Unit 6 Med

UNIT 6: Genitourinary System
FATIN NUR DHABITAH BT ZAINUDDIN

CLINICAL
FEATURES

At the end of the topic the student will be able to:
o Define and discuss the pathogenesis, signs, and
symptoms of the digestive tract abnormalities.
3
TOPIC OUTLINE
5.1 SYMPTOMATOLOGY GENITO URINARY SYSTEM & MALE

REPRODUCTIVE SYSTEM.
LEARNING OUTCOMES
At the end of this chapter, students will be able to:
• Explain genito urinary system & male reproductive system

symptomatology.
5.1.1 Explain genito urinary system & male reproductive system
symptomatology.
q SYMPTOMATOLOGY:
1. Polyuria.
2. Oliguria.
3. Nocturia.
4. Haematuria.
5. Pyuria or Dysuria.
6. Enuresis.
symptomatology.
q SYMPTOMATOLOGY:
1. Polyuria.
v Normal urine output in adult is 15ooml. per day.
v Polyuria is a condition usually defined as excessive or abnormally large
production or passage of urine greater than 2500ml. per day in adults).
v Increased production and passage of urine may also be termed diuresis.
v The most common cause of polyuria in both adults and children is
uncontrolled diabetes mellitus causing an osmotic diuresis.
symptomatology.
q SYMPTOMATOLOGY:
1. Polyuria.
v Other causes are:
§ Excessive secretion of aldosterone due to adrenal cortical tumor,
§ Primary polydipsia (excessive fluid drinking).
§ Central diabetes insipidus.
§ Nephrogenic diabetes insipidus.
symptomatology.
q SYMPTOMATOLOGY:
2. Oliguria.
v Oliguria or hypouresis is the low output of urine. It is clinically classified as
an output more than 100 ml/day but less than 400ml/day.
v The decreased output of urine may be a sign of:
§ Dehydration.
§ Kidney failure.
§ Hypovolemic shock.
§ Urinary tract .
symptomatology.
q SYMPTOMATOLOGY:
2, Oliguria.
v The most extreme type of oliguria is called anuria.
v Anuria is defined or clinically classified as less than 50ml. urine output per
day.
symptomatology.
q SYMPTOMATOLOGY:
3. Nocturia.
v Excessive urinating at night. Nocturia can be normal and more common with
aging.
v It is important to assess underlying causes such as diabetes or urinary
infection.
v Nocturia is a common symptom in both men and women.
v It can be troublesome in itself, by disturbing sleep, and can have a significant
impact on quality of sleep and quality of life.
v Nocturia is a symptom, not a diagnosis.
symptomatology.
q SYMPTOMATOLOGY:
4. Haematuria.
q Haematuria, is the presence of red blood cells (erythrocytes) in the urine.

q It may be idiopathic or benign.
q It can be a sign that there is a:
§ kidney stone.
§ A tumor in the urinary tract (kidneys, ureters, urinary bladder, prostate, and
urethra).
§ If white blood cells are found in addition to red blood cells, then it is a signal
of urinary tract infection.
symptomatology.
q SYMPTOMATOLOGY:
5. Pyuria or Dysuria.
v Pain during urination, or difficulty urinating. This pain can occur before and
after urinate. Dysuria is usually caused by inflammation of the urethra,
frequently as a result of infection.
v Most common bacteria that causes UTIs is Escherichia coli (E. coli), which is
found in the gastrointestinal (GI) tract.
v May complain of feeling like to urinate several times a day (urinary
frequency) or like to urinate immediately (urinary urgency) but very little
urine comes out.
v Men are also more likely than women to complain of taking longer to begin
urinating.
symptomatology.
q SYMPTOMATOLOGY:
6. Enuresis
v Involuntary urination, bed-wetting or urinary incontinence esp during sleep

which may be caused by a variety of factors.
v These include disorders of the kidneys, bladder, or ureter and/or poor
control of the muscles that control the release of urine.
v Enuresis is also occasionally associated with neurological disorders, such as
Tourette's syndrome, particularly in children.
v Nighttime (nocturnal) enuresis may be a symptom of a sleep disorder.
T.B Kidney.
Cystitis.
Orchitis.
Epidydimitis.

5.2.1 – 5.2.4 T.B. KIDNEY, CYSTITIS, ORCHITIS AND EPIDYDIMITIS.
LEARNING OUTCOMES
• Define T.B. kidney.

• State the causes T.B. kidney.
• State the clinical manifestation of T.B. kidney.
• Explain the management of T.B. kidney.
5.2.1.1 DEFINTION OF T.B. KIDNEY
q Kidney disease caused by tuberculosis. Tuberculosis is caused by

bacteria (Mycobacterium tuberculosis) and is a disease that
normally affects the lungs but it can affect many other body organs
such as the kidney.
q The tuberculosis bacterium is initially inhaled into the lungs where it

can then spread to other organs. Symptoms may not develop for
many years, even decades, after the initial infection. Also called
nephrotuberculosis or tuberculosis of the kidney.
5.2.1.2 CAUSES OF T.B. KIDNEY
q Tuberculosis of the kidney and urinary tract is, like other forms of the disease.
q Caused by members of the Mycobacterium tuberculosis complex. By far the most
common causative organism is the human tubercle bacillus, M. tuberculosis, but
the bovine tubercle bacillus, M. bovis, occasionally can be responsible.
q The vaccine strain, Bacille Calmette-Guérin (BCG), also has been the cause of renal
lesions as a complication of intravesical instillation of BCG for the treatment of
superficial bladder cancer.
5.2.1.2 CAUSES OF T.B. KIDNEY
q Chances of becoming infected are higher in certain countries where TB

is common.
q People who are at greater risk for TB infection include:
v The elderly.
v Homeless people.
v People with substance use problems.
v Weakened immune systems from HIV or AIDS (acquired immune
deficiency syndrome).
v Close or frequent contact with someone who has active TB symptoms.
Health care workers who may be exposed to patients with active TB.
5.2.1.3 CLINICAL MANIFESTATION OF T.B. KIDNEY
q CONSTITUTIONAL SYMPTOMS.:
v Coughing that lasts three or more weeks.

v Coughing up blood.
v Chest pain, or pain with breathing or coughing.
v Unintentional weight loss.
v Fatigue & malaise.
v Fever.
v Night sweats.
v Chills.
v Loss of appetite
v Kidney inflammation.
v Pyelonephritis.
v Kidney pain.
5.2.1.3 CLINICAL MANIFESTATION OF T.B. KIDNEY
q Tuberculosis of the urinary tract is easily overlooked.

v Bacterial cystitis. Suspicions of tuberculosis are aroused only when there
is no response to the usual antibacterial agents.
v Urine examination reveals pyuria in the absence of a positive culture on
routine media.
v Back, flank, and suprapubic pain.
v Hematuria.
v Frequency of passing urine.
v Nocturia.
v Renal colic is uncommon, occurring in fewer than 10% of patients.
5.2.1.4 DIAGNOSTIC INVESTIGATION OF T.B. KIDNEY
q Urine culture - Pyuria in the absence of infection.

q Inravenous urography to detect changes in a single calyx with
evidence of parenchymal necrosis, and typically there is calcification
on the plain film.
q More advanced disease, urography will show calyceal distortion,
ureteric strictures and bladder fibrosis.
q Ultrasound examination of the urinary tract may reveal renal
calycea,l dilation and evidence of obstruction.
LEARNING OUTCOMES
• Define cystitis.
• State the causes of cystitis..
• State the clinical manifestation of cystitis.
• Explain the management of cystitis.
5.2.2.1 DEFINTION OF CYSTITIS.
q Cystitis refers to inflammation of the wall of the bladder due bacterial

infection of Escherichia coli.
q Affects people of both sexes and all ages but more common
among females than males.
5.2.2.2 CAUSES OF CYSTITIS
v Sex. Frequent and/or vigorous sex increases the chances of physical damage
or bruising to the urethra and bladder, which in turn makes the likelihood of
cystitis developing higher.
v Poor hygiene can cause cystitis. Women have shorter urethras than men. A
woman's urethra opening is much nearer the anus than a man's.
Consequently, there is a higher risk of bacteria entering the urethra from
the anus.
v Does not empty his/her bladder completely, creating an environment for
bacteria to multiply in the bladder. Fairly common among pregnant women,
and also men whose prostates are enlarged.
v Diabetes. Urine can contain more sugar than usual. Passing urine that
contains more sugar than usual can encourage bacteria to grow in the
bladder and urethra.
v Menopause. During the menopause women produce less mucus in the

vaginal area. This mucus stops the bacteria from multiplying. Women
on HRT(hormone replacement therapy) have a lower risk of developing
cystitis compared to menopausal women not on.
v Having a catheter. Bacteria could get into the bladder through the catheter.
v Contraception. In women, using a diaphragm (a thin, flexible cap inserted
into your vagina) may increase your risk of getting cystitis. This is because
your diaphragm could prevent your bladder from emptying properly, which
can encourage bacteria to grow.
v Kidney or bladder stones. These can prevent your bladder from emptying
fully, which can encourage bacteria to grow. In men, a common cause of
cystitis is passing urine less often because the prostate is enlarged.
5.2.2.3 CLINICAL MANIFESTATION OF CYSTITIS
q Common symptoms of cystitis include:
v Pain when pass urine.

v Blood in the urine.
v Cloudy, dark or strong smelling urine.
v Frequent, urgent need to urinate, but you only pass small amounts or no
urine.
v Pain during sex.
v Pain in your lower abdomen (tummy) or lower back.
v Feeling tired or generally unwell.
v Mild fever.
5.2.2.4 MANAGEMENT OF CYSTITIS
v Cystitis usually clears up by itself, without the need for treatment.

v painkillers such as paracetamol and ibuprofen, may help to ease your pain.
v Increase fluid intake to help flush out the infection.
v Placing a warm hot water bottle on your lower back can help soothe any
discomfort in this area.
v Try to rest as much as possible.
v Antibiotic: - Trimethoprim and nitrofurantoin are commonly used to treat
cystitis. On average, antibiotics shorten the time you have symptoms by
about a day.
v Refrain from sex when infected.
5.2.3.1 DEFINTION OF ORCHITIS
q Orchitis is inflammation of the testes.

5.2.3.2 CAUSES OF ORCHITIS
v Sexually transmitted diseases eg gonorrhoea.

v Active mumps particularly in adolescent boys.
v Damage to the blood vessels of the spermatic cord during inguinal
herniorrhaphy.
5.2.3.3 CLINICAL MANIFESTATION OF ORCHITIS
v Hematospermia (blood in the semen)

v Hematuria (blood in the urine)
v Severe pain.
v Visible swelling of a testicle or testicles and often the inguinal
lymph nodes on the affected side
5.2.3.4 MANAGEMENT OF ORCHITIS
v Oral antibiotic such as cefalexin or ciprofloxacin until infection

clears up.
v non-steroidal anti-inflammatory eg naproxen or ibuprofen to
relieve pain.
5.2.4.1 DEFINTION OF EPIDIDYMITIS
q Inflammation and infection of the epididymis.

5.2.4.2 CAUSES OF EPIDIDYMITIS
q The causes of epididymitis vary depending on your age and behavior.

q In children it is most commonly associated with urinary tract
infections.
q In young, sexually active men, it is often linked to sexually
transmitted infection.
q in older men it is often caused by enlargement of the prostate gland.
q Bacterial infections - possibly spread from the rectal area or following
a urological procedure, also may cause epididymitis.
q Injury to the groin may cause epididymitis.
5.2.4.3 CLINICAL MANIFESTATION OF EPIDIDYMITIS
v Pain, tenderness, and swelling in the scrotum (epididymides or testicles)

that gradually get worse are the most common symptoms of epididymitis.
q Other symptoms may
v Low-grade fever and chills.
v Painful urination.
v Discharge from penis.
v Pain in the pelvic area.
v Pressure in the testicles.
v Painful and swollen scrotum.
v Red and warm scrotum.
v Pain and tenderness in the testicles.
v Enlarged lymph nodes in the groin.
5.2.4.4 management OF EPIDIDYMITIS
q Antibiotics are used to treat epididymitis.
q Supportive measures, such as bed rest with elevation of

the hips.
q Anti-inflammatory medicines (such as ibuprofen or

ketoprofen), may help relieve discomfort caused by
epididymitis.
q avoiding sexual intercourse to avoid risk of infection.

Urethritis.
Glomerulonephritis.
Nephrotic syndrome.
Pyelonephritis.

2. Infections:
. Urethritis.
. Glomerulonephritis.
. Nephrotic syndrome.
. Pyelonephritis.
. Cystitis.
39
. Urethritis:
. Inflammation of the urethra due to

gonococcal infection.
. Infection in men.
. In woman is usually associated
with cytitis or vaginitis.
40
. Urethritis:
41
. Incidence:
. Is a communicable disease.
. Mostly spread through sexual
contact and mostly occur in men.
. In woman is usually associated
with cytitis or vaginitis.
42
. Etiology:
a. Mongonococcal urethritis:
. Trichomonas vaginitis.
. Herpes simplex.
b. Gonococcal urethritis:
. Neisseria gonorrhoea.
c. Nonsexually transmitted:
. Bacterial urethritis.
. Trauma.
43
. Clinical Manifestation:
. Usually asymptomatic.
. Itching and burning around area of
urethra.
. Urethral discharge:
. Scanty or profuse.
. Thin, clear or mucoid.
. Thick and purulent (gonococcal).
. Dysuria, frequency and urgency.
. Penile discomfort.
. Nocturia.
. Microscopic or gross haematuria
44
. Diagnostic Evaluation:
. Urethral discharge or urine for gram

stain.
. Urine culture to detect presence of
bacteria.
. Urine microscopy shows RBC.
. First voided urine for screening.
45
. Management:
. Antibiotic:
. Im Procain Penicillin 2.4 gram.
. Capsule Ampicillin 2gram.
. Mist Potassium citrate 15 ml. tds to
relieve dysuria.
. Avoid sexual contact until heal.
46
. Nursing Care:
. Rest in bed.
. Drink plenty of water.
. Personal cleanliness especially in
the genitals.
. Patient partners or contacts to go
for examination and treatment.
47
. Complications:
. Prostatitis.
. Urethral stricture.
. Sterility.
. Salpingitis and ovaritis.
. Septicaemia.
. Epididimitis.
. Rectal infection, pharyngitis,
conjunctivitis.
48
Assessment:
. Obtain history.
. Assess signs and symptoms.
. Perform genital and abdominal
examination to assess for extent of
infection.
49
. Patient education and Health
Maintenance:
. Advise safer sex practices.
. Questions about voiding habits and
personal hygiene practices.
. Follow-up.
50
. Glomerulonephritis:
. Definition
. Risk factor.
. Etiology & pathophysiology.
. Clinical manifestations.
. Diagnostic evaluation.
. Clinical management.
. Complications.
. Nursing diagnosis.
. Discharge planning and teaching.
51
. Definition:
. Inflammation of the glomeruli
arising from an immune response of
the body.
52
. Glomerulonephritis:
53
. Etiology:
1. Multi system disease:

. systemic lupus erythematosis,
. arthritis rheumatoid,
. Vascular disease - hypertension.
. Metabolic disease - diabetes
mellitus.
54
2. Infection:
. Bacterial: Streptococcus.
. Viral:
. Mumps.
. Measles.
. Hepatitis B.
. Parasite:
. Toxoplasma.
. Rickettsia.
. Malaria.
55
3. Drugs: NSAID (non-steroid
anti inflammatory drug).
4. Maglinancy:
. Carcinoma:
. Colon, lung, stomach and breast.
56
. Presentation:
. Proteinuria
. Chronic renal failure.
57
. Bacterial streptococcal infection 7-
14 days.
. Tonsilitis.
. URTI.
. Early clinical manifestation include:
. Macroscopic haematuria.
. Proteinuria.
. Tea coloured urine and oliguria.
. Elevated ESR.
. Elevated anti streptolysine O titer.
. Later chemical manifestation:
. Circulatory congestion.
. Hypertension.
. End-stage renal failure.
. Generalised body oedema as a result
of decreased glomerular filtration.
. Oedema in the face around the eye
(Periorbital oedema) and puffiness
of the face.
58
. Later involved total body:
. Ascities.
. Peripheral oedema in the legs.
. Smoky urine indicative of bleeding in
upper urinary tract.
. Cardiomegaly and cardiac failure.
. Lethargy and anoreksia.
59
. Diagnostic Evaluation:
. Assess for signs and symptoms.
. Urine analysis:
. Urine is characterized by dark
brown colour.
. Macroscopic haematuria,
. Proteinuria.
. Microscopic studies:
. RBC.
. WBC.
. Epithelial and pus cell.
. Throat swab for culture.
. Blood studies:
. BUSE.
. Low serum albumin.
. High serum lipids.
. Increased creatinine.
. ASOT - Increased Anti-streptolysis
O titre.
. Anti-nuclear antibody - SLE.
60
. Chest xray to detect cardiomegaly
and pulmonary oedema.
. Renal biopsy.
61
. Diagnosis assessment:
. Patient’s history.
. Clinical manifestation.
. Physical examination.
. Laboratory investigation.
62
. Differential Diagnosis:
. Acute renal failure.
. Acute pyelonephritis.
. SLE.
63
. Management:
1. Renal function promotion:
. Bed rest during acute illness.
. Observe fluid balance. Intake
and output chart.
. Restriction of fluid, sodium and
calcium.
. Restriction of dietary protein
when oliguria is present.
Weigh twice daily.
. Carbohydrates increased to provide
energy and reduce catabolism of
protein.
64
2. Prevention and complication:
. Detect and treat infection with

antibiotic.
. Observe simptoms of renal failure.
. Assess patient for hypertensive
encaphalopathy, heart failure and
pulmonary oedema.
. Antihyperensive therapy and
diuretic.
65
4. Patient education:
. Follow up to assess:
. Blood pressure.
. Proteinuria.
. Blood urea.
. Advise to seek treatment for any
infection.
. Get early treatment for signs of
renal failure.
66
. Complications:
. Acute renal failure.

. Congestive cardiac failure.
. Pulmonary oedema.
. Urinary tract infection.
. Hypertensive encaphalopathy.
67
. Discharge teaching:
. Explain the need to monitor renal

function on an ongoing basis.
. Explain the importance of checking
blood pressure.
. Teach the importance of dietary
management.
68
. Nephrotic syndrome:
. Definition.
. Risk factors & etiology.
. Pathophysiology.
. Clinical manifestations
. Diagnostic evaluation.
. Complications.
. Nursing diagnosis.
69
. Nephrotic syndrom:
. Definition:
. Clinical disorder characterised by
masih proteinuria with generalized
edema, hyperlipidemia,and
decrease in albumin in the blood.
. Causes damage to the glomeruli
with resultant proteinuria.
. Most often seen in children 1 – 5
years.
70
71
72
. Etiology:
. Glomerulonephritis.
. Diabetic nephropathy.
. Pharmacologic agents:
. NSAIDs.
. ACE inhibitor - Captopril.
. Drug abuse - Heroin.
. Allergic response to:
. Toxins.
. Pollens.
. Insect stings.
. Infections:
. Bacterial: (streptococcal, syphillis).
. Viral: (herpes zoster, HIV and
Hepatitis)
73
. Pathophysiology:
. Damage of glomerular capillary

membrane.
. Altered permeability of basement
membrane allows greater filtration
of smaller proteins.
. Results in protenuria.
. Resulting hypoalbuminemia causes
edema.
74
. Umur 1 – 5.
. Male children more than female.
. Oedema:
. Appear slowly.
. Pitting oedema of extremities and
around the eye.
. Generalised oedema - ascitis,
pleural effusion and scrotal
oedema.
. Proteinuria.
. Hipoalbuminemia:
. Increased albumin secretion.
. General symptoms:
. Prolonged loss of protein.
. Anoreksia.
. Muscle wasting.
. Tiredness.
. Dyspnoea.
. Microscopic haematuria.
75
. Diagnostic investigation:
1. Urine:
. 24 hours urine for protein.
. FEME:
. RBC.
. Cast.
. Masive protein >5g/day.
2. Blood:
. Serum protein.
. Serum lipid.
. Serum albumin.
. BUSE.
. Serum creatinine.
. Blood glucose.
3. Renal biopsy.
76
. Clinical management:
. General:
. Bed rest.
. Diet - Normal protein with
sufficient calorie.
Less sodium.
. Restrict water intake.
. Diuretic - lasix to treat oedema.
. Antibiotic - Penicillin to treat
infection.
. Administration of albumin to
increase plasma oncotic pressure
and replace losses.
2. Specific:
. Corticosteroid therapy -
prednisolone.
77
. Prevention and treatment of
complications:
. Treat sepsis early with antibiotic.

. Treat renal failure - diuretic.
78
. Complications:
. Infection - peritonitis, cellulitis.

. Renal vein thrombosis.
. Sepsis.
. Acute or chronic renal failure.
. Venous thrombosis.
. Protein malnutrition:
. Growth retardation.
. Osteoporosis.
79
Discharge planning & teaching.
. Teach the pt to collect urine
specimen and evaluate the urine for
P.H, calcium and protein.
. Make sure that pt understands
medications dosage, and its side
effects.
. Emphasize the potential for relapse
of symptoms and the necessity of
prompt care.
. Proper teaching about diet.
80
. Pyelonephritis.
. Definition.
. Types.
. Causes.
. Risk factors.
. Pathophysiology.
. Diagnosis.
. Management.
. Complications.
81
. Definition.
. An inflammation of the renal pelvis

and the parenchyma commonly
caused by bacterial invasion.
. Types.
. Acute Pyelonephritis.
. Chronic Pyelonephritis.
82
. Acute Pyelonephritis:
. Often occurs after bacterial
contamination of the urethra or
following an invasive procedure of
the urinary tract.
. Chronic Pyelonephritis:
. Most commonly occurs following
chronic obstruction with reflux or
chronic disorder.
83
. Etiology:
1. Bacterial infection:
. Escherichia coli (75%)
. Most common cause.
. Streptococcal faecalis.
. Straphylococci aureus.
2. Obstruction:
. Enlarged prostate gland.
. Renal calculi.
. Congenital abnormality.
. During pregnancy.
84
. Risk factors.
. Urinary retention.
. Immobilization.
. Indwelling catheter.
. Calculi.
. Pregnancy.
. Dehydration.
85
. Pathophysiology.
. Pathogen enters the urinary
system through the ascending
urethral route.
. Urinary system become inflamed.
. Polymorphonucleocutes produced
in the urine.
. In chronic Pyelonephritis the
kidney become scarred, contracted
and nonfunctioning.
86
. Diagnostic evaluation:
1. Xray KUB and pelvic region. 8. Ultra sound abdomen:

- to identify abnormality in - to identify renal calculi and to
urinary tract.
locate any obstruction in urinary
2. Urine for C & S.
tract.
- to identify infection in urinary
tract.
3. Blood for C& S.
- to identify infection in blood.
4. Urine FEME:
- to identify infection in urinary
system.
5. Full blood count:
- to identify anaemia.
6. Smear for gram stain:
- to identify gonorrhoea.
7. BUSE:
- to identify renal function and
electrolyte balance.
87
. Clinical manifestations:
. Sudden onset.
. Fever, chills and headache.
. Nausea and vomiting.
. Flank pain.
. Muscular pain.
. Dysurea , cloudy bloody and foul
smelling urine.
. Increased white blood cells in the
urine.
. Frequency and urgency
88
. Differential diagnosis:
. Acute appendicitis.
. Acute cholecytitis.
. Acute salpingitis.
. Acute cystitis.
. Vesical calculi.
89
. Management:
. Antibiotic therapy:
. IV Ampicillin 500mgm. QID.
. IV Gentamycin 40 - 80mg TDS.
. IV Kanamycin 500mg. BD.
. Symptomatic treatment:
. Paracetamol for fever.
. Stemetil for vomiting.
90
. Ward mx:
. Bed rest.
. Monitor vital signs.
. Monitor intake and output chart.
. Monitor weight
. Encourage fluid intake up to
3liters/day.
. Diet high in protein.
Encourage adequate rest.

. Provide warm moist compress to
flank area.
. Encourage warm bath.
. Monitor signs of renal failure.
91
. Complications:
. Chronic pyelonephritis.
. Septicaemia.
. Renal failure.
. Pelvic abscess.
92
. Health education:
. Take medicine according to

doctor’s instruction.
. Follow up treatment.
. Drink plenty of water.
. Do not smoke and drink.
. Practice healthy life style.
93
Renal failure:
94
6. Renal failure:
. Definition.
. Types.
. Pathophysiology.
. Phases.
. Causes.
. Nursing interventions.
95
. Definition:
. Renal failure results when the

kidney cannot remove the body’s
metabolic wastes or perform their
regulatory function.
96
. Types:
1. Acute.
2. Chronic.
. Acute renal faiulre:

. A clinical syndrome characterized
by a rapid loss of renal function
with progressive azotemia.
(accumulation of nitrogen waste
products such as blood urea
nitrogen and increasing level of
serum creatinine).
97
. Risk factors:
. Hypertensive episodes.
. Recent surgery.
. Multiple organ failure.
. Renal disease.
. Diabetes.
. Nephrotoxic substance.
98
. Etiology:
. Hypovolemia & dehydration.

. Hemorrhage.
. Excessive diuresis.
. Burns.
. Cardiogenic shock.
. Antihypertensive drugs.
. Neurological disease.
. Septic shock.
. Hemolytic blood transfusion.
99
. Etiology:
100
. Etiology:
101
. Renal failure:
102
. Pathophysiology:
1. Physical trauma, infection,

inflammation or exposure to
chemical substances damage the
renal tubules causing tubular
necrosis or produces severe
vasoconstriction of renal blood
vessels, causing ischemia of kidney
tissue.
103
2. Excretion is impaired allowing
substances normally eliminated to
accumulate in body fluids.
3. Homeostatic, endocrine, and
metabolic functions are disrupted.
104
. Clinical manifestation:
a. Urinary:
. decreased urine output.
. Proteinuria.
. Decreased specific gravity.
. Increased urinary sodium.
105
b. Respiratory:
. Pulmonary edema.
. Kussmaul respirations deep rapid
respiration.
. Pleural effusion.
106
c. Cardiovascular:
. Volume overload.
. Congestive heart failure.
. Hypotention or hypertention.
. Pericarditis.
. Arrhythmias.
107
d. Gastrointestinal:
. Nausea & vomiting.

. Anorexia.
. Stomatitis.
. Bleeding.
. Diarrhea and constipation.
108
e. Hematologic:
. Anemia.
. Leucocytosis.
. Defect in platelet functioning.
109
f. Neurological:
. Lethargy.
. Seizures.
. Memmory impairment.
110
g. Metabolic:
. Increased creatinine.
. Increased potassium.
. Decreased P.H.
. Decreased bicarbonate.
. Decreased calcium.
. Decreased sodium.
111
. Phases of acute renal failure.
. Clinically A.R.F may progress

through 4 phases.
1. Initiating.
2. Oliguric.
3. Diuretic.
4. Recovery phase.
112
1. Initiating phase:
. Begins at the time of insult and
continues until the signs and
symptoms become apparent.
. Last hours to days.
113
2. Oliguric phase:
. Initial manifestations caused by a

reduction in the glomerular
filtration rate.
. Oliguria less than 400ml/day
occurs in 1-7 days .
. Changes in urine output.
. Fluid and electrolyte
. Abnormalities.
. Uremia.
114
3. Diuretic phase:
. Gradual increase of urine output to

3-5 litters/day.
. Lasts for 1-3 weeks.
. Near the end of the phase acid
base balance, electrolyte begin to
normalize.
115
4. Recovery phase.
. Begins when glomerular filtration

rate increases.
. Blood urea nitrogen level and
serum creatinine level to decrease.
. Renal function stabilizes within 12
months.
116
. Diagnostic evaluation:
. History and physical examination.

. Serum blood values shows increased
creatinine.
. Urine analysis reveals:
. Protenuria.
. Haematuria.
. Casts (epithelial tissue.)
. Renal ultrasound.
. C.T or M.R.I scan.
. Retrograde pyelogram.
117
. Clinical management:
. Treatment of precipitating cause.

. Fluid restriction:
. 600ml plus previous 24 hr fluid
loss.
118
. Nutritional therapy:
. Regulate protein intake according to

renal function.
. High carbohydrate feeding:
. greater protein sparing power.
. provide additional calorie.
. Sodium, phosphate and potssium
restriction.
. Calcium supplement.
119
. Total parenteral nutrition:
. Initiation of dialysis if needed.

. Antibiotics to treat infection.
. Bed rest is necessary:
. to reduce metabolic rate.
. to reduce exertion.
120
. Indication for dialysis:
. Volume overload.
. Elevated potassium level with
E.C.G changes.
. Metabolic acidosis.
. (bicarbonate level less than
15meq/l).
. Significant changes in mental
status.
. Pericarditis.
. Pericardial effusion.
121
. Chronic renal failure: (End stage).
. Definition:
. A progressive irreversible
deterioration in renal function
in which the body’s ability to
maintain metabolic and fluid
and electrolyte balance fails
resulting in uremia or azotemia.
(retention of urea and other
nitrogenous waste in the blood).
122
. Etiology:
. May follow acute renal failure.

. Renal artery occlusion.
. Chronic urinary obstruction.
. Recurrent infection.
. Hypertension.
. Diabetes mellitus.
. Autoimmune disorder.
123
. Clinical manifestation:
. Neurologic:
. Weakness.
. Fatigue.
. Confusion.
. Inability to concentrate.
. Disorientation.
. Seizures.
124
. Integumentary:
. Grey-bronze skin color.

. Dry skin.
. Pruritus.
. Ecchymosis.
. Purpura.
. Thin brittle nails.
. Thinning hair.
125
. Cardiovascular:
. Hypertension.
. Pitting edema.
. Periorbital edema.
. Engorged neck veins.
. Hyperkalemia.
. Pericarditis.
126
. Pulmonary:
. Crackles.
. Thick tenacious sputum.
. Pleuritic pain.
. Shortness of breath.
. Tachypnea.
. Kussmaul respiration
127
. Gastrointestinal:
. Ammonia odor to breath.

. Metallic taste.
. Mouth ulceration and bleeding.
. Anorexia, nausea and vomiting.
. Constipation and diarrhea.
. Gastrointestinal bleeding.
128
. Hematologic:
. Anemia.
. Thrombocytopenia.
. Reproductive:
. Amenorrhea.
. Testicular atrophy.
. Infertility.
129
. Musculoskeletal:
. Muscle cramps.
. Loss of muscle strength.
. Bone pain.
. Bone fracture.
. Foot drop.
130
. Pathophysiology:
. As renal function declines:
. Retention of sodium and water
causes edema, heart failure,
hypertension, ascites.
. Decreased renal insufficiency
causes renal failure.
. Uremia develops and adversely
affect every system of the body.
. Erythropoietin production by the
kidney decreases, causing
profound anaemia.
131
. Stages of renal failure:
. Stage 1:
. Reduced renal reserve.
. 40-75% loss of nephron function.
. Pt does not have any symptoms.
. Stage2:
. Renal insufficiency.
. 75-90% loss of nephron function.
132
. Stage3:
. End stage renal disease.
. Less than 10% of renal function
remaining.
133
. Complications:
. Hyperkalemia.
. Pericarditis.
. Hypertension.
. Pulmonary edema.
. Pneumonia.
. Anemia.
. Bone disease.
. Peptic ulcer .
134
. Management:
. Pharmacological therapy:
. Antacids:
. Aluminium based antacids to
treat hypocalcaemia.
. Antihypertensive and
cardiovascular agents.
. Antiseizure agents:
. Intravenous diazepam or
phenytoin.
135
. A hormone produced by the kidney
that stimulate the production of
R.B.C in the bone marrow.
136
. Nutritional therapy:
. Restriction of protein intake.

. Regulation of fluid intake to
balance fluid loss.
. Regulation of sodium intake to
balance sodium losses.
. Restriction of potassium.
. Adequate calorie and vitamin
supplement.
137
. Fluid allowances is 500-600ml more
than the previous day’s 24-hr urine
output.
138
. Other therapy:
. Dialysis peritoneal or
haemodialysis.
. Kidney transplant.
139
LIST OF REFERENCES
â Lewis, S.L.(2007). Study Guide for Medical Nursing

Assessment and Management Clinical
Problem.Elsevier.Philadelphia.USA.
â Lewis, S.M. et al. (2000). Medical–Surgical Nursing.

Mosby,
â Williams, L.S., Hopper, P.D. (2007). Understanding

Medical Surgical Nursing (3rd ed.). F.A. Davis,
Philadelphia.
â Smeltzer, S.C. et al. (2008). Brunner & Suddarth’s

Textbook of Medical-Surgical Nursing (11th ed.).
Lippincott Williams & Wilkins, Philadelphia
Thank you

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UNIT 6: Genitourinary System

FATIN NUR DHABITAH BT ZAINUDDIN

FATIN NUR DHABITAH BT ZAINUDDIN

5.1 SYMPTOMATOLOGY GENITO URINARY SYSTEM & MALE

• Explain genito urinary system & male reproductive system

q Haematuria, is the presence of red blood cells (erythrocytes) in the urine.

v Involuntary urination, bed-wetting or urinary incontinence esp during sleep

FATIN NUR DHABITAH BT ZAINUDDIN

At the end of this chapter, students will be able to:

• Define T.B. kidney.

5.2.1.1 DEFINTION OF T.B. KIDNEY

q Kidney disease caused by tuberculosis. Tuberculosis is caused by

q The tuberculosis bacterium is initially inhaled into the lungs where it

5.2.1.2 CAUSES OF T.B. KIDNEY

5.2.1.2 CAUSES OF T.B. KIDNEY

q Chances of becoming infected are higher in certain countries where TB

5.2.1.3 CLINICAL MANIFESTATION OF T.B. KIDNEY

v Coughing that lasts three or more weeks.

5.2.1.3 CLINICAL MANIFESTATION OF T.B. KIDNEY

q Tuberculosis of the urinary tract is easily overlooked.

5.2.1.4 DIAGNOSTIC INVESTIGATION OF T.B. KIDNEY

q Urine culture - Pyuria in the absence of infection.

5.2.2.1 DEFINTION OF CYSTITIS.

q Cystitis refers to inflammation of the wall of the bladder due bacterial

5.2.2.2 CAUSES OF CYSTITIS

5.2.2.2 CAUSES OF CYSTITIS

v Menopause. During the menopause women produce less mucus in the

5.2.2.2 CAUSES OF CYSTITIS

5.2.2.3 CLINICAL MANIFESTATION OF CYSTITIS

q Common symptoms of cystitis include:

v Pain when pass urine.

5.2.2.4 MANAGEMENT OF CYSTITIS

v Cystitis usually clears up by itself, without the need for treatment.

5.2.3.1 DEFINTION OF ORCHITIS

q Orchitis is inflammation of the testes.

5.2.3.2 CAUSES OF ORCHITIS

v Sexually transmitted diseases eg gonorrhoea.

5.2.3.3 CLINICAL MANIFESTATION OF ORCHITIS

v Hematospermia (blood in the semen)

5.2.3.4 MANAGEMENT OF ORCHITIS

v Oral antibiotic such as cefalexin or ciprofloxacin until infection

5.2.4.1 DEFINTION OF EPIDIDYMITIS

q Inflammation and infection of the epididymis.

5.2.4.2 CAUSES OF EPIDIDYMITIS

q The causes of epididymitis vary depending on your age and behavior.

5.2.4.3 CLINICAL MANIFESTATION OF EPIDIDYMITIS

v Pain, tenderness, and swelling in the scrotum (epididymides or testicles)

5.2.4.4 management OF EPIDIDYMITIS

q Antibiotics are used to treat epididymitis.

q Supportive measures, such as bed rest with elevation of

q Anti-inflammatory medicines (such as ibuprofen or

q avoiding sexual intercourse to avoid risk of infection.

FATIN NUR DHABITAH BT ZAINUDDIN

. Inflammation of the urethra due to

. Urethral discharge or urine for gram

1. Multi system disease:

. Detect and treat infection with

. Acute renal failure.

. Explain the need to monitor renal

. Damage of glomerular capillary

. Treat sepsis early with antibiotic.

. Infection - peritonitis, cellulitis.