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Genitourinary 5

  1. Management
  2. extracorporeal shock wave lithotripsy (ESWL)
  3. percutaneous nephrolithotomy (PCNL)
  4. percutaneous stone dissolution (Chemolysis)
    1. introduce a solvent (depending on the composition of the stone)
    2. give broad-spectrum antimicrobials before, during and after the procedure to maintain sterile urine
  5. ureteroscopy
  6. pyelolithotomy, nephrolithotomy, ureterolithotomy,
  7. cystolithotomy
  8. nephrectomy (surgical removal of a kidney)
  9. Complications
  10. obstruction from residual stone material (fragments)
  11. infection resulting from bacteria or spread of fragments from infected stone
  12. impaired renal function û may be chronic if stones obstructed tubes long before removal and treatment
  13. Nursing interventions
  14. assess
    1. history of UTI's, dietary habits, and family history of stones
    2. pain and location
    3. for findings of UTI
    4. for findings of obstruction
  15. manage pain
  16. maintain urine flow
  17. control infection
  18. client teaching 
  19. Acute renal failure
  20. Definition: kidneys fail to function
  21. Etiology
    1. causes; pathophysiology
      1. prerenal - decreased renal blood flow
      2. postrenal - stops or slows urine flow anywhere in the urinary tract
      3. intrarenal - injury to renal tissue due to toxins, intrarenal ischemia, vascular disorders and immunologic processes
    2. stages
      1. begins when kidney is injured
      2. oliguric/anuric phase (less than 500 ml of output in 24hrs)
      3. diuretic phase: 24-hr. urine exceeds 500 ml and there is no longer a rise in serum BUN and creatininelevels
      4. recovery phase:
        • several months to one year
        • more likely to leave scar tissue remnants
        • functional loss usually not clinically significant
    1. urinalysis
    2. serum creatinine and BUN levels rise
    3. urine chemistry evaluation to distinguish phase and form
    4. renal ultrasonography
  22. Management
    1. preventive
      1. patient education re: use of analgesics, proper hydration, exposure to nephrotoxins
      2. monitor intake and output
      3. avoid infection; if present, use only prescribed medications which will be specific to patient needs
    2. supportive
      1. improve renal perfusion
      2. monitor intake and output
      3. correct and control hyperkalemia
      4. maintain adequate blood pressure
      5. maintain nutritional intake
      6. if indicated, initiate hemodialysis or peritoneal dialysis
  23. Complications:
    1. infection
    2. arrhythmiassecondary to hyperkalemia
    3. electrolyteimbalances
    4. GI bleeding due to stress ulcer
    5. multiple organ and system failure
  24. Nursing interventions
    1. assess:
      1. history of cardiac disease, malignancy, sepsis or recent infection
      2. exposure to nephrotoxic drugs:
        • NSAIDs
        • antibiotics
        • chemical solvents
        • contrast media
      3. urine volume
    2. achieve fluid and electrolytebalance
    3. prevent infection
    4. monitor serum electrolytes
    5. prevent GI bleeding
    6. maintain neurologic function
    7. maintain adequate nutrition:
      1. regulate protein intake
      2. offer high-carbohydrate feedings
      3. weigh daily
      4. restrict (as needed) foods high in sodium, potassium and phosphorus
      5. give total parenteral nutrition(TPN) if indicated and ordered
  25. Chronic renal failure
  26. Definition - a progressive, irreversible deterioration in renal function: body cannot balance metabolism and fluid/electrolytes; result: uremia.
  27. Etiologies
    1. hypertension, severe and prolonged
    2. diabetes mellitus
    3. glomerulopathy
    4. interstitial nephritis
    5. polycystic disease (hereditary)
    6. obstructive uropathy
    7. congenital disorder
  28. Findings of chronic renal failure (by system):
  29. Diagnostics
    1. arterial blood gases
    2. elevated serum BUN, creatinine, phosphorus
    3. CBC to detect anemia
    4. decreased serum levels of bicarbonate, calcium, proteins (albumin)
  30. Management
    1. control diabetes
    2. treat hypertension
    3. maintain renal function for as long as possible
    4. regulate diet:
      1. maintain low protein intake
      2. prevent malnutrition
      3. restrict dietary potassium
      4. restrict dietary phosphorus by reducing intake of chicken, milk, legumes, carbonated drinks
    5. treat anemia with epoetin (Erythropoietin)
    6. treat acidosis with oral sodium bicarbonate
    7. dialysiswhen necessary
  31. Complication: death
  32. Nursing interventions
    1. assess
      1. history of chronic disorders
      2. degree of renal impairment
      3. effect on other body systems
      4. how client is responding to illness
      5. support systems
    2. maintain fluid and electrolyte balance
    3. maintain adequate nutrition
    4. maintain skin integrity
    5. prevent constipation
    6. maintain safe level of activity
    7. determine how much client understands and how well client will comply with treatment

  • After a urinary catheter is removed, the client may have some burning on urination, frequency and dribbling. These symptoms should subside.
  • After a TUR (transurethral resection), tell the client that, because the three-way foley catheter has a large diameter, he will continuously feel the urge to void.
  • After prostatic surgery, it is normal for the client's urine to be blood tinged and for him to pass blood clots and tissue debris.
  • Because the prostate gland receives a rich blood supply, it is important to observe the client undergoing a prostatectomy for bleeding and shock.
  • Breast cancer starts with the alteration of a single cell and takes a minimum of two years to become palpable.
  • At the time of diagnosis, about one-half of clients with breast cancer have regional or distant metastasis.

Nephrotic Syndrome
Stress Incontinence
Toxic shock syndrome
Urge Incontinence