Elimination: Urinary Flashcards
Kidneys: Location, Protection, Operation
- Location: behind/outside peritoneal cavity (retroperitoneal)
- Protected by: ribs (externally), fatty tissue (internally)
- Independent functions, blood supply, innervations
Kidneys: Renal Parenchyma
Medulla:
• loops of Henle, vasa recta, collecting ducts, juxtamedullary nephrons
Cortex:
• cortical nephrons
Kidneys: Blood Supply
- 20-25% cardiac output
- Supplied via renal artery
- Artery–> atrioles–> glomerulus (glomerular filtration)
Kidneys: Nephrons
- 1 million per kidney
- Most are in cortex (80-85%)
- Initial formation of urine
- 2 parts: glomerulus and tubule
- Filters fluids–> changes in composition according to body’s needs–> end product filtrate excreted as urine
Kidneys: Urine Formation
- In nephron via glomerular filtration, tubular reabsorption, tubular secretion
- Sodium, chloride, urea, creatinine, bicarbonate, glucose, uric acid
- 1 - 1.5 L of urine produced daily
Kidneys: Ureters, Bladder, Urethra
- Urine flows from kidneys to ureters
- Ureters empty into bladder
- Urethra at base of bladder drains urine
Renal and Urinary System Functions
(RbcPVdWHFeBpAb) • RBC production via synthesis of erythropoietin • Prostaglandins • Vitamin D synthesis • Waste removal • Homeostasis • Fluid and electrolyte balance • Blood pressure control via renin • Acid-base balance
Factors Affecting Urinary Elimination: Food and Fluid
• Dehydration= ↓ in urine, more concentrated
Factors Affecting Urinary Elimination: Psychological
- Individual, family, socio-cultural
* Daily schedule, privacy, time to void
Factors Affecting Urinary Elimination: Activity Level and Muscle Tone ↑↓
- Exercise promotes urinary elimination
* Immobility= ↓ muscle, bladder, sphincter tone
Factors Affecting Urinary Elimination: Developmental
Elderly:
• loss of ability to concentrate urine
• ↑ urge/frequency to void
Factors Affecting Urinary Elimination: Pathological
- Can affect quality and quantity or urine
* Hypertension, renal disease, diabetes mellitus, gout
Factors Affecting Urinary Elimination: Medication
- Nephrotoxic= renal damage
* Can affect amount/color of urine
Assessment: Health History: Subjective Data
- Onset
- Pain
- Voiding problems
- Infection/Obstruction history
- Fluid/Dietary intake
- Pattern
- Medications
- Drug use
- Childbirth
- Family history of kidney disease
- Recent change in weight
- Other urinary/renal problems
- Other health problems
Renal/Urinary Problems and Urinary Pain
- Pain= distension
- Distention caused by obstructed urine flow or inflammation
- Pain location, quality, duration depends on where distention is
Location of Renal/Urinary Problem is Consistent with Site of Urinary Pain
- Kidneys/ureter= CVAT; abdominal pain
- Bladder= suprapubic and voiding pain
- Urethral= voiding pain
- Prostate= perineal and rectal pain
Assessment: Physical Exam
- Kidneys should NOT be palpable
- Palpate for CVA
- Inspect abdomen for ascites
- Palpate/percuss bladder for distension
- Palpate inguinal area for enlarged lymph nodes and inguinal/femoral hernia
- Genitalia
- Edema/changes in body weight leading to fluid retention
Urine Color and Clarity
- Food, medications, hydration can affect
- Normal urine= straw/yellow
- Severe infection= milky green/yellow
- Cloudy/sediment/tissue shreds= infection
Urine Colors
- Pale yellow= normal
- Dark yellow= concentrated
- Amber= dehydration
- Orange= medications, liver/bile duct, food dye
- Green= pseudomonas infection, bacteria, meds, genetic disease, food dye
- Red= blood, food
- Brown/cola= concentrated, liver disease
- Fizzy= excess protein, kidney problem
Urine Clarity
- Clear= transparent
- Hazy= few particles
- Cloudy= many particles
- Milky
Urine Odor
- Can be affected by foods, infections, medications, concentration
- Foul odor= infection, concentrated from dehydration
Urine Frequency
- Adults 4-5 times/day
- Day= no greater than every 2 hours
- Night= 1-2 times
Urine Volume
- Adults 40-80 ml/hour (1500-2000/24 hour)
* MINIMUM 30 ml/hour
Diagnostic Urine Tests: Urinalysis
• hematuria, proteinuria, glucosuria
Diagnostic Urine Tests: Routine Urinalysis
•
Diagnostic Urine Tests: Clean Catch/Midstream Specimen
- Self-clean
- Void
- Stop void
- Continue void into sterile specimen cup
- Cover without contaminating
Diagnostic Urine Tests: Sterile/Catheterized Specimen
• Non-indwelling (straight) catheter
- Indwelling (foley) catheter clamped distal to injection port
- Clean with alcohol
- Aspirate amount of urine with sterile 5 mL syringe
- Unclamp and resume drainage
Diagnostic Urine Tests: 24 Urine Specimen
- Inform all family/personnel of test
- Start of test: patient void, discard, and record time
- Collect all urine after start
- At 24 hour mark: have patient void and add to collection
- Send to lab
Diagnostic Urine Tests: Urine Culture
- Identifies bacteria (strain/concentration)
* > 100,000 CFU= Urinary Tract Infection
Diagnostic Urine Tests: Post Void Residual Volume (PVR)
- Measures urine in bladder after voiding
* Bladder scanner or catheter
Renal/Urinary Diagnostic Studies: Bladder Scanner
- Bladder volume, PVR, need for catheter
* No patient preparation, no discomfort, non-invasive
Renal/Urinary Diagnostic Studies: Blood Urea Nitrogen (BUN)
- Urea formed in liver from ammonia, diffuses freely, excreted by kidneys
- BUN levels reflect the balance between production and excretion of urea
How is BUN Used
- Kidney function, kidney disease, acute/chronic kidney dysfunction/failure
- General health status as BMP/CMP
When is BUN Ordered
- Non-specific complaints
- Routine test
- Checking kidney function before starting drug therapies
- Acutely ill patient
- During hospital stay
Normal BUN Lab Values
14-adult: 8-21 mg/dL
Adult over 90: 10-31 mg/dL
BUN Indications
- Nutritional
- Hydration
- Hemodialysis
- Lymphoma after chemotherapy
- Liver function
- Renal function
- Nephrotoxic/Hepatotoxic drugs
BUN Levels
• Increased: impaired kidney function (kidney disease/damage/failure, CHF, shock, sever burns, myocardial infarction, obstruction of urine flow, dehydration)
• Decreased: liver disease, malnutrition, over hydration
*Increased and Decreased levels seen in normal pregnancy
BUN/Creatinine Ratio
- Between 10:1 and 20:1
- Increased: decreased blood to kidneys (CHF, dehydration), increased protein (GI bleed, diet)
- Decreased: liver disease (lack of formation urea), malnutrition
Creatinine, Blood
• Amount generated is proportional to mass of skeletal muscle unless muscle damage/disease
• Decreases with age
*DETERMINES RENAL CLEARANCE
How is Creatinine Blood Used
- Assess kidney function
- Monitor progress of kidney dysfunction/effectiveness of treatments in patient’s with abnormal levels/diseases affecting kidneys (diabetes)
- Prior to procedures (CT) that use drugs that affect kidneys
How is Creatinine Blood Used: Creatinine Clearance
- Measures how effectively kidneys are filtering small molecules out of blood
- 24-hr urine creatinine levels
How is Creatinine Blood Used: Correction Factor
- UP/CR, A/CR
- Evaluates kidney function
- Detects other urinary tract disease
How is Creatinine Blood Used: Serum Creatinine
- Calculates estimated glomerular filtration rate (eGFR)
* Evidence of kidney damage
Normal Creatinine Lab Values
- Male: 0.6-1.2 mg/dL
* Female: 0.5-1.1 mg/dL
Creatinine Indications
- Disorder involving muscles
* Impairment of renal function
Creatinine Levels
Increased: impaired kidney function
• damage to blood vessels in kidney (infection, auto-immune disease)
• Urinary tract obstruction (prostate disease, kidney stones)
• Death of cells in kidney (drugs, toxins)
• Bacterial Infection in kidney
• Reduced blood flow to kidney (shock, dehydration, CHF, atherosclerosis, diabetes)
• Muscle injury
Decreased
• Pregnancy
• Decreased muscle mass
