1. Linda S. Williams / Paula D. Hopper Copyright © 2011. F.A. Davis Company Understanding Medical Surgical Nursing, 4th Edition Chapter 36 Urinary System Function, Assessment, and Therapeutic Measures

2. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anatomy and Physiology  Two Kidneys  Two Ureters  Urinary Bladder  Urethra

3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Frontal Section of Left Kidney

4. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nephron

5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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

6. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Glomerular Filtration Rate  Renal Filtrate Kidneys Form in 1 Minute  Averages 100 to 125 mL/minute

7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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

8. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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

9. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Normal Urine Characteristics (cont’d)  Constituents  95% Water  Waste Products: Urea, Creatinine, Uric Acid

10. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Aging and the Urinary System

11. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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

12. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Assessment  Health History  Pain/Burning with Voiding  New Onset Edema, Shortness of Breath, Weight Gain  Fluid Intake  Functional Ability

13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Physical Assessment  Vital Signs  Lung Sounds  Edema  Daily Weights  Intake and Output

14. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Laboratory Tests  Urinalysis  Common Test  Voided or Cath Specimen  10 mL of Urine Collected

15. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Laboratory Tests (cont’d)  Urine Culture  Identifies Bacteria Present  Urine Collected Before Antibiotics  Sensitivity Test Determines Antibiotic That will Destroy Bacteria

16. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Laboratory Tests (cont’d)  Renal Function Tests  Serum Creatinine  Blood Urea Nitrogen  Uric Acid  Creatinine Clearance Test

17. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Radiologic Studies  Kidneys-Ureter-Bladder  Show Tumors, Swollen Kidneys, Kidney Stones

18. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Radiologic Studies (cont’d)  Intravenous Pyelogram  Dye Injected  Dye Outlines Renal Structures  Check Allergies  Increase Fluids Afterward

19. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Intravenous Pyelogram

20. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Radiologic Studies (cont’d)  Renal Angiography  Dye Visualizes Renal Arteries  Check Allergies

21. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Endoscopic Procedures  Cystoscopy and Pyelogram  Surgery: Cystoscope Inserted in Bladder Through Urethra  Pyelogram: Dye Injected in Kidney Pelvis  X-Rays Taken

22. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Ultrasound  Noninvasive Sound Waves Examine Anatomy of Urinary Tract  Shows Kidney Enlargement, Kidney Stones, Chronic Infection, Tumors

23. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Biopsy  Percutaneous or Open  Pre care  NPO, Mild Sedative

24. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Renal Biopsy (cont’d)  Post Care  Vital Signs  Observe for Bleeding  Biopsy Site, Urine  Pressure Dressing, Sandbag  Bedrest for 24 Hours

25. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Diagnostic Tests: Nursing Diagnoses  Anxiety  Acute Pain  Altered Urinary Elimination  Deficient Knowledge

26. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urinary Incontinence  Stress Incontinence  Involuntary Urine Loss from Increasing Abdominal Pressure  Urge Incontinence  Involuntary Urine Loss with Abrupt/Strong Desire to Void

27. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition 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

28. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Nursing Diagnoses  Stress Incontinence  Urge Incontinence  Functional Urinary Incontinence

29. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urinary Retention  Acute  Anesthesia, Medications, Local Trauma to Urinary Structures  Chronic  Enlarged Prostate, Medications, Strictures, Tumors

30. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urinary Retention (cont’d)  Monitor  Urine Output  Bladder Distention  Bladder Scan  Residual Volume of 150 to 200 mL Urine  Indicates Need For Treatment

31. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urinary Catheters  Indwelling Catheters  Justifiable Reasons  Shock  Urinary Tract Obstruction  Neurogenic Bladder  Urinary Incontinence is NOT Justification  Urinary Catheters Result in Infection

32. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urinary Catheters (cont’d)  Intermittent Catheterization  Best  Reduces Risk of Infection  Patients May Self-cath

33. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urinary Catheters (cont’d)  Suprapubic Catheter  Indwelling Catheter Inserted Through Incision in Lower Abdomen into Bladder