Urinary System Function, Assessment, and Therapeutic Measures Chapter 36 Urinary System Function, Assessment, and Therapeutic Measures

Anatomy and Physiology Two Kidneys Two Ureters Urinary Bladder Urethra

Frontal Section of Left Kidney

Nephron

Kidney Function Formation of Urine Excretion or Conservation of Water Electrolyte Balance Acid-base Balance Activation of Vitamin D Production of Erythropoietin Production of Renin

Glomerular Filtration Rate Renal Filtrate Kidneys Form in 1 Minute Averages 100 to 125 mL/minute

Ureters, Urinary Bladder, Urethra Ureters: Carry Urine from Kidneys to Bladder Bladder: Temporary Storage of Urine and its Elimination Urethra: Carries Urine from Bladder to Exterior

Normal Urine Characteristics Amount: 1,000 to 2,000 mL/24 Hours Color: Straw or Amber Clarity: Clear Specific Gravity: 1.002 to 1.028 Lower = Dilute; Higher = Concentrated pH: 4.6 to 8.0

Normal Urine Characteristics (cont’d) Constituents 95% Water Waste Products: Urea, Creatinine, Uric Acid

Aging and the Urinary System

Aging and the Urinary System (cont’d) Renal Mass Smaller Renal Flow Decreased 50% Decreased Tubular Function Bladder Muscles Weaken Bladder Capacity Decreases Voiding Reflex Delayed

Nursing Assessment Health History Pain/Burning with Voiding New Onset Edema, Shortness of Breath, Weight Gain Fluid Intake Functional Ability

Physical Assessment Vital Signs Lung Sounds Edema Daily Weights Intake and Output

Laboratory Tests Urinalysis Common Test Voided or Cath Specimen 10 mL of Urine Collected

Laboratory Tests (cont’d) Urine Culture Identifies Bacteria Present Urine Collected Before Antibiotics Sensitivity Test Determines Antibiotic That will Destroy Bacteria

Laboratory Tests (cont’d) Renal Function Tests Serum Creatinine Blood Urea Nitrogen Uric Acid Creatinine Clearance Test

Radiologic Studies Kidneys-Ureter-Bladder Show Tumors, Swollen Kidneys, Kidney Stones

Radiologic Studies (cont’d) Intravenous Pyelogram Dye Injected Dye Outlines Renal Structures Check Allergies Increase Fluids Afterward

Intravenous Pyelogram

Radiologic Studies (cont’d) Renal Angiography Dye Visualizes Renal Arteries Check Allergies

Endoscopic Procedures Cystoscopy and Pyelogram Surgery: Cystoscope Inserted in Bladder Through Urethra Pyelogram: Dye Injected in Kidney Pelvis X-Rays Taken

Renal Ultrasound Noninvasive Sound Waves Examine Anatomy of Urinary Tract Shows Kidney Enlargement, Kidney Stones, Chronic Infection, Tumors

Renal Biopsy Percutaneous or Open Pre care NPO, Mild Sedative

Renal Biopsy (cont’d) Post Care Vital Signs Observe for Bleeding Biopsy Site, Urine Pressure Dressing, Sandbag Bedrest for 24 Hours

Diagnostic Tests: Nursing Diagnoses Anxiety Acute Pain Altered Urinary Elimination Deficient Knowledge

Urinary Incontinence Stress Incontinence Urge Incontinence Involuntary Urine Loss from Increasing Abdominal Pressure Urge Incontinence Involuntary Urine Loss with Abrupt/Strong Desire to Void

Urinary Incontinence (cont’d) Functional Incontinence From Impairment of Physical/Mental Function Overflow Incontinence Involuntary Loss of Urine Associated with Bladder Overdistention Total Incontinence Continuous, Unpredictable Loss of Urine

Nursing Diagnoses Stress Incontinence Urge Incontinence Functional Urinary Incontinence

Urinary Retention Acute Chronic Anesthesia, Medications, Local Trauma to Urinary Structures Chronic Enlarged Prostate, Medications, Strictures, Tumors

Urinary Retention (cont’d) Monitor Urine Output Bladder Distention Bladder Scan Residual Volume of 150 to 200 mL Urine Indicates Need For Treatment

Urinary Catheters Indwelling Catheters Justifiable Reasons Shock Urinary Tract Obstruction Neurogenic Bladder Urinary Incontinence is NOT Justification Urinary Catheters Result in Infection

Urinary Catheters (cont’d) Intermittent Catheterization Best Reduces Risk of Infection Patients May Self-cath

Urinary Catheters (cont’d) Suprapubic Catheter Indwelling Catheter Inserted Through Incision in Lower Abdomen into Bladder