Genitourinary System ppt1

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external genitalia

penis

scrotum

scrotal sac

external genitalia: penis

urination and reproduction

• shaft

• glands

external genitalia: scrotum

thin-walled sac suspended below pubic bone, posterior to penis

• protective covering, maintain cooler temp

internal genitalia

testes

spermatic cord

epididymis

vas deferens

internal genitalia: testes

produce spermatozoa and testosterone

• suspended in scrotum

internal genitalia: vas deferenes

passage for transporting sperm for ejaculation

internal genitalia: epidiymis

curves over upper and posterior surface of testis

inguinal area

located btwn anterior superior iliac spine laterally and symphysis pubis medially

inguinal area: frequent site of

hernia

anus and rectum

anal canal

anal opening

prostate

palpated through anterior wall of rectum

adult hiv/aids: risk factors

unprotected sex, existing STI, IV drugs, uncricumcised, fetus of HIV positive mother

HIV prevention, risk

screening in all

precautions to decrease transfer of bodily fluids

HIV transmitted

person to person

• body fluids

  • infected blood, mother to child, IV drug users

teaching opportunity: hiv

discussion to reducing risk during health history interview

• trusting relationship

• key self-examination to detect early

risk factor for prostate cancer: age

rare in men under 40, rises rapidly after age 50

risk factor for prostate cancer: race/ethnicity

highest in African or Carribean males, less in Asian

hispanic more than in whites

risk factor for prostate cancer: geographics

NA, northwestern Europe, Australia, Carribean Islands

• less in ASia, Africa, CA, SA

risk factor for prostate cancer: family history

father or brother with prostate cancer

risk factor for prostate cancer: certain gene changes

exposure to agent orange

risk factor for prostate cancer: work

farm, tire plant, with pain, cadmium or firefighters exposed to toxic chemicals

risk factor for prostate cancer: diet

diet high in red meat or high fat, fewer veeggies

risk factor for prostate cancer: low melatonin levels

sleeping w even a small light

shift work

symptoms of prostate cancer

trouble urinating

decreased force in urine stream

blood in semen

swelling in legs

bone pain

erectile dysfunction

education topics: prostate cancer

eat moderately, high in fruits, veggies, fiber, omega 3

moderate exercise

consume soy products, legumes

green tea, no more than 2 alcoholic drinks

sleep in dark room; avoid bright light

testicular cancer

high mortality rate if not detected early

• testicular exam

testicular self-exam (TSE)

once a month, essential

• look of pea-like lump

testicular cancer: trusting relationship

sensitivities, open to sharing info

health assessment: collecting subjective data

cointerview approach (COLDSPA) for nursing assessment

• history of current health problem

• past and family histories

• lifestyle and health practices

health assessment: collecting objective data

physical examination of client

• prep, equipment (stool, gown, disposable gloves, flashlight, stethoscope)

physical assessment: penis

inspection and palpation

• base of penis and pubic hair

• shaft, foreskin, glans

  • urethral discharge

physical assessment: scrotum

inspection: size, shape, position, scrotal skin (uncircumsized)

palpation of scrotal contents

auscultation

transillumination

transillumination

shining a light through tissue, to view a mass

physical assessment: inguinal area

inspection for inguinal and femoral hernia

abnormalities for men

rashes, lesions, lumps

chancres, tight foreskin

older client findings

lumps, swelling, masses, sexual dysfunction

female genitalia: external

identified readily through inspection

female genitalia: internal

female reproductive organs

cervical cancer: risk factors

HPV infection

smoking

immunosuppression

chlamydia infection

diet low in fruits and veggies

overweight

intrauterine device use

multiple full-term pregnancies

younger than 17 at first full-term pregn

poverty

family history

cervical cancer: diethylstillbestrol (DES)

synthetic female hormone

• moms who took this while pregnant

cervical cancer: avoid risky sexual practices

sex at early age, multiple partners

cervical cancer: HPV vaccination

boys and girls as early as 9 years old and up to 26 years old

• especially btwn 10 and 11 years old

cervical cancer: Pap smears

routine, follow USPSTF guidelines

cervical cancer: incidence - lowest

Eastern Mediterranean countries

ex: Egypt, Libya, Lebanon, Jordan

cervical cancer: incidence - highest

African region where income levels tend to be low

risk reduction: discussion of ways to reduce

establish trusting relationship, teach self-examination

cervical cancer: history of current health problem

menstrual cycles, age of first menstrual period, menopause

vaginal discharge, pain/itching, lumps, urinating issues

sexual performance, pattern, fertility issues

cervical cancer: past and family history

gynecologic problems, last pelvic exam, last Pap smear

fever diagnosed with STDs

pregnancies

reproductive or genital cancer

cervical cancer: lifestyle and health practices

smoking, sexual partners, contraceptives

genitalia problems, sexual preference, comfort lvl

fears and stress with sex

fertility issues, menopause concerns

genital self-exam

HIV results, estrogen replacement, TSS, STD

cervical cancer - inspection of external genitalia

mons pubis

labia majora and perineum

labia minora, clitoris, urethral meatus, vaginal opening

cervical cancer - palpation of external genitalia

bartholin glands: only if issue present

urethra: shorter length, more prone to infection

cervical - physical assessment - internal genitalia - inspection

vaginal opening, vaginal musculature

cervix, vagina

cervical - physical assessment: bimanual exam

palpation of cervix, uterus, ovaries

rectovaginal exam

cervical cancer - findings

external genitalia and vaginal opening, cervix

vaginitis

uterine enlargement

adnexal masses - cysts on ovaries

cervical - older client findings

decrease in estrogen

vaginal infection

gray, thinning pubic hair

pale cervix after menopause

urinary incontinence from muscle weakness or loss or urethral elasticity

cervical - older clients’ decrease in estrogen

vaginal dryness, paleness, muscles atrophy

urinary system

eliminates toxins, filters blood, control fluid volume

urinary system is made up of

kidneys and ureters

bladder

urethra

kidneys and ureters: function

maintain comp and volume of body fluids

filter and excrete blood constituents not needed; retain those that are needed

excrete waste product (urine)

kidneys and ureters: excrete waste product (urine)

nephrons maintain and regulate fluid balance through mechanism of selective reabsorption and secretion of water, electrolytes, other substances

urine from nephrons empties into kidneys

bladder: smooth muscle sac

innervated by ANS

bladder serves as

temp reservoir for urine

bladder: composed of

3 layers of muscle tissue called detrusor muscle

• inner longitudinal, middle circular, outer longitudinal

bladder: sphincter guards

opening between urinary bladder and urethral

urethra conveys urine

from bladder to exterior

male urethra

functions in excretory and repro systems

no portion of female urethra

is external to body

act of urination

micturition, voiding

process of emptying bladder

detrusor muscle contracts, internal sphincter relaxes, urine enters posterior urethra

muscles of perineum and external sphincter relax

muscle of abdominal wall contracts slightly

diaphragm lowers, micturition occurs

factors affecting micturition - developmental considerations

potty training, should not force child if they are not ready

bedwetting at night

factors affecting micturition - food and fluid intake

high in water content

factors affecting micturition: psychological

depression, anxiety, stress

factors affecting micturition: activity and muscle tone

kegels (exercise the muscles)

lifting heavy weights

cath - makes it so patient does not have to use urinary muscles

factors affecting micturition: other

patholgoic conditions, meds (antidiuretics)

enuresis

bed-wetting

• toilet trian from 2 to 3 yrs old

effects of aging on micturition

nocturia, increased frequency

urine retention and stasis (doesn’t come out → prone to infection)

physical issues (arthritis) make it difficult to get to bathroom in time

diseases associated with renal conditions

congenital urinary tract abnormalities

polycystic kidney disease

UTI, urinary calculi

hypertension, diabetes mellitus, gout

connective tissue disorders

effects of meds on urine prod/elim: diuretics

prevent reabsorption of water and certain electrolytes in tubules

effects of meds on urine prod/elim: cholinergic meds

stimulate contraction of detrusor muscle, producing urination

effects of meds on urine prod/elim: analgesics and tranquilzers

suppress CNS, diminish effectiveness of neural reflex

meds affecting color of urine: anticogulants

red urine

meds affecting color of urine: diuretics

pale yellow urine

meds affecting color of urine: pyridium

orange to orange-red urine

meds affecting color of urine: antidepressant amitriptyline or B-complex vitamins

green or blue-green urine

meds affecting color of urine: levodopa

brown or black urine

kidneys: physical assess of urinary functioning

palpation - by advanced health care practitioner

urinary bladder: physical assess of urinary functioning

palpate and percuss the bladder or use a bedside scanner

urethral orifice: physical assess of urinary functioning

inspect for signs of infection, discharge, or odor

skin: physical assess of urinary functioning

assess for color, texture, turgor, excretion of wastes

urine: physical assess of urinary functioning

assess for color, odor, clarity, sediment

measuring urine output

ask patient into bedpan, urinal, specimen container

pour into measuring device, calibrated on flat surface

discard unless needed

urine specimens

routine urinalysis

clean-catch or midstream specimens

sterile specimens form indwelling cath

from urinary diversion

24 hr urine specimen

specimen from infants and children

point-or-care urine testing

routine urinalysis

pee in cup

clean-catch or midstream specimens

pee a little, wipe, put cup under

urine specimen from urinary diversion

if they have cancer, bring out urethra through stomach

specimens from infant and children

bag to place over area

promoting normal urination

maintaining normal voiding habits - mimic

• have them stand up or head up

promoting fluid intake

strengthening muscle tone

assisting with toileting

patients at risk for UTI

sexually active women

women who use diaphragms for contraception

postmenopausal women - estrogen

individuals with indwelling cath

individuals with diabetes mellitus

older adults

reasons for catheterization

ONLY if absolutely needed (standing orders)

relieving urinary retention, prolonged urinary retention

prolonged patient immobilization, need a sterile urine specimen

measurement of urinary output

assist in healing for incontinent, emptying before procedures or after

improved comfort for end-of-life care

types of urinary incontinence

transient, mixed, overflow, functional, reflex, total, stress