Prevention: regular and complete emptying of bladder
EPS and DRE for diagnostic tests
Patient teaching for prostatitis
Bladder log for 3-7 days
Educate about avoiding urine retention (anticholinergics, alpha-adrenergics)
Fluids and cranberry juice
(Benign Prostatic Hyperplasia)
Enlargement of prostate gland leading to urine retention and kidney distention
S/S: ↓ in size/force of stream, dribbling
Dx: DRE, urinalysis, BUN, transrectal ultrasound, urodynamic flow study
Treatment: alpha or testosterone blockers, transurethral microwave antenna, prostate balloon, incision of prostate, resection of prostate
Herbal: Saw Palmetto
What kind of meds could cause ED?
Most common are those prescribes for high blood pressure and cardiovascular disease
Most common cause of ED is circulatory problems
Alpha adrenergic blocker
Relaxes muscles in prostate and bladder neck
Used to improve urination with benign prostatic hyperplasia
Drug used to treat cancer by suppressing release of testosterone
What should sperm count be to get woman pregnant
20 million per millimeter of semen
Congenital condition where 1 or both testes don't descend into scrotum
If not descended by age 2, surgery is needed
If not by then, surgery should be done
Digital rectal exam
Gloved finger is inserted into rectum to examine prostate
Complications of BPH
Untreated it can cause:
Common side effect of prostate surgery
Semen falls back into the bladder
Causes no harm and is urinated out
Found most often in men over 65
High fat diet
S/S: Hematuria, urinary obstruction
Nitrogenous waste product excreted in the urine; end product of protein metabolism
The outer layer of kidney tissue
Contains the renal corpuscles and convoluted tubules of nephrons
The inner layer of kidney tissue
Contains the wedge shaped pieces called renal pyramids
Contains the loops of Henle and the collecting tubes of nephrons
A funnel shaped basin that forms the upper end of ureter.
Cuplike extension of the pelvis that collect urine are calyces
Urine enters from the papillae of the renal pyramids.
Cluster of capillaries surrounded by the nephron's glomelular capsule.
At the beginning of the nephron, the glomerulus is a network (tuft) of capillaries that performs the first step of filtering blood.
Location of kidneys in relation to peritoneum and backbone
They are not in the peritoneal cavity, but in the retroperitoneal space, behind the peritoneum
At level of last thoracic and first 3 lumbar vertebrae
How do the kidneys regulate BP?
When bp falls, it may limit filtration.
The cells release renin which activates angiotensin. Angiotensin constricts blood vessels, causing BP to raise
ANP is released when blood pressure is too high to lower
Produced when kidneys don't have enough O2Stimulates red cell production in the bone marrow
Behind the peritoneum
Structure of kidney
Right kidney lower than left to accommodate liver
Enclosed in renal capsule on outside, then adipose capsule
fascia anchors kidney to peritoneum and abd wall
Blood path of the kidney
Tubular resportion takes place where
From the renal tubule to the peritubular capillaries
Where does filtration take place in the kidney?
the glomerulus and glomerular capsule
What part of nephron drains to the loop of Henle?
(distal convoluted tubule)
Supplies the gomerulus with blood
carries blood from the glomerulus
Functional unit of the kidney
What drives materials out of glomerulus into glomelurlar capsule?
(3-4 times higher than in other capillaries)
Normal components of urine
1000 - 2000 mL/day
Straw or amber color
Where does reabsorption take place?
Proximal convoluted tubules
Where does secretion take place?
Peritubrular capillaries in the renal tubules
Reabsorption of small proteins
Process which water is reabsorbed by renal filtrate
Substances are reabsorbed from the distal convoluted tube into what?
The interstitial fluid, then peritubular capillaries, then return to circulation
Where is urine formed?
Begins with the glomerulus and into the renal tubule
How the kidneys regulate acid-base balance (PH) of body fluids
Active secretion of hydrogen ions and bicarbonate. when body fluids become too acidic kidneys secrete more hydrogen into renal filtrate and return bicarbonate ions back into blood. when too alkaline bicarbonate is excreted to renal filtrate and hydrogen into blood
Average PH of urine
4.6 - 8.0, with an average of 6.0
Kidneys respond to increased acidity in body fluids by doing what?
They secrete more hydrogen ions into renal filtrate and return more bicarbonate ions back into the blood
Normal glomerular filtration rate (GFR)
105 - 125 mL/min
It is the amount of renal filtrate formed by the kidneys in 1 min.
If blood increases, GFR increases, urinary output increases
Location of urinary bladder
Inside the peritoneum behind the pubic bones.
In women: bladder is inferior to uterus
In men: bladder is superior to the prostate gland
Ureters go from what to what?
from the hilus of the kidney to the lower, posterior side of the urinary bladder
In men, what does the urethra pass through?
It is 7-8 inches long and extends through the prostate gland and penis.
What sphincter provides voluntary control of urination reflex?
External urethral sphincter
How much urine does the bladder contain after urination?
Substances normally found in urine
Specific gravity measures what
The amount of dissolved solids and gases.
Range is 1.002 (very dilute) - 1.040 (very concentrated)
ADH does what
Increases water reabsorption in the kidney to dilute the excess sodium
Normal characteristics of urine
1000 - 2000 mL/day
Straw or amber colored
Specific gravity: 1.002 - 1.035
PH 4.6 - 8.0
Where does creatinine in urine derive from?
The metaboilism of creatine phosphate, an energy source in muscles
Waste products building up in the blood
Single best indicator of fluid balance
11 Things that are tested in Urinalysis
Good indicator of renal disease
Protein in urine
High creatinine level
If older patient has ↑ BUN, what could be the reason?
What would be considered abnormal if found in urine?
RBC and WBC's
Normal urinary output per hour
or 1 mL/kg per hour
Funnel shaped extensions of the renal pelvis
They enclose the papillae of the renal pyramids
Structures at the hilus of kidney
What provides energy for filtration?
(active transport is energized by ATP or stored energy)
What enzyme does Juxtaglomelular apparatus secrete?
(stimulated by low blood pressure)
How to collect a mid-stream urine specimen
Clean perineum from front to back
Start urinating in toilet
Move collection container under urine stream
Need at least 10 mL
If menstruating, specify on lab form
High specific gravity could mean what?
NPO 6-8 hours, no anticoagulants
Position: Prone, with sandbag under abdomen
Hold breath while needle is inserted to keep kidney from moving
Bedrest for 24 hours
Nursing interventions after arteriogram
Bedrest up to 12 hours to prevent bleeding at injection site
Check distal pulse in leg every 30-60 min
Do not bend or raise HOB >45°
Process of forming urine in kidneys
3 regulated processes of nephrons: filtration, reabsorption, and secretion
Filtration: blood from heart to nephrons
Reabsorption: Essential solutes and water move back into blood from nephron
Secretion: Move substances from blood into tubules, where they mix with water and other wastes and converted to urine
Complications of renal biopsy
Grossly bloody urine
Falling blood pressure
↑ pulse indicates bleeding and must be reported immediately
Stress incontinence vs.
Urge incontinence vs.
Stress: Involuntary loss of urine <50 mL assoc w/coughing, sneezing, laughing. Seen after menopause, child-birth for women. Prostatectomy and radiation
Urge: Unable to make it to bathroom in time. Most common
Functional: Inability to reach toilet because of environment, memory or physical limitations
How much urine for urinalysis
Why would renal failure patient have low hemoglobin
Damaged kidneys don't produce adequate erythropoetin (stimulates RBC production)
Blood loss during dialysis
What foods should you avoid with a calcium oxalate kidney stone?
Restrict protein and sodium
Infection of the renal pelvis, tubules and interstitial fluid of both kidneys
Urinalysis shows casts
What labs to look at in renal failure patient
Why would patient with foley develop UTI
Bacteria ascend catheter
Usually develop w/in 2 weeks
Nursing actions for renal calculi
Observation of urine abnormalities such as hematuria, pyuria or passage of stone
How to prevent crystals from forming in the urine
Encourage fluid intake to around 3000 mL
Avoid offending foods
Teaching for patient with UTI on antibiotics
Take all antibiotics
Many UTI infections are recurrent, teach what to do to avoid in future