Urinary System

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Chapter 39

• Urinary System

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Anatomy and Physiology Review

• Urinary system consists of two kidneys, two
  ureters, bladder, and urethra
• Functions
• Manufacture urine
• Expulse waste products

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Anatomy and Physiology Review
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Anatomy and Physiology Review
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Anatomy and Physiology Review
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Assessment

• Pain on urination
• Pattern of urination
• Strength of urine stream
• Urgency, frequency, incontinence, hematuria, and
  nocturia
• Intake and output
• Urine color, clarity, and odor

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Urinary Terms

• Anuria
• Cessation of urine production
• Dysuria
• Difficult urination
• Hematuria
• Blood in urine

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Urinary Terms

• Nocturia
• Excessive urination at night
• Oliguria
• Decreased urine production

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Urinary Terms

• Polyuria
• Excess urination
• Urgency
• Need to urinate immediately

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Changes with Aging

• Nephrons decrease
• Glomerular filtration rate decreases
• Blood urea nitrogen increases
• Sodium-conserving ability diminishes
• Bladder capacity decreases
• Renal function increases when lying down

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Changes with Aging

• Bladder and perineal muscles weaken
• Incidence of stress incontinence increases in
  females
• Prostate may enlarge in males

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Common Diagnostic Tests

• Urine tests
• Blood tests
• Radiographic tests
• Urodynamic tests
• Endoscopic exam
• Biopsy

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Common Diagnostic Tests
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Common Diagnostic Tests
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Urinary Retention

• Person unable to void when an urge
• Stasis may lead to infection
• May result in distended bladder
• Urine overflow may cause incontinence
• Caused by stress, calculus obstruction, stones,
  tumor, infection, medications, or trauma

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Urinary Retention

• Symptoms
• Frequency, voiding small amounts, and distended
  bladder
• Treatment
• Urinary analgesics, antispasmodics, catheter, and
  surgery

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Urinary Incontinence

• Involuntary loss of urine from bladder
• Types
• Stress
• Leakage of urine on straining
• Urge
• Sudden need to urinate

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Urinary Incontinence

• Types
• Overflow
• Full bladder leads to leakage
• Total
• No control of voiding
• Nocturnal enuresis
• Nighttime incontinence

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Urinary Incontinence

• Goal of treatment
• Keep perineum clean, dry, and intact

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Urinary Incontinence

• Potential treatment
• Medications
• Pelvic floor exercises
• Bladder retraining
• Catheter insertion
• Surgery

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Cystitis

• Inflammation of urinary bladder
• Caused by escherichia coli, candida albicans,
  coitus, prostatitis, and diabetes mellitus
• Treatment
• Culture/sensitivity testing, antimicrobial
  medication, and urinary tract analgesic

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Cystitis

• Increase fluid intake, acidic foods, and intake
  and output

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Pyelonephritis

• Bacterial infection of renal pelvis, tubules, and
  interstitial tissue of one or both kidneys
• Also known as pyelitis or nephropyelitis
• Treat to prevent from becoming chronic

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Pyelonephritis

• Treatment
• Urine culture/sensitivity testing,
  antimicrobials, antipyretics, analgesics,
  increase fluids, intake and output, and daily
  weight

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Acute Glomerulonephritis

• Glomerulus within nephron unit becomes inflamed
• May be bacterial or viral
• Treat to prevent renal complications, cardiac
  complications, and complications to cerebral
  functioning

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Acute Glomerulonephritis

• Treatment
• Drug therapy, fluid restriction, monitor labs,
  IO, bed rest, and VS

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Chronic Glomerulonephritis

• Slowly progressive, destructive process affecting
  glomeruli
• Causes loss of kidney function
• Treat to prevent further renal damage and cardiac
  or cerebral complications

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Chronic Glomerulonephritis

• Treatment
• Medications, protein and fluid restriction, bed
  rest, intake and output, VS, and monitor labs,
  daily weight, and lung sounds

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Urinary Calculi

• Calculus, or stone, formed in urinary tract
• Very small calculi may be flushed out by
  peristalsis and fluids
• All urine must be strained, stones collected, and
  sent to lab for composition

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Urinary Calculi
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Urinary Calculi
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Urinary Calculi

• Treatment
• Lithotripsy, surgery, analgesics, medications,
  and dietary changes

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Urinary Bladder Tumors

• May be cancerous or benign papillomas
• Surgery may remove tumor, part of bladder, or
  entire bladder
• Makes urinary diversion necessary
• Other treatment
• Chemotherapy, analgesics, and sometimes
  low-residue diet

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Urinary Bladder Tumors
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Urinary Bladder Tumors
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Renal Tumors

• Cancer in kidneys
• Radical nephrectomy may be performed if other
  kidney healthy and disease localized
• Treatment
• Immunotherapy, targeted therapy, analgesics,
  antiemetics, chemotherapy, and radiation
• Chemotherapy and radiation provide minimal benefit

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Polycystic Kidney

• Multiple grape-like clusters of fluid-filled
  cysts develop in and greatly enlarge both kidneys
• Treat to preserve kidney function, prevent
  infections, and relieve pain

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Polycystic Kidney

• Control hypertension
• Eventually, may need dialysis or renal
  transplantation

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Renal Failure

• Any acute or chronic loss of kidney function when
  some kidney function remains
• End-stage renal disease (ESRD)
• Total, or nearly total, permanent kidney failure

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Acute Renal Failure (ARF)

• Postrenal
• Disrupted urine flow
• Prerenal
• Disrupted blood flow to kidney
• Intrarenal
• Renal tissue damage
• Often reversible if diagnosed early

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ARF

• Treat to stabilize kidney function, return to
  normal using surgery, medications, and dietary
  restrictions
• Treatment
• Medication, dietary changes, fluid restrictions,
  and dialysis (peritoneal or hemodialysis)

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Chronic Renal Failure/ESRD

• Slow, progressive condition
• Kidneys ability to function ultimately
  deteriorates
• Not reversible
• Multisystem disease process

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Chronic Renal Failure/ESRD

• Goal
• Preserve remaining kidney function and prevent
  complications

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Dialysis

• Mechanical means of removing waste from blood
• Hemodialysis
• Machine with artificial membrane used to filter
  blood
• Peritoneal dialysis
• Uses peritoneal lining of abdominal cavity as
  membrane through which diffusion and osmosis occur

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Dialysis
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Kidney Transplantation

• Client must be tissue- and blood-typed to
  determine compatible donor
• After transplant surgery, immunosuppressive drug
  therapy to decrease chance of organ rejection
• Greatest complication
• Infection

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• Kidney Patient Guide

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Chapter 60

• Infants with Special NeedsBirth to 12 Months

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Hypospadias

• Urethral opening on ventral surface of penis
• Surgically corrected during first year of life

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Vesicoureteral Reflux

• Backflow of urine from bladder into ureters and
  possibly kidneys
• Primary symptom
• Recurrent urinary tract infections
• Treatment
• Preventing urinary tract infections and surgery

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Wilms Tumor

• Nephroblastoma
• One of the most common early childhood cancers
• Symptoms
• Abdominal mass to side of midline, abdominal
  pain, malaise, anemia, and fever

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Wilms Tumor

• Avoid palpating tumor
• Surgery is treatment of choice
• Also use chemotherapy and radiation

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Chapter 61

• Common Problems 118 Years

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Urinary System

• Acute poststreptococcal glomerulonephritis
• Nephrotic syndrome
• Enuresis