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Genitourinary 1
- Anatomy and Physiology
- Urinary system (illustration)
- Kidney
- structure (illustration)
- cortex (outer layer): glomeruli, proximal and distal tubules
- medulla (middle layer): about eight renal pyramids formed by collecting ducts and tubules
- renal pelvis (innermost layer): composed of calyces where papillae move urine into the ureter by peristalsis
- nephron: functional unit that filters, concentrates, reabsorbs and secretes to produce urine (illustration 1 illustration 2)
- glomerulus: filters fluid wastes out of the blood (plural: glomeruli)
- tubules (proximal, Henle's loop, distal): here fluid is made into urine
- functions
- fluid and electrolyte balance
- acid-base balance: HPO4 buffer system, NH3 buffer system
- to regulate arterial blood pressure: renin, aldosterone
- to excrete waste products: urea, creatinineproduction of erythropoietin
- Ureters
- convey urine from pelvis of the kidneys to the bladder
- consists of smooth muscle, moves by peristalsis
- Bladder - stores urine (illustration)
- Urethra
- Reproductive system - male (illustration)
- Testes: main male sex glands (illustration)
- Each testis is encased in a fibrous capsule which has partitions into the inner gland
- Seminiferous tubules form spermatozoa(illustration)
- Interstitial cells secrete testosterone
- Accessory glands
- seminal vesicles
- prostate gland
- bulbourethral glandssecrete lubrication prior to ejaculation
- Ducts
- epididymisconducts semen from testes to vas deferens
- vas deferensconduct semen from each epididymis to an ejaculatory duct (illustration)
- ejaculatory ducts
- urethra
- Scrotum
- Penis
- Reproductive system - female (illustration 1 illustration 2 illustration 3)
- Ovaries
- consist of graafian follicles in which ova develop
- functions of ovaries:
- oogenesis (illustration)
- ovulation (illustration)
- secretion of progesterone and estrogen
- Fallopian tubes- conduct ova from ovaries to uterus
- Uterusfunctions in menstruation and pregnancy
- Vagina (illustration)
- Vulva (illustration)
- Breasts
- Prostate Disorders
- Benign prostatic hyperplasia (BPH)
- Definition - enlargement of the prostate gland
- Etiology
- occurs as men age
- associated with circulating androgens
- as prostate enlarges, prostatic tissue forms nodules
- prostate becomes spongy and thick
- prostatic urethranarrows via compression
- impedes passage of urine
- Findings
- early stages often asymptomatic as enlargement occurs
- changes in micturition
- nocturia
- Diagnostics
- rectal examination
- urinalysis
- serum creatinine and BUN studies
- serum PSA
- Management
- if asymptomatic, follow annually
- use the following medications as indicated:
- beta blockers
- prazosin (Minipress) - to decrease findings of prostatic hyperplasia urinary urgency, hesitancy, nocturia
- doxazosin (Cardura)- management of the findings of BPH
- hormonal manipulation
- finasteride (Proscar) - decrease prostate size with associated decrease in urinary findings
- terazosin (Hytrin) - management of outflow obstruction in clients with BPH; decreases findings
- to relieve symptoms temporarily, use balloon dilation
- surgery if indicated:
- Complications
- acute urinary retention
- involuntary bladder spasms (contractions)
- hydronephrosis
- urinary tract infection (see below)
- gross hematuria
- Nursing interventions
- assessment
- history of current signs and symptoms
- assess abdomen for distention of the bladder
- measure postvoid residual (if needed)
- assess for infection, hematuria
- if beta blockers are used check sitting and standing blood pressures weekly while titrating dose
- facilitate urinary elimination (illustration)
- provide privacy for patient
- monitor intake and output, wieghts
- maintain catheter patency (if in use)
- medicate as prescribed by health care provider
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