AU Pharmacology genitourinary Notes

Genitourinary
- Discomfort, fear, psychosocial issues, & pt needs**,, what you do for the pt!
- A&P = kidneys, abdominal aorta, renal arteries/veins, ureters, bladder, urethra
- Glomerulus, neurons to promote urine
- Renin-angiotensin-aldosterone system (RAS system)...think BP**
- Labs = BUN, creatinine, creatinine clearance/GFR
- Urinalysis = osmolarity (ratio of solute-water) & osmolality (pressure)
- Color, pH, clarity (turbidity), bacteria, nitrates (UTI), glucose, casts, RBCs
& crystals (should be none*), epithelial cells
- Urine collection
- Voided urine
- Clean-catch specimen or Catheterized specimen
- 24 hr urine
- Spot lytes (electrolytes in 1 void ~reg urinalysis)
- Other tests = KUB (xray), IVP (dye/lights up system, no shellfish allergies**/functioning
kidneys ~BUN/creat is needed before), CT/MRI, cystoscopy, urodynamic studies

Kidneys can make: renin, prostaglandins, bradykinins, erythropoietin (RBC produc), & vit D
Hormones that influence kidney function = ADH/vasopressin, aldosterone, natriuretic hormones

Problems USUALLY involve urine storage & excretion,, these GENERALLY do not contribute to
hemostatic purposes of urinary elimination BUT kidney failure will cause multiple problems
● Can be infectious or non infectious

Infectious Disorders or Urinary
● Cystitis vs urethritis

UTIs
● Second most common reason for seeking health care
● Common site of nosocomial infection,, typically in urethra & bladder
● Lower UTIs
○ Cystitis (bladder)
○ Prostatitis
○ Urethritis
● Upper UTIs
○ Pyelonephritis = cute or
chronic
○ Institutional nephritis
○ Renal abscess and
perirenal abscess
● Risk factors = function of
glycosaminoglycan (GAG),
urethrovesical reflux,
ureterovesical reflux, uropathogenic bacteria (E. Coli), shorter urethra in women**

, ● No fragrances, no douching, empty frequently, cotton underwear

Cystitis (UTI in bladder)
● Inflammation of the bladder (irritation or microorganism)
○ Infection ~ E.coli, bacteria ~candida
● r/f = Irritation, trauma, catheterization (outside/inside catheter), poor hygiene/sexual
practices, females, menopause, constipation
○ Pericare ***, washed w/ soap & water, clean drainage bag, clean technique when
emptying
○ Can lead to pyelonephritis and sepsis (urosepsis)
● S/S = change in frequency/urgency, dysuria, cloudy urine/foul odor, confusion in older
adults
● Lab tests = urinalysis** (leukocyte esterase, nitrate, bacteria, blood, >20 epithelial cells)
& urine culture/sensitivity
● Tx = appropriate antibiotic** …pyridium (pain relief only)
● Prevention = void frequently (before & after intercourse), hygiene, increase fluids, avoid
vaginal washes, cranberry juice

Urethritis Symptoms
● Frequency, Urgency, Dysuria, Urethral discharge
● Could be caused by STDs
● Elderly = FALLS WITH ALL UTIs
○ If elderly comes in from a fall really confused you want to send them for a UA
(check for UTI) & a chest x ray (check for pneumonia)

Management of UTIs
● Prevention = avoid indwelling catheters; exercise proper care of catheters
● Exercise correct personal hygiene, cotton underwear, no baths, no wet clothing, no
douching or fragrance products, wipe front to back, urinate after sex, void often***
● antibiotics, analgesics, and antispasmodics
○ Apply heat to the perineum to relieve pain and spasm
○ Increase fluid intake & fiber
● Avoid urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol
● Catheters are sterile on the inside (aseptic technique) & clean outside bag
○ Pyridium = NORMAL SE is orange urine

Pyelonephritis (kidney infection)
● Acute or chronic inflammation due to bacterial infection of the parenchyma and pelvis of
the kidney (kidney infection w/ same organisms that climbed all the way up)
● 95% of cases are caused by the gram-negative enteric bacilli (Eschieria coli)
● Occurs more frequently in young women (short urethra) and older men (BPH)
● Risk factors = obstruction (kidney stones), HTN, hypokalemia, DM, pregnancy, UTIs,
catheterization (CAUTI), quadraplegic (self catheterization @ home), BPH