Genitalurinary System

1
Genital-urinary System

• Renal System
• Part 2

2
Behavioral Objectives

• Identify and describe the etiology,
  pathophysiology, clinical manifestations, nursing
  management and patient education for the
  following
• Urinary retention
• Urinary incontinence
• Urinary suppression
• Residual urine
• Discuss common pharmacological interventions
  appropriate in treatment of patient with GU
  disorders
• Describe general nursing consideration and
  intervention in pre and post-operative care of
  patients undergoing urological surgery
• Describe etiology, pathophysiology, clinical
  manifestations, nursing management and patient
  education for the following GU disorders
• Pyelonephritis
• Cystitis
• Urinary tract infections (UTI)
• Urethritis
• Nephritic syndrome
• Hydronephrosis
• Renal calculi
• Renal neoplasms

3
Dysfunctional Voiding Patterns

• Urinal Incontinence
• Pathophysiology
• Unplanned loss of urine that is sufficient to be
  considered a problem
• Continence requires intact urinary, neurologic
  and muscular-skeletal systems
• Any break in communication between these systems
  can lean to incontinence (or residual)

4
Types of Incontinence

• Stress Incontinence
• Involuntary loss of urine through an intact
  urethra due to a sudden h in intra-abd. pressure
• Treatment-mild Biofeedback bladder drills
• Treatment-moderate to severe surgery

5
Types of Incontinence

• Urge Incontinence
• Involuntary loss of urine associated with a
  strong urge to void that cannot be suppressed.
• Treatment-
• Biofeedback
• Pelvic floor nerve stimulation
• Bladder drill
• Anticholinergics

6
Types of Incontinence

• Reflux incontinence
• Involuntary loss of urine due to Hyperreflexia in
  the absence of normal sensation
• Associated with spinal cord injuries

7
Types of Incontinence

• Overflow incontinence
• Involuntary loss of urine due to over-distention
  of the bladder
• Bladder is unable to empty normally ?
• over distended ?
• frequent urination (just over flow) ?
• Incontinence
• Treatment
• Catheterization

8
Behavior Therapy Management

• Fluid Management
• Increase fluid
• Decrease fluid
• WATER!!!!
• Standardized voiding frequency
• Timed voiding
• Bladder retraining

9
Behavior Therapy Management

• Pelvic Muscle Exercises
• Kegel exercises
• Goal
• strengthen voluntary muscles

10
Behavior Therapy Management

• Pharmacological Therapy
• Anticholinergic agents
• Oxybutynin/Ditropan
• Action Inhibits bladder contractions
• Indications for use urge incontinence

11
Surgical management

• Involve lifting and stabilizing the bladder or
  urethra

12
Nursing Management

• h fluids
• No diuretics after 4PM
• Avoid bladder irritants
• Caffeine
• Alcohol
• Aspartame (nutrasweet)
• High fiber meals
• Void regularly
• Enc pelvic floor exercises
• Stop smoking

13
Urinary Retention

• Pathophysiology
• Urinary Retention
• The inability to empty the bladder completely
• Residual urine
• urine that remains in the bladder after voiding
• Assoc. with
• post-op d/t reflux spasm of sphincters
• Diabetes
• Prostatic enlargement
• Urethral pathology
• Trauma
• Pregnancy
• Neurologic disorders

14
Urinary Retention

• Assessment
• Measure post void residual urine
• Portable bladder scanner

15
Urinary Retention

• Complications
• Chronic infections ?
• Pyelonephritis ?
• Sepsis ?
• Kidney failure
• Deathmosis

16
Urinary Retention

• Nursing Management
• Promoting normal urinary eliminations
• Provide privacy
• Commode
• Male stand
• Sitz bath
• Hot tea
• Water faucet on
• Tapping pubic area
• Dipping hand in warm water
• Promoting urinary elimination
• Catheterization

17
Neurogenic Bladder

• A dysfunction d/t a lesion of the nervous system
• Two types of neurogenic bladder
• Spastic bladder / reflex bladder
• Empties on reflex
• Flaccid bladder
• Bladder becomes distended ?
• Overflow incontinence ?
• Bladder does not contract ?
• Can not feel discomfort

18
Neurogenic Bladder Management

• Catheterization
• Obstruction
• Post-op
• Monitor output with critical
• Neurogenic bladder or urinary retention
• Stage III or IV decubitus ulcers
• Indwelling devices
• Drainage bag below the level of the bladder
• Tubing not kinked and no too long
• Increase fluids
• Suprapubic catheterization

19
Suprapubic Catheter
20
Urological Surgery

• Drainage tubes
• Nephrostomy drainage
• Tube inserted directly into the kidney