Genitourinary

COMMON LAB TESTS

A. Blood
CBC
Serum chemistry
Serum electrolytes
Serum osmolality
Lipid levels
uric acid
ESR
CRP
RPR
HIV assay - ELISA
antiody responses! AS"# AS$ase# AHase# A%&ase-B
prostate-speci'ic anti(en

B. )rine
pH
"smolality
Speci'ic (ravity
Sodium
Creatinine
Sediment
Creatinine clearance
Casts
*BC
Culture and sensitivity
RBC
+etones
esterase
nitrates
Urinary diversions
A. ileal loop or conduit
A. a se(ment o' the ileum is removed and used as a passa(e 'or
urine
B. one end 'orms a stoma on the adominal ,all# the other is sutured
closed
C. the ureters are implanted into the se(ment
%. a pouch is ,orn to collect urine
E. remainder o' o,el is reanastamosed. Client has normal o,el
movements throu(h anus
-. urine should e yello,ish. may contain mucus shreds
B. continent urinary diversion
A. reservoir 'or urine made 'rom parts o' small or lar(e o,el
B. client needs no pouch
C. reservoir is catheteri/ed at speci'ic times to drain urine
C. ureterostomy
A. one or oth ureters are rou(ht throu(h the adominal ,all to
'orm a stoma0s1
B. stomas are pouched to collect urine
C. usually a temporary measure per'ormed on in'ants until ileal loop
can e done
%. complications include s+in rea+do,n# in'ection# necrosis
I. Anatomy and Physioloy
A. Urinary system
!. "idney
a. structure
i. corte2 0outer layer1! composed o' (lomeruli#
pro2imal and distal tuules
ii. medulla 0middle layer1! aout ei(ht renal pyramids
'ormed y collectin( ducts and tuules
iii. renal pelvis 0innermost layer1! composed o' calyces
,here papillae move urine into the ureter y
peristalsis
iv. nephron! 'unctional unit that 'ilters# concentrates#
reasors and secretes to produce urine
v. (lomerulus! 'ilters 'luid ,astes out o' the lood
0plural! (lomeruli1
vi. tuules 0'lo, se3uence throu(h loops# pro2imal#
Henle4s# distal1! here 'luid is made into urine
. 'unctions
i. 'luid and electrolyte alance
ii. acid-ase alance! HP"5 u''er system# &H6 u''er
system
iii. to re(ulate arterial lood pressure! hormones -
renin# aldosterone
iv. to e2crete ,aste products! urea# creatinine
v. production o' erythropoietin
#. Ureters
a. convey urine 'rom the renal pelvis to the ladder
. consists o' smooth muscle that moves 'luid y peristalsis
3. Bladder - stores urine
4. Urethra - openin( ,here 'luid e2its
B. Male $e%rodu&tive system
7. 8estes! main male se2 (lands
a. each testis is encased in a 'irous capsule ,hich has
partitions into the inner (land
. semini'erous tuules 'orm spermato/oa
c. interstitial cells secrete testosterone
9. Accessory (lands
a. seminal vesicles
. prostate (land
c. ulourethral (lands secrete lurication prior to e:aculation
6. %ucts
a. epididymis conducts semen 'rom testes to vas de'erens
. vas de'erens conduct semen 'rom each epididymis to an
e:aculatory duct 0see illustration above1
c. e:aculatory ducts
d. urethra
4. Scrotum
;. Penis
C. 'emale $e%rodu&tive system
!. Ovaries
a. consist o' (raa'ian 'ollicles in ,hich ova develop
. 'unctions o' ovaries!
i. oo(enesis 0see illustration above1
ii. ovulation 0see illustration above1
iii. secretion o' pro(esterone and estro(en
9. -allopian tues - conduct ova 'rom ovaries to uterus
6. )terus has 'unctions in menstruation and pre(nancy
5. Va(ina
;. Vulva
II. Prostate (isorders
A. Benin %rostati& hy%er%lasia )BP*+
7. Enlar(ement o' the prostate (land
9. Etiolo(y
a. occurs as men a(e
. associated ,ith circulatin( andro(ens
c. as prostate enlar(es# prostatic tissue 'orms nodules
d. prostate ecomes spon(y and thic+
e. the prostatic urethra narro,s via compression 'rom the
enlar(ed prostate# thus it impedes the passa(e o' urine
B. -indin(s
7. early sta(es o'ten asymptomatic as enlar(ement occurs
9. chan(es in micturition - di''iculty startin( or stoppin( stream.
stream is smaller than usual
6. nocturia
C. %ia(nostics
7. di(ital rectal e2amination
9. urinalysis
6. serum creatinine and B)& studies
5. serum PSA
%. <ana(ement
7. i' asymptomatic# 'ollo, ,ith annual dia(nostics
9. use the 'ollo,in( medications as indicated
a. eta loc+ers
I. pra/osin 0<inipress1 - to decrease the urinary
,indins o' prostatic hyperplasia! urinary ur(ency#
hesitancy# nocturia
II. do2a/osin 0Cardura1- mana(ement o' the 'indin(s
o' BPH
. hormonal manipulation
I. 'inasteride 0Proscar1 - decreases prostate si/e ,ith
associated decrease in urinary ,indins
II. tera/osin 0Hytrin1 - mana(ement o' out'lo,
ostruction in clients ,ith BPH. decreases urinary
,indins
c. alloon dilation - relieves urinary ,indins temporarily
d. sur(ery i' indicated
I. 8)RP transurethral resection o' prostate
II. open prostatectomy
III. laser sur(ery
IV. insertion o' prostatic stent
6. Complications
a. acute urinary retention
. involuntary ladder spasms 0contractions1
c. hydronephrosis
d. urinary tract in'ection 0see elo,1
e. (ross hematuria
5. &ursin( interventions
a. assessment
I. the history o' current 'indin(s to include i' in'ection
or hematuria
II. chec+ the supuic area 'or a distention o' the
ladder
III. evaluate strai(ht catheter results 'or a postvoid
residual 0i' ordered1
IV. i' eta loc+ers are ein( used chec+ 'or
di''erences in sittin( and standin( lood pressures
,ee+ly ,hile titratin( dose
. 'acilitate urinary elimination 0see catheterization of bladder1
c. provide privacy 'or clients durin( elimination
d. monitor inta+e and output and ,ei(hts on a daily asis
e. maintain urinary catheter patency 0i' in use1
'. medicate as prescried y health care provider
B. Prostate &an&er
7. A mali(nant neoplasm# usually adenocarcinoma# o' prostate (land
9. Etiolo(y = epidemiolo(y
a. more prevalent in A'rican American men
. most appear on the peripheral /one o' the (land
c. most are palpale on rectal e2amination
d. spreads via the lymphatics# the loodstream or y local
e2tension
e. speci'ic etiolo(y un+no,n. 'amilial history increases ris+
6. -indin(s
a. usually asymptomatic in early sta(es
. ostruction o' urinary 'lo, to result in chan(es in
micturition
c. pain in an area represents the location o' the metastases
i. lumosacral
ii. hips
iii. lo,er le(s
d. rectal discom'ort
e. ,ei(ht loss
'. anemia
(. edema o' the lo,er e2tremities
;. <ana(ement
a. conservative approach
i. usually no treatment 'or men over >? due to the
prostate cancer4s slo, pro(ression
ii. anal(esics to mana(e pain - oth nonnarcotic and
narcotic
iii. short course o' radiotherapy 0site-speci'ic1
iv. administration o' IV strontium chloride @A 0eta
emitter a(ent1
v. 8)RP in cases o' ladder ostruction
vi. placement o' suprapuic catheter 'or ostructed
out'lo, throu(h urinary tract
. sur(ical approach
i. radical prostatectomy
ii. laparoscopic dissection o' pelvic lymph node
iii. cryosur(ery
c. curative approach
i. e2ternal eam radiation
ii. interstitial radiation - the direct implantation o'
radioactive sustances into the prostate either
permanently 0seedin(1 or rie'ly 0hi(h dose rate1.
also called racytherapy# seed implantation
d. palliative approach
i. hormone manipulation
estro(en therapy diethylstilestrol 0%ES1
luteini/in( hormone-releasin( hormone
0LHRH1
ii. ilateral orchiectomy 0removal o' the testes1
iii. use o' anti-andro(en dru(s
me(estrol acetate 0<e(ace1 - antineoplastic
decreases the (ro,th o' prostate
carcinoma# an andro(en-sensitive tumor
'lutamide 0Eule2in1
dru(s are o'ten used in comination therapy
B. Complications
a. o' the cancer - one metastases
. o' hormone manipulation
i. nausea and vomitin(
ii. (ynecomastia
iii. se2ual dys'unction
iv. hot 'lashes
>. &ursin( interventions
a. assessment
i. otain history o' current 'indin(s
ii. e2amine adomen 'or palpale nodes
iii. as+ aout any 'lan+ pain
iv. chec+ the suprapuic 'or ladder distention
. control pain to acceptale levels
c. reduce an2iety in clients and 'amily memers y re'errals
d. discuss potential chan(es re! se2ual 'unctionin(# ener(y
levels
III. 'emale $e%rodu&tive (isorders
A. Cysto&ele
7. 8he ladder herniates into the va(inal canal
9. Etiolo(y
a. associated ,ith ostetrical trauma
. may e due to a con(enital de'ect
c. 'indin(s may appear a'ter hysterectomy
d. may appear as (enitalia atrophy ,ith a(e
6. -indin(s
a. in early sta(es# asymptomatic
. pelvic pressure
c. chan(es in micturition
5. %ia(nostics
a. pelvic e2amination
. urinalysis
c. urine culture
;. <ana(ement
a. in postmenopausal client# estro(en therapy
. insertion o' va(inal pessary to support the pelvic or(ans
c. sur(ical intervention 0i' indicated1
7. to restore ladder 'unction
9. to repair the anterior va(inal ,all
B. Complications
a. in'ection
. urinary incontinence
>. &ursin( interventions
a. assessment
7. history o' ostetrical trauma# adominal sur(ery#
menopause# and i' estro(en therapy
9. chan(es in micturition
6. pain level
5. i' ul(e 'rom va(ina ,hile standin( upri(ht
;. i' ul(e 'rom perineum ,hen ,oman ears do,n
. provide pain mana(ement as needed
c. teach actions to enhance control o' incontinence
d. discuss actions 'or clients to prevent urinary retention
B. Pelvi& in,lammatory disease )PI(+
7. In'ection o' the cervi2 ascendin( to the 'allopian tues and road
li(aments
9. Etiolo(y
a. increased incidence due to rein'ection o' selected S8%s
. causative a(ents!
i. neisseria (onorrhoeae
ii. C. trachomatis
iii. mycoplasma hominis
c. a history o' multiple se2ual partners
d. the use o' I)%4s 0intrauterine device1
e. history o' therapeutic aortion
'. history o' caesarean section0s1
6. -indin(s
a. pelvic pain
. 'ever# anormal cervical dischar(e
c. cervical motion tenderness
d. irre(ular cervical leedin(
e. nausea# vomitin(# acute adomen
'. dysuria# 're3uency
(. chlamydia 0see S8%s on pa(e 6? o' this lesson1
5. %ia(nostics
a. endocervical culture
. CBC ,ith a di''erential
c. laparoscopy to vie, 'allopian tues
;. <ana(ement
a. medications 0may e used in comination therapy1
i. tetracyclines
ii. penicillins
iii. 3uinolones
iv. cephalosporins
. potential sur(ical intervention to drain ascess
B. Complications
a. ectopic pre(nancy
. in'ertility
c. rupture o' ascess
d. sepsis
ECTOPIC P$EGNANC-
>. &ursin( interventions
a. assess
i. history o' menses# contraceptive use# se2ual haits
ii. level o' pain
iii. vital si(ns 'or hypotension# hypovolemia# and 'ever
iv. ho, an S8% ,ill impact client socially
. mana(e pain
c. restore 'luid alance
d. client teachin(
C. Endometriosis
Edu&atin Clients a.out PI( )Pelvi& In,lammatory (isease+
A. Report to the healthcare provider any pelvic pain# anormal odor or anormal dischar(e#
especially a'ter situations such as se2ual relations or childirth.
B. Proper perineal hy(iene should e 'ollo,ed such as ,ipin( 'rom 'ront to ac+.
C. %o not douche. %ouchin( reduces the natural 'lora that protect a(ainst in'ection. and it may
introduce acteria.
%. Have a (ynecolo(ical chec+ up at least once a year.
E. I' there is any chance o' transmittin( in'ection# the partner should ,ear a condom.
7. Endometrium tissue (ro,s in cysts at various sites throu(hout the
pelvis and=or adominal ,all
9. Etiolo(y
a. occurs at any a(e. most commonly in the a(e (roup 9; to
5; years old
. hi(her incidence in ,hite ,omen than in A'rican American
,omen
c. responds to ovarian hormonal stimulation
i. pro(estins decrease it
ii. estro(ens increase it
6. -indin(s
a. may e asymptomatic
. may e present ,ith pelvic pain
c. dyspareunia
d. pain'ul de'ecation
e. anormal uterine leedin(
'. persistent in'ertility
(. hematuria# dysuria and 'lan+ pain i' ladder is involved
5. %ia(nostics
a. pelvic e2amination
. di(ital rectal e2amination
c. laparoscopy
d. adomen! ultrasound# C8 scan# arium studies
;. <ana(ement
a. medical
i. dana/ol 0Cyclomen1 - atrophy o' ectopic
endometrial tissue
ii. leuprolide acetate 0Lupron1 - reduction o'
pain=lesions in endometriosis
iii. pro(estins - decreases endometriosis
iv. oral contraceptives
. sur(ical
i. laparoscopic sur(ery
ii. C"9 laser laparoscopy
iii. laparotomy
iv. presacral neurectomy
v. hysterectomy
B. Complication - in'ertility
>. &ursin( interventions
a. assess
i. history o' current 'indin(s
ii. pain level
iii. impact o' in'ertility 0especially in child-earin( a(e
(roup1
. reduce pain
c. provide re'errals ,ith 'ocus 'or clients to increase sel'-
esteem
(. Cervi&al &an&er
7. 8hree types
a. dysplasia
. carcinoma in situ
c. invasive carcinoma
9. Etiolo(y=epidemiolo(y
a. the most common a(e (roup is 6; to ;; years o' a(e
. hi(her incidence in A'rican Americans
c. hi(her incidence amon( lo, socioeconomic populations
d. ris+ 'actors include
i. multiple se2ual partners
ii. history o' S8%s
iii. se2ual activity at an early a(e
6. -indin(s
a. usually asymptomatic in early sta(es
. postcoital leedin(# irre(ular va(inal leedin(
c. spottin( et,een periods
d. spottin( a'ter menopause
e. evidence o' dischar(e
'. pain ,ith radiation to uttoc+s and le(s
(. anemia
h. ,ei(ht loss
i. 'ever
5. %ia(nostics
a. Papanicolaou test 0pap smear1
. sta(in( laparotomy
c. metastatic evaluation!
i. IVP
ii. cystoscopy
iii. si(moidoscopy
;. <ana(ement
a. radiotherapy
i. used in any sta(e
ii. internal - radium via applicator
iii. e2ternal - via linear accelerator or coalt
. sur(ery
i. hysterectomy
7. i' ,oman is o' childearin( a(e# is not
commonly recommended
9. i' carcinoma in situ or invasive carcinoma#
comine ,ith radiotherapy
6. complication! impairment o' the ladder
'unction is most commonly 'ound
ii. pelvic e2enteration
iii. coni/ation
c. chemotherapy
i. used as an ad:unct ,ith sur(ery or radiation i'
indicated
ii. speci'ic a(ents are dependent upon the dia(nosis
and o'ten used ,ith comination therapy 0i.e.# t,o
or more a(ents1
B. Complications include metastasis to!
a. lun(s
. mediastinum
c. ones
d. liver ,ith suse3uent spread to rectum and ladder
>. &ursin( interventions
a. otain assessment data
i. history o' pap smears# se2ual history and past
S8%4s
ii. history o' current complaints or 'indin(s
iii. client4s understandin( o' the disease
. reduce an2iety
c. enhance ody ima(e
E. Breast &an&er
7. 8ypes o' reast cancer
a. in situ ductal
. in situ loular
c. invasive ductal
d. invasive loular
e. in'lammatory
'. Pa(et4s %isease o' the nipple
(. tuular
h. medullary
i. mucinous
:. papillary
+. sarcoma
9. Etiolo(y
a. in ,omen# e(ins in linin( o' mil+ duct
. hi(her ris+ i' 'amily history
c. ris+ may increase ,ith the use o' hormones
Eleven $is/ 'a&tors ,or Breast Can&er
7. Estro(en replacement therapy
9. Alcohol use
6. "esity 0still unproven1
5. %iet hi(h in 'ats
;. "ral contraceptives
B. Personal history o' reast cancer
>. Sisters or dau(hters ,ho have had reast cancer
@. Early menarche
A. Late menopause - a'ter a(e ;?
7?. History o' eni(n reast disease
77. Radiation e2posure a'ter puerty and e'ore a(e 6;
6. -indin(s 0re'er to BSE1
a. painless# 'irm lump - most o'ten immoveale
. painless thic+enin( in a reast
c. enlar(ement o' a2illary nodes or supraclavicular nodes
d. nipple dischar(e
e. scaliness or retraction o' nipple 0seen more in Pa(et4s
%isease1
'. pain# ulceration# edema# oran(e-peel s+in 0usually late
'indin(s1
5. %ia(nostics
a. mammo(raphy
. iopsy or aspiration
c. tumor cell tests
d. la tests to determine metastases
;. <ana(ement
a. sur(ical approach 0,ill depend on the results 'rom the
lymph node iopsies and tumor sta(in(1
7. lumpectomy
9. partial mastectomy
6. modi'ied radical mastectomy
5. radical mastectomy
;. simple mastectomy
B. a2illary dissection
. radiation therapy
c. chemotherapy
7. cyclophosphamide 0Cyto2an1
9. methotre2ate 0<e2ate1
6. do2oruicin HCL 0Adriamycin1
5. paclita2el 08a2ol1
d. endocrine therapy
7. one marro, transplant
9. oophorectomy
6. adrenalectomy
e. hormone therapy
7. use o' tamo2i'en 0&olvade21
7. to loc+ the e''ects o' estro(en
9. 'or post-menopausal ,omen ,ith positive
nodes
6. the course o' treatment is commonly a
minimum o' t,o years
9. use o' other hormones in advanced disease
7. estro(ens 0%ES1 or ethinyl estradiol
0Estinyl1 to suppress -SH and LH
9. pro(estins may decrease estro(en
receptors
6. andro(ens may suppress -SH and estro(en
production
5. amino(lutethimide loc+s estro(en y
loc+in( adrenal steroids
;. corticosteroids 'rom the adrenal (lands
suppress secretion o' estro(en and
pro(esterone
B. Complications o' reast cancer
a. metastases
. one pain# neurolo(ic chan(es# ,ei(ht loss# anemia
c. shortness o' reath# cou(h# pleuritic pain# nonspeci'ic
chest discom'ort
>. &ursin( interventions
a. otain a health history
. identi'y the type o' education needed
c. evaluate the level o' an2iety and 'ear
d. determine the levels o' copin( ailities
e. re'er availale support systems to
7. reduce an2iety
9. provide education
6. enhance copin( strate(ies
@. Issues 'or male clients ,ith reast cancer
a. cancer resemles the types 'ound in ,omen
. a (reater incidence in men in their B?4s
c. accounts 'or aout 7C o' all reast cancer cases
d. pro(nosis is poor ecause men delay see+in( dia(nosis
and treatment
e. (ynecomastia is o'ten an associated 'actor
I0. Genitourinary (isorders
A. )rinary tract in'ections 0)8I1
7. In'ections# y various a(ents# in di''erent parts o' the urinary
system
9. Etiolo(y
a. causative a(ent enters via urinary meatus
. ,omen are more susceptile
c. can e caused y poor voidin( haits
d. in ,omen# acute in'ection caused more o'ten y
Escherichia coli
e. in men# cause is usually ostructive anormalities
6. -indin(s
a. dysuria# 're3uency# ur(ency# nocturia
. suprapuic pain
c. 'indin(s o' hematuria more o'ten ,ith +idney involvement
5. %ia(nostics! done on a urine sample
a. dipstic+
. microscopic evaluation
c. culture
;. <ana(ement
a. antimicroial therapy as indicated
. in uncomplicated in'ection
i. co-trimo2a/ole 0Bactrim1
ii. nitro'urantoin 0<acrodantin1
iii. 3uinlones
cipro'lo2acin 0Cipro1
o'lo2acin 0-lo2in1
nor'lo2acin 0&oro2in1
trova'lo2in 08rovan1
c. in complicated in'ection
i. oral antimicroials as ordered
ii. IV antimicroials may e indicated
iii. 'ollo,-up urine dia(nostics
B. Complications
a. pyelonephritis
. sepsis
>. &ursin( interventions
a. assess
i. history o' the 're3uency o' urinary tract in'ections
0)8Is1
ii. voidin( haits# personal hy(iene# contraceptive
methods
iii. history o' va(inal dischar(es# itchin(# irritation#
dysuria
. mana(e pain
i. systemic anal(esics
ii. urinary anal(esics=antispasmodics
c. provide client teachin( 0Re'er to tale elo,1
i. preventive measures
in the 'emale client# discuss the need to void
a'ter intercourse
cleanse the perineum 'rom 'ront to ac+
use cotton under,ear
ii. nutritional considerations
increase ,ater inta+e
avoid caronated and ca''einated 'luids
such as co''ee# tea# alcohol# and colas
B. Se1ually transmitted diseases )ST(s+ and enital lesions
7. A (roup o' diseases resultin( 'rom se2ual intercourse ,ith an
in'ected individual
Client tea&hin reardin UTIs
7. %rin+ plenty o' 'luids
9. Avoid co''ee# tea# colas and alcohol
6. Void every t,o to three hours durin( the day
5. Void immediately a'ter se2ual intercourse
;. 8a+e medications e2actly as prescried
B. Sho,er rather than athe in a tu
>. Cleanse perineum 'ront to ac+
Ty%e o, ST( Pathoen Sins2Sym%toms Test
Denital Herpes Herpes simple2 virus Clustered vesicles#
pain'ul ulcers# mild
lymphadenopathy.
reactivates ,ith!
stress# in'ection#
pre(nancy# sunurn
smears# viral cultures
Syphilis 8reponema pallidum Primary type!
nontender# shallo,#
indurated clean ulcer#
mild re(ional
lymphadenopathy.
Secondary type!
maculopapular rash#
mucous patches#
'ever# (enerali/ed
lymphadenopathy
tertiary! terminal
phase ,ith many
neurolo(ic de'icits
V%RL# Rapid Plasma
Rea(in 0RPR1
Chancroid Haemophilus ducreyi *ell circumscried
ulcers ,ith ra((ed
orders# purulent
e2udate# tender
in(uinal nodes in ;?C
o' clients
Dram Stain# Diemsa4s
Stain# or *ri(ht Stain
Lympho- (ranuloma
venereum# LDV
Lympho(ranuloma
venereum# a sutype
o' C. trachomatis
Small# transient#
nontender papule
ulcer ,hich precedes
'irm# unilateral
in(uinal and 'emoral
lymph nodes 0uoes1
,ith a characteristic
(roove in et,een
<icro-immuno-
'luorescence testin( o'
aspirate 'rom uo
Condyloma
acuminatum 0(enital
,arts1
Condyloma
acuminatum# sutype
o' Human
papillomavirus 0HPV1
Sin(le or multiple so't#
'leshy# ve(etatin(
(ro,th0s1. may occur
on penis
Pap smear and=or
iopsy
ChlamydiaE Chlamydia
trachomatis
Penile or va(inal
dischar(e# creamy
anti(en test# cell
tissue culture
DonorrheaE &eisseria
(onorrhoeae
o'ten no symptoms#
dischar(e ,hite or
(reenish# urnin( ,ith
urination
la analysis o'
e2udate
E clients are o'ten coin'ected ,ith chlamydia and (onorrhea
9. Etiolo(ies
a. (enital herpes - herpes simple2 virus
. syphilis - treponema pallidum
c. chancroid - haemophilus ducreyi
d. lympho(ranuloma venereum 0LVD1 - su type o' C.
trachomatis
e. condyloma acuminatum 0(enital ,arts1 - sutype o' human
papillomavirus 0HPV1
6. -indin(s 0see table on Se2ually transmitted diseases 0S8%s1
a. (enital herpes
7. clustered pain'ul vesicles and ulcers
9. mild lymphadenopathy
6. can e reactivated as a result o' stress# in'ection#
pre(nancy# sunurn
. syphilis
7. primary type! non-tender# painless# shallo,#
indurated clean ulcer# mild re(ional
lymphadenopathy
9. secondary type! maculopapular rash# mucous
patches# 'ever# (enerali/ed lymphadenopathy 0'lu-
li+e illness1
6. chancroid! ,ell circumscried# pain'ul ulcers ,ith
ra((ed orders# purulent e2udate# tender in(uinal
nodes in ;?C o' patients
5. LVD! small# transient# non-tender papule ulcer
,hich precedes 'irm# unilateral in(uinal and 'emoral
lymph nodes 0uoes1 ,ith a characteristic (roove
in et,een
;. condyloma acuminatum! sin(le or multiple so't#
'leshy# ve(etatin( (ro,th0s1. may occur on penis
5. %ia(nostics 0for lab tests, see table on page 30 of this lesson1
a. (enital herpes!8/an+ smear# viral culture
. syphilis! V%RL# rapid plasma rea(in 0RPR1
c. chancroid! (ram# (imesa# or *ri(ht stain
d. LDV! microimmuno'luorescence testin( o' aspirate 'rom
uo
e. condyloma acuminatum! Papanicolaou test and=or iopsy
;. <ana(ement and pharmacolo(y - common a(ents in the
treatment o' S8%s 0choice depends on dia(nosis1
a. systemic therapies
7. acyclovir sodium 0Fovira21
9. penicillin 0<e(acillin1
6. do2ycycline hyclate 0Viramycin1
5. tetracycline HCL 0Achromycin1
;. ce'tria2one sodium 0Rocephin1
. topical therapies
7. podo'ilo2 0Condylo21
9. podophylum resin 0Podoen1
B. &ursin( interventions
a. assess
7. history o' current lesions
9. history o' other se2ually transmitted diseases
. minimi/e any 'ear and an2iety throu(h education
c. discuss ,ith clients ,ays to cope ,ith altered ody ima(e
C. $enal &al&uli
7. 8he presence o' stones in the +idneys
9. Etiolo(y
a. causes
i. hypercalcemia
ii. hypercalciuria
iii. chronic dehydration
iv. hi(h purine diet 0or(an meats# yeast# etc.1
v. cystinuria 0(enetic disorder1
vi. chronic in'ections 0proteus vul(aris1
vii. chronic ostruction ,ith urinary stasis
viii. environmental 'actor! livin( in a ,arm# humid
climate
. epidemiolo(y
i. more prevalent in men
ii. can e 'ound any,here in the urinary system
iii. pea+ a(e o' onset is 9? to 6? years o' a(e
iv. spontaneous passa(e occurs in @?C o' clients
v. calculi can lod(e and cause ostruction. Common
sites are
ladder nec+
renal pelvis
ureters
vi. o'ten recurs in clients ,ith a history o' t,o or more
stones
6. -indin(s
a. pain - site dependent on location o' ostruction
. increased hydrostatic pressure
c. renal colic
d. ureteral colic
e. 'indin(s can mimic cystitis
'. ,ith ostruction! ,hen stones 0calculi1 loc+ urine 'lo,#
client ,ill sho, 'indin(s o' )8I ,ith 'ever and chills
(. (astrointestinal 'indin(s
i. nausea and vomitin(
ii. diarrhea
iii. adominal discom'ort
5. %ia(nostics
a. IVP to determine site and de(ree o' ostruction
. retro(rade or ante(rade pyelo(raphy
c. analysis o' stone material
d. urinalysis
e. urine culture and sensitivity
;. <ana(ement
a. e2tracorporeal shoc+ ,ave lithotripsy 0ES*L1
. percutaneous nephrolithotomy 0PC&L1
c. percutaneous stone dissolution 0Chemolysis1
i. introduce a solvent 0dependin( on the composition
o' the stone1
ii. (ive road-spectrum antimicroials e'ore# durin(
and a'ter the procedure to maintain sterile urine
d. ureteroscopy
e. pyelolithotomy# nephrolithotomy# ureterolithotomy
'. cystolithotomy
(. nephrectomy 0sur(ical removal o' a +idney1
B. Complications
a. ostruction 'rom residual stone material 0'ra(ments1
. in'ection resultin( 'rom acteria or spread o' in'ected stone
'ra(ments
c. impaired renal 'unction may e chronic i' stones ostructed
tues lon( e'ore removal and treatment
>. &ursin( interventions
a. assess
i. history o' )8I4s# dietary haits# and 'amily history o'
+idney stones
ii. pain# location# intensity - is typically severe
iii. 'or 'indin(s o' )8I
iv. 'or 'indin(s o' urinary ostruction
. mana(e pain - narcotics o'ten indicated
c. maintain urine 'lo, - strain urine
d. control in'ection
e. client teachin(
(. A&ute renal ,ailure
7. 8he +idneys 'ail to 'unction - may e one or oth +idneys
9. Etiolo(y
a. causes. pathophysiolo(y
i. prerenal - decreased renal lood 'lo,
ii. intrarenal - in:ury to renal tissue due to to2ins#
intrarenal ischemia# vascular disorders and
immunolo(ic processes
iii. postrenal - stops or slo,s urine 'lo, any,here in
the urinary tract
. sta(es
i. e(ins ,hen +idneys 0one or oth1 are in:ured
ii. oli(uric=anuric phase 0less than ;?? ml o' output in
95hrs1
iii. diuretic phase! 95-hr. urine e2ceeds ;?? ml and
there is no lon(er a rise in serum B)& and
creatinine levels
iv. recovery phase
several months to one year
more li+ely to leave scar tissue remnants
loss o' renal 'unction usually not clinically
si(ni'icant
Causes Ty%e o, A&ute $enal 'ailure 'indins3 *istory
Client Tea&hin4 (iet To Prevent "idney Stones
A. %ecrease sodium inta+e
B. Avoid the 'ollo,in(!
7. -oods enriched ,ith Vitamin % 0Vitamin % increases calcium reasorption1
9. %airy! cheeses# mil+# sour cream
6. <eat and 'o,l! rain# heart# liver# +idneys
5. Ve(etales! eets# collards# mustard (reens# spinach# peas# soyeans# endive#
celery
;. -ruits! all erries# currants# 'i(s# Concord (rapes
B. Breads! ,hole (rain reads# cereals etc# all reads made ,ith sel'-risin( 'lo,er#
,heat (erm# all (rits
>. %rin+s! any made 'rom mil+ or mil+ products. dra't eer. caronated drin+s
@. "ther! chocolate# nuts# peanut utter# all 'oods made 'rom mil+ or mil+ products#
such as ca+es# coo+ies
Systemic assault# such as
hemorrha(e# trauma# urn
Prerenal Hypotension# hypoper'usion#
reduced urine output#
shriveled s+in# dry mucous
memrane
$idney in'lamed or
ostructed
Postrenal History o' urinary ostruction.
di''iculty voidin(. chan(es in
micturition
$idney to2in or in:ury Intrarenal History o' (lomerulonephritis.
edema. rash. chan(es in
+idney 'unction# oth output
and chemistry
5. %ia(nostics
a. urinalysis
. serum creatinine and B)& levels rise
c. urine chemistry evaluation to distin(uish et,een the
phases
d. renal ultrasono(raphy
;. <ana(ement
a. preventive
i. provide client education re(ardin( the use o'
anal(esics# proper hydration# e2posure to
nephroto2ins
ii. teach client to avoid in'ection. i' present# only
prescried medications are used ,hich ,ill e
speci'ic to client needs
. supportive
i. improve renal per'usion
ii. monitor daily inta+e and output
iii. correct to control hyper+alemia
iv. monitor lood pressure 'or 'luid overload
v. alance nutritional inta+e to maintain normal serum
potassium and phosphate levels
vi. i' indicated# hemodialysis or peritoneal dialysis is
initiated
B. Complications!
a. systemic in'ection
. arrhythmias secondary to hyper+alemia
c. electrolyte imalances - potassium# phosphate# calcium#
sodium
d. DI leedin( due to stress ulcer
e. multiple or(ans ,ith system 'ailure
>. &ursin( interventions
a. assess
i. history o' cardiac disease# mali(nancy# sepsis or
recent in'ection
ii. e2posure to nephroto2ic dru(s
7. &SAI%s
9. antiiotics
6. chemical solvents
5. contrast media
iii. urine volume 'or 95 hour periods
. monitor serum las to achieve 'luid and electrolyte alance
c. prevent in'ection
d. monitor serum electrolytes
e. minimi/e stress to prevent DI leedin(
'. monitor neurolo(ic 'unction
(. maintain ade3uate nutrition
i. re(ulate protein inta+e
ii. o''er hi(h-carohydrate 'eedin(s
iii. ,ei(h daily
iv. restrict 0as needed1 'oods hi(h in potassium#
phosphorus# and sodium
v. (ive total parenteral nutrition 08P&1 as ordered i'
needed
E. Chroni& renal ,ailure
1. A pro(ressive# irreversi.le deterioration in renal 'unction! ody
cannot alance metaolism and 'luid=electrolytes. result! uremia.
9. Etiolo(ies
a. hypertension# severe and prolon(ed
. diaetes mellitus
c. (lomerulopathy
d. interstitial nephritis
e. polycystic disease 0hereditary1
'. ostructive uropathy
(. con(enital disorder
6. -indin(s o' chronic renal 'ailure 0y system1!

5. %ia(nostics
a. arterial lood (ases 'or acid-ase alance
. elevated serum creatinine# potassium# phosphorus# B)&
c. CBC to detect anemia
d. decreased serum levels o' icaronate# calcium# proteins
0alumin1
;. <ana(ement
a. control diaetes
. treat hypertension
c. maintain renal 'unction 'or as lon( as possile
d. re(ulate diet
i. maintain lo5 %rotein inta/e
ii. prevent malnutrition
iii. restrict dietary potassium
iv. restrict dietary phosphorus y reducin( inta+e o'
chic+en# mil+# le(umes# caronated drin+s
e. treat anemia ,ith epoetin 0Erythropoietin1 or epoetin al'a
0Procrit Epo(en1
'. treat acidosis ,ith oral sodium icaronate
(. dialysis ,hen necessary
B. Complication! death
>. &ursin( interventions
a. assess
i. history o' chronic disorders
ii. de(ree o' renal impairment
iii. e''ect on the other ody systems
iv. ho, client is respondin( to illness
v. availaility and interest o' support systems
. maintain 'luid and electrolyte alance
c. support ade3uate nutrition
d. maintain s+in inte(rity
e. prevent constipation
'. maintain sa'e level o' activity
(. evaluate ho, much clients understand and ho, ,ell clients
,ill comply ,ith treatment
*emodialysis - cleansin( the lood o' accumulated ,aste products
7. )ses
a. short term therapy in acutely ill clients
. lon( term use in clients ,ith end-sta(e renal disease
9. Hemodialysis re3uires 'ive thin(s
a. access to patient4s circulation 0usually via 'istula1
. access to a dialysis machine and dialy/er ,ith a
semipermeale memrane
c. the appropriate solution 0dialysate ath1
d. time! 79 hours each ,ee+# divided in three e3ual se(ments
e. place! home 0i' 'easile1 or a dialysis center
6. 8hree ,ays to access to client4s circulation 'or dialysis!
5. Procedure 'or hemodialysis
a. patient4s circulation is accessed
. unless contraindicated# heparin is administered
c. heparini/ed 0heparin! natural clot preventer1 lood 'lo,s
throu(h a semipermeale memrane in one direction
d. dialysis solution surrounds the memranes and 'lo,s in
the opposite direction
e. dialysis solution is!
i. hi(hly puri'ied ,ater
ii. sodium# potassium# calcium# ma(nesium# chloride
and de2trose
iii. either icaronate or acetate# to maintain a proper
pH
'. via the process o' di''usion# ,astes are removed in the
'orm o' solutes 0metaolic ,astes# acid-ase components
and electrolytes1
(. solute ,astes can then e discarded or added to the lood
h. ultra'iltration removes e2cess ,ater 'rom the lood
i. a'ter cleansin(# the lood returns to the client via the
access
;. Complications related to vascular access in hemodialysis
a. in'ection
. catheter clottin(
c. central venous thromosis
d. stenosis or thromosis
e. ischemia o' the a''ected lim
'. development o' an aneurysm
B. &ursin( interventions
a. e2plain procedure to client
. monitor hemodynamic status continuously
c. monitor acid-ase alance
d. monitor electrolytes
e. ensure sterility o' system
'. maintain a closed system
(. discuss diet and restrictions on!
i. protein inta+e
ii. sodium inta+e
iii. potassium inta+e
iv. 'luid inta+e
h. rein'orce ad:ustment to prescried medications that may
e a''ected y the process o' hemodialysis
i. monitor 'or complications o' dialysis related to!
i. arteriosclerotic cardiovascular disease
ii. con(estive heart 'ailure
iii. stro+e
iv. in'ection
v. (astric ulcers
vi. hypertension
vii. calcium de'iciencies 0one prolems such as
aseptic necrosis o' the hip :oint1
viii. anemia and 'ati(ue
i2. depression# se2ual dys'unction# suicide ris+
Continuous am.ulatory %eritoneal dialysis )CAP(+
7. A 'orm o' intracorporeal dialysis that uses the peritoneum 'or the
semipermeale memrane.
9. Advanta(es o' CAP% versus hemodialysis
a. more 'reedom
. less physical and psychosocial inter'erence
c. 'e,er dietary and 'luid restrictions
d. simple and easy to use
e. provides satis'actory iochemical control o' uremia
6. Procedure 'or CAP%
a. an ind,ellin( catheter is permanently implanted in the
peritoneum
. 'or each dialysis e2chan(e! to this catheter# attach a
connector and insert it into a sterile plastic a( o' dialysate
solution.
c. in'use the solution via (ravity 'or ten minutes 0avera(e t,o
liter volume1
d. the solution no, d,ells in the peritoneal cavity 'or a len(th
o' time speci'ied y the health care provider# usually 'our to
si2 hours.
e. at the end o' the d,ell time# the solution is released and
drained into a a(# via (ravity.
'. draina(e time is appro2imately ten to 9? minutes# durin(
,hich time ultra'iltration occurs.
(. clients avera(e 'our e2chan(es per day# includin( one
overni(ht ,hich allo,s 'or uninterrupted sleep durin( the
ni(ht.
5. Complications related to CAP%
a. in'ection
. in'ectious peritonitis
c. catheter mal'unction
d. communication et,een the peritoneum and the pleural
cavity
e. lea+a(e o' dialysate
'. hyper- or hypovolemia
(. leedin(
h. ostruction
;. &ursin( interventions
a. e2plain procedure to client
. assist health care provider accordin( to institutional
procedure
c. monitor inta+e and output
d. oserve 'or si(ns o' complications
e. record characteristics o' output dialysate
'. teach client
7. dietary restrictions
9. ho, to ,ei(h sel' daily
6. that i' in'ections occur# CAP% ,ill not e 'easile
lon(-term
5. 'indin(s o' in'ection
;. strict aseptic techni3ue
B. to ,ash hands e'ore and a'ter dialysis e2chan(es
>. that s+ippin( e2chan(es raises ris+ o' renal 'ailure
@. to inspect a( e'ore use 'or lea+s# alteration in
color
(. discuss early ,arnin( si(ns o' peritonitis!
7. adominal pain
9. cloudy peritoneal 'luid
6. adominal tenderness
5. malaise
;. 'ever
Points to $emem.er
A'ter a urinary catheter is removed# the client may have some urnin( on
urination# 're3uency and drilin(. 8hese symptoms should suside ,ithin 95 to
5@ hours.
A'ter a 8)RP 0transurethral resection o' the prostrate1# tell clients that# ecause
the three-,ay 'oley catheter has a lar(e diameter# they ,ill continuously 'eel the
ur(e to void 'or 95 to 5@ hours.
A'ter prostatic sur(ery# it is normal the clients4 urine to e lood tin(ed and 'or
them to pass medium to small lood clots and tissue deris 'or 95 to 5@ hours.
Because the prostate (land receives a rich lood supply# it is a priority to oserve
clients under(oin( a prostatectomy 'or leedin( and shoc+.
Breast cancer starts ,ith the alteration o' a sin(le cell and ta+es a minimum o'
t,o years to ecome palpale.
At the time o' dia(nosis# aout one-hal' o' clients ,ith reast cancer have
re(ional or distant metastasis.