Assessing Clients with Urinary Elimination Disorders - PowerPoint PPT Presentation

About This Presentation
Title:

Assessing Clients with Urinary Elimination Disorders

Description:

Assessing Clients with Urinary Elimination Disorders Chapter 28 Structures of the Urinary System Kidneys - Function 1. Balance electrolyte and water 2. – PowerPoint PPT presentation

Number of Views:270
Avg rating:3.0/5.0
Slides: 28
Provided by: BethA189
Category:

less

Transcript and Presenter's Notes

Title: Assessing Clients with Urinary Elimination Disorders


1
Assessing Clients with Urinary Elimination
Disorders
  • Chapter 28

2
Structures of the Urinary System
  • Kidneys - Function
  • 1. Balance electrolyte and water
  • 2. Excrete waste
  • 3. Regulate acid-base balance
  • 4. Secrete hormones
  • 5. Form urine
  • 6. Regulate blood pressure
  • Will affect the entire body.

3
(No Transcript)
4
Structures of the Urinary System
  • Ureters
  • transport urine from the kidneys to the bladder
  • Bladder
  • storage site for urine
  • holds 300-500cc
  • Urethra
  • channels urine to the outside of the body

5
Kidneys
  • Each kidney has 3 regions
  • Cortex- (Outer region) Contains glomeruli which
    are small clusters of capillaries. Glomeruli are
    part of the nephrons which are the functional
    units of the kidney
  • Each kidney contains 1 million nephrons which
    process blood to make urine!!
  • Medulla- (inner region) nephrons form the renal
    pyramids. They channel urine into branches of the
    innermost region or the renal pelvis.
  • Pelvis- Urine is channeled from the pelvis
    through the ureter and into the bladder for
    storage.

6
(No Transcript)
7
Formation of Urine
  • Glomerular Filtration
  • fluids and electrolytes go through a membrane
  • Tubular Reabsorption
  • nutrients are reabsorbed
  • Tubular Secretion
  • waste is secreted
  • Nephron is functioning unit which functions in
    glomerular filtration.

8
Process of urine formation
  • Glomerular Filtration- Blood from the renal
    artery is filtered in the glomerulus. The
    filtered product which contains water, salts,
    nutrients and waste products is called the
    glomerular filtrate.
  • Tubular Reabsorption- Nutrients and salts are
    actively reabsorbed and transported to the
    peritubular capillary network and some water is
    passively reabsorbed into the peritubular
    capillaries
  • Tubular Secretion- Some substances are actively
    secreted from the peritubular capillaries into
    the distal tubule for removal from the body.

9
Glomerular Filtration
  • Passive process where fluids and solutes move
    from the blood in the glomerulus into the
    Bowmans capsule
  • The amount of fluid filtered from the blood into
    the capsule per minute is called glomerular
    filtration rate or GFR.
  • GFR is the most accurate indicator of kidney
    function. What lab test tells us what GFR is?
  • Normal GFR is in adults 120/125 mL per minute.
  • What controls GFR?
  • -Blood pressure and blood volume.
  • A drop in blood pressure and or blood volume will
    cause the GFR and urine output to fall. / Renal
    failure in high risk patients trauma/ severe
    blood loss.

10
Reabsorption and Secretion
  • Tubular reabsorption- Healthy kidneys all organic
    nutrients such as glucose, and amino acids are
    reabsorbed.
  • Water and electrolyte reabsorption is
    continuously regulated and adjusted to maintain
    homeostasis.
  • This all happens in the proximal tubules.
  • Tubular Secretion- Excess potassium and waste
    products such as hydrogen ion, creatinine and
    ammonia are eliminate from the body. This
    process regulates the acid-base balance in the
    body.

11
Urine Concentration
  • Loop of Henle urine is concentrated. And further
    wastes are excreted through reabsorption and
    secretion..
  • Antidiuretic hormone- Determines the final
    concentration or dilution of the urine.
  • When ADH is secreted water is reabsorbed in the
    distal tubule and collecting duct and urine is
    more concentrated.
  • When ADH is not secreted, water cannot be
    reabsorbed and the urine is more dilute. What
    substances cause ADH to be secreted or not
    secreted?
  • Receptors in the hypothalamus detect changes in
    osmolality and blood volume, thus stimulating ADH
    production and release as needed.
  • Urine is about 95 water and 5 solutes.

12
Urine Concentration and Endocrine Function
  • Solutes normally excreted in the urine- Urea,
    sodium, potassium, phosphate, sulfate,
    creatinine, uric acid, calcium, magnesium, and
    bicarbonate.
  • The kidney also produces renin and erythropoietin
    and they activate Vitamin D.
  • Renin- Is an enzyme made by the juxtaglomerular
    apparatus in the kidney. It converts the plasma
    protein angiotensin to angiotensin 1. A1 is
    converted to A2 in the lungs.
  • Angiotension 2- is a potent vasoconstrictor that
    raises blood pressure, it also stimulates the
    adrenal glands to release aldosterone which
    promotes sodium and water retention. Drugs such
    as ACE inhibitors work on the Angiotension system
    to reduce blood pressure.
  • The effect of the Angiotensin system is to raise
    the BP and BV.

13
Endocrine Function- Kidney
  • Erythropoietin- a substance produced by the
    kidney in response to cellular hypoxia. It
    stimulates the bone marrow to produce red blood
    cells.
  • Vitamin D- Is inactive when it enters the body
    either through the diet or by exposure to
    ultraviolet light. It is activated in two steps
    by the liver and then the kidney.
  • Age Related Changes in the Kidney
  • Nephrons are lost with aging, thus kidney mass
    and GFR are reduced.
  • By age 80 GFR may be less than half of what it
    was at 30.
  • The kidneys are less able to concentrate urine.
  • Increased risk for dehydration. Potassium
    excretion may be decreased in older, thus
    electrolyte imbalances are a risk!

14
Formation of Urine
15
Assessment of Urinary Function
  • Health Assessment Interview
  • Any burning on urination?
  • Any difficulty in starting a stream?
  • Bladder control?
  • Ask about
  • Pregnancy
  • Family history of kidney disease
  • Alcohol and caffeine
  • dysuria, nocturia, hematuria, oliguria, polyuria

16
Physical Assessment
  • Inspection
  • Skin
  • Abdomen
  • Urine
  • Percussion
  • for CVA tenderness, suprapubic pain, bladder.
  • Palpation- Kidneys?

17
Physical Assessment
  • Palpation
  • bladder
  • palpate over the symphysis pubis for distension

18
Urinalysis - how collected, why collected?
19
Characteristics of Normal Urine
  • Color - pale to deep yellow, clear
  • Odor - aromatic
  • Specific Gravity - 1.001-1.030
  • pH - 4.5-8.0
  • Protein - negative to trace
  • Glucose - negative
  • Ketones - negative
  • WBCs 0-5
  • RBCs 0-5
  • Casts - negative to occasional

20
Laboratory Tests
  • UA- Urinalysis is a key part of the diagnostic
    evaluation of the urinary system.
  • Urea- is formed in the metabolism of dietary and
    body proteins.
  • Creatinine is produced by muscle cell metabolism.
  • Both substances are eliminated from the body by
    the kidneys by filtration and secretion neither
    is reabsorbed, thus BUN and Serum creatinine
    levels in the blood are effective indicators of
    renal function.
  • Creatinine Clearance test requires 24 hour urine
    sample- Another indicator of GFR./ Blood at the
    same time.
  • KUB- Abdominal X-ray evaluate the size, shape and
    position of organs in the urinary tract.
  • IVP-Intravenous pyelography- contrast medium and
    x-ray to evaluate the urinary tract.

21
NCLEX
  • Digoxin 0.25mg daily has been prescribed for an
    80 yo client.
  • The nurse observes closely for
  • A. Evidence of drug excretion without the desired
    effect
  • B. Excretion of the drug unchanged in the urine
  • C. Impaired urination due to the effects of the
    drug
  • D. Manifestations of drug toxicity due to
    impaired excretion

22
NCLEX
  • During the assessment of a clients renal system,
    the nurse is unable to palpate the kidneys. This
    finding is indicative of
  • A. inflammation
  • B. chronic renal disease
  • C. nothing
  • D. polycystic kidney disease

23
NCLEX
  • A client is admitted with an infection of the
    ureters. The nurse realizes that this infection
    could include which of the following structures
    of the kidney?
  • A. cortex
  • B. Medulla
  • C. Pelvis
  • D. Adrenal glands

24
NCLEX
  • During the assessment of a client with multiple
    injuries, the nurse notices a large hematoma
    located at the left costovertebral angle. Which
    additional body system should this nurse assess?
  • A. gastrointestinal
  • B. renal
  • C. spinal
  • D. respiratory

25
NCLEX
  • A client is experiencing a sudden decrease in
    systemic blood pressure. Which of the following
    will occur within the kidney to help control this
    blood pressure drop?
  • A. Juxtaglomerular cells will release renin
  • B. GFR will increase
  • C. Renal vessels will dilate
  • D. Hydrostatic pressure will increase

26
NCLEX
  • A client is voiding large amounts of highly
    diluted urine. The nurse realized the dilution
    or concentration of urine is determined by which
    of the following?
  • A. Presence of urea
  • B. Quantity of chloride
  • C. Patency of the ureters
  • D. Action of antidiuretic hormone

27
NCLEX
  • A client experienced a temporary reduction of
    oxygen due to an asthma attack. The nurse
    realized that this drop in oxygen level will have
    which impact on the clients renal functioning?
  • A. nothing
  • B. stimulate the absorption of calcium and
    phosphate
  • C. stimulate bone marrow to produce more red
    blood cells
  • D. produce large amounts of dilute urine
Write a Comment
User Comments (0)
About PowerShow.com