Genital-Urinary System
description
Transcript of Genital-Urinary System
Genital-Urinary System
Renal System Part 1
Behavioral Objectives:• Review the anatomy and physiology of the genito-urinary systems• Describe the physical assessment of the GU systems• Discuss the application of the nursing process as it relates to patients with
disorders of the GU system• Describe the purpose and methods for collecting sterile and “clean-catch”
urine specimens.• Discuss the importance of monitoring and maintaining intake and output
and appropriate documentation• Discuss common diagnostic tests, procedures and related nursing
responsibilities for the patient with GU disorders.• Explain the purpose of dialysis and differentiate between peritoneal and
hemodialysis
Introduction
• Essential to life• Every head to toe
assessment must include…
– Upper & lower urinary tract function
Anatomy: Kidney
• Kidneys– Shape• Bean
– Color• Brown-red
– How many / #• 2
Anatomy: Kidneys
Kidneys• Location– Posterior wall of the
abdomen– Base of the rib cage– Surrounded by renal
capsule– Right kidney is lower
than the left
Anatomy: kidney
Do You Remember?• What lies on top of each kidney?
A. LiverB. PancreasC. Meat ballsD. Adrenal gland
• What hormones do the adrenal glands secrete?– (Not a multiple choice question!)– Hint• Sugar, Sex & Salt
– Glucocorticoids– Androgens– Mineralcorticoids - aldosterone
Anatomy: Kidney
• Two distinct regions:– Renal parenchyma– Renal pelvis
• Renal parenchyma– Divided into 2 parts
• Cortex• Medulla
Renal parenchyma
• Medulla– Inner portion– Contain
• Loops of Henle• Vasa recta• Collecting ducts
Renal parenchyma
• Medulla– Collecting ducts connect
to Renal pyramids• Shape:
– Triangle
• Point toward– Hilum / pelvis
• Ea. Kidney contains– 8-18 pyramids
Anatomy: Kidney
• Medulla– Function
• Drain urine from the Nephrons to the renal pelvis
Renal parenchyma
• Divided into 2 regions
–Medulla–Cortex• Contains –Nephrons »Functional unit of
the kidneys
Anatomy: Kidney
• Renal pelvis– Ureter• Renal pyramids
drain urine into the ureter
– Renal artery– Renal Vein
Blood supply to the kidney
• Aorta • Renal artery • Afferent arteriole • Glomerulus– Capillary bed
• Efferent arteriole • Venules and veins• Inferior Vena Cava
Can you do it?• Place the following in order to best describe blood
flow threw the kidney.A. Afferent arterioleB. AortaC. Efferent arterioleD. GlomerulusE. Inferior Vena CavaF. Renal arteryG. VeinH. Venules
• B-F-A-D-C-H-G-E
QUESTION????
• Where in the flow of blood threw the kidney does filtration take place?
A. Afferent arterioleB. AortaC. Efferent arterioleD. GlomerulusE. Inferior Vena CavaF. Renal arteryG. VeinH. Venules
Anatomy: Nephrons
• Functional unit*• FYI– 1 million Nephrons in
ea. Kidney– Adequate renal
function with 1 kidney
Anatomy: Nephrons
• Nephron – Glomerulus– Bowman’s capsule– Proximal convoluted
tubule• Loops of Henle• Distal convoluted
tubule
Anatomy: Ureters
• Urine:nephrons renal pyramids renal pelvis ureter,
• a long narrow muscular tube
• Extends from renal pelvis bladder
• Two• Upper urinary tract
Anatomy: Ureters
• 3 narrowed areas – promotes efflux– prevents reflux
• micturition
– Propensity for obstruction by renal calculi
Anatomy: Ureters
• lining urothelium– prevents
reabsorption of urine• The movement of
urine is facilitated by peristaltic waves
Anatomy: Bladder
BLADDER• Description– Muscular– hollow sac
• Location– Behind pubic bone
• Function– Reservoir for urine
Anatomy: Bladder
• Normal capacity – 300-500 ml of urine
• Capable of holding– 1500-2000 ml
• CNS stim. “need to void”– 150-200 ml urine
Anatomy: Bladder
• Neck of the bladder – Internal urinary
sphincter– Involuntary control
Anatomy: Urethra
• Carries urine from the bladder & expels it from the body
• External urinary sphincter– voluntary control
Physiology of the Urinary System
• Function of the kidneys
– Urine formation– Excretion of waste
products– Regulation of
• Electrolytes• Acid-base control• RBC production• Ca+ & Ph
– Control • water balance• blood pressure
– Renal clearance– Synthesis of Vit. D
Physiology of the Urinary System
• Urine formation– The nephrons form
urine through a complex 3-step process
1. Glomerular filtration2. Tubular
reabsorption3. Tubular secretion
1. Glomerular filtration
Step 1• Most of the elements of
blood, except– large molecules – blood cells
• forced out of the blood capillaries of the glomerulus Bowman’s capsule filtrate
• High capillary BP in the glomerulus.
1. Glomerular filtration
• Filtration at Glomerulus– Water– Na+
– Cl-
– Bicarbonate– K+
– Glucose– Urea– Creatinine– Uric Acid
1. Glomerular filtration
• Glomerular filtration– Factors that can alter
process:• Blood flow• Blood pressure
2. Tubular reabsorption
Step 2• Filtrate Proximal convoluted
tubule • Reabsorption (back into blood)
– Most• Water• Na+• Cl-• Bicarb• K+• Uric Acid
– All of the glucose– None of the Creatinine
3. Tubular Secretion
• Elements secreted from blood into tubule for excretion in urine– Some
• Water• Na+• Cl-• Bicarbonate• K+• Uric acid
– Most Urea
• Filtrate – Tubules – Collecting duct – Renal pelvis – Ureter – Bladder – Urethra
Glucose• Normally all the glucose
filtered through the glomeruli will be reabsorbed back into blood – No glucose in the urine
• Glycosuria – Diabetes mellitus– serum glucose levels overwhelm
the nephron’s ability to reabsorb glucose
Sweet pea!
Protein
• Filtered by glomeruli & returned to the blood by tubular reabsorption.
• Slight proteinuria– OK– globulin, albumin
• Persistent proteinuria– Glomerular damage
Anti-diuretic hormone (ADH)
• AKA– Vasopressin
• Secreted by– Posterior Pituitary
• Secreted in response to– changes in blood
osmolality
Anti-diuretic hormone (ADH)Normally• Water intake • Blood osmolality
– • Stim. pituitary to
– ADH•
• ADH receptor site – Kidney
• Action– reabsorption of H2O – urine volume/output– returns blood osmolality to normal
Anti-diuretic hormone (ADH)Normally• Water intake • Blood osmolality
– • Stim. pituitary to
– ADH•
• ADH receptor site Kidney• Action
– reabsorption of H2O – urine volume (diuresis)– returns blood osmolality to normal
Osmolarity & Osmolality
• Osmolarity – # of particles
dissolved in solution• Osmolality– Thickness of solution
• Urine• Serum / blood
Regulation of water excretion
• The amt. of urine formed is r/t the amt. of fluid intake– fluid intake – volume urine
• • Characteristic
– Dilute
– fluid intake – volume of urine
• • Characteristic
– Concentrated
• Normally: kidneys rid the body of about 75% of fluids taken in
Regulation of Electrolytes Excretion
• Sodium– Normally serum Na+:
• 135 - 145 mmol/L
– Na+ filtered from the blood & reabsorbed from the tubule back into the blood
– Na+ excretion is controlled by Aldosterone– Aldosterone Na retention
• __?__ Serum Sodium level• serum sodium level
– Na+ most abundant electrolyte found outside the cells (extracellular)
Regulation of Electrolytes Excretion
• Potassium– K+ is the most abundant electrolyte found
inside the cells (intracellular). – Aldosterone K excretion • __?__ serum K+ level• serum K+ level
Regulation of Electrolytes Excretion
• Kidney’s not functioning normally– Na+ & K+ will not be adequately filtered from the blood
• Retention of K+ is the most life-threatening effect of renal failure
• Renal failure – Retention of K+ – Hyperkalemia – Cardiac dysrhythmias – Death
Regulation of acid excretion
• Proteins are broken down into acids– phosphoric acid – sulfuric acid.
• Acids in the blood – pH
• Normally kidneys– Filter acids from the
blood • Tubular filtration• Chemical buffer
mechanism
Regulation of acid excretion
• Tubular filtration– Acid is excreted into
the urine through tubular secretion
– Used until the bladder acidity • pH 4.5
– Any excess acid must be neutralized
Regulation of acid excretion
Neutralize acids – binding them to
chemical buffers – Be excreted without
altering the pH• Important buffers– Phosphate ions– Ammonia• NH3
Regulation of Red Blood Cell Production
• Kidneys measure O2 tension of the blood (PaO2)– PaO2 – (Hormone) erythropoietin – (Receptor site) bone marrow – (Action) production of RBC – Hgb – PaO2
• Normal RBC-Erythrocytes– Male: 4.7 - 6.1
million/mm3– Female: 4.2 - 5.4
million/mm3• Normal Hemoglobin– Male 14 - 18 g/dL– Female 12 - 16 g/dL
Vitamin D Synthesis
• Kidneys activate ingested Vitamin D
• Aid absorption of calcium
Excretion of waste products• Urea, (waste product of protein metabolism)– Blood Urea Nitrogen– BUN = renal dysfunction
• Other waster products of metabolism are – Creatinine– Phosphates– Sulphates– Ketone
• Along with BUN the serum Creatinine level is usually ordered whenever the MD suspects renal disease
Excretion of waste products
• Uric acid (purine metabolism)– Hyperuricemia
• gout,
• Kidneys also are the primary means of ridding the body of Drug metabolism
Auto-regulation of Blood Pressure
• Vasa recta constantly monitor the blood pressure
• blood pressure – Renin– angiotensin 2– vasoconstriction – blood pressure.
• B/P– Renin
• Vasa recta failure to recognize BP & stop/halt Renin secretion primary causes of hypertension.
Gerontological Considerations
– Function of the urinary tract declines. – GFR declines– Prone to develop hypernatremia & fluid volume
deficit – At risk for adverse drug effects
Assessment
Risk Factors • age• Instrumentation of urinary
tract• Immobility• Diabetes mellitus• HTN• Gout, hyperparathyroidism,
Crohn’s disease • Benign prostatic
hypertrophy• Obstetric injury
Assessment: Health history
• Chief complaint• Pain• Hx of UTI’s• Fever or Chills• instrumentation • Dysuria • Hesitancy, straining• Urinary incontinence• Hematuria
• Nocturia • Hx of kidney stones• Hx of STD’s• Tobacco, alcohol, drugs• Meds• Females
– # & types of deliveries– Hx vaginal infections
Physical Exam
• Abdomen, supropubic region, genitalia and lower back, the lower extremities
• Palpate kidney– Feel the rounded
lower border of the kidney • Right kidney
Physical Exam
• Palpation of bladder– Performed after voiding
if suspect urinary retention
Terms - matching1. Urgency2. Pyuria3. Proteinuria4. Polyuria5. Oliguria6. Nocturia7. Incontinence8. Hesitancy9. Hematuria10. Frequency11. Euresis12. Dysuria13. Anuria
A. Frequent voiding – more than every 3 hours
B. Strong desire to voidC. Painful or difficult voidingD. Delay, difficulty in initiating voidingE. Excessive urination at nightF. Involuntary loss of urineG. Involuntary voiding during sleepH. Increased volume of urine voidedI. Urine output less than 400 ml/dayJ. Urine output less than 50 ml/dayK. Red blood cells in the urineL. Abnormal amounts of protein in the urineM. Pus in the urine
• The presence of peritoneal fluid build up is described as which one of the following?A. “I’m so nervous I have to void” phenomenonB. BruitsC. Generalized edemaD. Peritoneal dialysisE. Ascites
Diagnostic Evaluation:Urinalysis
– Color; clarity; odor; urine pH and specific gravity• Colorless to pale yellow
» dilute (diuretics, alcohol, diabetes Insipidus, excess fluid intake)• Yellow to milky white
» Pyuria, infection• Bright yellow
» Multiple vitamin• Pink to red
» RBC, menses, Bladder or prostate surgery, beets, meds• Blue, blue green
» dyes, meds• Orange to amber
» Dehydration, bile, excess bilirubin or carotene, meds• Brown to black
» Old red blood cells, dehydration,
Diagnostic Evaluation: Urine Culture and Sensitivity
• ID microorganism(s) • Sensitivity report• Time– 2-3 days (48-72 hours)
Specific Gravity• The weight of urine • The specific gravity of distilled water
– 1.000• Normal urine specific gravity
– 1.003 – 1.030• Urine specific gravity is related to the level of
hydration. – fluid intake H20 excretion specific gravity – fluid intake H20 excretion specific gravity
Diagnostic Evaluation:Sterile urine specimens
• Safety– Standard precautions – Biohazard bag for transport
• Collection– Indwelling Foley Catheter
• Not from the drainage bag• Aspiration port
– Catheter – straight cath– A small amount of urine is allowed to run out of the catheter into
a basin, then the urine is allowed to run into a sterile specimen bottle.
Diagnostic Evaluation: Clean-catch or Clean-voided specimen
• Clean-voided – uncontaminated by skin flora.– Female
• Cleanse: front to back
– Male• Cleanse: tip of the penis downward
• Collect a "clean-catch" – Start to void– Midstream catch– Collect 1 to 2 oz of urine
Renal Clearance
• Purpose– Assess the Kidney’s ability to
clear solutes from the plasma • Procedure
– 24 hr urine collection – 12 hr serum Creatinine level
• Creatinine– waste product of skeletal muscle
contraction
Renal Clearance
• One function of the kidney is to excrete Creatinine. If the Creatinine clearance level (the amount of Creatinine excreted by the kidney) decreases, what does that tell you about the function of the kidney?
Renal Clearance
• renal function – Creatinine clearance
• Creatinine clearance evaluates – glomerular filtration rate
(GFR)• Detects and evaluates
progression of renal disease
Can you Critical Think????
• Mrs. Notafeela Sowell had a renal clearance test done 3 times this week. Is her renal disease getting better or worse?– Monday: Renal clearance = 70 ml/min– Wednesday: Renal clearance = 80 ml/min– Friday: Renal clearance = 90 ml/min
Diagnostic Evaluation: Intake and Output
• I&O– All fluids taken orally – Form
• Time • Amount
• Output– Urine– drainage from nasogastic tube– drainage tubes – Chest tubes– Wound tubes
Apply it!• Mr. Noah Awl is recovering from Prostatectomy due to benign
hypertrophy of the Prostate. Mr. Awl is on strict intake and Output. He requests a cup of ice chips because his throat hurts (due to intubation). You give him a 200cc cup of ice chips and he eats them all. How much to you make on the Intake?
A. 100ccB. 150 ccC. 200ccD. 300 ccE. 400 cc
Dialysis: Overview
• Purpose– Remove fluids and waste products from the
body • Definition– Mechanical means of removing waste from the
blood • Types:– Hemodialysis– Peritoneal dialysis
Dialysis: Process
• Process– Diffusion and osmosis across a semi permeable
membrane into a dialysate solution• prescribed specific to the individual clients needs
Dialysis: process
• Diffusion– Toxins & wastes
are removed by diffusion–Move from an
area of higher concentration to an area of lower concentration
• This photo shows the diffusion of fluids. I added a few drops of blue food coloring in a vase of water, and took a picture after a few seconds. Diffusion is the process of a substance moving from high concentration to low concentration. The cause of diffusion is random molecular motion of the fluids, in other words, molecules of both the food coloring and the water move at random causing them to mix. In this case, the diffusion of the food coloring goes from high concentration to low concentration.
• Osmosis– Excess water is removed
by osmosis– Water move from an area
of higher solute concentration (blood) to an area of lower solute concentration (dialysate)
Hemodialysis
• A machine with an artificial semi-permeable membrane used for the filtration of the blood.
Hemodialysis
– A graft or fistula is surgically prepared to access the clients circulatory system
Hemodialysis
– With each hemodialysis treatment, the catheter is inserted into the graft of fistula
Hemodialysis
– The clients blood is circulated past the semi permeable membrane
– Excess fluids are removed by osmosis
Hemodialysis
• Waste products are removed from the blood by diffusion
Hemodialysis
• Nursing interventions– Weighted before and
after – Strict asepsis
technique
HemodialysisNursing interventions:
• Assess fistula or graft– A thrill
• felt– A bruit
• heard– Pulse peripheral
• Protect Grafts – Not an IV port!– No BP in graft arm
The nurse is preparing to teach a client about his new shunt for hemodialysis. What should be included in this teaching?
A. Avoid overusing the arm with the shunt to protect from accidental harm.
B. Always use this arm for blood pressure readingsC. If you feel any vibrations over the skin of the shunt, call the
doctor.D. There’s nothing special to the care of the shunt. Pretend it
isn’t there.
HemodialysisNursing interventions:
• Meds are given after• Usually performed 3
time a week• Usually take 3-6 hours
Peritoneal Dialysis
• Uses the peritoneal lining of the abdominal cavity
Peritoneal Dialysis
– A catheter is placed by the MD into peritoneal space
Peritoneal Dialysis
• The dialysate, – In sterile container similar – Instilled aseptically into the abdominal
cavity.• The container remains connected to the
catheter– rolled up – dialysate remains in the abdominal
cavity for a specified length of time.• The container is then unrolled and
lowered– below the abdominal cavity – Dialysate drains back into the container
Peritoneal Dialysis
• Usually 2 liters of dialysate
• Less expensive, easier to perform and less stressful
• Complication– INFECTION
• Usually 4 x day – 7day/wk