Chapter 44 Urinary and Reproductive Disorders Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Urinary and Reproductive Disorders  Urinary and reproductive disorders are common.  Understanding these disorders gives meaning to the required care.  Disorders can occur in these major urinary system structures. The Kidneys The Kidneys Ureters Ureters Bladder Bladder Urethra Urethra  Men can develop prostate problems. Slide 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Urinary System Disorders  Urinary tract infections (UTIs) Infection in one area can progress through the entire system. Infection in one area can progress through the entire system. Microbes can enter the system through the urethra. Microbes can enter the system through the urethra. Common causes include: Common causes include:  Catheterization  Urological exams  Intercourse  Poor perineal hygiene  Immobility  Poor fluid intake UTI is a common healthcare-associated infection. UTI is a common healthcare-associated infection. Slide 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Urinary System Disorders (cont’d) Women are at high risk. Women are at high risk.  Microbes can easily enter the short female urethra. Prostate gland secretions help protect men from UTIs. Prostate gland secretions help protect men from UTIs.  However, an enlarged prostate increases the risk of UTI. Older persons are at high risk for UTIs. The following increase the risk: Older persons are at high risk for UTIs. The following increase the risk:  Incomplete bladder emptying  Perineal soiling from fecal incontinence  Poor fluid intake  Poor nutrition Slide 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 Cystitis is a bladder infection caused by bacteria. These signs and symptoms are common: These signs and symptoms are common:  Urinary frequency  Oliguria (scant amount of urine)  Urgency  Dysuria (difficult or painful urination)  Pain or burning on urination  Foul-smelling urine  Hematuria (blood in the urine)  Pyuria (pus in the urine)  Fever Treatment includes antibiotics and encouraging fluids. Treatment includes antibiotics and encouraging fluids. Slide 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

 Pyelonephritis is inflammation of the kidney pelvis. Infection is the most common cause. Infection is the most common cause. Cloudy urine may contain pus, mucus, and blood. Cloudy urine may contain pus, mucus, and blood. Signs and symptoms include Signs and symptoms include  Chills, fever, back pain  Nausea and vomiting  The signs and symptoms of cystitis Treatment involves antibiotics and fluids. Treatment involves antibiotics and fluids. Slide 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

 Prostate enlargement The prostate is a gland in men. The prostate is a gland in men.  It lies in front of the rectum and just below the bladder.  The prostate surrounds the urethra. The prostate enlarges as the man grows older. The prostate enlarges as the man grows older.  This is called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. Bladder function is gradually lost. Bladder function is gradually lost.  The enlarged prostate presses against the urethra obstructing urine flow. Slide 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

The following problems are common with prostate enlargement: The following problems are common with prostate enlargement:  A weak urine stream  Frequent voidings of small amounts of urine  Urgency and leaking or dribbling of urine  Frequent voiding at night  Urinary retention Treatment depends on the extent of the problem. Treatment depends on the extent of the problem.  The doctor may order drugs to shrink the prostate or stop its growth.  Some microwave and laser treatments destroy excess prostate tissue.  Transurethral resection of the prostate (TURP) is a common surgical procedure. Slide 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

 Urinary diversions Sometimes the bladder is surgically removed. Sometimes the bladder is surgically removed.  Cancer and bladder injuries are common reasons. Urinary diversion is a surgically created pathway for urine to leave the body. Urinary diversion is a surgically created pathway for urine to leave the body.  An ostomy is often involved.  A urostomy is a surgically created opening between a ureter and the abdomen. A pouch is applied over the stoma.A pouch is applied over the stoma. Urine drains through the stoma into the pouch.Urine drains through the stoma into the pouch. Pouches are changed every 5 to 7 days.Pouches are changed every 5 to 7 days. A pouch is replaced anytime it leaks.A pouch is replaced anytime it leaks.  Good skin care is needed. Observe and report skin changes around the stoma.Observe and report skin changes around the stoma. Slide 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

 Kidney stones (calculi) Most common in white men 40 years of age and older. Most common in white men 40 years of age and older. Risk factors include: Risk factors include:  Bedrest  Immobility  Poor fluid intake Stones vary in size. Stones vary in size. Slide 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

Signs and symptoms include: Signs and symptoms include:  Severe, cramping pain in the back and side just below the ribs  Pain in the abdomen, thigh, and urethra  Nausea and vomiting  Fever and chills  Dysuria (difficult or painful urination)  Urinary urgency  Burning on urination  Hematuria (blood in the urine)  Cloudy urine  Foul-smelling urine Slide 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

Treatment involves: Treatment involves:  Drugs for pain relief  Drinking 2000 to 3000 mL of fluid a day  All urine is strained.  Medical or surgical removal of the stone may be necessary. Some diet changes can prevent stones. Some diet changes can prevent stones. Slide 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

 Kidney failure (renal failure) The kidneys do not function or are severely impaired. The kidneys do not function or are severely impaired.  Waste products are not removed from the blood.  Fluid is retained. Heart failure and hypertension easily result.Heart failure and hypertension easily result. It may be acute or chronic. It may be acute or chronic. Slide 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

 Acute kidney failure is sudden. Blood flow to the kidneys is severely decreased. Blood flow to the kidneys is severely decreased. Causes include: Causes include:  Severe injury or bleeding  Heart attack  Heart failure  Burns  Infection  Severe allergic reactions Some persons develop chronic kidney failure. Some persons develop chronic kidney failure. Treatment involves drugs, restricted fluids, and diet therapy. Treatment involves drugs, restricted fluids, and diet therapy. Slide 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

 Chronic kidney failure The kidneys cannot meet the body’s needs. The kidneys cannot meet the body’s needs.  Nephrons in the kidney are destroyed over many years. Common causes are: Common causes are:  Hypertension  Diabetes Other causes include: Other causes include:  Infections  Urinary tract obstructions  Tumors Signs and symptoms appear when 75% of kidney function is lost. Signs and symptoms appear when 75% of kidney function is lost. Slide 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

Treatment for chronic kidney failure includes: Treatment for chronic kidney failure includes:  Fluid restriction  Diet therapy  Drugs  Dialysis Dialysis is the process of removing waste products from the blood. Dialysis is the process of removing waste products from the blood.  Hemodialysis removes waste and fluid by filtering the blood through an artificial kidney.  Peritoneal dialysis uses the lining of the abdominal cavity (peritoneal membrane) to remove waste and fluid from the blood. Slide 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Urinary System Disorders (cont’d)

Reproductive Disorders  Male reproductive system Produces and transports sperm Produces and transports sperm Deposits sperm in the female reproductive tract Deposits sperm in the female reproductive tract Secretes hormones Secretes hormones  Female reproductive system Produces eggs (ova) Produces eggs (ova) Secretes hormones Secretes hormones Protects and nourishes the fetus during pregnancy Protects and nourishes the fetus during pregnancy  Aging, many injuries, diseases, and surgeries can affect reproductive structures and functions. Slide 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Reproductive Disorders (cont’d)  A sexually transmitted disease (STD) is spread by oral, vaginal, or anal sex. Some people do not have signs and symptoms. Some people do not have signs and symptoms. Some are not aware of an infection. Some are not aware of an infection. Others know but do not seek treatment because of embarrassment. Others know but do not seek treatment because of embarrassment.  STDs occur in the: Genital and rectal areas Genital and rectal areas Ears, mouth, nipples, throat, tongue, eyes, and nose Ears, mouth, nipples, throat, tongue, eyes, and nose Slide 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

 Condom use helps prevent the spread of STDs. Especially the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) Especially the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)  Some STDs are also spread through skin breaks, by contact with infected body fluids, or by contaminated blood or needles. Standard Precautions and the Bloodborne Pathogen Standard are followed. Standard Precautions and the Bloodborne Pathogen Standard are followed. Slide 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Reproductive Disorders (cont’d)