The Urinary System
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| Define Anasarca? | Anasarca - severe, generalized edema
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| Define Anuria? | Anuria - urine output < 100 ml/day
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| Define Asthenia? | Asthenia - a general feeling of tiredness and listlessness
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| Define Azotemia? | Azotemia - the build-up of nitrogenous waste products in the blood
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| Define Dialysis? | Dialysis - a medical procedure for the removal of elements from the blood through an external semi-permeable membrane, or the peritoneum
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| Define Dysuria? | Dysuria - painful or difficult urination
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| Define Hematuria? | Blood in the urine.
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| Define hydronephrosis? | Hydronephrosis - dilation of the renal pelvis and calyces
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| Define Nephrotoxin? | Nephrotoxin - a substance that causes destruction of the kidney
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| Define Nocturia? | Nocturia - excessive urination at night
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| Define Oliguria? | Oliguria - low urine output 500 ml/day
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| Define Pyuria? | Pus in the urine.
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| Define Residual urine? | Residual urine - the volume of urine remaining in the bladder after a patient voids. Normal residual volume is <50 ml.
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| What is the purpose of the Kidneys? | Two Kidneys- Dark, red bean-shape organs 4 to 5 inches long; two to three inches wide and about one inch thick which produces urine by removing waste, excess water and electrolytes from the blood.
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| What does the Urinary system consist of? | Two Kindeys, Two Ureters, One Bladder, and One Urethra
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| What do the Ureters do? | Transport urine from the kidneys to the bladder.
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| What does the Bladder do? | Collects and stores urine.
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| What is the purpose of the urethra? | Transports urine from the bladder to the outside of the body for urination.
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| What are some of the kidney functions? | Excrete nitrogenous waste products (urea, ammonia and creatinine). Regulate fluid and electrolytes, maintain acid-base balance, and secrete erythopoietin to stimulate the prodcution of RBC's
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| Where are the kidney's located? | Found in the retro-peritoneum, just below the diaphragm on each side of the vertebral column. Surrounded by a layer of adipose tissue. The right kidney is slightly lower than the left due to the location of the liver.
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| What is the Hilus? | A notch found near the center of the medial (inside) border where the ureter blood vessels and nerves enter and exit the kidney.
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| What is the Renal Capsule? | Outer covering of the kidney made of strong connective tissue.
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| What is the Renal Cortex? | Just Beneath the caupule and contains 1.25 million renal tubules.
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| what is the Renal medulla? | Lies beneath the cortex and is darker in color, contain the triangular pyramids, and paillae: narrow points of the the pyramids that drain urine into the calyces.
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| What are some characteristics of the Adrenal glands? | Part of the endocrine system, sit on top of each kidney, secrete hormones that control BP and HR, primary mineralocortoticoid/ aldosterone.
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| What are the Nephrons/ | Functional unit of the kidney, maintains water balance, pH levels in the blood and removes toxins from the blood stream. +1 million per kidney, two main structures: renal corpsucle/tubule.
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| What are some characteristics of the Glomerulus. | Tightly bound network of capillaries, blood enters the glomerulus via the afferent arteriole, blood leaves via the efferent arteriole.
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| What is the Bowman's capsule? | Cup-like structure that encapsulates the filtering system of the kidney (the glomerulus). Serum is forced out of the blood into the Bowman's capsule. Remaining blood stays in the efferent arteriole into the peritubular cap network.
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| What is the functional unit of the kidney? | Nephron
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| What are some normal factors of the urinary system due to the aging process? | When aging, the kidney lose part of their normal functioning. Decreased blood supply and loss of nephrons. Between the ages of 40 and 70, the filtering mechanism becomes 50% less efficient.
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| What are some of the leading causes of institutional placement of older adults? | Urinary, Frequency, Urgency, Nocturia, and Incontinence.
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| What are some considerations of older adults when it comes to urination? | Weakened musculature in the bladder and urethra, diminished neurological sensation, decreased bladder capacity, and effects of medications, i.e. diuretics.
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| What is a urinalysis used for? | Evaluates systemic disease, condition of the kidneys, and lower urinary tract.
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| What are some characteristics of urine? | Evaluation of physical characteristics (color, clarity, and odor). Determination of pH (normal 4.6 - 8.0). Determination of specific gravity (normal 1.005 - 1.030).
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| What are some abnormalities that might be found in Urine? | Detection and rough measurement of protein, glucose, and ketone bodies - not normally found in urine. Examination for red and white blood cells and crystals - not normally found in urine.
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| What is a 24 hour urine test? | Provides a better overall measure of kidney function due to hourly changes in rate and secretion throughout the day. Discard first void and note time at the beginning of the 24-hour collection period.
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| What are some common substances measured in a 24 hour urine sample? | Total Protein, Creatinine, Urea, Uric Acid Levels, Catacholamines, epinephrine and Norrepinephrine.
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| What ia a Urine Culture and Sensitivity test done for? | Confirms suspected infections, identify causative organisms, determine appropriate antimicrobial therapy and periodically screen urine when the threat of a UTI persists.
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| What are normal serum creatinine levels? | 0.5-1.2my/dl
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| What is a Normal BUN range? | 10-20mg/dl.
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| What a normal Prostate Specific Antigen level? | Normal PSA is less than 4 ng/ml.
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| What can cause an elevated PSA result? | Prostate cancer, Benign prostatic hypertrophy, and prostatitis.
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| What is a KUB radiograph used for? | KUB radiograph-assesses the status of the abdomen, size, structure, and position of the urinary tract structures
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| What is a Renal ultrasonography used for? | Renal ultrasonography-visualize size, shape, and position of kidney and delineate any irregularities in structure (tumor, congenital anomalies, cysts, or obstructions-No prep
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| What are some considerations of IVP diagnostic testing? (Intravenous pyelogram) | Identify Structural Changes, not allergies to iodine (use corticosteroids antihistamine), eat a light supper, non gas forming laxitive, NPO 8 hours prior, radiograph taken at intervals to monitor dyes, and abnormalities (hydronephrosis, calculi, & tumor)
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| What is a BUN, Cratinine level used to assess? | Evaluate renal function
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| What are some Urine Drainage systems? | Foley, Suprapubic, Ureterostomy, cystostomy and a Nephrostomy.
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| What are Normal hemoglobin levels? | Male: 14-18 Female: 12-16
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| What is a normal HCT level? | Male: 40-54 Female: 37-47
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| What is the primary function of the kidney? | Filtration of water and blood products.
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| What is hydronephrosis? | Occurs when urine builds up in the kidneys and cannot drain out to the bladder. The kidneys swell from the excess urine. The condition may affect one kidney or both. Swelling of the kidneys can lead to kidney damage.
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| What is the minimum urine output that patient's should maintain? | 30ml/hr
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| What is the most common age of patients with Renal Calculi? | Men between ages 20-30.
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| List three conditions that predispose patients to the development of renal calculi? | Hyperparathyroidism, Recurrent UTI, Dehydration, Excessive intak of vtiamin D/milk products, and Osteoporosis.
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| What kind of diet modifications should be made with a patient with kidney stones? | Alter urine pH opposite from causative factor Avoid stone producing substances: cheese, whole grains, carbonated beverages, nuts, chocolate, shellfish and organ meat
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| What medications are given to a patient with Kidney Stones? | Sodium cellulose phosphate—to bind ingested calcium for calcium stone formation, Aluminum hydroxyzide—to bind phosphorous to promote intestinal and not urinary secretion Allopurinol—to decrease serum urate levels for cystine stone formation
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| What are three potential treatments for calculi of the renal system? | Cystoscopy, Surgical removal, Chemolysis, or Extracorporeal shock wave lithotripsy (ESWL).
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| Name one nursing diagnosis appropriate for the patient with an obstruction of urinary system. | Pain, Urinary retention, and knowledge deficit.
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| What is Bacteriuria? | Bacteriuria (bacteria in the urine) most common of all nosocomial infections; associated w/ use of urinary catheters. gram-negative microorganisms (e.g., E. coli, Klebsiella, Proteus, or Pseudomonas) infecting the urinary tract via the urinary meatus.
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| What is a normal bladder volume? | 750-1000ml
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| How full does the bladder get before the urge to urinate occurs? | 250cc
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| What does the upper urinary tract consist of? | Kidney's, Renal Pelvis, and Ureters.
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| What does the lower urinary tract consist of? | Bladder, Urethra and Pelvis floor muscles
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| How much urine stays in the bladder after voiding? | 10cc
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| What is Urinary micturition? | Urinary micturition is the passage of urine from the urinary bladder.
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| What percentage of Urine is water? | About 95% of water, the remainder is nitrogenous wastes.
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| What is the normal daily output of urine per day for the kidney's? | Daily the kidneys form 1-2L of urine and the average hourly output is > 30cc/hr for an adult.
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| Where is the external sphincter located? | The external sphincter is a circular band of skeletal muscle that is under voluntary control and located at the end of the urethra.
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| What is Dysuria? | Painful or difficult voiding associated with a sensation of pain or burning. - Seen frequently in females. - Associated with: Pathological conditions. Lower urinary tract infections
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| What can cause urinary hesitancy? | Results from: Compression of urethra. Outlet obstruction. Neurogenic bladder. UTI
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| What are the S&S of of a urinary infection? | Decrease in urine output or failure of catheter to drain urine. (Contact physician if urine output is<30 cc/hr for 2 hours). Change in urine color (bloody, cloudy). Fever greater than 101 degrees, hypotension, skin changes around the catheter.
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| What are some types of urinary catheters? | Foley, Coude, Malecot & Pezzer, Robinson & Whistle-tip, Ureteral, Suprapubic, and Eternal (Texas or Condom).
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| Describe the characteristics of a Foley Cath? | Designed with a balloon near its tip. The balloon is inflated after insertion, holding the catheter in the urinary bladder for continuous drainage. Available with 10 cc and 30 cc balloons.
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| Describe the characteristics of the Coude Cath? | Designed with a curved and tapered tip used in patients with an enlarged prostate.
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| Describe the characteristics of the Malecot and de Pezzer Catheter? | Also called a mushroom catheter, are used to drain urine from the renal pelvis of the kidney.
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| Define the Red Robinson Catheter? | Robinson catheter: has multiple openings in its tip to facilitate intermittent drainage.
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| Describe the Whistle-tip Catheter? | Has a slanted, larger orifice at its tip to be used with patients with hematuria (to prevent occlusion if clots are present).
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| Describe the Ureteral Catheter? | Long and slender to pass into the ureter
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| Describe the Suprapubic Catheter? | Inserted surgically through the abdominal wall above the symphysis, used to divert urine flow from the urethra s needed to treat injury.
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| In what urinary complications would a Suprapubic Catheter be indicated? | injury to the bony pelvis, urinary tract, or surrounding organs; strictures; or obstruction. Connected to a sterile closed drainage system and secured to avoid accidental removal.
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| Describe the Suprapubic Catheter? | Inserted surgically through the abdominal wall above the symphysis, used to divert urine flow from the urethra s needed to treat injury.
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| In what urinary complications would a Suprapubic Catheter be indicated? | injury to the bony pelvis, urinary tract, or surrounding organs; strictures; or obstruction. Connected to a sterile closed drainage system and secured to avoid accidental removal.
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| Define a Nephrectomy and what it entails? | surgical removal of the kidney. Usually due to malignant tumors or large stones resulting in a non-functioning kidney. A Nephrectomy due to renal tumor will also involve the removal of the adrenal gland.
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| What is a Nephrostomy Tube? | Nephrostomy - A catheter inserted into the kidney pelvis for drainage; requires surgical placement.
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| What is the limit of irrigation volume that can safely be instilled into a nephrostomy tube? | 5 ml
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| Identify post-operative nursing priorities for a nephrectomy? | Protection and detection of hemorrhage, promotion of deep breathing exercises, accurate I&O's, and Pain management.
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| What medications are used to prevent rejection and infection for a Kidney Transplant? | Cyslosporine and Mycophenolate
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| What is the most common urinary diversion procedure? | The most common urinary diversion procedure is the ileal conduit (Bricker's procedure or ileal loop).
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| Describe an Ileal Conduit procedure? | The bladder is removed A section of the ileum is removed, with the ends of the remaining ileum reanastomosed The ureters are implanted into the removed section of ileum Urine will contain mucus, as segments of bowel produce mucus
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| What are some complications of an Ileal Conduit procedure? | Wound infection, dehiscence Urinary leakage, ureteral obstruction, pyelonephritis, renal calculi Small bowel obstruction Stomal gangrene, atrophy of the stoma
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| : What will be found in the urine of a patient with an ileal conduit? | Mucus
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| What is the pathophysiology of Renal Tumors? | More common in men than women Adenocarcinomas primarily that develops unilaterally Often large when detected due to vague symptoms that are often ignored. Arise from cells of the proximal convoluted tubules.
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| What are the clinical manifestation of renal tumors? | Intermittent, painless, hematuria, flank pain, and flank mass
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| What Subjective data accompanies Renal Tumors? | Hematuria which “comes and goes” with no associated pain, Weight loss, Fatigue and Dull Flank pain
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| What Objective data accompanies Renal Tumors? | Palpable mass in flank, hematuria, and signs of metastasis
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| What Objective tests can be used to diagnose Renal Tumors | Urinalysis revealing hematuria IVP will detect renal mass Ultrasound will define composition Other scans, MRI and renal arteriography may be performed
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| What is the medical treatment for renal tumors? | Radical nephrectomy Radiation and chemotheraphy provide minimal benefit.
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| What Nursing Interventions would you implement for a patient being treated for Renal Tumors? | Care of post-operative nephrectomy patient Encourage verbalization of fears/concerns Due to late diagnosis of this cancer, many patients have poor prognosis. Assist patient to identify coping skills.
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| What are some possible Patient Teaching that would be addressed for a patient with Renal Tumors? | Community/Home support groups, medication regimen, decrease in physical activity
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| Define Polycystic Kidney Disease? | Genetic disorder with growth of numerous fluid-filled cysts which can slowly replace function of kidney, single renal cyst may occur without clinical significance, kidney interference,
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| What is the ETIOLOGY/PATHOPHYSIOLOGY BENIGN PROSTATIC HYERTROPHY? | Prostate encircles the male urethra at the base of the urinary bladder Secretes an alkaline fluid that helps neutralize seminal fluid and increases sperm motility BPH common in men over age 50 causing pressure on the urethra & vesical neck of bladder
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| What are the surgical interventions for Benign Prostatic Hypertrophy? | TURP (TransUrethral Resection of the Prostate) common surgical procedure for BPH Less invasive & less stress. Removal of prostate tissue through urethrea, prostate capsule is left intact to maintain
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| What care is given after a TURP (TransUrethral Resection of the Prostate) to treat BPH(BENIGN PROSTATIC HYPERTROPHY)? | Post-op Care is continuous bladder irrigation
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| What is a TULIP? | TransUrethral, Ultrasound-guided, Laser-induced Prostatectomy: Laser ablation of prostate, Blood loss is minimal, Sloughing of tissue may be delayed, with symptoms persistent some period of time Dysuria and prolonged catheterization may be necessary
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| What are the nursing interventions for BPH? | Three way foley catheter is used to provide continuous irrigation & continuous drainage, maintain patency of the catheter, avoid clost formations they can cause bladder spasms.
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| What is the function of the prostate? | Secrete an alkaline fluid that helps neutralize seminal fluid and increases sperm motility.
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| Explain the pharmacological and nursing implication of prostatic hypertrophy agents. | Antihypertensive `Pharmacological Profile Use: Urinary outflow obstruction in pts with prostatic hyperplasia. Action: decreases contractions in smooth muscle of the prostatic capsule. Example: Terazosin hydrochloride (Hytrin
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| What is the Etiology/Pathophysiology of CANCER OF THE PROSTATE? | Insidious cancer affecting men over 50yrs. Usually begins as a tumor on posterior of prostate.When the tumor causes urinary symptoms, the cancer is in advanced stages and metastasis is common Frequent metastatic sites are pelvic lymph nodes and bone
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| What are the Clinical Manifestations of Prostate Cancer? | Signs and Symptoms are related to urinary obstruction. Other s/s related to stage of cancer and metastasis.
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| What is the action and uses of Androgen Inhibitors? | Use: benign prostatic hypertrophy (BPH). Action: inhibits enzyme 5-alpha-reductase. Reduces the size of the prostate to relieve urinary symptoms R/T BPH (Benign prostatic hypertophy). Finasteride (Proscar)
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| What are Urinary Tract Antispasmodics used to treat and it's action? | Management of symptomatic benign prostatic hypertrophy (BPH). Action: Selectively blocks alpha1-adrenergic receptors in lower urinary tract to relax smooth muscle in bladder neck & prostate. alfuzosin (Uroxatral)
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| What are the side effects of alfuzosin (Uroxatral)? | CNS: dizziness, fatigue, headache. Resp: bronchitis, sinusitis. CV: postural hypotension. GI: abdominal pain, constipation, dyspepsia. GU: impotence.
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| What subjective assessment findings are common with Prostate Cancer? | Symptoms may not appear until cancer is advanced (FUN)_frequency, urgency, nocturia Hesitancy, dysuria, UTI Back pain or sciatica from metastasis Weight loss, fatigue
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| What objective assessment findings are common with Prostate Cancer? | Prostate gland firm & fixed w/ nodules, typically in posterior prostate. Pelvic lymph nodes enlarged, Metastatic changes in bones of lower spine, pelvis & hips with associated signs (discomfort/dysfunction), Hematuria, depending on stage of malignancy
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| How is Prostate Cancer diagnosed? | Cytological evaluation for definitive diagnosis-obtained by needle aspiration, and PSA (Prostate-specific antigen).
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| What does PSA (Prostate-specific antigen) test do to help diagnose Prostate Cancer? | PSA (Prostate-specific antigen) normally secreted/disposed by prostate. Normal 0-4ng/ml, elevations needed to evaluate transrectal ultrasounds, bone scan & serum alkaline phosphatase to assess degree of metastasis, grading of tumors termed Gleason score
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| What is the the Medical Management for Hydronephrosis? | Pain control Opioids (Morphine, Demerol) Anti-spasmodics (Pro-Bathnine) Antibiotics for infection Penicillin in combination with Sulfonamide (Gantrisin) Sulfamethoxazole (Septra, Bactrim)
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| What is tyhe Medical Management for Nephrotic syndrome? | Depends on tissue Corticosteroids, Antineoplastic agents for immunosuppressive effect. Loop diuretic Low sodium, high protein diet, normal serum albumin and protein-rich nutrition replacement therapy.
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| What Medications are commonly given to treat Acute Renal Failure? | Electrolyte replacements, Diuretics (Lasx), Anti-HPTNes (Beta/CA++ blockers), Anti convulsants(Dilantin), Vitamins (D& Calium), Anti infectives, Antacids(binds-phosphates), Kayexalate for hyperkalemia, & Antiemetic/laxatives as ordered
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