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
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
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