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Anatomy urinary tract proplems&stons


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Anatomy urinary tract proplems&stons

  1. 1. Urinary tract problems:Outlines:DefinitionPrimary problems in kidney and bladder:diseasesOliguria- Polyuria- Nocturia-Dysuria- Enuresis-Urinary incontinence- Pain-Hematuria- Leukocyturia-Pyuria- Proteinuria- Bacteriuria-
  2. 2. Disorders of the bladder, kidney, :urinary tractCystitis, Urethritis - Acute pyelonephritis- - Pyelonephritis- Abscesses in the region of the kidneys - Glomerulonephritis - Kidney stones-  Acute renal failure- Chronic renal insufficiency -  Renal tumors- 
  3. 3. Overview The urinary system is the organ system that produces, stores, and eliminates urine. Inhumans it includes two kidneys, two ureters,the bladder, and the urethra. The analogousorgan in invertebrates is the nephridium (in(. animalsPhysiology 
  4. 4. The kidneys are bean-shaped organs about the size of a bar of soap. Thekidneys lie in the abdomen, posterior orretroperitoneal to the organs ofdigestion, around or just below the. lumbar spine ribcage and close to theThe kidneys are surrounded by what is called peri-nephric fat, and situated on the superior pole of each kidney is an. adrenal gland
  5. 5. The kidneys receive their blood supply of 1.25 L/min (25% of the cardiac output(from the renal arteries which are fedby the Abdominal aorta. This isimportant because the kidneys mainrole is to filter water soluble wasteproducts from the blood. the ureters,which lies more medial and runs.bladder down to the trigone of the
  6. 6. Functional the kidneys it concentrates urine, plays a crucial role in regulating electrolytes, and.acid-base homeostasis maintainsThe kidney excretes and re-absorbs electrolytes (e.g. sodium, potassiumand calcium) under the influence of. hormones local and systemic
  7. 7. balance is regulated by the pH excretion of bound acids and. ammonium ionsthey remove urea, a nitrogenous waste product from the metabolism. amino acids of proteins fromThe end point is a hyperosmolar solution carrying waste for storage. urination in the bladder prior to
  8. 8. :Definition :Altered URINARY ELIMINATION* , Urinary frequency, Nocturia, Urgency Dysuria , Hesitancy, Enuresis , :Retention , Incontinenceliguria: Amount– of urine eliminated 100(ml ( normal urinary output 1 L1.5 500 ,Anuria : Elimination of less than 100 ml oliguria usually precedes
  9. 9. Causes:-Cardinal symptoms of acute renal failure . Obstructive uropathy (e.g-  enlarged prostate) - Dehydration , -  frequent in the elderly because of too little fluid intake -  diarrhea or -vomiting-  s - long term bladder catheterization  Important : Anuria is an emergency  situation and requires hospitalization
  10. 10. :Polyuria Definition : urinary output of more than 3 liters Causes - Most frequent cause : Hyperglycemia (glucose( in Diabetes mellitusSpecific phases in acute or chronic R - F Pollakiuria:Definition :-Frequent urge tourinate, low output volume, normal outputvolume within 24 hoursCauses: - Urinary tract infection or irritable  bladder -possibly bladder tumorIn males, enlargement of the - prostate
  11. 11. )Nighttime Urination ( Nocturia Definition :Increase nighttime urination Causes- Cardiac insufficiency , kidney  diseasesLarge quantities of liquids taken in -  the evening; use of diureticsComplications during urination )( DysuriaDefinition:Difficulty on urination with pain or burningCauses  Urinary tract infection - Tumors in the bladder and /or - 
  12. 12. White blood cells in the urine (( Leukocyturia: Definition Pathological elimination of red blood cells (leukocytes( in the urineCauses: Urinary tract infection (Pus in the urine (pyuria Definition: Pus, cloudiness, and streaks in the urineCauses: Severe inflammation of the kidneys and urinary tract
  13. 13. (Urinary Retention ( Anuresis Definition: Urination impossible  despite full bladderCauses Enlargement of prostate, - obstruction by calculiTumors of the urethra and / or -  bladder near urethra openingDisorders of the nerve supply - – to the bladder (disk prolapsed 
  14. 14. Blood in the urine ( Hematuria )  Pathological blood cells with urineelimination of red Causes- Tumors , calculi, and  inflammation of kidneys and bladder ,Increased bleeding tendency-  , glomerulonephritis Renal tuberculosis enlarged prostate Foods and medicines may also color- the urine red
  15. 15.  The process of urine formation: 3 steps includes. 1- Glomerular filtration: Filtration of the plasma a by glomerular as water, Na, Urea, Cl, bicarbonate, K, Glucose , creatinine & Uric acid 2) Tubular reabsorption. The filtrate enters. Bowmans capsule through tubular system of the nephron & either reabsorbed or excreted as urine 3) Tubular secretions the formed urine drains from the collecting tubules into renal pelvis & down to ureter. Then to the bladder. ]
  16. 16.  Assessment of patients with urinary dysfunction: History: The nurse obtain baseline data concerning a) general health, childhood , chronic family illness , D.M past medical history, allergies, sexual & reproductive health, exposure to toxic chemicals or gas b) History of present complain c) Assess risk factors for renal disorder d) Medication history. E) Persons usual voiding patterns as frequency and amount of urine F) Urine characteristics e.g., hematuria risk.
  17. 17. Physical examination: a) Inspection) includes, abdominal scars, abdominalmovement & pulsation, inspection of backfor bulging & bruising, b) Ascult theabdominal for bruits. (abnormal vascularsounds of blood vessels) C) Percussionabove symphysis pubis and toward thebladder (lymphatic or adult sound hered)d) palpation: palpate suprapubic area,assessing the kidneys for tenderness orpain by lightly striking the first at the). costovertebral angle (pain tenderness
  18. 18.  urine specimens for culture and sensitivity to identify organisms are usually midstream specimen (MSU) or catheter specimen of urine. 24 how urine collection: is the collection of the total volume of urine voided in 24 hrs period used in diagnosis of renal tones & impaired renal function. Urine specific gravity: to assess kidney ability to concentrate
  19. 19.  B) Blood tests: Include, Hemoglobin, WBCs, urea, creatinine & electrolyte estimation e.g., 9Na, potassium, chloride, bicarbonate, calcium & phosphorus). Liver function tests, blood group & Clotting screen. C) Radiological investigation; i- Plain X-ray of (KUB). ii- Intravenous urogram (IVU) iii- Renal scanning . iv- Computerized tomography (Ct scanning) V- ultrasound scan , VI- Cystoscop VII- Renal
  20. 20.  Assessing the chief complaint Voiding changes or disturbances . Urine volume changes. Irrigative voiding symptoms (frequency, urgency, nocturia, dysuria) Obstructive voiding symptoms (hesitancy, straining residual urine, retention, urinary stream forece and size). Urinary incontinence (toal overflow, stress, urge, functional ) Urine characteristics changes (color, hematuria, darity, odor, pH).
  21. 21. A) Preoperative nursing care the assessment under taken withinclude: observation of the patient,recording baseline observation(temp, p, R, B.p, unanalyzed & WT)medical / surgical history, pain,breathing eating / drinking , level ofindependence / dependence,imbecility problems, elimination ,sleeping, Body image GIT symptoms(nausea & vomiting ) and assess for. pain renal colic
  22. 22. Post operative Ng-care: Maintain safe environment pain control /communication breathing,elimination (I & O chart), eating &dinking (I.V fluid replacement & dietgradually when bowel complicationsas (hemorrhage / shock,pneumothorax, chest infection,wound infection , UTI due touretheral catheter & deep vein. thrombosis (DUT) due to immobility
  23. 23.  Patient education on discharge: Rest & activity: Return to normal routine in 3-4 wks. Wound healing: observe s & s of w. infection as (redness, discharge.) applied appropriate dressing. Elimination: drink 2 L / 42 hrs.Return to work : depend on type of work a manual sedentary work has alonger period of convalescence than a
  24. 24.  Risk factor for various renal or urologic disorders Risk factor Possible renal or urologic disorder Childhood diseases step throat impetigo, Nephrotic syndrome
  25. 25.  Chronic renal failure Advanced age Incomplete emptying of bladder, leading to urinary tract infection Instrumentation of urinary tract cystoxicity, catheterization Immobilization
  26. 26.  Kidney stone formation Occupational, recreational or environmental exposure to chemicals plastics, patch, tar rubber) Acute renal failure Diabetes mellitus Chronic renal failure , Neurogenic bladder
  27. 27. Kidney Stones dr/ amany lotfy 
  28. 28. Kidney Stones Formation of concretions in the urinary tract, frequently with( cramp-like pains (colicStones formed when urine is supersaturated with a stoneforming salt 
  29. 29. Causes Small crystals form when- 1• there is excessive concentration ofcertain urine components: theybecome larger, e.g. Calcium-containing stones (calcium oxalateor Phosphate(; uric acid calculiBacterial infection and urinary- 2 retention
  30. 30. :-signs &Symptoms Difficult urination, blood in the urine• ((injuries caused by calculi, Nausea, vomiting• .persistent pain• constant irritation of the renal -  mucosaInflammation and permanent - damage, as serious Kidney with.chronic renal failure
  31. 31. signs &Symptoms Dysuria: burning on urination when passing stones (rare). More typical of infection. Oliguria: reduced urinary volume caused by obstruction of the bladder or urethra by stone, or extremely rarely, simultaneous obstruction of both ureters by a stone. Pyuria: pus (white blood cells) in the urine. Abdominal distension. Loss of appetite Loss of weight
  32. 32. :Risk factors The exact cause of stone formation is , unknownSocioeconomic factors, renal stones are more common in industrialized. countriesDiet, intake of foods high in purine, calcium, and oxalate. level of activity,Persons who have a sedentary lifestyleor limited mobility, because of calciumloss from bones combined with urinary. stasis
  33. 33. Climate, persons lived in warm weather develop calculi, to be aresult of higher chance forDehydration and more.concentrated urine,Positive family history Hypercalceamia (high concentration of blood calciumcompounds)  Hypercalciuria (concentration of calcium in urin
  34. 34. Hypercalceamia (high concentration of blood calcium compounds) hypercalciuria (concentration ofcalcium in urine)  precipitation of.calcium and formation of renal stones: Hypercalacemia may be caused by .  Hyperparathyroidism .  Excessive intake of vitamin C or D .  Antacids. Renal tubular acidosis   Excessive intake of milk 
  35. 35. :Types of urinary calculi :such as . Uric Acid-1 . Cystine stones-2 . Calcium oxalate-3 . Calcium phosphate-4 . Magnesium phosphate-5 Struvite stones (ammonio--6  )managesium phosphate stones
  36. 36. Types of calculicalcium stones (Ca++ in complex with oxalate or phosphate orboth) – most common stone)triple (Mg NH4 PO4 struvite stones – quite common uric acid stones – 5% cystine or pure oxalate stones - inborn errors of metabolism
  37. 37. ?How urine PH affected calculus formation Normally the PH or urine fluctuates from slightly acidic to slightly alkaline over 24hrs period. If urine PH is consistentlyacidic or alkaline, the urine provides a. medium suitable for stone formationAcidic urine:  promotes formation of . cystine and uric acid calculiAlkaline urine:  promotes formation of calcium phosphate & ammonic. magnesium phosphate calculiN.B: Calcium oxalate calculi can form in .urine of varying PH
  38. 38. DiagnosisPhysical examination the location and severity of the pain ,-1 &which is typically colicky in naturein spasmodic waves). Pain in the back ( . &produce an obstruction in the kidneyDiagnostics Investigation X-rays.1 radio-opaque and they can be detected by a traditional X-ray of the abdomen thatincludes the Kidneys, Ureters and Bladder.KUB—
  39. 39. Diagnostics InvestigationIntravenous Pyelogram; Urogram( 2- IVP ).(IntraVenous(IVUAbout 50 ml of a special dye to be injectedinto the bloodstream that is excreted bythe kidneys and by its density helpsoutline an stone on a repeated X-rayComputed tomography.2 All stones are detectable by CT except veryrare stones
  40. 40. Diagnostics InvestigationUltrasound.3 As it gives details about the presence of hydronephrosis (swelling of the kidney— suggesting the stone is blocking the outflow(.of urineUsed to detect stones during pregnancy .when x-rays or CT are discouraged
  41. 41.  Microscopic study of urine, which may show proteins, red blood cells, bacteria, cellular casts and crystals. Culture of a urine sample to exclude urine infection (either as a differential cause of the patients pain, or secondary to the presence of a stone( Blood tests: Full blood count for the presence of a raised white cell count ( Neutrophilia( suggestive of infection, a check of renal function & abnormally high blood calcium blood levels hypercalcaemia(.
  42. 42.  24 hour urine collection to measure total daily urinary volume, magnesium, sodium, uric acid, calcium, citrate, oxalate and phosphate. Catching of passed stones at home (usually by urinating through a tea strainer or stone screen( for later examination and evaluation by a doctor.
  43. 43. :Medical intervention , two primary goals  removing the calculi-1  preventing recurrence-2 through correcting calculus-induced pathophysiologic changes,eliminating urinary infection and( . preventing renal damage
  44. 44. : Conservative treatmentof stones 4 mm or less in size 90% pass spontaneously without medical. interventionA- Treatment pain, nausea, and vomitingB-if it the stone is not moving fluid , therapy is neededC- pain management, antibiotics to prevent or treat infection caused by
  45. 45. Urologic interventions Surgery is necessary when the pain is-  persistent and severe non-invasive extracorporeal shock wave lithotripsy((ESWLUreteroscopic fragmentation laser, ultrasonic or mechanical (pneumatic,shock-wave( forms of energy to fragment.the larger stonesPercutaneous nephrolithotomy open surgerymay be necessary for large or complicated
  46. 46. : Nursing management Assessment A( History taken; ask the patient . about; 1. Prior stone formationRisk factors. .3- location, character, and . 2 duration for current pain. 4. Current andprevious radiation: B( Physical examination which include) Vital signs include increase pulse, respiration, . 1 and blood pressure associated with colicky pain;. fever indicates serious infectionHyperactive bowel sounds occur with nausea .2 .and vomiting hypoactive or absent bowel sounds
  47. 47. ; Nursing diagnosis Pain R / T irritation by presence of-1 . obstruction, or movement of the stoneKnowledge deficit R /T Unfamiliarity-2 with factors related to development ofurolithiasis, management, need for longterm management, diet therapyaccording to type of stone, or need for. prevention of recurrence of urolithiasisHigh risk for infection R /T Urinary-3 stasis, instrumentation of urinary tract,, surgical incision
  48. 48. :Nursing intervention Releive of pain &Administer-1  prescribed narcotic or analgesicapply hot application to the pain area my relieve pain&encourage and assist the patient to ambulate to "free" the stoneSupply fluid intake sufficient to-2 urinary output of approximately 2000 ml to 30000 ml per day: Health teaching-3 Assesses the patients understanding of . common risk factors. proper diet
  49. 49. A-Teach patients the following . regarding dietFor patients with stones R/T. 1 : hypecalciumaCalcium intake should be limited (diary products, beans, nuts, andchocolate,VitaminD
  50. 50. For patients with stones related to-2 uric acid, an alkaline ash diet isrecommended. include diary products;fruits, except cranberries, plums, andpurnes and vegetables especially.beansfor patients with Oxalates stones,-3 foods encouraged on an acid ash dietinclude meat, eggs, poultry, fish,cereals, and most fruits and vegetables
  51. 51. B-Teach patient about medications used to prevent therecurrence of renal stonessuch as sodium cellulose phosphate (SCP), which binds calcium so that GI .absorption of calcium is decreasedCholestyamine binds oxalate and - enhances GI excretion and allopurinol. reduce uric acid production 
  52. 52. B-Teach patient about medicationsthiazides, potassium citrate, magnesium citrate and allopurinol,(Zyloprim( depending on the cause. of stone formation Potassium citrate is also used in kidney . stone prevention increases urinary pH which helps reduce .calcium oxalate crystal
  53. 53. C-Teach patient to increase activity to prevent .stasis of urineD-Teach patient to report any of the following signs ofinfection; nausea, vomiting,chills; change in appearance. or odor of urine
  54. 54. :Follow up care After all treatment modalities the patient should be closely monitored forsigns of infection, renal dysfunction,-1 . bleedingpostoperative serum electrolyte -2 evaluations, 3-CBC counts and creatininestudiesContinuous appropriate parentrally-4 administered antibiotic. If an indwelling ureteral stent was placedinfectious complications,( Pyelonephritis-5 