Module 9: GU Flashcards
Structures of the Kidneys
Renal Arteries Renal Veins Nephrons (Glomerulus, Bowmans Capsule, Proximal Convoluted Tubule, Henles Loop, Distal Convoluted Tubule) Two Ureters One Bladder One Urethra
Purpose of the kidneys
maintain overall fluid balance, regulate fluid and minerals from food/toxins/medications/etc
Nephrons
basic functional and structural unit of the kidneys that regulate water and soluble substances in the blood by filtering it and reabsorbing what is needed and excreting what is unneeded
Its function is vital for homeostasis of blood volume, plasma osmolarity, and pressure
Glomerulus
To filter plasma, produce glomerular filtrate which passes down the length of the nephron tube to produce urine
Bowmans Capsule
First step in the filtration of blood to form urine
surrounds the glomerulus
Proximal Convoluted Tubule
efficiently regulates pH of filtrate by exchanging hydrogen ions
Loop of Henle
U Shape
Recover of water and sodium chloride from urine occurs here
Distal Convoluted Tubule
In the kidney cortex
Reabsorbs Ca, Na, and Chloride, and regulates pH of urine by secreting protons and absorbing bicarbonate
Ureters
Carries urine from the kidneys to the bladder
Anuria
urinary output less than 100 mL/24 hours
oliguria
diminished urinary output (100-400 mL/24 hours)
Polyuria
excessive urinary output (diuresis)
common in diabetes patients
Hematuria
blood in the urine
Dysuria
pain on urination, difficulty voiding, burning sensation
Proteinuria
protein in the urine
Keotnuria
ketones in the urine
Nocturia
Excessive urination at night
Enuresis
Involuntary voiding
Nocturnal - nighttime; Diurnal - daytime
Important Developmental Considerations of the GU System for Infants
The kidneys function better/begin after 9-12 weeks
Infant kidneys have less ability to concentrate/dilute urine
Important Developmental Considerations of the GU System for Children
Incontinence
Night Wetting
UTIs
Important Developmental Considerations of the GU System for Males
Urethra is 20-21 cm (7.5-8 inches)
Slit is vertical
Urethra goes through the prostate gland
There is a reproductive function
Important Developmental Considerations of the GU System for Females
Urethra is 3.5 cm (1.5 inches) - a lot shorter than males
Questions to ask the patient during the subjective interview for the GU system?
Frequency and Amount (polyuria or oliguria)
color changes/blood presence
pain (dysuria), burning
incomplete emptying
hesitancy, nocturia, dribbling
straining, narrowing stream
incontinence, overflow, stress
PMH
UTIs, STD, injuries
Stones, Gout
Medications (Diuretics)
HTN
What is gout?
uric acid substance backs up in the blood stream and crystallizes in the toes and fingers leading to intense pain
Example of 4 Diuretics
Lasiz
HCTZ
Bumix
Aldactone
Extra Considerations for the GU Subjective Interview for Children
Get parent permission
Onset of control
Frequency, hydration routine
Diurnal enuresis
Vincent’s curtsy
hx of UTIs?
Vincent’s Curtsey
squatting on the heels, crossing the legs, and flexing the pelvic floor muscles while performing a curtsy maneuver
Extra considerations for the GU subjective interview for adolescents?
Smoking, Alcohol, Drugs
Sexual Activity
Urinary Difficulties
Order of Objective GU Assessment Techniques
Inspection –> Palpation –> Percussion
Objective Findings for the Inspection of the GU System
Inspect for abnormalities:
Back
Peritoneal Area
Objective Findings for the Palpation of the GU System
CVA Tenderness
Pelvic Area / Flank Area (where kidneys are in lower back) check for tenderness, warmth, swelling, etc
Do light and deep palpation of pelvic area
Objective Findings for the Percussion of the GU System
Tympany - Empty Bladder
Dullness - full bladder/ over liquid
CVA Tenderness
nursing technique where one hand goes on flank and the other gently hits it - if pain is elicited that means there is a positive for kidney issue
When does the normal bladder urge begin around? (cc)
150-250 cc
A health bladder can hold urine for up to …
2-5hours
The normal volume of urine that enters the bladder is …
1-2 L per day
Objective Findings to look at when inspecting urine?
Color (Hydration)
Smell (Glucose)
Acidity (Diet)
Density (Hydration)
Composition (Urea, Uric Acid, Creatinine, Sodium, other trace elements)
Check if they can hold it for the normal timing
Causes of Acute Renal Failure
Obstruction
Dehydration
Medications
(Acute can be fixed but chronic cannot, like in those with diabetes mellitus)
Causes of Chronic Renal Failure
HTN
DM (Diabetes Mellitus)
Causes of Kidney Stones
Diet
Hereditary Traits
Abnormal Bladder Findings
UTI
Urinary Retention (Prostate, tumor, bladder dysfunction)
Urinary Incontinence
Interstitial Cystitis
Abnormal GU System Assessment Findings
Lower Urinary Tract Symptoms (LUTS)
Benign Prostatic Hyperplasia (BPH)
Prostatitis
Cancer/Tumors
Anatomical Abnormalities (ex: Vesicoureteral Reflux)
Vesicoureteral Refluex
GU abnormality where the urine goes back up the ureter and into the kidneys
High Risk Population for UTI
Sexually Active Women
Post Menopausal Women
> Women have shorter urethra, thus higher risk
Individuals with DM
Individuals with Indwelling catheters
The Elderly (may not drink enough fluids)
Stress incontinence
Most common in women
Urine leaks when coughing, sneezing, or laughing
Overflow Incontinence
inability to empty the bladder
dribbling of urine is almost constant
can be due to DM, prostate issues (blocked urethra), or a damaged bladder
common in older men with prostate issues
Reflex Incontinence
Symptoms the same as urge incontinence due to spinal or neurological trauma
Urge Incontinence
overactive muscles cause spasms, sudden and intense urge to urinate, and sudden loss of frequency
Functional Incontinence
normal urge to urinate but physical ailments prevent the person from making it successfully to the bathroom on time
The kidney is about the size of …
your fist
Normal Kidney v Diseased Kidney
Normal: Healthy function, proper size, low urine protein
Diseased: Granular surface, decreased fxn, smaller size, high urine protein
Test and Surgeries for Acute Kidney Disease
Urinalysis (Clean Collection) C&S (Sterile Collection) 24 Hour Collection Straight and Retaining Catheterizations Bladder Scanner Kidney Stone Filter Transurethral Resection (TUR) (Prostate or Bladder)
TUR
Transurethral Resection
removal of cancerous bladder tissue or a section of the prostate
U/A and C&S Considerations
Clean the meatus with a peri wipe FRONT TO BACK
Clean Catch v Straight Catheter
Clean Catch
patient pees in a cup
Straight Cath
Cath kit is put up the urethra to catch urine
24 hour urine collection
Tests for kidney function
the patient voids in the am (first morning) which is discarded and then after that you put a time on the gallon when you started to measure and start collecting at the second urination
collect all of it for 24 hours
patient voids right before 24 hour mark ends too
What to assess urine for
Color Amount Odor Turbidity pH Specific Gravity Constituents
Pale v Amber Urine
Pale means well hydrated, while amber color means dehydrated
Less that ___ cc/hr of urine indicates kidney failure
30
Odor indicates what about urine
infection, concentration, glucose presence
Normal Urine turbidity is …
clear initially, and gets cloudy as it stands
pH of urine
normal around 6 (4.6 to 8)
Specific Gravity of urine is …
the concentration of urine / weight in comparison to distilled water
Normal Urine constituents
urea, uric acid, creatinine
Abnormal urine constituents
blood
pus
albumin
glucose
ketones
blood
bile
bacteria