PA301 - GU Packet #1

What is the urinary system responsible for?

1. filtering blood plasma by retaining useful chemicals and eliminating 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

How are medications excreted?

renally or hepatically; it is important to know age, organ function, and how a drug is metabolized to know what to prescribe

What is erythropoietin?

a hormone that stimulates RBC production

What is anemia?

deficiency of RBCs or hemoglobin; can be a result of a lack of EPO

What are the components of the urinary system?

1. two kidneys (need at least one)

2. two ureters

3. urinary bladder (muscle that can only hold so much)

4. urethra (longer in males and increased risk of UTI in females)

How much urine can the urinary bladder hold?

1 liter

What are I+Os?

inputs (drink or IV) and outputs (urine excreted); input can be hard to calculate; output can be hard on the nurses; only order if necessary

Is there a difference between not making urine and not voiding urine?

yes -> not making urine is worse

What is a bladder scan?

ultrasound transducer is used to scan the pt bladder to tell if there is urine; numerical output is given; pt will then be asked to void the easy way (pee) or the hard way (catheter)

What can urine indicate?

pregnancy, drug levels, protein levels, UTI

What is the relationship between urine and blood?

urine is a filtrate of blood

How much urine should people make and at what rate?

-800-2000 mL/day or 30 mL/hour or 1 cc/min

-in 8 hrs, 480 cc should be made

What does frothy urine indicate?

proteinuria -> diabetes, lupus, chronic kidney disease

What does tea-colored urine suggest?

liver disease, kidney disease, rhabdomyolysis, hematuria

What is the midstream clean catch urine?

done to minimize bacterial contamination

1. wash hands

2. clean genitalia area with sterile wipe

3. begin urinating in toilet

4. after a few seconds, switch urine stream to collect into sterile container

5. finish urinating in toilet

6. seal, label, and send sample to lab

What is a catheter?

flexible tubing that passes through the urethra and into the bladder; the end has a balloon to keep the tube from sliding out; have to be careful if the pt pulls out and the balloon is pumped because damage to urethra can result; leave in until pt is up and moving

What are the pros of a catheter?

-keep track of urinary output

-can be used during surgery to keep sterile field with no pee on table

-can get urine out of bladder (for males with enlarged prostate)

What are the cons of a catheter?

-likely to cause an infection (E. coli)

-can be painful

What is the anatomy of the urinary system?

-kidneys lie at the level T12 to L3

-right kidney is lower because of liver pushing down

-aorta -> renal artery -> kidney -> series of filtration nephrons

-fluid to be kept is returned to the body's circulation via the renal vein

-fluid to be excreted enter the ureter -> bladder -> urethra

What is hematuria?

blood in the urine

What is microscopic hematuria?

greater than 5 RBCs per high powered field; don't see blood with naked eye; looks normal color

What is macroscopic (gross) hematuria?

can see blood in urine with naked eye

What is urgency?

need to void; common in UTI, diabetes, kids

What is dysuria?

painful urination associated with inflammation; burning pain at distal tip of urethra; common in UTI

What is frequency?

increased number of voids during day time

What is nocturia?

waking up more than once during the night to pee

What is the normal number of voids during day and night?

day: 7-8 times

night: 1-2 times

How can urination be increased?

1. increased urinary output (diabetes mellitus, diabetes insipidus, weakened pelvic floor, prostate disease)

2. decreased functional bladder capacities (bladder outlet obstruction)

What is hesitancy?

delayed initiation of urinary stream; need to void but there is a delay; common with a disruption of the prostate

What is incontinence?

involuntary loss of urine; can't control urine output

What is total incontinence?

don't have control over urine voiding

What is stress incontinence?

urine leakage with straining or intra-abdominal pressure; caused by pregnancy, working out, coughing/sneezing/laughing; common post-vaginal delivery

What is specific gravity?

ratio of the density of a substance to the density of a standard substance; concentration of solute and water; for water -> less than 1, floats and greater than 1, sinks; for urine -> less than 1.0101, water heavy and greater than 1.030, waste heavy (pt is dehydrated which can be determined by color, smell, or particulates in urine); measured with a urinometer

How can a patient become dehydrated?

-poor kidney function (diabetes)

-not drinking enough

-sweating

-UTI

-diarrhea/vomiting

What is the best urine?

-first urine of the day

-pregnant (40 weeks) women do a urine test every time they come in for proteins and other things

-midstream clean catch is used first thing in the morning to test kidney function and metabolism

-urine is refrigerated and brought into appointment

How is urine tested?

dipstick or microscopic urinalysis

What is dipstick urinalysis?

put stick in urine and compare colors (good screening tool but subjective)

What is microscopic urinalysis?

look at urine sample under microscope

What aspects of pH are measured in urinalysis?

metabolic and respiratory

What does protein have to do with urine?

normally the glomerulus prevents passage of protein from the blood to the urine so persistent presence of protein in the urine is the single most important indicator of renal disease (kidney is ineffective)

What is microalbuminuria?

small piece of protein in the urine

What diseases wreak havoc on the kidney causing proteinuria or microalbuminuria?

diabetes and hypertension

What does glycosuria indicate?

-glucose in the urine

-used to detect diabetes mellitus and evaluate effectiveness of treatment

Should ketones be in the urine?

-no

-ketones are released when glucose can't be used as energy and fat breaks down

What are nitrites?

bacteria breaks down nitrates into nitrites so nitrites in the urine indicates bacteriuria

What do leukocytes in the urine indicate?

infection

What does painless hematuria indicate?

bladder cancer (until proven otherwise in older patients)

What can cause hematuria?

kidney stones

What is BUN?

-blood test

-protein catabolism occurs in the liver and the product is urea which goes to the kidney

-kidney is supposed to clear 60% of urea from the blood

-high BUN could indicate kidney is not working well (normally) or a lot of protein catabolism is occurring

What is creatinine?

-blood test

-muscles breakdown at a constant rate releasing creatinine into the blood which goes to the kidney to be cleared

-elevated creatinine is more sensitive/specific for kidney disease than BUN

What can test positive in a urine drug screen?

-alcohol

-amphetamines

-benzodiazepines

-marijuana

-opioids (codeine, heroin, morphine)