Urinary System Disorders

Prepared by: Michael John R. Victoria, RN

Overview
DX
Urinalysis
Clean Catch, midstream
Renal Function Test
BUN=2.5-7 mmol/l
Creatinine= 0-1mg/dl
Uric acid= 3.5-7.8 mg/dl

DX tests
Radiologic tests
KUB xray- show size, shape and position of kidney and UB
IVP (pyelography)
NPO 8-10 hours, check for allergies
Laxative/enema to clear the bowel
Void prior to test
DX
Renal angiography-visualization of renal arterial supply. Contrast material injected through a
catheter
Enema b4; shave injection site (groin or ankle)
Post: cold packs on puncture site
Palpate peripheral pulses
Check color and temp of extrm
Bedrest for 24 hours, no sitting

DX
Cystoscopy- inspect the bladder and urethra. Catheter is inserted into the ureters to see
configuration and position of urethral orifices
Maybe thx- remove calculi from urethra, bladder and ureter
Post: pink-tinged or tea colored urine
Bright red or clots should be reported
INTERVENTIONS
Urinary catheterizations
Dialysis
Hemodialysis
Peritoneal dialysis
INTERVENTIONS
Surgery:
Cystectomy-removal of the UB w/ diversions
Types of urinary deviersions:
Ureterosigmoidostomy- ureters are excised from the bladder and implanted into sigmoid colon;
urine flows through the colon and excreted via the rectum
Ileal conduit- ureters are implanted into a segment of the ileum that has been resected from d
intestinal tract w/ formation of an abdominal stoma; most common
…cont.
Cutaneous ureterostomy- ereters are excised from the bladder and brought through abdominal wall
w/ creation of a stoma
Nephrostomy- insertion of a catheter into the renal pelvis via an incision into the flank or by
percutaneous catheter placement into the kidneys
…cont.
Care for bladder surgery
Maintain integrity of stoma
Monitor for impaired stomal healing (pale, dark, red or blue color, inc stomal height, edema,
bleeding)
Prevent skin irritation and breakdown
Place rolled gauzed around stoma
Cleanse stomal opening w/ mild soap and water
Remove alkaline encrustations by applying vinegar and water soln to peristomal area
Maintain urine acidioty (acid-ash diet, vit.C)
…cont.
Prevention of UTI
Adequate fluids
Empty pouch when half full
Change to bedside bag at night
Control odor (avoid foods w/ strong odor, place small amoun of vinegar or deodorizer in pouch)
Cystitis
Inflam of the UB due to bacterial invasion (usually E.coli)
W>M
Pred fx: stagnation of urine, obstruction, sexual intercourse

DX: urine culture and sensi

S&S
U. frequency and urgency
Burning in the urethra, flank pain and tenderness
Hematuria, fever
TX
Antibiotix
Force fluids
Warm sitz bath for comfort
Urinary tract analgesic- pyridium
Nephrolithiasis/ Urolithiasis
Stones present anywhere in the urinary tract
M>W, 30-55, more common in summer
Pred fx: obstruction, infection, inc uric acid levels, excessive intake of Ca, hyperparahtyroidism,
familial, immobility, DHN, sedentary lifestyle
Types of stones:
Ca oxalate- alkalinic
Ca phosphate- alkalinic
Cystines- acidic
Uric acid- acidic
Struvite- staghorn, Mg ammonium phosphate
DX
KUB- points location, # and size of stones
IVP- identifies site of obstruction
Urinalysis- presence of bacteria, inc CHON, WBC and RBC inc
S&S
Abdominal or flank pain
Renal colic (sudden and sharp)
Hemautria
Fever, chills
TX
Surgery
Percutaneous nephrostomy- tube is inserted through skin and underlying tissues into renal pelvis to
remove calculi
Percutaneous neprhostolithotomy- delivers UTZ waves through a probe placed on the calculus
ESWL- delivers shockwave from outside the body to the stone causing pulverization
TX
Force fluids (3000ml/day)
Encourage ambulation to prevent stasis
Analgesics for pain, moist heat to flank area
Meds: allopurinol- to decrease uric acid
Strain all urine- to analyze type of stone
TX
Diet- depends on the stone found
Calcium stones= limit dairy product; give acid-ash diet to acidify urine (cranberry juice, prune juice,
meat, eggs, fish, grapes, Vit.C)
Oxalate stones= avoid excess intake of foods high in oxalate (teas, chocolate, spinach); alkaline ash
diet (milk, veg, fruits except cranberry, prunes, plums)
Uric acid stones- avoid purine foods (organ meats, shellfish, meat soups, gravies)
Pyelonephritis
Inflammation of the renal pelvis, maybe uni or bilateral, acute or chronic
Acute- usually ascends from lower UT
Chronic- combination of structural alterations along w/ infexn
S&S
Acute: fever, chills, NV, severe flank pain
Chronic: client usually unaware of disease. May have bladder irritability, chronic fatigue, slight dull
ache over kidneys, HPN
TX
Antibiotix, antispasmodics
Urinary antiseptics for chronic- sulfanomides, nitrofurantoin
Adequate fluid intake
Acute Glomerulonephritis
An inflammatory disease involving the renal glomeruli of both kidneys caused by streptococcal
infection
Causative agent: beta-hemolytic strep
Usually resolves about 14 days, self-limiting
Hx of tonsillitis, pharyngitis
DX
Urinalysis- reveals WBC, RBC, CHON
Urine sp. Gr- inc
BUN and Creatinine- inc
ESR- elevated
S&S
Hematuria, edema, anorexia
Fever, HPN, H/A
Flank pain, anemia
TX
Antibiotics- for strepto, Penicillin
Anti-HPN
Fluid restriction if w/ renal insufficiency
Peritoneal dialysis- of indicated
Reduce CHON intake of oliguria and inc BUN
Nephrotic Syndrome
A clinical d/o characterized by marked proteinuria, hypoalbuminemia, edema and
hypercholesterolemia
Autoimmune process leading to structural alteration of glomerular membrane that results in inc.
permeability to plasma CHON, esp albumin
Risk Fx: glomerulonephritis, DM, toxins, renal vein thrombosis, lipid nephrosis in children
Common to preschoolers, boy>girls
Prognosos is good unless edema does not respond to steroids
Pathophysiology
Plasma CHON enters the renal tubulesexcreted in the urine COHNuriadec CHON in serum causes
altered oncotic pressure lowered plasma volume level hypovolemia triggers release of renin and
angiotensin stimulates inc secretion of aldosterone w/c inc reabsorption of water and Na in distal
tubules
Hypotension stimulates release of ADHfurther inc reabsorption of water SPM is alteredplasma leaks
into interstital spaces--> edema
S&S
CHONuria, hypoproteinemia, hyperchelesterolemia
Dependent body edema
Periorbital edema
Ascites
Scrotla edema
Ankle edema
Anorexia, NV, diarrhea, malNTN
Pallor, letahrgy
hepatomegaly
TX
Drug Thx
Corticosteroids- resolve edema
Antibiotix
Thiazide- diuretix
Bed rest- conserve energy
Diet:
High CHON, low Na
TX
Avoid IM injections- not absorbed into edematous tissue
Provide scrotal support
Protect from infexn- immunoppressed bec of steroids
Acute Renal Failure (ARF)
Abrupt cessation of renal fxn, potentially reversible
Causes:
Pre-renal (dec blood supply to kidneys)= cardiogenic shock, hemorrhage, burns, septicemia,
hypotension
Intra-renal (damage to nephrons)= DM, glomerulonephritis, tumors, bld transfusion rxns,
hypercaalcemia, nephrotoxins
Post-renal (mechanical obstructions from tubules to the urethra)= BPH, tumors, calculi, blood clots,
trauma
S & S/ DX
Oliguric phase- caused by reduction in GFR
U.O. < 400 ml/24hrs for 1-2 wks
Hypernatremia, hyperkalemia, hyperphosphatemia, hypocalcemia,met acid
HPN, hypervolemia
BUN crea elevated

Diuretic phase
Gradual inc in UO (3-5L/day) bec recovering kidney can not concentrate urine well
Lasts one week
hypoNa, hypoK, hypovolemia
BUN, crea- elevated to normal
Recovery phase- renal fxn stabilizes
Improvement for 3-12 mos.
TX
Maintain F & E bal
Accurate I&O, appearance of urine, IV fluids as ordered
Monitor VS, ECG, elec imbalances
Promote nutritional status
TPN as ordered, restrict CHON intake
Prevent complications
Pulmo embolism, skin breakdown, contractures

Prevent infection
dialysis
Chronic Renal Failure (CRF)
Progressive, irreversible destruction of the kidney that continues until nephrons are replaced by scar
tissue
Loss of renal fxn, gradual
Pred fx: recurrent infexn, nephritis, UT obstruxn, DM, ARF
Stages:
Renal impairment- 40-50% GFR
Renal insufficiency- 20-30% GFR
Renal failure- 10% GFR
ESRD- <10% GFR
S & S/ DX
NV, dec UO, dyspnea, fatigue
BUN, CREA, K, phosphate- inc
Edema, anemia, HPN (early), hypoTN(late)
Renal encephalopathy, uremic fetor (urine breath)
Uremic frost- accumulation of salts in skin
Stomatitis- bec of ammonia (irritant)
GI bleeding, CHF
TX
Diet
Low Na, K, CHON, high CHO
Drugs
Multivit and iron (for anemia)
Erythropoietin (eprex, epogen)
AlOH4 gel- to buffer hyperphosphatemia
Ani-HPN

Prevent neurological complications

Assess for uremia (fatigue, anorexia, apathy, dac UO, confusion)
Assess LOC
Promote GI fxn
Care for stomatitis
Assess GI bleeding

Dialysis
Promote skin integrity
Skin care for pruritus
Uremic frost- bath in plain water
Prevent bleeding
Admin hematinics as ordered
Bladder Cancer
Most common cancer site of the urinary tract
W>M; 50-70 y/o
Pred Fx: exposure to chemicals, cigarette smokingm bladder infexns
S&S
Intermittent painless hematuria,
Dysuria
frequency
TX
Radiation Thx
Chemo Thx
Direct bladder installations, IV infusion, oral ingestion
Agents: 5-fluorouracil methotrexate, bleomycin, mitomycin-C, hydroxyurea, doxorubicin,
cyclophosphamide, etc.
Surgery
Enuresis
Involuntary passage of urine after the age of control is expected (4y/o)
Types:
Primary- in children who have never achieved control
Secondary- in children who have developed complete control and lose it
May occur anytime, but most frequently at night
Most common in boys
Etiologic possibilities: sleep disturbance, delayed neurologic dev’t, immature dev’r of bladder,
psychologic problems
S&S
Repeated involuntary urination

TX:
Behavior modification- bed alarm
Avoid scolding and belittling child- thios is not a conscious behavior and the child is not misbehaving
TX
Drugs (usually the last resort because of untoward effects)
Tricyclic antideppressants (Tofranil)
anticholinergics
Provide information/ counselling to family as needed
Hydronephrosis (pedia)
Collection of urine in the renal pelvis due to obstruction to outflow
Causes: adhesions, calculi, congenital malformations
May be unilateral or bilateral. More common in left (unknown)
Prognosis is good when treated early

Patho:
Obstruction inc intrarenal pressure dec circulation atrophy of kidneys renal insufficiency

S&S
Repeated UTI’s
FTT
Abdominal pain, fever
Mass in kidney area
TX
Surgery- to correct/ remove obstruction
antispasmodics