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 Dysuria Hematuria Cessation of urine production Difficult urination Hematuria Blood in urine (continued)

Urinary Terms Nocturia Oliguria Excessive urination at night Decreased urine production (continued)

Urinary Terms Polyuria Urgency Excess urination 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: Treatment: 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 Total Nocturnal enuresis 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

Infants with Special Needs: Birth to 12 Months Chapter 60 Infants with Special Needs: Birth to 12 Months 50

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 Symptoms: 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

Common Problems: 1–18 Years Chapter 61 Common Problems: 1–18 Years

Urinary System Acute poststreptococcal glomerulonephritis Nephrotic syndrome Enuresis