BENIGN PROSTATIC HYPERPLASIA (prostate Surgery:

enlargement)
- Trans
- Urine obstruction, due to the prostate gland - Urethral
- Resection
Alpha 1 blocker – relax bladder neck.
- Prostate
- Effect: increase urine output
- Side effect: vasodilation
o Orthostatic hypotension

Hormonal therapy - decrease DHT (di-hydro

testosterone) – sex hormone) – shrink the prostrate
(effect >6months)

- Finasteride
- Saw Palmetto (herbal)
o Side effect: impotence
o Enlargement of breast (gynecomastia)

Sign and symptoms: incomplete bladder emptying.

(FUN)
Complications:
• FREQUENCY
• TUR-Syndrome – diluted blood due to the
• URGENCY
absorption of irrigation and blood. If there is
• NOCTURIA
diluted blood, which leads to CEREBRAL EDEMA
Complications: due to osmosis.
• Hemorrhage – blood loss
1. Infection (UTI)
o Hypotension (always monitor vital
2. Bladder distension
signs)
o HOW TO CHECK?
• Clot obstruction – contracts which leads to
▪ Round swelling above the pubis
painful bladder spasm.
▪ Restlessness
3. Hydronephrosis - Long term complications:
o ASSESSMENT:
▪ Fluid overload • Could be impotence (rare)
▪ Hypertension • Retrograde ejaculation – retro (backwards
▪ Pain (low back area) ejaculation) sperm goes to the bladder.
(costovertebral angle) o Male infertility
4. Renal failure POST OP TURP
o Increase serum creatinine
CBI (CONTINUOUS BLADDER IRRIGATION) /
AVOID: CYSTOCLYSIS
- Anticholinergic 3-way catheter
- Cholinergic

DRUGS TO USE: (ZOSIN, OSIN)

- Doxazosin
- Terazosin
- Prazosin
- Tamsulosin
Which is more inflow to outflow? – outflow (NSS, o usually causes brown urine (harmless)
BLOOD, URINE) o complication: Pulmonary
▪ Dyspnea
What is the normal color? Pink – amber yellow in 3 days
▪ Chest
Abnormal: ▪ (Notify the physician to stop the
medication)
- Bright red (arterial bleeding) – fast bleeding
o Check for vital signs (priority) Bactrim – Trimethoprim (Sulfamethoxazole)
- Dark red (venous bleeding) – slow bleeding
Sulfa based – crystalluria (crystal urine)

- Monitor: creatine
Clot obstruction - Management: increase fluid

- Painful bladder spasm

o Assess (priority) the output
o Irrigate (30-50 NSS)
o Pain meds:
▪ Bella donna
▪ Opium suppository
o Anticholinergic drugs – relaxes the
bladder (decrease the urine)
SIGN AND SYMPTOMS
o Oxybutynin
- Dysuria – painful burning urination
- Hematuria
UTI (URINARY TRACT INFECTION
- Fever
PHARMACOLOGY: - Foul smelling urine

- Urinary analgesic – for pain Elderly – asymptomatic UTI

o Phenazopyridine (Pyridium)
- Manifestation:
o Side effect: Red orange urine
o Sudden onset of confusion with no
▪ Wear dark underwear
history of dementia
UTI – Dysuria – painful burning urination
MANAGEMENT
- Antibiotics
- Increase fluids
o Uncomplicated UTI – young women +
- Heat on the abdomen – relaxes which decrease
sexually active – 3days above
the pain
o Complicated UTI – underlying disease
- Hot sitz bath
like: - 7 days above
- Acid ash diet
▪ Diabetes Mellitus
o Avoid milk and vegetables
▪ Multiple Sclerosis
o Prune juice
Methenamine (specific for UTI) – urine acidic o Cranberry
activate o Any meat (protein – acid ash)
- Avoid bladder irritants
o Acid ash diet
o Caffeine
▪ x alkaline
o Alcohol
▪ x milk
o Spicy foods
Nitrofurantoin

o encourage milk - help with GI

disturbances
PREVENTION MANAGEMENT

1. Pain management (priority)

a. IV narcotic analgesics
i. Demerol (Meperidine)
2. Increase Fluids
3. Strain the urine – to collect sample of the stone
– laboratory – to know the composition of the
stone. TYPES OF STONE:
a. Calcium oxalate – acid ash diet
b. Calcium phosphate – acid ash diet
c. Struvite – acid ash diet
d. Urice acid – alkaline diet
e. Cystine – alkaline diet
4. Extracorporeal Shock Wave lithotripsy

BPH – urine obstruction

UTI – dysuria a. Management

i. Preparation:
Calculi – severe pain 1. Informed consent
URINARY CALCULI – Stones in the urinary tract (physician)
2. NPO – 6-8hrs
Nephrolithiasis (stones forming in the kidney) 3. IV line
a. Sedative
Signs and symptoms
(Midazolam)
- Hematuria – blood in the urine b. Post op care
- Severe pain – which leads to vomit and diarrhea i. Ambulatory – to remove the
- Renal colic – kidney pain (flank area) stone (✓)
o Radiates to the: ii. Brusing and Bright hematuria
▪ Testicles (male) (✓)
▪ Bladder (female) iii. Clots in the urine – indication of
Urolithiasis – stones in the ureters hematoma (X)
iv. Dysuria – infection (X)
- Hematuria – blood in the urine v. Excrete stones in the urine (✓)
- Severe pain – which leads to vomit and diarrhea vi. Flank pain (X)
- Ureteral colic wave like intermittent pain
o Stone movement = pain
o Stone stop = stop pain
NEPHROTIC SYNDROME - kidney disorder that causes
your body to pass too much protein in your urine
Generalized Edema (Anasarca)
Proteinuria – protein + urine

Damage Glomerulus – large molecules can now pass –

massive proteinuria

Cause: unknown!

Theory: Autoimmune - caused the damage

Drug of choice: immunosuppressants

Example:

- Methotrexate (for cancers, chemotherapy)

RAAS
- Steroids: Prednisone, Cortisone

Complication:

- Infection

PRIVATE ROOM, IMMUNOSUPPRESSANT THERAPY

Signs and Symptoms

Proteinuria or Albuminuria

Management: Diuretic

1. Avoid Furosemide – Potassium wasting diuretic

2. Spironolactone – potassium sparring diuretic

NEPHROTIC SYNDROME

- NO ALBUMIN IN THE BLOOD

- EDEMA ANASARCA
Serum protein: 6 – 8 g/dL - PROTEINURA
- HYPERLIPIDEMIA
Serum Albumin: 3.5 – 5g/dL - RAAS – low potassium
Hyperlipidemia - OBTAIN WEIGHT DAILY
- TUBIG RETENTION
- IMMUNOSUPPRESSANTS – infection risk
- CHON or PROTEIN (intake)

GLOMERULONEPHRITIS - is inflammation of the tiny

filters in the kidneys (glomeruli).

Due to:

SORE THROAT

- Group A beta hemolytic streptococcal

AUTOIMMUNE
Glomerular injury ACE INHIBITORS (-prill) (blocks ACE) – vasodilator

- Gross hematuria - An hour before meal or empty stomach

o Cola colored - Coughing & Angioedema
o RBC plugs urine - End in prill
- Proteinuria o Enalaprill
o Foamy urine o Captoprill
- Increases serum potassium level
Glomerular injury leads to Scar Glomerulus which
causes decrease Glomerular Filtration Rate (125ml/min) NOTIFY THE PHYSICIAN – TO STOP THE MEDICATION

ARBS

Angiotensin II Receptor Blockers

- Vasodilator
- Increases serum potassium
- No cough
- No angioedema
FLUID OVERLOAD - (-sartan)
WEIGHT GAIN POTASSIUM SPARING DIURETICS (Spironolactone)
HYPERTENSION - Blocks aldosterone
- Aldactone
EDEMA
HYPERKALEMIA – increase potassium
- Mild
- Periorbital Cell destruction
COMPLICATIONS - always PISO (potassium in sodium out)
- Hypertensive encephalopathy Potassium level – 3.5 – 5.5
- Pulmonary edema
o Crackles on auscultation CRAM

MANAGEMENT: - Cell destruction

- Renal failure
- Neurological assessment - Acidosis (metabolic)
- Seizure precautions - Meds
CUTIEPIE Signs and Symptoms: MURDER
- COLA COLOR URINE - Muscle weakness
- URINE FOAMY - Urine decreases
- THROAT INFECTION – GABHS - Respiratory distress
- INCREASE SERUM POTASSIUM - Diarrhea
- EDEMA - ECG
- PROTEINURIA o >7 = Tall T – wave
- INCREASE SERUM CREATINE AND BUN o >10 = Ventricular Tachycardia
- ENCEPHALOPATHY o Leads to Cardiac arrest
- Reflexes
o Early: Hyperreflexia
o Late: hyporeflexia
MANAGEMENT: SICK

- Sodium bicarbonate (alkaline, reverses acidosis

- Insulin IV (regular insulin)
- Calcium gluconate – cardiac stimulant
- Kayexalate (sodium potassium exchange resin)
(sodium polystyrene)
o Oral
o Enema RENAL FAILURE
▪ Management: 30mins
Normal functions of the kidney

- Remove water, excess electrolytes

CENA

- Converts Vitamin D to final form

o Vit D is important for calcium
absorption. (ESRD patients sometimes
experiences fractures)
- Erythropoietin – RBC production
o Patients who have renal failure
PLOT (kinds of diuretics) experiences anemia
Potassium wasting diuretic - Nitrogen waste excretion, Creatinine (0.6 –
1.2ml/dL) and BUN (10 – 20mg/dL)
o Complication: hypokalemia o Nitrogen use for muscle repair
- Loop diuretic o Serum creatinine
o Furosemide o Ammonia – CNS toxin (<45mg/dL)
▪ Prioritize hypokalemia ▪ Liver: urea
▪ Side effect: photosensitivity • BUN
o Management: >2-3mins - ABG
o Less than a minute leads to ototoxic o Excrete acid
(deafness) ▪ Patient with renal failure
- Thiazide experiences Metabolic Acidosis
o (-diuril) Hydrochlorodiuril
o Excrete: water, potassium, hydrogen ACUTE RENAL FAILURE or AKI (Acute kidney injury)
(acid) – which causes metabolic
Causes:
alkalosis
o Retains: calcium 1. Pre-renal: Insufficient blood supply in the
- Osmotic diuretic kidneys
o Mannitol a. Shock
o Complication: Pulmonary Edema b. Heart failure
o Assess: crackles 2. Intra-Renal: Direct damage to the kidney
a. Nephrotoxic drugs (-mycin)
Kidney – nephron (unit of kidney)
i. Gentamycin
- Glomerulus ii. Erythromycin
- Tubules iii. vancomycin
o Proximal convoluted tubule b. Contrast medium
o Loop of Henle 3. Post-Renal: unable to secrete urine due to:
o Distal convoluted tube a. BPH
b. Stone obstruction
PHASES/STAGES: ▪ Metabolic Acidosis
- Kussmaul’s respiration
- Oliguric phase: <400ml/24hr or <30ml/hr
(rapid respiration)
(decrease GFR)
▪ Azotemia (>1.2ml/dL >
a. Fluid overload
20ml/dL)
▪ Hypotension
- Increase creatinine
▪ Weight gain
- Increase bun
▪ Edema
- Diuretic phase
▪ CHF (congestive heart failure)
a. Diuresis – 5L/day (n: 1.5L/day)
- Crackles on
▪ Complication: dehydration
auscultation
- Recovery phase
b. PUMA
a. 1 – 2 years
▪ Potassium – hyperkalemia
- Cardiac arrest CHRONIC RENAL PHASE or CKD (chronic kidney disease)
a. Assess ECG
Cause: (from)
b. Sodium
bicarbonate - Hypertension
c. Insulin o Mostly asymptomatic
d. Calcium - Diabetic nephropathy
gluconate o Mostly asymptomatic or
e. Kayexalate microalbuminuria – proteinuria which
▪ Phosphorus = leads to foamy urine
hyperphosphatemia (n: 2.5 – - Autoimmune
4.5mg/dL)
- Skin pruritus, that’s why >10% – mild damage
RF patients experiences >40% – moderate
itchy skin
- Decrease calcium, leads >70% - severe
to hypocalcemia >85% - ESRD or ESKD (end stage renal disease or end
- Drug of choice: stage kidney damage)
Aluminum
a. Calcium ESRD (END STAGE RENAL DISEASE)
bicarbonate
Oliguria: <400ml/24hr
- Avoid magnesium
▪ Uremia: increase BUN Anuria: <50ml/24hr
- Skin pruritus
LAHAT MERON SA ARF (ACUTE RENAL FAILURE) MERON
- Pericarditis
SA ESRD PLUS MORE!
- Ammonia (CNS toxin) –
attacks brain function Anemia
(renal encephalopathy)
a. Impaired
handwriting
b. Asterixis (flap
tremors)
confusion
c. Altered level of
consciousness
d. Coma
- Low protein diet (no
protein)
Drug of choice: Epogen (Epoeitin Alfa) HEMODIALYSIS – removal of blood by artificial means

o Subcutaneous or IV
o Two weeks before effective (2-6weeks)
▪ If in an emergency, use blood
transfusion
o Increase RBC production
o Refrigerator

Priority:

1. Hypertension
2. Thrombus formation
Not improved hemodialysis. - ANEMIA
Supportive treatment for anemia:

- FE supplements (iron)
- Folic Acid

Osteodystrophy - Abnormal changes in the growth and

formation of bone.

- Complications: fractures
- Management:
o Activated Vitamin D
o Phosphate binder
Before Hemodialysis After
o Calcium
Increase Potassium Decrease
Uremic frost – BUN = >200 goes to the skin – which Increase BP Decrease
leads to discoloration: gray-bronze skin Captopril Meds Removal
vasodilator
Skin – goes to the sweat glands + urea – dry urea Metabolic ABG Normal
powder or frosting acidosis
Increase Creatine and Decrease
Urea
Increase Weight Decrease

Complications:

- Disequilibrium syndrome or dialysis equilibrium

syndrome – first few sessions
o Cerebral edema causes increase intra
cranial pressure leads to altered level of
consciousness which causes seizures.
(too fast removal solutes outside brain)
o Prevention: slower hemodialysis
o Management: notify the physician
- Air embolism
o Pulmonary embolism leads to dyspnea
and chest pain
o Management: Left Trendelenburg (air
trapped at the ride side of the heart