Transcript The Urinary System
The Urinary System Anatomy and Physiology 2014
Structure
Kidneys
Ureters
Urinary bladder
urethra
Function
Maintains homeostasis
Controls blood and water volume
Maintains blood pressure
Regulates electrolyte levels
Eliminates protein wastes, excess salts and toxic materials from blood
Balances acid/base (PH)
Secretes renin and erythropoietin
Kidney Structure
2 reddish brown, bean shaped organs
Located in small of the back at lower edge of ribs on either side of spine
“Retroperitoneal”
How the kidneys Regulate BP
ADH RENIN ALDOSTERONE
Cortex
Medulla
Pelvis 3 Parts
Be comeHealthyNo w.com Home
Nephron
Functional units of the kidney
Cells that form urine
Over 1 million nephrons in each kidney
Glomerular Filtration
Tubular Reabsorption
Tubular Secretion
WORD WALL 1.
2.
3.
4.
5.
Oliguria Anuria Dysuria Polyuria hematuria
Urine
Body excretes 1000-2000 ml of urine/day
Is normally sterile
Color varies with hydration
Characteristics of Normal Urine
CLARITY
ODOR
SPECIFIC GRAVITY
THINK….
A STRONG, OFFENSIVE ODOR FROM FRESHLY VOIDED URINE IS SUGGESTIVE OF……..
Urinary Tract Infection
Composition of Normal Urine
Water
Protein wastes products (urea, uric acid & creatinine)
Excessive minerals from diet (Na+,K+, Ca,sulfates & phosphates
Toxins
Hormones
Bile compounds
Pigments from food/drugs
WORD WALL
Frequency
Urgency
Nocturia
Enuresis
retention
Effects of Aging on the Urinary System
Ability to filter blood, reabsorb electrolytes & secrete wastes decreases
Less ability to return to normal after changes in blood volume
Decrease in number & size of nephrons
Decrease in GFR
Smaller capacity of bladder
Weaker bladder muscles
Incontinence
Not a normal consequence of age Common due to many reasons See Chpter 23 for more information on incontinence
Critical Thinking Challenge COMPARE & CONTRAST
STRESS vs. FUNCTIONAL
COMPARE & CONTRAST
URGE vs. OVERFLOW
Nursing Assessment of The Urinary System
HEALTH HISTORY
Chief complaint History of Present Illness Past Medical History Family History Review of Systems
Diagnostic & Laboratory Tests Urinary System
URINE TESTS
UA ( urinalysis )
C & S ( Culture & Sensitivity )
Creatinine Clearance (24 hr)
BLOOD TESTS
BUN ( blood urea nitrogen )
Serum Creatinine
Serum Electrolytes
Radiographic Studies
KUB ( flat plate )
IVP
Arteriogram
Renal Scan
US
Invasive Procedures 1.
Renal Biopsy 2.
Cystoscopy
What are
Urodynamic Studies ??
What are common Therapeutic measures Related to “Catheterization”
Catheter Types Foley Ureteral Suprapubic Nephrostomy
Common Tubes and Catheters
Ureteral Catheter
Nephrostomy Tube
Urinary Stent
Pre-Op Care
Urologic Surgery
Evaluate fluid status Bowel cleansing Enterostomal Therapist/Nurse Counseling/Teaching
Post-Op Care
Urologic Surgery
Report to MD U/O < 30 ml/hr Pain Management Mon. lung sounds Assess for Paralytic ileus
Urinary Tract
Inflammation and Infections
Cystitis
Inflammation of the urinary bladder
Bacteria enters from the urethra, lymph nodes, infected kidneys
Women more suseptible
Causes
E-coli
Candida Albicans
Coitus
Diabetes mellitus
See Box 40-2 Risk Factors for UTI’s
Signs & Symptoms
Dysuria, hematuria
Frequency, urgency
Low grade fever
Pelvic or abd. discomfort
Bladder spasms
Med. Dx & Tx
C&S and UA obtained
Increase fluids 3-4 L / day
Antibiotics (Cipro,Bactrim,Septra
Analgesics(Pyridium)
See Pt. Teaching pg. 898
Gerontologic Considerations
Watch for signs of mental confusion
Fever may be masked
Sepsis develops quickly
Pyelonephritis
Bacterial infection of renal pelvis and kidney
Most common form of kidney disease
Often the result of reflux
Signs & Symptoms
Flank pain
Chills, fever,N & V
Dysuria, fatique
Bladder irritation
Med & Nursing Considerations
Bedrest
Increase fluids (8 8oz. Glasses water/day)
IV
Monitor I + O
Protein & Na+ restrictions
Mon. for circulatory overload
Pharmacological TX
Antibiotics (Bactrim) or Cipro
Antipyretics
Analgesics
Antispasmotics
Antihypertensives
Glomerulonephritis
Autoimmune disease
Glomerulus becomes inflammed
Symptoms dev. 1-3 wks after respiratory infection cau by group A- hemolytic strep
Signs & Symptoms
Tea colored urine
Decrease in u/o
Periobital edema
HTN
Hypervolemia
Medical Dx
Clinical Presentation UA Proteinuria BUN, Cr Strep. Antibody Tests Renal Biopsy or Ultrasound
Medical Treatment
Diuretics Antihypertensives Antibiotics
Nursing Considerations
Bedrest several weeks
Strict I & O, daily weights
Restrict Fluids if ordered
Low Na, low protein diet
Prognosis is good
UA w/ RBC’s, Albumin, casts protein
Treatment
Low Na, protein diet
Bedrest
VS, BP…
Strict I & O
Restrict fluids
Condition may lead to pulmonary edema, increased BP,anemia,cerebral hemorrage, CHF and ultimately uremia or ESRD
In the absence of dialysis or kidney transplant, prognosis is poor.
Polycystic Kidney Disease
Congenital, familial, also may be acquired
Fluid-filled cysts
Abdominal, low back or flank pain and headache
Diagnosis
X-ray or sonogram
BUN & Creatinine
Goal of management is…..
Renal Failure A.K.A. Uremia May be Acute or Chronic
Renal Failure
Kidneys no longer meet everyday demands
Kidneys unable to filter waste products from blood
BUN & Creatinine levels elevate
Causes of Renal Failure
Glomerulonephritis
IDDM
Any condition which decreases blood supply to kidneys
Injury
Recurrent UTI
Drug overdose
Poisoning
Nephrotoxic Drugs
Acute Renal Failure CAUSED BY: 1.
Prerenal Failure 2.
3.
Intrarenal Failure Postrenal Failure
Acute Renal Failure 4 PHASES 1.Onset
2.Oliguria
3.Diuresis
4.Recovery
Medical & Drug Management
Antihypertensives
Diuretics
Cardiotonics
Dialysis if needed
Diet & Fluids
Diet based on consideration of serum electrolytes and BUN. Adequate carbs to prevent breakdown of fat & protein.
Fluids calculated by adding 400-600ml to previous days output.
Nursing Considerations
Freq. BUN, Creatinine, Na & K levels
Usually Low Na, K and protein diet
Mon. I & O
Chronic Renal Failure “ESRD”
Irreversible
Chronic abnormalities in internal environment of kidney
Dialysis or kidney transplant necessary for survival
Signs & Symptoms
• • • • • •
Azotemia Hyperkalemia Hypocalcemia Metabolic acidosis Hypernatremia and hypervolemia Insulin Resistance
Medical Treatment
IV Glucose and Insulin Calcium, Vitamin D and phosphates Fluid restriction & diuretics Beta blockers, calcium channel blockers and ACE inhibitors Iron, folic acid and synthetic erythropoietin High carb/low protein diet
Urinary Tract Obstructions
RENAL CALCULI
Urolithiasis
Calculus or stone formed in the urinary tract
Etiology is unknown
Can occur in renal pelvis, ureters, bladder or urethra
Contributing Factors
Infection & or Dehydration
Urinary stasis
Immobility
Recurrent UTI’s
Diet low in calcium
Signs & Symptoms
Size & location of stone affects degree of pain
Spasm = “colic”
Hematuria
N & V
Medical Treatment
Opioids
NSAIDS
Antispasmodics
IV Fluids
Antibiotics
Surgical Management
Lithotripsy (ESWL)
Urethroscopy
Nephrolithotomy
See Post-Op Care Goals pg. 906
Nursing Considerations
Strain all urine & pain relief
Send gravel or stones to lab
Monitor of s/s infection
Give antispasmodics
Encourage fluids ; IV
Manage Pain
Hydronephrosis
Distention of kidney Can cause permanent damage Maintain accurate I & O Strain all urine Send all stones for analysis
Dialysis
•
Mechanical
•
Imitates the function of the nephron
• •
May be chronic or acute Removes body wastes through semipermeable membrane
Dialysis
Peritoneal
Hemodialysis
Hemodialysis
Blood circulates through a machine outside the body
Semipermeable membrane is within machine
“Artificial kidney”
Performed 3x/wk for approx. 4 hrs
AV Shunts, fistula or cannula
All allow access to the arterial system
All must be assessed for patency by:
“Feel the thrill” & “listen for the bruit”
http://classes.kumc.edu
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Peritoneal Dialysis
Uses the peritoneal lining of the abd. Cavity as semipermeable membrane
Diffusion & osmosis occur through membrane
Performed 4x/day 7 days/wk
3 Phases of Peritoneal Dialysis
Inflow Dwell Drain All 3 phases comprise one exchange
CAPD
•
Used in the home
•
Freedom from machines
•
Steady bld chemistry levels
•
Process is shorter
•
Less expensive
CCPD
Also called: Automated peritoneal dialysis
Requires a cycler
Free from exchanges during day
Must take cycler if traveling
Nursing Considerations
Weigh before & after
VS
Observe for edema, resp. distress
Check bleeding at access site
Acc. I & O, ? Fluid restriction
High calorie
Low protein, Na & K diet
Strict asepsis
Skin care ( s/s infection)
Kidney Transplant
Kidney Donation
Live donor or cadaver
Tissue and blood-typed
Amendment to Social Security Act
Why is counseling advised for both donor and recipient?
Before surgery…
BP medications Immunosuppressant drugs Possible transfusion Dialyzed before transplantation Explore patient understanding Record VS Address questions
Surgery & Complications
See fig. 40-16 pg. 924
ATN, rejection, renal artery stenosis, hematomas, abscesses and leakage of ureteral or vascular anastomoses
Organ Rejection
Hyperacute Acute Chronic s/s fever, ^ BP, pain at site of new kidney Immunosuppressant drugs
Why are they called: Immunosuppressants????
What is the patient predisposed to???
Routine Nursing Care
Monitor urine output
Monitor fluid intake
VS
Note weight changes
TC & DB
Control pain
Bladder CA
Most common site of urinary system CA
Men bet. 50-70 yrs
Most bladder tumors are malignant
Risk Factors
Cigarette smoking
Lung cancer
Caffeine intake
Dyes found in industrial compounds
Medical Treatment
Cytoscopic resection Fulguration Laser photocoagulation Segmental resection Radical cystectomy
Types of urinary Diversion
Ileal conduit (most common)
Colon conduit, ureterosigmoidostomy
Cutaneous ureterostomy
Internal ileal reservoir, aka: “Kock pouch” or “continent ileostomy”
Nursing Interventions
• • • • • •
VS I & O Patency of tubes BS, stoma appearance Special skin care Signs of infection