1. UNIT I_INTRO_URINARY SYSTE.M_BMS.pptx

The urinary system introduction

1. URINARY SYSTEM s.s

2. Review of A & P of Urinary System ccnm_mulenga bms

3. The kidney ccnm_mulenga bms

4. The Nephron Monday, July 22, 2024 ccnm_mulenga bms 4

5. Functions of the kidneys The urinary system plays a vital part in maintaining homeostasis of water and electrolyte concentrations within the body. The kidneys produce urine that contains metabolic waste products, including the nitrogenous compounds urea and uric acid, excess ions and some drugs.

6. Cont. Formation and secretion of urine Production and secretion of erythropoietin, the hormone that controls formation of RBC’s. Production and secretion of renin, an important enzyme in the control of BP.

7. Terminologies Antidiuretic lessening or decreasing of urine production or an agent that decreases the release of urine. Catheterization The process of inserting a catheter is catheterization.

8. Cont. Diuresis secretion and passage of large amounts of urine. Diuretic increasing of urine production, or an agent that increases the production of urine

9. Cont. Erythropoietin hormone that stimulates stem cells in the bone marrow to produce red blood cells Sphincter a muscle surrounding and able to contract or close a bodily opening

10. Cont. Dialysis the separation of substances in a solution by means of their unequal diffusion through a semi permeable membrane. Trigone triangular area on the inner surface of the bladder located between the opening of the ureters and the urethra

11. Cont. Urinalysis : the examination of urine to determine the presence of abnormal elements. Urination : the normal process of excreting urine.(Encarta 2005). Haematuria : the presence of blood or blood cells in the urine

12. Dysuria: difficult or painful urination Enuresis: the involuntary discharge of urine Urine incontinence: the inability to control excretory functions.

13. cont. Nocturia excessive urination during the night. Nocturnal enuresis incontinence during sleep. Oliguria Scant urination. Rena l pertaining to the kidney .

14. Cont. Stress incontinence the inability to control the voiding of urine under physical stress such as running, laughing or sneezing. .(Encarta 2005) Micturition another name for excretions

15. cont. Polyuria ‑ excessive secretion of urine due to diabetes or diuretics Glycosuria ‑ presence of glucose in the urine Oliguria ‑ deficient secretion of urine Anuria ‑ no urine is produced Haematuria ‑ blood in the urine Pyuria ‑ pus in the urine

16. cont. Albuminuria ‑ or proteinuria protein in the urine Uraemia increase of urea in the bloodstream due to disturbed kidney function Frequency the urge to pass urine more often than normal Urgency the urge to pass urine at once, unable to delay emptying the bladder

17. Cont. Retention the inability to pass urine, resulting in a very full, distended bladder Micturition/voiding/urination the excretion of urine

18. cont. Calculi stones in the urinary system formed from calcium and salts Casts degenerating cells cast off in the urine. They are in the shape of the tubules and may be fatty, epithelial or red blood Hypertrophy increase in size of an organ which does not involve tumour formation

19. Cont. Nephrectomy removal of a kidney Syndrome a group of signs or symptoms that together indicate a certain disease Stasis stagnation of normal flow of urine UTI urinary tract infection

20. Cont. Hypospadias congenital opening of the male urethra on the under‑surface of the penis Epispadias congenital opening of the male urethra on the upper‑surface of the penis Hydronephrosis collection of urine in the kidney pelvis due to obstructed outflow

21. Cont. Renin a enzyme produced by the kidney which acts as a vasoconstrictor on arteries and veins Lipaemia abnormal amount of fat in the blood Colic spasm in any hollow organ accompanied by pain, eg . renal colic

22. Roles of the Nurse In Investigations & Procedures Explain procedure and obtain a signed consent. Prepare the room for dialysis Ensures the patient is prepared for the procedure

23. Cont. Ensure equipment and needed fluids are readily available Assess baseline vital signs, weight and serum electrolyte levels. Encourage emptying of bladder and bowels to minimize risk of puncturing the internal organs and structures.

24. cont. Give patient necessary support and instruction to allay anxiety. Promote patient comfort during procedure i.e. provide physical comfort measures e.g. pressure area care, keep patient informed of progress and results, provide psychological care throughout procedure

25. Maintain dialysate infusion and drainage i.e. if fluid is not draining properly, move patient from side to side to facilitate the removal of peritoneal drainage. Never push in the catheter.

26. cont. Monitor changes in fluid and electrolyte balance, weight changes, vital signs and I and O record. Monitor for complications, i.e. peritonitis, watch for nausea and vomiting, anorexia, abdominal pain, tenderness, rigidity and cloudy dialysate drainage

27. General Investigations Urine examination During this examination, look at urine characteristics such as presence of Red Blood Cells, white blood cells, casts, bacteria, specific gravity, pH, and physical properties such as clarity, colour and odour.

28. Cont. In the laboratory, analysis such as levels of chemical substances such as uric acid, creatinine, and blood urea nitrogen is done

29. Cont. Renal function tests used to screen for and manage renal disease. Tests commonly used for this purpose are plasma creatinine, blood urea nitrogen (BUN), electrolytes, and routine urinalysis.

30. Cont. The most commonly used follow-up tests are creatinine clearance, plasma and urine osmolality, and urine sodium .

31. cont. Radiological examinations: Plain x-ray A plain x-ray of the abdomen is done to assess the size, shape, and position of kidneys, ureters and bladder and the possible area of the calcification and detect gross obstruction.

32. Cont. Intravenous Pyelogram This procedure is done to assess renal function, identify renal anomalies, to image presence of renal calculi including the size and location. It is also done to screen for injury after trauma.

33. Procedure of Intravenous Pyelogram An injection of x-ray contrast medium is given to a patient via a needle or cannula into the vein, typically in the arm. The contrast is excreted or removed from the bloodstream via the kidneys, and the contrast media becomes visible on x-rays almost immediately after injection.

34. Cont. X-rays are taken at specific time intervals to capture the contrast as it travels through the different parts of the urinary system

35. Cont. Procedure This gives a comprehensive view of the patient's anatomy and some information on the functioning of the renal system . Intravenous Pyelogram (IVP) is not allowed or contra-indicated in pregnancy and in people who have history of allergy to the dye.

36. R etrograde pyelogram A retrograde pyelogram is a type of X-ray that allows visualization of the bladder, ureters, and renal pelvis. Generally, this test is performed during a procedure called Cystoscopy – evaluation of the bladder with an endoscope (a long, flexible lighted tube). ccnm_mulenga bms 36 Monday, July 22, 2024

37. Cont. During a Cystoscopy, contrast dye, which helps enhance the X-ray images, can be introduced into the ureters via a catheter.

38. Indications of Retrograde pyelogram In  people suspected to have an obstruction People with a tumour Renal stone

39. Cont. Blood clot Stricture (narrowing) in the kidneys or ureters. Evaluate placement of a catheter or a ureteral hollow tube that allows passage of urine around an obstruction.

40. Indications of Retrograde pyelogram cont. An advantage of the retrograde pyelogram is that it can be performed even if the patient is allergic to contrast dye because a minimal amount of the contrast dye is absorbed by the body (unlike another more common test called an intravenous pyelogram).

41. Complications of Retrograde P yelogram Sepsis Urinary tract infection Bladder perforation Haemorrhage

42. Cystography Cystography is a diagnostic procedure that uses X-rays to examine the urinary bladder. Contrast dye is injected into the bladder. Contrast refers to a substance taken into the body that causes the particular organ or tissue under study to be seen more clearly.

43. Cont. Cystography may indicate how well the bladder empties during urination and whether any urine backs up into the kidneys (vesicoureteral reflux).

44. Indications of cystography To assess the cause of haematuria To assess recurring urinary tract infections (UTIs) To assess the urinary system when there has been trauma to the bladder. T o assess problems with bladder emptying and urinary incontinence.

45. Indications of cystography cont. Obstructions and strictures (narrowing) of the ureters or urethra may be evaluated by cystography. To assess enlargement of the prostate gland. It may also be performed following trauma to assess for a tear in the bladder wall.

46. Risks of Procedure: Cystography In pregnancy notify because radiation exposure during pregnancy may lead to birth defects. Allergic to or sensitive to medications

47. Cystography contraindications Recent bladder surgery Blockage of the urethra, or damage or tearing of the urethra Acute phase of urinary tract infection

48. Urethrography Urethrography is injection of radiopaque contrast into the urethra to elucidate urethral pathology such as rupture of the urethra from trauma or urethral stricture.

49. Indications of Urethrography Trauma Lower urinary tract symptoms Postoperative evaluation

50. Cystoscopy Cystoscopy is a test that allows the doctor to look at the inside of the bladder and the urethra using a thin, lighted instrument called a cystoscope

51. Ultra sound Ultrasound enables visualization of the various organs of urinary system. As a nurse you need to prepare the patient by taking adequate fluid/water as these organs and their internal structures are better visualized when fluid filled e.g. the bladder.

52. DIALYSIS Definition I s the process of removing fluid and uremic waste products from the body when the kidneys cannot do so. Dialysis is most often used in patients with acute/chronic renal failure.

53. The most common types are: Peritoneal and Hemodialysis

54. Peritoneal Dialysis (PD) The process uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood.

55. Cont. peritoneal Fluid is introduced through a permanent tube in the abdomen and flushed out either every night while the patient sleeps (automatic peritoneal dialysis) or via regular exchanges throughout the day (continuous ambulatory peritoneal dialysis)

56. Hemodialysis Is use of a synthetic semi permeable membrane to replace renal glomeruli and tubules and acts as the filter for the impaired kidneys. method that is used to achieve the extracorporeal removal of waste products such as creatinine and urea and free water from the blood in a state of renal failure.

57. Hemodialysis Monday, July 22, 2024 ccnm_mulenga bms 58

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