1. Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 24-1 Chapter 24 Genitourinary/Renal Disorders

2. 24-2 Objectives

3. General Anatomy Kidneys –Retroperitoneal space –Renal artery –Renal vein –Ureter –Filter the blood –Nephrons Function units of the kidneys 24-3

4. General Anatomy Components –Kidneys –Ureters –Bladder –Urethra 24-4

5. Functions The urinary system is responsible for the following functions: –Maintaining a balance of salts and other substances in the blood –Excreting waste products and foreign chemicals –Assisting in regulating arterial blood pressure –Producing a hormone that aids the formation of red blood cells 24-5

6. Renal Disorders 24-6

7. Kidney Stones Kidney stones are also called renal calculi –A hard mass that forms from crystallization of excreted substances in the urine –Shape and size vary 24-7

8. Kidney Stones Assessment findings and symptoms –Excruciating pain that is usually located in the flank, radiating to the groin –Nausea, vomiting, and sweating common –Restlessness –Hematuria –Dysuria 24-8

9. Urinary Tract Infection A urinary tract infection (UTI) is an infection that affects any part of the urinary tract. Inflammation/infection –Urethra = urethritis –Bladder = cystitis –Kidneys = pyelonephritis 24-9

10. Urinary Tract Infection Assessment findings and symptoms –Fever –Dysuria, hematuria –Urinary hesitancy –Lower abdominal pain and/or pressure (especially during urination) –Passing frequent, small amounts of urine –Cloudy or strong-smelling urine 24-10

11. Urinary Catheters A urinary catheter is a tube that is inserted into the bladder to empty it of urine. –Condom catheter –Straight catheter –Indwelling catheter 24-11

12. Urinary Catheters Before transporting a patient with a urinary catheter: –Ensure that the catheter is securely taped –Assess the urine collection bag –Note the color of the patient’s urine –Note if the patient’s urine is thick, cloudy, has mucus in it, or has red specks in it –Note if the patient’s urine has a strong smell or if he complains of pain 24-12

13. Pyelonephritis Pyelonephritis is an infection of the kidney. –Often the result of a bacterial bladder infection –More common in females than in males – Severe or recurring infections can cause permanent kidney damage. 24-13

14. Pyelonephritis Assessment Findings –Fever, chills –Fatigue –Nausea, vomiting –Dysuria –Hematuria –Cloudy or abnormal urine color –Foul or strong urine odor –Flank pain or lower back pain –Warm, moist skin –Increased urinary frequency –Pain increases with movement 24-14

15. Renal Failure Acute renal failure (ARF) Chronic renal failure (CRF) End-stage renal disease (ESRD) 24-15

16. Acute Renal Failure Assessment findings –Reduced or no urinary output –Excessive urination at night –Lower extremity swelling –Anorexia –Altered mental status –Metallic taste in mouth –Tremors or seizures –Easy bruising or prolonged bleeding –Flank pain –Tinnitus –Hypertension –Abdominal pain or discomfort 24-16

17. Chronic Renal Failure Assessment findings –Headache –Weakness –Loss of appetite –Vomiting –Increased urination –Rusty or brown- colored urine –Increased thirst –Hypertension –Itching 24-17

18. End-Stage Renal Disease Assessment findings –Altered mental status –Shortness of breath –Peripheral edema –Chest pain –Bone pain –Itching –Nausea, vomiting, diarrhea –Bruising –Muscle twitching, tremors, seizures –Hallucinations 24-18

19. Dialysis –A procedure that removes waste products from the blood that is normally performed by the kidneys –Two types Hemodialysis Peritoneal dialysis 24-19

20. Hemodialysis Requires the use of a machine called a dialyzer or artificial kidney Access to the patient’s vascular system is also necessary 24-20

21. Arteriovenous Shunt Used for short-term dialysis treatment An AV shunt is external Consists of two pieces of flexible tubing –One piece of the tubing is placed in an artery –Tip of the other is placed in a nearby vein 24-21

22. Arteriovenous Fistula Used for long-term dialysis treatment A large artery and vein are joined, usually at the patient’s wrist or near the elbow An AV fistula is placed under the patient’s skin Can often be used for years 24-22

23. Arteriovenous Graft Most commonly placed in the upper or lower arm Artificial material or a blood vessel from the patient’s body (such as a vein from the thigh) is used 24-23

24. Hemodialysis Procedure Transfer of a large volume of blood between the patient and the machine Dialysate draws excess water and salt and waste products from the blood through a semipermeable membrane 24-24

25. Hemodialysis Procedure Usually performed 2 to 3 times per week and lasts for 4 to 5 hours Often performed in a dialysis center or hospital Many patients have home dialysis units and can perform the procedure after receiving special training 24-25

26. Hemodialysis Possible complications –Muscle cramps –Nausea and vomiting –Hypotension –Infection and hemorrhage at vascular access site 24-26

27. Peritoneal Dialysis A catheter is inserted into the patient’s peritoneal cavity The catheter remains permanently in the abdomen The patient’s peritoneum serves as a semipermeable membrane across which wastes and excess fluids are exchanged 24-27

28. Peritoneal Dialysis Types of peritoneal dialysis –Continuous ambulatory peritoneal dialysis (CAPD) –Continuous cyclic peritoneal dialysis (CCPD) –Intermittent peritoneal dialysis (IPD) 24-28

29. Peritoneal Dialysis Possible complications –Peritonitis –Blockage of the catheter from clots –Kinking of the catheter –Hypotension –Hypovolemia 24-29

30. Patient Assessment 24-30

31. Patient Assessment Scene size-up General impression and primary survey Assess mental status Assess airway and breathing 24-31

32. Patient Assessment Assess pulse –Estimate heart rate –Assess pulse regularity and strength Assess perfusion Establish patient priorities Determine the need for additional resources Make a transport decision 24-32

33. Patient History Signs/symptoms Allergies Medications Past medical history Last oral intake Events prior Onset Provocation/ Palliation / Position Quality Region/Radiation Severity Time 24-33

34. Physical Examination Observe the patient’s position Listen to breath sounds 24-34

35. Physical Examination Assess vital signs and oxygen saturation Avoid taking a blood pressure in the arm with an AV shunt or fistula. 24-35

36. Physical Examination Assess the patient’s abdomen If the patient receives peritoneal dialysis, look at the area around the dialysis catheter for redness, swelling, or discharge. Carefully document all patient care information on a prehospital care report. 24-36

37. Emergency Care Prehospital care is supportive Allow the patient to assume a position of comfort, administer oxygen –Sitting position if pulmonary edema present Control bleeding from AV shunt or fistula if present –Place patient in supine position if signs of shock present Reassess as often as indicated 24-37

38. Questions? 24-38