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

2. Anatomy and Physiology
Two Kidneys
Two Ureters
Urinary Bladder
Urethra

3. Frontal Section of Left Kidney

4. Nephron

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

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

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

10. Aging and the Urinary System

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

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

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

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

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

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

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

19. Intravenous Pyelogram

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

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

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

23. Renal Biopsy
Percutaneous or Open
Pre care
NPO, Mild Sedative

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

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

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

27. 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. Nursing Diagnoses Stress Incontinence Urge Incontinence
Functional Urinary Incontinence

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

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

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

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

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