what are the parts of the urinary system?
1.Kidneys
2.Renal pelvis(pelvis)
3.Ureters
4.Lower urinary tract
5.Urinary bladder
6.Urethra
the primary function of the kidney
Urine formation
Excretion of waste products
Regulation of electrolytes and acid base balance
Control of water balance
Control of BP(rennin)
Regulate RBC formation(erythropoietin)
Synthesis of Vit. D to activate
renal pelvis
funnel-shaped reservoir that collects the urine and passes it to the ureter
ureters
two slender tubes, approximately 10 to 13 inches long, that receive urine from the kidneys and carry it via peristalsis to the posterior portion of the bladder
urinary tract
system of excretory organs that rids the blood of wastes, controls blood volume by removing excess water, and balances concentrations of salts and water
urinary bladder
sac like organ in which urine is stored before being excreted
urethra
tube leading from the urinary bladder to the outside of the body
urge to void urine
150ml
male urethra is how long?
Male urethra- 8-10 inches
the female urethra is how long?
1.5-2 inches
the assessment of a client with a urinary disorder
Urine characteristics- amount color odor, color
Urine vol. changes (norms) I & O (no matter the disorder they are put on this)
Normal range-1500ml-3000ml
24hrs-500ml
Hours- 30-50ml
Anuria, oliguria, polyuria
SX of pyelonephritis
Back pain or flank pain
Chills with shaking
Severe abdominal pain (occurs occasionally)
Fatigue
Fever
malaise
Mental changes or confusion*
Skin changes
Flushed or reddened skin
Moist skin (diaphoresis)
Warm skin
Urination problems
Increased urinary freque
Tx of pyelonephritis
The goals of treatment are to:
Control the infection
Relieve symptoms, Relieve pain fever
Antimicrobial drugs- (septra)
Antispasmotics oxybtynin(Ditropan)
Anticholenergics- propantheline (probanthine0
Goal prevent further kidney damage
nursing managment of pyelonephritis
VS
Assess for fluid retention- edema, SOB
Assess character of urine
I&O
Evaluates BUN, creatinine, electrolytes
Recommend acid forming foods punes plums cranberries meat fish
Increase fluids to 3000ml
Dx of acute glomerulonephritis
Elevated anti-streptolysin O titier -> indicates pt has had strep
Proteinuria/Hematuria ->Red blood count decreased (decreased hemoglobin)
Elevated BUN and creatininte
Hyperkalemia, hypermagnesemia, hypocalcemia
ALL ELECTROLYTES ELEVATED EXCEPT CA+
Sx of acute glomerulonephritis
Face pale & puffy
Periorbitol edema
Pain
Hypertension
Generalized edema
Hematuria anemia
Oliguria
Tx of acute glomerulonephritis
Symptomatic
Bedrest
Low Na+ diet
Antimicrobial drugs diuretics and antihypertensives
Iron supplements
Corticosteroids
Considered cured when the urine is free form protein and RBC for 6 months
Resume normal activity when urine clear for 1 month
nursing managment of acute glomerulonephritis
Bedrest
Assess B/P q4hrs
I &O
Encourage fluids
Low Na & protein, high carbs
pyelonephritis
Pyelonephritis is an infection of the kidney and the ureters, the ducts that carry urine away from the kidney
acute glomerulonephritis
Inflammatory, non infectious disease NOT BACTERIAL CAUSED
Characterized by widespread kidney damage
Occurs in children and young adults
Can lead to chronic nephrititis
polycystic disease
Infantile and adult forms
Renal failure- fatal unless hemodialysis/transplant
Multiple bilateral kidney cysts
Sx of polycystic disease
Hypertension
Proteinuria/ hematuria
pain
Tx of polycystic disease
No cure
Symptomatic
Dialysis
Transplant
kidney stones
also known as Nephrolithiasi-
etiology of kidney stones
Prolonged immobility
Calciuria
Dehydration
Obstructive disorders
Osteoporosis
Sx of kidney stones
Sudden sharp, severe flank pain that travels to the suprapubic area and external genitalia
Renal/ ureteral colic
Infection- chills and fever
Obstruction- urinary obstruction
Tx of kidney stones
Increased fluids
Analgesics
Ambulation
Drugs that dissolve stones
Extracorporeal shock wave lithotripsy
(ESWL ureteral catheter/ureteral stent)
nursing managment of kidney stones
Admin analgesics
Use non-pharmacological interventions for pain
Encourage fl's & ambulation.
I&O
Manage a Nephrostomy Tube
Maintain patency of all catheters or encourage pt to void q 2-3 hrs.
** Strain urine, then send to lab.
ureteral stricture
Narrowing of the Ureter
etiology of ureteral stricture
Ureteral calculi - inflammation
Pregnancy
S/Sx of ureteral stricture
Flank pain at Costovertebral Angle (CVA).
Pain increases w/large intake of fluids.
Tx of ureteral stricture
Filiform/Urethral sound - stretching the ureter
Ureteral plasty - take out narrow portion & reconnect 2 portions of the ureter.
Ureteral Stent (put in w/plasty to drain urine to bag-not permanent)
Provide support
Relieve obstruction
Maintain urine flo
nursing managment of ureteral stricture
Make sure we have urine drainage.
Measure output from ureteral cath hourly.
Complication: Obstruction of ureter
S&SX:
Shock
Decrease urinary output
Abdominal pain
UTI
tumor of the kidney
Hypernephroma (renal adencarcinoma
S/Sx of tumor of the kidney
Painless hematuria
Flank pain
Palpable mass
Tx of tumor of the kidney
Nephrectomy - removal of kidney
Nephroureterectomy - removal of kideny & ureter
Post Op care for nephrectomy
VS
Identify the type, location & patency of all drains and caths.
Usually done thru flank area
Notify MD of flank bleeding/or decrease in urinary output.
Don't position on the operative side
Interferes w/drainage & tubing
Encourage fl's/
acute renal failure
Sudden and rapid decrease in renal function
Reversible with early Tx of cause
Chronic renal failure (CRF)
Progressive and Irreversible damage to the nephrons
etiology of acute renal failure
Perennial disorders(ARF)
All types of shock
Dehydration
Intrarenal Disorders (inside the kidney)
Nephrotoxicity
glomerulonephritis
cause of acute renal failure
Obstructive problems in structures below the kidney causes:
Calculi
tumors and
ulcers
s/sx of acute renal failure
ARF & CRF
Elevated b/p
Weight gain (edema)
Decreased urinary output
Puffy, pale skin
Bleeding in GI tract and oral MM
Ha
Anorexia
Pruritis
Urine odor to skin and breath
Bone pain
Neurological symptoms- confusion, seizures
chronic reanal failure
the kidneys are so extensively damaged that they don not adequately remove protein by products and electrolytes from the blood and do not maintain acid-base balance
S/Sx of chronic reanal failure
elevated bp, weight gain, decreased urine output, puffy face from fluid retention,pale skin, bleeding oral mucous membranes, blood in feces
tx of chronic reanal failure
hydration,surgery, replacement fluids, continous monitoring of renal function,parenteral fluids to increase plasma, vasodilating and diuretic drugs, infusing dopamine to improve cardiac output, hemodialysis(machine that filters blood)
management of a client in reanl failure
dialysis
etiology of acute glomerulonephritis
SYMPTOMS OCCUR 2-3WKS after a URI with group A beta hemolytic strep.
Antigen- antibody reaction
RBC& Protein in urine
Decreased glomerular filtration rate
chronic glomerulonephritis
Inflammation of the glomeruli
Irreversible degeneration of nephron
dx of chronic glomerulonephritis
Low RBC's
Azotemia- elevated BUN & creatinine lvls
proteinuria
sx of chronic glomerulonephritis
Anascara - full body edema
Loss of albumin in urine
Dyspnea
Hypertension RETENTION OF FLUIDS
HA
Visual disturbances
tx of chronic glomerulonephritis
Symptomatic
surgical mgt of kidney stones
Percutaneous Nephrolithotomy- thru skin, in kidney, removing stone
Ureterthotomy- thru the ureter
Pyelolithotomy- thru renal pelvis
Nephrololithotomy- thru kidney
Nephrectomy- removal of kidney
Ureteral Strictures: Hydroureter
Area of the ureter above the stricture dilates with urine (Hydronephrosis) & kidney pelvis enlarges.
acute renal failure Intrarenal Disorders (inside the kidney)
Nephrotoxicity
glomerulonephritis
Postrenal disorderes
Obstructive problems in structures below the kidney causes:
Calculi
Calculi
tumors and
ulcers
tests performed for Dx of urologic and renal system diseases
radiography, ultrasonography, CT/MRI, angiography, cystoscopy, IVP, biopsy, cystogram
lab tests performed for Dx of urologic and renal system diseases
urinalysis, urine C & S, 24hr urine collection, urine specific gravity, urine protein, cratinine clearance test, blood chemistries
nursing mgt of the client undergoing dx evaluation of the urinary tract
check allergy history, instruct P to fast 8-12hrs, cleanse the bowel so that there in no interference with visuals, document base line V/S, explain procedure, advise warm tub baths to decrease urethral discomfort or spasms, no alcohol 48hrs
the upper urinary tract is composed of ?
Kidneys, renal pelves, ureters
the lower urinary tract is composed of?
bladder, urethra, pelvic floor muscles
the bladder holds up to?
300-500ml
KUB Radiography is performed to show?
the size and position of the kidneys ureter and bony pelvis as well as any stones, abnormal gas patterns and any defects of the bony spinal column
renal ultrasonography is performed to show?
I.D's kidney's shape size, location, collecting systems and adjacent tissues, it can be used in I.Ding renal cysts or needle placement for renal biopsy
CT scan and MRI is performed to show?
imagaing of the abs and pelvis may be obtained to dx renal pathology, kidney size and to evaluate tissue densities with or without contrast material
angiography is performed to show?
provides details of the arterial supply to the kidneys, specifically the location and number of renal arteries and the patency of each artery
cytoscopy is performed to show?
visual examination of the inside of the bladder
intravenous pyelogram (IVP)and retrograde pyleogram is performed to show?
is a radiologic study used to evaluate the structure and functionof the kidneys, ureters and bladder. it locates the site of urinary tract obstruction
biopsy is performed to show?
diagnose cancer, assess prostatic enlargement and to monitor progression of renal disease
cystogram is performed to show?
abnormalities in the bladder structure and filling through the instillation of contrast dye and radiography
urodynamic studies is performed to show?
bladder and urethral function and to assess causes of reduced urine flow, urinary retention, and urinary incontinence