Urinary Syste
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| Nephrons of the Kidney | Functional units of the kidney
They are the cells that form urine
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| Parts of the Nephron include: | The Glomerulus
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| Urine composed of: | 95% water
5 % dissolved solids and gases
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| Specific Gravity | amount of dissolved substances in the urine
(1.005-1.030)
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| Normal Urines | Nitrogenous Wastes: Urea, Uric Acid, Creatinine
Electrolytes
Pigment
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| Abnormal Urine | Glucose, Albumin, Blood, Ketones, WBC, Casts
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| Costvertebral Angle (CVA | tenderness assess the area of the back over the kidneys (Percussion)
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| Urinalysis | Specific Gravity 1.005-1.030 (kidneys ability to concentrate urine
Multiple types of bacteria indicate specimen contamination during collection
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| 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
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| Creatinine | (0.6-1.2)
Good indicator of kidney function
Elvevated serum creatinine levels usually indicates serious kidney disorder
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| 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
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| 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
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| Retrograde Pyelography | Pink tinged urine and dysuria is normal
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| 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
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| Catheter Care | Aseptic technique during catheter introduction
Avoid kinks or compression, check patency
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| Urinary Retention | Residual urine should be <100 mL
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| 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)
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| Lower UTI | cystitis, urethritis, prostatisis
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| Upper UTI | Pyelonephritis and glomerulonephritis
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| 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
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| 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
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| 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
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| Prostatis | Inflammation of the Prostate
DX: Elevated PSA (normal 0-4 mg/dL)
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| 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
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| 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
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| 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 -
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| Renal Cancer | S/S: Intermittent, microscopic or gross hematuria (initially painless)
DX: kidney biopsy confirms the DX
Urinalys: hematuria
NC: Assess for heorrhage
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| 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
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| Bladder Cancer | S/S: First sign: gross, painless, intermittent hematuria (in many cases with clots in urine)
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| Renal Trauma | S/S: Gross bleeding from urethra
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| Nephrotic (Nephretic) Syndrome | S/S: Edema, Proteinuria (foamy urine), Hypoalbuminemia
DX: serum albumin may fall
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| 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
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| 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
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| 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
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| Hemodialysis | Pre-Procedure NC:
Assess for patency of the access site bruit, palpable, thrill, distal pulses, and circulation
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| 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
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Created by:
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