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Genitourinary 1

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