Urinary A&P & Assessment
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What can cause plasma proteins & blood cells to pass into the urine?
increased capillary permeability that may be caused by man y renal diseases
Function of the proximal convoluted tubule?
reabsorption (back to body) of nutrients: most electrolytes & all glucose, amino acids, and small proteins
secretion (out of body) of: H+ ions & creatinine
Function of loop of Henle?
water conservation - concentration of urine
reabsorbtion of Cl- & some Na+
Function of distal convoluted tubules?
final regulation of water & pH balance
How is reabsorption of water performed in the distal convoluted tubule?
ADH is required for water reabsorption -> makes tubules permeable to water
What area of the nephron is responsive to aldosterone?
What are aldosterone's effects?
What 2 things affect aldosterone secretion?
distal convoluted tubules
reabsorption of Na+ & water & excretion of K+
blood volume & Na+ & K+ concentrations
Kidneys acid/base function?
Normal blood pH?
reabsorbing (back into body) bicarb (HCO3) & excreting excess H+
7.35 - 7.45
atrial natriuretic peptide - hormone released from R atrium of heart in response to atrial distention r/t increase in BV -> inhibits renin, ADH, & action of angiotensin II/aldosterone -> large volume of dilute urine
also causes relaxation of BV -> increases GFR
2 roles of renal tubules in Ca balance?
How does renal failure affect this?
- 1. PTH works on renal tubules to increase Ca reabsorption & decrease reabsorption of phosphate
- 2. converts vitamin D to active form -> vitamin D needed for Ca+ absorption in GI
person with renal failure will have Ca & phosphate imbalances
Kidney funtion in blood cell production?
How does renal failure affect this?
produces erythropoietin in response to hypoxia & decreased renal blood flow -> stimulates RBC production
renal failure can cause anemia
When is renin secreted & what effects does it have?
released in response to decreased renal perfusion, decreased arterial blood pressure, decreased ECF, decreased serum Na+ conc. & increased urinary Na+ conc.
renin -> angiotensin I -> I converted to angiotensin II by ACE -> stimulates aldosterone secretion -> Na+ & water retension & vasoconstriction
2 primary prostaglandins produced by the kidney?
PGE2 & PGI2
- 1. vasodialtion -> increase renal BF
- 2. promote Na+ excretion
- 3. counteract vasoconstrictor effect of substances: angiotensin & NE
carry urine from the kidneys to bladder
point where each ureter joins the renal pelvis
point where each ureter joins the bladder
Where do most urinary obstructions occur?
at the ureteropelvic junctions & ureterovesical junctions b/c they are the narrowest part of the ureteral lumens
acute pain that can occur with passage of a stone or clot
Normal adult urine output per day?
____ mL of urine in the bladder causes moderate distention & the urge to urinate
600 to 1000mL
Length of F & M urethra?
- F: 1-2inches
- M: 8 to 10 inches
Urethrovesical unit is includes the ___, ____, & ___ ____ _____.
What is its function?
bladder, urethra, & pelvic floor muscles
voluntary control of urination/continence
Stimulation of urination?
What areas of the spinal cord are involved?
distention of bladder -> stretch receptors in bladder -> brain -> spinal cord -> desire to urinate
T11 to L2 & S2 to S4
How can neurological disorders affect urinary system?
What medical conditions can cause this?
any disease/trauma that affects brain, spinal cord, or innervation of GU system can affect bladder function
DM, MS, paralysis/paraplegia, drugs that affect nerve transmission
Effects of aging on the urinary system?
In F & M?
- 1. decreased amount of renal tissue (starts decreasing at age 30)
- 2. decreased glomeruli functioning: decreased # of nephrons & renal BV/BF
- 3. decreased function of nephron tubules
- 4. alterations in hormone levels -> decreased concentrating ability, alterations in excretion of water & electrolytes (ADH, ANP, & aldosterone)
- 5. constipation - can affect urination - can cause urethral obstructions r/t rectum close proximity to urethra
- 6. Ureter, bladder, & urethra: decreased elasticity & muscle tone
- 7. weakening of sphincter
- 8. decreased bladder capacity
- 1. GU system losses elasticity, vascularity, & structure -> more prone to urethral irritation & bladder infections
- 2. incontinence higher in menopausal women who use HRT
- 3. thin, dry vaginal tissue r/t decreased estrogen
M: prostate enlarges
Assessment findings r/t decreased kidney function r/t aging?
- 1. decreased creatinine clearance
- 2. increased BUN & serum creatinine
- 3. alterations in drug excretion
- 4. nocturia & loss of normal diurnal excretory pattern b/c of decreased ability to conc urine
- 5. less concentrated urine
Menopausal women who use HRT are at risk for _____.
How may constipation affect urinary system?
partial urethral obstruction may occur because of the rectum's close proximity to the urethra
Subjective data need for urinary assessment?
- 1. Hx of diseases that effect the urinary system
- 2. specific urinary problems: cancer, infections, BPH, calculi
- 3. medications that may alter urinary output quantitiy, quality, or color or that may cause other urinary changes
- 4. previous hospitalizations or Tx with radiation or chemo
- 5. changes in weight or appetitie
- 6. excess thirst or fluid retention
- 7. complaints of HA, pruritus, or blurred vision may be r/t kidney dysfunction
- 8. occupational Hx - exposure to chemicals can damage kidneys
- 9. smoking Hx
- 10. location where pt lives
- 11. family Hx
- 12. lifestyle: nutrition, fluid, activity, sleep/rest
- 13. urination patterns & changes in urination/urine'
- 14. cognition, self-perception, & role performance
- 15. sexuality & reproductive pattern
10 medical conditions that may affect the urinary system?
- 1. HTN
- 2. DM & other met. probs
- 3. gout
- 4. connective tissue disorders: systemic lupus erythematosus, systemic sclerosis
- 5. skin or upper resp infection of strep
- 6. TB
- 7. viral hep
- 8. congenital disorders
- 9. neuro conditions
- 10. trauma
13 common drugs that are nephrotoxic?
- 1. amphotericin B
- 2. bacitracin
- 3. cephalosporins
- 4. micin/mycin drugs: gentamicin, kanamycin, neomycin, tobramycin, vancomycin
- 5. sulfonamides
- 6. captopril
- 7. cimetidine
- 8. lithium
- 9. methotrexate
- 10. NSAIDs
- 11. quinine
- 12. rifampin
- 13. salicylates in lg quantities
2 illegal drugs that are nephrotoxic?
cocaine & heroin
Meds that may alter the quantity and quality of urine output?
Meds that change the color of urine?
nitrofurantoin/Macrodantin & pyridium
4 types of drugs that may affect the ability of the bladder or sphincter to contract or relax normally?
- 1. antidepressants
- 2. Ca channel blockers
- 3. antihistamines
- 4. neurologic & MS disorder drugs
S/S of UTI in elderly?
may report malaise & abd discomfort as only s/s & may have cognitive changes
2 chemicals that are nephrotoxic?
- 1. phenol
- 2. ethylene glycol
Aromatic amines may increase the risk of _____ cancer.
4 occupations that increase risk or exposure to these chemicals?
- 1. textile workers
- 2. painters
- 3. hairdressers
- 4. industrial workers
Major risk factor in the development of bladder cancer?
Why is it necessary to know the location where a pt lives?
some areas have higher incidence of urinary calculi: Great Lakes, Southwest, & Southeast
travel to Middle Eastern or African areas -> parasites that can cause cystitis or bladder cancer
Large intake of certain foods such as ____ & ____ can contribute to development of renal calculi.
dairy & protein
What food can cause urine to smell musty?
Foods that are bladder irritants?
caffeine, alcohol, carbonated beverages, spicy foods
How may herbal teas affect the urinary system?
can cause diuresis
How may urinary system issue cause weight gain?
fluid retention secondary to a renal problem
If there is a problem with fecal incontinence along with urinary issues what may be the cause?
may be a neurologic cause
What problems with urinary system may occur r/t being sedentary?
- 1. urinary stasis -> infections & calculi
- 2. demineralization of bones -> increased urine calcium
What problem may occur with physical activity if a man has had prostate surgery?
may leak urine during activities like running
may develop chronic inflammatory prostatitis or epidiymitis after heavy liftin or long-distance driving
5 causes of nocturia r/t urinary system?
- 1. polyuria r/t renal disease
- 2. poorly controlled DM
- 3. alcoholism
- 4. excessive fluid intake
- 5. obstructive sleep apnea
Why is absence of pain when other urinary s/s exist a significant finding?
tumors are painless in early stages
Costovertebral angle (CVA)?
angle formed by the rib cage & the vertebral column
Palpation of the bladder?
normally not palpable unless distended with urine - smooth, round, firm organ & is sensitive to palpation
How may tenderness in the flank area be detected?
percussion (kidney punch) - normally should not cause pain
Auscultation of the urinary system?
use bell of stethoscope to listen to CVAs & abd upper abd quadrants: listen for bruit at abd aorta & renal arteries that indicateds impaired BF to the kidneys
bruit- abnormal blood flow
Inspection for urinary system?
inspect abd & urinary meatus for inlammation or discharge
3 possible causes?
no urination: 24h urine output <100mL
AKI, ESRD, & bilat ureteral obstruction
2 causes of burning on urination?
- 1. urethral irritaion
- 2. UTI
painful or difficult urination
UTI & interstitial cystitis & many others
involuntary nocturnal urinating
symptomatic of lower urinary tract disorder
increased incidence of urination
- 1. acutely inflamed bladder
- 2. retention with overflow
- 3. excess fluid intake
blood in urine
- 1. cancer of GU tract
- 2. blood dyscarsias
- 3. renal disease
- 4. UTI
- 5. stones in kidney or ureter
- 6. meds: anticoagulants
delay or difficulty in initiating urination
partial urethral obstruction
inability to voluntarily control discharge or urine
- 1. neurogenic bladder
- 2. bladder infection
- 3. injury to external sphincter
frequency of urination at night
- 1. renal disease with impaired concentrating ability
- 2. bladder obstruction
- 3. heart failure
- 4. DM
- 5. post-renal transplant
diminised amnt of urine in a given time: 24h urine output of 100-400mL
- 1. severe dehydration
- 2. shock
- 3. transfusion reaction
- 4. kidney disease
- 5. ESRD
What does pain in the suprapubic area, urethral pain, & flank pain indicate?
What are 6 causes of pain in the urinary system?
- suprapubic pain - bladder pain
- urethral pain - irritation of bladder neck
- flank pain = CVA pain - kidneys
- 1. infection
- 2. urinary retention
- 3. foreign body in urinary ract
- 4. urethritis
- 5. pyelonephritis
- 6. renal colic or stones
passage of urine containing gas
- 1. fistual b/t bowel & bladder
- 2. gas-forming UTI
lg volume of urine in a given time
- 1. DM
- 2. DI
- 3. CKD
- 4. diuretics
- 5. excess fluid intake
inability to urinate even though bladder contains excessive amnt of urine
- 1. post-pelvic surgery
- 2. childbirth
- 3. catheter removal
- 4. urethral stricture or obstruction
- 5. neurogenic bladder
- 6. postanesthesia
involuntary urination with increased pressure
weakness of sphincter control
What bowel preparations are contraindicated in pt with renal failure?
Mg citrate & fleet enema - any that contain Mg
b/c cannot excrete Mg
Important consideration if a pt is having Dx studies on consecutive days?
must prevent dehydration: pt NPO & may not eat/drink much after test then will be NPO again that evening
Make sure get adequate nourishment b/t studies
When is best time to get UA sample?j
When should it be examined?
first specimen urinated in am - most concentrated
exam within 1 h of collection - should refridgerate if not possible
What is creatinine?
waste product produced by muscle breakdown that is excreted in urine
What does creatinine clearance show?
gives close approximation of GFR
When should blood samples for the serum creatinine be collected?
during period of urine collection
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