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
