GU Final

• Mimic UTI symptoms:
• ↑ Urgency
• ↑ Frequency
• Hesitancy
• Dysuria
• Low back,perineal, or postejaculation pain
• Fever/chills

• Increased age
• Any bacteria that can cause a UTI (E. Coli, Staph aureus, STD)
• Bacteria ascending urethra
• Bacteria in bloodor lymphs
• Urethral trauma
• Excess alcohol (>2-3 oz/day)
• Multiple sexual partners

• Treatment to relieve obstruction caused by enlarged prostate
• Rectoscope inserted into urethra and prostate chipped away a piece at a time
• After: Foley inserted, 30-60 mL water to inflate balloon to stop bleeding 
• Irrigation done regularly during first 24 hours
• May need to save serial urines for progressively less blood in each void
• Complications: Clot formation, bladder spasms, infection
• After: drink up to 2500 mL fluid/day

• When uncircumcised skin is pulled back and not replaced in forward position
• Causes constriction of dorsal veins, which leads to edema and pain
• May lead to gangrene

• Painful erection lasting longer than 4 hours
• Permanent tissue damage may result
• May be complete loss of erection ability after
• Causes: sickle cell anemia, leukemia, cancer, spinal cord injury, meds for erectile dysfunction
• Treatment: Ice packs, sedatives, injection into penis to relax veins spasms, aspiration, shunt

• Penis is curved when erect
• Plaques form in tissue surrounding corpora cavernosa
• May be caused by injury or inflammation
• Treatments: Vit E, Colchicine, surgery, injection into scar tissue to break it down
• Not life threatening

• Inflammation or infection of testicles (rare)
• Caused by: trauma, epididymis infection, UTI, STD, systemic disease
• S/S: Swollen, tender, red, fever
• Treatments: bed rest, scrotal support, antibiotics, analgesics
• Sterility from mumps can be prevented by giving vaccine young

• Inflammation of epididymis 
• Painful, scrotal skin tender, red & warm
• Risks: STD, backflow of urine, prostate infections
• Treatment: antibitics, ice packs. Usually goes away in about a week
• Complications: Chronic epididymitis, abcesses, steriliity

• Collection of fluid in scrotal sac
• Not dangerous, usually no pain
• Cause unknown
• No treatment unless discomfort or threat to blood supply. 
• Surgically drain fluid

• Varicose veins in scrotum
• Area in scrotum feels like bag of worms
• S/S: pulling sensation, dull ache, scrotal pain. Sensations felt when standing up
• Usually occur on left side
• May increase temp of testicles, damaging sperm
• Treatment: surgical repair of varicose veins

• Urinate before
• may increase absorption
• Pellet inserted in urethra
• Usually works w/in 5-10 min and lasts 30-60 min

• Medication change
• Oral meds (cialis, viagra, levitral)
• Hormones
• Injections to penis
• transurethral suppository
• Vacuum device/penile ring
• Implants
• Surgery

• Inproper functioning of hypothalamus, pituitary gland, testicles
• Causes: Pituitary or adrenal tumors, thyroid problems, uncontrolled diabetes
• Rare

• 2 most common: varicoceles and idiopathic causes
• Other causes: Klinefelter's syndrome  or cryptochordism
• High fever or viral infection
• Excessive use of hot tubs, tight clothing and long haul truck driving

Most common: Surgery or injury along pathway from testicles to outside of body (vasectomy, bladder neck reconstruction)

1 year

• Antibiotic 
• Used to treat sever bacterial infections
• Nephrotoxic.  (Intrarenal injury) When taken, blood levels of the drugs are monitored to avoid toxic levels

• Daily weight
• Look for: JVD, SOB, crackles, frothy sputum.
• HOB raised to 30 degrees
• Monitor: vital signs, albumin and protein levels
• Sodium and fluid constrictions

• Inflammation of prostate gland
• 4 types: Acute bacterial, chronic bacterial, chronic pelvic pain syndrome, asymptomatic
• Prevention: regular and complete emptying of bladder
• EPS and DRE for diagnostic tests

• Bladder log for 3-7 days
• Educate about avoiding urine retention (anticholinergics, alpha-adrenergics)
• Fluids and cranberry juice

• (Benign Prostatic Hyperplasia)
• Enlargement of prostate gland leading to urine retention and kidney distention
• S/S: ↓ in size/force of stream, dribbling
• Dx: DRE, urinalysis, BUN, transrectal ultrasound, urodynamic flow study
• Treatment: alpha or testosterone blockers, transurethral microwave antenna, prostate balloon, incision of prostate, resection of prostate
• Herbal: Saw Palmetto

• Most common are those prescribes for high blood pressure and cardiovascular disease
• Most common cause of ED is circulatory problems

• Alpha adrenergic blocker
• Relaxes muscles in prostate and bladder neck 
• Used to improve urination with benign prostatic hyperplasia

• Leuprolide
• Goserelin
• Flutamide

20 million per millimeter of semen

• Congenital condition where 1 or both testes don't descend into scrotum
• If not descended by age 2, surgery is needed
• If not by then, surgery should be done

• Digital rectal exam
• Gloved finger is inserted into rectum to examine prostate

• Untreated it can cause:
• Hydronephrosis
• Renal insufficiency
• Urosepsis
• Bladder dysfunction
• Stones

• Common side effect of prostate surgery
• Semen falls back into the bladder
• Causes no harm and is urinated out

• Found most often in men over 65
• High testosterone
• High fat diet
• Family history
• S/S: Hematuria, urinary obstruction

Nitrogenous waste product excreted in the urine; end product of protein metabolism

• The outer layer of kidney tissue
• Contains the renal corpuscles and convoluted tubules of nephrons

• The inner layer of kidney tissue
• Contains the wedge shaped pieces called renal pyramids
• Contains the loops of Henle and the collecting tubes of nephrons

• A funnel shaped basin that forms the upper end of ureter.
• Cuplike extension of the pelvis that collect urine are calyces
• Urine enters from the papillae of the renal pyramids.

• Cluster of capillaries surrounded by the nephron's glomelular capsule. 
• At the beginning of the nephron, the glomerulus is a network (tuft) of capillaries that performs the first step of filtering blood.

• They are not in the peritoneal cavity, but in the retroperitoneal space, behind the peritoneum
• At level of last thoracic and first 3 lumbar vertebrae

• When bp falls, it may limit filtration.
• The cells release renin which activates angiotensin. Angiotensin constricts blood vessels, causing BP to raise
• ANP is released when blood pressure is too high to lower

• Produced when kidneys don't have enough O²
• Stimulates red cell production in the bone marrow

Behind the peritoneum

• Right kidney lower than left to accommodate liver
• Enclosed in renal capsule on outside, then adipose capsule
• fascia anchors kidney to peritoneum and abd wall

• Renal artery
• Afferent arteriole
• Glomerulus
• Efferent arteriole
• Peritubular capillaries
• Renal vein

From the renal tubule to the peritubular capillaries

the glomerulus and glomerular capsule

• Renal tubule
• (distal convoluted tubule)

Supplies the gomerulus with blood

carries blood from the glomerulus

Nephron

• Blood pressure
• (3-4 times higher than in other capillaries)

• 1000 - 2000 mL/day
• Straw or amber color

Proximal convoluted tubules

Peritubrular capillaries in the renal tubules

Reabsorption of small proteins

Osmosis

The interstitial fluid, then peritubular capillaries, then return to circulation

Begins with the glomerulus and into the renal tubule

Active secretion of hydrogen ions and bicarbonate. when body fluids become too acidic kidneys secrete more hydrogen into renal filtrate and return bicarbonate ions back into blood. when too alkaline bicarbonate is excreted to renal filtrate and hydrogen into blood

4.6 - 8.0, with an average of 6.0

They secrete more hydrogen ions into renal filtrate and return more bicarbonate ions back into the blood

• 105 - 125 mL/min
• It is the amount of renal filtrate formed by the kidneys in 1 min.
• If blood increases, GFR increases, urinary output increases

• Inside the peritoneum behind the pubic bones.
• In women: bladder is inferior to uterus
• In men: bladder is superior to the prostate gland

from the hilus of the kidney to the lower, posterior side of the urinary bladder

It is 7-8 inches long and extends through the prostate gland and penis.

External urethral sphincter

<50 mL

• Urea
• Uric acid
• Creatinine
• Electrolytes
• Pigment (Urochrome)(bilirubin)

• The amount of dissolved solids and gases.
• Range is 1.002 (very dilute) - 1.040 (very concentrated)

Increases water reabsorption in the kidney to dilute the excess sodium

• 1000 - 2000 mL/day
• Straw or amber colored
• Specific gravity: 1.002 - 1.035
• PH 4.6 - 8.0
• 95% water

The metaboilism of creatine phosphate, an energy source in muscles

Waste products building up in the blood

Weight

• Color
• Odor
• PH
• Specific gravity
• Protein content
• Glucose
• Ketones
• Bilirubin
• Nitrate
• RBC
• WBC

• Protein in urine
• High creatinine level
• Potassium level

• Dehydration
• high-protein diet
• GI bleeding
• heart failure

• Protein
• Glucose
• Ketones
• Bilirubin
• Nitrate
• RBC and WBC's

• 30-60 mL
• or 1 mL/kg per hour

• Funnel shaped extensions of the renal pelvis
• They enclose the papillae of the renal pyramids

• Renal artery
• Renal vein
• Ureter

• Blood pressure
• (active transport is energized by ATP or stored energy)

• Renin
• (stimulated by low blood pressure)

• Clean perineum from front to back
• Separate labia
• Start urinating in toilet
• Move collection container under urine stream 
• Need at least 10 mL
• If menstruating, specify on lab form

• Diabetes
• Nephrosis
• CHF
• Dehydration

• NPO 6-8 hours, no anticoagulants
• Position: Prone, with sandbag under abdomen
• Hold breath while needle is inserted to keep kidney from moving
• Bedrest for 24 hours

• Bedrest up to 12 hours to prevent bleeding at injection site
• Check distal pulse in leg every 30-60 min
• Do not bend or raise HOB >45°

• 3 regulated processes of nephrons: filtration, reabsorption, and secretion
• Filtration: blood from heart to nephrons
• Reabsorption: Essential solutes and water move back into blood from nephron
• Secretion: Move substances from blood into tubules, where they mix with water and other wastes and converted to urine

• Grossly bloody urine
• Falling blood pressure
• ↑ pulse indicates bleeding and must be reported immediately

• Flank pain
• Hematuria
• Light headedness
• Fainting

• Stress:  Involuntary loss of urine <50 mL assoc w/coughing, sneezing, laughing.  Seen after menopause, child-birth for women. Prostatectomy and radiation
• Urge: Unable to make it to bathroom in time. Most common
• Functional: Inability to reach toilet because of environment, memory or physical limitations 

10 mL

• Damaged kidneys don't produce adequate erythropoetin (stimulates RBC production)
• Blood loss during dialysis

• Restrict protein and sodium
• beets
• rhubarb
• spinach
• cocoa
• instant coffee
• milk
• cola
• beer

• Infection of the renal pelvis, tubules and interstitial fluid of both kidneys
• Urinalysis shows casts

• BUN
• Creatinine
• BUN/Creatinine ratio
• Cystatin
• Uric acid

• Bacteria ascend catheter
• Usually develop w/in 2 weeks

• I&O
• Observation of urine abnormalities such as hematuria, pyuria or passage of stone
• Obstruction
• Temperature
• BP

• Encourage fluid intake to around 3000 mL
• Encourage walking
• Avoid offending foods

• Take all antibiotics
• Many UTI infections are recurrent, teach what to do to avoid in future
• Pyridium - purple skin discoloration, urine orange

Daily weight

• Edema
• SOB
• Crackles & weezes
• Tachypnea
• JVD

Painless hematuria

• 3000 mL
• 10 oz cranberry juice

<400 mL/day

• Hematuria
• Inability to void

• Antispasmodic agents
• Antipyretics
• Heat to puprapubic area
• Pyridium

• Urine color changes to red-orange
• Blue-to purple skin discoloration
• Changes urine glucose testing
• Avoid in renal insufficiency

Abnormal dilation of kidneys caused by obstruction of urine flow

• Surgical incision into the kidney to remove a stone
• Pyelolithotomy is to remove stones in renal pelvis

• Void every 3 hours while awake
• Drink up to 3000 mL water/day
• One glass cranberry juice/day
• Avoid baths
• Wipe front to back
• Urinate after sex
• Avoid constricting clothing

• 24 hour cratinine clearance test
• Anxiety
• Cool, clammy skin
• Confusion
• ↓ or no urine output
• Pale skin
• Rapid breathing
• Unconciousness

• Calcium oxalate
• Calcium Phosphate
• Magnesium ammonia
• Uric Acid
• Cystine
• Most contain calcium

• Hereditary
• Grapelike cysts
• No treatment
• Hematuria, hypertension

• Garlic
• Onion
• Pepper
• Lemon juice
• Seasoning blends
• Vinegar
• Dry mustard

• Xray of kidneys after contrast medium injected
• NPO 8 hours before procedure
• Explain warm, flushing sensation and maybe strange taste
• After: encourage fluids, measure urine output

• Bleeding
• s/s: bloody urine, flank pain, falling BP

• Change in cognitive functioning
• Decline in mental status
• Fever

• Keep voiding log
• Determine any acute causes and fix
• Is clothing inhibiting?
• Obstacles to bathroom?
• Initiate schedule
• Use environmental cues

• Urinate and discard specimen
• Time is noted and this is start
• All voidings are saved in a container.
• Incomplete specimens aren't accurate

Document.  Normal to have mucus because it comes through the ileum

• Never clamped - will create pressure that destroys kidney function
• Make sure it's draining adequately

• Encourage fluids to remove contrast media
• Monitor urine output

• Encourage fluid consumption
• Wash perineum with soap and water once a day
• Remove catheter as soon as possible
• Keep catheter securely taped to patient, preventing back and forth movement of catheter

4.6 - 8.0 with an average of 6.0

• 1.002 - 1.035
• Low specific gravity indicates excessive fluid intake
• High indicates dehydration

• Minimum level of 10 mL per min to live w/out dialysis
• Reference value: 85-135 mL/min

• Evaluates hydration status
• Elevated occurs in hypovolemia

• Glomerular capsules get damaged, edema
• S/S: Microalbuminuria, ↓urine output
• Smaller doses of insulin needed
• Risk of CVD ↑
• Therapeutic measures: Strict control of blood sugar & BP, ACE inhibitors

• Serum albumin and total serum protein ↓
• Excretion of 3.5 g or more of protein in urine per day
• Edema
• ↑ cholesterol
• ↑ blood coagulation
• Low protein and sodium diet

• Hardening of renal blood vessels
• S/S: proteinuria, hyaline casts in urine
• Treatment: reduce BP and treat hypertension, low sodium diet
• May you prone to MI or CVA

• Inflammation of glomerulus
• Most commonly assoc. with Group A strep
• S/S: Protein, casts or RBCs in urine, fluid volume overload, hypertension, periorbital edema, flank pain, dark urine

• Oliguric phase: <400 mL urine in 24 hours. Low sodium level.Lasts 2 wks - several months
• Diuretic phase: 1-3L urine/day. BUN & Creatnine high. Lasts 1-3 weeks
• Recovery phase: BUN & creatnine decrease. Can take up to a year

• Prerenal injury: Interruption of blood supply to kidneys. (dehydration, blood loss, shock, NSAIDS)
• Intrarenal: Inside kidneys. (ischemia, toxins, aminoglycosides)
• Postrenal injury: Obstruction of urine flow out of body. (stones, tumors, enlarged prostate)

• Nephrons are damaged or destroyed
• End stage renal disease occurs when 90% of nephrons are lost
• S/S: edema, Uremia, ↓ urine output, Fatigue, Nausea/vomiting, SOB, Anemia

Should be placed on cardiac monitor and observed for cardiac dysrhythmias

• Restricted sodium
• Restricted potassium
• Increased calcium
• Restricted phosphorus
• Restricted fluids

Blood is removed from the kidney and filtered through a dialyzer. The waste products from the blood move into the dialysate by diffusion.  Then the cleansed blood is returned to the body

• Filters waste
• Removes extra fluid  
• Balances electrolytes (sodium, potassium, bicarbonate, chloride, calcium, magnesium and phosphate).

• 3-4 hours
• 3-4 times a week

• Patient is very tired/weak
• Dysrhythmias and angina may occur
• Hypotension

Heparin to prevent clotting in artificial kidney

• Arteriovenous (AV) fistula: (best option) Made by sewing a vein and artery together under the skin. May take 2-6 months to mature
• AV graft: Uses tube of synthetic material to attach to an artery and vein.  
• Central venous catheter: Temporary. Can't be used long because of risk of infection. Placed in subclavian vein, jugular vein, or femoral vein.

• Palpating for a thrill (tremor) and auscultating for a bruit (swishing sound)
• Any decrease in either indicates occlusion

Occlusion of the graft

When AV grafts cause distal ischemia

• Neurovascular checks every hour
• Extremity is elevated
• Range of motion exercises encouraged
• Teaching of care of access point

• Provides continuous dialysis 
• Dialysate solution instilled into peritoneal cavity (usually 1500 - 2000 mL)
• 3 steps of exchange: filling, dwell time (left for several hours), draining
• Repeated 3-4 times a day

There is a larger blood flow, and dialysis is more efficient

• Citrus fruits and juices
• Bananas
• Raisins
• Lima beans
• Tomato products
• Salt substitutes
• Potatoes
• Excessive dairy products
• Excessive meats
• Chocolate

• Inspects inside of bladder with fiber optic cytoscope
• Expect dysuria for 24 hours after

• Cigarette smoking
• Industrial pollutants

• Aldosterone: reabsorption of sodium and excretion of potassium
• ADH (pituitary): Promotes reabsorption of water from filtrate
• ANH: Decreases reabsorption of sodium
• Parathyroid: reabsoprtion of calcium and excretion of phosphate

6 weeks

• There are few cardiovascular effects
• The therapy is continuous
• Temporary vascular access is required

• Production of erythropoetin
• Secretion of renin
• Maintenance of normal PH of blood and tissue

• Epididymititis
• Varicocele
• Exposure to diethylstibestrol
• Mumps orchitis