Urinary System Flashcards
urinary system consists of….
two kidneys, two ureters, the urinary bladder, and the urethra
length of male urethra
3-5 inches
length of female urethra
2-3 inches
why is it hard to put in a cath for a male?
prostrate gland
coude
specially designed catheter to help get past prostrate; prostrate disease cancer
metal guide
need dr or someone from anesthia; not used too often; may bleed in urine for one to two days after; helps to get cath around prostrate gland; more invasive; used in males to get past prostrate gland
what is the role of kidneys?
produce urine
urine consists of…
95% water and 5% nitrogenous waste products of protein
what makes up nitrogenous waste of urine?
urea, uric acid, and creatinine
secondary functions of kidney
Erythropoietin (makes red blood cell) production, renin production, and the activation of Vitamin D3
Erythropoietin is produced and released in response to…
decreased oxygen in kidney blood supply which triggers RBC production in bone marrow
Unhealthy kidneys will have reduced erythropoietin production which in turn can make you…
anemic
role of vitamin D
promotes absorption of Ca in GI tract and regulate Ca balance
role of renin
- assists in blood pressure control
- ## anytime the kidneys sense a drop in fluid volume and blood pressure
excess electrolytes eliminated in the urine which include
Na, Ca, K, and phosphates.
why do you look at med doses when there is kidney dysfunction?
metabolism of medicine could be altered; may need to change dose
other functions of kidneys
- Assist the body to regulate blood volume by excreting or conserving water; ADH in endocrine system.
- Regulation of electrolyte balance.
- Regulation of the acid-base balance.
- Regulates the same components in tissue fluid.
where is urine produced?
kidney
how is the urine moved from kidney to bladder?
moved by virtue of peristalsis thru the ureters into the urinary bladder
how full is the bladder when it sends a signal to the spinal cord and brain to empty the bladder?
- 250-300cc’s is a general amount
- Some may have less and some may have more
micturition
expel urine from bladder
where are kidneys located?
retroperitoneal space
what hormone is responsible for producing RBCs?
erythropoietin
how does kidney assist in acid-base balance of the body?
secretes renin
what do you have to worry about when there is surgery on kidneys?
- always a high risk to bleed
- highly vascular in that area
3 parts of kidney
renal cortex, renal medulla and renal pelvis
renal cortex
outer most part of kidney
renal medula
- middle portion
- contains the collecting tubules and the renal pyramids
renal corpuscle
- glomerulus
- bowman’s capsule
glomerulus
a ball-like network of capillaries formed from an arteriole within the Bowman’s capsule
Bowman’s capsule
surrounds the glomerulus
where does Lasix start to work?
loop of henle
where do diuretics work?
ascending/descending loop tubule
Bowman’s capsule is attached to…
a long looped and coiled structure called the renal tubule
where does the blood go from the capillary network that is formed around the tubules?
collected by the venules
most of the contents except for large molecules and large blood cells are…
forced out of the blood from the capillaries of the glomerulus and into the Bowmans capsule
glomerular filtrate
matter that is filtered out of blood
what type of pressure does the capillary system have?
high pressure
what is in the matter that is filtered out of the blood?
water, electrolytes, various toxic substances, and other waste products
how much blood is processed by the kidneys?
400 quarts each day
GFR
changes with age; how well kidneys take on blood and how well it gets rid of unwanted parts and excrete
GFR produces…
about 2 quarts of waste products and extra water as urine
tubular reabsorption
During the process of filtration some of the necessary elements are reabsorbed and returned to circulation
what happens to the filtrate that is not reabsorbed?
is now urine and continues to travel thru the tubules
where does the urine go once it leaves the tubules?
to the collecting ducts and into the pelvis of the kidney and then to the rest of the urinary system
normal output of urine
1000-2000ml in 24 hours
average output of urine
1500 mL in 24 hours
minimum output of urine
30 mL per hour; need this much to have healthy kidney function
should urine be clear?
yes
what is the color range of urine?
pale yellow to amber or straw colored
what color of urine do you want?
pale yellow
what urine color is more dilute?
lighter color
what urine color is more concentrated?
darker color
urine screen
dip sticks; color shows what is wrong with them
who might use a urine screen
Camp counselor and emergency room
can the urine screen test check for ketones?
yes
can the urine screen test check for glucose?
yes
what does cloudy urine indicate?
presence of pus, red blood cells, or bacteria
dark red in urine indicates..
bleeding in the area of the kidney and high in ureter
bright red in urine indicates…
bleeding in the lower urinary tract/bladder and urethra
Interstitial cystitis
infection in walls of bladder; strands appear in urine
dark yellow urine…
may indicate the presence of bilirubin
brown looking urine…
Rhubarb and liver/gallbladder disease
beets make urine look…
bloody
pyridium makes urine look….
blaze orange; used to treat pain, dysuria and spasms
mandelamine makes urine look…
dark brown; made from sterile horse urine
foul smelling urine indicates…
infection
sweet smelling urine indicates…
glucose
should freshly collected urine be sweet or foul smelling?
no
Normal pH of urine
4.6 to 8.0 with an average of 6
The pH of urine indicates…
- the acid-base balance
- under 6 are more acidic; higher more alkaline
what does an alkaline measure in urine indicate?
- possible infection or bacteria
- high intake of citrus fruits or vegetables
what does acidic urine indicate?
- starvation
- dehydration
- diet high in meat/cranberries
- Atkins diet
should protein be positive or negative?
negative
why test urine for protein?
indicates renal function
how often are pregnant women checked for protein?
every visit
Normal specific gravity
- 1.010 to 1.025
- determine the ability of the kidney to concentrate and excrete urine
- hydration level of the patient
Normal specific gravity test allows you to…
correct fluid volume, get to better balance and help to decide on correct flow of iv
Nitrites
- should be negative
- if present would indicate possible infection
Ketones
should be negative
what are ketones?
end products of fatty acid breakdown
situation you might find ketones
- diabetic or special diets
- extreme athletes (should go away within a week)
crystals present in urine indicate…
- renal stone formation
- additional test to look for kidney stones
what are casts in urine?
- clumps of materials or cells that are abnormal in urine
- structures that form around other particles
each cast indicates…
a different problem
when are casts sometimes found in urine?
after exercise
Hyaline casts indicate…
- protein problems
- Atkin’s diet
Granular casts indicate…
- some type of nephrotic syndrome
- problem with kidneys
- 85% loss of nephrons
Epithelial casts indicate…
possible glomerulonephritis
Waxy casts indicate…
chronic renal disease or renal failure
WBC
- more than 5 indicate infection
- Culture and sensitivity will be done
RBC
- more than two could indicate kidney disease, trauma, or tumor
- Blood in the urine can also indicate infection
BUN
- 8-20 mg/dl
- Reflective of age - higher with age
- Less hydrated - higher it will be
- not foolproof to diagnose kidney disease
Creatinine
- 0.5-1.1mg/dl
- True kidney disease for anything above 1.1
- Reliable test for diagnosis of kidney disease
Cystoscopy
- Scope to see what is going on in bladder (infection, tumor, polyps)
- Can do biopsy as they are looking
- Direct visualization of bladder
complications of cystoscopy
- change in vital signs
- stronger bleeding
- some blood in urine after procedure
Cystometry
- check to see when they feel the urge to go
- irrigate bladder
- should get urge at 250-300 mL
- don’t put in more than 1000 mL
who would you perform a cystometry on?
- people with some degree of incontinence
- neuromuscular disease (ALS, multiple sclerosis)
- don’t feel the urge to urinate
how do you treat someone who doesn’t have the urge to urinate?
- kegel exercise
- meds
- suprapubic cath
IVP
- check for allergy to dye
- x-ray to see the flow of the dye
- look for abnormalities
- drink water after test
Ultrasound
- look at kidney and pelvis
kidney biopsy
- highly vascular
- look for signs of bleeding
What is the urination pattern?
- Number of times, ask targeted questions
- Would you say you urinate 10 times per day?
Is there any sense of urinary retention after urination?
- Men over 50 yrs start to feel like they always have urine left
- Postpartum women or surgical intervention
how much urine can you take at a time?
- max is 1000 mL
- take too much could affect blood pressure
Does the client have complaints of excessively dry skin or pruritus?
- Not able to clear waste products
- Urea starts to come to the skin
Uremic frost
end stage renal disease; waste product comes to surface of skin; bile and ureic salts
should you be able to palpate the bladder?
- not usually
- usually about 400-500 mL before you can feel it
how much urine does a newborn produce?
15 to 60 ml of urine per kilogram per day
how do you measure urine output for newborn?
Weigh diaper before you put it on and when you take it off
how do newborns concentrate urine?
poorly
how many times does a newborn void in the first 24 hours?
25 times
how many times do infants void in 24 hours?
8 - 10 times
what do you ask parent when infant is experiencing nausea or vomiting and not feeling well?
how many wet diapers
when is toilet training done?
18-24 months
Enuresis
daytime wet
Nocturnal enuresis
nighttime wet
what age should you be concerned if child is not toilet trained?
6 yrs
reasons for difficulty in toilet training
- cognitive delays
- bad tonsils
geriatric considerations
- Decline in filtration rate
- Decreased capacity
Anuria
without urine, less than 100 mL in 24 hours
Oliguria
less than 300 - 400 mL in 24 hours
Polyuria
excessive urination
Dysuria
painful urination
Urgency
the feel to go
Frequency
how often
Nephrotoxic
tylenol beyond healing doses
Pyridium
dysuria, spasm, turn urine bright orange
Diuretics
Thiazides, Potassium-Sparing
Meds that can cause urinary retention:
antihistamines, tricyclic antidepressants, MAO inhibitors, antispasmodics, Parkinson drugs, and Beta blockers
Med to treat urinary retention
Urecholine
Meds that are nephrotoxic
Gentamycin/Garamycin (ototoxic), Amphotericin B, aspirin, and Motrin, Tylenol
Infection/inflammation
- Symptoms can be kind of the same
- Dysuria, burning, low grade temp
- No WBC or bacteria in inflammation
- Treat both with antibiotics
Renal calculi
- Stones
- Miserable
- Need a lot of fluid
- Pain better when stones are passed
BPH
- Benign prostatic hyperplasia
- Men
- May need to remove part of prostrate
- Prostrate - look for growth and nodules
- PSA - if elevated check to cancer, 0-4 i
- Cath males over 50, use coude cath
cardiac disease
decreased blood flow to kidneys
kidney output ok
profuse adequate 30 mL/hr
Urinary Incontinence
he uncontrolled loss of urine from the bladder. Incontinence has many causes some of which might be a result of a urinary tract problem, a neurological problem, and some medications as well as others
Stress incontinence
the most common type of incontinence and women are more likely a ffected. There is leakage of urine when the person does anything that strains the abdomen such as coughing, sneezing, laughing, jogging, dancing, and lifting.
treatment of stress incontinence
bladder retraining, medications such as estrogens, surgery, and teaching of Kegel exercises
Atrophic vaginitis
painful intercourse, slight bleeding after intercourse, irritation,
treat atrophic vaginitis
- estrogen, vaginal is less risky than oral
- don’t use estrogen if risk of breast cancer
Urge incontinence
Occurs when a person is unable to suppress the sudden urge to urinate. Sometimes urine may leak without warning. Often an irritated bladder is the cause stemming from infection or concentrated urine.
treatment of urge incontinence
Suprapubic cath as last resort
Total incontinence
no urine can be retained in the bladder. The cause of this is usually neurological and can be treated with a Foley catheter. Treatment might also include urinary diversion or suprapubic catheter.
who can have total incontinence?
- people with delayed cognitive ability
- Neurologic - paraplegic, quadriplegic
treatment of total incontinence
- Use incontinent products
- Urinary diversion products
Nocturnal enuresis
- during sleeping
- not unusual up to the age of 6-8.
- typically the client will be checked to rule out infection by ordering a urinalysis and urine culture.
treatment for nocturnal enuresis if no infection
limiting fluids, awakening the child, setting alarms, and etc
possible causes of nocturnal enuresis include
pinworms, constipation, diabetes, sickle cell anemia, sexual abuse, stress, and sleep disorders
meds to treat nocturnal enuresis
- Ditropan (adults)
- DDAVP (diabetes insipidus, urinate less often, nasal spray)
- Tofranil (low dose antidepressant)
Urinary Retention
Urinary retention is when a person has the urge to void but cannot empty the bladder. When urinary retention is present it creates urinary stasis and increases the risk of infection.
causes of urinary retention
Stress, obstruction by calculi, tumor, infection, interference of the urinary sphincter during a surgical procedure, side effect of medications, and perineal trauma as in childbirth.
symptoms of urinary retention
Discomfort, anxiety, frequency of urination which can result in small frequent amounts, incontinence, may occur, can palpate the distended bladder over the pelvis.
treatment of urinary retention
Urinary analgesics such as Pyridium, antispasmodics, catheter, or surgery if an obstruction is present. Urecholine is also used to treat urinary retention. Doctor may order to measure residual volumes which should be less than 50 ml.
Voided specimen
implies that a hat in toilet; not good (better than nothing)
Midstream clean catch
- Wash genital area; start urine stream; put cup midway through; take cup out and finish
- Best specimen short of cath
Mini-cath
- females only
- sterile procedure
- one way to get sterile specimen
condom cath
- Urine specimen for a male who is incontinent
- Works for younger males but not so much for older men
- Connect to leg or drainage bag
- Good for quadriplegic or paraplegic who don’t like to be wet
Straight cath
One lumen - straight; go in, get urine and come out; not meant to stay in; used mostly with men
U-bag (peds)
- attach to genitalia (labia or penis)
- put diaper back on and wait for them to go
Sterile collection - foley
- Just put Foley on - very first urine in bag can be taken from bag
- Foley has been on for awhile - clamp on cath, come back in 15 minutes, bring syringe (needless), let clamp go and aspirate into syringe
24 hour urine collection
- Know type and let lab know so that you get the appropriate container (some may have preservatives)
- Void at a specific time; start collecting after that for the next 24 hours
- Refrigerate or bucket of ice to keep it cool
Foley cath - two lumen
- meant to stay in
- one lumen for urine
- one lumen for water to inflate balloon
- 5, 10, & 30 cc balloon
Foley cath - three lumen
- meant to stay in
- one lumen for urine
- one lumen for water to inflate balloon
- one lumen to irrigate
- 5, 10, & 30 cc balloon
what do you do when you irrigate a bladder?
keep track of how much solution you use so you can subtract from output
Water intoxication
irrigation drifts into vascular system; had alert patient and a while later they have a change of personality; behavior changes, etc.; Call dr because now you may have an electrolyte imbalance
Urometer
accurately measures amount of urine, attached to collection bag of Foley cath
Strainer
strain all urine; look for kidney stones; should have dr orders but can do because of std practice
Urostomy bag
remove bladder; ureters are places in small intestine and surgical opening in pelvis; plate area attached into bag (kock pouch)
caths are measured in ….
- French
- 12-16 french is average size
