Power Point Presentation for Practical Nurse Course

1. THE URINARY SYSTEM
PATRICIA N. HARRINGTON, RN
DEWIT, S. & KUMAGAI, C.
MEDICAL-SURGICAL NURSING, CONCEPTS & PRACTICE (2ND ED.)
CHAPTERS 34 AND 35

2. ANATOMY AND PHYSIOLOGY

3. STRUCTURES OF THE URINARY TRACT
KIDNEYS, URETERS, URINARY BLADDER AND URETHRA
KIDNEYS:
1) BEAN-SHAPED ORGANS LOCATED ON EITHER SIDES FIRST LUMBAR VERTEBRA
2) LAYERS: CORTEX (OUTER): BLOOD VESSELS AND NEPHRONS
MEDULLA (INNER): COLLECTING TUBULES
PELVIS: GATHERS URINE AND SENDS IT TO THE BLADDER

4. STRUCTURES OF THE URINARY TRACT

5. STRUCTURES OF THE URINARY TRACT
NEPHRON
1) FUNCTIONAL UNIT OF THE KIDNEY
2) 1 MILLION NEPHRONS IN A KIDNEY
3) CONSISTS OF GLOMERULUS (BOWMAN’S CAPSULE) AND THE TUBULAR SYSTEM
4) SECRETES AND REABSORBS IONS, FLUIDS, WASTES, ELECTROLYTES, ACIDS,
AND BASES

6. STRUCTURES OF THE URINARY TRACT

7. STRUCTURES OF THE URINARY TRACT
TUBULAR SYSTEM:
1) PROXIMAL CONVOLUTED TUBULE, LOOP HENLE, THE DISTAL CONVOLUTED
TUBULE, AND THE COLLECTING DUCT
2) FILTERED FLUID IS CONVERTED TO URINE IN THE TUBULES, MOVES TO THE
PELVIS OF THE KIDNEY
3) URINE IS TRANSPORTED FROM THE KIDNEYS BY THE URETERS TO THE
BLADDER

8. STRUCTURES OF THE URINARY TRACT
BLADDER:
1) HOLLOW, MUSCULAR ORGAN
2) RESERVOIR FOR URINE
3) LINED WITH MUCOUS MEMBRANES
4) SMOOTH MUSCLES (DETRUSOR) HELPS TO DISTEND AND CONTRACT TO ACCOMMODATE
URINE VOLUMES
5) URETEROVESICAL SPHINCTER PREVENTS REFLUX OF URINE FROM THE BLADDER TO THE
KIDNEY; EXTERNAL URETHRAL SPHINCTER CONTROLS THE RELEASE OF URINE TO THE
OUTSIDE
6) HOLDS UP TO 1 LITER OF URINE

9. STRUCTURES OF URINARY TRACT

10. STRUCTURES OF THE URINARY TRACT
BLOOD FLOW:
1) BLOOD IS BROUGHT TO THE KIDNEYS BY THE RENAL ARTERY
2) BLOOD IS RETURNED TO THE INFERIOR VENA CAVA BY VEINS

11. FUNCTIONS
KIDNEYS:
1) REGULATE FLUID AND ELECTROLYTES BY FILTRATION AND REABSORPTION; MAINTAINS ACID-BASE
BALANCE
2) ELIMINATE WASTE PRODUCTS, SUCH AS, CREATININE AND BUN, BY FILTRATION
3) NEPHRON FILTERS BLOOD PLASMA; 200 L/24 HOURS; 1.5L – 2L OF URINE IS PRODUCED AND
EXCRETED
4) GLOMERULAR FILTRATION RATE (GFR) IS THE AMOUNT OF BLOOD FILTERED BY THE NEPHRON
(125ML/MIN)
5) REGULATE FLUIDS BY FILTRATION, REABSORPTION, AND EXCRETION
6) EXCRETE BACTERIAL TOXINS, WATER-SOLUBLE DRUGS, AND DRUG METABOLITES
7) REGULATE BLOOD PRESSURE THROUGH THE RENIN-ANGIOTENSIN SYSTEM
8) PRODUCE ERYTHROPOIETIN WHICH STIMULATES RED BLOOD CELL PRODUCTION

12. FUNCTION
URETERS, BLADDER AND URETHRA:
1) URETERS CARRY URINE FROM THE KIDNEY TO THE BLADDER; 25 CM. LONG
2) BLADDER CAPACITY IS APPROXIMATELY 1000 – 1800 ML
3) SIGNAL TO VOID OCCURS WITH THE COLLECTION OF ABOUT 150 -200 ML OF
URINE
4) URINE PASSES FROM THE BLADDER TO THE URETHRA TO THE OUTSIDE
5) FLOW IS CONTROLLED BY THE INTERNAL AND EXTERNAL SPHINCTERS

13. FUNCTIONS

14. NCLEX QUESTION
A NURSE IS REVIEWING THE CLIENT’S RECORD AND NOTES THAT THE PHYSICIAN
HAS DOCUMENTED THAT THE CLIENT HAS A RENAL DISORDER. ON REVIEW OF
THE LABORATORY RESULTS, THE NURSE WOULD MOST LIKELY EXPECT TO NOTE
WHICH OF THE FOLLOWING?
1. DECREASED HEMOGLOBIN LEVEL
2. DECREASED RED BLOOD CELL (RBC) COUNT
3. DECREASED WHITE BLOOD CELL (WBC) COUNT
4. ELEVATED BLOOD UREA NITROGEN (BUN) LEVEL

15. NCLEX QUESTION
4. BLOOD UREA NITROGEN LEVEL
THE BUN IS A FREQUENTLY ORDERED TEST USED TO DETERMINE RENAL
FUNCTION. THE BUN STARTS TO RISE WHEN THE GLOMERULAR RATE FALLS

16. GERIATRIC CHANGES
 FUNCTION AND BLOOD FLOW DECREASES
 MALES: PROSTATE GLAND ENLARGES CAUSING VARYING DEGREES OF OBSTRUCTION RESULTING IN
PROBLEMS WITH URINARY FLOW AND RETENTION
 RENIN, ALDOSTERONE AND VITAMIN D LEVELS ARE DECREASED
 BLADDER MUSCLE (DETRUSOR) CHANGES RESULTING IN INCOMPLETE BLADDER EMPTYING AND
URINARY INCONTINENCE
 DECREASE IN BLADDER CAPACITY
 NOCTURIA
 WOMEN: DECREASES OF ESTROGEN RESULTING IN ATROPHY OF STRUCTURES LEADING TO
INFECTION AND INCONTINENCE

17. GERIATRIC CHANGES

18. DISORDERS OF THE URINARY SYSTEM
CAUSES
1) INFECTION
2) INFLAMMATION
3) OBSTRUCTIONS DUE TO STONES OR TUMORS
4) DRUGS
5) BLOOD PRESSURE CHANGES
6) CORONARY ARTERY DISEASE
7) DIABETES
8) SHOCK

19. PREVENTION AND HEALTH MAINTENANCE
ENCOURAGE ADEQUATE FLUID INTAKE OF AT LEAST 2L-2.5L/DAY
TEACH CLIENTS WITH HTN AND DM TO BE COMPLIANT WITH MEDICATION,
THERAPEUTIC DIETS, AND EXERCISE
PROMOTE GOOD BLADDER HEALTH; PROMPT BLADDER EMPTYING
TEACH CLIENTS ABOUT SIDE-EFFECTS OF MEDICATIONS THAT MY CAUSE INJURY
TO THE KIDNEYS; SOME ANTIBIOTICS, ANTIHYPERTENSIVES AND DIURETICS
AVOID EXCESSIVE USE OF OTC MEDS; NSAIDS AND TYLENOL

20. QUESTION
WHAT IS THE FIRST ACTION THAT THE NURSE SHOULD TAKE TO ASSIST THE
CLIENT TO DEVELOP A TOILETING SCHEDULE?
1. ENCOURAGE USE OF CONDOM CATHETERS OR INCONTINENCE PADS.
2. ASSESS PATTERN OF INCONTINENCE
3. SCHEDULE TRIPS TO THE BATHROOM
4. PROVIDE POSITIVE REINFORCEMENT FOR SMALL SUCCESSES

21. QUESTION
ANSWER: 2
ALWAYS USE THE NURSING PROCESS. ASSESSMENT IS THE FIRST STEP IN THE
NURSING PROCESS!

22. DIAGNOSTIC TESTS AND PROCEDURES
1) BLOOD TESTS: CBC, BUN, SERUM CREATININE, AND CREATININE CLEARANCE
2) BUN AND CREATININE ARE MOST FREQUENTLY USED TO DETERMINE KIDNEY
FUNCTION. BUN AND CREATININE WILL RISE PROPORTIONATELY.
NORMAL VALUES:
BUN (10-20 MG/DL)
CREATININE (0.6-1.2 MG/DL)

23. DIAGNOSTIC TESTS AND PROCEDURES
1) RADIOLOGIC EXAM (KUB, IVP, MRI, CT) USED TO VIEW THE KIDNEYS, URETERS
AND BLADDER TO DETECT STRUCTURAL ABNORMALITIES, STONES AND OTHER
OBSTRUCTIONS
2) ANGIOPLASTY: USED TO ASSESS FOR AND RELIEVE BLOCKAGES IN THE RENAL
ARTERIES
3) CYSTOSCOPY: ENDOSCOPIC EXAMINATION OF THE INTERIOR OF THE BLADDER
4) BIOPSY: REMOVAL OF TISSUE TO DIAGNOSE RENAL DISEASE; CANCER OR
ORGAN REJECTION
5) CYSTOMETROGRAPHY (CMG): TEST USED TO MEASURE URODYNAMICS,
PRESSURE, SENSATIONS, VOLUME AND FLOW

24. NCLEX QUESTION
A NURSE IS CARING FOR THE CLIENT WHO HAS A RENAL BIOPSY. WHICH
INTERVENTION WOULD THE NURSE AVOID IN THE CARE OF THE CLIENT AFTER
THIS PROCEDURE?
1. ADMINISTERING PAIN MEDICATIONS AS PRESCRIBED
2. ENCOURAGING FLUIDS TO AT LEAST 3L IN THE FIRST 24 HOURS.
3. LIE ON BACK FOR 6-24 HOURS FOLLOWING THE PROCEDURE
4. AMBULATING THE CLIENT IN THE ROOM AND ALL FOR SHORT DISTANCES

25. NCLEX QUESTION
ANSWER: 4
PAIN AND BLEEDING ARE EXPECTED FOLLOWING THE PROCEDURE. FLUIDS ARE
ENCOURAGED FOLLOWING THE PROCEDURE TO FLUSH THE SYSTEM. BED REST IS
ORDERED TO REDUCE THE POSSIBILITY OF BLEEDING AND HEMORRHAGE.

26. NURSING MANAGEMENT
ASSESSMENT:
HISTORY OF UTI’S, SURGERY, CAD, DM, KIDNEY STONES
MEDICATION HISTORY
OCCUPATIONAL EXPOSURE
SEXUALLY TRANSMITTED INFECTIONS
URINARY FUNCTION AND PATTERNS
PHYSICAL EXAMINATION

27. PHYSICAL ASSESSMENT
SIGNS AND SYMPTOMS:
HEMATURIA: MICROSCOPIC OR GROSS BLOOD IN THE URINE
PROTEINURIA: HIGH PROTEIN FOUND IN THE URINE
PNEUMATURIA: GAS IN THE URINE (SUGGESTS FISTULA BETWEEN THE
VAGINA/BOWEL AND THE BLADDER
CHANGES IN VOIDING PATTERNS
PAIN AND DISCOMFORT

28. NCLEX QUESTION
WHEN STARTING A 24-HOUR URINE COLLECTION, WHAT IS ESSENTIAL IN ORDER
TO ENSURE CORRECT RESULTS?
1. INCLUDE THE FIRST VOID OF THE 24-HOUR PERIOD
2. RECORD THE TIME OF THE INITIAL VOID AS THE START TIME OF THE TEST.
3. DISCARD THE LAST VOID OF THE 24-HOUR PERIOD.
4. ENCOURAGE FLUID INTAKE BEFORE STARTING THE TEST.

29. NCLEX QUESTION
ANSWER: 2
REVIEW PAGE 768 CLINICAL CUES!

30. ASSESSMENT
PAIN:
1) ASSESS LOCATION OF PAIN; OVER BLADDER OR FLANK PAIN
2) CHARACTERISTICS OF THE PAIN; DYSURIA
3) FREQUENCY OF PAIN
4) MEASURES TO RELIEVE THE PAIN
5) WHAT FACTORS INTENSIFY THE PAIN

31. INTERVENTIONS
1) MONITORING MEDICATIONS EFFECTS AND SIDE EFFECTS
2) MONITORING INTAKE AND OUTPUT
3) MAINTAIN STERILE TECHNIQUE WITH CATHETER INSERTION
4) PREVENTION OF CATHETER-ASSOCIATED UTI’S (CAUTI)
5) ENCOURAGE FLUID INTAKE TO 3L/DAY IF NOT CONTRAINDICATED
6) KEEP DRAINAGE SYSTEM INTAKE
7) DISCONTINUE CATHETER AS SOON AS POSSIBLE

32. URINARY INCONTINENCE
ETIOLOGY AND PATHOPHYSIOLOGY:
1) COMMON IN INSTITUTIONALIZED PATIENTS
2) WOMEN HAVING MULTIPLE BIRTHS
3) MEN WITH HISTORY OF PROSTATE ENLARGEMENT
4) INDIVIDUALS WITH SPINAL CORD INJURIES, DEMENTIA, FUNCTIONAL
DISORDERS
5) UTI’S, OBESITY, MEDICATIONS

33. URINARY INCONTINENCE
PATHOPHYSIOLOGY:
• LOSS OF SPHINCTER CONTROL
• LOSS OF MUSCLE TONE
• TYPES: URGE, STRESS, MIXED, OVERFLOW, FUNCTIONAL, OR
INCONTINENCE DUE TO NEUROLOGICAL PROBLEMS

34. URINARY INCONTINENCE
URGE INCONTINENCE: INVOLUNTARY LOSS OF CONTROL WHEN THERE IS AN URGE
(URGENCY)
STRESS INCONTINENCE: URETHRAL SPHINCTER FAILS WITH AN INCREASE IN
ABDOMINAL PRESSURE, LAUGHING, SNEEZING, COUGHING, AND EXERCISE
OVERFLOW INCONTINENCE: POOR CONTRACTILITY OF THE MUSCLES OR
OBSTRUCTION OF THE URETHRA WITH BPH OR PROLAPSE
FUNCTIONAL INCONTINENCE: COGNITIVE PROBLEMS, RESTRAINTS, INABILITY TO
GET TO THE BATHROOM, UNABLE TO MANAGE CLOTHING INDEPENDENTLY
NEUROLOGICAL INCONTINENCE: MULTIPLE SCLEROSIS, SPINAL CORD INJURY,
STROKE

35. INCONTINENCE
DIAGNOSIS:
1) COMPLETE PHYSICAL HISTORY AND ASSESSMENT
2) URINALYSIS AND CULTURES TO RULE OUT INFECTION
3) POST RESIDUAL VOIDS, URODYNAMIC STUDIES, CYSTOSCOPY, OR CYSTOGRAM

36. INCONTINENCE
TREATMENT:
1) KEGEL EXERCISES
2) MEDICATIONS: PRO-BANTHINE, DITROPAN, DETROL, TOFRANIL, VESICARE,
BOTOX, FLOMAX
3) SURGICAL PROCEDURES: MARSHALL-MARCHETTI-KRANTZ, ARTIFICIAL
SPHINCTER IMPLANT
4) CATHETERIZATION
5) USE OF PROTECTIVE GARMENTS

37. INCONTINENCE
NURSING CARE:
1) HONEST AND SENSITIVE APPROACH
2) ESTABLISH RAPPORT
3) ESTABLISH A TOILETING SCHEDULE
4) GOOD HYGIENE AND SKIN CARE
5) AVOID BLADDER STIMULANTS; CAFFEINE AND ALCOHOL
6) SPACE OUT FLUIDS

38. URINARY RETENTION
1) ACUTE: POST SURGICAL, CATHETER REMOVAL, MEDS
2) CHRONIC: NEUROLOGICAL DISORDERS, CONFUSION, OUTFLOW OBSTRUCTIONS
3) TREATMENT: INTERMITTENT CATHETERIZATION (IN-OUT STRAIGHT CATH)
TOILETING
MEDICATIONS: FLOMAX, CARDURA, PROSCAR

39. NCLEX QUESTION
WHICH ACTION BY A NURSE ASSISTANCE INDICATES INADEQUATE KNOWLEDGE
REGARDING INDWELLING CATHETER CARE?
1. KEEPING THE DRAINAGE BAG BELOW THE LEVEL OF THE INSERTION SITE
2. USING ASEPTIC TECHNIQUE TO EMPTY THE DRAINAGE BAG
3. PLACING THE DRAINAGE ON THE BED WHEN REPOSITIONING THE PATIENT
4. PERFORMING THE PERINEAL CARE AT LEAST TWICE DAILY

40. NCLEX QUESTION
ANSWER: 3
REVIEW PAGE 776 BOX 34-3 FOR REVIEW