Chapter 37 Urinary and Reproductive Disorders All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Urinary System Disorders   Urinary tract infections (UTIs)   Infection in one area can involve the entire system.   Common causes include: Catheterization Urological exams Intercourse Poor perineal hygiene Immobility Poor fluid intake 2 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

UTIs: Risk Factors and Complications   Risk factors Women are at high risk. An enlarged prostate increases the risk of UTI in older men. Older persons are at high risk. Incomplete bladder emptying, perineal soiling from fecal incontinence, poor fluid intake, and poor nutrition increase the risk of UTI in older persons.   Cystitis is a bladder infection caused by bacteria. Treatment involves antibiotics and encouraging fluids. If untreated, cystitis can lead to pyelonephritis.   Pyelonephritis is inflammation of the kidney pelvis. Infection is the most common cause. Treatment involves antibiotics and fluids. 3 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Benign Prostatic Hyperplasia   Prostate enlargement   The prostate lies in front of the rectum and just below the bladder and surrounds the urethra.   The prostate grows larger as the man grows older (benign prostatic hyperplasia [BPH]).   BPH causes urinary problems. The enlarged prostate presses against the urethra.   Bladder function is gradually lost. These problems are common: A weak urine stream Frequent voidings of small amounts of urine Urgency and leaking or dribbling of urine Frequent voiding at night Urinary retention (The man cannot void.) 4 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

BPH: Treatment   Treatment of BPH depends on the extent of the problem and includes medications, microwave and laser treatments, and surgery   Transurethral resection of the prostate (TURP) is a common surgical procedure. The doctor inserts a lighted scope with a wire loop. The loop cuts tissue and seals blood vessels. The removed tissue is flushed out of the bladder. A special catheter is inserted and left in place for a few days for flushing fluid. Urine and flushing fluid flow out of the bladder through the same catheter. 5 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Urostomy   Urinary diversions   Sometimes the urinary bladder is surgically removed. Cancer and bladder injuries are common reasons.   A new pathway (urinary diversion) is needed for urine to exit the body. Often an ostomy is involved.   A urostomy is a surgically created opening between the ureter and the abdomen.   A pouch is applied over the stoma for urine to drain. Urine drains through the stoma into the pouch. Pouches are changed every 5 to 7 days. A pouch is replaced any time it leaks. 6 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Kidney Stones   Renal calculi are kidney stones.   Risk factors White men between the ages of 20 and 40 years are at greatest risk. Bedrest Immobility Poor fluid intake   Treatment involves: Medication for pain relief Drinking 2000 to 3000 mL of fluid a day Straining all urine Surgical removal of the stone if necessary   Some dietary changes can prevent stones. 7 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Renal Failure   In renal failure, the kidneys do not function or are severely impaired.   Waste products are not removed from the blood.   The body retains fluid. Heart failure and hypertension easily result.   Kidney failure may be acute or chronic.   Acute renal failure is sudden. Blood flow to the kidneys is severely decreased. Causes include severe injury or bleeding, heart attack or heart failure, burns, infection, and severe allergic reactions. Hospital care is needed. Oliguria occurs at first; then diuresis. It can develop into chronic kidney failure. Treatment involves medications, restricted fluids, and diet therapy. 8 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Chronic Renal Failure   With chronic renal failure, the kidneys cannot meet the body’s needs.   Causes include hypertension, diabetes, infections, urinary tract obstructions, and tumors.   Signs and symptoms appear when 75% of kidney function is lost.   Every system is affected as waste products build up in the blood.   Treatment for chronic renal failure includes: Fluid restriction Diet therapy Medications Dialysis Some persons have kidney transplants. 9 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Reproductive System Disorders   The male reproductive system:   Produces and transports sperm   Deposits sperm in the female reproductive tract   Secretes hormones   The female reproductive system:   Produces eggs (ova)   Secretes hormones   Protects and nourishes the fetus during pregnancy   Aging, many injuries, diseases, and surgeries affect the reproductive system. 10 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Pelvic Organ Prolapse   Pelvic organs may drop down into the vaginal canal   When the bladder drops down it is called a cystocele.   When the rectum shifts forward it is called a rectocele.   When the uterus shifts forward into the vaginal canal it is called a uterine prolapse. Treatment may include bedrest, Kegal exercises, and a support device such as a pessary or surgery. 11 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Sexually Transmitted Diseases   Sexually transmitted diseases (STDs) are spread by oral, vaginal, or anal sex.   Using condoms helps prevent the spread of STDs, especially HIV and AIDS.   Some people do not have signs and symptoms or are not aware of an infection.   Others know but do not seek treatment because of embarrassment.   STDs occur: In the genital and rectal areas In the ears, mouth, nipples, throat, tongue, eyes, and nose   Standard Precautions and the Bloodborne Pathogen Standard are followed. 12 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Quality of Life   Urinary and reproductive disorders can vary from mild, to severely uncomfortable, to life threatening.   Follow the care plan and the nurse’s directions carefully. Report your observations promptly.   The care you give affects the person’s quality of life.   Protect the person’s rights.   Follow Standard Precautions and the Bloodborne Pathogen Standard. 13 All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.