GU Packet 1

What is the responsibility of the urinary system?

Filters blood plasma (retains useful chemicals and eliminates waste)

Detoxifies poisons (medications)

Synthesizes glucose

Balances electrolytes and blood pH

Regulates blood volume/pressure by eliminating or conserving water

Secretes erythropoietin which stimulates production of RBCs

What are the steps someone goes through when off hemodialysis when it is necessary?

1-3 days: they’re fine

4-7 days: their mental status is diminished

8-10 days: they are in a coma and then die

They survive only 10 days without hemodialysis

What are the 2 ways medications can be excreted?

Renally (kidney with urine) and hepatically (liver)

When kidneys are bad what happens?

They retain fluid

What happens when kidneys retain fluid?

Makes heart work harder leading to hypotension, which destroy kidneys further

What are the components of the urinary system

2 kidneys

2 ureters

Urinary bladder

Urethra

How many kidneys do you need?

1

What makes urine?

Kidneys

What are the ureters?

A tube where fluid (urine) flows (no peristalsis and no muscle contractions)

What are the ureters connections?

Connects the kidney to the bladder

What is the job of the urinary bladder?

Holds urine

How much urine can the urinary bladder hold?

Expands to hold 1L

What is the function of the urethra?

Transport of how we expel urine

How long is the urethra?

1-2” in women

7-8” in men

When we want to check how much urine is in the bladder what do we use?

Bladder scan

What is a bladder scan?

Essentially an ultrasound that tells you how much urine is in the bladder

How does a urinary catheter work?

A flexible tube is inserted into the urethra into the bladder and on the distal end of the tube a balloon is inflated and used to hold it in the urinary bladder so they can void and not accidentally void

What is useful piece of information that a catheter can tell us?

Shows how much they excrete

Name 5 electrolytes

Sodium

Potassium

Magnesium

Calcium

Chloride

What are the downsides of a urinary catheter?

Patients don’t love it and may dislodge themselves due to irritation

They will get an infection at some point when it is in there (definitely if it is in there for a long duration) (asks the question, WHEN will they get an infection)

What is one disease from blood that destroys kidneys?

Hypotension

What are the some things a urine test can tell you?

Pregnancy

Drugs

Protein

UTIs

What drugs can be evaluated on a urine drug screening?

Amphetamines

Cannabinoids

Cocaine

Opiates

Phencyclidine

How can we tell if you’re pregnant with a urine test?

hCG (human chorionic gonadotropin)

Where is the position of the kidneys?

Posterior of the abdomen between T12-L3

How is the position of the right and left kidneys different?

Right kidney is lower because liver pushes it down

What is the process of blood flow to excretion from the aorta to it exiting your body?

Aorta —> Renal artery —> kidneys —> series of filtration nephrons (fluid to be kept is returned to the body’s circulation via the renal vein) —> fluids to be excreted enter the ureter —> Enter the urinary bladder and voided through urethra

(Bonus because I feel he skipped a lot and other people’s Quizlets have so much more)

What is the urine-blood relationship?

Urine is a filtrate of blood

(Bonus because I feel he skipped a lot and other people’s Quizlets have so much more)

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

Loop of Henle

What ins do we monitor?

How much IV patients get and/or how many fluid they drink

What outs do we monitor?

How much the patient voided

What makes it easy to tell how much a patient voided?

Catheter

How many ccs of pee do we make a minute?

1cc

Is it normal for a patient that took in 1200cc to only void out 200cc in 8 hours, and what could be the cause?

No the patient should of voided 480cc

Isn’t making enough urine, isn't making urine effectively (kidneys aren’t working), or it’s in the urinary bladder (order a bladder scan)

What are the 2 types of hematuria?

Microscopic hematuria

Macroscopic hematuria

What is hematuria?

RBCs present in the urine

What is microscopic hematuria?

Blood in the urine that isn’t visible to the naked eye (5 or more RBCs)

What is macroscopic hematuria?

Blood in the urine that is visible to the naked eye

What is urgency?

Sudden strong desire to void

What are some disease processes that can cause urgency?

1. Prostate disease (prostate enlarges leading to it squeezing the urethra making them have to pee (typically 40 year-olds and up)

2. UTIs

What is dysuria?

Pain associated with peeing usually associated with inflammation

Where is dysuria typical?

Distal tip of the urethra

What are some disease processes that can cause dysuria?

UTI

STI

Kidney stones

What is frequency?

Increase of umber of voids during the day

What is nocturia?

Increased number of voids during the night (peeing at night for 2 or more times - 1 if we go off of what he told us)

What is the normal amount a person pees in one day?

5/6 times per day and none at night

What are some examples of reasons why you would have increased urinary output (peeing more than 5/6 times a day and/or at night)?

Diabetes mellitus

Diabetes insipidus

UTI

Medications (diuretic medications)

Hypotension

Excessive fluid ingestion

Decreased functional bladder capacity (bladder obstruction)

What is hesitancy?

Delay in the start of the urine stream

What is the usual cause of hesitancy?

Prostate disease (prostate is getting large, squeezing proximal urethra, and the urinary bladder now has to get enough pressure past the prostate but can’t get all the urine out of the urinary bladder)

What is incontinence?

Involuntary loss of urine

What is total incontinence?

No way to prevent urine from draining out

What are some reasons of total incontinence?

Kids can’t control it until around age 2

Prostatectomy

What is stress incontinence?

Leak urine when there’s pressure on the bladder (sneeze, cough, laugh = leaking)

What is the best urine sample to obtain for urinalysis?

First urinary void of the day

What is a midstream clean catch?

Clean distal tip of urethra, void, don’t collect initial 1/3, collect the middle 1/3

What does it mean to have frothy urine?

Proteinuria

Diabetes

Infections

Grandma lies on the floor for 8 hours after falling and her urine looks like iced tea, what does this signify?

Signifies muscle breakdown, causing the release of myoglobin directly into the blood (rhabdomyolysis), leading to kidney stress

How can urine be tested?

Dipstick urinalysis

Microscopic evaluation

Culture

What can a dipstick/microscopic urine test show/test for?

pH

Protein

Glucose/Ketones

Nitrites

Leukocytes

Blood (hematuria)

How do we use a dipstick urine test?

Dip the stick into the urine and read the stick by comparing panels

What are the benefits of a dipstick urine test compared to a microscopic?

Fast

What are the benefits of a microscopic urine test compared to a dipstick?

More accurate

What kind of conditions can pH be measured under?

Metabolic

Respiratory

What does specific gravity show?

How concentrated the urine is (fluid to particles)

What does a low and high specific gravity look like?

Low = Less aroma and clearer

High = strong aroma and darker (more particles of urine)

What are some reasons for a high specific gravity for urine?

Exercise

Dehydration

Diarrhea

Vomiting

UTI

Diabetes

Kidney dysfunction

What is proteinuria?

Protein in the urine

Protein in urine paragraph? (Should only need to know the basics)

Normally, the glomerulus prevents passage of protein from the blood to the urine. Thus, the persistent presence of protein in urine is the single most important indicator of renal disease

What are type of protein are we looking for when checking for protein in urine?

Microalbuminuria (small pieces of albumin (protein) in the urine) can show problems but protein shows late stage renal disease

What prevents passage of protein from the blood to the urine?

Glomerulus

What does the glomerulus prevent?

Passage of protein from the blood to the urine

Presence of protein in urine is the single most important indicator of what?

Renal disease

What is microalbuminuria?

Small proteins in the urine

Glucose/Ketones tests for what?

Detects diabetes mellitus and assesses diabetes mellitus control

Should you have glucose and/or ketones in your urine?

No

What is the body’s main energy source and what will the body use if it runs out?

Glucose

Will go to stored fats when you run of glucose

What does fat break down into?

Ketones

Why would glucose be in the urine with someone that has diabetes mellitus?

Glucose is not in the blood due to lack of insulin

What breaks down nitrates into nitrites?

Bacteria

What does nitrites in the urine signify?

Bacteriuria

What is bacteriuria?

Bacteria in the urine

What are leukocytes?

WBCs

What do leukocytes in the urine signify?

Infection (UTI)

What is a painful cause of hematuria and a painless cause of hematuria?

Painful = Kidney stones

Painless = Bladder cancer

What substance do we take from patient to measure BUN?

Blood

What is BUN test

A blood test to evaluate kidney function by checking for urea and nitrogen

How is urea excreted through the urine?

Protein catabolism (breakdown) occurs in the liver —> liver produces urea -—> urea enters the blood —> blood is processed and kidneys excrete urea —> then excreted through ureters, urinary bladder, and urethra

What does having urea and nitrogen signify?

Kidneys not working properly

What is a creatine test?

Blood test that checks for creatine

What is creatinine?

The byproduct of muscle breakdown that is happening at a consistent rate

What does a faster rate of muscle breakdown mean for creatinine and the kidney?

More creatinine and impaired renal function

Name 2 blood tests that deal with the urinary system?

BUN
Creatinine

Name 4 tests that can be done for urine?

Urine dipstick

Microscopic urinalysis

Culture

Urine drug test