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Genital-Urinary System Renal System Part 1. Behavioral Objectives: Review the anatomy and physiology of the genito-urinary systems Describe the physical.

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Presentation on theme: "Genital-Urinary System Renal System Part 1. Behavioral Objectives: Review the anatomy and physiology of the genito-urinary systems Describe the physical."— Presentation transcript:

1 Genital-Urinary System Renal System Part 1

2 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

3 Introduction Essential to life Every head to toe assessment must include… – Upper & lower urinary tract function

4 Anatomy: Kidney Kidneys – Shape Bean – Color Brown-red – How many / # 2

5 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

6 Anatomy: kidney Do You Remember? What lies on top of each kidney? A.Liver B.Pancreas C.Meat balls D.Adrenal gland

7 What hormones do the adrenal glands secrete? – (Not a multiple choice question!) – Hint Sugar, Sex & Salt – Glucocorticoids – Androgens – Mineralcorticoids - aldosterone

8 Anatomy: Kidney Two distinct regions: – Renal parenchyma – Renal pelvis Renal parenchyma – Divided into 2 parts Cortex Medulla

9 Renal parenchyma Medulla – Inner portion – Contain Loops of Henle Vasa recta Collecting ducts

10 Renal parenchyma Medulla – Collecting ducts connect to Renal pyramids Shape: – Triangle Point toward – Hilum / pelvis Ea. Kidney contains – 8-18 pyramids

11 Anatomy: Kidney Medulla – Function Drain urine from the Nephrons to the renal pelvis

12 Renal parenchyma Divided into 2 regions – Medulla – Cortex Contains – Nephrons » Functional unit of the kidneys

13 Anatomy: Kidney Renal pelvis – Ureter Renal pyramids drain urine into the ureter – Renal artery – Renal Vein

14 Blood supply to the kidney Aorta  Renal artery  Afferent arteriole  Glomerulus – Capillary bed Efferent arteriole  Venules and veins Inferior Vena Cava

15 Can you do it? Place the following in order to best describe blood flow threw the kidney. A.Afferent arteriole B.Aorta C.Efferent arteriole D.Glomerulus E.Inferior Vena Cava F.Renal artery G.Vein H.Venules B-F-A-D-C-H-G-E

16 QUESTION???? Where in the flow of blood threw the kidney does filtration take place? A.Afferent arteriole B.Aorta C.Efferent arteriole D.Glomerulus E.Inferior Vena Cava F.Renal artery G.Vein H.Venules

17 Anatomy: Nephrons Functional unit* FYI – 1 million Nephrons in ea. Kidney – Adequate renal function with 1 kidney

18 Anatomy: Nephrons Nephron – Glomerulus – Bowman’s capsule – Proximal convoluted tubule Loops of Henle Distal convoluted tubule

19 Anatomy: Ureters Urine:nephrons  renal pyramids  renal pelvis  ureter, a long narrow muscular tube Extends from renal pelvis  bladder Two Upper urinary tract

20 Anatomy: Ureters 3 narrowed areas – promotes efflux – prevents reflux micturition – Propensity for obstruction by renal calculi

21 Anatomy: Ureters lining urothelium – prevents reabsorption of urine The movement of urine is facilitated by peristaltic waves

22 Anatomy: Bladder BLADDER Description – Muscular – hollow sac Location – Behind pubic bone Function – Reservoir for urine

23 Anatomy: Bladder Normal capacity – 300-500 ml of urine Capable of holding – 1500-2000 ml CNS stim. “need to void” – 150-200 ml urine

24 Anatomy: Bladder Neck of the bladder – Internal urinary sphincter – Involuntary control

25 Anatomy: Urethra Carries urine from the bladder & expels it from the body External urinary sphincter – voluntary control

26 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

27 Physiology of the Urinary System Urine formation – The nephrons form urine through a complex 3-step process 1.Glomerular filtration 2.Tubular reabsorption 3.Tubular secretion

28 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.

29 1. Glomerular filtration Filtration at Glomerulus – Water – Na + – Cl - – Bicarbonate – K + – Glucose – Urea – Creatinine – Uric Acid

30 1. Glomerular filtration Glomerular filtration – Factors that can alter process: Blood flow Blood pressure

31 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

32 3. Tubular Secretion Elements secreted from blood into tubule for excretion in urine – Some Water Na+ Cl- Bicarbonate K+ Uric acid – Most Urea

33 Filtrate  – Tubules  – Collecting duct  – Renal pelvis  – Ureter  – Bladder  – Urethra

34 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!

35 Protein Filtered by glomeruli & returned to the blood by tubular reabsorption. Slight proteinuria – OK – globulin, albumin Persistent proteinuria – Glomerular damage

36 Anti-diuretic hormone (ADH) AKA – Vasopressin Secreted by – Posterior Pituitary Secreted in response to – changes in blood osmolality

37 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

38 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

39 Osmolarity & Osmolality Osmolarity – # of particles dissolved in solution Osmolality – Thickness of solution Urine Serum / blood

40 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

41 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)

42 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

43 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

44 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

45 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

46 Regulation of acid excretion Neutralize acids – binding them to chemical buffers – Be excreted without altering the pH Important buffers – Phosphate ions – Ammonia NH 3

47 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

48 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

49 Vitamin D Synthesis Kidneys activate ingested Vitamin D  Aid absorption of calcium

50 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

51 Excretion of waste products Uric acid (purine metabolism) – Hyperuricemia gout, Kidneys also are the primary means of ridding the body of Drug metabolism

52 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.

53 Gerontological Considerations – Function of the urinary tract declines. – GFR declines – Prone to develop hypernatremia & fluid volume deficit – At risk for adverse drug effects

54 Assessment Risk Factors  age Instrumentation of urinary tract Immobility Diabetes mellitus HTN Gout, hyperparathyroidism, Crohn’s disease Benign prostatic hypertrophy Obstetric injury

55 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

56 Physical Exam Abdomen, supropubic region, genitalia and lower back, the lower extremities Palpate kidney – Feel the rounded lower border of the kidney Right kidney

57 Physical Exam Palpation of bladder – Performed after voiding if suspect urinary retention

58 Terms - matching 1.Urgency 2.Pyuria 3.Proteinuria 4.Polyuria 5.Oliguria 6.Nocturia 7.Incontinence 8.Hesitancy 9.Hematuria 10.Frequency 11.Euresis 12.Dysuria 13.Anuria A.Frequent voiding – more than every 3 hours B.Strong desire to void C.Painful or difficult voiding D.Delay, difficulty in initiating voiding E.Excessive urination at night F.Involuntary loss of urine G.Involuntary voiding during sleep H.Increased volume of urine voided I.Urine output less than 400 ml/day J.Urine output less than 50 ml/day K.Red blood cells in the urine L.Abnormal amounts of protein in the urine M.Pus in the urine

59 The presence of peritoneal fluid build up is described as which one of the following? A.“I’m so nervous I have to void” phenomenon B.Bruits C.Generalized edema D.Peritoneal dialysis E.Ascites

60 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,

61 Diagnostic Evaluation: Urine Culture and Sensitivity ID microorganism(s) Sensitivity report Time – 2-3 days (48-72 hours)

62 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

63 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.

64 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

65 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

66 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?

67 Renal Clearance  renal function  –  Creatinine clearance Creatinine clearance evaluates – glomerular filtration rate (GFR) Detects and evaluates progression of renal disease

68 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

69 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

70 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.100cc B.150 cc C.200cc D.300 cc E.400 cc

71 Dialysis: Overview Purpose – Remove fluids and waste products from the body Definition – Mechanical means of removing waste from the blood Types: – Hemodialysis – Peritoneal dialysis

72 Dialysis: Process Process – Diffusion and osmosis across a semi permeable membrane into a dialysate solution prescribed specific to the individual clients needs

73 Dialysis: process Diffusion – Toxins & wastes are removed by diffusion – Move from an area of higher concentration to an area of lower concentration

74 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.

75 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)

76 Hemodialysis A machine with an artificial semi- permeable membrane used for the filtration of the blood.

77 Hemodialysis – A graft or fistula is surgically prepared to access the clients circulatory system

78 Hemodialysis – With each hemodialysis treatment, the catheter is inserted into the graft of fistula

79 Hemodialysis – The clients blood is circulated past the semi permeable membrane – Excess fluids are removed by osmosis

80 Hemodialysis Waste products are removed from the blood by diffusion

81 Hemodialysis Nursing interventions – Weighted before and after – Strict asepsis technique

82 Hemodialysis Nursing interventions: Assess fistula or graft – A thrill felt – A bruit heard – Pulse peripheral Protect Grafts – Not an IV port! – No BP in graft arm

83 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 readings C.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.

84 Hemodialysis Nursing interventions: Meds are given after Usually performed 3 time a week Usually take 3-6 hours

85 Peritoneal Dialysis Uses the peritoneal lining of the abdominal cavity

86 Peritoneal Dialysis – A catheter is placed by the MD into peritoneal space

87 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

88 Peritoneal Dialysis Usually 2 liters of dialysate Less expensive, easier to perform and less stressful Complication – INFECTION Usually 4 x day – 7day/wk

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