Chapter 45: Urinary System Flashcards
Two kidneys and two ureters
Upper urinary system
Urinary bladder and a urethra
Lower urinary system
Kidney Functions
Regulate volume and composition of ECF. Excrete waste products. Control BP. Produce EPO. Activate Vit. D. Regulate acid-base balance. Filter the blood. Maintain homeostasis. Nephron is functional unit (glomerulus, Bowman's capsule, Tubular system). Glomerular function (blood is filtered by hydrostatic pressure. Glomerular filtration rate [GFR]- normal is 125 mL/min).
Joint the renal pelvis to the bladder
Ureters
Serves as a reservoir for urine. Capacity: 600-1000 mL. Bladder muscle (detrusor)- distention for filling and contraction during emptying. Evacuation of urine= urination, micturition, voiding.
Bladder
Extends from bladder neck to outside. Female: 1-2 inches (3-5 cm). Male: 8-10 inches (20-25 cm).
Urethra
Gerontological considerations
Lose 30-50% of glomeruli function by age 70. Atherosclerosis accelerates decrease in kidney size. Decreased renal blood flow, decreased GFR (decreased creatinine clearance, increased BUN). Decreased urinary concentrating ability. Alterations in excretion of water, sodium, potassium, and acid. Loss of elasticity, vascularity, and structure of the female genitalia. Enlarged prostate for men.
Subjective assessment highlights
Color changes (from meds)
“Tired all the time”
Bladder tumors- higher incidence in textile workers, painters, hairdressers, industrial workers, cigarette smokers
Kidney stones- higher risk in great lakes, southwest, southeast
Family hx
Diet and Urination
Dietary intake and effects on urine output.
Dehydration- increased risk of UTI, stones, and renal failure
Large daily intake of diary products or foods high in protein increase risk of stone formation
Asparagus makes urine smell musty
Beets make urine look pink
Caffeine, alcohol, carbonated beverages, spicy foods can aggravate inflammatory process.
Herbal teas cause diuresis
Objective data: inspection
Skin: pallor, yellow-gray cast, excoriations, changes in turgor, bruises, texture
Mouth: stomatitis, ammonia breath odor
face and extremities: generalized edema, peripheral edema, bladder distention, masses, enlarged kidneys
Abdomen: Midline mass in lower abdomen (may indicate urinary retention) or unilateral mass (occasionally seen in adult, indicating enlargement of one or both kidneys from large tumor or polycystic kidney)
Weight: weight gain 2* to edema; weight loss and muscle wasting in kidney failure
General state of health: fatigue, lethargy, and diminished alertness
Palpation
Kidneys are usually not palpable. Bladder is usually not palpable.
Percussion
Tenderness in the flank area may be detected by fist percussion (kidney punch). Normally no pain at CVA. If CVA tenderness and pain are present, it may indicate a kidney infection of polycystic kidney disease.
Auscultation
The bell of the stethoscope may be used to auscultate over both CVAs and in the upper abdominal quadrants. With this technique, auscultate the abdominal aorta and renal arteries for a bruit (an abnormal murmur). Use the diaphragm of the stethoscope to auscultate the bowels, since they may also affect the urinary system
Painful or difficult urination. Sign of UTI, interstitial cystitis, and a wide variety of pathologic conditions
dysuria
Involuntary nocturnal urination. Symptomatic of LURD (lower urinary tract disorders)
enuresis