Vocational Nursing Mission College VN 55A2 Medical Surgical Theory Genitourinary Lisa Chance, RN, BSN
Jan 02, 2016
Vocational NursingMission College
VN 55A2Medical Surgical Theory
Genitourinary
Lisa Chance, RN, BSN
Quiz Today
• Yes, there is a quiz today.• It is just a little one.• It is fill in.• It is on anatomy, physiology, and
medical terminology.• Not to worry. I will review items first.
• Nothing should be on your table top except the test, appropriate answer material, & your pencil.
• No calculators or electronic thesaurus are permitted.
• No cheating.• You may go to the bathroom during a test;
however, you will not be allowed to continue taking the test.
• Today is a fill in test.
• When there are color tests or exams, indicate what color, letter, or number of test you have on your test paper or Scan-Tron.
• You should not be sitting next to a person who has the same color quiz, test or exam.
• There are two finals in this class: one on GU & on of F&E.
Quizzes & Exams
• From current NCLEX test questions.
• From current nursing articles (last five years).– Continuing education articles
we will go over.
• Web sites questions we that will count as class participation points and will have the answers and rationales.
• Hints in lecture questions.
Urinary System•Upper
– Kidneys make urine
– Ureters convey urine
•Lower
– Bladder stores urine
– Urethra conveys urine
one on each side of the spine just below the liver and spleen.
The Kidneystwo organs located in the posterior part of the abdomen
The two kidneys are located in the lumbar region of the back behind the parietal peritoneum.
http://www.merckmedicus.com/pp/us/hcp/frame_emedtool_search.jsp?pg=/ppdocs/us/hcp/content/emed/Urinary/Urinary_JPEGs/index.htm
The Kidneys•Essential for survival!•Responsible for:
– regulating body fluid composition & water & chemicals in blood such as:
• sodium (Na+)• potassium (K+ primary
regulators !!)• phosphorus (P)• calcium (Ca)
filtering the blood – Remove drugs & toxins introduced
into the body.
– Releasing hormones into blood to help the body:
• regulate blood pressure
• red blood cell production
• Maintain body's calcium levels promote strong bones
The Kidneys
The kidneys are surrounded by fat, which protects them.
•Are attached to the abdominal wall at the level of the last thoracic & first three lumbar vertebra.
The kidneys:
•Hard to palpate unless:
– Enlarged with
Hydronephrosis
Cyst
neoplasm
– Patient slim.
– Often confused with spleen on palpation.
• Left is usually easier to find by palpation than right.
The Adrenal Glands
•Produce hormones that help control:
–heart rate
–blood pressure
– the way the body uses food (metabolism)
–& other vital functions
Adrenal Glands
•Cortex secretes:
– steroid (cortisone-related) hormones
– mineralocortoids that regulate the levels of minerals such as sodium and potassium in the blood
Open your workbooks!
• There is an error!
• Where is that line going?
●Note the location of the renal pelvis! It is used as a major landmark in this diagnostic test.
● Pt injected with radiopaque dye & X-rays are taken as the dye travels through the urinary tract.
The hard outer portion of the kidney is called the:
O CalyxO FasciaO PapillaO MedullaO Cortex
The hard outer portion of the kidney is called the:
Cortex
The 2 kidneys are only 0.4% of the body weight but receive about 25% of the blood flow (cardiac output).
The functional unit of the kidney is the
nephron.
•1 million nephrons in each kidney have the job of:
– filtering the blood to form urine
– excreting toxins and other wastes
– returning the filtered blood to the renal veins to put it back into the general circulation
GlomerulusBowman’scapsule
Distalconvolutedtubule
Afferent arterole
Efferentarteriole
LoopofHenle
Collectingduct
Interlobarartery
Interlobarartery
Glomerulus- tuft of capillaries where filtration occurs
Bowman's capsule- surrounds glomerulus, collects filtrate
• Bowman’s capsule, which surrounds the glomerulus, is the starting point of the tubule, where reabsorption and secretion take place. Filtrate passing into Bowman’s capsule is channeled into the tubule.
• The glomerulus is a group of tiny capillaries with very thin walls.
• As blood passes through, particles and waste products are filtered out into a liquid filtrate.
• Blood cells and proteins, too large to penetrate the glomerular walls, return to the general circulation.
Where filtration occurs.
Proximalconvolutedtubule
Distalconvolutedtubule
Glomerulus
Loop of HenleTo bladder
Outgoingvenousblood
Incomingarterialblood
Collectingtubule
Bowman’scapsule
The actual filtration of the body's waste products takes place in the:
O Nephrons
O Bladder
O Urethra
O Renal pelvis
O Ureters
The actual filtration of the body's waste products takes place in the:
NephronsProximalconvolutedtubule
Distalconvolutedtubule
Glomerulus
Loop of HenleTo bladder
Outgoingvenousblood
Incomingarterialblood
Collectingtubule
Bowman’scapsule
Each nephron consists ofthe renal tubule & the renal corpuscle
called the:
O Nephron
O Efferent arteriole
O Afferent arteriole
O Glomerulus
O Bowman's capsule
Each nephron consists ofthe renal tubule & the renal corpuscle
called the:
Bowman's capsule
Another name for voiding is:
O Diuresis
O Cystitis
O Urgency
O Nephrosis
O Micturition
Another name for voiding is:
Micturition
Waste products are removed from the blood through the three stages called filtration, reabsorption, and:
O Enuresis
O Pubic symphysis
O Homeostasis
O Secretion
O Peristaltic waves
Waste products are removed from the blood through the three stages called filtration, reabsorption, and:
Secretion
One of the most vital functionsof the kidneys is to:
O Regulate blood pressure
O Produce aldosterone
O Regulate the body's electrolytes
O Supply blood to the renal artery
O Produce the hormone ADH
One of the most vital functionsof the kidneys is to:
Regulate blood pressure
The involuntary discharge of urine after the age by which bladder
control should have been established is called:
O Phimosis
O Enuresis
O Nocturia
O Dysuria
O Diuresis
The involuntary discharge of urine after the age by which bladder
control should have been established is called:
Enuresis
Practice for the NCLEX-PNby CramExam
a) 19:00
b) 12:00
c) 10:00
d) 07:00
The client with The client with enuresisenuresis is being taught is being taught regarding bladder retraining. The nurse regarding bladder retraining. The nurse should advise the client to refrain from should advise the client to refrain from drinking after:drinking after:
Practice for the NCLEX-PNby CramExam
The client with The client with enuresisenuresis is being taught is being taught regarding bladder retraining. The nurse regarding bladder retraining. The nurse should advise the client to refrain from should advise the client to refrain from drinking after:drinking after:
a) 19:00
Urea
• Nitrogenous waste product from the metabolism of amino acids.
• Over-consumption of protein for a prolonged period of time can also increase the formation of a highly toxic ammonia called urea.
• Since the urea in your body must be excreted, an overabundance of urea places a strain on your liver and kidneys and is oftentimes responsible for a form of arthritis known as gout.
anuria
• absence of urination
hematuria
• blood in the urine
dysuria
• painful urination
pyuria
• presence of pus in urine
oliguria• decreased urine output (<400 mL per 24 hours) • urine output less than 20 ml/hr may be found in
any patient due to disorders related to:– Cardiology– Nephrology– Urology– Endocrinology– Medical– surgical
uremia
• condition that occurs when waste products in the blood quickly accumulate to toxic levels
The combining form lith/o means:
O urine
O kidney
O renal pelvis
O bladder
O stone
The combining form lith/o means:
stone
•Little is stored in the body
•Instead it responses to what is circulating in the body, such as:
increased potassium levels
or decreased blood flow to the kidneys
• cells of adrenal cortex (the zona glomerulosa) secrete the mineralocorticoid aldosterone into the blood as part of the renin-angiotensin system
One of these mineralocorticoids
is aldosterone.
• Aldosterone regulates the body's concentration of electrolytes, primarily sodium and potassium, by acting on the distal convoluted tubule of kidney nephrons to:– increase potassium excretion – increase sodium reabsorption – increase water reabsorption through
osmosis
Endocrine Glandsrelease hormones (chemical messengers)
ADH
• a hormone
• Produced in a region of the brain called the hypothalamus
• Stored and released from the pituitary gland, a small gland at the base of the brain
antidiuretic hormone (ADH) blood level
• Alternative Names:– arginine vasopressin– antidiuretic hormone– AVP– Vasopressin
• Normal values: – 0 to 4.7 pg/mL
Note: pg/ml = picograms per milliliter
http://www.umm.edu/ency/article/003702res.htm
Diabetes Insipidus (DI)
• Uncommon condition• Occurs when the kidneys are unable to conserve
water as they perform their function of filtering blood.
• Amount of water conserved is controlled by ADH• Two types of DI
– central diabetes insipidus– nephrogenic diabetes insipidus
central diabetes insipidus
• caused by damage to the hypothalamus or pituitary gland as a result of:
– surgery
– infection
– tumor– head injury
Nephrogenic Diabetes Insipidus
• involves a defect in the parts of the kidneys that reabsorb water back into the blood stream
• Even more uncommon than central DI
• may occur as an inherited disorder in which male children receive the abnormal gene that causes the disease on the X-chromosome from their mothers
• caused by– diseases of the kidney
• i. e. polycystic kidney disease
– effects of certain drugs• Lithium• amphotericin B• demeclocycline
Nephrogenic Diabetes Insipidus…continued
Does everyone have e-mail?
• Send me an e-mail telling me a little about yourself and why you want to become a nurse.
• Do not assume I have received your e-mail unless you get a reply from me via e-mail.
Does everyone have a home computer?
Picture from 1954 Popular Mechanics Magazine
Your e-mail addresses!!
• Send me an e-mail saying “Hi.”
• Put your name at the bottom. I do not know who [email protected] is.
• I will send you the following articles:– Keeping kidney function flowing, Nursing
Made Incredibly Easy, Sept. 2004.– An ACE Up Your Sleeve…, Nursing Made
Incredibly Easy, Sept. 2003.
PowerPoint Slides
• http://salsa.missioncollege.org/chance/
What drugs should you know?
• Know drugs on page 334 of Williams & Hopper– Aldosterone antagonist spironolactone
(Aldactone) Blocks effects of aldosterone Positive effect on Na+ & K+ balance
– “loop diuretics” (meaning Loop of Henle) Furosemide (Lasix) Bumetanide (Bumex) Torsemide (Demadex)
Also:
• Drugs for heart & lungs that are renal protective
• Angiotensin-Converting Enzyme inhibitors (ACE-Is or ACE inhibitors) such as
• Angiotensin Receptor Blockers (ARBs)– Good choices for complex patients, such as
those with: hypertension heart failure diabetes or metabolic syndrome
Renin-angiotensin-aldosterone system (RAAS)
• Influences blood pressure• Normal response to decreased blood pressure or
vascular volume– Proteolytic enzyme renin is produced in the
kidneys– Renin circulates throughout the body via the
bloodstream & is converted to angiotensin I which is inactive.
RAAS…continued
– In the presence of angiotensin converting enzyme (ACE), angiotensin I is converted to angiotensin II, which is a powerful vasoconstrictor.
• Angiotensin II latches onto the angiotensin II receptors in:– vascular smooth muscle (blood vessels)– Kidneys– adrenal glands– Heart– Liver– brain
• Repercussions throughout the body, causing:
– an increase in sympathetic transmission,
which increases myocardial contractility
– This stimulates release of epinephrine and norepinephrine, resulting in blood vessel constriction.
– greater release of vasopressin, the antidiuretic hormone (ADH), which results in water retention
– increased release of aldosterone from the adrenal glands (which sit on top of the kidneys), leading to salt retention and further water retention
Non-steroidalanti-inflammatory drugs (NSAIDs)
• NSAIDs decrease the effectiveness of:– angiotensin-converting enzyme inhibitors
(ACE-Is)– angiotensin receptor blockers (ARBs)– exacerbate heart failure and hypertension
The kidneys and bones
• Convert vitamin D to it active form, a necessary step for bone maintenance and, research suggest, muscle maintenance, too.
Tufts University Health & Nutrition Letter, Mar2004, Vol. 22 Issue 1, Tufts University Health & Nutrition Letter, Mar2004, Vol. 22 Issue 1, p4-5, 2p, p4-5, 2p,
• Rate of filtration is approximately 125 ml/min or 45 gallons (180 liters) each day.
• Considering that you have 7 to 8 liters of blood in your body, this means that your entire blood volume gets filtered approximately 20 to 25 times each day!
Percussion of bladder
• Percussion of a distended bladder caused a dull sound.
• Percussion of a distended loop of bowel will be tympanitic.
• Causes of distended bladder: – Outlet obstruction: urethral valves (child)– Prostatic hypertrophy– carcinoma urethral stricture
• Decreased bladder tone:– neurogenic bladder (spinal cord injury)– myogenic (overstretched bladder) – Senility or bed rest: Some patients are unable
to void in the supine position
• DIFFERENTIAL DIAGNOSIS: – Uterus: pregnancy or tumor– Ovary: cyst or tumor – Colon: tumor or fecal impaction
Percussion of bladder
Urinalysis (UA)
• Red cells and casts may indicate glomerular disease. Casts only originate in the kidneys and because of gelation within the tubules. Casts can trap other materials when they are formed.
• Type of cast seen gives clue to where in the kidney they were made; for example:– Glomerular– Tubulointerstitial– vascular
UA …continued
• White blood cells can be seen in interstitial nephropathies
• Pyuria
• Protein, if present, is an important marker of renal disease
• Persistent proteinuria is usually the first indicator of kidney damage.
GFR and EGFR
Glomerular Filtration Rate &Estimated Glomerular Filtration Rate
Why get tested?To assess kidney function
When to get tested?As a screening test to look for evidence of kidney damage (EGFR) or for changes in kidney function if you already have kidney disease (GFR)
Sample required?EGFR is calculated from your age, weight, gender, and serum creatinine (requires a blood sample from a vein in your arm); in some formulas, race is also used in the calculation.
GFR is calculated from serum and urine creatinine; it requires both a blood sample from a vein in your arm and a 24-hour collection of urine.
GFR and EGFR
• In a healthy person GFR fluctuates somewhat in response to– hydration status– Pregnancy– drug use– Age– Sex– body size
•GFR is considered the most accurate way to detect changes in kidney status.
•While measurement of serum BUN (urea nitrogen) and creatinine are easier to do, they cannot pick up early damage to the kidneys.
•If kidney damage is detected early, it may be possible to prevent worsening damage to the kidneys with treatment of high blood pressure, diabetes, or other diseases that can damage the kidney.
• Normal: 0.6 to 1.5 mg/dL
• > 1.5 mg/dL means kidney dysfunction
• Creatinine levels may be 10%-30% higher in people who eat a diet that is very high in meat.
• ratio of BUN to creatinine is usually between 10:1 and 20:1
Creatinine
Creatinine• What is being tested?
– test measures the amount of creatinine in blood and/or urine
– Creatinine is a waste product produced in muscles from the breakdown of a compound called creatine.
– Creatine is part of the cycle that produces energy needed to contract muscles and it as well as creatinine are produced at a relatively constant rate.
– Almost all creatinine is excreted by the kidneys, so blood levels are a good measure of how well the kidneys are working.
– The quantity produced depends on the size of the person and their muscle mass. For this reason, creatinine concentrations will be slightly higher in men than in women and children.
Creatinine…continued
Creatinine…continued
• Blood and urine levels of creatinine stay relatively constant.
• The body's ability to keep these levels constant depends in part on the glomerular filtration rate (GFR).
• The GFR, or rate at which the kidneys filter blood, is normally 120 ml/min in adults, but can not be measured directly.
• So when the kidneys are not functioning properly, the rate of filtration decreases, and you will see– rise in the serum creatinine level– a drop in urine creatinine
• This test measures the amount of urea nitrogen in the blood.
• Nitrogen, in the form of ammonia, is produced in the liver when protein is broken into its component parts (amino acids) and metabolized.
• The nitrogen combines with other molecules in the liver to form the waste product urea.
• The urea is then released into the bloodstream and carried to the kidneys, where it is filtered out of the blood and excreted in the urine.
BUN: Blood Urea Nitrogen
What is being tested?What is being tested?
BUN
• Since this is an ongoing process, there is usually a small but stable amount of urea nitrogen in the blood.
• Most diseases or conditions that affect the kidneys or liver have the potential to affect the amount of urea present in the blood.
• If increased amounts of urea are produced by the liver or decreased amounts are excreted by the kidneys, then urea concentrations will rise.
• If significant liver damage or disease inhibits the production of urea, then BUN concentrations may fall.
BUNBlood Urea Nitrogen
Why get tested?To evaluate kidney function and monitor the effectiveness of dialysis and other treatments related to kidney disease or damage
When to get tested?As part of a routine comprehensive or basic metabolic panel (sometimes called a “Chem7” or “Panel7” and when a patient is acutely or chronically ill with a condition that may cause or be exacerbated by kidney dysfunction.
Sample required?A blood sample drawn from a vein in the arm.
HbA1c
• A hemoglobin A1c (HbA1c) assay– measures a type of glycosylated hemoglobin– indicates one’s level of glucose control– Generally between about 4% and 6% for
people without diabetes– recommend under 7% for those with diabetes
Frequently used drugsthat may effect urine color
Generic & brand names
Drug classification
Urine color
Cascara sagrada Stimulant laxative
Red in alkaline urine; yellow-brown in acid urine
Chloropuine (Aralen)
AntimalVerdana, Arial, Helvetica, san-serif
Rusty yellow or brown
Chlorzoxazone (Paraflex)
Skeletal muscle relaxant
Orange or purple-red
Docusate calcium (Doxidan, Surfak)
Laxative Pink to red to red-brown
Furazolidone (Furoxone)
Antiinfective, antiprotozoal
Brown
Iron preparations (Ferotran, Imferon)
Hematinic Dark brown or black on standing
Frequently used drugsthat may effect urine color
Generic & brand names
Drug classification
Urine color
Levodopa Antiparkinsonian Dark brown on standing
Methylene blue (Urolene Blue)
Antimethemoglobinemic
Blue-green
Methyldopa (Aldomet)
Antihypertensive Darkening
Metronidazole (Flagyl)
Antiinfective Darkening, reddish brown
Nitrofurantoin (Macrodantin,
Nitrodan)
Antibacterial Brown-yellow
Phenazopyridine (Pyridium)
Urinary tract anagestic
Orange to red
Phenolphthalein(Ex-Lax)
Contact laxative Red or purplish pink in alkaline urine
Frequently used drugsthat may effect urine color
Generic & brand names
Drug classification
Urine color
Phenothiazine (e.g., prochlorperazine
[Compazine])
Antipsychotic, neuroleptic, antiemetric
Red-brown
Phenytoin (Dilantin)
Anticonvulsant Pink, red, red-brown
Riboflavin (vitamin B)
Vitamin Intense yellow
Rifampin Antibiotic Red-orange
Sulfasalizine (Azulfidine)
Antibacterial Orange-yellow in alkaline urine
Triamterene (Dyrenium)
Diuretic Pale blue fluorescence
Off The Mark, by Mark Parisi
April 22, 2004
1. acute renal failure2. alkaline ash diet & acid-ash diet3. benign prostatic hypertrophy or hyperplasia
(BPH)4. chronic renal failure5. continuous ambulatory peritoneal dialysis6. cystoscopy7. cystitis/urinary tract infections8. epididymitis9. supra pubic cath care10. genitourinary tuberculosis
Patient Teaching Projects
11. glomerulonephritis12. hemodialysis13. hydronephrosis14. hypercalcemia & hypocalcemia 15. hyperkalemia & hypokalemia16. hypermagnesemia & hypomagnesemia17. hyperphosphatemia & hypophosphatemia18. hyponatremia & hypernatremia19. incontinence, management of20. IVP
Patient Teaching Projects
20. kidney biopsy21. kidney stones22. kidney transplantation23. kidney tumors24. nephrotic syndrome25. peritoneal dialysis26. peritoneal dialysis-dietary guidelines27. pheochromocytoma28. polycystic kidney disease
Patient Teaching Projects
29. pre & post op care of TURP30. prostatitis31. renal angiogram32. renal ultrasound33. uremic syndrome34. ureteritis and pyelonephritis35. Lasix36. Aldactone37. HydroDIURIL38. BUN39. creatinine tests40. Pyelogram41. Clean intermittent self-catheterization (home)
Patient Teaching Projects
Assessing a Web Site
• .org
• .gov
• .edu
Nursing Center
http://www.nursingcenter.com
www.rnweb.com
National Library of MedicineNational Institutes of Health (NIH)
www.nlm.nih.gov
http://kidney.niddk.nih.gov/
• Imagine you are at a party…you have been drinking…and then you have to visit this bathroom?
• Now remember, the floor is just a painted floor!
Kind of Kind of takes takes your your breath breath away… away… doesn’t doesn’t it?!it?!