1. Alteration in Genitourinary function
Lecture 12

2. Anatomy and physiology
The genitourinary is made up of the urinary and reproductive organs.
The urinary system of the kidneys, ureters, bladder and urethra.
Normal function requires the following:
Unimpaired renal blood flow.
Adequate glomerular filtration.
Normal Tubular function.
Un obstructed urine flow.
The functional unit of the kidney is nephron.

3. Urinary System Organs

4. Nephrons

5. Biological Variances All nephrons are present at birth
Kidneys and tubular system mature throughout childhood reaching full maturity during adolescence.
During first two years of life kidney function is less efficient.

6. Pediatric Differences
Kidney begins to reach adult functioning about 1 year of age
Infants cannot concentrate urine as efficiently as older children and adults.
Urine output:
Infant 2ml/kg/hr
Children 0.5ml/kg/hr.
Adolescent ml/hr

7. Bladder Bladder capacity increases with age 20 to 50 ml at birth
700 ml in adulthood

8. Review Genitourinary System
Maintain fluid & electrolyte balance through glomerular filtration, tubular reabsorption, and secretion
Hormonal functions
Produces renin in glomerulus—regulates BP.
Produces Erythropoietin—stimulates RBC.
Metabolized Vitamin D—to active form which is important in calcium metabolism.

9. Diagnostic Tests Urinalysis Ultrasound
VCUG – Voiding cysto urethrogram
IVP – Intravenous pyelogram
Cystoscopy
CT Scan
Renal Biopsy

10. VCUG test

11. IVP test

12. Renal Biopsy

13. Cystoscopy Invasive surgical procedure Visualizes bladder and
ureter placement.

14. CT Scan

15. Urinalysis Protein Leukocytes Red blood cells Casts Specific Gravity
Urine Culture for bacteria

16. Urine
Whaley & Wong
Application of urine collection bag.

17. Urinary Tract Infections

18. Urinary tract infection (UTI)?
UTI is an infection of urinary tract.
Classification of UTI:
Urethritis: inflammation of the urethra
Cystitis: inflammation of the bladder
Ureteritis: inflammation of the ureters
Pyelonephritis: inflammation of the upper urinary tract and kidneys

19. Causes urinary tract infections in children
Escherichia coli accounts for 80% of all cases.
Anatomical factors
stasis of urine due to incomplete bladder emptying.
Vesicoureteric reflux (the backward flow of urine from the bladder into the ureters during voiding)
Physical factors
The presence of urinary catheters allows ascending infection of the urinary tract.
Tight clothing or pants,.
Bubble baths and shampoos can irritate the ureters in both boys and girls and increase the risk of developing infection.
Chemical factors
An adequate fluid intake promotes flushing of the bladder, thereby reducing the number of organisms in the urine.
Urine is slightly acidic and most pathogens favour an alkaline medium. Certain beverages such as cranberry juice are thought to lower urinary pH.

20. Signs and Symptoms Frequency Urgency Dysuria
Small volumes of urine passed
Lower abdominal or flank pain
Enuresis
Fever
Haematuria
Vomiting
 Smell from urine

21. Management Elimination of the current infection.
Identification of contributing factors in order to reduce recurrence.
Prevention of systematic spread of the infection and the preservation of renal function.

22. Can UTIs in children be prevented
Hygiene
Complete bladder emptying.
Avoid the carbonated drinks, high amounts of citrus, caffeine (sodas), and chocolate.
Avoid bubble baths
Prophylactic antibiotics: Daily low-dose antibiotics under a doctor's supervision may be used in children with recurrent UTIs.

23. Interventions Antibiotic therapy for 7 to 10 days
E-coli most common organism 85%
Amoxicillin or Cefazol or Bactrim or Septra
Increase fluid intake
Cranberry juice
Acetaminophen for pain
Teach proper cleansing

24. 2.Enuresis
Unable to control bladder function although reached an age at which control of voiding is expected
“Nocturnal Enuresis”—Bed wetting

25. Etiology of Enuresis Control of urination is r/t maturation of CNS
By 5 years, most are aware of bladder fullness and can control voiding
Daytime first with nighttime dryness later.
Girls seems to master before boys.
Children with primary enuresis may have delayed maturations of this part of CNS. They are not able to “sense” bladder fullness and do not awaken to void.

26. Nsg Dx: Enuresis
low self-esteem r/t bedwetting or urinary incontinence
Impaired social interaction r/t bedwetting or urinary incontinence
Ineffective family coping r/t negative social response

27. Interventions Pharmacological intervention:
Desmopressin synthetic vasopressin acts by reducing urine production and increasing water retention and concentration
Tofranil: anticholinrgic effect – FDA approval for treatment of enuresis
Side effect may be dry mouth and constipation
Some CNS: anxiety or confusion
Need to be weaned off

28. Treatment Enuresis Diet control Bladder training
Reduce fluids in evening
Control sugar intake
Bladder training
Praise and reward
Behavioral chart to keep track of dry nights
Alarm system

29. Obstructive Uropathy
Obstructive uropathy is a condition in which the flow of urine is blocked, causing it to back up and injury one or both kidneys.

30. Ureteral Reflux

31. Common causes of obstructive uropathy include:
Bladder stones
Kidney stones
Benign prostatic hyperplasia (enlarged prostate)
Bladder or ureteral cancer
Colon cancer
Cervical cancer
Uterine cancer
Any cancer that spreads
Problems with the nerves that supply the bladder

32. Symptoms may include:
Mild to severe pain in the middle of the body (flank pain).
Fever         
Weight gain or swelling (edema)
Urge to urinate often
Decrease in the force of urine stream
Dribbling of urine
Not feeling as if the bladder is emptied
Decreased amount of urine
Blood in urine

33. Treatment
Stents or drains placed in the ureter or in a part of the kidney called the renal pelvis may provide short-term relief of symptoms.
Nephrostomy tubes, which drain urine from the kidneys through the back, may be used to bypass the obstruction.
A Foley catheter, placed through the urethra into the bladder, may also be helpful.

34. Acute Renal Failure
Sudden interruption of kidney function resulting from obstruction, reduced circulation, or disease of the renal tissue
Results in retention of toxins, fluids, and end products of metabolism
Usually reversible with medical treatment
May progress to end stage renal disease, uremic syndrome, and death without treatment

35. Acute Renal Failure Causes Prerenal Intrarenal Postrenal
Hypovolemia, shock, blood loss, embolism, pooling of fluid r/t ascites or burns, cardiovascular disorders, sepsis
Intrarenal
Nephrotoxic agents, infections, ischemia and blockages, polycystic kidney disease
Postrenal
Stones, blood clots, urethral edema from invasive procedures
Nephrotoxic agents – antibiotics, lead and mercury, chemicals,

36. Acute Renal Failure Symptoms
vomiting
edema
Increase K+
decrease Na
Increase BUN and creatinine
Acidosis
uremic breath
hypertension caused by hypovolemia, anorexia
sudden drop in UOP
convulsions, coma
Nausea
Loss of appetite
Headache

37. Acute Renal Failure Medical treatment Fluid and dietary restrictions
Maintain E-lytes
D/C or change cause
May need dialysis to jump start renal function
May need to stimulate production of urine with IV fluids, Dopomine, diuretics, etc.
If caused by meds, must stop meds
If caused by obstruction, must remove obstruction
If caused by blockage of artery, must open artery
Dietary restrictions may include : low K+, adequate carbs, also may give TPN
Fluids : calculate closley I/O
Hyperkalemia is life threatening
Lower K+ with Kayexalate, glucose, insulin, NaBicarb, caalcium carbonate

38. Acute Renal Failure Medical treatment Hemodialysis Peritoneal dialysis
Subclavian approach
Femoral approach
Peritoneal dialysis

39. Acute Renal Failure Nursing interventions
Monitor I/O, including all body fluids
Monitor lab results
Watch hyperkalemia symptoms: malaise, anorexia, parenthesia, or muscle weakness, ECG changes
watch for hyperglycemia or hypoglycemia if receiving TPN or insulin infusions
Maintain nutrition
Safety measures
Mouth care
Daily weights
Assess for signs of heart failure
Skin integrity problems