GU Packet #1

What is the urinary system responsible for? (6)

1. Filtering blood plasma; retaining useful chemicals and eliminates waste

2. Detoxify poisons (medications)

3. Synthesize glucose

4. Balance electrolytes and blood pH

5. Regulates blood volume/pressure by eliminating or conserving water as necessary

6. Secretes Erythropoietin which stimulates production of RBCs

What two ways can medications be excreted?

1. Renally (via kidney with urine)

2. Hepatically (via liver)

What is important to pay attention to when prescribing medications and the kidneys do not work? (2)

Rx strength and how the medication is excreted

Erythropoietin

A hormone that stimulates production of RBCs

What hematologic disease is associated with compromised renal function?

Anemia

What is anemia?

Low RBC count

Kidneys ______ of what we don't need.

Rid

Why is the kidney vital for life?

Life is not sustainable with out functioning kidneys because you will not be able to excrete toxins or water

What are the components of the urinary system? (4)

1. 2 kidneys

2. 2 ureters

3. Urinary bladder

4. Urethra

What do the kidneys do?

Make urine

What happens if the kidney is non-functioning?

No urine is produced

What is the function of the ureters?

To connect the kidneys to the bladder

What is the function of the bladder?

Holds urine

How much urine can the bladder hold?

1 liter

If the bladder pops, what can this pose a threat to?

Threaten the sterile abdominal cavity

What is the function of the urethra?

Urine exits through here

What are some things that a urine test can tell you? (4)

1. Pregnancy

2. Drugs

3. Protein

4. UTI's

Should protein be in the urine?

No

Urine-blood relationship

Urine is a filtrate of blood

What anatomical structure of the kidney promotes the urine-blood relationship?

Loop of Henle

I & O

Urinary input and output; Ex. 1,000 cc I, 280 cc O

When would you do an I & O?

Only if necessary

What kind of questions should you be asking yourself to consider doing an I & O? (2)

1. Is Pt making the urine and it is getting stuck or is no urine getting made?

2. Is Pt making enough?

Bladder scan

Ultrasound of the Pt bladder to evaluate presence of urine and will detect the cc (amount)

Do males or females more commonly get UTIs? Why?

Females; Shorter distance from urethra to anus

Catheter

Flexible tube that goes through the urethra into the bladder

How does the catheter stay in the Pt?

Balloon secures distal end of the catheter into the bladder

What are the benefits of a catheter? (2)

1. Tracking urine output

2. Used in operating room because Pt would void without it and contaminate sterile field

What are the disadvantages of a catheter? (3)

1. Pt can pull it out and cause damage

2. Cause infection

3. Not a matter of if, but when it will cause a UTI or enlarged prostate

Where do the kidneys lie?

T12 to L3

Is the right kidney higher or lower than the left kidney? Why?

The right kidney is lower than the left kidney because the liver is on the right side and pushes down the kidney

Describe the flow of blood from the heart to the kidney.

Aorta -> Renal artery -> Kidney

What happens once the blood reaches the kidney?

A series of filtration nephrons to be filtered

How is fluid to be kept returned to the body's circulation?

Renal vein

Where do fluids that need to be excreted enter?

Ureter; Stay in bladder or exit via urethra

Where is fluid retained?

Bladder

Hematuria

RBCs present in the urine either microscopically or macroscopically

Microscopic hematuria

Greater than 5 RBCs per high power field; urine looks right in color, but evaluated for RBCs

Macroscopic hematuria

Can visually see that urine is red/pink; Gross meaning can see the color with the naked eye

TRUE OR FALSE: RBCs should be present in the urine.

False

Urgency

Strong desire to void and void right now

What are some disease processes that can cause urgency? (2)

1. UTI

2. Diabetes

Dysuria

Painful urination usually involved with some inflammation

Where is the pain with dysuria located?

At the distal tip of the urethra

What is a disease process that dysuria is common in?

UTI

Frequency

Increased number of voids during the day time

Nocturia

Increased number of voids during night time

What medical conditions can caused an increased urinary output? (3)

1. Diabetes (mellitus and insipidus)

2. Anatomical issue with pelvic floor

3. Prostate issues

What should you as a provider think if a Pt reports increased urinary output? (Ex. 10x/day, 3x/night)

DIABETES!!!

What can diabetes cause in relation to GU?

Frequent voiding

What can cause decreased functional bladder capacities?

Bladder obstruction

When a Pt has a bladder obstruction they ___ ___ ______ as much.

Do not void

Hesitancy

Delayed initiation of urinary strain; disruption of flow

What can cause hesitancy?

Enlarged prostate

Incontinence

Involuntary loss of urine control OR inability of control urine

Total incontinence

No control over urine disseminating out of urethra; once in bladder, it's out

Stress incontinence

Urine leakage with increased abdominal pressure

What can cause increased abdominal pressure? (4)

1. Pregnancy

2. Working out causes strain

3. Coughing and sneezing

4. Can experience after vaginal delivery

What happens to the uterus during pregnancy due to increased abdominal pressure?

Uterus will get big and be below the xiphoid process because of so much pressure on the bladder

What is the best urine sample to obtain for urinalysis?

Best urine is the 1st urine of the day

How long is pregnancy? When is urine taken? What are you specifically looking at in the urine?

1. 40 weeks

2. Taken every appointment

3. Looking at protein

When doing a midstream clean catch, what is the benefit of using the 1st urine of the day?

It gives insight

How can urine be tested? (2)

1. Dipstick

2. Microscopic

What can a dipstick urine test show/test for? (6)

1. pH

2. Protein

3.Glucose/Ketones

4. Nitrites

5. Leukocytes

6. Blood (hematuria)

How does a dipstick work?

Dip the stick into urine and compare panels

Dipstick urinalysis is used in _________ as a screening tool.

Outpatient

What kind of conditions can pH be measured under? (2)

1. Metabolic

2. Respiratory

TRUE OR FALSE: pH of urine can be seen with the naked eye when testing.

True

Specific gravity of urine

How concentrated or diluted the urine is

What components of urine can be related to the specific gravity? (3)

1. Color

2. Aroma

3. Matter (clarity)

What does specific gravity of urine measure?

Concentration of solute vs. water

What can cause a high specific gravity of urine? (8)

1. Dehydration

2. Cause/indication of diabetes

3. Kidney dysfunction

4. Not drinking enough water

5. Not eating enough

6. UTI

7. Diarrhea

8. Vomiting

Proteinuria

Protein in the urine

Protein (definition from notes)

Normally the glomerulus prevents passage of protein from the blood the urine. Thus, the persistent presence of protein in the urine is... a significant indicator of renal disease.

Meatball and a strainer comparison from class meaning

Protein should not go through

What can cause protein in the urine? (2)

1. Diabetes

2. Hypertension (HTN)

How often should testing for protein in the urine be done?

Each year

What does this testing specifically test for?

Microalbuminuria

Microalbuminuria

Small piece of albumin (protein) in the urine

What do you need to recalculate microalbuminuria with?

A kidney that does not work

Glucose/Ketones tests for what? (2)

1. Used to detect diabetes mellitus (DM)

2. Ketones

Glycosuria

Glucose int he urine

What is testing of glucose with DM used for?

To evaluate effectiveness of Tx; glucose should go down with Tx

Should ketones be positive or negative in urine?

Negative

What is the body's main energy source?

Glucose

What will happen if glucose is not being used as the main energy source?

Fat storage will be used

What are some causes of glucose storage not being used? (2)

1. Not eating carbs

2. Inability of take in glucose via diabetes

What does fat break down into?

Ketones

What breaks down nitrates into nitrites?

Bacteria

What do nitrites in the urine indicate?

Bacteriuria

Bacteriuria

Bacteria in the urine

What do the presence of leukocytes (WBCs) and nitrites in the urine suggest?

Infection

Hematuria

Blood in the urine

What does painless hematuria typically suggest? (2)

1. Tumor or cancer

2. Hard substance scratching the ureter

Where type of cancer usually occurs with painless hematuria?

Bladder carcinoma

What is usually the hard substance scratching on the ureter causing painless hematuria?

Kidney stones

Exam Question: Is BUN measured using blood, urine, both, or neither?

Blood

BUN

A blood test to evaluate Pt kidney function

Explain how urea is excreted through the urine.

Protein catabolism (breakdown) occurs in the liver -> Liver produces urea -> Urea enters the blood -> Blood goes through the kidney

Example of how a BUN test works.

10 in the blood

-Blood urea= 4

-6 taken out via urine