Bladder Control System

Bloddu CO#ltrol Syst4'm

GOOD MORNING!
'\"- Al ( ',
:z.Eli) j u rine ,· /

urethra. ~
,
·, ' lbladder
, } muse.le
pelvic , sphincter
floor m uscies
muscles

Drogs Acting on Renal System

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DRUGS FOR THE RENAL SYSTEM
A. Diuretics
B. Parenteral Fluids
_.
;: C. Electrolytes
D. Drugs for the Urinary Tract Disorders
• Urinary Antiseptics
• Urinary Analgesics
• Urinary Stimulants
• Antispasmodics

Anatomy and Physiology of the

,- if=~ Genitourinary Syste~

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A. Diuretics
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A •Al1'M •ADI.II.

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Diuretics - acts to increase flow of11rine ). Osmotic Diuretic

Ex: .Mann/lo/ (OJmllrol), Urea (Ureaphil)
Purpose: I: Increased !OP , ICP and prevent kidney
® Decrease hypertension failure
® Decrease edema
MOA: Increases plasma and blood concentration
in renal tubules
• Thiazides & Thiazide-like
• Loop diuretics S/E :
• K+ sparing diuretics
• Carbonic Anhydrase inhibitor - F&E imbalance
• Osmotic Diuretics - Pulmonary Edema
- N&V
- Tachycardia
- Acidosis

Diuretics
I. THIAZIDES & THIAZIDE-LIKE
E.x: Chlorothiazide (Diuril)
Hydroch/orothiazide (l{ydrodiuril)
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Osmotic_c~ ~
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• Nsg Mngt for mannitol
I: hypertension and peripheral edema
>mannitol crystallizes at low temp
MOA: Acts on the distal convoluted tubules to -use in-line filter
promote Na, CI, and H20 excretion -may be warmed
S/E : H}'.JJO/(, l.)111QMg, hyper{_:a, dizziness, -fast drip
headache, N& V, conshpatjon\ orthosll)tic . -give with extreme caution if with
hypotens1on, hyperglycemm, nyper uncem1a
heart condtion/heart failure

2. LOOP DIURETICS/ HIGH CEILING

4.Carbonic Anhydrase inhibitors
Ex: Furosemide (Lasix)
Ex: Acetazolamide (Diamox) 125,250mgtab _
Bumetanide (Bumex)

I: Edema
I: increased !OP in open angle glau~ ma· ~niy~
epilepsy, high alt. or acute mountain sickness
t:a;
MOA: Acts on the ascending loop of Henle by MOA: Blocks the action of the enzyme Carbonic
inhibiting Na reabsorption Anhydrase = increased NA, K, HCO3 excretion

S/E : HypoK, Na, Ca, Mg, Cl S/E : F&.E imbalance

dizziness, headache, N&V, orthostatic - Metabolic acidosis
hypotension - Crystalluria
- Orthostatic Hypotcnsion
- NN. anorexia, confusion

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5. K+ Sparing Diuretics
Ex: Spi11oro/acto11e (Aldacto11e)
Amiloride (Midamor)
Body Fluids
I: Edema ond HF Osmol~lity of body fluids - conccntrationo i BMJl:!f
.
fluids;
280-300mOsm/L
MOA: Acts primarily in the collecting duct renal
I. Isoosmolar
tubules to promote Na,H20 excretion & K 2. Hypoosrnolar
retention
S/E : 3. Hyperosmolar
- Hyperkalemia
- Caution with poor renal functioning
- Anorexia, NN, diarrhea

Nursing Considerations For Diuretics Hyposm,tir Hyperosmotic lsOSD"M)tic

® Monitor Vital Signs e:,--pecially BP
® Monitor Serum Electrolyte leveis'
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® Ask patient to sit a while prior to standing up to

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prevent orthostatic hypotension I I

® Watch out for S/Sx of Hypotension

® Monitor weight .
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® Monitor Urine Output
.
® Proper nutrition , K rich foods for K wasting diuretics
® DO NOT administer after mid afternoon
® Take with food if with GI upset ' • ..• !v" ~
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cellexpams cell winks cellmnnaI

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FLUID AND ELECTROLYT• .

REPUCEMENT , .: .

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I • Tonicity- effect of fluid on
ceftlllitl~ceme_nt
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HYPERTONIC SOLUTION
•contains a high concentration of
r;:i- solute
1. Hypotonic: <240 mOsm/L •Fluid is drawn from the cell into the
vascular system = cell shrinks
2. Isotonic: 240--340 mOsm/L
3. Hypertonic: >340 mOsm/L •reduce swelling /edema

• IV solns are used to replace body fluid

loss

ISOTONIC SOLUTION HYPERTONIC SOLUTION

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•ttas equal concentration of solute ,,.. e _ A
•Toe same tonicity as plasma •D5 0.45NSS
•Fluid neither enters or leaves the cell •D5NSS
• Can increase circulating volume •D 10W
•Produce no discomfort when instilled in the •D5 ½ (0.45) NS
eyes, nasal tract, blood or other body tissues. •DSLR

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ISOTONIC SOLUTION HYPOTONIC SOLUTION

•DSW*
-~ •contains a low concentratio: oi si'fl v
•NSS or 0.9 NaCl •water diffuses into the cell, causing cell
to swell or burst
•LR solution
•D5 0.225% NS
orDS ¼ NS

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• Tonicity- effect of fluid on
ce'laltitl<Rlplµcement HYPERTONIC SOLUTION
•contains a high concentration of
solute
1. Hypotonic: <240 mOsm/L *Fluid is drawn from the cell into the
2. Isotonic: 240-340 mOsm/L vascular system =cell shrinks
3. Hypertonic: >340 mOsm/L •reduce swelling /edema

• IV solns are used to replace body fluid

loss

ISOTONIC SOLUTION HYPERTON/C SOLUTION

•ttas equal concentration of solute .
*The same tonicity as plasma •D5 0.45NSS
*Fluid neither enters or leaves the cell •D5NSS
• Can increase circulating volume •D 10W
*Produce no discomfort when instilled in the •D5 ½ (0.45) NS
eyes, nasal tract, blood or other body tissues. •DSLR

ISOTONIC SOL ~: - HYPOTONIC SOL UT. .

*Contains a low concentration of solu e·
•DSW *
•NSS or 0.9 NaCl *Water diffuses into the cell, causing cell
•LR solution to swell or burst

•D5 0.225% NS
or OS ¼ NS

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 HYPOTONIC SOLUTION
Colloids
-=--- Volume expanders
•0.45%NaCl ~'Dextran solutions
•0.33%NaCl :~Amino acids
] Hetastarch
•D2.sW ::i!IPlasmanate
~ 1Colloidal gelatin

Lipids
Classifications ofIV SQlu~g . Blood and blood prod\lcts
~ J
Fat emulsion solution
~ Crystalloids •Whole blood
•Packed RBC
G!Colloids •Plasma- concentrate,
~ Lipids FFP
~ Blood and blood products •Albwnin

*Main line: PNSS

Crystalloids Nursing interventions

Monitor VS and report abN findings. ~
Purpose
• Monitor wine output.
•for replacement
Monitor weight daily.
•maintenance fluid therapy
• Check for sis of fluid volume deficit.
Check for sis of tluid volwne excess.
Ex: Dextrose, saline, and lactated Ringer's Monitor lab results.
solution Monitor the types of fluids the client is receiving.

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 •Potassium
•Sodium
•Calcium
•Magnesium
-Chloride
Electrolytes
' -·
\I! · Nursing responsibilities

•
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Potassium

Give om! K with sufficient amt of waler and juice.

Dilute the IV KC! in the IV bag.
MonitorUO.
•Phosphorus (phosphate) • Monitor serum K level.
• Monitor ECG.
• Check the IV site.
Monitor clients receiving various medications for
hyperkalemia.

Potassium J.J---5.JmEq/L Sodium 135--WmEqlL

Fxn: ·
Fxn: transmission and conduction of ne~J llll
and for the contraction of skeletal, cardiac and • Major electrolyte that regulates body fluids
smooth muscles. • Promotes transmission and conduction of
HYPOKALEMIA HYPERKALEMIA
•Nausea •Nausea nerve impulses
•Vomiting •Abdominal cramps
•Dvsrhythmias •Oliguria • Part of the Na-K pump that causes cellular
•Abdominal distention •Tacbycardia activity
•Soft, flabby muscle •Later bradycardia
•Weakness
•Numbne5$ or tingling in
the extrenulles

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Potassium Sodium /35-145mEqlL

DRUGS _; J~ J HYPONATREMIA: HYPERNATRE , :

Foods rich in potassium '
•Fruit juices KC/ ( K-/yt•i • Muscular •Flushed skin
•Citrus fruits (Kooch/or)
weakness .;";!>ody temp
•Dried fruits (K-Dur)
•Bananas (K-Tah/ • Headaches Uap
•Nuts • Abdominal
•Potatoes • Rough, dry tongue
cramps
•Broccoli
-Green leafy vegetables • NN

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 Calcium
Nursing responsibilities:
Sodium
, ... ,.,' Ca Drugs: Ca gluconate '"};9
Ca chloride
• Monitor serum level of sodium.
• Instruct client with hypematremia to avoid Nursing responsibilities:
food rich in Na : canned foods, ham, pork, • Administer N fluids slowly.
pickles, potato chips ... • Monitor ECG.
• Take with meals or after meals.

Fxn:
Calcium 9-llmg/dl

Fxn:
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-- - ~,
Magnesium I.8--J_mg(!il

• Neuromuscular activity
• Nerve and muscle activity
• Contraction of the myocardium
• Increases contraction of the heart
muscle • Metabolism of CHO and CHON
• Cellular permeability • Na-K transmission
• Promotes blood clotting
• Formation of bones and teeth

Calcium 9-I 1 mg/di Magnesium

HYPOMg HYPERM( ..
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HYPOCALCEMJA: HYPERCALCEMIA: • anorexia,
• Anxiety
•NN ® hypotension,
•Flabby muscle
• Irritability
•Pain over bony areas • abd distention, ® muscle weakness,
• Tetany ® lethargy,
•Kidney stones • depression,
® drowsiness,
• confusion,
® loss ofDTR
• +Chvosteks and
Trousseau sign,
• convulsions

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 HYPOPHOSPHATEMIA HYPERPHOSPHATEMlA
Magnesium Muscle weakness Tetony __ _ .
Mg Drugs: MgS04
Milk of Magnesia Tremors Hypcrefl ex1e
Magnesium Citrate Paresthesia Nausea
Bone pain Diarrhea
Nursing responsibilities:
Hyporeflexia Abdominal cramps
• Administer IV slowly. Sz
MonitorUO. Hyperventilation
Monitor electrolyte results anorexia
• AJS DTR prior to admin dysphagia
• Ca gluconate at the bedside.

Chloride 95-109mEq/L
..,,._~ Drugs/or Urinary Tract
• In ECF
• For acid-base balance
•
-1 Disorders
HYOCHLOREMIA HYPERCHLOREMIA
Tremors Weakness
A. Urinary Antiseptics
Twitching Lethargy
Slow/shallow RR Deep/rapid RR B. Urinary Analgesics
Dec. Bp (in severe Unconsciousness C. Urinary Stimulants
loss) (late)
D. Antispasmodics

•InOCF
Phosphorus 1. 7-

• Associated with calcium

2.~~~. ·
A. URINARY ANTISEPTICS
Reduces bacterial growth in tJ:ie
& .renal tubules due to lITI
~DRUG CLASS
• For bone and teeth formation 1. Nitrofurantoin
• For neuromuscular activity 2. Methenamine
3. Quinolones
• Whole grain cereals, nuts, milk, meat
• Eg: Na phosphate, K Phosphate 4. Trimethoprim

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 Methenomlne
Urinary antiseptics 5/E:
1. Nitrofurantoin
vomiting, belching diarrhea,
Ex: Nitrofurantoin ( Furadantln) abdominal pain •·• •~
(Macrodantin)
NsgMngt:
I: acute & chronic UTI ( except Pseudomonas Aeruginosa are mild and resolves
infection)
Report allergic reactions, bladder irritation,
dysuria, frequency
MOA: interferes with several bacterial enzyme systems
Vil C containing fruits or cranberry juice to
maintain urine acidity
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SIE: 3, Quinolones
> NN, anorexia, diarrhea, abdominal pain, tinted Ex: Nalidi.xic acid ( Negram) , .
(Azo-wintomy/01!)
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rust brown to yellow wine color (hormle:<~) - ''btJii• . l t. --'
"':!> Cinoxacin (Cinovax) ·•
Norfloxacin ( Naroxin. Lexino1; Zuritracin)
NsgMngt:
Ciprojloxacin ( Cipro, Ciprobay)
Instruct to report allergic reactions, superinfections,
peripheral neuropathies
Take with food or milk I: lower UTI
MOA: acts on DNA & disable its ability to
replicate
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3. Quinobm

2. Methenamine 5/E: N/V, anorexia, Abdominal cramps,

Ex: Methenamine hippurate ( Hiprex) flatulence, drowsiness ' dizziness ' ;,.:.;:,,~
headache, visual disturbances (Ml~
Methenamine mandelate (Man
acid), photosensitivity, hematuria.'~

NSGM~T:
I: short-acting for Tx of chronic UTI
Check for allergic reactions
MOA: yields fonnadehyde in acidic urine
which suppress bacterial growth Instruct to avoid direct sun exposure
Safety

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 Side Effects & Adverse .
4. Trimethoprim
Reactions. -~
Ex. Trimethoprim (Triglo~) • • Gastrointestinal distur~a?"'
Co- Trimoxazole (Bactrim) · • Hemolytic anemia
Nephrotoxicity
I: acute & chronic UTI Hepatoxicity
MOA: Prevents bacterial synthesis of • Urine is reddish orange due to
nucleic acid & CHON presence of azo-dye
(harmless)

c. URINARY STIMULANTS
Ex. Bethanecol Chloride ( UrechoHz
Side Effects & Adverse R!}tl · ( " -
I: decreased bladder function · ·
• Rashes MOA: cause contraction of the de~n.Js~r
urinae muscle in the bladder resulting in
• Pruritus urination.
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• Nausea vomiting S/E: hypotension, dizziness, blurred
vision, N/V, abdominal cramps, dyspnea

D. URINARY ANTISPASMODIC
B. URINARY ANALGESICS Ex. Flavoxate ( Urispas )
Ex. Phenazopyridine HCI ( Azo-111in(af,J') Oxybutynin ( Ditropan J •$
i,o,11•'"''
Dimethyl Suloxide ( demasorb)
I: irritation to UT mucosa due to trauma, to relieve dysuria, frequency,
surgery or instrumentation urgency, nocturia, incontinence and
suprapubic pain.
MOA: Creates an anesthetic effect with an
directly on the smooth muscles of
azo-dye acting on the urinary tract mucosa the UT relieving muscle spasm due to
infection or injury.
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Side Effects & Adverse
Reactions
Dry mouth
t heart rate

Intestinal distention
constipation

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Thankyou!

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