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MS Genito Urinary System

MS Genito Urinary System

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03/18/2014

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St. Louis Review Center
THE URINARY TRACT
Structure and Functions
The Urinary Tract
KIDNEY
\u2022
Bean-shaped organ
\u2022
Highly vascular
\u2022
Has exocrine and endocrine functions
\u2022
Weight: 150 g
\u2022
Length: 4.5 inches (11.4 cm)
\u2022
Width: 2.5 inches (6.4 cm)
\u2022
Location: Retroperitoneal
\u2022
Supine: T12-L3
\u2022
Trendelenburg: 10th-11th ICS
\u2022
Standing: Down the iliac crest
\u2022
1 contains about millionnephrons.
NEPHRON
2 sections:
1.
Bowman's capsules - outercortex region
2.
Renal tubules - from the cortex into the darkermedulla.
Filtration:

Blood flows to the glomerulus (from the renal artery)
Pressure in the glomerulus forces: water, glucose, urea, salts through thecapillar y wall and tubule (Protein & blood cells remain)
Blood leaves the glomerulus
Moves to capillaries that surround the renal tubule.
Glomerular filtrate passes along the tubule.

(GFR \u2013 125 cc/min)
Glucose, most of the water and salts are absorbed back into the blood in the nearby capillaries. (TRR \u2013 124 cc/min)
Urea and other wastes stay dissolved in the glomerular filtrate.
They pass down the tubule and eventually reach thebladder.

(Blood flows out of the kidney to the renal vein.)
URETERS
\u2022
Length: 10-12 inches (25-30 cm)
\u2022
Diameter: 2-8 mm
\u2022
Major function: Channel urine down to the bladder by peristaltic waves (1-5x/min)
\u2022
Ureterovesical valve \u2013 prevents reflux of urine
URINARY BLADDER
\u2022
Hollow, spherical, muscular organ
\u2022
Anterior and inferior to the pelvic cavity
\u2022
Posterior to Symphysis Pubis
\u2022
Elastic as it stores urine
a.
First Urge: 200-300 cc
b.
Moderately full: 500-600 cc
c.
Maximum capacity: 1000-1800 cc (Rises up to the Symphisis Pubis
\u2022

Effects of:
a. Parasympathetic Nerves: Contract
b. Sympathetic Nerves: Relax

URETHRA
\u2022
Anterior to the vagina (female) \u2013 behind symphisis pubis
\u2022
Length
a.Female: 3-5 cm
b.Male: 20 cm
RENAL EXCRETORY FUNCTION STUDIES
ROUTINE URINALYSIS
Color
: Amber / Straw
pH
: 4.5-8 (Average \u2013 6)
Specific Gravity
: 1.010-1.025
Protein
: Absent
RBC
: 0-5 / hpf
WBC
: 0-5 / hpf
Pus
: Absent
Glucose
: Absent
Genito-urinary System
Page 1 of 11
St. Louis Review Center
Ketones
: Absent
Casts
: 0-4
Creatinine Clearance:
\u2022
24 hour urine specimen
\u2022
Test for renal function
\u2022
Normal Values (Per 24 hours)
a. Male \u2013 20-26 mg/kg
b. Female \u2013 14-22 mg/kg
Blood Tests:
BUN
: 10-20 mg/dL
Serum Creatinine
: .4-1.2 mg/dL
Serum Uric Acid
: 2.5-8 mg/dL
Albumin
: 3.2-5.5 mg/dL
RBC
: 4.5-5.5 mg/dL
Hematocrit
: 38-54 vol%
Serum Electrolytes:
Potassium
: 3.5-5 mEq/L
Sodium
: 135-145 mEq/L
Calcium
: 4.5-5.5 mEq/L
Magnesium
: 1.5-2.5 mEq/L
Phosphorus
: 3.5-5.5 mEq/L
Chloride
: 98-108 mEq/L
DIAGNOSTIC STUDIES
CYSTOSCOPY
\u2022
Provides a means of direct visualization of the urethra, bladder, and urethral orifices
\u2022
The Cystoscope (an instrument with lighted lens) is inserted into the urethra
\u2022
Biopsy specimens, lesions, small stones and small foreign bodies can be removed by this means.
Preparation for Cystoscopy:
\u2022
Written consent
\u2022
Force fluids
\u2022
Done under local / general anesthesia
\u2022
Inform that desire to void will be felt
\u2022
Position: Lithotomy
After Cystoscopy:
\u2022
BR until VS are stable
\u2022
Blood-tinged (pink) witihin 24-48 hours is normal
\u2022
Due to irritation:
a. Dysuria
c. Hematuria
b. Frequency
\u2022
Assess for:
a. Urinary retention
c. Prolonged / excessive hematuria
b. Signs of infection
\u2022
Monitor VS and I&O
\u2022
Force fluids
KUB (Abdominal x-ray film)
\u2022
KUB (Kidney, Ureters, Bladder)
\u2022
Used to determine the size, shape and position of the kidneys.
\u2022
Used to note any stones that may be present in the kidney, bladder or ureters
\u2022
Procedure for KUB
\u2022
A flat plate x-ray film is placed over the abdomen
\u2022
Non-invasive
\u2022
Assure patient it is painless
\u2022
Bowel preparation as feces / gas may interfere with the visualization
EXCRETORY UROGRAM / INTRAVENOUS PYELOGRAPHY
\u2022
An x-ray photograph of the renal pelvis and ureter.
\u2022
A radiopaque material is given IV and excreted through the kidneys making the radiographic visualization possible.
Before IVP . . .
\u2022
Secure written consent
\u2022
NPO 6-8 hours
\u2022
Bowel preparation
\u2022
Check for hypersensitivity to iodine (sea foods)
\u2022
Emergency drug: Epinephrine (for possible anaphylactic shock)
\u2022
Inform: warm flushing sensation on IV injection site is normal
After the IVP . . .
\u2022
Monitor VS
\u2022
Increase fluid intake\ue000 flush the dye
\u2022
Inform: Burning sensation during urination may be experienced
\u2022
Assess: Late allergic reactions
RETROGRADE PYELOGRAM (RPG)
Genito-urinary System
Page 2 of 11
St. Louis Review Center
\u2022
Outlines renal pelvis and ureters by injecting a dye into each ureter with use of catheter through cystoscope
Before RPG:
\u2022
Written consent
\u2022
Check for iodine / dye allergy
\u2022
Inform: discomfort of the procedure
\u2022
Emergency drug: Epinephrine (for possible anaphylactic shock)
After RPG:
\u2022
Monitor VS
\u2022
Increase fluid intake\ue000 flush the dye
\u2022
Inform: Burning sensation during urination may be experienced
\u2022
Assess: Late allergic reactions
VOIDING CYSTOURETHROGRAM FILM
\u2022
Provides visualization in 3 phases:
\u2022
Before voiding: Outlines bladder wall
\u2022
During voiding: Outlines urethra and reflux of urine into ureters
\u2022
After voiding: demonstrates if bladder is emptied completely
\u2022
Contrast medium as instilled into the bladder by the use of cystoscope
\u2022
Nursing responsibilities: Same as of RPG
RENAL ARTERIOGRAM
\u2022
Provides x-ray pictures of the blood vessels supplying the kidney.
\u2022
Introduction of a radiopaque dye directly into the renal artery.
\u2022
Most common site is the femoral artery
\u2022
Used in evaluating persons suspected of having renal artery stenosis, abnormalities on the renal blood vessels or vascular damages.
Before RA
\u2022
Cleanse bowel(Laxative)
\u2022
Shave catheter insertion site
\u2022
After RA
\u2022
VS until stable
\u2022
Cold puncture on the puncture site
\u2022
Check for swelling / edema
\u2022
Assess peripheral pulses
\u2022
Check for color and temperature of the skin
\u2022
Bedrest for 24 hours, no sitting
\u2022
Measure I and O
ULTRASOUND
\u2022
Detects tumors, cyst obstructions and abscesses
Nursing Interventions:
\u2022
Cleanse the bowel
\u2022
Force fluids
\u2022
Withhold voiding
RENAL BIOPSY
\u2022
To determine malignancies
\u2022
Nursing Interventions
\u2022
NPO 6-8 hours
\u2022
Check PTT, PT (Bleeding is usual)
\u2022
Mild Sedation
\u2022
Local anesthesia
\u2022
Hold breath during insertion of needle
\u2022
UTZ to locate kidneys
Care after biopsy\u2026
\u2022
Bedrest \u2013 24 hours
\u2022
Monitor V/S
\u2022
Assess for pain, N/V
\u2022
HCT and HGB to detect bleeding
\u2022
No heavy activity \u2013 2 weeks
ALTERATIONS IN THE GENITO-URINARY SYSTEM
\u2022
A reversible condition characterized by a sudden reduction or cessation of renal function\ue000 retention of waste compounds\ue000 increase in
urea and creatinine
Other names of ARF:
\u2022
Acute Tubular Necrosis
\u2022
Renal Parenchymal Failure
\u2022
Vasomotor Nephropathy
Genito-urinary System
Page 3 of 11

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