gut system

7/30/2019 Gut System

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GENITOURINARY SYSTEM

Function:Promote excretion of nitrogenous waste productsMaintain F&E & acid base balance

1. Kidneys

- pair of bean shaped organ- Retro peritonially (back of peritoneum) on either side of vertebral column. Encasedin Bowmanss capsule.

Parts:

Renal pelvis pyenophritis inflamedCortexMedulla

Nephrones basic living unit

Glomerulus filters blood going to kidneys

Function of kidneys:1.) Urine formation 25% of total CO (Cardiac Output) is received by kidneys

1. Filtration Normal GFR/ min is 125 ml of blood

2. Tubular Reabsorption 124ml ofultra infiltrates (H2O & electrolytes is for reabsorption)3. Tubular Secretion

1 ml is excreted in urine

2.) Regulation of BP:Predisposing factor:Ex: CS hypovolemia decrease BP going to kidneys

Activation of RAAS

Release of Renin (hydrolytic enzyme) at juxtaglomerular apparatus

Angiotensin I mild vasoconstrictor

Angiotensin II vasoconstrictor

Adrenal cortex increase CO increase PR

Aldosterone Increase BP

Increase Na &H2O reabsorption

Hypervolemia


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2.Ureters 25 35 cm long, passageway of urine to bladder

3.Bladder Muscular & elastic tissue that is distensible located behind symphisis pubis.

Function reservoir or urine

1200 1800 ml Normal adult can hold200 500 ml needed to initiate micturition reflex

Color amberOdor aromaticConsistency clear or slightly turbidpH 4.5 8Specific gravity 1.015 1.030

WBC/ RBC (-)Albumin (-)E coli (-)Mucus thread fewAmorphous urate (-)

4.Urethra extends to external surface of body. Passage of urine, seminal & vaginal fluids.

- Women 3 5 cm or 1 to 1 - Male 20cm or 8

URINARY TRACT INFECTION1. CYSTITIS

inflammation of bladder

Predisposing factors:1. Microbial invasion E. coli2. High risk women3. Obstruction4. Urinary retention5. Increase estrogen levels

6. Sexual intercourse

Signs & Symptoms:1. Pain flank area2. Urinary frequency & urgency3. Burning upon urination4. Dysuria & hematuria5. Fever, chills, anorexia, gen body malaise

Diagnostic Exam:1. Urine culture & sensitivity - (+) to E. coli

Nursing Management:1. Force fluid 2000 ml2. Warm sitz bath to promote comfort


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3. Monitor & assess for gross hematuria4. Acid ash diet cranberry, vit C -OJ to acidify urine & prevent bacterial

multiplication5. Meds: systemic antibiotics

AmpicillinCephalosporinSulfonamides cotrimaxazole (Bactrim)- Gantrism (ganthanol)Urinary antiseptics Mitropurantoin (Macrodantin)Urinary analgesic- Pyridum

Health Teachings:a.) Importance of Hydrationb.) Void after sexc.) Female avoids cleaning back & front

Bubble bath, Tissue paper, Powder, perfumed.) Complications:

Pyelonephritis

2. PYELONEPHRITIS acute/ chronic inflamation of 1 or 2 renal pelvis of kidneys leading to tubulardestruction, interstitial abscess formation. Lead to Renal Failure

Predisposing factors:1. Microbial invasion

a.)E. Coli

b.)Streptococcus2. Urinary retention /obstruction3. Pregnancy4. DM5. Exposure to renal toxins

Signs & Symptoms:1.) Acute pyelonephritis

a.) Costovertibral angle pain, tendernessb.)Fever, anorexia, gen body malaise

c.) Urinary frequency, urgencyd.)Nocturia, dsyuria, hematuriae.)Burning on urination

2.) Chronic Pyelonephritisa.)Fatigue, wt lossb.)Polyuuria, polydypsiac.) HPN

Diagnostic Exam:1. Urine culture & sensitivity (+) E. coli & streptococcus

2. UrinalysisIncrease WBC, CHON & pus cells

3. Cystoscopic exam urinary obstruction


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Nursing Management:1. Provide CBR acute phase2. Force fluid3. Acid ash diet4. Meds:

a.) Urinary antiseptic nitrofurantoin (macrodantin)SE: peripheral neuropathyGI irritationHemolytic anemiaStaining of teeth

b.)Urinary analgesic Peridium

Complication- Renal Failure

NEPHROLITHIASIS / UROLITHIASIS- formation of stones at urinary tract- calcium oxalate uric acid

milk cabbage anchoviescranberries organ meatnuts tea nutschocolates sardines

Predisposing factors:1. Diet increase Ca & oxalate2. Hereditary gout3. Obesity4. Sedentary lifestyle5. Hyperparathyroidism

Signs & Symptoms:1. Renal colic2. Cool moist skin (shock)3. Burning upon urination4. Hematuria5. Anorexia, n/v

Diagnostic Exam:1. IVP intravenous pyelography. Reveals location of stone2. KUB reveals location of stone3. Cytoscopic exam- urinary obstruction4. Stone analysis composition & type of stone5. Urinalysis increase EBC, increase CHON

Nursing Management:1. Force fluid2. Strain urine using gauze pad3. Warm sitz bath for comfort

4. Alternate warm compress at flank area5. Medsa.) Narcotic analgesic- Morphine SO4

b.) Allopurinol (Zyeoprim)


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c.) Patent IV lined.) Diet if + Ca stones acid ash diet

If + oxalate stone alkaline ash diet - (Ex milk/ milk products)If + uric acid stones decrease organ meat / anchovies sardines

Surgery Treatment:Nephectomy

removal of affected kidneyLitholapoxy removal of 1/3 of stones- Stones will recur. Not advised for

pt with big stonesExtracorporeal shock wave lithotripsy

- Non - invasive- Dissolve stones by shock wave

Complications:Renal Failure

BENIGN PROSTATIC HYPERTROPHY

- enlarged prostate gland leading to:a.) Hydro ureters dilation of uretersb.)Hydronephrosis dilation of renal pelvisc.) Kidney stonesd.)Renal failure

Predisposing factor:1. High risk 50 years old & above

60 70 (3 to 4 x at risk)2. Influence of male hormone

Signs & Symptoms:1.Decrease force of urinary stream2.Dysuria3.Hematuria4.Burning upon urination5.Terminal bubbling6.Backache7.Sciatica

Diagnostic Exam:

1. Digital rectal exam enlarged prostate gland2. KUB urinary obstruction3. Cystoscopic exam obstruction4. Urinalysis increase WBC, CHON

Nursing Management:1. Prostatic message promotes evacuation of prostatic fluid2. Limit fluid intake3. Provide catheterization4. Meds:

a. Terazozine (hytrin) - Relaxes bladder sphincter

b. Fenasteride (Proscar) - Atrophy of Prostate Gland

Surgery Treatment:*Prostatectomy TURP- Transurethral resection of Prostate- No incision


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-Assist in cystoclysis or continuous bladder irrigation.

Nursing Management:c. Monitor symptoms of infectiond. Monitor symptoms gross/ flank bleeding. Normal bleeding within 24h.3. Maintain irrigation or tube patent to flush out clots - to prevent bladderspasm & distention

ACUTE RENAL FAILURE sudden immobility of kidneys to excrete nitrogenous waste products & maintain

F&E balance due to a decrease in GFR. (N 125 ml/min)

Predisposing factors:1. Pre renal cause- decrease blood flowCauses:

1. Septic shock2. Hypovolemia3. Hypotension decrease flow to kidneys4. CHF5. Hemorrhage6. Dehydration

2. Intra-renal cause involves renal pathology= kidney problem1. Acute tubular necrosis-2. Pyelonephritis3. HPN4. Acute GN

3. Post renal cause involves mechanical obstruction1. Stricture2. Urolithiasis3. BPH

CHRONIC RENAL FAILURE irreversible loss of kidney function

Predisposing factors:1. DM2. HPN3. Recurrent UTI/ nephritis4. Exposure to renal toxins

Stages of CRF1. Diminished Reserve Volume asymptomatic

Normal BUN & Crea, GFR < 10 30%2. Renal Insufficiency3. End Stage Renal disease

Signs & Symptoms:

1.) Urinary System 2.) Metabolic disturbances


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a.) polyuriab.) nocturiac.) hematuriad.) Dysuriae.) oliguria

a.) azotemia (increase BUN &Crea)b.) hyperglycemiac.) hyperinulinemia

3.) CNS

a.) headacheb.) lethargyc.) disorientationd.) restlessnesse.) memory impairment

4.) GIT

a.) n/vb.) stomatitisc.) uremic breathd.) diarrhea/ constipation

5.) Respiratorya.) Kassmauls respb.) decrease cough reflex

6.) Hematologicala.) Normocytic anemia

bleeding tendencies

7.) Fluid & Electrolytes

a.) hyperkalemiab.) hypernatermiac.) hypermagnesemiad.) hyperposphatemiae.) hypocalcemiaf.) met acidosis

8.) Integumentary

a.) itchiness/ pruritusb.) uremic frost

Nursing Management:1. Enforce CBR2. Monitor VS, I&O3. Meticulous skin care. Uremic frost assist in bathing pt

4. Meds:a.) Na HCO3 due Hyperkalemiab.) Kagexelate enemac.) Anti HPN hydralazined.) Vit & mineralse.) Phosphate binder

(Amphogel) Al OH gel - S/E constipationf.) Decrease Ca Ca gluconate

5. Assist in hemodialysis1.)Consent/ explain procedure2.)Obtain baseline data & monitor VS, I&O, wt, blood exam3.)Strict aseptic technique4.)Monitor for signs of complications:

B bleedingE embolismD disequilibrium syndromeS septicemiaS shock decrease in tissue perfusion

Disequilibrium syndrome from rapid removal of urea & nitrogenous waste prodleading to:

a.) n/vb.)HPN


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c.) Leg crampsd.)Disorientatione.)Paresthesia

2. Avoid BP taking, blood extraction, IV, at side of shunt or fistula. Can lead tocompression of fistula.

3. Maintain patency of shunt by:i. Palpate for thrills & auscultate for bruits if (+) patent shunt!ii. Bedside- bulldog clip- If with accidental removal of fistula to prevent embolism.- Infersole (diastole) common dialisate used

Complication- Peritonitis- Shock

Surgery Treatment:

*Renal transplantation Complication rejection. Reverse isolation

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