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