Kendra Patrick, RN, BSN

 The Urinary System consist of

 Upper urinary tract

◦ Kidneys
◦ Renal pelvis
◦ Ureters
 Lower urinary tract
◦ Bladder
◦ Urethra
◦ Pelvic floor muscles
 Kidneys
◦ Two , paired, bean-shaped organs
◦ Upper abdomen on either side of the vertebral
column or retroperitoneal.
◦ Span from 12th thoracic vertebra to the 3rd lumbar
vertebra
 Blood Supply
◦ Renal artery- arises from the aorta
◦ Renal vein- empties into the inferior vena cava
 Kidneys receive 25% of total cardiac output.
 Internal Structures

 The urethrovesical unit

◦ Bladder ,urethra, and pelvic
Floor muscles
 Cortex (Outer Layer) Structures
◦ Nephrons: Microscopic; Approximately 1 million
 Smallest functioning renal structure
 Composition:
 Glomerulus; Afferent arteriole; Efferent arteriole;
Bowman’s capsule; Distal and proximal convoluted
tubules; Loop of Henle; Collecting tubule

 Medulla (Inner Layer) Structures

◦ Calyces (pyramids); Renal pelvis; Ureter
 Glomerulus
 Afferent arteriole
 Efferent Arteriole
 Bowman’s capsule
 Distal tubule `The (DCT)
 Proximal tubule (PCT)
 Loop of henle
 Collecting tubule
 Pelvic Floor Muscles: Form sling, which supports
bladder, urethra, rectum, various reproductive
organs
 Urinary Bladder: Hollow, muscular organ; Shape,
size dependent on client age, amount of urine
contained (usu. 300 – 500 ml)
 Urethra: Hollow tube; Begins at bladder neck, ends
at external meatus
◦ Serves as a conduit during urination, has a sphincter
mechanism to prevent urine leakage.
◦ Length: Male ≈ 24 cm; Female ≈ 4 cm
 Formation: Three steps
◦ Glomerular filtration;
◦ Tubular reabsorption;
◦ Tubular secretion
 Elimination: Renal pelvis through ureter into
bladder
◦ Peristaltic action-move urine into bladder
◦ Nerve reflex triggered ≈ 150ml urine
accumulates
◦ Bladder muscle contracts; Sphincter muscles relax
 History
◦ Health, childhood, family, allergies, sexual, reproductive, chief complaint,
medication history.
 Physical Examination
◦ Have pt. void, inspection, auscultation, percussion, palpation
 Diagnostic Tests
◦ Radiography
 KUB; X-ray- size and position of the kidneys, ureters, bony pelvis,
radiopaque urinary calculi, abnormal gas patterns, defects of bony spinal
column
◦ Ultrasonography- Shape, size, location, collecting systems and
adjacent tissues of kidneys, renal cyst, obstruction sites, needle biopsy
◦ CT; MRI- renal pathology, kidney size eval tissue densities, calculi,
polycystic disease, infections, congenital abnomalities
◦ Angiography-arterial supply to kidneys
◦ Cytoscopy- look inside the bladder, id cause of painless
hematuria, urinary incontinence, urinary retention
 Inserted through the
Urethra into the bladder
local anesthesia, spinal , general
Procedure 30-45 minutes
Preop
- sedatives, antispasmodics
- Urine culture
- Vital signs
Post op
-vital signs
-Pain meds as ordered
 Intravenous Pyelogram (IVP): Radiologic study to evaluate structure,
function of KUB
◦ Using radiographs
 Retrograde Pyelogram: Visualization of complete ureter, renal pelvis
needed
◦ Performed during cystoscopy
◦ Carries risk of sepsis, severe UTI
 Nursing Management
◦ Allergies iodine, seafood, contrast Encourage fluids
◦ NPO 8-12 hours before Warm tub baths
◦ Bowel prep Avoid alcohol 48 hrs
◦ Baseline vital signs Antibiotics 1-3 days p
◦ Explain procedure/ purpose
◦ May exp burning, hot flushing sensations
Metallic taste in mouth
 Cystogram: Evaluates bladder structure abnormalities,
filling, instill contrast dye
 Voiding Cystourethrogram (VCUG): Rapid series of x-
rays while voiding
◦ Contraindicated in UTI
 Urodynamic Studies: Evaluate bladder, renal function;
Assess cause of reduced urinary flow, urinary retention
or incontinence
◦ Uroflowmetry- urinary flow rate
◦ Cystometrogram-evaluates bladder tone and capacity
◦ Postvoid residual-amt. of urine left in bladder after
voiding. Normal level is 0-30ml
 Nursing Management
◦ See pg 906 in text book
 Specific gravity-:1.003-1.029
 Urine osmolality: 50-1200
 Ph: 4.5-7.5
 BUN: 7-18
 Creatinine: males 0.7-1.3, females 0.6-1.1
See pg 909
 Frequency- frequent voiding- more than
every 3 hours
 Pyuria- pus in urine
 Urgency- strong desire to void
 Nocturia- excessive urination at night
 Hematuria- Red blood cells in urine
 Anuria- urine output less than 50ml/day
 Oliguria- urine output less than 400ml/day
Is the following statement true or false?

The urethra are the hollow tubes that extend

from the kidneys to the bladder.
False.

The ureters are the hollow tubes that extend

from the kidneys to the bladder, which
drain urine. In males, they measure
approximately 24 cm, in females,
approximately 4 cm
What is the smallest functioning renal
structure

a. Renal artery
b. Nephron
c. Cell
d Calyx
B. Nephron

The nephron is the smallest functioning renal

structure. While being microscopic in size,
there are approximately 1 million nephrons
per kidney.
Is the following statement true or false?

Performing an IVP carries the risk of sepsis or

introducing microbes which could cause an
urinary tract infection.
False.

Performing an IVP involves introducing IV

contrast and producing radiographs. A
retrograde pyelogram is performed during
an cystoscopy and carries the risk of sepsis
or introducing microbes which could cause
an urinary tract infection.
 Percussion of an empty bladder results in this
sound
a. Dullness
b. Tympany
c. Resonance
d. bruits
 B. Tympany

Percussion usually produces a tympanic sound. A dull

sound is produced if the bladder is filled.
End of Presentation