneys during micturation

  • The cause may be

    • a defective bladder valve (UTI)

    • incorrect placement of ureters

  • Severity of VUR depends on the degree/grade of VUR

Vesicoureteral reflux vur1
Vesicoureteral Reflux (VUR)

  • Grading system depends on the extend of the VUR , dilatation of ureter and calyces (part of the kidney where urine collects)

Vesicoureteral reflux vur2
Vesicoureteral Reflux (VUR)

  • Primary reflux: congenital anomaly affects the ureterovesical junction

  • Secondary reflux: occurs as a result of an acquired condition, UTI, neuropathic bladder dysfunction

  • Radiological Tests

    • Renal/Bladder Ultrasound

    • Voiding Cystourethrogram (VCUG)

  • Management

    • Spontaneous resolution over time 20-30%

    • Continuous low-dose antibacterial therapy (prophylactic antibiotics)

    • Frequent urine cultures

    • Surgical correction for grades IV & V, anatomical abnormalities, recurrent UTI

Vesicoureteral reflux vur3
Vesicoureteral Reflux (VUR)

  • Nursing Diagnosis

    • High risk for injury related to possibility of kidney damage from chronic infection (pyelonephritis)

    • Anxiety related to unfamiliar procedures

    • Altered family processes related to illness of a child

  • Nursing Interventions

    • Administration of antibiotics

    • Education

    • Prevention

      • Perineal hygiene; Complete bladder emptying; Frequent voiding

Hypospadias epispadias

  • Is a condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface of the penile shaft

    • mild cases the meatus is just below the tip of the penis.

    • severe malformations the meatus is located on the perineum between the halves of the scrotum

  • Management

    • Surgical repair

      • Circumcision delayed to save the foreskin for repair

      • Surgical correction by 1 year old, before toilet training

Acute glomerulonephritis agn
Acute Glomerulonephritis (AGN)

  • Inflammation of the Glomeruli occurs as an immune complex disease after infection

  • Common in school age children

  • 1-2 weeks After Streptococcal Infection (sore throat) antibodies are formed, an immune complex reaction is then occurs after a period of time which become trapped in the glomerular capillary loop

Acute glomerulonephritis agn1
Acute Glomerulonephritis (AGN)

  • Clinical manifestations

    • Tea-colored urine

    • Anorexia

    • Joint stiffness & pain

  • Lab Results

    • Urine analysis: ↑ WBC, epithelial cells, RBC casts

    • Proteinuria

    • Serum: ↑ BUN, creatinine, ESR, decreased Hgb

    • Hypoalbuminemia

    • Serum ASO titers may be elevated

Acute glomerulonephritis agn2
Acute Glomerulonephritis (AGN)

  • Management

    • Usually resolves spontaneously, treatment is focused on relief of symptoms.

    • Antibiotics, such as penicillin to destroy any streptococcal bacteria that remain in the body.

    • Antihypertensive medications and diuretic medications to control swelling and high BP

    • Dietary salt restriction may be necessary to control swelling and high blood pressure

    • > 90% recover from AGN

Acute glomerulonephritis agn3
Acute Glomerulonephritis (AGN)

  • Complications

    • Acute/chronic renal failure

    • Hyperkalemia

    • Nephrotic syndrome

    • Chronic glomerulonephritis

    • Hypertension

    • Congestive heart failure or pulmonary edema (inspiratory crackles)

Acute glomerulonephritis agn4
Acute Glomerulonephritis (AGN)

  • Nursing Diagnosis

    • Fluid volume excess r/t decreased U.O.

    • Risk for impaired skin integrity r/t edema and decreased activity

    • Anxiety r/t hospitalization, knowledge deficit of disease

  • Management

    • No added salt diet & Fluid restriction

    • Q4h BP & Daily weights

    • I & O

Nephrotic syndrome ns
Nephrotic Syndrome (NS)

  • Unknown cause of high proteinuria as a result of damage to the Glomerular Capillary Wall leading to low serum albumin and edema

  • NS is a sign of a disease that damages the glomeruli in the kidney

  • Forms of NS

    • Primary: Minimal Change Nephrotic Syndrome (MCNS)

      • Idiopathic

      • 80% of all cases

      • Good prognosis

    • Secondary to another disorder

    • Congenital: autosomal recessive gene

Nephrotic syndrome ns1
Nephrotic Syndrome (NS)

  • Clinical Manifestations

    • weight gain

    • Puffiness of face, periorbital at morning which subsides during the day

    • swelling of abdomen, scrotum & lower extremities is more prominent

    • Respiratory difficulty (pleural effusion)

    • Edema of intestinal mucosa cause diarrhea, loss of appetite, poor intestinal absorption

    • Decrease urine volume/dark, frothy

    • Irritable, easily fatigued

Nephrotic syndrome ns2
Nephrotic Syndrome (NS)

  • Diagnostic test

    • Marked proteinuria +1 - +4

    • Minimal hematuria

    • Reduce serum albumin < 2 g/dl

    • Increase serum cholesterol: > 450-1500mg/dl

    • Increase SG

    • Elevated ESR

Nephrotic syndrome ns3
Nephrotic Syndrome (NS)

  • Managements

    • Reduce urinary protein excretion

    • Maintain a protein-free urine

    • Reduce edema & Prevent infection

    • Minimize complications

    • General measures:

      • Daily weight & bed rest during edema, change position Q 2hrs to decrease pressure on body and reduce edema

      • Antibiotics with infections

      • Diet: restricted salt during massive edema, high protein diet

      • Corticosteroids: prednisone (side effect ↑ chance for infection)

      • Immunosuppressants (do not administer immunization)

      • Albumin (plasma expander) and lasix

Nephrotic syndrome ns4
Nephrotic Syndrome (NS)

  • Nursing Diagnosis

    • Fluid volume excess related to fluid accumulation in tissues

    • Risk for fluid volume deficit (intravascular) r/t proteinuria, edema, and effects of diuretics

    • Risk for impaired skin integrity r/t edema and decreased circulation

    • Risk for infections r/t urinary loss of gammaglobulins

    • Anxiety (parental) r/t caring for child with chronic disease and hospitalization

Nephrotic syndrome ns5
Nephrotic Syndrome (NS)

  • Interventions

    • Assess I & O

    • Assess changes in edema

    • Measure abd girth

    • Measure edema around eyes / & dependent areas

    • Weigh daily note degree of pitting

    • Test urine for specific gravity and albumin (hyperalbuminuria )

    • Administer corticosteroids (to reduce excretions of urinary protein)

    • Administer diuretics (relieve edema)

    • Limit fluids as indicated

Renal failure rf
Renal Failure (RF)

  • Renal failure is the inability of the kidneys to excrete waste material, concentrate urine, and conserve electrolytes

  • Could be acute or chronic renal failure

Acute renal failure arf
Acute Renal Failure (ARF)

  • ARF is an abrupt decline in glomerular and tubular function

  • Could be caused by Escherichia coli (which is usually contracted from eating improperly cooked meat or contaminated dairy products)

  • Classic sign is Elevated blood urea nitrogen level

Acute renal failure arf1
Acute Renal Failure (ARF)

  • Clinical manifestations

    • Azotemia: accumulation of nitrogenous waste (Blood Urea Nitrogen (BUN)) within the blood

    • circulatory congestion/ hypervolemia

    • electrolytes abnormalities:

      • Increased K(potassium level > 7mEq/L) & phosphate

      • Decreased Na+ (seizures) & calcium

    • metabolic acidosis, hypertension

    • oliguria: output < 1ml/kg/hr; Anuria: no urinary output in 24 hours

    • Nausea, Vomiting, Drowsiness

Acute renal failure arf prevention
Acute Renal Failure (ARF): Prevention

  • recognize patients at risk (postoperative states, cardiac surgery, septic shock)

  • prevent progression from pre-renal to renal

  • preserve renal perfusion

    • isovolemia,

    • cardiac output,

    • normal blood pressure

  • avoid nephrotoxins (aminoglycosides, NSAIDS)

Acute renal failure arf management
Acute Renal Failure (ARF): Management

  • Treat the underlying disease

  • Management of the complications

  • Provision of supportive therapy

  • Strictly monitor intake and output (weight, urine output, insensible losses, IVF) & monitor serum electrolytes

  • Adjust medication dosages according to GFR

  • Nutrition

    • provide adequate caloric intake

    • limit protein intake to control increases in BUN

    • minimize potassium and phosphorus intake

    • limit fluid intake

  • If adequate caloric intake can not be achieved due to fluid limitations, some form of dialysis should be considered

Chronic renal failure
Chronic Renal Failure

  • Progressive deterioration of kidneys functions over months or years produces a variety of clinical and biochemical disturbances that eventually culminate in the clinical syndrome known as uremia

  • Uremia is a retention of nitrogenous products that produce toxic symptoms

  • Renal damage is judged by elevated serum creatinine (Normal 0.4- 1.2 d/L)

  • Renal function is compromised when creatinine is above 1.2

  • The end-stage renal disease (ESRD), is irreversible

Chronic renal failure1
Chronic Renal Failure

  • Uremia

    • Retention of waste products

    • Water and sodium retention

    • Hyperkalemia

    • Metabolic acidosis

    • Anemia

    • Calcium & phosphorus disturbances

    • Growth disturbance

Chronic renal failure2
Chronic Renal Failure

  • Uremic symptoms can affect every organ system,

    • Neurological system: cognitive impairment, personality change, asterixis (motor disturbance that affects groups of muscles), seizures

    • GI: nausea, vomiting, food distaste

    • Blood-forming system–anemia due to erythropoetin deficiency, easy bruising and bleeding due to abnormal platelets

    • Pulmonary system–fluid in the lungs, with breathing difficulties

    • Cardio: chest pain due to pericarditis & pericardial effusion

    • Skin –generalized itching

Chronic renal failure management
Chronic Renal Failure: Management

  • Peritoneal Dialysis/Hemodialysis

    • is required when the glomerular filtration rate decreases below 10% to 15% of normal

  • Restrict protein intake

  • Calcium and Vitamin D, Antihypertensives, Diuretics, Bicarbonate, Antiepileptics, Antihistamines

  • Transplantation