GU System
Handout 4 – Renal system B
Behavioral Objectives: By the end of this lecture the student will be able to:
 Identify and describe the etiology, pathophysiology, clinical manifestations, nursing management
and patient education for the following:
o Urinary retention
o Urinary incontinence
o Urinary suppression
o Residual urine
 Discuss common pharmacological interventions appropriate in treatment of patient with GU
disorders
 Describe general nursing consideration and intervention in pre and post-operative care of patients
undergoing urological surgery
 Describe etiology, pathophysiology, clinical manifestations, nursing management and patient
education for the following GU disorders:
o Pyelonephritis
o Cystitis
o Urinary tract infections (UTI)
o Urethritis
o Nephritic syndrome
o Hydronephrosis
o Renal calculi
o Renal neoplasm’s
I.
Dysfunctional Voiding Patterns
a. Urinal Incontinence
i. Pathophysiology
1. Unplanned loss of _______________that is sufficient to be considered a
problem
2. Continence requires intact ________________, _______________ &
___________-____________systems
3. Any break in ________________between these systems can lean to
incontinence (or residual)
ii. Types of incontinence
1. Stress Incontinence
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
Involuntary loss of urine through an intact urethra due to a
__________________________________

Treatment – mild: ___________________________

Treatment – moderate to severe: _______________
2. Urge Incontinence

Involuntary loss of urine associated with a strong __________ to
void that cannot be __________

Treatment
i.
ii. Pelvic floor ______________
iii. Bladder ____________
iv. Meds: ________________________
3. Reflux incontinence

Involuntary loss of urine due to _____________in the
_____________of normal ________________

Assoc. with _______________________________
4. Overflow incontinence

Involuntary loss of urine due to ____________of the bladder
5. Overflow incontinence

Involuntary loss of urine due to over-distention of the bladder

Bladder is unable to _____________ over ________________
 frequent _____________(just over flow)  incontinence

Treatment: _________________________
iii. Behavior Therapy management
1. _________________ management

Increase

Decrease
2. Standardized ______________frequency

3. Pelvic Muscle Exercises
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
_____________ exercises

Goal : strengthen ___________________ muscles
4. Pharmacological Therapy

Anticholinergic agents
i. Oxybutynin/Ditropan
ii. Action
iii. Indications
5. Surgical management

Involve ________________________________the bladder/urethra
6. Nursing Management

Fluids_________________

No _________________ after 4PM

Avoid bladder irritants: _________________ ____________
Aspartame (_________________)

High ____________ meals

Void _________________

Enc pelvic floor exercises

Stop ________________
b. Urinary Retention
i. Pathophysiology
1. Urinary retention: the inability to __________the bladder completely
2. Residual urine: urine that remains ____________________________
3. Assoc. with
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_____________ d/t reflux spasm of sphincters

Diabetes

______________ enlargement

____________ pathology

Trauma

____________

________________ disorders
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ii. Assessment
1.
iii. Complications
1. Chronic _________________  pyelonephritis  ______________ 
kidney failure 
iv. Nursing Management
1. Promoting normal urinary eliminations






2. Promoting urinary elimination

c. Neurogenic Bladder
i. A dysfunction d/t a lesion of the _____________ system
ii. Two types of neurogenic bladder
1. ______________ bladder / _____________ bladder

2. Flaccid bladder

Bladder becomes ________ _________incontinence  Bladder
does not ___________ Can not _______________ discomfort
iii. Management
1. Catheterization





2. Indwelling devices

Drainage bag ____________________ the level of the bladder

Tubing not ___________________ and no too long

_____________________ fluids
3. Suprapubic catheterization
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II.
Urological surgery
a. Brunner and Suddarth’s Medical Surgical nursing pg 1299-1306
b. Post-operative management
i. Drainage tubes
ii. Nephrostomy drainage
1. Tube inserted directly into the kidney for temporary or permanent urinary
diversion
2. Nursing management

Assess for _________________

Ensure _________________

Never _________________

Irrigate

Encourage _____________________

_________________ technique

Measure _________________
iii. Urethral stents
1. A tubular device that maintains position & patency of _______
c. Nursing process
i. Diagnosis/interventions
1. Ineffective airway clearance related to the location of the surgical incision
2. Ineffective breathing pattern related to surgical incision and general
anesthesia








3. Acute pain related to the location of the surgical incision, and the position
the patient assumed on the operative table during surgery and abdominal
distention
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4. Urine retention related to pain, immobility and anesthesia




ii. Potential complications
1. Bleeding
2. Pneumonia
3. Infection
4. Fluid disturbances
5. Deep vein thrombosis
III.
Describe etiology, Pathophysiology, clinical manifestations, nursing management and patient
education for Urinary tract infections (UTI)
a. Brunner and Suddarth’s Medical Surgical nursing pg 1310-1315
b. Pathophysiology
i. Urinary tract infections are caused by pathogenic micro-organisms in the urinary
tract
1. Bacteria must gain access to the bladder  attach to the bladder 
colonize in the epithelium of the urinary tract
ii. Reflux
1. Backward flow of urine from the urethra to the bladder
2. ________________ __________bladder pressure  urine forced into
_____________  stop coughing  ___________pressure  urine flows
back into ________________
iii. The normal urinary tract is sterile above the urethra
iv. Types of UTI’s
1. Cystitis –
2. Prostatitis –
3. Urethritis –
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4. Pyelonephritis –
5. Interstitial nephritis –
v. Defense mechanisms
1.
2.
3. Men vs Women
vi. Predisposing factors to urinary tract infections
1. Factors increasing urinary ____________
2. ________________ bodies
3. ______________ factors
4. Factors _________________ immune response
c. Clinical Manifestations
i. Lower UTI
1.
5.
2.
6.
3.
7.
4.
ii. Upper UTI
1.
5.
2.
6.
3.
7.
4.
iii. Gerontologic considerations
d. Assessment and Diagnostic findings
e. Medical management/pharmacological therapy
i. Antibacterial
ii. Cephalosporin
iii. Bactrim/Septra
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iv. Urinary analgesic - phenazopyridine (Pyridium
f. Nursing process
i. Assessment
ii. Diagnosis
1. Acute pain related to inflammation of the urinary tract
2. Deficient knowledge detection, preventions and recurrence and meds
iii. Nursing interventions
1. Hygiene






2. Fluid intake






3. Voiding habits
IV.






Describe etiology, pathophysiology, clinical manifestations, nursing management and patient
education for Pyelonephritis
a. Brunner and Suddarth’s Medical Surgical nursing pg 1315-17
b. Pyelonephritis is a bacterial infection of the__________________, ________and
interstitial tissue of one or both_____________________.
c. Pathophysiology
i.
iii.
ii.
iv.
d. Clinical manifestations
e. Assessment and diagnostic findings
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i. Ultrasound
ii. CT scan
iii. UA
f. Medical Management
g. Pharmacological therapy
h. Complications
i. End Stage Renal Disease
ii. Hypertension
iii. Kidney stones
iv. Urosepsis
V.
Describe etiology, pathophysiology, clinical manifestations, nursing management and patient
education for Urethritis
a. Brunner and Suddarth’s Medical Surgical nursing pg 1357
b. Pathophysiology
i. Inflammation of the _______________
c. Clinical manifestations – Men
1.
2.
3.
4.
d. Clinical Manifestations - Women
i. Asymptomatic
e. Treatment
VI.
Describe etiology, pathophysiology, clinical manifestations, nursing management and patient
education for Nephrotic syndrome
a. Brunner and Suddarth’s Medical Surgical nursing pg 1320-21
b. Pathophysiology
i. Primary ______________________ disease characterized by:
1. Marked increase in _____________ in the urine (proteinuria)
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2. Decrease in ______________ in the blood (hypoalbuminemia)
3. ______________
4. High serum _________________ and low-density lipoprotein
c. Clinical Manifestation
i. #1 – _______________
ii. Malaise
iii. ____________
iv. Irritability
v. Fatigue
d. Assessment and diagnostic findings
i. Proteinuria
ii. Hyperlipidemia
iii. Hypoalbuminemia
e. Complications
i.
iii.
ii.
iv.
f. Medical Management
i. Diuretic
ii. Nonsteroidal anti-inflammatory
iii. Diet
g. Nursing management - edema
VII.
Describe etiology, pathophysiology, clinical manifestations, nursing management and patient
education for Hydronephrosis
a. Brunner and Suddarth’s Medical Surgical nursing pg 1357
b. Pathophysiology
i. __________________of the renal pelvis and calyces of one or both kidneys due
to an _____________________
c. Clinical manifestations
d. Medical management
VIII.
Describe etiology, pathophysiology, clinical manifestations, nursing management and patient
education for Renal calculi, nephrolithiasis
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a. Brunner and Suddarth’s Medical Surgical nursing pg 1337-42
b. Pathophysiology
i. Stones are formed in the urinary tract when urinary concentrations of the
substances such as calcium oxalate, calcium phosphate and uric acid increase
ii. Calculus =
iii. Lithiasis =
iv. Certain factors favor the formation of stones:
1.
3.
2.
4.
c. Clinical manifestations
i. Pain / discomfort
ii. Hematuria
d. Assessment and diagnostic findings
i. X-ray
ii. Ultrasonography
iii. 24-hour urine test
iv. Cystoscopy
v. IVP
e. Medical management
i. Opioid analgesic
ii. Antibiotics
iii. NSAIDs
iv. Diet
f. Surgical Management
i. Ureteroscopy
1. First visualize the stone
2. Destroy the stone
ii. ESWL - Extracorporeal shock wave lithotripsy
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iii. Nursing Process
1. Diagnosis

Acute pain

Deficient knowledge to prevent recurrence of renal stone
2. Interventions
IX.










Describe etiology, pathophysiology, clinical manifestations, nursing management and patient
education for Renal neoplasm’s
a. Brunner and Suddarth’s Medical Surgical nursing pg 1344-47
b. Pathophysiology
i. Risk factor
ii.
c. Clinical Manifestations
i.
ii.
d. Medical treatment
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X.
Study Questions
a. What is a cystoscopy and what are nursing considerations in caring for a patient
following this procedure?
b. Where can kidney stone be found?
c. What are risk factors for developing kidney stones?
d. Signs and symptoms of kidney stones?
e. What are the nursing interventions in caring for a patient with kidney stones?
f. What are common medical treatments used in the treatment of kidney stones?
g. A serious complication of fluid overload is what?
h. What are the symptoms of Pyelonephritis?
i. What is the Pathophysiology of Pyelonephritis (how do you get it?)?
j. What is the most common organism to cause UTI’s?
k. What are the signs and symptoms of a UTI
l. Define stress incontinence
m. What signs and symptoms are associated with bladder cancer?
n. What are measures to prevent to recurrence of UTI?
o. What are the body’s defense mechanisms to prevent UTI’s?
p. How do you measure residual volume?
q. What is IVP (intravenous pyelogram)?
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