Disorders of the Genitourinary System


CHAPTER 18






Disorders of the Genitourinary System


 

 





LEARNING OUTCOMES






 


Upon completion of this chapter, the nurse will:



1.  Summarize the different disorders of the genitourinary system


2.  Examine approaches to assess different disorders of the genitourinary system


3.  Determine approaches that can be used for more than one genitourinary system disorder


GENITOURINARY SYSTEM DISORDERS


Disorders within the genitourinary system can be acute, chronic, or an adverse effect caused by a medication or other health problem. The disorders that would be the most appropriate for telephonic care include:



  Acute renal failure (recovery from)


  Chronic renal failure


  Kidney stones


  Urinary tract infection


  Prostatitis


  Benign prostatic hyperplasia (BPH)


  Prostate cancer


  Benign breast disease


  Breast cancer


Disorders that “might come up” in the course of a conversation that would not necessarily be considered a reason for disease management include:



  Urinary incontinence


  Erectile dysfunction


  Menstrual difficulties


  Menopausal difficulties


ASSESSING DISORDERS OF THE GENITOURINARY SYSTEM


Remember that the client has been diagnosed with a genitourinary system problem. The assessment should focus on the client’s current status and if there have been any changes in symptoms.


 




























































































































































































































Health Problem


Changes


Acute renal failure


When were you told you had a kidney problem?


 


What caused it, such as:


  An injury?


  Kidney stone?


  Infection?


 


How are you feeling right now?


 


Has your urine output returned to the amount prior to the problem?


 


What medicines have you been taking for the problem?


 


When are you supposed to see your doctor or health care provider again for the kidney problem?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the kidney problem?


Chronic renal failure


When were you told that you have chronic kidney problems?


 


What treatment are you having?


  Peritoneal dialysis?


  Hemodialysis?


 


(If hemodialysis) On which arm is your fistula for the treatments?


 


How does the skin over the fistula look?


 


Can you feel anything when you touch the skin over the fistula like a buzzing or vibration?


 


When do you have treatments, such as:


  Monday, Wednesday, and Friday?


  Tuesday, Thursday, and Saturday?


 


(If peritoneal dialysis) Do you do the treatments at home or at the kidney center?


How often do you have treatments?


Are you having any problems, such as:


  Blood in the drainage?


  Cloudy drainage?


  Abdominal pain?


  Fever?


 


What medicine are you taking because of the kidney failure?


  Are you taking the medicine as prescribed?


  Are you having any side effects from the medicine?


  Are you receiving a medicine that is injected every week to 10 days?


 


What diet changes have you had to make because of the kidney failure, such as:


  Reduce dairy products?


  Avoid foods high in potassium?


 


Are you considering or being considered for a kidney transplant?


  If so, what have you been told about the transplant?


 


When are you supposed to see your doctor or health care provider again for the kidney problem?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the kidney problem?


Kidney stones (renal calculi)


When were you told that you have kidney stones?


 


What symptoms are you having right now, such as:


  Flank pain?


  Groin pain?


  Blood in the urine?


 


What treatment are you having/had for the kidney stones?


  Lithotripsy?


  Medication?


 


Have you been directed to strain your urine? If so, what has been strained out?


 


Have you been directed to make dietary or fluid intake changes? If so, what changes have you made?


  Reduce dairy?


  Increased fluid?


 


When are you supposed to see your doctor or health care provider again for the kidney stones?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the kidney stones?


Urinary tract infection


When were you told that you have a urinary tract infection?


 


What symptoms are you having right now, such as:


  Burning with urination?


  Blood in the urine?


  Low-grade fever?


 


What medicine are you taking for the infection, such as:


  Antibiotics?


  Antispasmodics?


 


What information were you told about the medicine, such as:


  Take the full course of the antibiotics even if the symptoms of the infection go away


 


How often do you take the medicine for the bladder spasms? Is the medication helping?


 


What other information were you told to help prevent future infections, such as:


  Appropriate cleansing after toileting?


  Increasing the intake of oral fluids?


  Wearing breathable clothing?


  Voiding after intercourse?


  Not ignoring the urge to void?


  Avoiding tub baths?


 


When are you supposed to see your doctor or health care provider again for the infection?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the infection?


Prostatitis


When were you told that you have prostatitis?


 


Is this the first time that you have had the problem or have you had it before?


 


What symptoms are you having right now, such as:


  Low-back pain?


  Discomfort with sitting?


  Weak urinary stream?


  Pain with ejaculation?


 


What medicine are you taking for the prostatitis, such as:


  Antibiotics?


  Nonsteroidal anti-inflammatory agents?


 


What else have you been directed to do to help with the problem, such as:


  Avoid sitting for long periods of time?


  Taking a warm tub bath?


 


When are you supposed to see your doctor or health care provider again for the problem?


 


For what reasons have you been directed by your doctor or health care provider to seek additional medical care because of the problem?


Benign prostatic hyperplasia (BPH)


When were you told that you have BPH?


 


What tests did you have done?


  Digital exam?


  Blood tests?


  Urine tests?


  Biopsy?


 


What symptoms are you having right now, such as:


  Urinary frequency?


  Dribbling?


 


What medicine are you taking for the BPH?


  Are you taking the medicines prescribed?


  Have you noticed if the medicine is helping?


 


Were you or are you using anything else for the symptoms, such as:


  Saw palmetto?


  Echinacea?


 


Are you going to have/had surgery for the problem?


  When will it be done?


(Postoperative: When was it done?)


  What was done?


  How are you feeling right now?


 


When are you supposed to see your doctor/health care provider again for the BPH?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the BPH?


Prostate cancer


When were you told that you have prostate cancer?


 


What tests did you have done, such as:


  Blood test (prostate-specific antigen [PSA])?


  Biopsy?


  Digital examination?


 


What symptoms are you having right now, such as:


  Pain with urination?


  Frequency?


  Blood in the urine?


  Bone or joint pain?


  Lower extremity weakness?


  Weight loss?


  Fatigue?


 


What treatment are you having for the prostate cancer, such as:


  Surgery?


  Medication?


  Radiation?


  Watch and wait?


 


When are you supposed to see your doctor/health care provider again for the prostate cancer?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the prostate cancer?


Benign breast disease


When were you told that you have a breast condition?


 


What were you told that you have?


 


What symptoms are you having right now, such as:


  Breast pain?


  Nipple discharge?


 


What have you been directed to do to help with the breast condition, such as:


  Wearing a well-fitted bra?


  Avoiding coffee, tea, cola, and chocolate?


  Using over-the-counter pain medication?


  Applying heat/cold?


 


When are you supposed to see your doctor/health care provider again for the breast condition?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care because of the breast condition?


Breast cancer


When were you told that you have breast cancer?


 


When was your last mammogram?


 


When was the biopsy done?


 


What were you told when you received the results of the biopsy?


 


What treatment are you having/going to have:


  Chemotherapy:


      When will/did this start?


      How many treatments/how many weeks?


  Radiation:


      When will/did this start?


      How many treatments/how many weeks?


  Surgery:


      When will this be/was this done?


      What type will be/was done (remove the entire breast, remove a portion of the breast)?


 


What information were you given about the treatments, such as:


  Potential for nausea and hair loss with chemotherapy?


  Skin care for radiation treatments?


  Risk for arm swelling (lymphedema) after breast surgery?


 


How are you feeling right now? (The client with breast cancer can have many psychosocial issues. The best approach would be to ask: What can I do to help you right now?)


 


When are you supposed to see your doctor/health care provider again?


 


For what reasons have you been directed by your doctor/health care provider to seek additional medical care?


ADDITIONAL DISORDERS


It is unlikely that a client will be enrolled in a disease management program for problems with urinary incontinence, menstruation, menopause, or erectile dysfunction; however, these problems may be identified during the course of a regular care call.


 
































































Problem


Questions


Urinary incontinence


Assess when the problem started


 


Assess when the problem occurs:


  Stress: occurs when sneezing, coughing


  Urge: loss of urine with a strong urge to void


  Overflow: bladder does not empty and excess urine leaks out


  Functional: cannot get to the bathroom in time because of physical problem


 


Assess the frequency that this occurs


 


Assess what has been done about it:


  Wearing protection


  Bathing more frequently


  Voiding schedule


 


Assess if medication has been prescribed and the effectiveness of the medication


 


Encourage to adhere to prescribed treatment plan or seek medical attention for any new onset of symptoms.


Erectile dysfunction


Assess for length of time the problem has been occurring


 


Assess if the problem has been discussed with a health care professional


 


Assess if the problem can be associated with taking a newly prescribed medication (such as antihypertensives, other cardiac medications) or disease process (diabetes)


 


Suggest to discuss the problem with a health care professional


Menstrual difficulties


Assess for the type of difficulty:


  Cramping


  Large blood flow


  Clotting


  Bleeding between menstrual cycles


 


Assess for the length of time the problem has been occurring


 


Assess for what has been done to help with the problem:


  Applying heat (cramps)


  Changing diet (cramps)


  Increasing activity (cramps)


  Resting (large blood flow/clotting)


 


Suggest discussing the problem with a health care professional


Menopausal difficulties


Assess for the type of difficulty:


  Hot flashes


  Night sweats


  Insomnia


  Painful urination


  Painful intercourse


 


Assess for the length of time the problem has been occurring


 


Assess for what has been done to help with the problem:


  Exercise


  Daily calcium intake


  Water-soluble lubricant


  Increased fluid intake


  Wearing breathable clothing


  Complementary/alternative therapies or supplements


 


Suggest to discuss the problem with a health care professional


SUGGESTIONS FOR GENITOURINARY DISORDERS


  Use the same terminology that the client uses to describe the problem.


  Always ask how the patient/client is feeling right now.


  Genitourinary disorders can adversely affect activities of daily living. The patient may restrict leaving the home and change routine activities because of the fear of becoming incontinent during an inopportune time. Assess how the problem has affected regular activities.


  Remember that talking about this body system and problems can cause the patient embarrassment. Keep the conversation “matter of fact” and do not proceed if the patient refuses to discuss any problems further.


  Ask about the prescribed treatment for a health problem and reinforce the treatment. Do not recommend a complementary or alternative therapy. If asked about something that is not mainstream treatment, encourage the patient to discuss the approach with the health care professional.


 

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Oct 5, 2017 | Posted by in NURSING | Comments Off on Disorders of the Genitourinary System
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