REF

GENITOURINARY REF (I.Renal) - Bone Marrow (II.Aplastic) -

Erythroblasts (III.Nutritional) - RBC - Blood
SYSTEM Loss, Hemolytic (IV.Morphologic)

Renin (RAAS)
- Excretory
Renal Artery > Aldosterone - Na Retention
- Receives blood from the kidneys. > ADH - H2O Absorption
- Filtrates
Kidneys > H2O
- Metabolic function (Conserves > Erythrocytes
HCO3) > Glucose
- Endocrine function (Production of > Wastes (Urea, Uric acid)
Hormones)
- Excretory (Removal of waste
Urine Output - 30 - 60 cc/hr
products via urine)
GFR - 125 cc/min
TRR - 124 - 124.5 cc/min
Calcium Regulation Transport
Total = .5 - 1 cc/min x 60
● Calcium
● Vitamin D
● Parathyroid Hormone
● Thyrocalcitonin
Diseases
Calcium - Intestine (Lactose, Pancreatic
Enzyme) - Blood (Anionized) - Vitamin D
RENAL FAILURE
(Sunlight) - Bones (Matrix Formation,
Mineralization) - Blood (Ionized) - PTH Acute
(Stress, Steroids) - Increased PTH - ● Reversible
Thyrocalcitonin ● Sudden
● Azotemia (Uremia)
* Decreased estrogen - decreased
thyrocalcitonin - increased PTH Chronic
● Irreversible
VITAMINS ● Progressive
● Azotemia

Elevated Labs:
● BUN - 10 -20 mg/dL
● Uric Acid - 2.5 - 8 mg/dL
● Crea - 4 - 1.2 mg/dL

DIAGNOSTIC MARKER : ELEVATED

CREATININE LEVEL
Most Accurate: Creatinine Clearance (24 hr STAGES OF CHRONIC RENAL FAILURE
urine clearance)
1st Diminished Asymptomatic
Catabolysm & Deamylation Renal (10%)
Protein - Liver - Albumin, Uric Acid, Reserve
Ammonia
2nd Stage Renal Mild - 25%
Albumin & Globulin Transfer - Amino Acid Insufficiency Moderate -
(Excrete 50%
(Amine Derivatives, Muscle Repair & Tissue
only) Azotemia -
Building) 75%
Uric Acid (Purines) - Blood - Kidneys (Urine)
Ammonia (Heavy Toxin) - Deamilation 3rd ESRF (All) Life
(Detox, Conversion) - Liver - BUN (Light) Threatening
(90%)
BUN
- 20% - Large Intestine - Feces Excretory Pathophysiology
- 80% - Kidneys - Urine I. Increased BUN
a. Middle Molecule Trapping
Cause: - Hyperglycemia
● Pre - renal (blood supply > Profound Weakness
insufficiency) - Hyperlipidemia
● Intrarenal (damage to kidneys) > Atherosclerosis
- DM, HTN, SLF (Lupus) > Decreased ADEK
● Post - renal (obstruction to urine - Hormonal Imbalances
flow) > Impotence
> Infertility, Amenorrhea
STAGES OF ACUTE RENAL FAILURE - Decreased Keratin
> Yellow, Sallow Color
> Split Ends
Onset Oliguric/ Diuretic Recove
Anuric ry > Brittle Hair
b. BUN Travel
GFR - X - - - Skin (Uremic Frost -
Pruritus)
TRR - - X - - Pericarditis
Sym Asym Increase Shock, Normal - Pleuritis
ptom ptoma d BP, Fluid , 6 - 12 - GI Tract (Stomatitis,
s tic Edema, Volume months Esophagitis, Gastritis)
Pulmona Deficit, - Renal Encephalopathy
ry Decrea (CNS Depression, Psycho
Edema, sed
Symptoms)
CHF, Edema
Fluid
Volume Metabolic Pathophysiology
Excess I. Increased Uric Acid + Decreased
HCO3
 a. Metabolic Acidosis T - tachycardia
- Decreased WBC (Infection) I - insomnia
- Decreased Acetylcholine G - generalized weakness
(Seizures) U - unusual irritability
E - exertional dyspnea
Brain - Acetylcholine - Cholinesterase - D - dizziness
Acetylcholine (breakdown) - Substantia P - pallor
Nigra - Dopamine - GABA (relaxes the T - thin, dry skin & hair
muscle)
III. Oliguria
Decreased Dopamine + GABA = - false activation of RAAS
Parkinson’s a. Hypertensive Crisis
b. Gout - DOC: Phentolamine Mesylate
- Arthritis (Regitive), Alpha adrenergic,
- Urolithiasis Vasodilator (IV, Monitor BP q15)
- Antidote: Dopamine
II. Increased Electrolytes b. FVE
- Increased Na, Mg, K, - Anasarca
- Pulmonary Edema
Endocrine Pathophysiology - CHF
I. Decreased Hydroxyl - Vitamin D- Ca
- Ca Gluconate Management:
a. Bleeding Tendencies 1. Monitor Fluid & Electrolyte
b. Secondary - VS
Hypoparathyroidism - ECG (Tall peaked T - wave)
- Osteoporosis - P. Edema
- Fractures 2. Control nutrition
c. Tetany - Control fluid
- Hypocalcemia - Diet
- Spams - Simple CHO
- Prescribed K, Na, P
- Limited protein
Tetany S&S
3. Control hypocalcemia
● (+) Chovtek’s Sign
- Phosphate binder - aluminum
● (+) Trousseau's Sign
hydroxide
● Laryngospasm (Stridor)
- Calcium gluconate
*P & Ca are always inversely
II. Decreased REF proportional
- Renal Anemia 4. Control hyperkalemia
- DOC: Alfa (Epogen) - Low potassium diet
- Kayexalate (Na Polystyrene
S&S: Sulfonate)
F - fatigue - IV insulin with D5W
A - anorexia
 - abruptly transport glucose Symptoms:
to the cell & bring K A. Cystitis & Urethritis (Lower)
- D5W (avoids hypoglycemia) - Asymptomatic
- Dialysis > Frequency
5. Prevent Infection, Fatigue & Injury > Urgency
6. Promote Comfort > Dysuria (irritation)
- Relieve pruritus DOC: Phenazopyridine
MNGMT: (Pyridium)
- Bathe w/ warm water MNGT:
(1L) & Distilled - After Meals
vinegar or baking - Red - orange urine
soda (10 mL) (1:10) - Oral
- Antipruritic creams > Suprapubic Pain
- Emollient soaps DOC: Propantheline
- Prevent oral cracking Bromide (Probanthine)
> Hematuria
URINARY TRACT INFECTION > Pyuria

Etiology Fever Pathophysiology:

● E. Coli Pathogen (Blood) - Pyrogens -
● Pyelonephritis Hypothalamus - Pyrexia (Fever)
- Ascending infection
- Hematogenous spread B. Pyelonephritis
● Cystitis - Acute
- BPH - Symptoms:
- Women (shorter urethra) > Fever
● Urethritis > Chills
- Bacteria > Frequency
- viral > Dysuria
> Groin
Prone to UTI: > Flank pain
● Pregnant > *Costovertebral Angle
● Sexually Active Tenderness (Kidney Punch
● Teens Test)

Factors: Management:
● Stasis 1. Increase Fluid Intake (3-5 L a day)
● Urinary Retention 2. Acidity (Cranberry, Plum, Prunes)
● Bladder Distention 3. Hot sitz bath
● Poor Hygiene 4. 3 W’s : Wash, Wipe, Wear proper
● Instrumentation underwear
● Fecal Incontinence 5. Empty bladder (2-3 hrs, after
● Sexual Transmission intercourse)
6. Antibacterials
 - Sulfonamide (Lower) “zole”s + Assessment:
increase water intake ● Diagnostic Procedures
- Antibiotic (upper) “in”s + c&s before - Direct Rectal Examination
antibiotic therapy - Cystoscopy
● Nocturia
UROLITHIASIS ● Hesitancy
- Common site: Kidneys ● Hematuria
● Residual Urine
Etiology:
● Urinary pH Management:
● Diet 1. TURP (Transurethral Resection of
● Urinary Stasis the Prostate)
● Dehydration - No incision
- Continuous Bladder
Assessment: Cystoclysis (irrigate clots)
● *CVA pain - Complication: Hemorrhage
● Infection & Fever 2. Suprapubic Prostatectomy
● Decreased Urinary output - Incision over lower abdomen
& bladder
Diagnosis: 3. Retropubic Prostatectomy
● UTZ - Incision under the abdomen

Management: Post-Op Care:

1. Increase oral fluid intake 1. Care for TURP
2. Strain urine - Maintain patency
3. Encourage ambulation - Drainage
4. Diet
5. Analgesics
Clear - Decreased Flow Rate
DOC: Demerol (most responsive)
Dark - Increase Flow Rate
6. Surgery
Bright - notify MD
- Massive bleeding
- Severe obstruction
- Uncontrolled pain 2. Practice Asepsis
7. Extracorporeal Shockwave (ESWR) 3. PNSS when flushing
- Increase oral fluid intake 4. Prevent Thrombophlebitis
5. Monitor first 24hrs
BENIGN PROSTATIC HYPERPLASIA - First 24hrs : Dark Red
- Unknown cause - 3 Days Post OP: Amber
6. May feel an urge to void due to
Predisposing Factors: pressure on the internal sphincter by
● Hormonal Imbalances balloon of catheter.
● Age: >40 y.o. 7. Increase fluid intake
● Genetics 8. Analgesics: Demerol
● Stress
9. Client Teaching: urinary retention,
dribbling, incontinence
MNGMT: Kegel’s Exercises