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Urinary Syste

Nephrons of the Kidney Functional units of the kidney They are the cells that form urine
Parts of the Nephron include: The Glomerulus
Urine composed of: 95% water 5 % dissolved solids and gases
Specific Gravity amount of dissolved substances in the urine (1.005-1.030)
Normal Urines Nitrogenous Wastes: Urea, Uric Acid, Creatinine Electrolytes Pigment
Abnormal Urine Glucose, Albumin, Blood, Ketones, WBC, Casts
Costvertebral Angle (CVA tenderness assess the area of the back over the kidneys (Percussion)
Urinalysis Specific Gravity 1.005-1.030 (kidneys ability to concentrate urine Multiple types of bacteria indicate specimen contamination during collection
Blood Urea Nitrogen (BUN) (6-20) Elevated BUN is indicative of dehydration and strongly suggestive of renal disease A severe elevation can lead to significant disorientation or seizures
Creatinine (0.6-1.2) Good indicator of kidney function Elvevated serum creatinine levels usually indicates serious kidney disorder
Prostate Specific Antigen (PSA) Used to screen for prostate cancer and to monitor the disease after treatment PSA levels of <4ng/mL are normal Elevated PSA are associated with prostate pathology and cancer The client should not ejaculate for at least 24 hours before the exam to avoid
Intravenous Pyelogrom (IVP)e IV urography Client will require bowel preparation Uses IV contrast dye: assess allergies to shellfish and iodine Monitor BUN and Crt: dye is nephrotoxic Monitor for SOB, rash, pruritis NPO after midnight (client may vomit from contrast Push fluids
Retrograde Pyelography Pink tinged urine and dysuria is normal
Renal Arteriography (Angiography) Femoral arterial puncture is performed, catheter is guided into abdominal aorta and renal arter; mark pedal pulses Monitor for bleeding from catheter isertion site, monitor for hematoma, monitor VS Bedrest supine for 4-6 hrs with legs extended, push flu
Catheter Care Aseptic technique during catheter introduction Avoid kinks or compression, check patency
Urinary Retention Residual urine should be <100 mL
Urine Incontinence Stress: loss of small amounts of urine with sneezing, laughing, or lifting related to weak pelvic muscles, urethra, or surrounding tissue DX: Postvoid residual urine to rule out urinary retention (100mL)
Lower UTI cystitis, urethritis, prostatisis
Upper UTI Pyelonephritis and glomerulonephritis
Urinary Tract Infection (UTI) caused by Klebsiella, Proteus, Serratia, Pseudomonas, and Escherichia coli (from bowel Untreated UTI: urosepsis (systemic infection) septic shock and death Catheters cause most UTI's
Acute Cystitis Inflammation of the Urinary Bladder R/F: female gender= short urethra S/S: Dysuria (painful) - Pyuria (foul smell, cludy) Urgency and frequency, Hematuria DX: Urinalysis positive for Pyuria, hematuria, or bacteriuria NC: promote fluid intake 2-3L/D
Urethritis Inflammation of the Urethra R/F: Unprotected sex with someone with STI (chlamydia or gonorrhea) S/S: males thin slightly cloudy, thick yellow/green purulent discharge from penis DX: C & S identifies causative organism NC: all sexual parterners mus be
Prostatis Inflammation of the Prostate DX: Elevated PSA (normal 0-4 mg/dL)
Pyelonephritis Infection and inflammation of renal perlvis, calyces, and medulla Usually begins in the lower urinary tract with organisms ascending into the renal perlvis One of the most common sign of renal diseases Symptoms characteristically developed rapidly over
Hydronephrosis An abnormal dilation of the renal pelvis and the calyces of one or both kidneys Caused by obstruction of urine flow Pressure built up in the area of obstruction R/F: Bengin prostatic hyperplasia Calculi, kidney stones, nephrolithiasis
Renal Calculidration, R/F: Dehydration, stasis, retention, immobility S/S: severe pain; flank pain that radiates towards the groin - Hematuria NC: in extracorporeal shock wave lithotripsy (ESWL): Strain urine following procedure for stones NC: priority is pain management -
Renal Cancer S/S: Intermittent, microscopic or gross hematuria (initially painless) DX: kidney biopsy confirms the DX Urinalys: hematuria NC: Assess for heorrhage
Polycystic Kidney Disease Inherited disorder characterized by multiple, bilateral, grapelike clusters of fluid filled cysts Leads to end stage renal disease NC: refer children for genetic counseling
Bladder Cancer S/S: First sign: gross, painless, intermittent hematuria (in many cases with clots in urine)
Renal Trauma S/S: Gross bleeding from urethra
Nephrotic (Nephretic) Syndrome S/S: Edema, Proteinuria (foamy urine), Hypoalbuminemia DX: serum albumin may fall
Glomerulonephritis Bilateral inflammation of the glomerular capillaries, commonly following a strep infection R/F: for acute: Streptococcal infection S/S: Edema (periorbital) (most common in children) and peripheral edema - Hypertension - Hematuria (smokey, cola or coffee
Acute Renal Failure S/S: Oliguria - Urine output 100-400 mL/D Azotemia with confusion (increase BUN and Creatinine), Hyperkalemia DX: increase BUN (80-100) high creatnine 1-6 mg/dl TX: correction of electrolyte imbalance: K+ - Fluid restriction NC: Daily weight, restri
Chronic Renal Failure S/S: Hypertension, peripheral edema, Uremic frost, pruritis DX: increased BUN and Creatinine NC: Assess for fluid excess: lung sounds, JVD, edema, hypertension - monitor for s/s of electrolyte imbalance
Hemodialysis Pre-Procedure NC: Assess for patency of the access site bruit, palpable, thrill, distal pulses, and circulation
Peritoneal Dialysise Siliconized rubber catheter is surgically placed into the abdominal cavity for infusion of the dialysate - Continous ambulatory PD (CAPD) client infusis four 2L exchanges, wher dialysate remains 4-8hrs/7days a week Pre procedure NC: check weight Intra
Created by: yyolanda