Chapter 57 Introduction to the Urinary System

8/8/2019 Chapter 57 Introduction to the Urinary System

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Kendra Patrick, RN, BSN


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` The Urinary System consist of

` Upper urinary tract Kidneys

Renal pelvis

Ureters

` Lower urinary tract Bladder

Ureth

ra Pelvic floor muscles


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` Kidneys Two , paired, bean-shaped organs

Upper abdomen on either side of the vertebral

column or retroperitoneal.

Span from 12th thoracic vertebra to the 3rd lumbar

vertebra

` Blood Supply Renal artery- arises from the aorta

Renal vein- empties into the inferior vena cava

x Kidneys receive 25% of total cardiac output.


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` Internal Structures

` The urethrovesical unit Bladder ,urethra, and pelvic

Floor muscles


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` Cortex (Outer Layer) Structures Nephrons: Microscopic; Approximately 1 million

x Smallest functioning renal structure

x Composition:x Glomerulus; Afferent arteriole; Efferent arteriole; Bowmans

capsule; Distal and proximal convoluted tubules; Loop of Henle;Collecting tubule

` Medulla (Inner Layer) Structures Calyces (pyramids); Renal pelvis; Ureter


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` Glomerulus

` Afferent arteriole

` Efferent Arteriole

`

Bow

mans capsule` Distal tubule `The (DCT)

` Proximal tubule (PCT)

` Loop ofhenle

`

Collecting tubule


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` Pelvic FloorMuscles: Form sling, which supports

bladder, urethra, rectum, various reproductive organs

` Urinary Bladder: Hollow, muscular organ; Shape, size

dependent on client age, amount of urine contained

(usu. 300 500 ml)

` Urethra: Hollow tube; Begins at bladder neck, ends

at external meatus Serves as a conduit during urination, has a sphincter

mechanis

mto

prevent urine leakage. Length: Male 24 cm; Female 4 cm


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` Formation:Three steps

Glomerularfiltration;

Tubular reabsorption;

Tubular secretion

` Elimination: Renal pelvis through ureter into bladder

Peristaltic action-move urine into bladder

Nerve reflex triggered 150ml urine accumulates

Bladder muscle contracts; Sphincter muscles relax


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` History Health, childhood, family, allergies, sexual, reproductive, chief complaint,

medication history.

` Physical Examination Have pt. void, inspection, auscultation, percussion, palpation

` Diagnostic Tests Radiography

x KUB; X-ray- size and position of the kidneys, ureters, bony pelvis,radiopaque urinary calculi, abnormal gas patterns, defects of bony spinalcolumn

Ultrasonography- Shape, size, location, collecting systems andadjacent tissues of kidneys, renal cyst, obstruction sites, needle biopsy

CT; MRI- renal pathology, kidney size eval tissue densities, calculi,polycystic disease, infections, congenital abnomalities

Angiography-arterial supply to kidneys Cytoscopy- look inside the bladder, id cause of painless

hematuria, urinary incontinence, urinary retention


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` Inserted through the

Urethra into the bladder

local anesthesia, spinal , general

Procedure 30-45 minutes

Preop- sedatives, antispasmodics

- Urine culture

- Vital signs

Post op

-vital signs-Pain meds as ordered


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` Intravenous Pyelogram (IVP): Radiologic study to evaluate structure,function ofKUB

Using radiographs

` Retrograde Pyelogram: Visualization of complete ureter, renal pelvisneeded

Performed during cystoscopy Carries risk ofsepsis, severe UTI

` Nursing Management

Allergies iodine, seafood, contrast Encourage fluids

NPO 8-12 hours before Warm tub baths

Bowel prep Avoid alcohol 48 hrs

Baseline vital signs Antibiotics 1-3 days p Explain procedure/ purpose

May exp burning, hot flushing sensations

Metallic taste in mouth


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` Purpose Diagnose cancer; Assesses prostatic enlargement Monitor progression of renal disease Evaluates treatment of renal transplant rejection

x Risk of postprocedure bleeding

` Nursing Management Reassure patient, explain procedure/purpose Assess vital signs Review labs, U/A, IVP, and renal scan

Discharge

Po

st pro

cedureLimit activity for sev days

-bed rest Complete antibiotic therapy-assess urine for hematuria Notify MD s/s infection, bleeding

- Assess dsg frequently for bleeding- Assess pain, difficulty voiding


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` Cystogram: Evaluates bladder structure abnormalities, filling,instill contrast dye

` Voiding Cystourethrogram (VCUG): Rapid series of x-rayswhile voiding Contraindicated in UTI

` Urodynamic Studies: Evaluate bladder, renal function;Assess cause of reduced urinary flow, urinary retentionor incontinence Uroflowmetry- urinary flow rate Cystometrogram-evaluates bladder tone and capacity Postvoid residual-amt. of urine left in bladder after voiding.

Normal level is 0-30ml` Nursing Management

See pg 906 in text book


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` Specific gravity-:1.003-1.029

` Urine osmolality: 50-1200

` Ph: 4.5-7.5` BUN: 7-18

` Creatinine: males 0.7-1.3, females 0.6-1.1See pg 909


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` Frequency- frequent voiding- more than every 3

hours

` Pyuria- pus in urine

` Urgency- strong desire to void` Nocturia- excessive urination at night

` Hematuria- Red blood cells in urine

` Anuria- urine output less than 50ml/day

` Oliguria- urine output less than 400ml/day


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Is the following statement true or false?

The urethra are the hollow tubes that extend from

the kidneys to the bladder.


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False.

The ureters are the hollow tubes that extend from

the kidneys to the bladder, which drain urine. Inmales, they measure approximately 24 cm, in

females, approximately 4 cm


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What is the smallest functioning renal structure

a. Renal artery

b. Nephronc. Cell

d Calyx


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B. Nephron

The nephron is the smallest functioning renalstructure. While being microscopic in size, there

are approximately 1 million nephrons per kidney.


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Is the following statement true or false?

Performing an IVP carries the risk of sepsis or

introducing microbes which could cause anurinary tract infection.


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False.

Performing an IVP involves introducing IV contrast

and producing radiographs. A retrogradepyelogram is performed during an cystoscopy

and carries the risk of sepsis or introducing

microbes which could cause an urinary tract

infection.


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` Percussion of an empty bladder results in this

sounda. Dullness

b. Tympany

c. Resonance

d. bruits


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` B. Tympany

Percussion usually produces a tympanic sound. A dullsound is produced if the bladder is filled.


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End of Presentation

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Chapter 57 Introduction to the Urinary System