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
Technically no urination (24 hr urine output
Anuria
Diminished amount of urine in a given time (24 hr urine output of 100-400 mL). Severe dehydration, shock, transfusion reaction, kidney disease, end-stage kidney disease
Oliguria
Large volume of urine in a given time. DM , DI, chronic kidney disease, diuretics, excess fluid intake, obstructive sleep apnea
Polyuria
Diagnostic studies prep
Many require use of a bowel prep in the evening. Some bowel preps (i.e. Fleets, magnesium citrate) are contraindicated in pts with renal failure. Be cautious when multiple tests are ordered over multiple days, if all require NPO status pt can become severely dehydrating
Urine Studies
UA- first study to be done, first void of am, examine within 1 hour
Creatinine clearance- most accurate indicator of renal function, closely approximates GFR, must also get a blood specimen for creatinine during the 24 hr test
24 hr studies- discard first void to start the test, save urine for 24 hrs, have pt void at the end of the collection to complete the test
Urinalysis
Color- amber yellow is normal. variations in color d/t various things
Protein- increased by renal failure and non-renal causes. Characteristic of acute and chronic kidney disease, esp. involving glomeruli. HF. In absence of disease: high-protein diet, strenuous exercise, dehydration, fever, emotional stress, contamination by vaginal secretions.
Specific gravity: 1.003-1.030 is normal. Low- dilute urine, excessive diuresis, diabetes insipidous. High- dehydration, albuminuria, glycosuria
pH: 4-8. >8- UTI. Urine allowed tons and at room temp.
Urine studies
Culture- after cleaning have pt start urinating and then void into sterile container (mid-stream)
Residual- catheterize pt immediately after voiding or use bladder ultrasound (bladder scan)
Cytology- done if bladder cancer is suspected, do NOT use morning’s first voided specimen
Blood studies
BUN (6-20)- can be affected by non-renal factors
Creatinine (0.6-1.3)- more reliable that BUN
Potassium (3.5-5.0)
Sodium (135-145)
Bicarbonate (22-26)
Radiological studies
KUB- shows size, shape, position of kidneys
Intravenous pyelogram (IVP)- shows urinary tract after administration of IV contrast media. Don’t do it pf has renal failure!! need bowel prep. Force fluids after procedure. Watch urine output carefully after procedure.
Retrograde pyelogram- cystoscope is inserted and arterial catheters are inserted into the ureter, contrast media is injected through the catheters and X-rays are taken, causes pain, anesthesia is given. Done in urology office or radiology.
Renal arteriogram (angiogram)- visualized renal blood vessels, catheter is inserted into the femoral artery and passed up to the renal arteries, contrast media is injected, post procedure care is like cardiac cath.
Renal ultrasound- NO bowel prep is needed
CT, MRU
Cystogram- radioactive solution is instilled into bladder via cystoscope or catheter; visualized bladder and evaluates vesicoureteral reflux, neurogenic bladder, recurrent UTIs
Urethrogram- contrast media is injected into the urethra to look for strictures or diverticula of the urethra, if trauma is suspected may do this before attempting catheterization
VCUG (voiding cystourethrogram)- voiding study of the bladder opening and urethra, bladder is filled with contrast media then films are taken, another film is taken during and after urination to look for residual urine
Looks at the interior of the bladder with a lighted scope. Can also be used to insert ureteral catheters, remove stones, obtain biopsies, treat bleeding lesions. Lithotomy position. Force fluids before procedure. Post procedure expect burning, pink-tinged urine, and urinary frequency. Call for bright red bleeding or temperature.
Cystoscopy
Measure urinary tract function. Entail study of the storage of the urine within the bladder and the flow of urine through the urinary tract to the outside of the body. A combination of techniques may be used to provide a detailed assessment of urinary function.
Urodynamics
Looks at structure and perfusion of the kidneys, IV radioactive iota’s are given
Renal scan
Puncture the lower lobe of kidney. Don’t do if they have a bleeding disorder, single kidney, or uncontrolled HTN. Post-procedure: apply pressure dressing, keep on AFFECTED side for 30-60 minutes, bed rest for 24 hrs, frequent VS, watch for hematuria
Renal biopsy
