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Genital-Urinary System

Genital-Urinary System. Renal System Part 1. Behavioral Objectives:. Review the anatomy and physiology of the genito-urinary systems Describe the physical assessment of the GU systems Discuss the application of the nursing process as it relates to patients with disorders of the GU system

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Genital-Urinary System

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  1. Genital-Urinary System Renal System Part 1

  2. Behavioral Objectives: • Review the anatomy and physiology of the genito-urinary systems • Describe the physical assessment of the GU systems • Discuss the application of the nursing process as it relates to patients with disorders of the GU system • Describe the purpose and methods for collecting sterile and “clean-catch” urine specimens. • Discuss the importance of monitoring and maintaining intake and output and appropriate documentation • Discuss common diagnostic tests, procedures and related nursing responsibilities for the patient with GU disorders. • Explain the purpose of dialysis and differentiate between peritoneal and hemodialysis

  3. Introduction • Essential to life • Every head to toe assessment must include… • Upper & lower urinary tract function

  4. Anatomy: Kidney • Kidneys • Shape • Bean • Color • Brown-red • How many / # • 2

  5. Anatomy: Kidneys Kidneys • Location • Posterior wall of the abdomen • Base of the rib cage • Surrounded by renal capsule • Right kidney is lower than the left

  6. Anatomy: kidney Do You Remember? • What lies on top of each kidney? • Liver • Pancreas • Meat balls • Adrenal gland

  7. What hormones do the adrenal glands secrete? • (Not a multiple choice question!) • Hint • Sugar, Sex & Salt • Glucocorticoids • Androgens • Mineralcorticoids - aldosterone

  8. Anatomy: Kidney • Two distinct regions: • Renal parenchyma • Renal pelvis • Renal parenchyma • Divided into 2 parts • Cortex • Medulla

  9. Renal parenchyma • Medulla • Inner portion • Contain • Loops of Henle • Vasa recta • Collecting ducts

  10. Renal parenchyma • Medulla • Collecting ducts connect to Renal pyramids • Shape: • Triangle • Point toward • Hilum / pelvis • Ea. Kidney contains • 8-18 pyramids

  11. Anatomy: Kidney • Medulla • Function • Drain urine from the Nephrons to the renal pelvis

  12. Renal parenchyma • Divided into 2 regions • Medulla • Cortex • Contains • Nephrons • Functional unit of the kidneys

  13. Anatomy: Kidney • Renal pelvis • Ureter • Renal pyramids drain urine into the ureter • Renal artery • Renal Vein

  14. Blood supply to the kidney • Aorta • Renal artery  • Afferent arteriole • Glomerulus • Capillary bed • Efferent arteriole • Venules and veins • Inferior Vena Cava

  15. Can you do it? • Place the following in order to best describe blood flow threw the kidney. • Afferent arteriole • Aorta • Efferent arteriole • Glomerulus • Inferior Vena Cava • Renal artery • Vein • Venules • B-F-A-D-C-H-G-E

  16. QUESTION???? • Where in the flow of blood threw the kidney does filtration take place? • Afferent arteriole • Aorta • Efferent arteriole • Glomerulus • Inferior Vena Cava • Renal artery • Vein • Venules

  17. Anatomy: Nephrons • Functional unit* • FYI • 1 million Nephrons in ea. Kidney • Adequate renal function with 1 kidney

  18. Anatomy: Nephrons • Nephron • Glomerulus • Bowman’s capsule • Proximal convoluted tubule • Loops of Henle • Distal convoluted tubule

  19. Anatomy: Ureters • Urine:nephrons  renal pyramids  renal pelvis  ureter, • a long narrow muscular tube • Extends from renal pelvis  bladder • Two • Upper urinary tract

  20. Anatomy: Ureters • 3 narrowed areas • promotes efflux • prevents reflux • micturition • Propensity for obstruction by renal calculi

  21. Anatomy: Ureters • lining urothelium • prevents reabsorption of urine • The movement of urine is facilitated by peristaltic waves

  22. Anatomy: Bladder BLADDER • Description • Muscular • hollow sac • Location • Behind pubic bone • Function • Reservoir for urine

  23. Anatomy: Bladder • Normal capacity • 300-500 ml of urine • Capable of holding • 1500-2000 ml • CNS stim. “need to void” • 150-200 ml urine

  24. Anatomy: Bladder • Neck of the bladder • Internal urinary sphincter • Involuntary control

  25. Anatomy: Urethra • Carries urine from the bladder & expels it from the body • External urinary sphincter • voluntary control

  26. Physiology of the Urinary System • Function of the kidneys • Urine formation • Excretion of waste products • Regulation of • Electrolytes • Acid-base control • RBC production • Ca+ & Ph • Control • water balance • blood pressure • Renal clearance • Synthesis of Vit. D

  27. Physiology of the Urinary System • Urine formation • The nephrons form urine through a complex 3-step process • Glomerular filtration • Tubular reabsorption • Tubular secretion

  28. 1. Glomerular filtration Step 1 • Most of the elements of blood, except • large molecules • blood cells • forced out of the blood  capillaries of the glomerulus  Bowman’s capsule  filtrate • High capillary BP in the glomerulus.

  29. 1. Glomerular filtration • Filtration at Glomerulus • Water • Na+ • Cl- • Bicarbonate • K+ • Glucose • Urea • Creatinine • Uric Acid

  30. 1. Glomerular filtration • Glomerular filtration • Factors that can alter process: • Blood flow • Blood pressure

  31. 2. Tubular reabsorption Step 2 • Filtrate  Proximal convoluted tubule  • Reabsorption (back into blood) • Most • Water • Na+ • Cl- • Bicarb • K+ • Uric Acid • All of the glucose • None of the Creatinine

  32. 3. Tubular Secretion • Elements secreted from blood into tubule for excretion in urine • Some • Water • Na+ • Cl- • Bicarbonate • K+ • Uric acid • Most Urea

  33. Filtrate  • Tubules  • Collecting duct  • Renal pelvis • Ureter  • Bladder  • Urethra

  34. Sweet pea! Glucose • Normally all the glucose filtered through the glomeruli will be reabsorbed back into blood • No glucose in the urine • Glycosuria • Diabetes mellitus • h serum glucose levels overwhelm the nephron’s ability to reabsorb glucose

  35. Protein • Filtered by glomeruli & returned to the blood by tubular reabsorption. • Slight proteinuria • OK • globulin, albumin • Persistent proteinuria • Glomerular damage

  36. Anti-diuretic hormone (ADH) • AKA • Vasopressin • Secreted by • Posterior Pituitary • Secreted in response to • changes in blood osmolality

  37. Anti-diuretic hormone (ADH) Normally • Water intake i • Blood osmolality  • h • Stim. pituitary to • ADH • h • ADH receptor site  • Kidney • Action • h reabsorption of H2O • i urine volume/output •  returns blood osmolality to normal

  38. Anti-diuretic hormone (ADH) Normally • Water intake h • Blood osmolality  • i • Stim. pituitary to • ADH • i • ADH receptor site Kidney • Action • i reabsorption of H2O • h urine volume (diuresis) •  returns blood osmolality to normal

  39. Osmolarity & Osmolality • Osmolarity • # of particles dissolved in solution • Osmolality • Thickness of solution • Urine • Serum / blood

  40. Regulation of water excretion • The amt. of urine formed is r/t the amt. of fluid intake • h fluid intake  • volume urine • h • Characteristic • Dilute • i fluid intake  • volume of urine • i • Characteristic • Concentrated • Normally: kidneys rid the body of about 75% of fluids taken in

  41. Regulation of Electrolytes Excretion • Sodium • Normally serum Na+: • 135 - 145 mmol/L • Na+ filtered from the blood & reabsorbed from the tubule back into the blood • Na+ excretion is controlled by Aldosterone • h Aldosterone  h Na retention  • __?__ Serum Sodium level • h serum sodium level • Na+ most abundant electrolyte found outside the cells (extracellular)

  42. Regulation of Electrolytes Excretion • Potassium • K+ is the most abundant electrolyte found inside the cells (intracellular). • h Aldosterone  hK excretion  • __?__ serum K+ level • i serum K+ level

  43. Regulation of Electrolytes Excretion • Kidney’s not functioning normally • Na+ & K+ will not be adequately filtered from the blood • Retention of K+ is the most life-threatening effect of renal failure • Renal failure • Retention of K+  • Hyperkalemia  • Cardiac dysrhythmias  • Death

  44. Regulation of acid excretion • Proteins are broken down into acids • phosphoric acid • sulfuric acid. • Acids in the blood  • ipH • Normally kidneys • Filter acids from the blood • Tubular filtration • Chemical buffer mechanism

  45. Regulation of acid excretion • Tubular filtration • Acid is excreted into the urine through tubular secretion • Used until the bladder acidity • pH 4.5 • Any excess acid must be neutralized

  46. Regulation of acid excretion Neutralize acids • binding them to chemical buffers • Be excreted without altering the pH • Important buffers • Phosphate ions • Ammonia • NH3

  47. Regulation of Red Blood Cell Production • Kidneys measure O2 tension of the blood (PaO2) • i PaO2  • (Hormone) herythropoietin • (Receptor site) bone marrow  • (Action) h production of RBC  • h Hgb  • h PaO2

  48. Normal RBC-Erythrocytes • Male: 4.7 - 6.1 million/mm3 • Female: 4.2 - 5.4 million/mm3 • Normal Hemoglobin • Male 14 - 18 g/dL • Female 12 - 16 g/dL

  49. Vitamin D Synthesis • Kidneys activate ingested Vitamin D  • Aid absorption of calcium

  50. Excretion of waste products • Urea, (waste product of protein metabolism) • Blood Urea Nitrogen • h BUN = renal dysfunction • Other waster products of metabolism are • Creatinine • Phosphates • Sulphates • Ketone • Along with BUN the serum Creatinine level is usually ordered whenever the MD suspects renal disease

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