Genitourinary system
Age related changes
o in renal blood flow, glomerular filtration, ability to concentrate/ dilute urine, clearing of
wastes, filtration efficiency → accumulation of drugs in kidneys = drug toxicity
o Higher threshold for glucose to appear in the urine when hyperglycemic
o Nocturia – urinating at night
o r/o infection d/t incomplete bladder emptying – UTI****
o Kidney fx improves in recumbent position lying down
Holistic Promotion
o Ask pt: frequency, concentration, any difficulty urinating, PQRST, medication history,
ask Pt to drink water and ask them to couch
The kidneys produce urine, but the patient is unable to empty the bladder
Urinary
Retention E Effects of anesthesia or opioids, trauma to the urinary tract, or anxiety about
voiding, kidney stones (renal calculi), BPH
• Normal urine output is about 30 mL/h.
o d/t UTI, dehydration, kidney disease (acute vs chronic)
• Frequent catherization r/o infection
• Always bring two catheters into the room for females, wrong insertion into
vagina, can’t use the same one for urethra
S/S • Difficulty starting to urinate, weak dribble or stream of urine, lack or urge
• Lower abdominal pain/ pressure, & abdominal distention****
• Difficulty fully emptying the bladder/ inability to feel when bladder is full
DX • Physical Examination
• Lab test - Bladder Scanner (>400-500), CT/US to rule out pathological cause
• Kidney function (CBC, GFR, Creatinine, BUN, Electrolytes)
• Cystoscopy – to visualize urethra
TX TREAT UNDERLYING CAUSE
• Try voiding, no straining
• Catheter to drain urine = pain/distention
• Alpha-blockers (tamsulosin/Flomax)
• 5-alpha reductase inhibitors (finasteride/Proscar)
NI → prevent/ treat urinary retention
• Tap to stimulate, TRIAL VIODING before CATHETERS
• Infection - Administer ABX, give PRN
• Hygiene***
• Educate on proper hygiene, hydration and encourage fluids (contraindication
– HEART FAILURE)
, • Monitor Intake/output – 30ml/hr***
• Kegel exercise / relaxation
• Monitor the labs: CBC, Kidney function and electrolytes
• Foley care is important to reduce infection risk, empty the drainage bag on
time (2/3 full), keep monitor for S/S
Urinary Types of Incontinence
Incontinence • Stress Incontinence: Weak supporting pelvic muscles from sneezing,
coughing, and laughing. Kegel Exercise.
• Urgency Incontinence: spasms on the bladder walls
• Overflow Incontinence: accumulation of urine in the bladder
Involuntary loss of urine
• Normal controlled voiding requires healthy bladder muscle, a patent
urethra, normal transmission of nerve impulses, and mental alertness.
HX Data collection relevant to urinary incontinence includes:
Record voiding pattern, volume, S/S, meds
Medical history
Physical findings
TX Treatment goals are developed based on the underlying cause
• Kegel exercises
• Biofeedback
• Medication to improve stress incontinence, toilet schedule
• Surgery
• improvement of mobility to provision of a bedside commode
Prevent and treat
NI o Toileting schedule – functional/urge incontinence
o Depends/liners for consistent dribbling throughout the day – self-esteem/
may avoid going out – embarrassment
o Limit fluids PM, void before bed
o Smoking/ETOH – lifestyle changes
o Monitor their IN/OUT, labs – kidney function, electrolytes
o Hygiene**** explain them S/S
o Monitor their meds & diet
Age related changes
o in renal blood flow, glomerular filtration, ability to concentrate/ dilute urine, clearing of
wastes, filtration efficiency → accumulation of drugs in kidneys = drug toxicity
o Higher threshold for glucose to appear in the urine when hyperglycemic
o Nocturia – urinating at night
o r/o infection d/t incomplete bladder emptying – UTI****
o Kidney fx improves in recumbent position lying down
Holistic Promotion
o Ask pt: frequency, concentration, any difficulty urinating, PQRST, medication history,
ask Pt to drink water and ask them to couch
The kidneys produce urine, but the patient is unable to empty the bladder
Urinary
Retention E Effects of anesthesia or opioids, trauma to the urinary tract, or anxiety about
voiding, kidney stones (renal calculi), BPH
• Normal urine output is about 30 mL/h.
o d/t UTI, dehydration, kidney disease (acute vs chronic)
• Frequent catherization r/o infection
• Always bring two catheters into the room for females, wrong insertion into
vagina, can’t use the same one for urethra
S/S • Difficulty starting to urinate, weak dribble or stream of urine, lack or urge
• Lower abdominal pain/ pressure, & abdominal distention****
• Difficulty fully emptying the bladder/ inability to feel when bladder is full
DX • Physical Examination
• Lab test - Bladder Scanner (>400-500), CT/US to rule out pathological cause
• Kidney function (CBC, GFR, Creatinine, BUN, Electrolytes)
• Cystoscopy – to visualize urethra
TX TREAT UNDERLYING CAUSE
• Try voiding, no straining
• Catheter to drain urine = pain/distention
• Alpha-blockers (tamsulosin/Flomax)
• 5-alpha reductase inhibitors (finasteride/Proscar)
NI → prevent/ treat urinary retention
• Tap to stimulate, TRIAL VIODING before CATHETERS
• Infection - Administer ABX, give PRN
• Hygiene***
• Educate on proper hygiene, hydration and encourage fluids (contraindication
– HEART FAILURE)
, • Monitor Intake/output – 30ml/hr***
• Kegel exercise / relaxation
• Monitor the labs: CBC, Kidney function and electrolytes
• Foley care is important to reduce infection risk, empty the drainage bag on
time (2/3 full), keep monitor for S/S
Urinary Types of Incontinence
Incontinence • Stress Incontinence: Weak supporting pelvic muscles from sneezing,
coughing, and laughing. Kegel Exercise.
• Urgency Incontinence: spasms on the bladder walls
• Overflow Incontinence: accumulation of urine in the bladder
Involuntary loss of urine
• Normal controlled voiding requires healthy bladder muscle, a patent
urethra, normal transmission of nerve impulses, and mental alertness.
HX Data collection relevant to urinary incontinence includes:
Record voiding pattern, volume, S/S, meds
Medical history
Physical findings
TX Treatment goals are developed based on the underlying cause
• Kegel exercises
• Biofeedback
• Medication to improve stress incontinence, toilet schedule
• Surgery
• improvement of mobility to provision of a bedside commode
Prevent and treat
NI o Toileting schedule – functional/urge incontinence
o Depends/liners for consistent dribbling throughout the day – self-esteem/
may avoid going out – embarrassment
o Limit fluids PM, void before bed
o Smoking/ETOH – lifestyle changes
o Monitor their IN/OUT, labs – kidney function, electrolytes
o Hygiene**** explain them S/S
o Monitor their meds & diet
