Alteration in Genitourinary function - PowerPoint Presentation

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Alteration in Genitourinary function

Lecture 8

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Anatomy and physiology The genitourinary is made up of the urinary and reproductive organs.

The urinary system of the kidneys, ureters, bladder and urethra.Normal function requires the following:Unimpaired renal blood flow.Adequate glomerular filtration.Normal Tubular function.

Un obstructed urine flow.

The functional unit of the kidney is

nephron.

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3Urinary System OrgansSlide4

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NephronsSlide5

Biological Variances

All nephrons are present at birthKidneys and tubular system mature throughout childhood reaching full maturity during adolescence.During first two years of life kidney function is less efficient.

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Pediatric Differences

Kidney begins to reach adult functioning about 1 year of ageInfants cannot concentrate urine as efficiently as older children and adults.Urine output:

Infant 2ml/kg/hr

Children 0.5ml/kg/hr.

Adolescent 40-80 ml/hr

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BladderBladder capacity increases with age

20 to 50 ml at birth700 ml in adulthood7Slide8

Review Genitourinary System

Maintain fluid & electrolyte balance through glomerular filtration, tubular reabsorption, and secretionHormonal functions

Produces

renin

in glomerulus—regulates BPProduces Erythropoietin—stimulates RBC production in bone marrow

Metabolized Vitamin D—to active form which is important in calcium metabolism

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Urine

Application of urine collection bag.

Whaley & Wong

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Diagnostic Tests

UrinalysisUltrasoundVCUG – Voiding cysto urethrogramIVP – Intravenous pyelogramCystoscopyCT Scan Renal Biopsy

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VCUG test

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IVP test

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Renal Biopsy

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Cystoscopy

Invasive surgical procedure

Visualizes bladder and

ureter placement.

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CT Scan

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Urinalysis

ProteinLeukocytesRed blood cellsCastsSpecific GravityUrine Culture for bacteria16Slide17

Treatment Modalities

Urinary diversionStentsDrainage tubesIntermittent catheterizationWatch for latex allergiesPharmacological management

Antibiotics

Anticholinergic for bladder spasm

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Urinary Tract Infections

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Urinary tract infection (UTI)?

A urinary tract infection is an infection of the bladder (cystitis) or kidney(s) (pyelonephritis). Cystitis is considerably more common than the more severe and more serious pyelonephritis.

Classification of UTI:

Urethritis: inflammation of the urethra Cystitis: inflammation of the bladder

Ureteritis

: inflammation of the

ureters

Pyelonephritis

: inflammation of the upper urinary tract and kidneys

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Causes urinary tract infections in children

Escherichia coli accounts for 80% of all cases.2 Anatomical factors

stasis of urine due to incomplete bladder emptying.

Vesicoureteric

reflux (the backward flow of urine from the bladder into the ureters during voiding)

Physical factors

The presence of urinary catheters allows ascending infection of the urinary tract.

Tight clothing or pants,.

Bubble baths and shampoos can irritate the

ureters

in both boys and girls and increase the risk of developing infection.

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Chemical factors

An adequate fluid intake promotes flushing of the bladder, thereby reducing the number of organisms in the urine.

Urine is slightly acidic and most pathogens

favour

an alkaline medium. Certain beverages such as cranberry juice are thought to lower urinary

pH.

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Specific

Frequency Urgency Dysuria Small volumes of urine passed Lower abdominal or flank pain Enuresis in a previously continent child Fever Haematuria

Vomiting

 Smell from urine

non-specific

Failure to thrive

Vomiting and

diarrhoea

Jaundice

Pyrexia

Irritability

Strong smell from urine

Persistent nappy rash

Frequent/infrequent voiding

Screaming on voiding

Sign and Symptom

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Management

Elimination of the current infection Identification of contributing factors in order to reduce recurrence

Prevention of systematic spread of the infection and the preservation of renal function.

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Can UTIs in children be prevented

Hygiene: Wipe females from front to back during diaper changes or after using the toilet in older girls. With uncircumcised males, mild and gentle traction of the foreskin helps to expose the urethral opening. Most boys are able to fully retract the foreskin by 4 years of age.Complete bladder emptying:

Avoid the carbonated drinks, high amounts of citrus, caffeine (sodas), and chocolate.

Avoid bubble baths

Prophylactic antibiotics: Daily low-dose antibiotics under a doctor's supervision may be used in children with recurrent UTIs.

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Interventions

Antibiotic therapy for 7 to 10 daysE-coli most common organism 85%Amoxicillin or Cefazol or Bactrim or SeptraIncrease fluid intakeCranberry juiceSitz bath / tub bathAcetaminophen for painTeach proper cleansing

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Enuresis

Unable to control bladder function although reached an age at which control of voiding is expected“Nocturnal Enuresis”—Bed wetting25Slide26

Pathophys and etiology of Enuresis

Control of urination is r/t maturation of CNSBy 5 years, most are aware of bladder fullness and can control voidingDaytime first with nighttime dryness laterGirls seems to master before boys

Children with primary enuresis may have delayed maturations of this part of CNS. They are not able to “sense” bladder fullness and do not awaken to void

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Nsg

Dx: Enuresislow self-esteem r/t bedwetting or urinary incontinenceImpaired social interaction r/t bedwetting or urinary incontinenceIneffective family

coping

r/t negative social

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Interventions

Pharmacological intervention:Desmopressin synthetic vasopressin acts by reducing urine production and increasing water retention and concentration Tofranil: anticholinrgic effect – FDA approval for treatment of enuresis Side effect may be dry mouth and constipationSome CNS: anxiety or confusionNeed to be weaned off

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Treatment Enuresis

Diet controlReduce fluids in eveningControl sugar intakeBladder trainingPraise and rewardBehavioral chart to keep track of dry nightsAlarm system

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Obstructive uropathy

Obstructive uropathy is a condition in which the flow of urine is blocked, causing it to back up and injury one or both kidneys.

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Ureteral Reflux

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Common causes of obstructive uropathy

include:Bladder stonesKidney stonesBenign prostatic hyperplasia (enlarged prostate)Bladder or ureteral

cancer

Colon cancer

Cervical cancerUterine cancerAny cancer that spreadsProblems with the nerves that supply the bladder

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Symptoms may include:

Mild to severe pain in the middle of the body (flank pain).Fever         Weight gain or swelling (edema) Urge to urinate oftenDecrease in the force of urine streamDribbling of urine

Not feeling as if the bladder is emptied

Decreased amount of urine

Blood in urine

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Treatment

Stents or drains placed in the ureter or in a part of the kidney called the renal pelvis may provide short-term relief of symptoms.Nephrostomy tubes, which drain urine from the kidneys through the back, may be used to bypass the obstruction.

A Foley catheter, placed through the urethra into the bladder, may also be helpful.

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Hypospadias

Incomplete formation

of the anterior urethral

segment.

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Hypospadias

Incomplete formation of the anterior urethral segmentCordee – downward curve of penis.Goal of surgery: to make urinary & sexual function as normal as possible and improve appearance of penis

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Nsg

Dx: HypospadiusKnowledge deficit (parental) r/t diagnosis, surgical correction, & post-op careRisk of infection r/t indwelling catheterImpaired physical mobility r/t surgical procedure of penis

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Extrophy of Bladder

Interrupted abdominal development in early fetal life produces an exposed bladder and urethra, pubic bone separation, and associated anal and genital abnormalities.38Slide39

Extrophy

of BladderOccurs is 1 of 400,000 birthsCongenital malformation in which the lower portion of abdominal wall and anterior bladder wall fail to fuse during fetal development.

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Clinical Manifestations

Visible defect that reveals bladder mucosa and ureteral orifices through an open abdominal wall with constant drainage of urine.40Slide41

Extrophy of Bladder

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Extrophy of Bladder

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Treatment

Surgery within first hours of life to close the skin over the bladder and reconstruct the male urethra and penis.Urethral stents and suprapubic catheter to divert urineFurther reconstructive surgery can be done between 18 months to 3 years of age43Slide44

Goals of Treatment

Preserve renal function: prevent infectionAttain urinary controlRe-constructive repairSexual function

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Long Term Complications

Urinary incontinenceInfectionBody imageInadequate sexual function

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Acute Renal Failure

Sudden interruption of kidney function resulting from obstruction, reduced circulation, or disease of the renal tissueResults in retention of toxins, fluids, and end products of metabolismUsually reversible with medical treatmentMay progress to end stage renal disease, uremic syndrome, and death without treatment

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Acute Renal Failure

CausesPrerenalHypovolemia, shock, blood loss, embolism, pooling of fluid r/t ascites or burns, cardiovascular disorders, sepsis

Intrarenal

Nephrotoxic agents, infections, ischemia and blockages, polycystic kidney diseasePostrenal

Stones, blood clots,

urethral

edema from invasive procedures

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Acute Renal Failure

Subjective symptomsNauseaLoss of appetiteHeadacheLethargy

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Acute Renal Failure

Objective symptomsvomiting disorientation, edema,

Increase K

+

decrease Na Increase BUN

and

creatinine

Acidosis

uremic breath

hypertension

caused by

hypovolemia

, anorexia

sudden drop in UOP

convulsions, coma

changes in bowels

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Acute Renal Failure

Diagnostic testsBUN, creatinine, sodium, potassium. pH, bicarb. Hgb and

Hct

Urine studies

US of kidneysKUBrenal CT/MRI

Retrograde

pyloegram

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Acute Renal Failure

Medical treatmentFluid and dietary restrictionsMaintain E-lytes D/C or change causeMay need dialysis to jump start renal functionMay need to stimulate production of urine with IV fluids, Dopomine, diuretics, etc.

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Acute Renal Failure

Medical treatmentHemodialysisSubclavian approachFemoral approach

Peritoneal

dialysis

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Acute Renal Failure

Nursing interventionsMonitor I/O, including all body fluidsMonitor lab resultsWatch hyperkalemia symptoms: malaise, anorexia, parenthesia, or muscle weakness, EKG changes

watch for hyperglycemia or hypoglycemia if receiving TPN or insulin infusions

Maintain nutrition

Safety measures

Mouth care

Daily weights

Assess for signs of heart failure

GCS and Denny Brown

Skin integrity problems

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Chronic Renal Failure

Results form gradual, progressive loss of renal functionOccasionally results from rapid progression of acute renal failureSymptoms occur when 75% of function is lost but considered chronic if 90-95% loss of function

Dialysis is necessary

R/T

accumulation or uremic toxins, which produce changes in major organs

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Chronic Renal Failure

Subjective symptoms are relatively same as acuteObjective symptomsRenalHyponaturmia

Dry mouth

Poor skin

turgorConfusion, salt overload, accumulation of K with muscle weakness

Fluid overload and metabolic acidosis

Proteinuria

,

glycosuria

Urine = RBC’s, WBC’s, and casts

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Chronic Renal Failure

Lab findingsBUN – indicator of glomerular filtration rate and is affected by the breakdown of protein. Normal is 10-20mg/dL. When reaches 70 = dialysisSerum creatinine – waste product of skeletal muscle breakdown and is a better indicator of kidney function. Normal is 0.5-1.5 mg/dL. When reaches 10 x normal, it is time for dialysis

Creatinine clearance is best determent of kidney function. Must be a 12-24 hour urine collection. Normal is > 100 ml/min

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Chronic Renal Failure

Nursing diagnosisExcess fluid volumeImbalanced nutritionIneffective copingRisk for infectionRisk for injury

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Chronic Renal Failure

Nursing careFrequent monitoring Hydration and outputCardiovascular functionRespiratory status

E-lytes

Nutrition

Mental statusEmotional well being

Ensure proper medication regimen

Skin care

Bleeding problems

Care of the shunt

Education to client and family

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