1. Chapter 39
Urinary System

2. Anatomy and Physiology Review
Urinary system consists of two kidneys, two ureters, bladder, and urethra
Functions:
Manufacture urine
Expulse waste products

3. Anatomy and Physiology Review

4. Anatomy and Physiology Review

6. Anatomy and Physiology Review

8. 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

9. Urinary Terms Anuria Dysuria Hematuria Cessation of urine production
Difficult urination
Hematuria
Blood in urine
(continued)

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

11. Urinary Terms Polyuria Urgency Excess urination
Need to urinate immediately

12. 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)

13. Changes with Aging Bladder and perineal muscles weaken
Incidence of stress incontinence increases in females
Prostate may enlarge in males

14. Common Diagnostic Tests
Urine tests
Blood tests
Radiographic tests
Urodynamic tests
Endoscopic exam
Biopsy

15. Common Diagnostic Tests

16. Common Diagnostic Tests

17. 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)

18. Urinary Retention Symptoms: Treatment:
Frequency, voiding small amounts, and distended bladder
Treatment:
Urinary analgesics, antispasmodics, catheter, and surgery

19. Urinary Incontinence Involuntary loss of urine from bladder Types:
Stress
Leakage of urine on straining
Urge
Sudden need to urinate
(continued)

20. Urinary Incontinence Types: Overflow Total Nocturnal enuresis
Full bladder leads to leakage
Total
No control of voiding
Nocturnal enuresis
Nighttime incontinence
(continued)

21. Urinary Incontinence Goal of treatment:
Keep perineum clean, dry, and intact
(continued)

22. Urinary Incontinence Potential treatment: Medications
Pelvic floor exercises
Bladder retraining
Catheter insertion
Surgery

23. 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)

24. Cystitis
Increase fluid intake, acidic foods, and intake and output

25. 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)

26. Pyelonephritis Treatment:
Urine culture/sensitivity testing, antimicrobials, antipyretics, analgesics, increase fluids, intake and output, and daily weight

27. 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)

28. Acute Glomerulonephritis
Treatment:
Drug therapy, fluid restriction, monitor labs, I&O, bed rest, and VS

29. 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)

30. Chronic Glomerulonephritis
Treatment:
Medications, protein and fluid restriction, bed rest, intake and output, VS, and monitor labs, daily weight, and lung sounds

31. 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)

32. Urinary Calculi

33. Urinary Calculi

34. Urinary Calculi Treatment:
Lithotripsy, surgery, analgesics, medications, and dietary changes

35. 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

36. Urinary Bladder Tumors

37. Urinary Bladder Tumors

38. 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

39. 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)

40. Polycystic Kidney Control hypertension
Eventually, may need dialysis or renal transplantation

41. 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

42. Acute Renal Failure (ARF)
Postrenal
Disrupted urine flow
Prerenal
Disrupted blood flow to kidney
Intrarenal
Renal tissue damage
Often reversible if diagnosed early
(continued)

43. 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)

44. Chronic Renal Failure/ESRD
Slow, progressive condition
Kidney’s ability to function ultimately deteriorates
Not reversible
Multisystem disease process
(continued)

45. Chronic Renal Failure/ESRD
Goal:
Preserve remaining kidney function and prevent complications

46. 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

47. Dialysis

48. 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

49. Kidney Patient Guide

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

51. Hypospadias Urethral opening on ventral surface of penis
Surgically corrected during first year of life

52. 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

53. 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)

54. Wilms’ Tumor Avoid palpating tumor Surgery is treatment of choice
Also use chemotherapy and radiation

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

56. Urinary System Acute poststreptococcal glomerulonephritis
Nephrotic syndrome
Enuresis