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Urinary System
Urinary System
• Essential to life• Every head to toe
assessment must include…
– urinary tract function
Anatomy: Kidney
• Kidneys– Vascular– Shape• Bean
– Color• Brown-red
– How many / #• 2
Anatomy: Kidney
• 3 areas– Cortex– Medulla– Renal Pelvis
Cortex
Medulla
Renal Pelvis
Kidney: Cortex
• Contains– Nephrons • Functional unit of the
kidneys• Glomeruli / glomerulus• Filters blood • Creates urine
Kidney: Medulla
• Function–Drain urine from
the Nephrons to the renal pelvis
Kidney: Renal Pelvis
• Ureter• Renal artery• Renal Vein
Anatomy: Nephrons
• FYI– Functional unit*– 1 million Nephrons in
ea. Kidney– Adequate renal
function with 1 kidney
Urine flow
• Nephrons • Medulla (pyramids) • renal pelvis • ureter
Anatomy: Ureters
• Long narrow muscular tube
• Moves urine via peristaltic waves
• Extends from renal pelvis bladder
• Two
Anatomy: Bladder
BLADDER• Description– Muscular– hollow sac
• Location– Behind pubic bone
• Function– Reservoir for urine
Anatomy: Bladder
• Normal capacity – 300-500 ml of urine
Anatomy: Urethra
• Carries urine from the bladder & expels it from the body
Physiology of the Urinary System
• Function of the kidneys
– Urine formation– Excretion of waste
products– Regulation of
• Electrolytes• Acid-base control• RBC production• Ca+ & Ph
– Control • water balance• blood pressure
– Renal clearance– Synthesis of Vit. D
Physiology of the Urinary System
• Urine formation– The nephrons form
urine through a complex process
Anatomy: Nephrons
• Nephron – Glomerulus– Bowman’s capsule
• Proximal convoluted tubule• Loops of Henle• Distal convoluted
tubule
Regulation of water excretion
• The amt. of urine formed is r/t the amt. of fluid intake– h fluid intake – volume urine
• h • Characteristic
– Dilute– i fluid intake – volume of urine
• i • Characteristic
– Concentrated
Excretion of waste products
• Urea, (waste product)– Blood Urea Nitrogen• h BUN = renal dysfunction
• Creatinine– The creatinine clearance compares the level of
creatinine in urine with the levels in the blood– i Creatinine clearance = renal dysfunction
Excretion of waste products
• Primary means of ridding the body of Drug metabolism
Small Group Question
1. Describe the flow of urine from formation to excretion
2. What is the functional unit of the urinary system? What does it do?
3. Increased or decreased fluid intake has what effect on volume of urine and its characteristics
4. What two main waist products do the kidneys rid the body of?
Assessment:
• Urine– Color– Odor– Amount
• Difficulty urinating• Fluid intake• Painful urination– dysuria
Assessment
• Urinating at night – Nocturia
• Blood in the urine– Hematuria
• Cloudy urine– Pyuria
• Discharge?
Assessment
• Pain– Abd– Suprapubic– Flank
Assessment: Health history
• Symptoms• Associated symptoms• Hx of UTI’s• Meds• Smoking or Alcohol• Females
– Pg
Physical Assessment
• Urine sample– Clean-catch
• V/S• Skin– Color– Moisture– Edema
• Palpate abd• Percuss kidney for
tenderness
Physical Exam
• Abdomen, supropubic region, genitalia and lower back, the lower extremities
Physical Exam
• Palpation of bladder– Performed after voiding
if suspect urinary retention
Urinalysis: normal
• Color– Light straw – amber– Clear
• Specific gravity– 1.005 – 1.030
• pH– 4.5 – 8.0
• Protein– Neg - trace
Urinalysis: normal
• Glucose– -
• Ketones– -
• RBC– 1-2
• WBC– 3-4
• Casts– -
• Bacteria– -
Specific Gravity• The weight of urine • Related to the level of hydration.
– h fluid intake h H20 excretion i specific gravity – i fluid intake i H20 excretion h specific gravity
Diagnostic Evaluation: Urine Culture and Sensitivity
• ID microorganism(s) • Sensitivity report• Time– 2-3 days (48-72 hours)
Diagnostic Evaluation: Clean-catch or Clean-voided specimen
• Clean-voided – uncontaminated by skin flora.– Female
• Cleanse: front to back
– Male• Cleanse: tip of the penis downward
• Collect a "clean-catch" – Start to void– Midstream catch– Collect 1 to 2 oz of urine
Diagnostic Evaluation:Sterile urine specimens
• Safety– Standard precautions – Biohazard bag for transport
• Collection– Indwelling Foley Catheter
• Not from the drainage bag• Aspiration port
– Catheter – straight cath– A small amount of urine is allowed to run out of the catheter into
a basin, then the urine is allowed to run into a sterile specimen bottle.
I&O
Intake
• Oral liquids– Milk– Tea– Juice– Broth
• Liquid at room temp– Ice cream– Jello
• NGT/GT• IV
Output
• Urine• GI suction• Emesis• Drainage– Chest tubes– Wound tubes
• Healthy person• Fluid output =• Fluid input
• If the client takes in more fluid than they excrete – edema
S&S Edema
• Weight– h
• Swelling– Feet– Ankles– Face– Fingers
• Urine output– i
• Fluid pooling– Lungs– Abd
• Ascites
• Pitted edema is tested by pressing & holding your finger into the swollen tissue over a bony area for 5 seconds. If there is an indentation left behind when you remove your finger it is pitted edema.
• To classify the pitted edema you measure the depth of pitting & compare the measurement to the following scale;
• +1 = 2mm of pitting• +2 = 4mm of pitting• +3 = 6mm of pitting• +4 = 8mm of pitting
What is the nursing diagnosis for a client with edema?
• Fluid Volume Excess
• If a client excretes more fluid than they take in – dehydration
Dehydration S&S
• Thirst• Constipation• Urine output– i
• BP– i
• Pulse– Weak– h
• Mentation– Confused– Lethargy
• Skin– Dry
• Mucus membranes– Dry
• Weight– i
1. Describe the nursing assessment of a client who is complaining of voiding issues?
2. What dx test do you expect the doctor to order for a client with renal failure
3. What does a UA measure & what should not be found in the blood.
4. Increased & decreased fluid intake have what effect on specific gravity
5. Describe how to get a clean catch and a sterile urine specimen?
Cystitis
• Inflammation of the urinary tract– Bladder– UTI
• Etiology– Bacteria
Cystitis: S&S
• Dysuria• Frequency• Urgency• Nocturia• Pyuria• Hematuria• Lower abd discomfort
Gerontologic considerations
• Few S&S• Fatigue• Alt cognitive function• drop in temp
Defense Mechanism
• Who is more likely to get a UTIA. MaleB. Female
• Why?– Shorter urethra
Pyelonephritis
• Inflammation of the renal pelvis & parenchyma
• Etiology– Bacteria
• E-coli
Pyelonephritis: S&S
• S&S of Cystitis– +
• Flank pain• Vomiting / diarrhea• Fever / chills• Malaise
Assessment & Dx findings
• Urinalysis– UA
• Culture
Medical management/pharmacological therapy
• Antibiotic• Urinary analgesic
Nursing Process: UTI
• Assessment– S&S– Voiding patterns– Sexual intercourse– Urine
Nursing: health promotion
• Fluid intake– h
• Void when you feel the need– Q3-4 hours
• Female– Clean front to back
• Void after intercourse
• Avoid – bubble bath– Feminine hygiene– Douching
• Cotton underwear• Shower not bath
Nrs Dx: Pain
• Assess pain• Admin. Analgesics, antibiotics per order• Teach non-Rx – Heating pad– Warm showers
• Cranberry juice• Vitamin C• Avoid excess milk, fruit juice
1. What are the S&S of cystitis?2. Differentiate with cystitis & Pyelonephritis3. What are the gerontological considerations
for a client with a UTI?4. What would you teach a client about
preventing further UTI’s
Glomerulonephritis
• Inflammation of the glomerulus– Damage
• Blood • Protein• escapes into tubule
Glomerulonephritis
• Etiology– Acute
• Bacterial infection
– Chronic• Diabetes• Lupus
Nephrotic syndrome
• Group of symptoms (glomerulonephritis)• Protein in the urine• i serum albumin• Edema• h serum cholesterol
Nephrotic syndrome
– Clinical Manifestation• #1 – edema• Malaise• H/A• Irritability• Fatigue
Glomerulonephritis
• Assessment and diagnostic findings– Edema– Proteinuria– Hyperlipidemia – Hypoalbuminemia– Azotemia• Increased waste product in the blood
– (Urea, Creatinine etc.)
Glomerulonephritis
• Complications– Renal Failure– Embolism
Glomerulonephritis
• Medical Management– Edema
• Diuretic
– Inflammation• Glucocortioids• NSAID
– Infection• Antibiotics
– Diet• Sodium
– i
• protein– h – Azotemia i
• Fat– i
Glomerulonephritis
• Nursing Management - Edema– qD weight– I&O– Abd. Girth– Clean skin– Diet per order
Kidney stones /Renal Calculi
• Risk factors– Dehydration– Urinary stasis– Infection– Immobility
Renal calculi or nephrolithiasis
• Clinical Manifestations– Pain
• Abd / flank• Severe• N&V
– Hematuria
Renal calculi or nephrolithiasis
• Assessment and diagnostic findings– UA– X-ray– CT-scan/MRI– Cystoscopy
Renal calculi
• Cystoscopy– Lighted scope to inspect
bladder– Gen anesthesia
Renal calculi
• Medical management– Pain relief• Opioid analgesic• NSAIDs
– Diuretics?– Antibiotics?
Renal calculi
• Medical management
– Diet• Fluids• i protein• i Sodium
Renal calculi or nephrolithiasis
• Surgical Management– If > 4mm will not
pass through ureter– If not pass
spontaneously or if complications surgery
Nrs Dx: Acute Pain / Deficient knowledge to prevent recurrence of renal stone
• Admin Meds– opioid agents– NSAIDS
• Position of comfort• Amb.• Heat to flank
• Fluids– h
• Assess urine• I&O• Strain urine – gauze• Avoid dehydration
Small Group Questions
1. What are the classic clinical manifestations fro a client with Glomerulonephritis
2. What causes Glomerulonephritis3. What are the medical interventions for a client
with Glomerulonephritis4. What are the specific nursing interventions of
this client5. What are the S&S of renal calculi6. How is a renal calculi treated?
Cancer of the urinary tract
• Pathophysiology– Most common site• Bladder
– Carcinogen• #1 Tobacco
– Metastasize early– 1/3 have metastasis at time of diagnosis
Cancer of the urinary tract
• Clinical Manifestations– Initial• Painless hematuria
– Late• Frequency• Dysuria
Cancer of the urinary tract
• Medical treatment– Goal:• Eradicate before metastasis
– Surgery» Cystectomy» Nephrorectomy
• Radiation• Chemotherapy
Renal Failure
• Kidneys unable to remove accumulated waste products from the blood– Acute– End-stage
What is the medical term for accumulation of waste product in the blood?
• Azotemia
Acute Renal Failure
• Abrupt onset• Often reversible• Etiology– Trauma– Infection
Acute Renal Failure: S&S
• Oliguria– Urine < 400 mL/day
• BUN– h
• GFR – i
• Azotemia– Confusion– Na+ & H2O retention
• Edema• HTN
– Hyperkalemia
End Stage Renal Failure
• Gradual kidney destruction
End Stage Renal Failure: S&S
• Uremia– (Urine in the blood)– N/V– Weakness– Fatigue– Confusion
Renal Failure: Tx
• No nephrotoxic drugs– NSAID’s
• Antihypertensives• Diuretics• Fluid– Restriction
• Sodium– Restriction
Dialysis: Overview
• Purpose– Remove fluids and waste products from the
body • Definition– Mechanical means of removing waste from the
blood • Types:– Hemodialysis– Peritoneal dialysis
Dialysis: Process
• Process– Diffusion and osmosis across a semi permeable
membrane into a dialysate solution• prescribed specific to the individual clients needs
Dialysis: process
• Diffusion– Toxins & wastes
are removed by diffusion
• Osmosis– Excess water is removed
by osmosis
Hemodialysis
• A machine with an artificial semi-permeable membrane used for the filtration of the blood.
Hemodialysis
– The clients blood is circulated past the semi permeable membrane
– Excess fluids are removed by osmosis
Hemodialysis
• Waste products are removed from the blood by diffusion
Hemodialysis
• Frequency– 2-3 times a week– Total
• 9-12 hours
Peritoneal Dialysis
• Uses the peritoneal lining of the abdominal cavity
Peritoneal Dialysis
– A catheter is placed by the MD into peritoneal space
Peritoneal Dialysis
• Complication– INFECTION
• Usually 4 x day – 7day/wk