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GU1

GU1

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Published by dlneisha61

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Published by: dlneisha61 on Mar 19, 2009
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01/30/2013

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1
URINARY SYSTEM
KIDNEYS:
Located between 12
th
thoracic & 3
rd
lumbar vertebrae. Each kidney 4-5inches long. More than 1 million nephrons in each kidney. Urine flows fromnephrons in the parenchyma into the renal pelvis, which tunnels it into theureter
FUNCTIONS:
(KIDNEYS)
o
Filters blood to remove waste products
o
Regulate fluid and electrolyte
o
Regulates acid-base balance
o
Urine formation
o
Hormone production (growth hormone)
o
Regulates calcium and phosphorous
o
Erythropoietin (stimulates RBC production)
o
Activates Vitamin D (promotes bone reabsorption of calcium &phosphorus)
o
Renin (assists with blood pressure regulation)
o
Prostaglandin secretion
URETERS:
Connects each kidney to the bladder. Urine is propelled from the kidney tothe urinary bladder via peristaltic contractions of the smooth muscle fibers inthe middle layer of the ureter.
URINARY BLADDER:
Muscular sac that serves as a reservoir for urine. Composed of an inner liningof epithelial cells, a middle layer of three muscle types, and an outer lining.
Holds 300 to 600 ml urine
Bladder fullness sensation at 150 to 200 ml in adults
URETHRA:
Provides passageway for urine to be eliminated, leads from urinary bladder tothe urethral meatus where urine exits the body: 6-8 inches in males, 1-2inches in females, this difference in length predisposes women to UTI’s
Urine Formation:
3 Step Process in Nephrons
o
Glomerular Filtration- Fluid in the blood is filtered across the capillariesof the glomerulus and into the urinary space of the Bowman’s capsule
o
 Tubular Reabsorption- Passage of fluid from Bowman’s capsule to theproximal tubules where reabsorption takes place (body selectivelykeeps the substances it needs while ridding itself of wastes)
o
 Tubular Secretion- Passage of unwanted substances from capillariessurrounding the nephron are added to the glomerular filtrate
 
2Parts of Nephron:
Antidiuretic Hormone (ADH)
o
Other name Vasopressin
o
Hormone secreted by the posterior pituitary
o
Decreases the production of urine by increasing reabsorption of waterby the renal tubules
Atrial Natriuretic Factor (ANF) or Atrial Natriuretic Peptide (ANP)
o
a hormone released to regulate renal and cardiovascular homeostasis
o
Release in response to atrial dilation or increased intravascular volume
o
Causes natriuresis, diuresis, renal vasodilation
o
Reduces circulating concentrations of renin, aldosterone, andantidiuretic hormone (ADH)
Assessment:
Health history
Physical exam
Age-related changes
Health History
Subjective Data
Past health history
Medications
Nutritional status
Activity-rest patterns
Elimination patterns
Sexuality and reproductive pattern
Cognitive and perceptual pattern
Self perception and self concept
Role and relationship patterns
Physical Exam:
Objective Data
Inspection (external genitalia, edema)
Palpation- costovertebral angle (CVA)
Percussion bladder (tympanic to dull)
Auscultation (for bruits or thrills)
Age-Related Changes of the Kidney
Decrease in the size & weight
Decrease in the blood flow
Decrease in the number of functioning glomeruli
Decreased glomerular filtration rate (GFR)
 
3
Decrease ability to conserve Na, dilute or concentrate urine & excrete an acidload
Decrease renal reserve function
Diagnostic Studies Used to Assess Genitourinary Function:
Urinalysis (needs at least 10 ml)
o
Random specimens-collected at any time collected in a cleancontainer, cannot be used for urine C&S
Clean-Catch Specimen (midstream urine)
o
Women- separate labia and cleanse front to back with antiseptictowelette, then void some into commode, then collect specimen insterile container.
o
Men- Retract foreskin and cleanse in circular motion from meatus toglans penis, void some in commode, then void in sterile container. Thistype specimen is done if urine is to be cultured.
Catheterized specimen- may be a catheterized specimen or may bewithdrawn from indwelling catheter (must be fresh urine), and almost alwaysused for specimens to be cultured.
24-Hour specimens (also referred to as “composite urine specimen”)-collected in one large container. Some specimens need a chemicalpreservative in container &/or refrigeration, so check with the lab.
o
Container may be packed in container of ice or insulated ice packs.When specimen collection begins, patient voids and this specimen isdiscarded. All urine for next 24 hours is placed in container.
o
24 hours from time of first voiding, nurse instructs patient to void andadds this to container and sends to lab. If any voiding is not added,must restart test!!
Renal Clearance
o
Kidneys ability to clear solutes from plasma
o
Most popular test is creatinine clearance
Creatinine clearance (urine) is most common 24 hour urine ordered.
o
Male: 95-135 mL/min
o
Female: 85-125 mL/min
o
Calculated By
o
Volume of urine(mL/min) X Urine creatinine (mL/dL) Serum creatinine(mg/dL)
Normal Findings in Routine Urinalysis
o
Color- pale yellow to deep amber (some color changes because of medications and certain foods or pathology)
o
Opacity- clear (increases in opacity denote presence of bacteria,crystals, or other foreign material)

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