Urinary and Reproductive Disorders Chapter 44 Urinary and Reproductive Disorders

Urinary and Reproductive Disorders Urinary and reproductive disorders are common. Understanding these disorders gives meaning to the required care. Disorders can occur in these major urinary system structures. The Kidneys Ureters Bladder Urethra Men can develop prostate problems. See the Body Structure and Function Review: The Urinary System Box on p. 720 in the Textbook.

Urinary System Disorders Urinary tract infections (UTIs) Infection in one area can progress through the entire system. Microbes can enter the system through the urethra. Common causes include: Catheterization Urological exams Intercourse Poor perineal hygiene Immobility Poor fluid intake UTI is a common healthcare-associated infection. UTIs are common.

Urinary System Disorders (cont’d) Women are at high risk. Microbes can easily enter the short female urethra. Prostate gland secretions help protect men from UTIs. However, an enlarged prostate increases the risk of UTI. Older persons are at high risk for UTIs. The following increase the risk: Incomplete bladder emptying Perineal soiling from fecal incontinence Poor fluid intake Poor nutrition

Urinary System Disorders (cont’d) Cystitis is a bladder infection caused by bacteria. These signs and symptoms are common: Urinary frequency Oliguria (scant amount of urine) Urgency Dysuria (difficult or painful urination) Pain or burning on urination Foul-smelling urine Hematuria (blood in the urine) Pyuria (pus in the urine) Fever Treatment includes antibiotics and encouraging fluids. Fluids are usually encouraged to 2000 mL per day. If untreated, cystitis can lead to pyelonephritis.

Urinary System Disorders (cont’d) Pyelonephritis is inflammation of the kidney pelvis. Infection is the most common cause. Cloudy urine may contain pus, mucus, and blood. Signs and symptoms include Chills, fever, back pain Nausea and vomiting The signs and symptoms of cystitis Treatment involves antibiotics and fluids.

Urinary System Disorders (cont’d) Prostate enlargement The prostate is a gland in men. It lies in front of the rectum and just below the bladder. The prostate surrounds the urethra. The prostate enlarges as the man grows older. This is called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. Bladder function is gradually lost. The enlarged prostate presses against the urethra obstructing urine flow. After age 60, most men have some symptoms of BPH.

Urinary System Disorders (cont’d) The following problems are common with prostate enlargement: A weak urine stream Frequent voidings of small amounts of urine Urgency and leaking or dribbling of urine Frequent voiding at night Urinary retention Treatment depends on the extent of the problem. The doctor may order drugs to shrink the prostate or stop its growth. Some microwave and laser treatments destroy excess prostate tissue. Transurethral resection of the prostate (TURP) is a common surgical procedure. With urinary retention, the man cannot void. Urine remains in the bladder. A transurethral resection of the prostate (TURP) involves the doctor inserting a lighted scope through the penis. The scope has a wire loop used to cut tissue and seal blood vessels. The removed tissue is flushed out of the bladder. Flushing fluid enters the bladder through a catheter. Urine and the flushing fluid flow out of the bladder through the same catheter. Some bleeding and blood clots are normal. The care plan may include the measures listed on p. 721 in the Textbook.

TURP

Urinary System Disorders (cont’d) Urinary diversions Sometimes the bladder is surgically removed. Cancer and bladder injuries are common reasons. Urinary diversion is a surgically created pathway for urine to leave the body. An ostomy is often involved. A urostomy is a surgically created opening between a ureter and the abdomen. A pouch is applied over the stoma. Urine drains through the stoma into the pouch. Pouches are changed every 5 to 7 days. A pouch is replaced anytime it leaks. Good skin care is needed. Observe and report skin changes around the stoma. When the bladder is removed, urine must still leave the body. You may care for persons with long-standing urostomies. The person assists with care as able. Urine on the skin can cause irritation, breakdown, and infection. Review the Promoting Safety and Comfort: Urinary Diversions Box on p. 722 in the Textbook.

Urinary System Disorders (cont’d) Kidney stones (calculi) Most common in white men 40 years of age and older. Risk factors include: Bedrest Immobility Poor fluid intake Stones vary in size. Stones may be as small as grains of sand or as large as golf balls.

Urinary System Disorders (cont’d) Signs and symptoms include: Severe, cramping pain in the back and side just below the ribs Pain in the abdomen, thigh, and urethra Nausea and vomiting Fever and chills Dysuria (difficult or painful urination) Urinary urgency Burning on urination Hematuria (blood in the urine) Cloudy urine Foul-smelling urine

Urinary System Disorders (cont’d) Treatment involves: Drugs for pain relief Drinking 2000 to 3000 mL of fluid a day All urine is strained. Medical or surgical removal of the stone may be necessary. Some diet changes can prevent stones. The fluids help stones pass from the body through the urine.

Urinary System Disorders (cont’d) Kidney failure (renal failure) The kidneys do not function or are severely impaired. Waste products are not removed from the blood. Fluid is retained. Heart failure and hypertension easily result. It may be acute or chronic. The person is very ill.

Urinary System Disorders (cont’d) Acute kidney failure is sudden. Blood flow to the kidneys is severely decreased. Causes include: Severe injury or bleeding Heart attack Heart failure Burns Infection Severe allergic reactions Some persons develop chronic kidney failure. Treatment involves drugs, restricted fluids, and diet therapy. At first, oliguria occurs. This phase lasts a few days to 2 weeks. Then diuresis (the process of passing urine) occurs. Large amounts of urine are produced. Kidney function improves and returns to normal during the recovery phase. This can take up to 1 year. Every system is affected by the build-up of waste products in the blood. Death can occur. The diet is high in carbohydrates and low in protein and potassium. The care plan may include the measures listed on p. 723 in the Textbook.

Urinary System Disorders (cont’d) Chronic kidney failure The kidneys cannot meet the body’s needs. Nephrons in the kidney are destroyed over many years. Common causes are: Hypertension Diabetes Other causes include: Infections Urinary tract obstructions Tumors Signs and symptoms appear when 75% of kidney function is lost. Review the signs and symptoms of chronic kidney failure in Box 44-1 on p. 723 in the Textbook. Every system is affected as waste products build up in the blood.

Urinary System Disorders (cont’d) Treatment for chronic kidney failure includes: Fluid restriction Diet therapy Drugs Dialysis Dialysis is the process of removing waste products from the blood. Hemodialysis removes waste and fluid by filtering the blood through an artificial kidney (Done over several hours; 3-5 times per week, depending). Peritoneal dialysis uses the lining of the abdominal cavity (peritoneal membrane) to remove waste and fluid from the blood (typically performed every night for 8-10 hours). You will assist in the person’s care. Review the “Care of the Person in Chronic Kidney Failure” in Box 44-2 on p. 724 in the Textbook.

Reproductive Disorders Male reproductive system Produces and transports sperm Deposits sperm in the female reproductive tract Secretes hormones Female reproductive system Produces eggs (ova) Protects and nourishes the fetus during pregnancy Aging, many injuries, diseases, and surgeries can affect reproductive structures and functions. Sexual activities involve the structures and functions of the reproductive system.

Male Reproductive System

Female Reproductive System

STI’s

Reproductive Disorders (cont’d) A sexually transmitted infection (STI) is spread by oral, vaginal, or anal sex. Some people do not have signs and symptoms. Some are not aware of an infection. Others know but do not seek treatment because of embarrassment. STDs occur in the: Genital and rectal areas Ears, mouth, nipples, throat, tongue, eyes, and nose Review the contents of Table 44-1 on p. 725 in the Textbook. Herpes simplex of the male (A) and female (B).

STI’s Gonorrhea Chlamydia Trichomonas Hepatitis Syphilis HIV HepB HPV https://www.cdc.gov/std/healthcomm/fact_sheets.htm

Address: 1645 E Roosevelt St STI Clinic Maricopa County Department of Public Health STD Clinic at 1645 E Roosevelt St, Phoenix, Arizona Phone: (602) 506-2934 Address: 1645 E Roosevelt St Phoenix, Arizona 85006 Website: maricopa.gov

Reproductive Disorders (cont’d) Condom use helps prevent the spread of STDs. Especially the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) Some STDs are also spread through skin breaks, by contact with infected body fluids, or by contaminated blood or needles. Standard Precautions and the Bloodborne Pathogen Standard are followed. The Right Way To Use A Male Condom Condom Dos and Don’ts DO use a condom every time you have sex. DO put on a condom before having sex. DO read the package and check the expiration date. DO make sure there are no tears or defects. DO store condoms in a cool, dry place. DO use latex or polyurethane condoms. DO use water-based or silicone-based lubricant to prevent breakage. DON’T store condoms in your wallet as heat and friction can damage them. DON’T use nonoxynol-9 (a spermicide), as this can cause irritation. DON’T use oil-based products like baby oil, lotion, petroleum jelly, or cooking oil because they will cause the condom to break. DON’T use more than one condom at a time. DON’T reuse a condom. Review the Focus on Children and Older Persons: Sexually Transmitted Diseases Box on p. 724 in the Textbook.