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Genitourinary disorders

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Presentation on theme: "Genitourinary disorders"— Presentation transcript:

1 Genitourinary disorders
Islamic University Nursing College

2 Genitourinary Tract Main function of GU is
Maintaining the composition and volume of the body fluids in equilibrium Production of certain hormonal substance (e.g., erythropoietin) Remove wastes from bloodstream

3 Genitourinary Tract The nephrons increase in number throughout gestation and reach their full complement by birth but still immature and less effective Glomerular filtration and absorption are relatively low at birth and do not reach adult values until 1- 2 years

4 Genitourinary Tract Loop of Henle (site of the urine concentrating mechanism) is short in the newborn which reduces the ability of the newborn to reabsorb sodium and water . Concentrating ability reaches adult levels by around 3rd month of age Amount of urine excreted in 24 hours depends on : fluid intake, state of kidney health, and age

5 GU: Diagnostic tests: urine analysis

6 GU: Diagnostic tests Serum creatinine: 0.7 – 1.5 mg/ 100ml
Urine Culture (suprapubic aspiration) Glomerular filtration rate: measured by the creatinine clearance test (100ml/min) BUN: is used to measure the amount of urea nitrogen in the blood tests glomerular function (N= 5 – 20 mg/ 100ml) Serum creatinine: 0.7 – 1.5 mg/ 100ml

7 GU: Diagnostic tests Sonography & MRI
To visualize the sizes of kidneys, ureters differentiate between solid or cystic masses. X-ray: KUB IVP: intravenous pyelogram CT scan: size & density of kidneys, adequacy of urine flow Cystoscopy : evaluate stenosis Voiding Cystourethrogram (VCUG): evaluate reflux in ureters Renal biopsy

8 Genitourinary Tract: Assessment
Chief concern: Burning or cries during urination Blood in urine/ Frequency of urination Abdominal pain/ Flank pain Enuresis Periorbital edema Poor appetite Strong urine odor Diaper rash Family history (Renal disease) Pregnancy history(Nephrotoxic drugs) Past illnesses (Recurrent UTI)

9 Urinary Tract Infection (UTI)
UTI is the presence of significant numbers of microorganisms anywhere within the urinary tract May present without clinical manifestations Peak incidence between 2-6 years of age Female has greater risk of developing UTI The likelihood of reoccurrence in female is 50% Prevalence of UTI in infants is 2% in boys and 3.7% in girls

10 Urinary Tract Infection (UTI)
Escherichia coli (80% of cases) and other gram-negative enteric-organisms are most commonly causative agents A number of factors contribute to the development of UTI including: Anatomy of UT Physical properties of UT Chemical conditions properties of the host’s urinary tract

11 Factors contributing to UTI
Shorter urethra in females Uncircumcised males Incomplete bladder emptying (reflux, stenosis) Altered urine and bladder chemistry/ sterility: Adequate fluid intake promote urine sterility Use of cranberry juice increased urine acidity and so prevent UTI Extrinsic factors: Poor hygiene, use of bubble bath, hot tubs Bladder neck obstruction, chronic constipation, tight clothing/ diapers Altered Normal. flora: antimicrobial agents Catheters

12 UTI: Assessment Any child with fever, dysuria, urgency should be evaluated for UTI Clean – catch urine for culture & sensitivity UTI, urine is positive for proteinuria due to bacterial growth Hematuria due to mucosal irritation Increase WBC Urine pH is more alkaline (>7)

13 Gastrointestinal Tract: clinical manifestation
Cystitis (infection of bladder): low grade fever (LGF) Mild abdominal pain Enuresis (preschooler) Pyelonephritis (kidneys): Symptoms are more acute High fever Flank or abdominal pain Vomiting Malaise

14 UTI: Clinical Manifestations

15 UTI: Management Identify contributing factors to
eliminate the infection reduce the risk of recurrence Prevent urosepsis Preserve renal function 7-10 days antibiotics matching organism sensitivity (penicillins, sulfonamide, cephalosporins, tetracyclines) Mild analgesics/ antipyretics Increase fluid intake: flush out infection Clean – catch urine after 72 hrs to assess effectiveness For recurrent UTI, prophylactic antibiotics for 6 months

16 UTI: Nursing Care Education regarding prevention & treatment
Instruct parents to observe for clues that suggest UTI: Incontinence in a toilet- trained child Strong- smelling urine Frequency

17 Cryptorchidism (Crptorchism)
is failure of one or both testes to descend normally through the inguinal canal into the scrotum Absence of testes within the scrotum can be a result of Undescended (cryptorchid) testes, Retractile testes (withdrawal of the testes) Anorchia (absence of testes) Actopic : emerges outside the inguinal ring

18 Cryptorchidism (Crptorchism)
Cryptorchid testes are often accompanied by congenital hernias and abnormal testes, and they are at risk for subsequent torsion Unknown cause, but this problem is believed to be partly inherited Risk Factors Prematurity; Low birth weight; Twin Down syndrome (fetus); Hormonal abnormalities (fetus) Toxic exposures in the mother Mother younger than 20 or older than 35 years of age A family history of undescended testes

19 Cryptorchidism (Crptorchism)
CM Non-palpable testes Affected hemiscrotum will appear smaller than the other In retractile testes :Intermittently observing the testes in the scrotum , thus hands should be warm when examining the baby in a warm room Management Retractile testis can be manipulated into the scrotum. By 1 year of age, cryptorchid testes will descend spontaneously in approximately 75% of cases in both full- term and preterm infants In true undescended testes rarely descend spontaneously after 1 year of age and need a surgery

20 Cryptorchidism (Crptorchism)
Surgical repair is done to prevent damage to the undescended testicle & decrease the incidence of tumor formation, avoid trauma and torsion & prevent the cosmetic and psychologic handicap of an empty scrotum Postoperative care: prevention of infection instructing parents in home care of the child about: pain control; carefully cleansing the operative site of stool and urine Observation of the wound for complications; Activity restriction

21 Vesicoureteral Reflux (VUR)
Retrograde flow of urine from the bladder up the ureters and possibly to the kidneys during micturation The cause may be a defective bladder valve (UTI) incorrect placement of ureters Severity of VUR depends on the degree/grade of VUR

22 Vesicoureteral Reflux (VUR)
Grading system depends on the extend of the VUR , dilatation of ureter and calyces (part of the kidney where urine collects)

23 Vesicoureteral Reflux (VUR)
Primary reflux: congenital anomaly affects the ureterovesical junction Secondary reflux: occurs as a result of an acquired condition, UTI, neuropathic bladder dysfunction Radiological Tests Renal/Bladder Ultrasound Voiding Cystourethrogram (VCUG) Management Spontaneous resolution over time 20-30% Continuous low-dose antibacterial therapy (prophylactic antibiotics) Frequent urine cultures Surgical correction for grades IV & V, anatomical abnormalities, recurrent UTI

24 Vesicoureteral Reflux (VUR)
Nursing Diagnosis High risk for injury related to possibility of kidney damage from chronic infection (pyelonephritis) Anxiety related to unfamiliar procedures Altered family processes related to illness of a child Nursing Interventions Administration of antibiotics Education Prevention Perineal hygiene; Complete bladder emptying; Frequent voiding

25 Hypospadias/Epispadias
Is a condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface of the penile shaft mild cases the meatus is just below the tip of the penis. severe malformations the meatus is located on the perineum between the halves of the scrotum Management Surgical repair Circumcision delayed to save the foreskin for repair Surgical correction by 1 year old, before toilet training

26 Acute Glomerulonephritis (AGN)
Inflammation of the Glomeruli occurs as an immune complex disease after infection Common in school age children 1-2 weeks After Streptococcal Infection (sore throat) antibodies are formed, an immune complex reaction is then occurs after a period of time which become trapped in the glomerular capillary loop

27 Acute Glomerulonephritis (AGN)
Clinical manifestations Tea-colored urine Anorexia Joint stiffness & pain Lab Results Urine analysis: ↑ WBC, epithelial cells, RBC casts Proteinuria Serum: ↑ BUN, creatinine, ESR, decreased Hgb Hypoalbuminemia Serum ASO titers may be elevated

28 Acute Glomerulonephritis (AGN)
Management Usually resolves spontaneously, treatment is focused on relief of symptoms. Antibiotics, such as penicillin to destroy any streptococcal bacteria that remain in the body. Antihypertensive medications and diuretic medications to control swelling and high BP Dietary salt restriction may be necessary to control swelling and high blood pressure > 90% recover from AGN

29 Acute Glomerulonephritis (AGN)
Complications Acute/chronic renal failure Hyperkalemia Nephrotic syndrome Chronic glomerulonephritis Hypertension Congestive heart failure or pulmonary edema (inspiratory crackles)

30 Acute Glomerulonephritis (AGN)
Nursing Diagnosis Fluid volume excess r/t decreased U.O. Risk for impaired skin integrity r/t edema and decreased activity Anxiety r/t hospitalization, knowledge deficit of disease Management No added salt diet & Fluid restriction Q4h BP & Daily weights I & O

31 Nephrotic Syndrome (NS)
Unknown cause of high proteinuria as a result of damage to the Glomerular Capillary Wall leading to low serum albumin and edema NS is a sign of a disease that damages the glomeruli in the kidney Forms of NS Primary: Minimal Change Nephrotic Syndrome (MCNS) Idiopathic 80% of all cases Good prognosis Secondary to another disorder Congenital: autosomal recessive gene


33 Nephrotic Syndrome (NS)
Clinical Manifestations weight gain Puffiness of face, periorbital at morning which subsides during the day swelling of abdomen, scrotum & lower extremities is more prominent Respiratory difficulty (pleural effusion) Edema of intestinal mucosa cause diarrhea, loss of appetite, poor intestinal absorption Decrease urine volume/dark, frothy Irritable, easily fatigued

34 Nephrotic Syndrome (NS)
Diagnostic test Marked proteinuria Minimal hematuria Reduce serum albumin < 2 g/dl Increase serum cholesterol: > mg/dl Increase SG Elevated ESR

35 Nephrotic Syndrome (NS)
Managements Reduce urinary protein excretion Maintain a protein-free urine Reduce edema & Prevent infection Minimize complications General measures: Daily weight & bed rest during edema, change position Q 2hrs to decrease pressure on body and reduce edema Antibiotics with infections Diet: restricted salt during massive edema, high protein diet Corticosteroids: prednisone (side effect ↑ chance for infection) Immunosuppressants (do not administer immunization) Albumin (plasma expander) and lasix

36 Nephrotic Syndrome (NS)
Nursing Diagnosis Fluid volume excess related to fluid accumulation in tissues Risk for fluid volume deficit (intravascular) r/t proteinuria, edema, and effects of diuretics Risk for impaired skin integrity r/t edema and decreased circulation Risk for infections r/t urinary loss of gammaglobulins Anxiety (parental) r/t caring for child with chronic disease and hospitalization

37 Nephrotic Syndrome (NS)
Interventions Assess I & O Assess changes in edema Measure abd girth Measure edema around eyes / & dependent areas Weigh daily note degree of pitting Test urine for specific gravity and albumin (hyperalbuminuria ) Administer corticosteroids (to reduce excretions of urinary protein) Administer diuretics (relieve edema) Limit fluids as indicated

38 CM APGN MCNS Strep. antibody titers Elevated Normal BP
Normal or decreased Edema Primarily periorbital and peripheral Generalized & severe Circulatory congestion Common absent Proteinuria Mild to moderate Massive Hematuria Gross or microscopic Microscopic or none Serum protein levels Minimal reduction Marked decreased Serum lipid levels Peak age onset 5-7 years 2-3 years

39 Renal Failure (RF) Renal failure is the inability of the kidneys to excrete waste material, concentrate urine, and conserve electrolytes Could be acute or chronic renal failure

40 Acute Renal Failure (ARF)
ARF is an abrupt decline in glomerular and tubular function Could be caused by Escherichia coli (which is usually contracted from eating improperly cooked meat or contaminated dairy products) Classic sign is Elevated blood urea nitrogen level

41 Acute Renal Failure (ARF)
Clinical manifestations Azotemia: accumulation of nitrogenous waste (Blood Urea Nitrogen (BUN)) within the blood circulatory congestion/ hypervolemia electrolytes abnormalities: Increased K(potassium level > 7mEq/L) & phosphate Decreased Na+ (seizures) & calcium metabolic acidosis, hypertension oliguria: output < 1ml/kg/hr; Anuria: no urinary output in 24 hours Nausea, Vomiting, Drowsiness

42 Acute Renal Failure (ARF): Prevention
recognize patients at risk (postoperative states, cardiac surgery, septic shock) prevent progression from pre-renal to renal preserve renal perfusion isovolemia, cardiac output, normal blood pressure avoid nephrotoxins (aminoglycosides, NSAIDS)

43 Acute Renal Failure (ARF): Management
Treat the underlying disease Management of the complications Provision of supportive therapy Strictly monitor intake and output (weight, urine output, insensible losses, IVF) & monitor serum electrolytes Adjust medication dosages according to GFR Nutrition provide adequate caloric intake limit protein intake to control increases in BUN minimize potassium and phosphorus intake limit fluid intake If adequate caloric intake can not be achieved due to fluid limitations, some form of dialysis should be considered

44 Chronic Renal Failure Progressive deterioration of kidneys functions over months or years produces a variety of clinical and biochemical disturbances that eventually culminate in the clinical syndrome known as uremia Uremia is a retention of nitrogenous products that produce toxic symptoms Renal damage is judged by elevated serum creatinine (Normal d/L) Renal function is compromised when creatinine is above 1.2 The end-stage renal disease (ESRD), is irreversible

45 Chronic Renal Failure Uremia Retention of waste products
Water and sodium retention Hyperkalemia Metabolic acidosis Anemia Calcium & phosphorus disturbances Growth disturbance

46 Chronic Renal Failure Uremic symptoms can affect every organ system,
Neurological system: cognitive impairment, personality change, asterixis (motor disturbance that affects groups of muscles), seizures GI: nausea, vomiting, food distaste Blood-forming system–anemia due to erythropoetin deficiency, easy bruising and bleeding due to abnormal platelets Pulmonary system–fluid in the lungs, with breathing difficulties Cardio: chest pain due to pericarditis & pericardial effusion Skin –generalized itching

47 Chronic Renal Failure: Management
Peritoneal Dialysis/Hemodialysis is required when the glomerular filtration rate decreases below 10% to 15% of normal Restrict protein intake Calcium and Vitamin D, Antihypertensives, Diuretics, Bicarbonate, Antiepileptics, Antihistamines Transplantation

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