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The Urinary System

The Urinary System. Anatomy and Physiology 2015. Structure. Kidneys Ureters Urinary bladder urethra. Function. Maintains homeostasis Controls blood and water volume Maintains blood pressure Regulates electrolyte levels.

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The Urinary System

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  1. The Urinary System Anatomy and Physiology 2015

  2. Structure • Kidneys • Ureters • Urinary bladder • urethra

  3. Function • Maintains homeostasis • Controls blood and water volume • Maintains blood pressure • Regulates electrolyte levels

  4. Eliminates protein wastes, excess salts and toxic materials from blood • Balances acid/base (PH) • Secretes renin and erythropoietin

  5. 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”

  6. How the kidneys Regulate BP • ADH • RENIN • ALDOSTERONE

  7. 3 Parts • Cortex • Medulla • Pelvis

  8.     BecomeHealthyNow.com Home

  9. Nephron • Functional units of the kidney • Cells that form urine • Over 1 million nephrons in each kidney

  10. Glomerular Filtration • Tubular Reabsorption • Tubular Secretion

  11. WORD WALL • Oliguria • Anuria • Dysuria • Polyuria • hematuria

  12. Urine • Body excretes 1000-2000 ml of urine/day • Is normally sterile • Color varies with hydration

  13. Characteristics of Normal Urine • CLARITY • ODOR • SPECIFIC GRAVITY

  14. THINK…. • A STRONG, OFFENSIVE ODOR FROM FRESHLYVOIDED URINE IS SUGGESTIVE OF…….. Urinary Tract Infection

  15. Composition of Normal Urine • Water • Protein wastes products (urea, uric acid & creatinine) • Excessive minerals from diet (Na+,K+, Ca,sulfates & phosphates

  16. Toxins • Hormones • Bile compounds • Pigments from food/drugs

  17. WORD WALL • Frequency • Urgency • Nocturia • Enuresis • retention

  18. 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

  19. Decrease in number & size of nephrons • Decrease in GFR • Smaller capacity of bladder • Weaker bladder muscles

  20. Incontinence • Not a normal consequence of age • Common due to many reasons • See Chpter 23 for more information on incontinence

  21. Nursing Assessmentof The Urinary System

  22. HEALTH HISTORY • Chief complaint • History of Present Illness • Past Medical History • Family History • Review of Systems

  23. Diagnostic & Laboratory Tests Urinary System

  24. URINE TESTS • UA ( urinalysis ) • C & S ( Culture & Sensitivity ) • Creatinine Clearance (24 hr)

  25. BLOOD TESTS • BUN ( blood urea nitrogen ) • Serum Creatinine • Serum Electrolytes

  26. Radiographic Studies • KUB ( flat plate ) • IVP • Arteriogram • Renal Scan • US

  27. Invasive Procedures • Renal Biopsy • Cystoscopy

  28. What are Urodynamic Studies ??

  29. What are common Therapeutic measures Related to “Catheterization”

  30. Catheter Types Foley Ureteral Suprapubic Nephrostomy

  31. Common Tubes and Catheters • Ureteral Catheter • Nephrostomy Tube • Urinary Stent

  32. Pre-Op Care  Urologic Surgery • Evaluate fluid status • Bowel cleansing • Enterostomal Therapist/Nurse • Counseling/Teaching

  33. Post-Op Care Urologic Surgery • Report to MD U/O < 30 ml/hr • Pain Management • Mon. lung sounds • Assess for Paralytic ileus

  34. Urinary Tract Inflammation and Infections

  35. Cystitis • Inflammation of the urinary bladder • Bacteria enters from the urethra, lymph nodes, infected kidneys • Women more suseptible

  36. Causes • E-coli • Candida Albicans • Coitus • Diabetes mellitus • See Box 40-2 Risk Factors for UTI’s

  37. Signs & Symptoms • Dysuria, hematuria • Frequency, urgency • Low grade fever • Pelvic or abd. discomfort • Bladder spasms

  38. 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

  39. Gerontologic Considerations • Watch for signs of mental confusion • Fever may be masked • Sepsis develops quickly

  40. Pyelonephritis • Bacterial infection of renal pelvis and kidney • Most common form of kidney disease • Often the result of reflux

  41. Signs & Symptoms • Flank pain • Chills, fever,N & V • Dysuria, fatique • Bladder irritation

  42. Med & Nursing Considerations • Bedrest • Increase fluids (8 8oz. Glasses water/day) • IV • Monitor I + O • Protein & Na+ restrictions • Mon. for circulatory overload

  43. Pharmacological TX • Antibiotics (Bactrim) or Cipro • Antipyretics • Analgesics • Antispasmotics • Antihypertensives

  44. Glomerulonephritis • Autoimmune disease • Glomerulus becomes inflammed • Symptoms dev. 1-3 wks after respiratory infection cau by group A- hemolytic strep

  45. Signs & Symptoms • Tea colored urine • Decrease in u/o • Periobital edema • HTN • Hypervolemia

  46. Medical Dx • Clinical Presentation • UA  Proteinuria • BUN, Cr • Strep. Antibody Tests • Renal Biopsy or Ultrasound

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