Chapter 39

Urinary System

Anatomy and Physiology Review

• Urinary system consists of two kidneys, two ureters, bladder, and urethra

• Functions:– Manufacture urine– Expulse waste products

Anatomy and Physiology Review

Anatomy and Physiology Review

Anatomy and Physiology Review

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Assessment

• Pain on urination

• Pattern of urination

• Strength of urine stream

• Urgency, frequency, incontinence, hematuria, and nocturia

• Intake and output

• Urine color, clarity, and odor

Urinary Terms

• Anuria– Cessation of urine production

• Dysuria– Difficult urination

• Hematuria– Blood in urine

(continued)

Urinary Terms

• Nocturia– Excessive urination at night

• Oliguria– Decreased urine production

(continued)

Urinary Terms

• Polyuria– Excess urination

• Urgency– Need to urinate immediately

Changes with Aging

• Nephrons decrease

• Glomerular filtration rate decreases

• Blood urea nitrogen increases

• Sodium-conserving ability diminishes

• Bladder capacity decreases

• Renal function increases when lying down

(continued)

Changes with Aging

• Bladder and perineal muscles weaken

• Incidence of stress incontinence increases in females

• Prostate may enlarge in males

Common Diagnostic Tests

• Urine tests

• Blood tests

• Radiographic tests

• Urodynamic tests

• Endoscopic exam

• Biopsy

Common Diagnostic Tests

Common Diagnostic Tests

Urinary Retention

• Person unable to void when an urge– Stasis may lead to infection– May result in distended bladder– Urine overflow may cause incontinence

• Caused by stress, calculus obstruction, stones, tumor, infection, medications, or trauma

(continued)

Urinary Retention

• Symptoms:– Frequency, voiding small amounts, and

distended bladder

• Treatment:– Urinary analgesics, antispasmodics,

catheter, and surgery

Urinary Incontinence

• Involuntary loss of urine from bladder

• Types:– Stress

• Leakage of urine on straining

– Urge• Sudden need to urinate

(continued)

Urinary Incontinence

• Types:– Overflow

• Full bladder leads to leakage

– Total• No control of voiding

– Nocturnal enuresis• Nighttime incontinence

(continued)

Urinary Incontinence

• Goal of treatment:– Keep perineum clean, dry, and intact

(continued)

Urinary Incontinence

• Potential treatment:– Medications– Pelvic floor exercises– Bladder retraining– Catheter insertion– Surgery

Cystitis

• Inflammation of urinary bladder

• Caused by escherichia coli, candida albicans, coitus, prostatitis, and diabetes mellitus

• Treatment:– Culture/sensitivity testing, antimicrobial

medication, and urinary tract analgesic

(continued)

Cystitis

• Increase fluid intake, acidic foods, and intake and output

Pyelonephritis

• Bacterial infection of renal pelvis, tubules, and interstitial tissue of one or both kidneys

• Also known as pyelitis or nephropyelitis

• Treat to prevent from becoming chronic

(continued)

Pyelonephritis

• Treatment:– Urine culture/sensitivity testing, antimicrobials,

antipyretics, analgesics, increase fluids, intake and output, and daily weight

Acute Glomerulonephritis

• Glomerulus within nephron unit becomes inflamed

• May be bacterial or viral

• Treat to prevent renal complications, cardiac complications, and complications to cerebral functioning

(continued)

Acute Glomerulonephritis

• Treatment:– Drug therapy, fluid restriction, monitor labs,

I&O, bed rest, and VS

Chronic Glomerulonephritis

• Slowly progressive, destructive process affecting glomeruli

• Causes loss of kidney function

• Treat to prevent further renal damage and cardiac or cerebral complications

(continued)

Chronic Glomerulonephritis

• Treatment:– Medications, protein and fluid restriction, bed

rest, intake and output, VS, and monitor labs, daily weight, and lung sounds

Urinary Calculi

• Calculus, or stone, formed in urinary tract

• Very small calculi may be flushed out by peristalsis and fluids

• All urine must be strained, stones collected, and sent to lab for composition

(continued)

Urinary Calculi

Urinary Calculi

Urinary Calculi

• Treatment:– Lithotripsy, surgery, analgesics, medications,

and dietary changes

Urinary Bladder Tumors

• May be cancerous or benign papillomas

• Surgery may remove tumor, part of bladder, or entire bladder– Makes urinary diversion necessary

• Other treatment:– Chemotherapy, analgesics, and sometimes

low-residue diet

Urinary Bladder Tumors

Urinary Bladder Tumors

Renal Tumors

• Cancer in kidneys

• Radical nephrectomy may be performed if other kidney healthy and disease localized

• Treatment:– Immunotherapy, targeted therapy, analgesics,

antiemetics, chemotherapy, and radiation• Chemotherapy and radiation provide minimal

benefit

Polycystic Kidney

• Multiple grape-like clusters of fluid-filled cysts develop in and greatly enlarge both kidneys

• Treat to preserve kidney function, prevent infections, and relieve pain

(continued)

Polycystic Kidney

• Control hypertension

• Eventually, may need dialysis or renal transplantation

Renal Failure

• Any acute or chronic loss of kidney function when some kidney function remains

• End-stage renal disease (ESRD)– Total, or nearly total, permanent kidney

failure

Acute Renal Failure (ARF)

• Postrenal– Disrupted urine flow

• Prerenal– Disrupted blood flow to kidney

• Intrarenal– Renal tissue damage

• Often reversible if diagnosed early

(continued)

ARF

• Treat to stabilize kidney function, return to normal using surgery, medications, and dietary restrictions

• Treatment:– Medication, dietary changes, fluid restrictions,

and dialysis (peritoneal or hemodialysis)

Chronic Renal Failure/ESRD

• Slow, progressive condition

• Kidney’s ability to function ultimately deteriorates

• Not reversible

• Multisystem disease process

(continued)

Chronic Renal Failure/ESRD

• Goal:– Preserve remaining kidney function and

prevent complications

Dialysis

• Mechanical means of removing waste from blood

• Hemodialysis– Machine with artificial membrane used to

filter blood

• Peritoneal dialysis– Uses peritoneal lining of abdominal cavity

as membrane through which diffusion and osmosis occur

Dialysis

Kidney Transplantation

• Client must be tissue- and blood-typed to determine compatible donor

• After transplant surgery, immunosuppressive drug therapy to decrease chance of organ rejection

• Greatest complication:– Infection

Kidney Patient Guide

Chapter 60

Infants with Special Needs:Birth to 12 Months

Hypospadias

• Urethral opening on ventral surface of penis

• Surgically corrected during first year of life

Vesicoureteral Reflux

• Backflow of urine from bladder into ureters and possibly kidneys

• Primary symptom:– Recurrent urinary tract infections

• Treatment:– Preventing urinary tract infections and surgery

Wilms’ Tumor

• Nephroblastoma– One of the most common early childhood

cancers

• Symptoms:– Abdominal mass to side of midline, abdominal

pain, malaise, anemia, and fever

(continued)

Wilms’ Tumor

• Avoid palpating tumor

• Surgery is treatment of choice– Also use chemotherapy and radiation

Chapter 61

Common Problems: 1–18 Years

Urinary System

• Acute poststreptococcal glomerulonephritis

• Nephrotic syndrome

• Enuresis