1. REVIEW ANATOMY and PHYSIOLOGY

2. The urinary system consists of:
A. 2 kidneys
B. 2 ureters (upper urinary tract)
C. A urinary bladder
D. A urethra (lower urinary tract)

3. Urine normally consists of
95% water
Nitrogenous waste products or protein (urea, uric acid, creatinine)
Excessive eletrolytes (Na, Ca, K, Ph)
Bile pigments
Hormones
Metabolized drugs and toxins
Micturition

4. A. The Kidneys
Weighs about g, is 12 long, 6 cm wide, and 2.5cm thick
Well protected by the ribs, muscles, Gerota’s fascia, perirenal fat and the renal capsule

5. Location of kidneys Function of kidneys: In the retroperitoneal space
Urine formation
Excretion of waste products
Regulation of electrolytes
Regulation of acid base balance
Control of water balance
Control BP
Regulation of RBC production
Synthesis of vitamin D to active form
Secretion of prostaglandins

7. Each nephrons consists of a glomerulus
Nephrons: (a functional unit of kidney) responsible for urine formation
Each nephrons consists of a glomerulus
A glomerulus (filters the blood)
Bowman’s capsule
Proximal tubule
Loop of Henle (reabsorb water and important nutrients in the filtrate)
Distal tubule
Collecting ducts

10. B. Ureters Urine flows into the ureter
The ureters are narrow, muscular tubes
24 – 30cm long
Originate at the lower portion of the renal pelvis and terminate in the trigone of the bladder wall
Ureter functions to convey urine from kidneys to the bladder

11. C. Bladder
The urinary bladder is a muscular, hollow sac just behind the pubic bone
Adult bladder capacity is 300ml – 600 ml of urine
The wall of the bladder is consists of adventitia, detrusor, lamina propria, urothelium
Urothelium (impermeable to water): prevents the reabsorption of urine stored in the bladder

12. D. Urethra Arises from the base of the bladder.
In male, it passes through the penis
In female, it opens just anterior to the vagina
Muscular tube that drains urine from the body
Is 3-4 cm long in females, but closer to 20cm in males

14. Assessment
Included in the baseline data for all clients. Ask an open-ended question

15. Describe the urine pattern
Subjective Data
Ask the client to describe how the symptoms developed and progressed
Is there pain?
PQRST
Describe the urine pattern
Is there a difficulty starting the stream? Is there urgency, frequency, incontinence, or hematuria?
Does the bladder feel empty after voiding? Does the client have pruritis or dry skin?

16. Objective Data
If edema is present, ask the client if it is always present or if it disappears during the night
Monitor I & O and v/s and palpate the bladder for retention
Weigh the client
Assess mucous membranes for moisture and the skin for dryness and uremic frost
Evaluate urine for color, clarity and odor
Review diagnostic tests

17. Grading for Edema

18. Changes with Aging
The following changes are found in the urinary system as a result of aging:
Nephrons decrease, resulting in decreased filtration and gradual decrease in excretory and reabsorptive functions of renal tubules
GFR decreases = decreased renal clearance of drugs
BUN increases 20% by age 70. Creatinine clearance test is a better index than BUN of renal function in the elderly
Sodium-conserving ability is diminished
Bladder capacity is decreases (causing frequency of urination and nocturia)
Bladder and perineal muscles weaken, result in inability to empty the bladder (risk for cystitis)
The prostate may enlarge, causing frequency or dribbling in males

19. Common Diagnostic Test
Urine Tests
Blood Tests
Radiographic Tests
Urodynamic Tests
Endoscopic Exam