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🩸ELIMINATION PATTERNS & THE URINARY SYSTEM

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Main Function

The urinary system maintains the body’s fluid and electrolyte balance, removes waste, and regulates blood pressure, RBC production, and vitamin D activation.

⚙

ANATOMY AND PHYSIOLOGY

🧠

Kidneys

Location: Retroperitoneal (behind peritoneum), from T12 to L3 vertebra.

• Size: About 10–13 cm long and 250 g each.

• Left kidney is slightly longer and narrower than the right.

• Larger kidneys may mean obstruction or polycystic disease.

• Smaller kidneys may indicate chronic kidney disease.

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FUNCTIONS OF THE KIDNEY

1.

Regulatory Functions

Maintain fluid, electrolyte, and acid-base balance through:

a.

Glomerular Filtration

• First step in urine formation.

• Blood filters through the glomerulus → Bowman’s capsule → forms filtrate.

• Normal GFR = 125 mL/min

• Only 1–3 L/day of filtrate becomes urine; rest is reabsorbed.

• If BP < 70 mmHg → GFR stops, risking renal failure.

b.

Tubular Reabsorption

• Reabsorbs essential substances (water, glucose, ions) to prevent dehydration.

• Controlled by ADH (antidiuretic hormone) and aldosterone.

• Renal threshold for glucose = 220 mg/dL
  
  

  • Below this → all glucose reabsorbed

  • Above this → glucose appears in urine (glycosuria).

• 
  

c.

Tubular Secretion

• Substances like potassium & hydrogen ions move from blood to urine for pH and electrolyte balance.

2.

Hormonal Functions

The kidneys release:

🧓

AGING AND THE URINARY SYSTEM

• Kidney shrinks with age; ↓ blood flow (~10% per decade).

• GFR decreases → by age 65, ~65 mL/min.

• ↓ ability to concentrate urine → nocturia and dehydration risk.

• ↓ renin, aldosterone, and vitamin D activation.

• ↓ bladder elasticity → urinary urgency and incontinence.

🩺

NURSING ASSESSMENT

🔸 Patient History

• Sudden hypertension >50 yrs = possible kidney disease

• Men: Prostate enlargement may alter urination

• Women: Short urethra → prone to UTI/cystitis

• Ask about:
  
  

  • Diabetes, hypertension, infections, stones, surgeries

  • Chemical exposure (lead, mercury, gasoline, etc.)

  • OTC meds (NSAIDs, analgesics, herbal, etc.)

  • Drug use (heroin, cocaine, meth)

• 
  

🔸 Nutrition History

• Assess diet and fluid intake

• Encourage 3 L/day of water (if not contraindicated)

• High protein or low fluid → kidney stone risk

🔸 Medication History

• Drugs for diabetes, hypertension, cardiac or hormonal disorders may affect kidneys.

• Gentamicin (antibiotic) may cause sudden renal dysfunction.

• Long-term NSAIDs and acetaminophen can impair renal function.

🔸 Current Health Problems

• Observe for urinary pattern changes: frequency, nocturia, urgency, incontinence

• Normal output: 1500–2000 mL/day

• Pain:
  
  

  • Flank → kidney

  • Radiating to groin → ureteral obstruction (renal colic)

• 
  

• Uremia: Accumulation of waste → fatigue, itching, muscle cramps, N/V

🧍‍♀

PHYSICAL ASSESSMENT

Kidneys, Ureters, Bladder

• Auscultate first (for bruit) → then percuss and palpate.

• Inspect for swelling or discoloration (esp. costovertebral area).

• Dull sound on percussion → distended bladder.

Urethra

• Inspect meatus for redness, discharge, lesions.

• Note pain or irritation during urination.

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DIAGNOSTIC EVALUATION

• Nurse should explain purpose, procedure, and side effects of each test.

• Manage anxiety, especially during urine collection (some patients may have “guarding” or difficulty urinating due to embarrassment).

🧭

SUMMARY

That’s a very detailed and comprehensive nursing reviewer on urinary system assessment, urinalysis, and urinary tract infections (UTIs). 💧

Here’s a clear, organized, and summarized explanation (great for nursing review, recitation, or quiz prep) — arranged by topic and with key points emphasized 👇

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URINALYSIS & URINE CULTURE

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Purpose

🌈

URINE CHARACTERISTICS

Other findings:

• Clarity & Odor: Foul smell → infection.

• pH & Specific Gravity: Indicate concentration & acidity.

• Microscopy: Detects RBCs (hematuria), WBCs (pyuria), casts, crystals, and bacteria.

• Telomerase activity: Marker for bladder cancer.

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ABNORMAL URINALYSIS FINDINGS

1.Hematuria More than 3 RBCs/HPF (high-power field)

Causes: Infection (UTI, prostatitis), stones, tumors, bleeding disorders, meds (warfarin, heparin)

2Proteinuria

3.pH

• <7 = acidic urine (high-protein diet)

• 7 = alkaline urine (high fruit/vegetable diet)

4.Glucose

• Normal: None

• If blood glucose > 220 mg/dL, glucose spills into urine → glycosuria (seen in diabetes).

5.Ketones

• None normally.

• Present with fat metabolism (starvation, ketoacidosis).

6.Proteins

• Not normally present.

• 300 mg/24 hr = abnormal.

⚖SPECIFIC GRAVITY

• Measures urine concentration

• Normal: 1.010–1.025

💧OSMOLALITY

Most accurate measure of kidney’s concentration ability

🔍RENAL FUNCTION TESTS

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IMAGING TESTS

🧠

COMMON NURSING DIAGNOSES

• Impaired Urinary Elimination (frequency, urgency, nocturia)

• Urinary Retention

• Stress / Urge Incontinence

• Acute Pain (bladder spasm)

• Risk for Infection / Sepsis

• Ineffective Health Maintenance

🦠URINARY TRACT INFECTION (UTI)

Definition

Infection by pathogens in the urinary tract (normally sterile above the urethra).

👉 2nd most common infection in the body.

Classification

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MECHANISMS THAT MAINTAIN STERILITY

1. Urethra acts as barrier

2. Continuous urine flow

3. Competent ureterovesical junction

4. Antibacterial enzymes & antibodies

5. Bladder mucosal defenses

⚠

CONTRIBUTING FACTORS

• Female gender

• Diabetes, pregnancy, neuro or immune disorders

• Incomplete bladder emptying

• Catheterization / cystoscopy

• Obstructions (stones, strictures, tumors)

🧫

PATHOPHYSIOLOGY

Bacteria → attach to urinary tract → colonize → evade defenses → cause inflammation.

Reflux Types:

• Urethrovesical reflux: Urine pushed back into urethra → returns to bladder with bacteria.

• Vesicoureteral reflux: Backflow from bladder → ureters → kidneys → renal damage.

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ETIOLOGY

• 90% caused by E. coli

• Others: Staph. saprophyticus, Klebsiella, Proteus, Enterobacter

• Catheter use is #1 hospital risk (infection after 48 hrs of insertion)

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RISK FACTORS

• Immunosuppression (steroids, AIDS, diabetes)

• Long-term antibiotics (fungal infections)

• Chemical exposure (e.g., Cytoxan, radiation)

• Autoimmune diseases (SLE)

🚑

HEALTH PROMOTION

• Avoid unnecessary catheter use

• Maintain sterile technique

• Remove catheters ASAP

• Drink ≥3 L water/day

• Void every 3–4 hrs

• Maintain hygiene (daily perineal wash)

• Avoid caffeine, alcohol, and sugary drinks

💊

MANAGEMENT OF UTI / CYSTITIS

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Drug Therapy

🔹

Nutrition

• Increase fluids

• Avoid bladder irritants (coffee, soda, tomato)

• Cranberry juice (50 mL daily × 3–4 weeks)

🔹

Comfort Measures

• Warm sitz bath 2–3× daily for 20 min

• Urinate in warm water if pain is severe

🔹

Surgery

• For obstruction removal, reflux repair, or stone extraction.

💡

SUMMARY TABLE

That’s a comprehensive nursing reviewer covering upper urinary tract infections (pyelonephritis), urinary stones (urolithiasis), and chronic kidney disease (CKD).

Here’s a simplified and summarized version — organized per topic, with clear Taglish explanations perfect for review, oral recitation, or quiz prep 👇

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🦠 UPPER URINARY TRACT INFECTIONS: PYELONEPHRITIS

🔹 Definition

• Pyelonephritis – bacterial infection sa kidney at renal pelvis (upper urinary tract).

• May be acute (biglaan) or chronic (paulit-ulit).

🔹 Pathophysiology

• Bacteria mula sa bladder o dugo ay umaakyat sa kidney → inflammation → tissue damage or abscess formation.

⸻

🧬 Types

Type Description Causes

Acute Pyelonephritis Active infection; may cause fever, flank pain, CVA tenderness Bacterial entry (E. coli, Proteus, Klebsiella, Pseudomonas)

Chronic Pyelonephritis Repeated or long-term infection; may cause scarring at renal tissue Urine reflux, obstruction, catheter use, diabetes

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⚠ Etiology / Risk Factors

• E. coli – most common cause

• Enterococcus faecalis – common in hospitalized patients

• Predisposing factors:

• Urinary reflux or obstruction

• Pregnancy

• Diabetes

• Catheterization

• Overuse of analgesics

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👩‍⚕ Clinical Manifestations

Acute Chronic

Fever, chills, flank or back pain, CVA tenderness Hypertension

Tachycardia, tachypnea Inability to conserve sodium

Abdominal discomfort, N/V, fatigue Nocturia, polyuria

Burning urination, urgency Hyperkalemia, acidosis

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🧪 Diagnostic Tests

• Urinalysis → + leukocyte esterase, + nitrites, WBCs, bacteria

• Urine culture → identifies causative bacteria

• Blood tests: ↑ ESR, ↑ CRP

• Imaging: KUB X-ray, IV urography, cystourethrogram, gallium scan

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💊 Management

🔸 Non-surgical Management

• Antibiotics: Ciprofloxacin, Gentamicin (broad spectrum), then switch based on C&S result

• Urinary antiseptic: Nitrofurantoin (Macrodantin)

• Fluids: 2–3 L/day (if no restriction)

• Nutrition: Balanced diet to promote healing

🔸 Surgical Management

Procedure Purpose

Pyelolithotomy Remove large stones blocking urine flow

Nephrectomy Remove severely damaged kidney

Ureteroplasty / Reimplantation Repair or reposition ureter to prevent reflux

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💎 UROLITHIASIS (Urinary Stones)

🔹 Definition

• Formation of stones (calculi) in urinary tract (kidney = nephrolithiasis, ureter = ureterolithiasis).

• Causes severe flank pain (renal colic).

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🧬 Types of Stones

Type Composition Common Cause

Calcium oxalate / phosphate 75% Hypercalcemia, dehydration

Struvite (triple phosphate) 15% Infection

Uric acid 8% ↑ uric acid, gout

Cystine 3% Genetic defect in amino acid metabolism

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⚙ Pathophysiology

• Slow urine flow → urine supersaturation → crystal formation

• Urinary tract injury → crystal adherence → stone formation

• Urine acidity/alkalinity affects stone type:

• Acidic = uric acid/cystine stones

• Alkaline = calcium phosphate/struvite stones

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🚨 Clinical Manifestations

• Renal colic (severe flank pain)

• Nausea, vomiting, diaphoresis

• Hematuria (bloody urine)

• Oliguria/anuria (possible obstruction)

• Fever if infection present

⸻

🧪 Diagnostics

• Urinalysis → RBCs, WBCs, cloudy urine

• ↑ Serum calcium, phosphate, uric acid

• Imaging: KUB X-ray, CT scan (non-contrast = most accurate), IVP, ultrasound

⸻

💊 Management

🔸 Non-surgical

• Pain relief: Morphine, Ketorolac

• Spasmolytics: Oxybutynin, Propantheline

• Strain urine: to catch stones

• Hydration: adequate (not excessive)

🔸 Lithotripsy (ESWL)

• Shock waves break stones into fragments

• Sedation given; monitor ECG; strain urine after

🔸 Surgical

Procedure Description

Stenting Tube placed to widen ureter

Ureteroscopy Endoscopic removal

Percutaneous nephrolithotomy Removal via small skin incision

Open surgery For large or resistant stones

🔸 Prevention

• Antibiotics for infection

• Hydration (2–3 L/day)

• Diet modification (avoid excess calcium, purines, or oxalate foods)

⸻

💀 CHRONIC KIDNEY DISEASE (CKD)

🔹 Definition

• Progressive, irreversible kidney damage leading to loss of function.

• When kidney can’t sustain life → End-Stage Kidney Disease (ESKD).

⸻

⚙ Pathophysiology

• Gradual nephron destruction → ↓ GFR → waste accumulation (uremia).

Uremic Symptoms:

• Metallic taste, anorexia, nausea, muscle cramps, pruritus, fatigue, edema.

⸻

🧬 Stages of CKD (by GFR)

Stage GFR (mL/min) Description

1 >90 Normal function but at risk

2 60–89 Mild CKD, early waste buildup

3 30–59 Moderate CKD, symptoms appear

4 15–29 Severe CKD, major imbalance

5 <15 ESKD; dialysis or transplant needed

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🩺 Common Causes

• Diabetes mellitus

• Hypertension

• Glomerulonephritis

• Polycystic kidney disease

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🧍‍♀ Clinical Manifestations

System Manifestations

Neurologic Lethargy, confusion, seizures, tremors

Cardiac Hypertension, heart failure, pericarditis

Respiratory Dyspnea, Kussmaul respirations, uremic breath

Hematologic Anemia, bleeding tendencies

GI Nausea, vomiting, anorexia, metallic taste

Skin Yellowish color, pruritus, uremic frost

Urinary Initially polyuria → oliguria/anuria

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🧪 Lab Findings

• ↑ BUN & Creatinine

• ↓ GFR

• Electrolyte imbalance (↑ K⁺, ↓ Ca²⁺, ↑ Phosphate)

• Anemia (↓ Hgb, Hct)

⸻

💊 Management

🔸 Nutrition

• Low protein (to reduce urea)

• Fluid & sodium restriction

• Limit potassium & phosphorus

• High calorie, vitamin & mineral support

🔸 Medications

• Phosphate binders: Calcium acetate, Sevelamer

• Erythropoietin (Epoetin alfa): Treat anemia

• Antihypertensives: Control BP

• Diuretics: For volume control

🔸 Dialysis or Transplant

• Required in Stage 5 (ESKD).

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🧠 KEY TAKEAWAY SUMMARY

Disorder Key Feature Management Focus

Pyelonephritis Infection of kidney Antibiotics, hydration, correct obstruction

Urolithiasis Stone formation Pain relief, stone removal, hydration

CKD Irreversible kidney failure Slow progression, manage electrolytes, dialysis

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