GENITO-URINARY SYSTEM • Wash perineal area if soiled

• Obtain first voided morning specimen

FUNCTIONS OF KIDNEYS: • Send to lab immediately
1. Maintain homeostasis of blood and acid-base balance. • Should be examined within 1 hour of voiding
2. Excrete end products of body metabolism.
3. Control fluid and electrolyte balance. 2. CLEAN CATCH (MIDSTREAM) SPECIMEN for URINE CULTURE
4. Excrete bacterial toxins, water-soluble drugs, and drug metabolites. • Cleanse perineal area
5. Secrete renin and erythropoietin, which play a role in the function Female: Spread labia and cleanse meatus front to back using antiseptic
of the parathyroid hormones and vitamin D sponges
Male: Retract foreskin (if uncircumcised) and cleanse glans with
BLADDER antiseptic sponges
• The bladder detrusor muscle, composed of smooth muscle, distends • Have client initiate urine stream then stop
during bladder filling and contracts during bladder emptying. • Collect specimen in a sterile container
• The ureterovesical sphincter prevents reflux of urine from the • Have client complete urination, but not in specimen container.
bladder to the ureter.
• The total capacity of the bladder is 1L. BLOOD STUDIES
Structure: 1. BICARBONATE
3 Layers - 22-25 mEq/l
• Outer Layer 2. BUN
- loose connective tissue - measures renal ability to excrete urea nitrogen
• Middle Layer - Normal: 5-20 mo/dl
- smooth muscle and elastic fibres 3. CALCIUM
• Inner Layer - 90-10.5 mg/di
- lined with transitional epithelium 4. SERUM CREATININE
- Specific tests for renal disorders
- Reflects ability of kidneys to excrete creatinine
ADRENAL GLANDS
- 0.7-15 mo/d
• One adrenal gland is on top of each kidney.
5. PHOSPHORUS
• The adrenal glands influence blood pressure and sodium and water
- 2.5-4.5 mo/dl
retention
6. SODIUM
- 136-145 mEo/l
PROSTATE GLAND
7. POTASSIUM
• The prostate gland surrounds the male urethra
- 3.55 mEan
• Contains a duct that opens into the prostatic portion of the urethra
8. SERUM URIC ACID LEVEL
and secretes the alkaline portion of seminal fluid, which passing
- 2.5 to 8.0 mg
sperm.
KUB - KIDNEY URETHER BLADDER
Assessment
• An x-ray of the urinary system and adjacent structures is used to
Risk factors associated with Renal Disorders:
detect uriary calculi
• Chemical or environmental toxin exposure
• calculi - bato
• Contact sports
• Diabetes mellitus
INTRAVENOUS PYELOGRAM (IVP)
• Family history of renal disease
• Fluoroscopic visualization of the urinary tract after injection with a
• Frequent urinary tract infections
radiopaque dye
• Heart failure
• High sodium diet
Nursing Care (Pre-Test)
• Assess for iodine sensitivity
LABORATORY/DIAGNOSTIC TESTS
• Obtain consent
URINE STUDIES
• Inform client he will lie on a table throughout procedure
1. URINALYSIS
• Administer cathartic or enema the night before
• Examination to assess the nature of the urine produced
• Keep the client NO for 8 - 10 hours pretest
a. Evaluates color, pH, and specific gravity
• Inform client about possible throat irritations, flushing of face,
Color: pale to amber
warmth or a sally taste that may be experienced during the test
Volume: 30 ml/hour
Appearance: Clear
Nursing Care (Post-Test)
Odor: aromatic then strong ammoniacal odor
• Force fluids
Specific Gravity:
• Assess venipuncture, site for bleeding
• 1.015-1.025 (24 hour urine collection)
• Monitor V/S for U/O
• 1.003-1.030 (random specimen)
pH: 4.8-8.0
CYSTOSCOPY
b. Determines the presence of glucose, protein, ketones and blood.
• Use of a lighted scope (cystoscope) to inspect the bladder
c. Analyzes sediment for cells
• Inserted into the bladder via the urethra.
- presence of WBC, casts bacteria, crystals
• May be used to remove tumors, stones, or other foreign material or
to implant radium, place catheters in ureters
=
2. URINE CULTURE and SENSITIVITY
Nursing Care (Pre-Test)
• Diagnoses bacterial infections of the urinary tract
• Explain to client that the procedure will be done under general/local
anesthesia
3. RESIDUAL URINE
• Obtain CONSENT
• Amount of urine left in the bladder after voiding measured via
• Confirm consent form is signed
catheter (permanent or temporary) in bladder.
• Administer sedatives 1 hour before test, as ordered
• General anesthesia: Keep client on NPO
4. CREATININE CLEARANCE
• Local anesthesia: offer liquid breakfast
• Determines amount of creatinine (waste product or protein
breakdown) in the urine over 24 hours
Nursing Care (Post-Test)
• Measures overall renal function; measures GFR
• Monitor V/S and I/O
• Pink tinged/tea colores urne is expected
URINE COLLECTION METHODS
• Bright red urine/presence of large clots should be reported
1. ROUTINE URINALYSIS
• Advise client that burning on urination is normal and will subside. • Use strict aseptic technique in FBC
• Encourage deep breathing exercises to relieve bladder spasms • Administer medications as ordered
• Administer sitz baths for back and abdominal pain • Client teaching
• Administer analgesics as Rx
• Force fluids as prescribed Client Teaching
• Acidic urine diminish the action of aminoglycoside, sulfonamide,
RENAL ANGIOGRAPHY nitrofurantioin (macrodantin)
• The infection of a radiopoque dye through a catheter for examination • Discourage caffeine products such as coffee, tea and cola
of the renal artery supply • Avoid alcohol
• Wipe perineal area from front to back
Nursing Care (Pre-Test) • Void and drink a glass of water after intercourse
• Obtain consent • Void q2H
• Assess client for allergies to iodine, seafoods, and radiopaque dyes • Encourage menopausal women to use estrogen vaginal creams to
• Inform patient about possible burning sensation along the vessel restore pH
• NO post-midnight before the test • Instruct female client to use water-soluble lubricants for coitus,
• Instruct client to void immediately before the procedure especially after menopause
• Shave injection sites as prescribed
• Assess and mark the peripheral pulses  PYELONEPHRITIS
• Inflammation of the renal pelvis & parenchyma, commonly caused by
Nursing Care (Post-Test) bacterial invasion
• Assess V/S and peripheral pulses • Acute Infection
• Provide bedrest and use of sandbag at the insertion for 4-8 hours - usually ascends from the lower urinary tract or following an invasive
• NPO postmidnight before the test procedure of the urinary traet
• Assess color and temperature at the involved extremity - can progress to bacteremia or chronie pyelonephritis
• Force fluids unless C/I
• Monitor urinary output Assessment
• Fever and chills
DISORDERS OF THE GENITOURINARY SYSTEM • N/V
• CVA tenderness, flank pain on the affected side
 URINARY TRACT INFECTION • Headache, muscular pain, dysuria
- common to females • Frequency and urgency

Predisposing Factors • Chronic Infection

• Poor hygiene - Major cause is ureterovesical reflux
• Irritation from bubble baths - Result of recurrent infections is eventual parenchymal deterioration
• Urinary reflux and possible renal failure

Clinical Findings Assessment

• Low grade fever • Client usually unaware of the disease
• Abdominal pain • May have bladder irritability
• Pain/burning on urination • Chronic fatigue
• Frequency • Slight dull ache over the kidneys
• Hematuria • Azotemia
• Eventually develops hypertension, atrophy of the kidneys
Nursing Care
• Administer antibiotics as ordered. Nursing Care
- prevention of kidney infection/glomerulonephritis • Monitor I & O
- obtain cultures before starting antibiotics • EOF
• Provide warm sitz baths to alleviate painful voiding • Encourage adequate rest
• Force fluids • Administer antibiotics, analgesics as ordered
• Encourage measures to acidify urine. • Support client and significant others and explain the possibility of
• Provide client teaching and discharge planning dialysis, transplant options if significant renal deterioration.
• Provide client teaching and discharge planning:
 CYSTITIS - Medication regimen
Clinical Findings - Diet: high calorie, low protein
• Abdominal or flank pain/tenderness
• Frequency and urgency of urination  NEPHROTIC SYNDROME (NEPHROSIS)
• Pain on voiding General Information
• Nocturia • Autoimmune process leading to structural alteration of glomerular
• Fever membrane that results in increased permeability to plasma proteins,
particularty atbumin.
Diagnostic Tests • Course of the disease consists of exacerbations and remissions over a
• Urine culture and sensitivity period of months to years.
- presence of E. coli (80%) • Commonly affects preschoolers.
- boys more often than girls
• most common causative agent: E. coli, enterobacter, • Prognosis is good unless edema does not respond to steroids.
Pseudomonas and Serratia
• Causes: bubble bath, allergens, bladder distention, invasive urinary
tract procedures
• Sexually active and pregnant women are most vulnerable to cystitis
• Poor-fitting diaphragms
• Use of spermicides
• Wet bathing suits

Nursing Care
• Force fluids (3L/day)
• Warm sitz bath for comfort
Clinical Findings
• Assess urine for odor, hematuria, and sediment
• Proteinuria, hypoproteinemia, hyperlipidemia • Surgery to correct or remove obstruction
• Dependent body edema
- puffiness around eyes in morning Nursing Care
- ascites • Monitor V/S frequently
- scrotal edema • Monitor for F/E imbalances including dehydration after the
- ankle edema obstruction is relieved.
• Anorexia, vomiting, diarrhea, malnutrition • Monitor diuresis w/c could lead to fluid depletion
• Pallor, lethargy • WOD
• Hepatomegaly • Monitor urine from specific gravity, albumin and glucose
• Administer fluid replacement as prescribed
Medical Management
• Drug therapy Post-op Care
- Corticosteroid- to resolve edema • Monitor drains
- Antibiotics- for bacterial infections - may have one from bladder and one from each ureter (ureteral
- Thiazide diuretics- edematous stage stents)
• Bedrest • Check output from all drains and record carefully
• Diet modification - expect bloody urine initially
- High CHON • Observe drainage from abdominal dressing and note color, amount
- Low Na and frequency
Nursing Care • Administer medication for bladder spasms as ordered
• Provide bed rest
- Conserve energy  NEPHROLITHIASIS /UROLITHIASIS
- Find activities for quiet play General Information
• Provide high CHON, low sodium diet during edema phase only • Presence of stones anywhere in the urinary tract
• Maintain skin integrity • Frequent compositions of stones:
- Don't use Band-Aids - calcium (phosphate), uric acid and cystine (rare) stones
- Avoid IM injections • Most often occurs in men age 20-55 years; more common in the
- medication is not absorbed in the edematous tissue summer
• Obtain morning urine for CHON studies
• Provide scrotal support Predisposing Factors
• Monitor input and output, V/S and WOD • Diet: large amount of calcium, oxalate
• Administer steroids to suppress autoimmune response as ordered • Increased uric acid levels
• Protect from known sources of infection • Sedentary lifestyles, immobility
• Family history of gout or calculi
 ACUTE GLOMERULONEPHRITIS • Hyperparathyroidism
General Information
• Immune complex disease resulting from an antigen-antibody Clinical Findings
reaction. • Abdominal pain or flank pain
• Secondary to a beta-hemolytic streptococcal infection occurring • Renal colic
elsewhere in the body. - severe pain in the kidney area radiating down the flank to the pubic
• Occurs more frequently in boys, usually between ages 6-7 years area
• Usually resolves in about 14 days • Hematuria, frequency, urgency, nausea
• Self-limiting • History of prior associated health problems
- gout, parathyroidism, immobility, dehydration, UTI
Clinical Findings • Diaphoresis
• History of a precipitating streptoccal infection, usually URTI or • Pallor
impetigo • Grimacing
• Edema, anorexia, lethargy • Vomiting
• Hematuria or dark-colored urine • Pyuria if infection is present
• Fever
• Hypertension Medical Management
1. Surgery
Diagnostic Findings A. Percutaneous Nephrostomy
• UA - Tube is inserted through skin and underlying tissues into renal pelvis
- reveals RBCs, WBCs, CHON, cellular casts to remove calculi
• Urine specific gravity increased B. Percutaneous Nephrolithotomy
• BUN and serum creatinine increased - Delivers U/S waves thorough a probe placed on the calculus
• ESR elevated 2. Percutaneous Ultrasonic Lithotripsy (PUL)
• HGB and HCT decreased - Nephroscope is inserted through skin into kidney
- Ultrasonic waves disintegrate stones that are then removed by
Nursing Care suction and irrigation
Monitor input and output, BP, urine and WOD 3. Extracorporal Shock-Wave Lithotripsy (ESWL)
• Provide diversional therapy - Client is placed in water and exposed to shock waves that
• Provide client teaching and planning concerning: disintegrate stones so that they can be passed with urine
- Medication administration - This procedure is non-invasive
- Prevention of infection
- Signs of renal complications Nursing Care
- Importance of long-term follow-up • Strain all urine through gauze to detect stones and crush all clots
• Force fluids (3000 - 4000 mL/day)
 HYDRONEPHROSIS • Encourage ambulation to prevent stasis
Clinical Findings • Relieve pain by administration of analgesics as ordered and
• Repeated UTIs application of moist heat to flank area.
• Failure to thrive • Monitor input and output
• Abdominal pain, fever • Provide modified diet, depending upon stone consistency
• Fluctuating mass in region of kidney

Medical Management DIET MODIFIED/STONE

• CALCIUM STONES There are four clinical phases of ARF;
• Low calcium diet (400 mg daily) 1. Initiation Period- begins with the initial insult and ends when
• Achieved by eliminating milk/dairy products oliguria develops
• Provide acid-ash diet to acidify urine 2. Oliguria Period- is accompanied by an increase in the serum
- Cranberry or prune juice concentration of substances usually excreted by the kidneys (urea,
- Meat creatinine, uric acid, organic acids, and the intracellular cations
- Eggs (potassium and magnesium)
- Poultry 3. Diuresis Period- is marked by a gradual increase in urine output,
- Fish which signals that glomerular filtration has started to recover
- Grapes Diuretic Phase
- Whole grains 1. Urine output rises slowly, and then diuresis occurs (4 to 5 L/day)
- Take vitamin A & C. Folic acid supplements and Riboflavin 2. Excessive urine output indicates recovery of damaged nephrons
3. Hypotension occurs
• OXALATE STONES 4. Tachycardia occurs
• Avoid excess intake of foods/fluids high in oxalate 5. Level of consciousness improves
- Tea 4. Recovery Period- signals the improvement of renal function and
- Chocolate may take 3 to 12 months.
- Rhubarb Recovery Phase (convalescent)
- Spinach 1. Recovery is a slow process; complete recovery may take 1 to 2 years
• Maintain alkaline-ash diet to alkalinize urine 2. Urine volume is normal
- Milk 3. Increase in strength occurs
- Vegetables 4. Level of consciousness occurs
- Fruits except prunes, cranberries and plums 5. Blood urea nitrogen is stable and normal
6. Client can develop chronic renal failure
• URIC ACID STONES
• Uric acid is a metabolic product of purines Clinical Findings
• Reduce foods high in purine Oliguric Phase Diuretic Phase Convalescent Phase
- Liver, brains, kidneys, venison, shellfish, meat soups, gravies, legumes Hypernatremia Hyponatremia Normal Urine
and whole grains Volume
• Maintain alkaline urine Hypocalcemia Hypokalemia Increase in LOC
- Alkaline-ash diet Hyperkalemia Hypovolemia BUN stable and
normal
• CYSTINE STONES (rare) Hyperphosphatemia May develop CRF
• Low methionine Hypermagnesemia
- Methionine is the essential amino acid from which the nonessential Metabolic acidosis
amino acid cystine is formed,
• Limit protein foods
Medical Management
- Meat, milk, eggs, cheese A. Pharmacologic Therapy
• Maintain alkaline-ash diet
• The elevated potassium levels may be reduced by administering
carbon-exchange resins (sodium polystyrene sulfonate (Kayexalate])
Nursing Care
orally or by retention enema.
• Administer Allopurinol (Zyloprim) as ordered.
• Sorbitol may be administered in combination with Kayexalate to
- to decrease uric acid production
induce a diarrhea-type effect it induces water loss in the GI tract)
- force fluids when giving Allopurinol
• Kayexalate retention enema is administered.
• Encourage daily weight-bearing exercise
• If the patient is hemodynamically unstable (low blood
• Provide client teaching and discharge planning concerning:
pressure, changes in mental status, dysrhythmia)
- Prevention of urinary stasis by OF especially in hot weather and
• IV dextrose 50%, insulin and calcium replacement may be
during illness, mobility, voiding whenever the urge is felt and at least
administered to shift potassium back into the cells.
twice during the night
• Adjust antibiotic medications (aminoglycosides), digoxin, ACE
- Adherence to prescribed diet
inhibitors, and magnesium-containing agents
- Need for routine U/A (at least every 3-4 months)
• Diuretic agents
- Need to recognize and report S/S of recurrence
• Severe acidosis
- hematuria, flank pain
• Provide care ff a nephrolithotomy or PUL
Nursing Management
- Change dressings frequently during the first 24 hours after a
A. Monitoring Fluid and Electrolyte Balance
nephrolithotomy
• Parenteral fuids, all oral intake, and all medications are screened
- Maintain patency of ureteral catheter as well as urethral catheter to
careful
prevent hydronephrosis.
• Patient's cardiac function and musculoskeletal status are monitored
- Encourage use of incentive spirometry and coughing and deep
closely for signs of hyperkalemia.
breathing to prevent atelectasis.
B. Reducing Metabolic Rate
• Bed rest
 RENAL FAILURE
• Fever and infection are prevented or treated
Prerenal Causes Intrarenal Postrenal Causes
C. Promoting Pulmonary Function
Hypotension Acute Tubular Calculi • Attention is given to pulmonary function
Necrosis (ATN) • The patient is assisted to turn, cough, and take deep breaths
Cardiogenic shock Diabetes mellitus Tumors frequently
Acute Malignant Blood clots D. Preventing Infection
vasoconstriction hypertension • Asepsis is essential with invasive lines and catheters
Hemorrhage Acute BPH • Indwelling urinary catheter is avoided
glomerulonephritis E. Providing Skin Care
Burns Tumors Strictures • Meticulous skin care is important
Septicemia Blood transfusion Trauma • Turning the patient frequently, bathing him or her with cool water,
reactions and keeping the skin clean and well mosturized and the fingernails
CHF Nephrotoxins Anatomic trimmed to avoid excoriated
malformation F. Providing Support
• The patient with ARF may require treatment with Hemodialysis,
peritoneal dialysis, to prevent serious complications
Phases of Acute Renal Failure
 DIALYSIS - Most serum protein's pass through the peritoneal membrane and are
• Diffusion lost in the dialysate fluid
• Osmosis - Monitor serum protein levels closely
• Ultrafiltration
 KIDNEY TRANSPLANTATION
Types General Information
• Hemodialysis • Transplantation of a kidney from a donor to recipient to prolong the
• Peritoneal dialysis life of person with renal failure
1. CAPD Sources of Donor Selection
2. APD • Living relative with compatible serum and tissue studies, free from
a. CCPD systemic infection and emotionally stable
b. IPD • Cadavers with good serum and tissue crossmatching, free from renal
c. NPD disease, neoplasms and sepsis, absence of ischemia/trauma

 HEMODIALYSIS Nursing Care: Pre-op

General Information • Provide routine pre-op care.
• Shunting of blood from the client's vascular system through an • Discuss the possibility of post-op dialysis/immunosuppressive drug
artificial dialyzing system and return of dialyzed blood to the client's therapy with client and significant others
circulation
• Dialysis coil acts as the semi-permeable membrane Nursing Care: Post-op
• Dialysate is a specially prepared solution • Provide routine post-op care
• Monitor fluid and electrolyte balance carefully
Nursing Care: (Before and during hemodialysis) - Monitor input and output hourly and adjust IV fluid administration
• Have client void accordingly
• Chart client's weight - Anticipate possible massive diuresis
• Assess vital signs before and every 30 mins. during procedure • Encourage frequent and early ambulation
• Withhold antihypertensives, sedatives, and vasodilators • Monitor V/S especially temperature and report significant changes
- to prevent hypotensive episode (unless ordered otherwise) • Provide mouth care and Nystatin (Mycostatin) mouthwashes for
• Ensure bed rest with frequent position changes for comfort Candidiasis.
• Inform client that headache and nausea may occur • Administer immunosuppressive agents as ordered
• Monitor closely for signs of bleeding since blood has been • Assess for signs of rejection.
heparinized for procedure Note for:
- Decreased urine output
Nursing Care: (Post-dialysis) - Fever/pain over transplant site
• Chart client's weight - Edema
• Assess for complications - Sudden weight gain
A. Hypovolemic Shock - Increasing BP
- May occur as a result of rapid removal or ultrafiltration of fluid from - Generalized malaise
the intravascular compartment - Rise in serum creatinine
B. Dialysis Disequilibrium Syndrome - Decrease in creatinine clearance
- Urea is removed more rapidly from the bleed than from the brain.
- Assess fer nausea, vomiting, elevated BP, disorientation and Nursing Care: Post-op
peripheral paresthesia • Provide client teaching and discharge planning concerning:
- Medication regimen
 PERITONEAL DIALYSIS - S/Sx of tissue rejection and the need to report it immediately to the
General Information physician
- Introduction of a specially prepared dialysate solution into the - Dietary restrictions
abdominal cavity, where the peritoneum acts as a semi-permeable - Restricted Na and calories
membrane between the dialysate and blood into the abdominal - Increased CHON
vessels. - Daily weights
- Daily measurements of input and output
Nursing Care - Resumption of activity and avoidance of contact sports in which the
• Chart client's weight transplanted kidney may be injured
• Assess V/S before, q15 min during first exchange, & qH thereafter.
• Assemble specially prepared dialysate solution with added  NEPHRECTOMY
medications. Indications
• Have client void. • Renal tumor
• Warm dialysate solution to body temperature. • Massive trauma
• Assist physician with trocar insertion. • Removal for a donor
Inflow: Allow dialysate to flow unrestricted into peritoneal cavity. • Polycystic kidneys
- 10-20 minutes
Dwell: Allow fluid to remain in peritoneal cavity for prescribed period Nursing Care: Pre-op
- 30-45 minutes • Provide routine pre-op care
Drain: Unclamp outflow tube and allow to flow by gravity. • Ensure adequate fluid intake
• Assess electrolyte values and correct imbalances before surgery
Observe characteristics of dialysate outflow • Avoid nephrotoxic agents in any diagnostic tests
a. Clear pale yellow- normal • Advise client to expect flank pain after surgery if retroperitoneal
b. Cloudy- infection, peritonitis approach (flank incision) is used
c. Brownish- bowel perforation • Explain that the client will have chest tube if thoracic approach is
d. Perforation- common during first few exchanges, abnormal: if used
continuous
• Monitor input and output and maintain records Nursing Care: Post-op
• Assess for complications • Provide routine post-op care
• Assess urine output every hour
Nursing Care • Observe urinary drainage on dressing and estimate amount
A. Peritonitis • Weigh daily
B. Respiratory Difficulty • Maintain adequate functioning of chest drainage, ensure adequate
C. Protein Loss oxygenation and prevent pulmonary complications
• Administer analgesics as ordered - Mild to moderate glandular enlargement, hyperplasia, and
• Encourage early ambulation overgrowth of the smooth muscles and connective tissue
- As the gland enlarges, it compresses the urethra resulting to urinary
Epididymis retention.
• 1st part of the ductal system
• Stores spermatozoa while they mature General Information
 EPIDIDYMITIS • Most common problem of the male reproductive system
• Inflammation of epididymis, one of the most common intrascrotal - occurs in 50% of men over age 50
infections. - 75% of men over age 75
• Etiology: may be sexually transmitted, usually caused by N.
gonorrhea, C.trachomatis, also caused by GU instrumentation, urinary Etiology
reflux, UTI or prolonged used of Foley catheter • Unknown
- may be related to hormonal mechanism
Predisposing Factor:
May be sexually transmitted, usually caused by N. gonorrhea, Unknown, aging process, hormonal (testosterone)
C.trachomatis, also caused by GU instrumentation, urinary reflux, UTI ↓
or prolonged used of Foley catheter Increased size of prostate gland
↓ ↓
Infective organism passes upward through the Urethra and ejaculatory Narrowing of the urethral lumen
duct along the vas deferens ↓
↓ Change in bladder patterns
To the epididymis ↓
Assessment Findings: Frequency, residual >50 mL, nocturia, hesitancy, decrease in urinary
• Sudden scrotal pain dynamic flow
• Scrotal edema ↓
• Tenderness over the spermatic cord Renal insufficiency
• Groin pain, swelling in groin
• Pus in the urine Clinical Findings
• Fever and chills • Nocturia
• + bacteria in urine • Frequency
• Abscess development • Decreased force and amount of urinary stream
• Diagnostic test: urine culture reveals specific organism • Hesitancy
- difficulty in starting voiding
Nursing interventions: • Hematuria
• Administer antibiotics and analgesics as ordered • Enlargement of prostate gland upon palpation by digital rectal exam
• Provide bed rest with elevation of the scrotum to prevent traction on
the spermatic cord to facilitate drainage and relieve pain Diagnostic Tests
• Apply ice packs to scrotal area to decrease edema • Urinalysis
• Increased fluid intake - alkalinity increased
• Instruct to use sitz bath - specific gravity normal or increased
• Avoid lifting, straining and sexual contact until the infection subsides • BUN and creatinine elevated
- if long standing BPH
 PROSTATITIS • Prostate-specific antigen (PSA) elevated
• Inflammatory condition that affects the prostate gland - Normal: 44 ng/ml
Prostate- located below the bladder and front of the rectum + • Cystoscopy
secretes milk fluid that aids the passage of sperm and keeps them - reveals enlargement of gland and obstruction of urine flow
viable. UTZ, MRI, CT scan

Types: Nursing Care

1. Acute bacterial prostatitis • Administer antibiotics as ordered
2. Chronic bacterial prostatitis • Provide client teaching concerning medications
- Usually caused by E. coli, N gonorrhea, Enterobacter or Proteus • Terazocin (Hytrin)
species and group D streptococai - relaxes bladder spincter and makes it easier to urinate
4. Abacterial prostatitis- caused by viral illness or decrease in sexual - may cause hypotension and dizziness
activity, lower UTI’s • Finasteride (Proscar).
- shrinks enlarged prostate
Assessment Findings: • Force fluids
1. Acute- fever, chills, dysuria, urethral discharge, prostatic • Provide care for the catheterized client
tenderness, copious purulent discharge upon palpation, presence of • Provide care for the client with prostatic surgery
WBC in prostatic secretions
2. Chronic- backache, perineal pain, mild dysuria, frequency, enlarged  PROSTATIC SURGERY
firm, hematuria, slightly tender prostate upon palpation General Information
3. Diagnostic test: • Indicated for benign prostatic hypertrophy and prostatic cancer
a. WBC elevated
b. bacteria in initial urinalysis specimens Types
1. Transurethral Resection
Nursing Interventions: 2. Suprapubic Prostatectomy
1. Administer antibiotics, analgesics, antispasmodic and stool softeners 3. Retropubic Prostatectomy
as ordered 4. Radical Perineal Prostatectomy
2. Increased OFI
3. Provide sit bath/rest to relieve discomfort  TRANSURETHRAL RESECTION
4. Provide client teaching • Prostatic tissues are excised through a resectoscope
a. maintaining adequate hydration • Does not cause incontinence or impotence
b. antibiotic therapy • Continuous bladder irrigation (CBI)
c. activities that drain the prostate (masturbation, sexual intercourse, • Done post-op to irrigate the bladder and remove blood clots
prostatic massage) • Done through 3-way foley catheter

BENIGN PROSTATIC HYPERTROPHY  TURP- CONTINUOUS BLADDER IRRIGATION

• Prevent bleeding and infection
• Teach kegel exercise prevent retention and dribbling
• Avoid vigorous exercise, heavy lifting, sexual intercourse for 3 weeks
after discharge
• Avoid straining, prolonged sitting/standing, crossing legs, long trips
for 2 weeks after discharge

 SUPRAPUBIC PROSTATECTOMY
• Involves removal of the prostate gland through abdominal and
bladder incision
• Client will have cystostorhy and 2-way foley catheter
• CBI is prescribed and administered to keep urine pink

 RADICAL PERINEAL PROSTATECTOMY

• Removal of the prostate gland through a lower abdominal incision
• No incision site into the bladder
• CBI may be prescribed
• Removal of the prostate gland through an incision made between the
scrotum and the anus
• Causes incontinence and sterility
• Avoid inserting rectal tubes, rectal temperature taking, enemas

Nursing Care: Pre-op

• Provide routine pre-op care
• Information about the procedure and the expected post-op care,
including catheter drainage, irrigation, and monitoring of hematuria is
discussed
• Reinforce what surgeon has told client/significant others regarding
effects of surgery on sexual function
• Bowel prep
• Force fluids, administer antibiotics, acid-ash diet to eradicate UTI

Nursing Care: Post-op

• Provide routine post-op care
• Maintain patency of urethral catheter placed after surgery (3-way
catheter, continuous bladder irrigation/cystoclysis)
• Prevent infection
• Relieve pain
• Reduce anxiety
• Health education and health maintenance
• Expect hematuria for 2-3 days
• Control/treat bladder spasms, encourage short frequent walks,
administer anticholinergic, antispasmodic, stool softener as ordered
• Avoid rectal temperature, enemas, monitor Hgb, hct. Report bright
red, thick blood in the catheter, persistent clots, persistent drainage
on dressings
• Avoid heavy lifting, straining defecation and prolonged travel (at
least 8-12 weeks)