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45 Cards in this Set
- Front
- Back
What is all included in the urinary system?
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Upper urinary tract
- Kidneys - Ureters Lower urinary tract - Bladder - Urethra |
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Functions of the Kidney
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- Filtration
- Excretion - Fluid and electrolyte balance - RBC production - BP regulation - Bone mineralization |
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Functions of the Kidney (continued)
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- kidney receives 20-25% of cardiac output
- the functional unit is the nephron, which has a glomerulus which actually filters the blood and begins to form urine - 99% of filtrate is reabsorbed - key method for fluid and electrolyte balance -produce erythropoietin = RBC production - Vit D conversion = bone mineralization - produce renin = BP regulation |
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Renin – Angiotensin Pathway
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regulation of BP
- Renal ischemia >> release of renin - Renin conversion pathway results in Angiotensin II -Angiotensin II >> vasoconstriction and release of aldosterone - Aldosterone >> sodium and water retention, potassium and hydrogen excretion - Result is increase in arterial BP and renal bloodflow |
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Anti-Diuretic Hormone (ADH)
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BP Regulation
- Osmoreceptors in hypothalamus - Trigger release of ADH by posterior pituitary - ADH causes renal tubules and collecting ducts to be more permeable -ADH also triggers thirst center |
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Urination(Voiding)
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- Involves voluntary muscles (external sphincter) and involuntary muscles of urethra, plus voluntary muscles of pelvic floor, plus muscles of bladder
-Bladder muscles constrict and urethral muscles relax to permit voiding - Involves upper and lower CNS control: micturition centre in sacral SC, and pontine centre in cerebral cortex |
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Oliguria
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diminished urinary output relative to intake (usually 400mL/24 hours)
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Anuria
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no urine
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Polyuria
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voiding large amounts of urine
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Diuresis
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increased formation of urine by the kidney
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Nocturia
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frequent or excessive urination at night
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Bacteruria
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bacteria in urine
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Urosepsis
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bacteria from urine gets into blood
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Proteinuria
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protein in the urine
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Ketonuria
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ketones in urine
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Residual urine
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volume of urine remaining after voiding (>100mL)
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Hematuria
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Blood in the urine
this could be due to trauma |
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Glycosuria
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sugar in the urine
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Cystitis
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infection of bladder
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Dysuria
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painful or difficult urination
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Pyelonephritis
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kidney infection
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Urinary retention
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accumulation of urine inthe bladder, with inability of bladder to empty fully
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Hydronephrosis
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enlargement of the kidneys due to back pressure
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Factors Influencing Urination
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-Fluid balance
-medications -pelvic floor muscle tone -diagnostic examinations and surgical procedures -psychological factors -disease conditions |
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Disease Conditions Influencing Urination
(Renal Function Affected) |
- Prerenal – decreased bloodflow to kidneys
- Renal – damage to renal tissues -Postrenal – obstruction of urine flow in upper UT system |
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Disease Conditions Influencing Urination
(Urination Affected) |
-Neurological impairment (MS, diabetes, stroke, parkinson’s disease)
-BPH (benign prostatic hypertrophy) -Cognitive impairment (dementia – don’t know) -Impaired mobility – impaired ability to get to bathroom, manipulate clothing, etc. |
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End Stage Renal Disease(ESRD)
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-Severe metabolic disturbance
-Fatal if not treated -Uremic syndrome: nitrogenous wastes in blood, marked fluid & electrolyte imbalance >> nausea, vomiting, headache, convulsions, coma -Hyperkalemia is most severe risk of renal failure -Tx: Conservative: meds, diet & fluid restrictions (b4 dialysis) Daily weight: 1 kg = 1 L of retained fluid Ultimately peritoneal dialysis, then hemodialysis Organ transplant |
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Problems in Urinary Elimination
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Urinary tract infection (UTI)
Urinary incontinence Urinary retention – BPH, cannot pee out, cant sense the pee (neuro or muscular) Renal calculi (kidney stone) – extreme pain; drink lots of water(prevent) |
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Urinary Tract Infection
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Causative organisms – ecoli(80%);
Contributing factors – BPH (M); shorter urethra in females; ABs; anything causing retention; Females versus males - more frequent in females Signs/Symptoms – burning, more often urination, (urgency/frequency); nausea vomiting, fever Urine – cloudy, darker, odour, Kidney infection is painful, elevated temp, fever/chills |
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Infection Control and Catheters
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Nursing measures:
-Prevent reflux -Prevent obstruction of tubing -Maintain sterility of system -Acidify/dilute urine |
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Types of Urinary Incontinence
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-Functional – impairs your ability to go to the bathroom, able to walk or get ready; dementia, osteoarthritis
-Overflow – bladder is still full and it spills out a little bit at a time (overextention of bladder) -Reflex – impaired spinal function & neuro function; can still pee, but you have to get to the toilet – SC still maintains the peeing, but you can’t feel it (ability to void present/ no sensation) -Stress – women who have lots of children; cough and pee -Urge – sudden urge to void now! Usually often -Mixed - usually mix b/w stress and urge -Total – no control |
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Urinary Changes due to Aging
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Prostate enlargement in males
Older adults -Older adults have lots of reasons why they can’t control their urine : cant concentrate urine as effectively; despite some of problems that they have, incontinence is still not considered to be ‘normal’ in aging |
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Nursing Assessment
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-Health history
-Physical assessment -Assessment of urine -Urine testing -Diagnostic examination |
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Assessment
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text p 1091
Nursing health history -Pattern of urination >> bladder diary -Symptoms of urinary alterations -Factors affecting urination -Psychological impact – limit social activities because of incontinence, embarrassment |
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Physical assessment
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-Skin – may have skin breakdown
-Kidneys – ask about pain -Bladder – palpation to assess distension -Female perineum -Male perineum |
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Assessment of urine
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-Intake and output:
Normal adult output – 1500 to 1600 mL / day if drinking adequately Alert if: < 30 mL/hour or no void in 6 to 8 hours or volume > 2000 – 2500 mL/day -Characteristics: color, clarity, odor -Urine testing: specimen collection |
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Common urine tests
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-Urinalysis (U/A)
-Specific gravity – concentration of urine, high specific graviity – concentrated urine means decreased blood flow to kidney, low specific gravity – dilute urine, overhydration, renal disease -Culture – sterile specimen |
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Blood Tests
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- Blood urea nitrogen (BUN) – blood sample, level of urea & nitrogen
- Serum creatinine – increased level means renal dysfunction |
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Normal Urinalysis Values
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pH: 4.6 – 8.0; average 6.0
Protein: none or up to 8 mg/100 mL Glucose: none Ketones: none Blood: up to 2 RBC’s Specific gravity: 1.01. – 1.025 WBC’s: 0 – 4 per low-power field Bacteria: none |
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Diagnostic Tests
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Nursing Care:
-Consents – make sure its signed & on the chart -Allergies – ask for allergy to dye or shellfish -Pre- and post-procedure care --Pre: sometimes NPO, need bowel prep --Post: monitoring condition Notify physician if any abnormalities following invasive procedures -Ultrasound – need to fill bladder prior to -Renal scan – radioisotope tracer used – double flush urine, caution for radioactivity -Endoscopy procedures – eg. nephroscopy, cystoscopy – usually general anesthetic thus precautions with anaesthetic i.e urine output, vitals at regular intervals, encourage fluids |
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Renal Arteriogram (Angiography)
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- Radio-opaque contrast injected through femoral artery into renal arteries >> x-rays taken
- Pre-test: Ask re: allergies to shellfish or iodine - Post-test care: -Watch injection site for bleeding -Monitor vital signs – in case of hemorrhage -Bed rest -Push fluids to flush contrast -Monitor CSM of affected limb |
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Tests Using Iodine Dye
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Intravenous pyelogram (IVP), Retrograde pyelogram, Retrograde urethrogram (males), renal arteriogram, CT scan with contrast
Ask re: allergies to shellfish/iodine Advise re: flushing, metallic taste Post-test: Push fluids to flush dye out, observe for allergic reaction |
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Continuous Bladder Irrigation (CBI)
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- Used after some urological surgeries or procedures
-Triple lumen catheter permits irrigation fluid to enter catheter and flush UT system, then drain out Nursing care: -Maintain flow of irrigation -Maintain sterility of system -Monitor for signs of obstruction or hemorrhage |
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Nursing Interventions: Restorative Care
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-Lifestyle modification – avoiding caffeine, smoking, weight loss, use of incontinence products
-Bladder training – establishing a voiding schedule > every 3-4 hours, goal is increase bladder capacity -Habit retraining and prompted voiding – prompt them to go, take them to the toilet like reminding a kid to go -Self-catheterization – at home clean procedure is used rather than sterile -Kegel exercises |
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Kegel Exercises
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- Improve strength of pelvic floor muscles
- Stress incontinence -Other causes of urinary incontinence - Client tightens/raises pelvic floor and holds for ten seconds, then relaxes, repeating x 10 -Do not do while voiding |