Professional Documents
Culture Documents
Urological Assessment
Key Signs and Symptoms of Urological Problems
EDEMA - associated with fluid retention
- renal dysfunctions usually produce ANASARCA
PAIN
Suprapubic pain= bladder
Colicky pain on the flank= kidney
HEMATURIA
Painless hematuria may indicate URINARY CANCER!
Early-stream hematuria - urethral lesion
Late-stream hematuria - bladder lesion
Urinary Urgency
Urinary retention
Laboratory examination
1. Urinalysis
2. BUN and Creatinine levels of the serum
3. Serum electrolytes
Diagnostic examination
1. Radiographic
2. IVP
3. KUB x-ray
4. KUB ultrasound
5. CT and MRI
6. Cystography
PATHOPHYSIOLOGY
The invading organism ascends the urinary tract, irritating the mucosa
and causing characteristic symptoms
Ureter - ureteritis
Bladder - cystitis
Urethra - urethritis
Pelvis - pyelonephritis
Assessment findings
1. Low-grade fever
2. Abdominal pain
3. Enuresis
4. Pain/burning on urination
5. Urinary frequency
6. Hematuria
Laboratory Examination
1. Urinalysis
2. Urine Culture
Nursing interventions
1. Administer antibiotics as ordered.
2. Provide warm baths and allow client to void in water to alleviate painful
voiding.
3. Force fluids. Nurses may give 3 liters of fluid per day.
4. Encourage measures to acidify urine (cranberry juice, acid-ash diet).
Provide client teaching and discharge planning concerning
1. Avoidance of tub baths
2. Avoidance of bubble baths that might irritate urethra
3. Importance for girls to wipe perineum from front to back
4. Increase in foods/fluids that acidify urine.
Pharmacology
1. Sulfa drugs
Highly concentrated in the urine
Effective against E. coli!
2. Quinolones
Nephrolithiasis/Urolithiasis
Nephrolithiasis/Urolithiasis
Predisposing factors
1. Diet: large amounts of calcium and oxalate
2. Increased uric acid levels
3. Sedentary life-style, immobility
4. Family history of gout or calculi
5. Hyperparathyroidism
Pathophysiology
Supersaturation of crystals due to stasis
Stone formation
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May pass through the urinary tract
Assessment findings
1. Abdominal or flank pain
2. Renal colic radiating to the groin
3. Hematuria
4. Cool, moist skin
5. Nausea and vomiting
Diagnostic tests
1. KUB Ultrasound and X-ray: pinpoints location, number, and
size of stones
2. IVP: identifies site of obstruction and presence of non-
radiopaque stones
3. Urinalysis: indicates presence of bacteria, increased protein,
increased WBC and RBC (hematuria)
Medical management
1. Surgery
a. Percutaneous nephrostomy: tube is inserted through skin and
underlying tissues into renal pelvis to remove calculi.
b. Percutaneous nephrostolithotomy: delivers ultrasound waves
through a probe placed on the calculus.
Nursing interventions
1. Strain all urine through gauze to detect stones and crush
all clots.
2. Force fluids (3000—4000 cc/day).
3. Encourage ambulation to prevent stasis.
4. Relieve pain by administration of analgesics as ordered
and application of moist heat to flank area.
5. Monitor intake and output
6. Provide modified diet, depending upon stone consistency:
Calcium, Oxalate and Uric acid stones
Calcium stones
- limit milk/dairy products; provide acid-ash diet to
acidify urine (cranberry or prune juice, meat, eggs,
poultry, fish, grapes, and whole grains)
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Oxalate stones
- avoid excess intake of foods/ fluids high in oxalate
(tea, chocolate, rhubarb, spinach); maintain
alkaline-ash diet to alkalinize urine (milk;
vegetables; fruits except prunes, cranberries, and
plums)
PATHOPHYSIOLOGY
● Pre-renal failure
● Intra-renal failure
● Post-renal failure
Prerenal CAUSE:
Factors interfering with perfusion and resulting in diminished
blood flow and glomerular filtrate, ischemia, and oliguria; include CHF,
cardiogenic shock, acute vasoconstriction, hemorrhage, burns,
septicemia, hypotension, anaphylaxis
Intrarenal CAUSE:
Conditions that cause damage to the nephrons; include acute
tubular necrosis (ATN), endocarditis, diabetes mellitus, malignant
hypertension, acute glomerulonephritis, tumors, blood transfusion
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reactions, hypercalcemia, nephrotoxins (certain antibiotics, x-ray dyes,
pesticides, anesthetics)
Postrenal CAUSE:
Mechanical obstruction anywhere from the tubules to the
urethra; includes calculi, BPH, tumors, strictures, blood clots, trauma,
and anatomic malformation
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● Provide skin care
● Provide emotional support
Nursing interventions
1. Monitor and maintain fluid and electrolyte balance.
a. Measure l & O every hour. note excessive losses in diuretic phase
b. Administer IV fluids and electrolyte supplements as ordered.
c. Weigh daily and report gains.
d. Monitor lab values; assess/treat fluid and electrolyte and acid-base
imbalances as needed
2. Monitor alteration in fluid volume.
a. Monitor vital signs, PAP, PCWP, CVP as needed.
b. Weigh client daily.
c. Maintain strict I & O records.
3. Assess every hour for hypervolemia
a. Maintain adequate ventilation.
b. Restrict FLUID intake
c. Administer diuretics and antihypertensives
4. Promote optimal nutritional status.
a. Weigh daily.
b. Administer TPN as ordered.
c. With enteral feedings, check for residual and notify physician if
residual volume increases.
d. Restrict protein intake to 1 g/kg/day
e. Restrict POTASSIUM intake
d. HIGH CARBOHYDRATE DIET, calcium supplements
5. Prevent complications from impaired mobility (pulmonary
embolism, skin breakdown, and atelectasis)
6. Prevent fever/infection.
a. Assess for signs of infection.
b. Use strict aseptic technique for wound and catheter care.
7. Support client/significant others and reduce/ relieve anxiety.
a. Explain pathophysiology and relationship to symptoms.
b. Explain all procedures and answer all questions in easy-to-
understand terms
c. Refer to counseling services as needed
8. Provide care for the client receiving dialysis.
9. Provide client teaching and discharge planning concerning
a. Adherence to prescribed dietary regimen
b. Signs and symptoms of recurrent renal disease
c. Importance of planned rest periods
d. Use of prescribed drugs only
e. Signs and symptoms of UTI or respiratory infection need to report to
physician immediately
Pathophysiology
STAGE 1= reduced renal reserve, 40-75% loss of nephron
function
STAGE 2= renal insufficiency, 75-90% loss of nephron function
STAGE 3= end-stage renal disease, more than 90% loss.
DIALYSIS IS THE TREATMENT!
Assessment findings
1. Nausea, vomiting; diarrhea or constipation; decreased urinary
output
2. Dyspnea
3. Stomatitis
4. Hypertension (later), lethargy, convulsions, memory
impairment, pericardial friction rub
Diagnostic tests:
a. 24 hour creatinine clearance urinalysis
b. Protein, sodium, BUN, Crea and WBC elevated
c. Specific gravity, platelets, and calcium decreased
D. CBC= anemia
Medical management
1. Diet restrictions
2. Multivitamins
3. Hematinics and erythropoietin
4. Aluminum hydroxide gels
5. Anti-hypertensive
6. Anti-seizures
7. DIALYSIS
Nursing interventions
1. Prevent neurological complications.
a. Assess every hour for signs of uremia (fatigue, loss of
appetite, decreased urine output, apathy, confusion, elevated
blood pressure, edema of face and feet, itchy skin, restlessness,
seizures).
b. Assess for changes in mental functioning.
c. Orient confused client to time, place, date, and persons;
institute safety measures to protect client from falling out of
bed.
d. Monitor serum electrolytes, BUN, and creatinine as ordered
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2. Promote optimal GI function.
a. Assess/provide care for stomatitis
b. Monitor nausea, vomiting, anorexia
c. Administer antiemetics as ordered.
DIALYSIS
a procedure that is used to remove fluid and uremic wastes from
the body when the kidneys cannot function
Two methods
1. Hemodialysis
2. Peritoneal dialysis
Nursing management
1. Meet the patient's psychosocial needs
2. Remember to avoid any procedure on the arm with the
fistula (HEMO)
3. Monitor WEIGHT, blood pressure and fistula site for
bleeding
4. Monitor symptoms of uremia
5. Detect complications like infection, bleeding (Hepatitis
B/C and HIV infection in Hemodialysis)
6. Warm the solution to increase diffusion of waste products
(PERITONEAL)
7. Manage discomfort and pain
8. To determine effectiveness, check serum creatinine, BUN
and electrolytes
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Male reproductive disorders
DIGITAL RECTAL EXAMINATION- DRE
• Recommended for men annually with age over 40 years
• Screening test for cancer
• Ask patient to BEAR DOWN
TESTICULAR EXAMINATION
• Palpation of scrotum for nodules and masses or inflammation
• BEGINS DURING ADOLESCENCE
Assessment findings
1. DRE: enlarged prostate gland that is rubbery, large and
NON-tender
2. Increased frequency, urgency and hesitancy
3. Nocturia, DECREASE IN THE VOLUME AND FORCE OF
URINE STREAM
Medical management
1. Immediate catheterization
2. Prostatectomy
3. TRANSURETHRAL RESECTION of the PROSTATE (TURP)
4. Pharmacology: alpha-blockers, alpha-reductase inhibitors.
SAW palmetto
Nursing Intervention
1. Encourage fluids up to 2 liters per day
2. Insert catheter for urinary drainage
3. Administer medications – alpha adrenergic blockers and
finasteride
4. Avoid anticholinergics
5. Prepare for surgery or TURP
6. Teach the patient perineal muscle exercises. Avoid
valsalva until healing
Nursing Intervention: TURP
1. Maintain the three way bladder irrigation to prevent
hemorrhage
2. Only initially the drainage is pink-tinged and never
reddish
3. Administer anti-spasmodic to prevent bladder spasms
PROSTATE CANCER
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- a slow growing malignancy of the prostate gland
- Usually an adenocarcinoma
- This usualy spread via blood stream to the vertebrae
Predisposing factor
➢ Age
Assessment Findings
1. DRE: hard, pea-sized nodules on the anterior rectum
2. Hematuria
3. Urinary obstruction
4. Pain on the perineum radiating to the leg
Diagnostic tests
1. Prostatic specific antigen (PSA)
2. Elevated SERUM ACID PHOSPHATASE indicates SPREAD or
Metastasis
Nursing Interventions
1. Prepare patient for chemotherapy
2. Prepare for surgery
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