1 L. renal a.

2 L. kidney

3 L. ureter

4 Urinary bladder

5 Urethra

6 R. ureter

7 R. kidney

8 R. renal v.

9 Adrenal gland

The functional unit of the kidney is called the _____.

There are more than 1,000,000 of them in ea kidney

• Maintain composition and volume of body fluids
• Filter and excrete blood constituents not needed; retain those that are needed

It is a hollow smooth muscle sac

Composed of three layers of muscle tissue called detrusor muscle

The ______ ______ guards the opening between the urinary bladder and the urethra.

Parasympathetic never stimulation results in _________ of the detrusor muscle and ________ of the internal spincter, which permits urination.

What is the average length of the female and male urethra?

Which is more susceptible for bacteria to enter the body?

female 1 to 2 inches, men 8 inches

For females because of the shorter length of the urethra

1. Detruser muscle contracts, internal sphincter relaxes, urine enters posterior urethra
2. Muscles of the perineum and external sphincter relax
3. Muscle of the abdominal wall contracts slightly
4. Diaphragm lowers, micturition occurs

• Filtration
• Reabsorption
• Secretion

Filtration

The process of filtration begins at the ________. The ____ _____ bring blood the kidneys; the smaller branches of these arteries bring blood to the ________ of each nephron.

glomerulus

renal arteries

glomerulus

Reabsorption

The _____ of the nephron actively and passively reabsorbs substances that the body wants to retain.

What substances are absorbed in varying amounts?

What percentage of the glomular filtrate is reabsorbed through this structure?

tubule

water and electrolytes; all glucose and amino acides

99%

1200 to 1500mL

min 200mL/void, max 500mL/void

30mL/hr

<30mL/hr can indicate inadequate blood flow to the kidneys

• Fluid intake
• Loss of body fluid
• Nutrition
• Body position
• Psychological issues
• Cognition
• Obstruction of urine flow - renal calculi, prostatic enlargement, tumors, structural abnormalities
• Infection
• Hypotension
• Neurologic injury - spinal cord injury, stroke, brain tumor
• Decreased muscle tone - aging, multiple pregnancies, obesity
• Pregnancy
• Surgery - anesthesia, edema, immobility
• Medications
• Urinary diversions 

Term meaning the formation and excretion of excessive amounts of urine in the absence of a concurrent increase in fluid intake

Polyuria is defined by a urine output of more than _____ to _____mL in 24 hours.

What conditions can greatly incruse urine output?

2500 mL to 3000 mL

Untreated diabetes insipidus and hyperglucemia; ingestion of diuretics, caffine, and alcohol

The formation and excretion of decreased amounts of urine, or urinary output less than ____ mL in 24 hours.

What conditions could cause decreased urinary output?

Oliguria; 500mL

excessive vomiting, diarrhea, diaphoresis, burns, or bleeding. People with renal disease may be Oliguric

The formation and excretion of less than 100mL of urine in 24 hours.

What does this mean of the kidney?

Blood in the urine; can be gross or occult.

What is the meaning of gross or occult?

Hematuria

gross = visible on visual examination

occult = not visible on visual examination

How do diuretics have an effect on urine production and elimination?

Cholineric medications?

Anticholinergic drugs?

Analgesics and tranquilizers?

diuretics prevent reabsorption of water and certain electrolytes in tubules

Cholineric meds stimulate contraction of detrusor muscle, producing urination

Anticholinergic drugs cause urinary retention

Analgesics/tranqs suppress CNS, diminsh effectiveness of neural reflex

Medications Affecting Color of Urine

Anticoagulants -

Diuretics -

Pyridium -

Elavil -

Levodopa -

Anticoagulants - red urine

Diuretics - pale yellow urine

Pyridium - orange to orange-red urine

Elavil - green or blue-green urine

Levodopa - brown or black urine

Types of Urinary Incontinence

1. an increase in intra-abdominal pressure
2. urine lost during abrupt and strong desire to void
3. symptoms of 1 & 2 present
4. overdistention and overflow of bladder
5. caused by factors outside the urinary tract
6. emptying of the bladder without sensation of need to void
7. continuous, unpredictable loss of urine

1. stress incontinence

2. urge incontinence

3. mixed incontinence

4. Overflow incontinence

5. Functional incontinence

6. Reflex incontinence

7. Total incontinence

• Congenital urinary tract abnormalities
• Polycystic kidney disease
• Urinary tract infection
• Urinary calculi
• Hypertension
• Diabetes mellitus
• Gout
• Connective tissue disorders

Subjective data

• Normal pattern identification: voiding patterns, habits, past history of problems
• Risk Identification
• Dysfunction identification

Inspection

Percussion

Palpation

Bladder Ultrasound (BUS)

required for accurate measurement of the kidney's excretion of substances that the kidney does not excrete at the same rate throughout the day.

The first void of the day is discarded and collection starts thereafter.

Urinalysis can be performed on any random specimen of ___ to ___ mL of urine.

What is the normal pH of urine?

What is the normal specific gravity of urine?

How many RBC's are normal in urine?

How many WBC's?

20 to 30 mL.

pH normal: 6

Specific Gravity: 1.015-1.025

RBC = 0-3

WBC = 0-5

In blood tests, what two commonly performed tests are used to screen for kidney disease?

Which one is a more sensative indicator  of renal function?

BUN & Serum Creatinine

Serum creatinine (Cratinine is a waste product formed from the breaddown of skeletal muscle tissue. As creatinine forms, the bloodstream carries it to the kidneys for filtration and excretion. Damage to a large number of nephrons prevents efficient excretion of creatinine and causes it to accumulate in the blood. An elevated serum creatinine concentratin is idicative of impaired renal function)

Describe what you would do to each of the following as part of your physical assessment of urinary functioning

Kidneys

Urinary bladder

Urethral meatus

Skin

Kidneys: check for costovertebral tenderness

Urinary bladder: palpate and percuss the bladder or use bedside scanner

Urethral meatus: inspect for signs of infection, discharge, or odor

Skin- assesss for color, texture, turgor, and excretion of wastes

• Sexually active women
• postmenopausal women
• individuals with indwelling urinary catheters
• indv. with diabetes mellitus
• elderly people

_______ involves insertion of a tube into the bladder for the purpose of direct visualization.

this procedure look for in the bladder?

cystoscopy

tumores, stones, or structural abnormalities

strong smelling urine is an indication of:

sweet smelling or fuzzy, bubbly urine is an indication of:

dehytration

diabetes