urinary system. essential to life every head to toe assessment must include… – urinary tract...
TRANSCRIPT
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Urinary System
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Urinary System
• Essential to life• Every head to toe
assessment must include…
– urinary tract function
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Anatomy: Kidney
• Kidneys– Vascular– Shape• Bean
– Color• Brown-red
– How many / #• 2
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Anatomy: Kidney
• 3 areas– Cortex– Medulla– Renal Pelvis
Cortex
Medulla
Renal Pelvis
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Kidney: Cortex
• Contains– Nephrons • Functional unit of the
kidneys• Glomeruli / glomerulus• Filters blood • Creates urine
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Kidney: Medulla
• Function–Drain urine from
the Nephrons to the renal pelvis
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Kidney: Renal Pelvis
• Ureter• Renal artery• Renal Vein
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Anatomy: Nephrons
• FYI– Functional unit*– 1 million Nephrons in
ea. Kidney– Adequate renal
function with 1 kidney
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Urine flow
• Nephrons • Medulla (pyramids) • renal pelvis • ureter
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Anatomy: Ureters
• Long narrow muscular tube
• Moves urine via peristaltic waves
• Extends from renal pelvis bladder
• Two
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Anatomy: Bladder
BLADDER• Description– Muscular– hollow sac
• Location– Behind pubic bone
• Function– Reservoir for urine
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Anatomy: Bladder
• Normal capacity – 300-500 ml of urine
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Anatomy: Urethra
• Carries urine from the bladder & expels it from the body
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Physiology of the Urinary System
• Function of the kidneys
– Urine formation– Excretion of waste
products– Regulation of
• Electrolytes• Acid-base control• RBC production• Ca+ & Ph
– Control • water balance• blood pressure
– Renal clearance– Synthesis of Vit. D
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Physiology of the Urinary System
• Urine formation– The nephrons form
urine through a complex process
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Anatomy: Nephrons
• Nephron – Glomerulus– Bowman’s capsule
• Proximal convoluted tubule• Loops of Henle• Distal convoluted
tubule
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Regulation of water excretion
• The amt. of urine formed is r/t the amt. of fluid intake– h fluid intake – volume urine
• h • Characteristic
– Dilute– i fluid intake – volume of urine
• i • Characteristic
– Concentrated
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Excretion of waste products
• Urea, (waste product)– Blood Urea Nitrogen• h BUN = renal dysfunction
• Creatinine– The creatinine clearance compares the level of
creatinine in urine with the levels in the blood– i Creatinine clearance = renal dysfunction
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Excretion of waste products
• Primary means of ridding the body of Drug metabolism
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Small Group Question
1. Describe the flow of urine from formation to excretion
2. What is the functional unit of the urinary system? What does it do?
3. Increased or decreased fluid intake has what effect on volume of urine and its characteristics
4. What two main waist products do the kidneys rid the body of?
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Assessment:
• Urine– Color– Odor– Amount
• Difficulty urinating• Fluid intake• Painful urination– dysuria
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Assessment
• Urinating at night – Nocturia
• Blood in the urine– Hematuria
• Cloudy urine– Pyuria
• Discharge?
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Assessment
• Pain– Abd– Suprapubic– Flank
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Assessment: Health history
• Symptoms• Associated symptoms• Hx of UTI’s• Meds• Smoking or Alcohol• Females
– Pg
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Physical Assessment
• Urine sample– Clean-catch
• V/S• Skin– Color– Moisture– Edema
• Palpate abd• Percuss kidney for
tenderness
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Physical Exam
• Abdomen, supropubic region, genitalia and lower back, the lower extremities
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Physical Exam
• Palpation of bladder– Performed after voiding
if suspect urinary retention
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Urinalysis: normal
• Color– Light straw – amber– Clear
• Specific gravity– 1.005 – 1.030
• pH– 4.5 – 8.0
• Protein– Neg - trace
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Urinalysis: normal
• Glucose– -
• Ketones– -
• RBC– 1-2
• WBC– 3-4
• Casts– -
• Bacteria– -
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Specific Gravity• The weight of urine • Related to the level of hydration.
– h fluid intake h H20 excretion i specific gravity – i fluid intake i H20 excretion h specific gravity
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Diagnostic Evaluation: Urine Culture and Sensitivity
• ID microorganism(s) • Sensitivity report• Time– 2-3 days (48-72 hours)
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Diagnostic Evaluation: Clean-catch or Clean-voided specimen
• Clean-voided – uncontaminated by skin flora.– Female
• Cleanse: front to back
– Male• Cleanse: tip of the penis downward
• Collect a "clean-catch" – Start to void– Midstream catch– Collect 1 to 2 oz of urine
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Diagnostic Evaluation:Sterile urine specimens
• Safety– Standard precautions – Biohazard bag for transport
• Collection– Indwelling Foley Catheter
• Not from the drainage bag• Aspiration port
– Catheter – straight cath– A small amount of urine is allowed to run out of the catheter into
a basin, then the urine is allowed to run into a sterile specimen bottle.
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I&O
Intake
• Oral liquids– Milk– Tea– Juice– Broth
• Liquid at room temp– Ice cream– Jello
• NGT/GT• IV
Output
• Urine• GI suction• Emesis• Drainage– Chest tubes– Wound tubes
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• Healthy person• Fluid output =• Fluid input
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• If the client takes in more fluid than they excrete – edema
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S&S Edema
• Weight– h
• Swelling– Feet– Ankles– Face– Fingers
• Urine output– i
• Fluid pooling– Lungs– Abd
• Ascites
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• Pitted edema is tested by pressing & holding your finger into the swollen tissue over a bony area for 5 seconds. If there is an indentation left behind when you remove your finger it is pitted edema.
• To classify the pitted edema you measure the depth of pitting & compare the measurement to the following scale;
• +1 = 2mm of pitting• +2 = 4mm of pitting• +3 = 6mm of pitting• +4 = 8mm of pitting
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What is the nursing diagnosis for a client with edema?
• Fluid Volume Excess
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• If a client excretes more fluid than they take in – dehydration
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Dehydration S&S
• Thirst• Constipation• Urine output– i
• BP– i
• Pulse– Weak– h
• Mentation– Confused– Lethargy
• Skin– Dry
• Mucus membranes– Dry
• Weight– i
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1. Describe the nursing assessment of a client who is complaining of voiding issues?
2. What dx test do you expect the doctor to order for a client with renal failure
3. What does a UA measure & what should not be found in the blood.
4. Increased & decreased fluid intake have what effect on specific gravity
5. Describe how to get a clean catch and a sterile urine specimen?
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Cystitis
• Inflammation of the urinary tract– Bladder– UTI
• Etiology– Bacteria
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Cystitis: S&S
• Dysuria• Frequency• Urgency• Nocturia• Pyuria• Hematuria• Lower abd discomfort
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Gerontologic considerations
• Few S&S• Fatigue• Alt cognitive function• drop in temp
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Defense Mechanism
• Who is more likely to get a UTIA. MaleB. Female
• Why?– Shorter urethra
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Pyelonephritis
• Inflammation of the renal pelvis & parenchyma
• Etiology– Bacteria
• E-coli
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Pyelonephritis: S&S
• S&S of Cystitis– +
• Flank pain• Vomiting / diarrhea• Fever / chills• Malaise
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Assessment & Dx findings
• Urinalysis– UA
• Culture
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Medical management/pharmacological therapy
• Antibiotic• Urinary analgesic
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Nursing Process: UTI
• Assessment– S&S– Voiding patterns– Sexual intercourse– Urine
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Nursing: health promotion
• Fluid intake– h
• Void when you feel the need– Q3-4 hours
• Female– Clean front to back
• Void after intercourse
• Avoid – bubble bath– Feminine hygiene– Douching
• Cotton underwear• Shower not bath
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Nrs Dx: Pain
• Assess pain• Admin. Analgesics, antibiotics per order• Teach non-Rx – Heating pad– Warm showers
• Cranberry juice• Vitamin C• Avoid excess milk, fruit juice
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1. What are the S&S of cystitis?2. Differentiate with cystitis & Pyelonephritis3. What are the gerontological considerations
for a client with a UTI?4. What would you teach a client about
preventing further UTI’s
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Glomerulonephritis
• Inflammation of the glomerulus– Damage
• Blood • Protein• escapes into tubule
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Glomerulonephritis
• Etiology– Acute
• Bacterial infection
– Chronic• Diabetes• Lupus
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Nephrotic syndrome
• Group of symptoms (glomerulonephritis)• Protein in the urine• i serum albumin• Edema• h serum cholesterol
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Nephrotic syndrome
– Clinical Manifestation• #1 – edema• Malaise• H/A• Irritability• Fatigue
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Glomerulonephritis
• Assessment and diagnostic findings– Edema– Proteinuria– Hyperlipidemia – Hypoalbuminemia– Azotemia• Increased waste product in the blood
– (Urea, Creatinine etc.)
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Glomerulonephritis
• Complications– Renal Failure– Embolism
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Glomerulonephritis
• Medical Management– Edema
• Diuretic
– Inflammation• Glucocortioids• NSAID
– Infection• Antibiotics
– Diet• Sodium
– i
• protein– h – Azotemia i
• Fat– i
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Glomerulonephritis
• Nursing Management - Edema– qD weight– I&O– Abd. Girth– Clean skin– Diet per order
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Kidney stones /Renal Calculi
• Risk factors– Dehydration– Urinary stasis– Infection– Immobility
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Renal calculi or nephrolithiasis
• Clinical Manifestations– Pain
• Abd / flank• Severe• N&V
– Hematuria
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Renal calculi or nephrolithiasis
• Assessment and diagnostic findings– UA– X-ray– CT-scan/MRI– Cystoscopy
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Renal calculi
• Cystoscopy– Lighted scope to inspect
bladder– Gen anesthesia
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Renal calculi
• Medical management– Pain relief• Opioid analgesic• NSAIDs
– Diuretics?– Antibiotics?
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Renal calculi
• Medical management
– Diet• Fluids• i protein• i Sodium
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Renal calculi or nephrolithiasis
• Surgical Management– If > 4mm will not
pass through ureter– If not pass
spontaneously or if complications surgery
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Nrs Dx: Acute Pain / Deficient knowledge to prevent recurrence of renal stone
• Admin Meds– opioid agents– NSAIDS
• Position of comfort• Amb.• Heat to flank
• Fluids– h
• Assess urine• I&O• Strain urine – gauze• Avoid dehydration
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Small Group Questions
1. What are the classic clinical manifestations fro a client with Glomerulonephritis
2. What causes Glomerulonephritis3. What are the medical interventions for a client
with Glomerulonephritis4. What are the specific nursing interventions of
this client5. What are the S&S of renal calculi6. How is a renal calculi treated?
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Cancer of the urinary tract
• Pathophysiology– Most common site• Bladder
– Carcinogen• #1 Tobacco
– Metastasize early– 1/3 have metastasis at time of diagnosis
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Cancer of the urinary tract
• Clinical Manifestations– Initial• Painless hematuria
– Late• Frequency• Dysuria
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Cancer of the urinary tract
• Medical treatment– Goal:• Eradicate before metastasis
– Surgery» Cystectomy» Nephrorectomy
• Radiation• Chemotherapy
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Renal Failure
• Kidneys unable to remove accumulated waste products from the blood– Acute– End-stage
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What is the medical term for accumulation of waste product in the blood?
• Azotemia
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Acute Renal Failure
• Abrupt onset• Often reversible• Etiology– Trauma– Infection
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Acute Renal Failure: S&S
• Oliguria– Urine < 400 mL/day
• BUN– h
• GFR – i
• Azotemia– Confusion– Na+ & H2O retention
• Edema• HTN
– Hyperkalemia
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End Stage Renal Failure
• Gradual kidney destruction
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End Stage Renal Failure: S&S
• Uremia– (Urine in the blood)– N/V– Weakness– Fatigue– Confusion
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Renal Failure: Tx
• No nephrotoxic drugs– NSAID’s
• Antihypertensives• Diuretics• Fluid– Restriction
• Sodium– Restriction
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Dialysis: Overview
• Purpose– Remove fluids and waste products from the
body • Definition– Mechanical means of removing waste from the
blood • Types:– Hemodialysis– Peritoneal dialysis
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Dialysis: Process
• Process– Diffusion and osmosis across a semi permeable
membrane into a dialysate solution• prescribed specific to the individual clients needs
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Dialysis: process
• Diffusion– Toxins & wastes
are removed by diffusion
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• Osmosis– Excess water is removed
by osmosis
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Hemodialysis
• A machine with an artificial semi-permeable membrane used for the filtration of the blood.
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Hemodialysis
– The clients blood is circulated past the semi permeable membrane
– Excess fluids are removed by osmosis
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Hemodialysis
• Waste products are removed from the blood by diffusion
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Hemodialysis
• Frequency– 2-3 times a week– Total
• 9-12 hours
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Peritoneal Dialysis
• Uses the peritoneal lining of the abdominal cavity
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Peritoneal Dialysis
– A catheter is placed by the MD into peritoneal space
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Peritoneal Dialysis
• Complication– INFECTION
• Usually 4 x day – 7day/wk