NUR 2163 RENAL NURSING TOPIK 1

NUR 2163

PN WAN NAPISAH BINTI WAN OMAR
FKSK
KUIM

RENAL NURSING

CONGENITAL ABNORMALITIES

LEARNING OUTCOME

At the end of this session, students should be able to:
1. Define the terminology.
2. Explain the pathophysiology.
3. Explain the etiology & risk factors.
4. Identify signs & symptoms of disease.
5. Explain the management and treatment for the disease.

HYPOSPADIAS

birth defect (congenital)
the opening of the urethra is on the underside of the penis

instead of at the tip.

signs and symptoms
1) Opening of the urethra at a location other than the tip of

the penis.
2) Downward curve of the penis (chordee)
3) Hooded appearance of the penis -only top of the penis

is covered by foreskin.
4) Abnormal spraying during urination

Types of hypospadias

• -depending on where the urethra opening is located:
1. Near the head of the penis (subcoronal)
2. Along the shaft of the penis (midshaft)
3. Where the penis and scrotum meet, or on the scrotum

(penoscrotal)

HYPOSPADIAS

Etiology

Certain hormones stimulate the formation of the urethra
and foreskin.

When these hormones malfunction, it causing the urethra
to develop abnormally.

Risk factor
Exact cause – unknown
1.Fertility treatments.
-hormone therapy or medicine to help her get pregnant
2.Genetics.
-hormones stimulate formation of the male genitals.

3. Maternal age over 35.
4.Exposure to certain substances during pregnancy.
-pesticides or industrial chemicals, smoking.
-need further studies to confirm this.
5.Premature.

Complication
1. Abnormal appearance of the penis.
2. Problems learning to use a toilet.
3. Abnormal curvature of the penis with erection.
4. Problems with impaired ejaculation.

Treatment

Treated with surgery
When the child is between 6 and 12 months old, because:
easier to take care.
safe to undergo anesthesia.
Prevent mental and emotional problems.
Correct curvature of the penis and to place the opening of

the urethra in the right spot.
After surgery, the baby may have a small catheter in

order to pass urine(PU) for a few days to 2 weeks.
Antibiotics –to reduce risk of infection
Pain drugs – reduce pain and help any discomfort.
Procedures are highly successful.

Surgery

PHIMOSIS

Nur2163

Phimosis

Phimosis

oDefinition :
The foreskin can’t be retracted (pulled back) from around
the tip of the penis.
Common in baby boys who aren’t circumcised.

o Symptom:
1. Inability to retract the foreskin by the age of 3. But,

usually loosen over time. By 17, should be able to easily
retract his foreskin.
2. Swelling of the foreskin while urinating.

Etiology

• Foreskin is forcibly retracted before it’s ready. This can
harm the skin & cause scarring, make more difficult to
retract.

• Inflamation or infection of the foreskin or the head of the
penis (glans)

• Balanitis – inflamation of the glans ,cause by poor
hygiene or infection. Infection that can lead to balanitis is
called lichen sclerosus.

• Triggered by abnormal immune response or hormone
imbalance.

• White spot or patches on the foreskin.
• Skin may itchy and easily torn.

Treatment for phimosis

1. Continue to “ wait and see” if the phimosis will go away
on its own.

2. Use a steroid cream to help stretch the foreskin.
3. Have surgery to partially or completely remove the

foreskin (circumcision).
Prevention

1. The head and the foreskin need to be washed and dried
regularly.

2. Be gentle, if you pull it back don’t forget to put it back in
place when you finish.

3. Consider getting circumcised.

Undescended testis

Undescended testis

• An undescended testicle (cryptorchidism) is a testicle that
hasn't moved into its proper position in the bag of skin
hanging below the penis (scrotum) before birth.

• Usually just one testicle is affected, but about 10 percent
of the time both testicles are undescended.

• common among baby boys born prematurely.
• surgery can relocate the testicle into the scrotum, if

doesn't correct itself.

Symptoms

• Not seeing or feeling a testicle
• Testicles form in the abdomen during fetal development.

During the last couple of months of normal fetal
development, the testicles gradually descend from the
abdomen through a tube-like passageway in the groin
(inguinal canal) into the scrotum.
• With an undescended testicle, that process stops or is
delayed.

Causes / Risk factors

• Causes – unknown
• Risk factors
1. Low birth weight
2. Premature birth
3. Family history of undescended testicles or other problems of

genital development
4. Conditions of the fetus that can restrict growth, such as

Down syndrome or an abdominal wall defect
5. Alcohol use by the mother during pregnancy
6. Cigarette smoking by the mother or exposure to secondhand

smoke
7. Parents' exposure to some pesticides

Complications

• Testicular cancer.
-Testicular cancer usually begins in the cells in the testicle that
produce immature sperm. What causes these cells to develop
into cancer is unknown.

• Fertility problems.
-Low sperm counts, poor sperm quality and decreased fertility

• Testicular torsion.
-twisting of the spermatic cord, which contains blood vessels,
nerves and the tube that carries semen from the testicle to the
penis. This painful condition cuts off blood to the testicle.

• Trauma.
- If a testicle is located in the groin, it might be damaged
from pressure against the pubic bone.

• Inguinal hernia.
- If the opening between the abdomen and the inguinal
canal is too loose, a portion of the intestines can push into
the groin.

Treatment

• Diagnose :
• Laparoscopy – to locate an intrabdominal testicle.
• Open surgery – direct exploration of the abdomen or groin

through a larger incision.
• Absent testicle can cause serious medical problem if left

undiagnosed and untreated.
• Imaging test (U/S ,MRI ) aren’t recommended for

diagnosing an undescended testicle.

Treatment :
1.Surgery – before the child 18 months old.
• Orchiopexy – manipulate the testicle into the scrotum and

stitches it into place. (laparoscopy /open).

• After surgery – surgeon will monitor the testicle.
• Might include – physical exams

- u/s of the scrotum
- test of hormone levels
2. Hormone treatment
-injection of human chorionic gonadotropin (HCG) ,to move
testicle into scrotum.
*but less effective

3. Other treatments
if the child doesn’t have one or both testicle (missing/ didn’t
survive after op) – testicular prostheses can be implanted during
late childhood or adolescence.
If have at least one healthy testicle – doctor will refer to hormon
specialist (endocrinologist).



INFECTION

Urinary tract infection

UTI

• Def:
occurs when an infecting organism, typically gram-

negative bacteria such as E-coli, enters the urinary tract.
Inflamation of the local area occurs
The bacteria are present on the skin in the genital area

and enter the urinary tract through the urethral opening.
Can also be introduced during sexual contact, CBD,

cystoscopy (instrument not completely sterilized).



Types of UTIs

• Cystitis: A bladder infection (cystitis) is the most common UTI
in women. You may have urgent or frequent urination. You may
also have pain, burning when you urinate, and bloody urine.

• Urethritis: This is an inflamed urethra, which is the tube that
carries urine from the bladder to outside the body. You may
have lower stomach or back pain. You may also have urgent or
frequent urination.

• Pyelonephritis: This is a kidney infection. If not treated, it can
be serious and damage your kidneys. In severe cases, you
may be hospitalized. You may have a fever and lower back
pain.

Prognosis

UTI – typically treated and resolve.
Untreated infection can travel upward through the urinary

tract to involve the kidneys or become a systemic
infection or sepsis, especially in elderly.

Signs & symptoms
1) Frequency due to irritation of bladder muscles.
2) Urgency
3) Dysuria
4) Feeling of fullness in suprapubic area
5) Low back pain

Diagnostic test

1. Urinalysis – shows leukocytes, nitrites, and RBCs.
2. Urine C&S - indicate the infecting organism and the

appropraite antibiotic to treat the infection.

Treatment
1.Administer antibiotics:
 Ciprofloxacin, Levofloxacin, Ampicilin, Amoxicilin ,

thrimethoprim-sulfamethaxazole.
2.Encourage fluids, to make urine less concentrated.
3.Administer phenazopyridine for symptom of dysuria.
4.Repeat urine testing after antibiotics are complete.

Nursing diagnosis

• Risk of impaired urinary elimination
• Risk of urge urinary incontinence

Nursing intervention
Monitor intake output.
Monitor vital signs for changes, signs of fever.
Encourage fluid intake.
Encourage cranberry juice to acidify urine.
Explain to the patient:

- phenazopyridine will cause orange-colored urine.

Lifestyle changes to treat and prevent UTIs

• Drink plenty of fluids. This includes water, juice, or other
caffeine-free drinks. Fluids help flush bacteria out of your
body.

• Empty your bladder. Always empty your bladder when
you feel the urge to urinate. And always urinate before
going to sleep. Urine that stays in your bladder can lead
to infection. Try to urinate before and after sex as well.

• Practice good personal hygiene. Wipe yourself from
front to back after using the toilet. This helps keep
bacteria from getting into the urethra.

•

Lifestyle changes to treat and prevent UTIs

• Use condoms during sex. These help prevent UTIs
caused by sexually transmitted bacteria. Also, avoid using
spermicides during sex. These can increase the risk of
UTIs.

• Follow up with your health care provider as
directed. The doctors may test to make sure the infection
has cleared. If necessary, additional treatment may be
started.

PYLONEPHRITIS

PYLONEPHRITIS

- def:
- Inflamation of renal pelvis and renal parenchyma tissue due to

bacterial infection.
- Most common bacteria are Esherichia coli, Klebsiella,

Enterobacter, Pseudomonas, & Staphylococcus saprophyticus.
Etiology

a) Ascending tract infection is infection spread from bladder to
the ureter and finally spread to the kidney.

b) Ureterovisicle reflux – allows urine backflow to the ureter
when urinating due to incomplete uterovesicle valve.

c) Obstruction – renal calculi, tumour or stricture will obstruct
the flow of urine and causes bacterial growth.

Prognosis

Most cases start off lower UTI
Older patients and patients with co-morbidities have a

greater chance of complication.
Impaired renal function may complicate recovery in some

patients.
Septic shock may occur.

Statistic

1-2 : 1000 women are affected. * young adult female
0.5 : 1000 males
Among people are over 65yo ,risk of death is about 40%.

Signs & symptoms

• Flank pain (unilateral)
• Fever and chills due to infection
• Frequency, urgency, dysuria – UTI
• Nausea, vomitting, & diarrhea
• Increase heart rate due to fever
• Costovertebral angle tenderness (CVAT)

Diagnostic test

1. Urine FEME- presence of RBC,WBC,cast & bacteria.
2. Urine C&S – to determine the pathogen & selection of

appropriate antibiotic.
3. Blood profile –blood urea serum electrolytes (BUSE).
4. Random blood sugar (RBS), Blood C&S,FBC.
5. X-ray IVP, KUB.
6. Ultrasound of kidney.

Management & treatment

• Surgical –underlying causes such as renal calculi,
ureterovesicle reflux, and obstruction.

• Medical – antibiotic therapy is prescribed. Antibiotic infusion
will be started 3-5 days until patient afebrile. Then,oral
antibiotic will cont for 2-4 weeks.

• Analgesic should be given for flank pain.
*completion of antibiotic is important to prevent the
recurrence of infection.
• Administer phenazopyridine for relief of dysuria symptoms.

Management & treatment

• General – advice pt to take large amount of water about
2-3 liter/day.Frequent urination help in eliminating
bacteria.

• Repeat urine culture after completion of antibiotic.

Risk factor

1) Sexual intercourse (change sexual partner)
2) Prior UTI
3) Diabetes
4) Problems of the urinary tract (vesicoureteral

reflux,kidney stones etc)
5) Spermicide use

Prevention
Urination after sex
Drinking sufficient fluids

Nursing diagnosis

• Impaired urinary elimination
• Nausea & vomitting
• Hyperthemia

Nursing intervention

Monitor vital signs.
Monitor intake and output.
Asses for side effects of medication.
Explain to patient: -phenazopyridine will cause orange-
coloured urine.

Activity

oMrs Mina is a 25 year old woman has symptoms of
dysuria, frequency and urgency. She also had flank pain,
febrile and chills. She visited her panel clinic and is
diagnosed with pyelonephritis.

oBased on the above scenario develop a nursing care plan
on Mrs Mina with pylonephritis.

Your NCP should include nursing diagnosis, objective,
nursing intervention and evaluation.



ACUTE GLOMERULONEPHRITIS

GLOMERULONEPHRITIS

• Def:
• GN is a primary/secondary immune mediated renal

disease characterised by inflammation of the glomeruli, or
small blood vessel in the kidneys.
• Also known as acute nephritic syndrome.

Etiology

Typically precede by an ascending infection / secondary
to another systemic disorder.

Infectious cause, include group A beta-hemolytic
Streptococcus, measles, mumps,varicella, pneumonia
due to mycoplasma, or pneumococcal infection.

Etiology

Systemic disorders – SLE,viral Hepatitis B or C, multiple
myloma.

Exposure to hydrocarbon solvents increase risk of GN.

Signs & symptom
1) Hematuria (urine may be dark,rust colored,or tea colored).
2) Peripheral edema.
3) Elevated blood pressure, compared with pt’s norm.
4) Oliguria –decrease in urine output.
5) Nausea,vomitting,loss of appetite as renal function declines
6) Malaise,fatique,anorexia, muschel aches.





Common test result

1. Urinalysis shows protein, RBCs,and RBC cast.
2. Glomerular filtration rate –decrease
3. 24hr urine collection for protein will be elevated.
4. BUN level – increased
5. Serum albumin – decresed
6. Renal biopsy – to determine cause.