UNIT 03

GENITOURINARY

TRACT DISORDERS
OBJECTIVES

At the end of the lecture, learners will be able to:

 Learn about GUT disorders
 Know the causes of GUT disorders
 Understand pathophysiology of GUT disorders
 Identify clinical manifestations of GUT disorders
 Learn about diagnostic tests
 Know how to manage GUT disorders
 Apply nursing interventions regarding GUT disorder
GENITOURINARY TRACT DISORDER
 Urinary tract infections
 Renal abscess & tuberculosis
 Glomerulo-nephritis (immunologic disorder)
 Urethral strictures, hydroureter and hydronephrosis
 Urinary incontinence/ retention & urinary calculi
 Acute & chronic renal failure
 Urinary bladder and renal cell carcinoma
URINARY TRACT INFECTION

 A urinary tract infection (UTI) is an infection in any part of the urinary system
 The urinary system includes the kidneys, ureters, bladder and urethra
 Most infections involve the lower urinary tract — the bladder and the urethra
 The majority of UTI are caused by the bacteria E.coli
CAUSES & RISK FACTORS
Following are the causes & risk factors, that can contribute to UTI:
 Female gender
 Urinary stasis
 Contamination of perineal area
 Certain types of contraception (Diaphragms)
 Menopause
 Blockage of urinary tract
 Suppressed immune function
 Catheterization
 Recent urinary procedure
CLASSIFICATION

UTIs can be divided into :

1. Upper urinary tract infections:
Infection of the kidneys and ureters (pyelonephritis)
2. Lower urinary tract infection:
Infections of bladder and urethra ( cystitis/Urethritis)
PYELONEPHRITIS

 Pyelonephritis is the infection/inflammation of kidneys.

 The cause is mainly ascending bacterial infection and infection in the blood
stream.
 Pathophysiology includes ; Formation of small abscesses throughout the
kidney and gross enlargement of kidney.
CYSTITIS

 Cystitis is inflammation of the bladder, usually caused by a bladder infection.

 It's a common type of urinary tract infection (UTI).
 Signs & symptoms are Dysuria, frequent urination, urgency, cloudy urine.
URETHRITIS

 Urethritis is the inflammation of urethra

 Can be caused by chemical irritant, bacterial infections, & can be sexually
transmitted
 Symptoms can be urinary urgency, frequency & dysuria. Male patient can
have penile discharge.
CLINICAL MANIFESTATIONS
UTIs don't always cause symptoms. When they do, they may include:

 A strong urge to urinate that doesn't go away

 A burning feeling when urinating
 Urinating often, and passing small amounts of urine
 Urine that looks cloudy
 Urine that appears red, bright pink or cola-colored — signs of blood in the urine
 Strong-smelling urine
 Pelvic pain, in women — especially in the center of the pelvis and around the area
of the pubic bone
DIAGNOSTIC TESTS
 Complete urine examination Urine culture
 Ultrasound CT Scan
 MRI Cystoscopy

MANAGEMENT:
 Antibiotics
 Pain killers
 Hydration therapy
 Vaginal estrogen therapy if menopause is cause
NURSING INTERVENTIONS

 Assess the symptoms of UTI

 Encourage patient to drink fluids
 Check catheterization frequently
 Administer antibiotic as ordered
 Encourage patient to void frequently
 Educate patient on proper wiping (from front to the back)
 Educate patient on drinking acidic/citrus juices which help deter growth of
bacteria
 Patient teaching to prevent UTIs
COMPLICATIONS

 Bacteremia
 Sepsis
 Multiple organ system dysfunctions
 Shock
 Acute renal failure
RENAL ABSCESS

A renal abscess, also known as a perirenal or kidney abscess, is a pocket of pus that
develops in the kidney tissue

Causes:
 Kidney inflammation
 Trauma
 UTIs
 Septicemia
 Reproductive/urinary tract surgery
SIGNS/SYMPTOMS

Symptoms of a renal abscess vary, but may include one or more of the
following:

 Pain during urination

 Blood in the urine
 Fever and chills
 Severe Abdominal pain
 Tenderness in the back
 Night sweats (due to pain)
 Weight loss
DIAGNOSTIC TESTS

 Complete blood count

 Blood culture
 Abdominal ultrasound
 Urinalysis
 Urine culture
 CT scan
MANAGEMENT
 IV antibiotics
 Pain killers
 Drainage of pus via syringe
 Surgical incision can be given to drain the pus out
NURSE’S ROLE
 Monitor I/O record (decrease in output may indicate acute kidney failure)
 Keep an eye on RPM and S/Electrolytes
 Monitor urine’s specific gravity
 Daily weight record
 Monitor HR, BP, CVP, JVP
 Auscultate lung and heart sound (for fluid retention)
 Assess LOC and changes in mentation (due to electrolyte imbalances)
 Provide safety measures
 Administer diuretic as needed (to overcome fluid overload)
 Administer Antihypertensive medication as needed
GLOMERULO-NEPHRITIS

Glomerulonephritis is inflammation of the tiny filters in the kidneys (glomeruli)

The excess fluid and waste that glomeruli remove from the bloodstream exit
the body as urine

Glomerulonephritis can come on suddenly (acute) or gradually (chronic)

CAUSES AND RISK FACTORS

 Infections (bacterial endocarditis, viral infections)

 Auto immune disease
 Genetics
 Post op sepsis
SIGNS & SYMPTOMS
Glomerulonephritis signs and symptoms may include:

 Pink or cola-colored urine from red blood cells in urine (hematuria)

 Foamy or bubbly urine due to excess protein in the urine (proteinuria)
 High blood pressure (hypertension)
 Fluid retention (edema) with swelling evident in your face, hands, feet and
abdomen
 Urinating less than usual
 Muscle cramps
 Fatigue
DIAGNOSTIC TEST
 Urinalysis
 Blood tests
 Imaging tests
 Kidney biopsy

MANAGEMENT
Treatment of glomerulonephritis and outcome depend on:

 Whether you have an acute or chronic form of the disease

 The underlying cause
 The type and severity of signs and symptoms
URETHRAL STRICTURE
A urethral stricture involves scarring that narrows the tube that carries urine out of
the body (urethra)
A stricture restricts the flow of urine from the bladder

CAUSES
 Intermittent or long-term use of urinary catheter
 Trauma or injury to the urethra
 An enlarged prostate gland
 Cancer of the urethra or prostate
 Cystoscopy
 Sexually transmitted infections
SIGNS & SYMPTOMS

Signs and symptoms of urethral stricture include:

 Decreased urine stream

 Incomplete bladder emptying
 Difficulty, straining or pain when urinating
 Increased urge to urinate or more-frequent urination
 Urinary tract infection
DIAGNOSTIC TESTS

 Urinalysis USG
 Urinary flow test MRI

MANAGEMENT
 Urethroplasty (removal of narrowed part & reconstruct the remaining part
 Endoscopic urethrotomy
 Implant stent
NURSE’S ROLE

 Maintain adequate hydration

 Give Analgesics as ordered
 Monitor I/O
 Sitz bath (to prevent from infection & to encourage voiding)
 Administer proper antibiotics (to prevent from post op sepsis)
 Catheterization care
 Provide appropriate perineal cleaning
HYDROURETER & HYDRONEPHROSIS

Hydroureter is when the ureter gets

bigger than normal due to a backup
of urine

Hydronephrosis is a condition where

one or both kidneys become
stretched and swollen as the result
of a build-up of urine inside them
CAUSES & MANIFESTATIONS
Can be caused by blockage in the passage of urine, infection and any nerve
problem

Signs & symptoms may include:

 Flank pain
 Urinating problems
 Decrease urine output
 Fever
 Failure to thrive in infants
DIAGNOSTIC TESTS
 Physical examination
 Urine test
 Blood test
 Imaging tests

MANAGEMENT
 Causative treatment i.e.
 If blockage is caused by stone, remove
 If it is due to infection, administer antibiotics
 Analgesics
URINARY INCONTINENCE

Urinary incontinence means a person leaks urine by accident

While it can happen to anyone, urinary incontinence, also known as overactive

bladder, is more common in older people, especially women

Bladder control issues can be embarrassing and cause people to avoid their
normal activities
CAUSES

 UTI
 Vaginal infections
 Constipation
 Some medications i.e. sedatives, diuretics
 Weak/Overactive bladder muscles
 Damage to nerve
 Enlarged prostate
TYPES OF URINARY INCONTINENCE

Stress incontinence occurs when urine leaks as pressure is put on the

bladder, such as during exercise, coughing, sneezing, laughing, or lifting heavy
objects. It’s the most common type of bladder control problem in younger and
middle-aged women

Urge incontinence happens when people have a sudden need to urinate

and cannot hold their urine long enough to get to the toilet
CONTD…

Overflow incontinence happens when small amounts of urine leak from a

bladder that is always full. A man can have trouble emptying his bladder if an
enlarged prostate is blocking the urethra

Functional incontinence occurs in many older people who have normal

bladder control. They just have a problem getting to the toilet because of
arthritis or other disorders that make it hard to move quickly
SIGNS & SYMPTOMS

Common signs and symptoms of urinary incontinence include:

 Leaking urine when coughing, sneezing, laughing, or exercising

 Feeling sudden, uncontrollable urges to urinate
 Frequent urination
 Waking up many times at night to urinate
 Urinating during sleep
DIAGNOSTIC EVALUATION

 History and physical examination

 Dip stick test (to check UTI)
 Residual urine test
 Cystoscopy (to check any bladder abnormality)
 Urodynamic tests (measuring the pressure in bladder by inserting a catheter
into your urethra
& asking the pt to urinate into a special machine that measures
the amount and flow of urine)
MANAGEMENT

Bladder control training

Pelvic muscle exercises
Urgency suppression
Timed voiding

Medication
Vaginal estrogen cream (rejuvenating the tissues and making them more
elastic)
Bulking agents (thickens the area around the urethra, may need repeatedly)

Surgery if incontinence is due to blockage/enlarged prostate

NURSE’S ROLE
 Complete a focused record of the incontinence including duration, frequency and severity of
leakage episodes
 Assess the patient’s recognition of the need to void
 Assess the causes of incontinence
 Set toileting schedule
 Eliminate environmental barriers to toileting
 Assist the person to change their clothing to maximize toileting access
 Tell the patient to limit fluid intake 2 to 3 hours before bedtime and to void just before
bedtime
 Perineal care
 Explain to patient and caregiver the rationale behind and implementation of a toilet training
 Dietary modifications i.e. fiber diet to prevent constipation
URINARY RETENTION

Urinary retention is a condition in which you are unable to empty all the urine from
your bladder.
Urinary retention is not a disease, but a condition that may be related to other health
problems, such as prostate problems in men or a cystocele in women

Causes
 Enlarged prostate
 Bladder outlet obstruction, such as urethral stricture
 Urinary tract stones
 Constipation
 Pelvic masses
 Infections, such as urinary tract infection
 SIGNS & SYMPTOMS
CHRONIC URINARY
ACUTE URINARY RETENTION RETENTION

 The inability to urinate  The inability to completely empty

bladder
 Pain — often severe — in lower
 Frequent urination in small amounts
abdomen
 Difficulty starting the flow of urine,
 The urgent need to urinate
called hesitancy
 Swelling of your lower abdomen
 A slow urine stream
 Feeling the need to urinate after
finishing urination
 Leaking urine without any warning or
urge

 DIAGNOSTIC TEST

History and physical examination Residual urine test

Urinalysis Imaging tests

MANAGEMENT
 Catheterization
 Treat the cause
 Symptomatic treatment
 URINARY CALCULI

Urinary calculi means the formation of stones in urinary tract i.e. kidneys, ureters,
bladder, urethra

Causes
 Diet
 Excess body weight
 Some medical conditions
 Supplements
 Medications
CLINICAL MANIFESTATIONS

 Severe, sharp pain in the side and back

 Pink, red or brown urine
 Cloudy or foul-smelling urine
 A persistent need to urinate, frequent urination
 Nausea and vomiting
 Fever and chills if an infection is present
 Urinary retention in case of urethral stones
 Recurrent UTIs
DIAGNOSTIC TESTS
 Blood tests
 Urine tests
 Imaging tests

MANAGEMENT
For small stones
 Drinking water
 Pain reliver

For large stone

 Lithotripsy
 Surgery
ACUTE RENAL FAILURE
Acute kidney failure occurs when kidneys suddenly become unable to filter waste
products from the blood
When kidneys lose their filtering ability, dangerous levels of wastes may accumulate
Also called Acute Kidney Injury (AKI), Acute Kidney Failure

Causes
 Injury
 Blockage of ureters
 Infections
 Severe blood loss
 Dehydration
 Severe burn
CONTD…
The etiology of AKI has always been traditionally divided into three
categories:
 Pre-renal
 Renal
 Post-renal

Pre-renal includes any reduced blood flow to the kidney. This may be part
of systemic hypoperfusion resulting from hypovolemia or hypotension or
might be due to selective hypoperfusion to the kidneys, such as those
resulting from renal artery stenosis, aortic dissection
Renal includes acute tubular necrosis, which can result from several
different causes. Prolonged renal ischemia, sepsis, and nephrotoxins
being the most common ones. It is worthwhile mentioning that pre-renal
injury can convert into a renal injury if the exposure to the offending
factor is prolonged enough to cause cellular damage

Post-renal mainly includes obstructive causes, which lead to

congestion of the filtration system and thus eventually lead to shutting
down the kidneys. The most common ones being renal/ureteral calculi,
tumors, or any urethral obstruction
SIGNS & SYMPTOMS
 Decreased urine output
 Fluid retention, causing swelling in your legs, ankles or feet
 Shortness of breath
 Fatigue
 Confusion
 Nausea
 Weakness
 Irregular heartbeat
 Chest pain or pressure
 Seizures or coma in severe cases
DIAGNOSTIC EVALUATION
 Urine output measurement
 Urine test
 Blood tests (AKI is the presence of any of the following:
Increase in serum creatinine by 0.3 mg/dL within 48 hours
Increase in serum creatinine to 1.5 times or more baseline, within the
prior 7 days
Urine volume less than 0.5 mL/kg/h for at least 6 hours)

 Imaging tests
MANAGEMENT

Treat the cause

Treatment to balance the amount of fluid
Medication to regulate potassium
Medication to regulate calcium
Hypertensive medication
Dialysis to remove toxins
NURSING INTERVENTION

 Monitor vitals including urine output

 Weigh patient daily to determine fluid retention
 Assess heart and lung sounds
 Monitor mental status changes and level of consciousness
 Assess periorbital and dependent edema
 Review chest x-ray and laboratory parameters (BUN and creatinine)
 Insert a Foley catheter to monitor ins and outs
 Administer diuretics as prescribed
CONTD…

 Monitor blood pressure and treat accordingly

 Check levels of potassium and if high, treat as clinician orders
 Limit intake of fluids
 Encourage a low sodium diet, limit foods with high potassium like bananas,
oranges, and tomatoes
 Keep head of bed elevated