Nursing Assessment: Urinary System

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Nursing Assessment Urinary System

• NURS 1228
• Spring 2003
• By Nina Green, RN, Instructor

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Structures and Functions of the Urinary System

• Please review your A P textbook
• Look closely at the Macrostructure and
  Microstructure of the Kidneys

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Normal Glomerular Filtrate (Review)

• Normally the capillary pores are to small to
  allow loss of large blood components.
• With many renal diseases, capillary permeability
  is increased allowing plasma proteins to enter
  urine.
• It is like blood, except it doesnt have the
  large blood components (plasma proteins, blood
  cells, and platelets)

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Normal Glomerular Filtration Rate

• Normal GFR is 125 ml/minute
• However, because much is reabsorbed by the
  peritubular capillary network as the filtrate
  travels toward the collecting duct, usually only
  1 ml/minute is excreted as urine

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Antidiuretic Hormone (ADH)

• Released from the posterior pituitary gland
• Stimulated by increased serum osmolality and
  decreased blood volume
• Acts on the distal convoluted tubules and
  collecting ducts increasing wall permeability to
  water, allowing water reabsorption back into the
  capillaries.

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Aldosterone

• Released from the adrenal cortex
• Release is stimulated by the circulating blood
  volume and plasma concentrations of sodium ion
  (Na) and potassium ion (K)
• Acts on the distal tubule
• Causes the reabsorption of (Na) and water.
• In exchange for Na, K is excreted.

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Acid-base regulation

• The conservation of bicarbonate (HCO3-) and the
  excreting of excess hydrogen ion (H-).
• The distal tubule functions to maintain the pH of
  the ECF between 7.35 and 7.45

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Atrial Natriuretic Factor (ANF)

• Hormone released from the right atrium of heart
• Stimulated by elevated right atrial blood
  pressures
• Inhibits secretion of ADH and its effect on
  reabsorption of water into blood system
• Causes dilute urine in large amounts

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Parathyroid Hormone

• Released from the parathyroid gland
• Stimulated by low serum calcium (Ca) levels in
  blood
• Causes the reabsorption of calcium ions
  increasing serum calcium

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Other Renal Functions

• Production of erythropoietin
• Released in response to decreased oxygen tension
  in the renal blood supply (usually due to loss of
  RBCs)
• Stimulates the production of RBCs in bone marrow
• A deficiency of erythropoietin causes anemia in
  renal failure

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Other Renal Functions

• Assists in the activation of Vitamin D
• Ingested Vitamin D and Vitamin D from the sun via
  the skin are inactive until they are acted upon
  by the liver and kidney.
• Vitamin D is essential for the uptake of calcium
  from the GI tract.
• The patient with renal failure has a deficiency
  of the active metabolite Vitamin D and so has
  problems with calcium and phosphate balance.

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Other Renal Functions

• Renin
• Assists in the regulation of blood pressure
• Is released in response to decreased arterial
  blood pressure,renal ischemia, ECF depletion,
  increased norepinephrine, and increased levels of
  Na in urine
• Catalyzes the splitting of the plasma protein
  angiotensinogen into angiotensin 1

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Other Renal Functions

• Angiotension 2
• Is converted from angiotension 1
• Stimulates the release of aldosterone. (Na and
  water retention and yields greater ECF volume)
• Causes increased peripheral vasoconstriction
  which combined with the increased ECF volume
  causes increased blood pressure. This inhibits
  the release of renin.

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Prostaglandin's

• Synthesized by most body tissues
• In kidney, produced mainly in Medulla
• Causes vasodilation, increased blood flow, and
  Na excretion, lowers blood pressure
• Counteracts angiotensin and norepinephrine
• Loss of Prostaglandin tissue in the kidney due to
  renal failure ? Cause of HTN in renal patients.

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Organs of Urinary System

• Kidneys
• Ureters
• Urethra
• Female 1-2 inches long
• Male 8-10 inches long
• Meatus

• Bladder
• Urethrovesical Unit
• Bladder
• Bladder neck
• Urethra
• Pelvic floor muscles

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Effects of aging on Urinary System

• Decreased
• Renal tissue
• Number of nephrons
• Renal vascular supply
• Function of loop of Henle and tubules
• Elasticity of muscle tone in bladder/urethra

• Decreased
• Bladder capacity and sensory receptors
• Weakened
• Urinary sphincter
• Estrogen deficiency causing thin, dry vaginal
  tissues
• Prostatic enlargement

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Causing

• Kidneys to be less palpable
• Decrease in creatinine clearance, increase in BUN
• Alterations in drug excretion
• Nocturia, frequency, urgency, incontinence

• Decreased ability to concentrate urine, diluted
  urine
• Loss of usual pattern with urination
• Urine retention
• Stress incontinence, dysuria, dribbling
• Increased infections

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Functional Health Patterns

• Health Perception-Health Management Pattern
• How is energy level?
• Vision changes?
• Smoker? How long?

• Nutritional-Metabolic Pattern
• How is appetite?
• Weight changes?
• Vitamin or mineral supplements?
• Kinds of fluids drink? How much? Caffeine?
• Caffeine or spicy foods? How much?

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Functional Health Patterns

• Elimination Pattern
• Urination, how often? Nocturia?
• Color? Blood?
• Urgency? Frequency? Incontinence? Dribbling?
  Pain?
• Use special devices for elimination or control?
• Bowels regular?

• Activity-Exercise Pattern
• Changes in ADLs?
• Activities aggravate urinary problem?
• Urinary problem caused you to alter or stop
  activities or exercise?
• Require assistance moving? To bathroom?

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Functional Health Patterns

• Cognitive-Perceptual Pattern
• Pain with urination?

• Self-Perception-Self-Concept Pattern
• How does urinary problem make you feel about
  yourself?
• Different body perception since urinary problem?

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Functional Health Patterns

• Role-Relationship Pattern
• Problems with relationships due to urinary
  problem?
• Change in job status or ability to do job related
  responsibilities due to urinary problem?

• Sexuality-Reproductive Pattern
• Change in sexual pleasure or performance due to
  urinary problem?
• Hygiene problems r/t sexual activities causing
  concerns?

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Functional Health Patterns

• Coping-Stress Tolerance Pattern
• Able to manage urinary problem?
• Strategies using to cope with urinary problem?

• Values-Beliefs Pattern
• Present illness affecting belief system?
• Treatment decisions r/t urinary problem in
  conflict with value system?

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Common Abnormalities of Urinary System

• Dysuria
• Frequency
• Enuresis
• Hesitancy
• Urgency
• Hematuria
• Burning on urination
• Pneumaturia

• Retention
• Pain
• Incontinence
• Stress incontinence
• Nocturia
• Polyuria
• Anuria
• Oliguria

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Diagnostic Studies of the Urinary System

• Urine Studies
• Urinalysis
• Creatinine clearance
• Urine culture (clean catch midstream)
• Concentration test
• Residual urine
• Protein determination
• Urine cytology

• Blood Chemistries
• BUN
• Creatinine
• Uric acid
• Sodium
• Potassium
• Calcium
• Phosphorus
• bicarbonate

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Diagnostic Studies of the Urinary System

• Radiologic Procedures
• Kidneys, ureters, bladder (KUB)
• IVP or excretory urogram
• Nephrotomogram
• Retrograde pyelogram

• Radiologic Procedures
• Cystogram
• Renal arteriogram (angiogram)
• Ultrasound
• CT scan
• MRI

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Diagnostic Studies of the Urinary System

• Renal Radionuclide Imaging
• Renal Scan
• Endoscopy
• Cystoscopy

• Urodynamics
• Cystometrogram
• Invasive Procedure
• Renal biopsy