DISORDERS OF THE GENITO-URINARY TRACT
CYSTITIS
- Infection of urinary bladder
- Usually caused by an ascending bacterial infection (E.coli)
- Most common route is transurethral
- Female (shorter urethra, childbirth, anatomic proximity of urethra to
rectum)
- Male (due to epididymitis, prostatitis, renal calculi)
Predisposing factors:
o Microbial invasion - E.coli
o High risk - women
o Obstruction
o Urinary retention
o Increase estrogen levels
o Sexual intercourse
Clinical Manifestation
o Pain- flank area o Fever
o Hematuria o Urgency
o Nocturia o Chills
o Dysuria o Suprapubic pain
o Pyuria o Urinary frequency
Diagnostic Tests
o Urine culture & sensitivity (+) to E.coli
Management
o Pharmacologic Management
o Antibiotics
Co-trimoxazole - drug of choice
o Antispasmodics
o Analgesic
Nursing Management
o Force fluid / hydration
o Diet
Cranberry/orange juice
Avoid urinary tract irritants
(coffee, tea, alcohol)
o Warm sitz bath
o Empty bladder after sexual intercourse
o Good hygiene
o Encourage frequent voiding
URETHRITIS
- Inflammation of the urethra
- Causative agents: E. coli, staphylococcus, streptococci, Pseudomonas
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- Although inflammatory symptoms are similar to gonorrheal urethritis,
sexual contract is not the cause
- May cause prostatitis & epididymitis
- Sign and symptoms:
- Burning on urination
- Purulent urethral discharge appear 3-14 days
- Treatment:
- Tetracycline or doxycycline
NEPHROLITHIASIS/UROLITHIASIS
o Formation of stones at urinary tract
o Types of Stones: Acidic and Alkaline
Acidic Stones Cause/Diet
Calcium oxalate Cabbage, beans, spinach, cranberry,
nuts, tea, chocolate
Uric Acid Anchovies, organ meat, whole grain,
nuts, sardines
Cystine Meat, milk, eggs, cheese
Alkaline Stones Cause/Diet
Calcium Phosphate Dairy products, meat, immobility,
obesity, hyperparathyroidism
Struvite Urea-splitting bacteria
Predisposing Factor
o Diet- increase Ca & oxalate
o Hereditary- gout
o Obesity
o Sedentary lifestyle
o Hyperparathyroidism
o Males (3x) more common
o Catheterization, infection, urinary stasis
o Dehydration
Signs and Symptoms
o Nephrolithiasis
Intense, deep ache in costovertebral region
Hematuria
Pyuria
Acute pain, nausea, vomiting, costovertebral area tenderness (renal
colic)
Abdominal discomfort
Diarrhea
o Ureterolithiasis
Acute, excruciating, colicky, wavelike pain, radiating down the thigh
to the genitalia
Frequent desire to void, but little urine passed
o Hematuria
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Urolithiasis
Hematuria
Symptoms of irritation
Urinary retention
Possible sepsis
Diagnostic Test
o Intravenous Pyelogram
o Kidney Ureter Bladder x-ray
o Cystoscopic exam
o Stone analysis
o Urinalysis
o Ultrasound
Management
o Pharmacologic Management:
Narcotic analgesic
Antispasmodics
Allopurinol (uric acid)
Diuretics
Antibiotics
o Surgical management
Nephrolithotomy- renal stone
Pyelolithotomy- renal pelvis stone
Ureterolithotomy- ureteral stone
Cystolithotomy- bladder stone
Nursing Management
o I & O ü Stain urine using gauze pad & save solid materials for analysis
o Exercise
o Warm sitz bath - for comfort
o Alternate warm compress at flank area
o Diet:
Force fluid (3L/day) to help client pass stone
Acidic stones: Alkaline-ash diet
Fruits and Vegetables
Milk
Alkaline stones: Acid-ash diet
Cranberry
Prune
Plum
Meat and poultry
Calcium stone (low calcium, diet; acid-ash diet; decrease dietary
protein and sodium intake)
Uric Acid (low purine foods; alkaline-ash diet)
Cystine stone (low methionine; alkaline-ash diet)
Phosphate stone (aluminum hydroxide gel, low in phosphorus)
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BENIGN PROSTATIC HYPERPLASIA
- Slow enlargement of prostate gland in men >40 yrs old
- Constriction of urethra & subsequent interference in urination
- Unknown cause
Predisposing factors
o Aging process
o Hormonal imbalance (estrogen, androgen)
Clinical Manifestation
o Frequency
o Nocturia
o Hesitancy
o Residual Urine
o Decrease in force of urine steam
Diagnostic Tests
o Digital rectal exam (DRE)
o Cystoscopy
o Renal biopsy
o Prostatic massage
o Relief of obstruction by insertion of indwelling catheter
Management
o Pharmacologic Management:
o Terazosin (Hytrin)
A1 - adrenergic receptor blocker
Relaxes bladder sphincter
o Finasteride (Proscar)
Inhibits 5- alpha reductase (blocks uptake & & utilization of
androgens by the prostate)
Reduction of glandular hyperplasia
Atrophy of prostate gland
o Balloon Dilation
To relax smooth muscle of the bladder neck and prostate
o Immediate Catheterization
If patient cannot void
o Watchful waiting
To monitor disease progression
Surgical Management
o TURP (Transurethral Resection of the Prostate)
No incision
Prostate resected through urethra
Continuous bladder irrigation (cystoclysis)
No incontinence
No impotence
o Suprapubic prostatectomy
Incision over lower abdomen & bladder
With cystostomy tube & 2 - way foley catheter
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No incontinence
No impotence
Surgical Management
o Retropubic prostatectomy
o Low abdominal incision
o No incontinence
o No impotence
o Perineal prostatectomy
o Impotence
o Incontinence or rectal injury my be a complication
Post-operative Nursing Care
Increase fluid intake
Maintain patency of the catheter
If drainage is reddish, increase flow rate
Practice asepsis
Use a sterile NSS to prevent water intoxication
Prevent thrombophlebitis
Monitor for hemorrhage
After removal of catheter observed for urinary retention/dribbling
Kegel’s exercise
Avoid anti-cholinergics
Antihistamines
Upon discharge avoid the following:
o Vigorous exercise
o Heavy lifting
o Sexual intercourse 3 weeks after discharge
o Driving 2 weeks after discharge
o Straining w/defecation
o Prolonged sitting or standing
o Crossing the legs
o Long trips
PYELONEPHRITIS
o Infection of kidney
o Bacteria (most common) fungal, viral
o 2 TYPES
Acute
Bacterial contamination from urethra by instrumentation (iatrogenic)
or hematogenous spread
o E. Coli/streptococcus
o Chronic
Idiopathic; obstruction or reflex (stone, tumor, or neurogenic
bladder)
Progressive scarring of the kidney resulting in weight loss,
hypertension and renal failure
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Clinical Manifestation
Acute Chronic
Fever Fatigue
Urgency Headache
Chills Poor appetite
Hematuria Polyuria
Nocturia Excessive thirst
Pyuria Weight loss
Flank pain
Urinary frequency
Costovertebral Tenderness
Dysuria
Malaise
Diagnosis Tests
o Urinalysis
o Urine culture & sensitivity
o Cystoscopy, IVP, ultrasound
o CT-scan
Management
o Pharmacologic management
Antibiotics
Antispasmodics
Analgesics
Nursing management
o Complete bed rest
o VS, I & O, weight
o Diet
Cranberry juice, orange juice
Force fluids (3-4 L/day)
o Empty the bladder regularly
o Performing recommended perineal hygiene (wipe the perineum from front
to back)
ACUTE GLOMERULONEPHRITIS (AGN)
- Inflammatory & degenerative disorder of the glomerulus
- Damage to both kidney from filtration of trapping of antibody-antigen
complexes within the glomeruli resulting to decrease glomerular
filtration rate
Types
o Acute Post-Streptococcal
After 7 - 10 days after streptococcal throat infection
Immune reaction to the presence of an infectious organism (group A
beta hemolytic streptococcus/GABHS)
o Chronic Glomerulonephritis
Hypertensive nephrosclerosis
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Heat failure
Chronic renal failure
Signs and Symptoms
o Pathognomonic sign: Periorbital edema
o Flank pain, costovertebral tenderness
o Headache, visual disturbance
o Fever, malaise, weakness, fatigue
o Anorexia
o Dyspnea (salt & water retention)
o Tachycardia, hypertension
o Oliguria
Assessment and Diagnostic Test
o Urinalysis
Hematuria & proteinuria (MOST important indicator of glomerular
injury)
Casts
o Elevated BUN & creatinine
o Positive antibody response test for streptococcus
o Elevated Erythropoietin Sedimentation Rate
o Hyponatremia, hypophosphatemia
o Hyperkalemia
Management
o Pharmacologic management
Diuretics
Antihypertensive
Corticosteroids
If residual streptococcal infection is suspected, penicillin is the agent
of choice
Nursing management
o Monitor VS, I & O daily weight & urine specific gravity
o Dietary restriction of sodium, fluid & protein
o Carbohydrates are given liberally to provide energy and reduce the
catabolism of protein.
o Provide special skin care
o Provide for complication (renal failure, cardiac failure, hypertensive
encephalopathy)
o Monitor urinalysis, BUN creatinine levels
o Promote rest & regular activity when hematuria & proteinuria resolve
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Condition of hyperfunctioning of the posterior pituitary gland in which
excess ADH is released, but not in response to the body’s need for it.
- Causes include trauma, stroke, malignancies (often in the lungs or
pancreas), medications, and stress.
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- The syndrome results in increased intravascular volume, water
intoxication, and dilutional hyponatremia. d. May cause cerebral edema
and the client is at risk for seizures.
Assessment
o Signs of fluid volume overload
o Changes in level of consciousness and mental status changes
o Weight gain without edema
o Hypertension
o Tachycardia
o Anorexia, nausea, and vomiting
o Hyponatremia
o Low urinary output and concentrated urine
Interventions
o Monitor vital signs and cardiac and neurological status.
o Provide a safe environment, particularly for the client with changes in level
of consciousness or mental status.
o Monitor for signs of increased intracranial pressure. d. Implement seizure
precautions.
o Elevate the head of the bed a maximum of 10 degrees to promote venous
return and decrease baroreceptor-induced ADH release.
o Monitor intake and output and obtain weight daily. g. Monitor fluid and
electrolyte balance. h. Monitor serum and urine osmolality.
o Restrict fluid intake as prescribed.
o Administer IV fluids (usually normal saline [NS] or hypertonic saline) as
prescribed; monitor IV fluids carefully because of the risk for fluid volume
overload.
o Loop diuretics may be prescribed to promote diuresis but only if serum
sodium is at least 125 mEq/L(125 mmol/L);potassium replacement may be
necessary if loop diuretics are prescribed.
o Vasopressin antagonists may be prescribed to decrease the renal response
to ADH.
Diabetes insipidus
- Hyposecretion of ADH by the posterior pituitary gland caused by stroke,
trauma, or surgery, or it may be idiopathic
- Kidney tubules fail to reabsorb water.
- In central diabetes insipidus there is decreased ADH production.
- In nephrogenic diabetes insipidus, ADH production is adequate but the
kidneys do not respond appropriately to the ADH.
Assessment
o Excretion of large amounts of dilute urine
o Polydipsia
o Dehydration (decreased skin turgor and dry mucous membranes)
o Inability to concentrate urine
o Low urinary specific gravity; normal is 1.003– 1.030 (1.005–1.030)
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o Fatigue
o Muscle pain and weakness
o Headache
o Postural hypotension that may progress to vascular collapse without
rehydration
o Tachycardia
Interventions
o Monitor vital signs and neurological and cardiovascular status.
o Provide a safe environment, particularly for the client with postural
hypotension.
o Monitor electrolyte values and for signs of dehydration.
o Maintain client intake of adequate fluids; IV hypotonic saline may be
prescribed to replace urinary losses.
o Monitor intake and output, weight, serum osmolality, and specific gravity of
urine for excessive urinary output, weight loss, and low urinary specific
gravity.
o Instruct the client to avoid foods or liquids that produce diuresis.
o Vasopressin or desmopressin acetate may be prescribed; these are used
when the ADH deficiency is severe or chronic.
o Instruct the client in the administration of medications as prescribed;
desmopressin acetate may be administered by subcutaneous injection,
intravenously, intranasally, or orally; watch for signs of water intoxication
indicating overtreatment.
o Instruct the client to wear a MedicAlert bracelet.
Guillain-Barre Syndrome
- An acute infectious neuronitis of the cranial and peripheral nerves.
- The immune system overreacts to the infection and destroys the myelin
sheath.
- The syndrome usually is preceded by a mild upper respiratory infection
or gastroenteritis.
- The recovery is a slow process and can take years.
- Note: The major concern in Guillain-Barre syndrome is difficulty
breathing; monitor respiratory status closely
Assessment
o Paresthesias
o Pain and/or hypersensitivity such as with the weight of bed sheets or other
items touching the body
o Weakness of lower extremities
o Gradual progressive weakness of the upper extremities and facial muscles
o Possible progression to respiratory failure
o Cardiac dysrhythmias
o CSF that reveals an elevated protein level
o Abnormal electroencephalogram
Interventions
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o Care is directed toward the treatment of symptoms, including pain
management.
o Monitor respiratory status closely.
o Provide respiratory treatments.
o Prepare to initiate respiratory support.
o Monitor cardiac status.
o Assess for complications of immobility.
o Provide the client and family with support
AUTONOMIC DYSREFLEXIA
- Also known as autonomic hyperreflexia
- It generally occurs after the period of spinal shock is resolved and
occurs with lesions or injuries above T6 and in cervical lesions.
- It is commonly caused by visceral distention from a distended bladder
or impacted rectum.
- It is a neurological emergency and must be treated immediately to
prevent a hypertensive stroke.
Assessment
o Sudden onset, severe throbbing headache
o Severe hypertension and bradycardia
o Flushing above the level of the injury
o Pale extremities below the level of the injury
o Nasal stuffiness
o Nausea
o Dilated pupils or blurred vision
o Sweating
o Piloerection (goose bumps)
o Restlessness and a feeling of apprehension
Interventions
o Raise the head of the bed and ask that the health care provider (HCP) be
notified.
o Loosen tight clothing on the client.
o Check for bladder distention or other noxious stimulus.
o Administer an antihypertensive medication.
o Document the occurrence, treatment, and response.
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