GENITOURINARY SYSTEM

By: JOHN MARK B. POCSIDIO, RN, USRN, MSN

KIDNEYS
 FUNCTIONS:
 Urine formation
 Excretion of waste products
 Regulation of acid/base balance
 Control of water balance
 Control of blood pressure
 Renal clearance
 Regulation of RBC production
 Synthesis of vit D to active form
 Secretion of prostaglandins

KIDNEYS
 Each person has 2 kidneys ; each is attached to the abdominal wall at the level of the
last thoracic and the first three lumbar vertebrae.
 The kidneys are enclosed in a renal capsule
 The cortex is the outer layer of the renal capsule.
 The medulla is surrounded by the cortex
 The nephrons makes up the functional unit of the kidneys

NEPHRONS
 The nephrons is the functional renal unit
 The nephrons is composed of glomerulus and tubules

GLOMERULUS
 The glomerulus is encased in the Bowman’s capsule
 The glomerulus filters the fluid out of blood

TUBULES
 The tubules include proximal, distal, and loop of henle
 Fluid is converted to urine in the tubules, and then the urine moves to the pelvis of
the kidney
 The urine flows from the pelvis of the kidney through the ureter and empties into
bladder

Ureter
 Long fibromuscular tube that connects the kidneys to the bladder
 A narrow muscular tube, 24 – 30 cm long
 Originated at the lower portion of the renal pelvis and terminate in the trigone of the
bladder wall
 Left is shorter than the right
 Transitional cell epithelium

BLADDER
 The ureterovesical sphincter prevents reflux of urine from the bladder to the ureter
 The total capacity of the bladder is 1L

PROSTATE GLAND
 The prostate gland surrounds the male urethra
 The prostate gland contains a duct that opens into the prostatic portion of the urethra
and secretes the alkaline portion of seminal fluid

URINE PRODUCTION
 1. As fluids flows through the proximal tubules, water and solutes are reabsorbed
 2. Water and solutes that are not reabsorbed become urine
 3. The process of selective reabsorption determines the amount of water and solutes
to be secreted
 Urethra
 Tube extending from the urinary bladder to the external urethral orifice
 1 ½ inches in females
 3 parts in Males
 Prostatic urethra- most dilatable
 Membranous urethra- least dilatable and shortest
 Penile urethra- longest

 a. Males: 8 inches long (20 cm) channels for semen and urine; Protstate gland
encircles urethra at base of bladder; urinary meatus located at end of the glans penis
 b. Females: 1.5 inches long (3 -5 cm) anterior to vaginal orifice

URINE FORMATION
 Urine formation
 Three steps
 Glomerular filtration
 Tubular reabsorption
 Tubular secretion

Glomerular filtration
 1200ml/min. 20%(180L/day) are filtered.
 Filtrate normally consist of water, electrolytes and small molecules.
 Efficient filtration will depend on the blood flow
 Tubular reabsorption and tubular secretion
 Occurs in the renal tubules
 99% is reabsorbed making 1500 – 2000 ml urine/day
 Controlled by ADH (vasopresin)

BP regulation
 Vasa recta constantly monitor blood pressure.
 Juxtaglomerular cells secretes renin.
 Converts angiotensin I to II.
 Adrenal cortex secretes aldosterone
 Glomerular filtration
o Glomerular filtration fate (GFR): amount of fluid filtered from blood into
capsule per minute
o GFR is influenced by 3 factors
o Total surface area available for filtration
o Permeability of filtration membrane
 Net filtration pressure (proportional to GFR
 Normal GFR in both kidneys is 120 – 125 ml/min in adults
 ASSESSMENT
 IRRITATION
 Dysuria
 Frequency
 Urgency
 Nocturia

OBSTRUCTION
 Weak Stream
 Hesitancy
 Terminal Dribbling
 Incomplete emptying
 Nocturia

PAIN
 Flank or lumbar
 Inguinal or iliac
 Initiation of
 voiding
 End of voiding
 Painless
 Hematuria

URINE CHANGES

 Proteinuria
 Ketonuria
 Glucosuria
 Hematuria
 Pyuria
 Fecaluria

 Procedures
 URINE SPECIMEN
 Provides important clinical information on kidney function.
 Urine culture determines the presence of bacteria and identify antimicrobial therapy
best suited for the strain identified.
 Diagnostic Procedures
 There is no single test for renal function
 Best results are obtained by combining a number of clinical tests
 Renal function is variable from time to time
 Renal function may be within normal limits until >50% of renal function is
lost

URINALYSIS
 Collection of Urine
Specimen
 URINALYSIS
 SPECIFIC GRAVITY: 1.010-1.030
 Negative for glucose, protein, red blood cells, WBC
 PH: 5-8
 First voided morning sample preferred;15,ml
 Send to lab immediately or refrigerate
 If clean catch, get urine for culture prior to starting antibiotics
 a.) Cleans labia, glans penis
 b.) Obtain midstream sample

 Blood Studies
 Blood Urea Nitrogen or serum BUN or Urea Nitrogen

 Specific for kidney disease

 normal value = 20-30 mg/dl

 BLOOD STUDIES
 Serum Creatinine
 is more specific for renal function test
 is not affected by dietary intake or hydration status
 can not be reabsorbed by the kidney tubules
 normal value 0.5-1.5 mg/dl

SERUM ELECTROLYTES
 All electrolytes are elevated in CRF except calcium and HCO3
 Diuretics may alter serum electrolytes

 CBC
 Erythropoietin activity
 RBC – significantly low in CRF
 WBC
 Platelets

 Radiology and Imaging

 Radiology and Imaging
 KUB Ultrasound
 Intravenous Pyelography (IVP) or
Excretory Urography
 Retrograde Urography
 MRI (with injection of contrast media)
 Renal Angiography

Kub ( x-ray)
 Shows sixe, shape, and position of kidneys, ureters, bladder.
 REMEMBER: NO PREPARATION NEEDED!!!!
 Ensure that the patient removes metallic belts- CBQ
 INTRAVENOUS PYELOGRAPHY(IVP)
 Visualization of urinary tract
 NURSING INTERVENTION:
- Obtain informed consent
 - Keep client NPO for 8-10 hours
- Administer laxatives to clear bowel
- Restrict fluids
- Check allergies to iodine or shellfish
 IVP
 Cont.
 6.) Inform the client that flushing , warmth, nausea, salty, metallic taste may
accompany injection of the die
 7.) Have emergency equipment available during procedure--- BRING EPINEPHRINE-
CBQ
 8.) Push fluids after the procedure to flush out the die
 Renal angiography
 Visualization of renal arterial supply; contrast material injected through a catheter
NURSING INTERVENTION ( same as IVP plus)
 Shave the proposed injection sites: groin or ankle
 Locate and mark peripheral pulses
 Have the client void before the procedure
 Teach the client that: procedure takes ½ hour to 2 hours ; client will feel heat along
the vessel
 Nursing intervention after
 1.) Maintain bed rest 4-12 hours
 2.) Monitor vital signs until stable
 3.) Apply cold compress to punctured site
 4.) Observe for swelling and hematoma
 5.) Palpate peripheral pulses / vascular checks
 6.) Monitor urinary output

cYSTOSCOPY
 DIAGNOSTIC USES: Inspect bladder and urethra; insert catheters into ureters; see
configuration and position of urethral orfices
 TREATMENT USES: Remove calculi from urethra, bladder and ureter; treat lesion of
bladder, urethra, prostate
 Nursing intervention ( pre-op)
 1.) Maintain NPO if general anesthesia; liquids if local anesthesia
 2.) Administer pre-op catharthics/ enemas
 3.) Teach client deep breathing exercises to relieve bladder spasm
 4.) Monitor postural hypotension
 5.) Inform client that pink-tinged or tea colored urine is common following the
procedure; bright red urine or clots should be reported to the physician

 Cont.
 6.) Inform the client that post-procedural pain may be present
 A.) leg cramps due to lithotomy position
 B.) back pain and or abdominal pain
 C.) warm sitz bath is comforting
 7.) Push fluids and give analgesics
 8.) Monitor for intake and output; make sure no obstruction

RENAL BIOPSY
 Needle biopsy of the kidney
 NURSING INTERVENTION ( PRE-BIOPSY)
 0btain bleeding , clotting and prothrombin times
 Obtain results of pre-biopsy xrays of kidneys, IVP
 Inform pregnant client that ultrasound may be used
 Keep client NPO 6-8 hours
 5) Position client prone with pillow under abdomen, shoulders on bed
 NURSING INTERVENTION ( POST BIOPSY)
 1.) Keep client supine , bed rest for 24 hours- CBQ
 2.) Monitor vital signs q 5-15 minutes for 4 hours then decrease if stable
 3.) Maintain pressure to punctured site 20 minutes
 4.) Observe for pain, nausea, vomiting, BP changes
 5.) Push fluids to 3000ml
 CONT.
 6.) Assess HCT and Hgb 8 hours after the procedure
 7.) Measure the output
 8.) Educate client to avoid strenuous activity, sports, and heavy lifting for at least 2
weeks- CBQ

Genitourinary disorders
 By: JOHN MARK B. POCSIDIO, RN, USRN, MSN
URINARY RETENTION
 Inability to empty the bladder completely during attempts to void.
 Chronic urine retention often leads to overflow incontinence.
 Can occur postoperatively in any patient particularly if the surgery affected the
perineal or anal regions.
 General anesthesia reduces bladder muscle innervation and suppresses the urge to
void, impeding bladder emptying.
 Pathophysiology
 Urinary retention may result from diabetes, prostatic enlargement, urethral
pathology, trauma, pregnancy, or neurologic disorders such as cerebrovascular
accident, spinal cord injury, multiple sclerosis, or Parkinson’s disease.
 May also be caused by medications
 URINARY RETENTION: Complications
 Chronic infections
 Calculi
 Pyelonephritis and sepsis
 Hydronephrosis and obstructive form of uropathy and chronic renal failure
 Urine leakage with perineal skin breakdown and irritation

URINARY RETENTION: Nursing Management

 Prevent overdistention of the bladder
 Treat infection
 Correct obstruction
 Promote normal urinary elimination
 Providing privacy
 Ensuring an environment and a position conducive to voiding
 Assisting the patient with the use of the bathroom or commode
 Applying warmth to relax the sphincters
 Promote normal urinary elimination
 Giving patient hot tea
 Offering encouragement and reassurance
 Simple trigger techniques (turning on the water faucet while the patient is trying to
void, stroking the inner thighs or abdomen, tapping above the pubic area, dipping
the patient’s hands in warm water)
 Administering analgesics post-surgery
 Promote urinary elimination
 Transurethral catheterization
 Suprapubic catheterization
 Promoting home care

URINARY INCONTINENCE
 Is the involuntary or uncontrolled loss of urine from the bladder
 More common in the elderly
 URINARY INCONTINENCE
 Risk factors:
o Pregnancy: vaginal delivery, episiotomy
o Menopause
o Genitourinary surgery
o Pelvic muscle weakness
o Incompetent urethra due to trauma
o Immobility
o High-impact exercise
o Diabetes mellitus
o Stroke
 URINARY INCONTINENCE
 Risk factors:
o Age-related changes in the urinary tract
o Morbid obesity
o Cognitive disturbances: dementia, Parkinson’s disease
o Medications: diuretics, sedatives, hypnotics, opioids
o Caregiver or toilet unavailable

Types of incontinence
 STRESS INCONTINENCE- is the involuntary loss of urine through an intact urethra
as a result of a sudden increase in intra-abdominal pressure( sneezing, coughing, or
changing position)
 URGE INCONTINENCE- is an involuntary loss of urine associated with urgency ( the
patient is aware of the need to void but is unable to reach the toilet.)
 FUNCTIONAL INCONTINENCE- voiding at socially inappropriate times and places
caused by loss of cognition.
 OVERFLOW INCONTINENCE- is an involuntary urine loss associated with over
distention of the bladder

Assessment and Diagnosis

 Detailed description of the problem and a history of medication use
 Voiding history and diary of fluid intake and output
 Urodynamic tests (cystometrogram)
 Urinalysis and urine culture
 URINARY INCONTINENCE:
Medical Management
 Depends on the underlying cause
 Behavioral therapy are always the first choice to decrease or eliminate incontinence
 Timed voiding
 Prompted voiding
 Habit retraining
 Bladder retraining or “bladder drill”
 Pelvic muscle exercises or Kegel exercises
 Vaginal cone retention exercises

Medical Management
 Pharmacologic therapy
o Anticholinergics (oxybutynin, dicyclomine)
o Tricyclic antidepressants (imipramine, doxepin)
o Pseudoephedrine (Sudafed)
o Estrogen

Urinary tract infection

 There are 3 most common UTI’S, these are cystitis, urethritis and pyelonephritis
 Cystitis- is an infection of the urinary bladder
 Urethritis- is an infection of the urethra
 Pyelonephritis- is an infection of the kidney
 Classified as upper (kidney) or lower (bladder, urethra)

 etiology
 Bacteria, usually E. Coli.
 Pyelonephritis  spread of bacteria into the bloodstream, urinary reflux, obstruction
or ascending UTI.
 Cystitis:
 BPH
 Occurs more commonly in women
 Uretheritis - bacterial and viral infections
 Other factors include:
 Stasis
 Urinary retention and bladder distention.
 Instrumentation
 Poor hygiene
 Fecal incontinence
 Sexual transmission of bacteria

assessment
 Frequency & urgency
 Dysuria
 Suprapubic tenderness, pain in region of bladder or flank pain
 Hematuria
 Fever/malaise/chills
 Cloudy, foul smelling urine
 Diagnostic test
 Urine culture and sensitivity reveals specific organism (80% E-coli)
 Nursing interventions:
 C AND S before antibiotic therapy
 Fluid intake (3 – 5 L/day)
 Acidity
 Hot Sitz bath
 3 W’s: wash, wear, wipe
 Empty bladder every 2-3hours
 Empty bladder immediately after sexual intercourse
 Analgesic: PYRIDIUM (Phenazopyridine) - Causes red – orange discoloration of body
secretions -CBQ

 Urinary Antiseptic
 Cinoxacin (Cinobac)
 Nalidixic (Noroxin)
 Nitrofurantoin (Macrodatin)
 Metheranime Mandelate (mandelamine)
 Sulfonamides
 Co-trimoxazole (Bactrim)
 Sulfisoxazole (Gantrisin)
 Cholinergics (to relieve urinary retention)
 Bethanechol chloride (Urecholine)
 Anticholinergics (to decrease bladder muscle spasms)
 Propantheline Bromide (Pro-Banthine)
 Antibiotics
 Ciprofloxacin (Cipro)
 Cephalexin (Keflex)

URINARY CALCULI
 The formation of stones in the urinary tract secondary to precipitates
 PREDISPOSING FACTORS
 DIET: Large amount of calcium, oxalate
 Increased uric acid levels
 Sedentary lifestyle, immobility
 Family history of gout or calculi; hyperparathyroidism

assessment
 Chills and fever
 Cool, moist skin
 Costovertebral tenderness
 Diaphoresis
 Dysuria
 Flank pain
 Frequency of urination
 Nausea & vomiting
 Pallor
 Renal colic
 Syncope
 Urgency of urination

Nursing interventions
 1.) Fluids ( 3000 mls/day)
 2.) Strain all urine
 3.) Adjust urine ph
 Ca stones
- Limit dairy products
- Acid ash diet ( cranberry/ prune juice, meat, eggs, fish, poultry, grapes,
whole grains, citrus fruits, Vit C)
 Oxalate stones
 -Avoid excess tea, chocolate, spinach
 Acidic stones
 Alkalinize urine
 -Na Bicarbonate tablets
 -Alkaline ash diet ( milk, vegetables, fruits, salmon)
 Uric acid stones
 AVOID PURINE FOODS
 Organ meat
 Shellfish
 Meat soups
 Gravy
 Legumes
 Salted anchovies
 Mushroom
 sardines
 CONT. NURSING INTERVENTION
 4.) Encourage ambulation
 5.) Pain control (demerol)
 6.) Allopurinol ( to decrease uric acid)
 SURGERY: Nephrolithotomy, Pyelolithotomy, Ureterolithetomy, Litholapaxy,
 ESWL: Extracorporeal Shock Wave Lithotripsy( crushing of stones with the use of
ultrasonic waves while the body is half immersed in water) painful but meds will be
given to minimize the pain- CBQ

 MANAGEMENT
 PUL percutaneous ultrasonic lithotripsy
 Nephroscope is inserted to kidney, an ultrasonic waves disintegrates stones
followed by suction and irrigation
 Laser lithotripsy = non invasive procedure
 Post nsg care = increase fluids, encourage ambulation, strain urine and
watchout for obstruction and bleeding
 prostatitis
 Inflammation of the prostate gland
 Caused by bacterial agent or tissue hyperplasia ( abacteria)
 Bacterial type is caused by an organism reaching the prostate via urethra or the
blood stream
 Abacterial type usually occurs following a viral illness or decrease sexual activity

 Signs & symptoms

 1.) BACTERIAL PROSTATITIS
 Fever & chills
 Dysuria
 Urethral discharge
 Prostate is tender, indurated, warm to touch
 Urethral discharge upon palpation of the prostate
 White blood cells found in prostatic secretions
 2.) ABACTERIAL
 Backache
 Dysuria
 Perineal pain
 Frequency
 Hematuria
 Irregularity enlarged, firm, and tender prostate

INTERVENTIONS
 1. Encourage adequate fluid intake
 2. Instruct client about the use of sitz bath for comfort
 3. Administer antibiotics, analgesics, antispasmodics, and stool softeners as
prescribed
 4. Masturbation, increase sexual activity, prostatic massage is encouraged.—CBQ
 5. Avoid spicy foods, coffee, alcohol, prolonged automobile rides, and sexual
intercourse during acute inflammation--CBQ

 BPH
Benign Prostatic Hyperplasia
 Slow enlargement of the prostate
 Men over 40 year -ANDOGEN(prostate gland enlargement begins)
 On the latent phase it will constrict the urethra which interferes in urination
 assessment
 SUBJECTIVE
 Frequency
 Urgency
 Difficulty initiating stream
 Incomplete emptying of the bladder after urination
 SIGNS/SYMPTOMS
 OBJECTIVE
 Nocturia
 Hematuria
 Weak stream
 Urinary retention
 Biopsy reveals hyperplasia
 Rectal Examination

 Diagnostic results
 CYSTOSCOPY- Shows enlarged prostate gland, obstructed urine flow, and urinary
stasis

 RECTAL EXAMINATION- Shows enlarged prostate gland

 Management
 TURP (Transurethral Resection of the Prostate)
 No incision
 Continuous bladder irrigation (CBI) or dystoclysis I done postpop
 This is to irrigate the bladder and remove blood clots
 No incontenence, no impotence postop.- CBQ
 TURP
 SUPRAPUBIC PROSTATECTOMY
 RETROPUBIC PROSTATECTOMY
 TRANSURETHRAL INCISION OF PROSTATE ( TUIP)
 Management cont.
 Suprapublic Prostatectomy
 Incision over lower abdomen and bladder
 With cystostomy tube and 2-way foley chatter postop
 No incontenence, no impotence post
 Retropublic Prostatectomy
 Incision over the abdomen
 No incontenence, no impotence postop
 Postoperative care
 Care of the patient with CBI (post – TURP)
 Maintain patency of catheter
 If drainage:
 Reddish – increase flow rate- CBQ
 Clear – decrease flow rate- CBQ
 Practice asepsis
 Use sterile NSS to prevent water intoxication-CBQ

 Postoperative turp
 Prevent thrombophlebitis
 Monitor for hemorrhage
 Red to light pink urine – 1st 24 hours; amber – 3 days postop -CBQ
 Advice not to void around catheter  bladder spasm
 Increase fluid intake
 Relieve pain-analgesic - spasm ↓ after 24-48 hours
 Client Teaching:
 After removal of catheter: observe for urinary retention/dribbling
 Dribbling: KEGEL’s exercise to strengthen pubococcygeal muscle and help regain
control voiding
 Avoid the following -CBQ
 Vigorous exercise
 Having lifting sexual intercourse 3 weeks after the discharge
 Driving 2 weeks after discharge
 Straining with defection
 Prolonged sitting / standing
 Crossing the legs
 Long trips

PROSTATE CANCER
 Prostate cancer is the slow growth of cancer cells in the form of tumors that originate
in the posterior prostate gland, which may progress to widespread bone metastasis
and death
 Usually androgen dependent type of adenocarcinoma
 Risk increases in men with each decade after 50

 Risk factors
  Age over age 50
 Family history
 High fat diet
 testosterone

 DIAGNOSTIC TEST
 Transrectal prostatic ultrasonography.
 Bone scan.
 Excretory urography.
 Magnetic resonance imaging (MRI).
 Computed tomography (CT).4
 Biopsy
 TREATMENTS
 Chemotherapy.
 Radiation.
 Hormonal therapy. ( Luteinizing hormone)
 Radical prostatectomy.
 Transurethral resection of the prostate.
 Chemotherapy agents: mitoxantrone (Novantrone), vinblastine
 (Velban), paclitaxel (Taxol).
 Prednisone.
 Management
 TURP (Transurethral Resection of the Prostate)
 No incision
 Continuous bladder irrigation (CBI) or dystoclysis I done postpop
 This is to irrigate the bladder and remove blood clots
 No incontenence, no impotence postop.- CBQ

NEPHROTIC SYNDROME
 A clinical disorder associated with protein-wasting secondary to diffuse glomerular
damage
 ETIOLOGY: Unknown; kidneys become more permeable to protein

assessment
 Insidious onset of pitting edema( generalized edema anasarca)
 Proteinuria; hypoalbuminemia and hyperlipidemia
 Anemia
 Anorexia and malaise
 Nausea
 Oliguria
 Ascitis

Nursing intervention
 GOAL: Preserve renal function
 Maintain bed rest ( during severe edema only)
 Maintain low-sodium, low potassium, moderate protein, high calorie diet
 Protect client from infection
 Monitor intake and output- CBQ
 Weigh the patient daily-CBQ
 Measure abdominal girth
 DRUG THERAPY
 LOOP DIURETICS ( LASIX)
 STERIODS ( PREDNISONE)
 IMMUNOSUPPRESSIVE AGENTS CYCLOPHOSPHAMIDE (CYTOXAN)
 ACE INHIBITORS
 HEPARIN to lower proteinuria, dec. pulmonary embolus

Acute glumerulonephritis
 Bilateral infection of the glomeruli
 Caused by:
 Post infection (GABS) COMMON GROUP A beta hemolytic streptococcus)
 IMPETIGO--- CGFNS/ NCLEX
 Systemic diseases (SLE, glomerular deposits)
 Idiopathic
 Common in boys ages 3-7

 AGN
 Pathophysiology
 Acute poststreptococcal infection
 ANTIGEN stimulates formation of ANTIBODIES
 ANTIGEN-ANTIBODY-COMPLEXES are lodged in the glomerular capillaries
 Increasing capillary permeability
 ASSESSMENT
 S/sx:
 proteinuria, periorbital edema, hematuria, oliguria, azotemia and HPN
 smoky or coffee-colored urine, bibasilar crackles, nausea and malaise
 Dx Tests:
 Based from signs & symptoms and result of urine test.
 Elevation of BUN and crea
 Serum protein levels are reduced
 Hb count is also reduced
 ASO titers are elevated
 KUB (bilateral enlargement)
 UA (postive RBC, WBC, and protein)
 AGN
 Management:
 Treat the underlying cause
 Antibiotics 7-10 days
 Diuretics to reduce fluid overload
 DIET restrictions: sodium and electrolytes, CHON is restricted in severe
AZOTEMIA
 Fluids restriction
 Strict I and O
 Vasodilators to control HPN
 Steroids to reduce inflammation
 Plasmapheresis to reduce circulating antibodies
 Dialysis or kidney transplantation
 CGN
 The unfortunate outcome of AGN
 Most common cause of ESRD
 s/sx: same with AGN
 HPN and OLIGURIA are the dominant clinical features
 Microscopic hematuria is usually present than GROSS hematuria
 Dx: BLOOD WORK, URINALYSIS, CT SCAN, RENAL BIOPSY
 Prognosis is POOR
 Management: same with AGN
 DIALYSIS and KIDNEY transplant

POLYCYSTIC KIDNEY DISEASE

 Is a cystic formation and hypertrophy of the kidneys, which lead to cystic rupture,
infection, the formation of scar tissue, damaged nephrons
 The ultimate result of this disease is renal failure
 Types:
 Infantile polycystic disease- an inherited autosomal recessive trait that results in the
death of the infant within a few months after birth
 Adult polycystic disease- an autosomal dominant trait that results in end stge renal
disease

 ASSESSMENT
 Flank, lumbar, or abdominal pain
 Fever and chills
 UTI’S
 Hematuria, proteinuria, pyuria
 Hypertension
 Calcaluses
 Palpable abdominal masses & enlarged kidneys
 meds
 ACE inhibitors ( enalapril)
 DIURETICS
 ANTIBIOTICS
 CHLORAMPENICOL
 CIPROFLOXACIN

NURSING INTERVENTIONS
 1. Monitor for gross hematuria, which indicates cyst rupture
 2.Increase sodium and water intake because sodium loss rather retention occurs
 3. Provide bed rest if ruptured cysts and bleeding occurs
 4. Prepare the client for percutaneous cyst puncture for relief of obstruction or for
draining an abscess
 5. Administer antihypertensives as prescribed
 6. Prepare the client for dialysis or renal transplantation
 7. Encourage the client to seek genetic counseling
 Acute renal failure
 Sudden inability of the kidneys to regulate fluid and electrolyte balance and remove
toxic products from the body
 CAUSES:
 PRERENAL: Factors interfering with perfusion & resulting in decreased blood flow &
glomerular filtrate, ischemia, & oliguria
 E.g CHF, Cardiogenic shock, acute vasoconstriction, hemorrhage, burns, septicemia,
hypotension
 INTRARENAL: Conditions that cause damage to the nephrons.
 E.g Acute tubular necrosis, Endocarditis, Diabetes mellitus, Malignant hypertension,
Acute glumerulonephritis, Tumors, Blood transfusion reaction, Hypercalcemia,
Nephrotoxins (pesticides, x-ray dyes, antibiotics)
 POSTRENAL: Mechanical obstruction anywhere from the tubules to the urethra
 E.g Calculi, BPH, Tumors, Strictures, Blood clots, Trauma, Anatomic malformation
 Stages of arf
 OLIGURIC PHASE
 Urine output= 400mls/<per day
 Increased BUN, Serum creatinine
 Edema, Hypertension
 Hyperkalemia
 Hyponatremia
 Hypermagnesemia
 Hyperphosphatemia
 Metabolic acidosis
 Last 1-2 weeks---- CBQ
 DIURETIC PHASE
 Urine output= 3-5L/day
 Initially
 BUN, Serum creatinine elevated
 BP elevated
 Metabolic acidosis
 Later
 Normalize
 Hypokalemia
 Last 1 week------CBQ
 RECOVERY
 Takes 6-12 months
 Normal BUN, serum creatinine
 Avoid nephrotoxic drugs ( aminoglycoside)

CHRONIC RENAL FAILURE

 Progressive, irreversible destruction of the kidneys that continues until nephrons are
replaced by scar tissue; gradual loss of renal function
 PREDISPOSING FACTORS:
 Recurrent infections, Exacerbations of nephritis, Urinary tract obstructions, Diabetes
mellitus, Hypertension

 Stages of crf
 First stage (Diminished Renal reserve) GFR 35-50%
 Renal function is reduced
 No metabolic wastes accumulate.
 The healthier kidney compensates for the diseased one.
 Asymptomatic
 Second stage (Renal Insufficiency) GFR 25-35%
 Metabolic wastes accumulate
 Decreasing GFR, classified as mild, moderate, or severe. (25% nephrons are
damaged)  symptoms of renal failure (increasing BUN, fatigue)

 Stages of crf
 Final stage (End-stage Renal failure) GFR 15-20%
 Excessive amounts of metabolic wastes,
 Kidneys are unable to maintain homeostasis - a life-threatening condition.

 SIGNS & SYMPTOMS

 FATIGUE
 HEADACHE
 NAUSEA, VOMITING, DIARRHEA
 HYPERTENSION
 IRRITABILITY
 CONVULSION/COMA
 ANEMIA
 EDEMA
 HYPOCALCEMIA
 HYPERKALEMIA
 PRURITUS
 UREMIC FROST
 ELEVATED BUN & CREATININE
 METABOLIC ACIDOSIS

 NURSING INTERVENTIONS
 GOAL: HELP KIDNEYS MAINTAIN HOMEOSTASIS
 MAINTAIN BED REST
 IMPLEMENT RENAL DIET: low protein, low potassium, high carbohydrates, vitamin,
calcium supplements, low sodium, low phosphate NO TO SODA
 Give diuretics for hypertension
 Strict I & O
 Monitor electrolytes
 Give amphojel
 Cont.
 Maintain dialysis
 Assess for bleeding tendencies
 Prevent infection
 Evaluate need for kayexalate to lower potassium
 Give EPOGEN
 Provide emotional support to patient & family
 hemodialysis
 Alternates to the excretory but not on the endocrine function of the kidneys
 Practice ARM PRECAUTION-CBQ
 Assess for patency: auscultate for bruit, palpate for thrill- CBQ
 Tourniquet be always available if A – V shunts is present.
 A – V shunt may be used immediately
 A – V fistula may be used after 4-6 weeks wait for healing. It can be used for 3-4
years.
 ARTERIOVENOUS FISTULA

 Vascular access:
 Arteriovenous fistula.
 Arteriovenous graft.
 External arteriovenous shunt.
 Femoral vein catheterization.
 Subclavian vein catheterization.

NURSING RESPONSIBILITY
 Assess the access site for bruit sounds (through auscultation)
 Absence of thrill=may indicate occlusion (through palpation)
 Assess neurovascular condition distal to the site
 No BP taking on the access site-CBQ
 Cover the access site with adhesive bandage (dry sterile dressing)

NURSING RESPONSIBILITY
 Check blood chemistry
 Constant monitoring of hemodynamic status, electrolytes and acid base balance
 Start low flow rate, watch out for dialysis disequilibrium)
 250 ml/hr (rate), 3-4 hours duration
 Vinegar, hot water, bleach, NSS (cleanser, disinfectant)
 NURSING RESPONSIBILITY
 Hold medications that can be dialyzed off (water soluble vitamins and certain
antibiotics)- CBQ
 Hold antihypertensive and other meds that can affect the BP before the procedure as
described-CBQ
 Monitor for shock and hypovolemia
 Provide adequate nutrition
 COMPLICATIONS
 Dialysis encephalopathy
 Disequilibrium syndrome
 Electrolyte changes
 Hepatitis
 Hypotension
 Sepsis
 Loss of blood
 Muscle cramping
 Dialysis
 Peritoneal Dialysis

 Hemodialysis

PERITONEAL DIALYSIS
 Substitute for kidney function during failure
 Uses peritoneum as a dialyzing membrane
 Usually short-term
 Peritoneal catheter inserted by physician
 Advantages: (CBQ)
 Steady state of blood chemistries.
 Patient can dialyze alone in any location without need for machinery.
 Patient can readily be taught the process.
 Patient has few dietary restrictions; because of loss of CHON in daily dialysate, the
patient is usually placed on a high CHON diet.
 Patient has much more control over daily life.
 Peritoneal dialysis can be used for patients that are hemodynamically unstable.

 Nursing intervention
 Have the client void prior to procedure
 Weigh the client daily
 WARM the solution ( room warmed)
 Monitor vital signs, baseline electrolytes
 Maintain asepsis
 Keep accurate record of fluid balance
 Procedure:
 Watch video
 Monitor for complications like: CHECK THE OUTFLOW!!!
 PERITONITIS
 BLEEDING
 RESPIRATORY DIFFICULTY
 ABDOMINAL PAIN
 BOWEL PERFORATION
 BLADDER PERFORATION
 CONTRAINDICATION
 Peritonitis
 Recent abdominal surgery
 Impending renal transplant
 Abdominal adhesions

Kidney transplant
 Indicated for individual with irreversible ESRD
 REQUIRES WELL-MATCHED DONOR
 1. living donors: best donors are twin or family members
 2.Cadaver donors
 CRITERIA
 Cadaver kidney from persons who
 a. Meets criteria for brain death
 b. Are aged < 65 years old
 c. Are free of systemic disease, malignancy, or infection including HIV, hepatitis
B, C

 Preoperative management
 Regain normal metabolic state
 Tissue typing
 Immunosuppressive therapy
 Hemodialysis within 24 hours
 Teaching and emotional support

 Postoperative management
 Maintain homeostasis until kidney is functioning
 Position: semi fowlers
 Monitor for GROSS HEMATURIA
 Administer immunosuppressive medication: AZATHIOPRINE( IMURAN), CYCLOSPORIN
(SANDAIMUNE), STERIODS for life!!
 Monitor for rejection
 Monitor for infection
 Maintain reverse isolation
 Provide emotional support
 CBQ- CliENT INSTRUCTION
 Avoid prolonged periods of sitting
 Recognize the signs & symptoms of infection & rejection
 Avoid contact sports
 Avoid exposure to persons with infections
 Use medication as prescribed , & maintain immunosuppressive therapy for life
 Ensure follow-up care

 REJECTION
 Watch out for signs and symptoms of kidney transplant rejection these are:
 Fever
 Malaise
 Elevated WBC
 Graft tenderness
 Signs of deteriorating renal function
 Acute hypertension
 Anemia

 CBQ- CliENT INSTRUCTION

 Avoid prolonged periods of sitting
 Recognize the signs & symptoms of infection & rejection
 Avoid contact sports
 Avoid exposure to persons with infections
 Use medication as prescribed , & maintain immunosuppressive therapy for life
 Ensure follow-up care