Chapter 24
Genitourinary/Renal
Disorders
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24-1
Objectives
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General Anatomy
• Kidneys
– Retroperitoneal space
– Renal artery
– Renal vein
– Ureter
– Filter the blood
– Nephrons
• Function units of the kidneys
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General Anatomy
• Components
– Kidneys
– Ureters
– Bladder
– Urethra
24-4
Functions
• The urinary system is responsible for the
following functions:
– Maintaining a balance of salts and other
substances in the blood
– Excreting waste products and foreign
chemicals
– Assisting in regulating arterial blood
pressure
– Producing a hormone that aids the
formation of red blood cells
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Renal Disorders
24-6
Kidney Stones
• Kidney stones are also called renal calculi
– A hard mass that forms from
crystallization of excreted substances in
the urine
– Shape and size vary
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Kidney Stones
• Assessment findings and symptoms
– Excruciating pain that is usually located in
the flank, radiating to the groin
– Nausea, vomiting, and sweating common
– Restlessness
– Hematuria
– Dysuria
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Urinary Tract Infection
• A urinary tract infection (UTI) is an infection
that affects any part of the urinary tract.
• Inflammation/infection
– Urethra = urethritis
– Bladder = cystitis
– Kidneys = pyelonephritis
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Urinary Tract Infection
• Assessment findings and symptoms
– Fever
– Dysuria, hematuria
– Urinary hesitancy
– Lower abdominal pain and/or pressure
(especially during urination)
– Passing frequent, small amounts of urine
– Cloudy or strong-smelling urine
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Urinary Catheters
• A urinary catheter is a tube that is inserted
into the bladder to empty it of urine.
– Condom catheter
– Straight catheter
– Indwelling catheter
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Urinary Catheters
• Before transporting a patient with a urinary
catheter:
– Ensure that the catheter is securely taped
– Assess the urine collection bag
– Note the color of the patient’s urine
– Note if the patient’s urine is thick, cloudy,
has mucus in it, or has red specks in it
– Note if the patient’s urine has a strong
smell or if he complains of pain
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Pyelonephritis
• Pyelonephritis is an infection of the kidney.
– Often the result of a bacterial bladder
infection
– More common in females than in males
– Severe or recurring infections can cause
permanent kidney damage.
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Pyelonephritis
Assessment Findings
– Fever, chills
– Fatigue
– Nausea, vomiting
– Dysuria
– Hematuria
– Cloudy or
abnormal urine
color
– Foul or strong
urine odor
– Flank pain or
lower back pain
– Warm, moist skin
– Increased urinary
frequency
– Pain increases
with movement
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Renal Failure
• Acute renal failure (ARF)
• Chronic renal failure (CRF)
• End-stage renal disease (ESRD)
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Acute Renal Failure
• Assessment findings
– Reduced or no
urinary output
– Excessive urination
at night
– Lower extremity
swelling
– Anorexia
– Altered mental status
– Metallic taste in
mouth
– Tremors or seizures
– Easy bruising or
prolonged bleeding
– Flank pain
– Tinnitus
– Hypertension
– Abdominal pain or
discomfort
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Chronic Renal Failure
• Assessment
findings
– Headache
– Weakness
– Loss of appetite
– Vomiting
– Increased
urination
– Rusty or browncolored urine
– Increased thirst
– Hypertension
– Itching
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End-Stage Renal Disease
• Assessment
findings
– Altered mental
status
– Shortness of
breath
– Peripheral edema
– Chest pain
– Bone pain
– Itching
– Nausea, vomiting,
diarrhea
– Bruising
– Muscle twitching,
tremors, seizures
– Hallucinations
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Dialysis
• Dialysis
– A procedure that removes waste products
from the blood that is normally performed
by the kidneys
– Two types
• Hemodialysis
• Peritoneal dialysis
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Hemodialysis
• Requires the use of a machine called a
dialyzer or artificial kidney
• Access to the patient’s vascular system is
also necessary
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Arteriovenous Shunt
• Used for short-term dialysis treatment
• An AV shunt is external
• Consists of two pieces of flexible tubing
– One piece of the tubing is placed in an
artery
– Tip of the other is placed in a nearby vein
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Arteriovenous Fistula
• Used for long-term dialysis treatment
• A large artery and vein are joined, usually
at the patient’s wrist or near the elbow
• An AV fistula is placed
under the patient’s skin
• Can often be used for years
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Arteriovenous Graft
• Most commonly placed in the upper or
lower arm
• Artificial material or a blood vessel from
the patient’s body (such as a vein from the
thigh) is used
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Hemodialysis Procedure
• Transfer of a large volume of blood between
the patient and the machine
• Dialysate draws excess water and salt and
waste products from the blood through a
semipermeable membrane
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Hemodialysis Procedure
• Usually performed 2 to 3 times per week and
lasts for 4 to 5 hours
• Often performed in a dialysis center or
hospital
• Many patients have home dialysis units and
can perform the procedure after receiving
special training
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Hemodialysis
• Possible complications
– Muscle cramps
– Nausea and vomiting
– Hypotension
– Infection and hemorrhage at
vascular access site
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Peritoneal Dialysis
• A catheter is inserted into the patient’s
peritoneal cavity
• The catheter remains permanently in the
abdomen
• The patient’s peritoneum serves as a
semipermeable membrane across which
wastes and excess fluids are exchanged
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Peritoneal Dialysis
• Types of peritoneal dialysis
– Continuous ambulatory peritoneal dialysis
(CAPD)
– Continuous cyclic peritoneal dialysis
(CCPD)
– Intermittent peritoneal dialysis (IPD)
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Peritoneal Dialysis
• Possible complications
– Peritonitis
– Blockage of the catheter from clots
– Kinking of the catheter
– Hypotension
– Hypovolemia
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Patient Assessment
24-30
Patient Assessment
• Scene size-up
• General impression and primary survey
• Assess mental status
• Assess airway and breathing
24-31
Patient Assessment
• Assess pulse
– Estimate heart rate
– Assess pulse regularity and strength
• Assess perfusion
• Establish patient priorities
• Determine the need for additional resources
• Make a transport decision
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Patient History
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•
•
•
•
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Signs/symptoms
Allergies
Medications
Past medical history
Last oral intake
Events prior
• Onset
• Provocation/
Palliation / Position
• Quality
• Region/Radiation
• Severity
• Time
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Physical Examination
• Observe the patient’s position
• Listen to breath sounds
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Physical Examination
• Assess vital signs and
oxygen saturation
• Avoid taking a blood pressure
in the arm with an AV shunt
or fistula.
24-35
Physical Examination
• Assess the patient’s abdomen
• If the patient receives peritoneal dialysis,
look at the area around the dialysis catheter
for redness, swelling, or discharge.
• Carefully document all patient care
information on a prehospital care report.
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Emergency Care
• Prehospital care is supportive
• Allow the patient to assume a position of
comfort, administer oxygen
– Sitting position if pulmonary edema present
• Control bleeding from AV shunt or fistula if
present
– Place patient in supine position if signs of
shock present
• Reassess as often as indicated
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Questions?
24-38