1 / 72

Urinary system

Urinary system. Urinary System. Consist of: Kidneys Ureters Bladder Urethra. Specific Function : Urine formation Excretion of waste products Regulation of electrolyte excretion Regulation of acid excretion Regulation of water excretion Auto regulation of blood pressure

solorio
Download Presentation

Urinary system

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Urinary system

  2. Urinary System • Consist of: • Kidneys • Ureters • Bladder • Urethra

  3. Specific Function: • Urine formation • Excretion of waste products • Regulation of electrolyte excretion • Regulation of acid excretion • Regulation of water excretion • Auto regulation of blood pressure • Regulation of red blood cell production • Renal clearance • Vitamin D synthesis • Secretions of prostaglandins • Urine storage • Bladder emptying General Function: • Excretory • Regulatory • Secretory

  4. Location and External Anatomy of Kidneys • Located retroperitoneally • Lateral to T12–L3 vertebrae • Average kidney • 12 cm tall, 6 cm wide, 3 cm thick -Bean-shaped, brownish-red structures.right lower than left • Hilus • On concave surface • Vessels and nerves enter and exit • Renal capsule surrounds the kidney

  5. Regions • Renal parenchyma • Cortex • Glomeruli, proximal and distal convoluted tubules, cortical collecting ducts, and adjacent peritubular capillaries. • Medulla • Pyramids • 8- 18 pyramids/ kidney

  6. 2. Renal Pelvis - it is the concave portion of the kidney through which the renal artery enters and the renal vein exits - composed of afferent arteriole and efferent arteriole

  7. Nephrons - Functional units of kidney: • Glomerulus • Bowman’s capsule • Proximal tubule • Distal tubule • Loop of Henle • Collecting ducts

  8. Calyx • Minor calyx- 4-13 minor calices • Major calyx- 2-3 major calices • Glomerulus 3 filtering layers: • Capillary endothelium • Basement membrane • Epithelium

  9. Ureters • Fibromuscular tube that connect each kidney to the bladder • Narrow, muscular tubes, 24-30 cm long • 3 narrowed areas: • Ureteropelvic junction • Ureteral segment • Ureterovesical junction - prevents reflux of urine

  10. Urinary Bladder • Muscular, hollow- sac located just behind the pubic bone • 300- 600 ml of urine 4 layers of the urinary bladder: • Adventitia- outermost layer • Detrusor- beneath the adventitia • Lamina Propria- interface between detrusor and urethelium. • Urothelium- innermost layer

  11. Urethra • Small tube leading from the floor of urinary bladder • 1.5 inch in length in females & 8 inch in male • Function: passageway for urine & semen

  12. Acid- Base Regulation • Acid Base Balance • Homeostasis of the body fluids at a normal arterial blood pH ranging between 7.35- 7.45 • Body fluids are slightly alkaline, metabolic processes of the body generally produced excess acid. • Maintained partially through the reabsorption of bicarbonate (HCO3-) in the proximal tubule

  13. Acids • release hydrogen ions (H+) in solutions • Ex. Hydrochloric acid (HCl)- strong acid Carbonic acid (H2CO3)- weak acid • Bases or alkalis • decrease hydrogen ion (H+) concentration • accept H+ in solutions • Ex: Sodium Hydroxide (NaOH) – strong base Bicarbonate (HCO3) – weak base

  14. Regulation System • Buffer Regulation System - chemicals which neutralizes excess acids and bases a. bicarbonate buffer system - controls the pH in ECF of the body b. phosphate buffer system - important ICF buffer system c. protein buffer system - largest buffer system of the body; includes Hgb in RBC, histone proteins and nucleic acids inside the cells.

  15. Respiratory Regulation System - excretes or retains CO2 in the lungs • Renal Regulation System - excretion or retention of Hydrogen ions (H+) and bicarbonate ions (HCO3)

  16. Acid Base Imbalances • Metabolic Acidosis (Base Bicarbonate Deficit) • Definition - results because of high acid content of the blood, which also causes loss of sodium bicarbonate - characterized by low pH and low plasma bicarbonate concentration - 2 forms: 1. high anion gap acidosis 2. normal anion gap acidosis • Compensatory Mechanism - increased ventilation and renal retention of bicarbonate - lungs “blow off” CO2 to raise pH and conserve HCO3-

  17. Laboratory Findings (ABG)- low plasma pH (below 7.35) or a normal pH (if compensated) - normal PCO2 or low if compensated in an attempt by the lungs to blow off more acid- low plasma bicarbonate:-below 21 mEq/L in adults-below 20 mEq/L in children- low urine pH (below 6) • Causes -DKA or Diabetic Ketoacidosis with starvation -Salicylate overdose -Lactic Acidosis 2o hypoperfusion -Methanol and ethylene Glycol toxicity -uremia

  18. Manifestations A. Acute - headache - drowsiness - nausea and vomiting - confusion - increased RR and depth - shock - peripheral vasodilation - dysrhythmia - cold and clammy skin - decreased BP B. Chronic -asymptomatic • Medical and Nursing Management 1. Correct metabolic defect 2. If resulted from excessive intake of Chloride, eliminate the source of Chloride. 3. Administer bicarbonate if pH < 7.1 and bicarbonate level < 10. 4. Closely monitor serum potassium level 5. Correct hypokalemia 6. Give alkalizing agents, if serum bicarbonate level < 12meq/L 7. Hemodialysis 8. Peritoneal dialysis

  19. Metabolic Alkalosis (Base Bicarbonate Excess) • Definition - marked by the heavy loss of acid from the body or by increased level of bicarbonate - characterized by increased pH and increased plasma bicarbonate. • Compensatory Mechanism - decreased ventilation to conserve CO2 and increase the PaCO2 - lung retains CO2 to lower pH - kidney conserves H+ to excrete HCO3

  20. excessive diarrhea-hyperaldosteronism- Cushing’s syndrome- villous adenoma- cystic fibrosis- hypokalemia • Laboratory Findings (ABG) - high plasma pH (above 7.45) - normal or high PCO2 (above 45 mmHg) as a compensatory elevation - high plasma bicarbonate: - above 28 mEq/L in adults - above 25 mEq/L in children - high urine pH (above 7) • Causes - overzealous administration of sodium bicarbonate - excessive or prolonged vomiting - excessive diuresis - gastric suction with loss of hydrogen and chloride ions - pyloric stenosis

  21. E. Manifestations a. Acute - tingling of fingers and toes - slow, shallow respiration (compensatory) - hypertonic muscles - tetany - mental dullness - dizziness - respiratory depression - atrial tachycardia may occur - ventricular disturbances - decreased motility and paralytic ileus b. Chronic - same with acute metabolic alkalosis - PVC (premature ventricular contractions or U- waves seen in ECG)

  22. Medical and Nursing Management: 1. Sufficient chloride must be supplied. 2. Restore normal fluid volume by administering sodium chloride fluids. 3. In patient with hypokalemia, administer potassium as KCl. 4. Administer H2-receptor antagonist such as Cimetidine (Tagamet) to reduce the production of gastric HCl, thereby decreasing the metabolic alkalosis associated with gastric suction. 5. Carbonic anhydrase inhibitors are useful in patients who cannot tolerate rapid volume expansion. 6. Monitor fluid intake and output. 7. Correct the underlying acid-base disorder.

  23. Respiratory Acidosis (Carbonic Acid Excess) A. Definition - marked by an increased arterial CO2 concentration (PaCO2), increased carbonic acid, and increased hydrogen ion concentration (low pH) - may be acute or chronic - due to inadequate excretion of CO2 with inadequate ventilation B. Compensatory Mechanism - excess hydrogen is excreted in the urine in exchange for bicarbonate ions - kidney eliminate hydrogen ion and retain HCO3 - kidney will retain increased amounts of HCO3 to increase pH

  24. C. Laboratory Findings (ABG) - low plasma pH (below 7.35) or a normal pH (if compensated) - increased PCO2 (above 45 mmHg) - normal or high plasma bicarbonate (HCO3) if compensated - above 28 mEq/L in adults - above 25 mEq/L in children D. Causes - narcotic coma - respiratory depression (drugs, CNS, trauma) - pulmonary diseases (COPD, asthma, pneumonia) - hypoventilation - cardiac arrest/respiratory arrest - head and spinal cord injury - acute pulmonary edema - aspiration of a foreign object - atelectasis

  25. - ventricular fibrillation (in anesthesized person) - increased ICP - papilledema - dilated conjunctival blood vessels - hyperkalemia E. Manifestations a. Acute - increased RR, PR and BP - mental cloudiness - feeling of fullness in head - hypoventilation, shallow respiration - poor exhalation - mental alertness and disorientation - cerebrovascular vasodilation - increased cerebral blood flow

  26. Chronic - cerebral vasodilation will increase ICP - cyanosis and tachypnea will develop - pneumothorax - overdose of sedatives - sleep apnea syndrome - ARDS - muscular dystrophy - myasthenia gravis - Guillain-Barre Syndrome F. Medical and Nursing Management 1. Improve ventilation 2. Bronchodilators 3. Antibiotics 4. Thrombolytics 5. Pulmonary hygiene measures

  27. 6. Adequate hydration 7. Supplemental oxygen PRN 8. Mechanical ventilation, use appropriately 9. Semi-Fowler’s position 4. Respiratory Alkalosis (Carbonic Acid Deficit) A. Definition - marked by decreased PaCO2 and increased pH - clinical condition in which the arterial pH is greater than 7.45 and the PaCO2 is less than 38 mmHg - acute and chronic condition may occur

  28. B. Compensatory Mechanism - renal excretion of bicarbonate increase, and hydrogen ion is retained - kidneys will excrete increased amounts of HCO3 to lower pH - kidneys conserve H+and excrete HCO3 C. Laboratory Findings (ABG) - high plasma pH (above 7.45) - decreased PCO2 (below 35 mmHg) - decreased plasma bicarbonate as a compensatory measure - below 21 mEq/L in adults - below 20 mEq/L in children - high urine pH (above 7)

  29. Causes - extreme anxiety - “panic” attack - hypoxemia - early phase of salicylate intoxication - gram-negative bacteremia - inappropriate ventilator setting - chronic respiratory alkalosis results from chronic hypercapnia - low serum bicarbonate level

  30. Manifestations a. Acute - lightheadedness - inability to concentrate - numbness and tingling from decreased calcium ionization - tinnitus - loss of consciousness at times - tachycardia - ventricular and atrial dysrhythmias - deep or rapid breathing - paresthesias - mental restlessness and agitation progressing to hysteria

  31. Medical and Nursing Management 1. Instruct patient to breathe more slowly to allow CO2 to accumulate or breathe into a close system (such as a paper bag) 2. Sedative may be required 3. Correct underlying problems

  32. HYDRONEPHROSIS • Is distention of the renal pelvis and calices caused by an obstruction of normal urine flow.

  33. Etiology • congenital or acquired • stricture from ulceration of the ureter, or may be due to a calculus. • thickening of the bladder walls from cystitis • enlarged prostate • urethral stricture • Pressure from a pregnant or displaced uterus • ovarian tumors

  34. PRESENCE OF CALCULUS, TUMORS, SCAR TISSUE, CONGENITAL DEFECTS, KINK IN THE URETER URINE FLOW OBSTRUCTION URINE ACCUMULATION & STASIS PRESSURE IN THE KIDNEY WALLS IRREVERSIBLE NEPHRON DESTRUCTION DISTENTION OF THE KIDNEYS SUSTAINED/INTERMITTENT INCREASE PRESSURE

  35. Assessment Acute • Renal colic • Severe back pain Chronic • Dull, aching discomfort in the flank on the affected side • Painful hydronephrosis that occurs intermittently

  36. General • Vague intestinal symptoms such as: • nausea • vomiting • abdominal pain • Pain in the sides • Abdominal mass • Nausea and vomiting • Very high Fever • Dysuria (Painful urination) • Increased urinary frequency • Hematuria (blood in the urine) • High number of white blood cells in the urine

  37. Feel fatigued • Appear pale • Diarrhea • Respiratory distress • Foam in the toilet water, which may be caused by excess protein in your urine • Weight gain due to excess fluid retention • High blood pressure • Thromboembolism • severe pain and swelling in arm or leg • changes in color or temperature of arm or leg

  38. Diagnostics: • Ultrasonography • Intravenous pyelogram (IVP) • Abdominal magnetic resonance imaging (MRI) • Urine tests • Blood Test • Endoscopy • Kidney (Renal) Scan • Bladder catheterization (insertion of a hollow, flexible tube through the urethra

  39. Complications • kidney infection (pyelonephritis) • urinary tract infection

  40. Nursing Diagnosis • Excess Fluid Volume related to Sodium Retention • Impaired Urinary Elimination related to Inflammation • Risk for Infection • Pain related to infection • Deficient Knowledge related to Factors of Development of the Disease

  41. INTERVENTION MEDICAL • Pain relief • Analgesics • Antispasmodic • Antibiotics administration

  42. SURGICAL Pyeloplasty • Pre operative • ensure optimal renal function • encourage to recognize and express feelings of anxiety • Post operative • VS • permit oral fluids after passage of flatus • maintain sterility of nephrostomy tube • ensure unobstruction in the nephrostomy tube or catheter • never clamp nephrostomy tube • MIO • In case of ureteral stent • Monitor for bleeding • MIO • Assess for signs of UTI • monitor colicky pain & decrease urine output (stent displacement)

  43. NEPHROTIC SYNDROME • Is a set of clinical manifestations caused by protein wasting secondary to diffuse glomerular damage.

  44. ETIOLOGY • Nephrotic syndrome is a protein wasting disease • Caused by: • glomerulonephritis • diabetes mellitus • Lupus erythematosus • Amylodidosis • Carcinoma

  45. Membranous glomerulonephritis Glomerular basement membranedamage Glomerular permeability to plasma protein proteinuria Albumin depletion in the blood hypoalbuminemia Alteration in osmotic pressure in the vessels Fluid moves to interstitial spaces Increase synthesis of LDL, HDL in the liver with decrease lipid catabolism Decreased plasma volume edema Hyperlipidemia Stimulates aldosterone secretion lipiduria Sodium & water retention edema Decreased glomerular filtration rate

  46. Assessment • Proteinuria • Hypoalbuminemia (low level of albumin in the blood) • Edema (swelling) • Hypercholesterolemia (high level of cholesterol in the blood) • High blood pressure • Susceptibility to infections • Oliguria • Hematuria

  47. Diagnostics: • Complete medical history and physical examination • Urinalysis • Blood analysis • Kidney biopsy

  48. Complications • kidney infection (pyelonephritis) • urinary tract infection • Blood clots • High blood cholesterol and elevated blood triglycerides • Poor nutrition • High blood pressure • Acute kidney failure • Chronic kidney failure

More Related