Urologic Disorders

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Urologic Disorders

• NPN 200
• Medical Surgical Nursing I

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Function of the Urinary System

• Maintain homeostasis
• Remove metabolic wastes
• Kidneys regulate the volume, acid base balance,
  and electrolyte balance
• Responsible for detoxification of the blood
• Aides in erythropoiesis
• Helps to regulate B/P
• Regulates serum potassium, calcium, and phosphate

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Anatomy and Physiology of Urinary System

• Components of system
• Kidneys
• Ureters
• Bladder
• Urethra

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Anatomy
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Data Collection

• Subjective symptoms
• Problems with elimination
• Changes in voiding habits
• Discharge from the urethra
• Pain in the supra-pubic area or back
• Burning sensation on voiding

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Data Collection

• Objective systems
• Bladder distention (rigid, tender abdomen)
• Urine color, odor, cloudiness, presence of mucus,
  sediment, blood, casts, bacteria
• Genital irritation
• Amount of urine output
• Electrolyte studies
• Edema of extremities
• Vital signs

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Data Collection

• History
• Previously normal urinary habits
• Health problems with urinary system
• Presence and location of edema
• Medications
• Food or medicine allergies
• Spasms or pain or both in the bladder region or
  flank area
• Presence of discharge

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Physical Examination

• Color of skin and crystals on skin
• Skin turgor
• Look for edema of eyes, sacrum and extremities
• Observe respirations for signs of acidosis, fluid
  overload,
• Check heart rate and rhythm
• Palpate abdomen for distention and flank for pain
• Examine genitals

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Diagnostic Exams

• Blood and Urine
• Urinalysis, and culture and sensitivity, glucose,
  protein, ketones
• Creatinine clearance
• BUN
• Serum creatinine
• Serum electrolytes

• X- rays
• Flat plate of ABD/ KUB
• IVP
• Renal scan
• Renal Angiogram
• MRI
• CT

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Diagnostic Exams

• Renal biopsy
• Cyctoscopy and retrograde pyleograms
• Cystogram uses dye into bladder
• Cystometrogram evaluates bladder tone
• Bladder scanners (estimates bladder volume

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Urinary Tract Infections

• More common in women
• Most prevalent nosocomial infection
• Are ascending or descending
• Are described by their location in the tract
• Lower
• Urethritis
• Cystitis
• Prostatitis
• Upper
• Pyelonephritis
• Site and type of bacteria determines treatment

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Factors Contributing to UTIs

• Invasive procedures catheters
• Obstruction bacteria can grow in pool of urine
• Stones obstructs and irritates mucosa
• Vesicoureteral reflux urine goes up into
  kidneys
• Diabetes- glucose is food for bacteria
• Gender closes to bacteria
• Age not emptying, neuromuscular, medications
• Sexual activity irritation, increased bacteria
  in area

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Urethritis

• Inflammation of the urethra
• In men
• Usually burning, or difficulty with urination
• Most common cause is an STD
• In women
• Burning, pain and difficulty voiding
• Irritation from vaginal deodorants and bubble bath

• Treatment
• Treat STD
• Treat with antibiotics if bacteria present
• Sitz baths
• Wipe front to back
• Void before and after sex
• Decrease bubble baths
• And vaginal deodorants

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Cystitis

• Inflammation of the bladder
• More common in women
• S/S burning, frequency, urgency, hematuria,
  incontinence, pain, fever, cloudy urine
• Diagnosis urinalysis and a CS
• Treatment antibiotics, analgesics, Pyridium,
  Urispas

• Interventions
• Sitz baths
• Analgesics
• fluid
• Teach
• avoid tight clothing
• showers over tub
• no caffeine
• wipe front to back
• cranberry juice

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Interstitial Cystitis

• Chronic inflammation of the bladder
• Cause unknown
• More females
• Severe pelvic pain with urinary frequency and
  urgency
• Bladder becomes stiff and scarred, with ulcers
  and bleeding

• Treatment is mostly out patient
• Pain management
• Antidepressants
• NSAIDS
• Antispasmodics

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Pyelonephritis

• Acute or chronic (chronic usually caused by long
  term UTIs)
• One or both kidneys
• May be ascending or blood borne
• May lead to renal failure

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Pyelonephritis, cont.

• S/S
• High fever, N/V, dysuria, severe back and flank
  pain, fatigue
• Treatment
• Antibiotics may be long term
• Antispasmodics
• Analgesics

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Pyelonephritis, cont.

• Nursing Care
• Give pain RX
• Assist with
• ADLs
• Ensure adequate diet
• Provide IV fluids and oral fluids up to 2-3
  liters/day

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Drugs Used for Urinary Tract Disorders

• Diuretics
• Antihypertensives
• Phosphate binders
• Vitamins and mineral supplements
• Antibiotics
• Urinary antiseptics