MRE-COL-SG-WK1

REAL WORLD READY PROGRAM

SUPLEMENTAL STUDY GUIDE

Subject NCM 105- FLUIDS & ELECTROLYTES

Topic Urinary System
Course/Year BSN – 3rd Year
Week Week 11
School Year 1st Semester/AY 2020-2021

I. Objectives

• Recall anatomy of Urinary System

• Identify drugs affecting Nephron activity & Diagnostic Test used to
determine problem in the urinary system
• Enumerate Common Disorder in the Urinary System, identify its causes,
sign & symptoms and appropriate management.

II. Discussion

Normal Functions:

- Upper Urinary Tract

• Kidney functional unit is Nephron

*Ultrafiltration of blood
* Maintenance of H20 & electrolyte hemeostasis

- Lower urinary Tract

• Pelvicalyceal – urine collection

• Ureters – transportation of urine
• Bladder & Urethra – storage & voiding of urine

- Glomerulus
*Filter fluids at a rate of 180L/day

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*Act as a bulk filter to pass along protein-free & RBC free filtered

- Proximal Tubule
*Has freely permeable cell membrane
* Re absorb most electrolytes, glucose, urea & amino acid
*Carries large amounts of H20 with electrolytes back to circulation
*Reduces H20 content of filtrate by 70%

- Loop of Henle
*Contains a high concentration of salts, mostly Na
*Pulls Cl & Na out of filtrate without H20 & re absorb them in ascending limb
*Causes filtrate to become more dilute as it moves into distal tubules

- Distal Tubule
*Reabsorb H20 & concentrate urine as a result of antidiuretic hormone action
*Reabsorb Na & H20
*Secretes K as a result of aldosterone action

- Collecting Duct
* Has ADH which reabsorb H20
* Absorbs or secrete K,Na, Urea, hydrogen ions & ammonia according to the
body needs

Promotion of Normal Urinary Functions:

• Adults
-Adequate hydration
-Activity
-Regular Habits

• Children
Proper Toilet Training:
-2 ½ -3 ½ years old – bladder reflex control
-3 years old - regular voiding habits
- 4 years old - independent bathroom activities
- 5 years old - nighttime control

Drugs Affecting Nephron Activity:

1. Dopamine
2. Carbonic anhydrase inghibitors
3. K-sparing diuretics

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4. Thiazide diuretics
5. Metazolone
6. Mannitol
7. Loop Diuretics

Diagnostic Studies:

• Urinalysis
• Urine Culture & Sensitivity
• Cystometrogram
• Creatine clearance
• BUN
• Cystoscopy
• Cystourethrogram
• Intravenous Pyelogram
• Renal Scan
• Ultrasound
• Renal Biopsy
• Schilling Test

Common Disorder in the Urinary System:

Congenital Malformations of the Urinary System

- Epispadias – Urethral opening on dorsal surface of the penis
- Hypospadias- Male urethral opening on the ventral surface of penis or female
urethral opening in vagina
- Bladder Exstrophy- Posterior & lateral surfaces of the bladder are exposed

Management:
• Surgical Correction
• Reconstructive surgery

Enuresis
- Bed wetting in a child over 4 years old
- Usually have small bladder capacity
- More common in males
- Tend to be deep sleeper

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Urinary Tract Infection

- is a microbial invasion of the kidneys, ureters, bladder or urethra
Causes:
• Incomplete bladder emptying
• Irritation by bubble baths
• Poor hygiene
• Reflux
Sign & Symptoms:
- Cloudy & foul- smelling urine
- Low grade fever
- Lethargy
- Hematuria
- Abdominal pain
- Enuresis
- Poor feeding pattern
- Frequent urges to void
Treatment:
- Force fluids
- Cranberry Juice
- Assess toileting habits
- Proper perineal hygiene
- Antibiotics

Renal & Urethral Stones

- Mineral crystallization form around organic matter
Types:
• Urolithiasis
-Urinary stones
• Nephrolithiasis
-Kidney Stone

Kidney Stone
- A hard mass developed from crystals that separate from the urine & build up
on the inner surface of the kidney
- Made of salts & mineral
Common Cause:
• Inadequate fluid replacement
• Medical condition
• Family history

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Predisposing Factors:
- UTI
- DHN
- Hypercalcemia
- Urinary Stasis
- Obstruction
- Genetics
Risk Factor:
• Men at age 40’s-70’s
• Women at age 50’s
• Diet
Food rich in Vitamin C & D
Foods rich in protein, Na, Ca, Oxalate rich foods
• Weight gain
• High BMI
• Large waist size
• Inactive person
• Some medicine
Sign & Symptoms:
- Excruciating pain in the lower back and/or side, groin, abdiomen
- Fever & chills
- Nausea & Vomiting
- Hematuria
- Diaphoresis
- Low grade fever
Diagnostic Test:
• Helical CT Scan
• Ultrasound
Management:
• Monitor I & O
• Force fluid
• Strain urine
• Monitor temperature
• Pain Management
• Diet
-Low Ca
-Low Protein
- Low Na
-Low in Uric acid
-Low in oxalates

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Treatment:
• Lithotripsy
• Percutaneous Nephrolithotomy
Prevention:
Drink 10 glass of H20 per day

Cystitis
- Inflammation of the bladder
Predisposing factor:
• More prone in female
• Catheterization, instrumention
• Nosocomial infection
• Kidney infection
• Pregnancy
• Sexual intercourse
• Stagnation of urine in the bladder
• Radiation
• Incorrect perineal hygiene
• Obstruction of the urethra
• Kidney infection
Sign & symptoms:
-Urgency
-Frequency
- Burning during radiation
- Low grade fever
- Suprapubic/flank tenderness
- Pus/blood in urine
Diagnostic Test:
• Cystoscopy
• Urine C & S
Nursing Management:
-Force Fluids to 3000ml/d
-Antibiotic therapy
-Encourage drinking cranberry juice
-Discourage caffeine
-Teach females to avoid following intercourse
-Clean properly after defecation
-Obtain clean-catch midstream urine specimen for urinalysis, C& S,
colony count & possible gram stain

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Medication:
-Antibiotics
-Urinary Tract analgesic
- Antipyretic

Acute Glomerulonephritis
- Primary or secondary autoimmune renal disease involving the glomerulus in
the kidney
Causes:
-Bacterial
-Viral
-Parasitic Pathogen
Sign & Symptoms:
• Oliguria
• Hematuria
• Fever & chills
• Anorexia
• Nausea & Vomiting
• Abdominal/flank pain
• Periorbital/facial/generalized edema
• Moderate-severe HTN
Management:
-Restrict H20 if Oliguria
-Restrict Na intake
-Daily weights
-Monitor I & O
-Bedrest
-High-calorie, low protein diet
-Medications:
Antibiotics
Corticosteroid
Antihypertensive
Immunosuppressive agent
- Dialysis/Plasma electrophoreses if renal failure develops

Acute Tubular Necrosis

- Medical condition involving the death of tubular cells that form the tubule
that transports urine to the ureters while reabsorbing 99% of the H20
Causes:
-Poisons
-Drugs
-Heavy Metals

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-Molecules
-Organic solvents

Hydronephrosis
- Renal Colic
- Distention & dilation of the renal pelvis, usually caused by obstruction of the
free flow of urine from the kidney leading to tissue destruction & renal failure
Assessment:
• Pain
• Nausea & Vomiting
• S/S of UTI
• Abdominal Muscle spasm
Management:
-Bedrest
-Antibiotics
-Catheterization
-Force fluids to 300ml/d
-Urinary diversion
Surgical Corre tion
Strain all urine

Nephrosis
-Nephrotic Syndrome
-Idiopathic syndrome characterized by proteinuria & hypoalbuminemia
Types:
• Congenital Nephrotic syndrome
• Secondary Nephrotic syndrome
• Idiopathic Nephrotic syndrome
Sign & Symptoms:
-Edema
-Pallor
-Lethargy
-Oliguria
-Dark, frothy urine
-Decrease serum protein
-Increased serum Cholesterol & plasma lipids
Nursing Management:
-Steroids & antibiotic therapy
- Monitor for infection
- Bedrest
- Fluid restriction

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-I & O
-High protein, low Na, high Caloric diet

Pyelonephritis
- Urinary/ chronic infection & inflammation of the kidney or renal pelvis
Predisposing factor:
• Pregnancy
• Urinary Obstruction
• Metabolic Disorder
• Trauma
• Obstruction
• UTI
• Bacterial Infection
Sign & Symptoms;
-Chills
-Fever
-General malaise
-Pyuria
-Flank pain/Back pain
Nursing Management:
-Serial urine culture
-Periodic blood test
-Bedrest
-Antibiotic therapy

Urinary Retention
- Also known as Ischuria
- Lack of ability to urinate
Causes:
• Functional
• Mechanical
Predisposing Factor:
-Bedrest
-Tumors
-Prostatic Hypertrophy
-Decrease Bladder tone
-Bladder/urethral cancer
-Post op effects
-Calculi
-Medications

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Clinical Manifestation:
• Voiding at frequent intervals in small amount
• Suprapubic discomfort & bladder distention
• Appropriate hydration with no urinary output for more than 6 hours
• Specific gravity is elevated
Complications:
-Rupture of bladder
-Infection
-Uremia
Management:
-Stimulate voiding
-Pouring tepid water over perineum
-Positioning
-Catheterization
-Surgery:
* Suprapubic cystostomy
* Surgery for kidney stones

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III. Learning Rubric

Instruction: Please read carefully and check the corresponding box for your answer.
(Basahin ng mabuti ang bawat tanong at i-tsek ang kahon ng iyong sagot).

Note: Your honest answers will help us gather accurate data to understand and provide
appropriate interventions for the topic discussed. (Ang matapat na pagsagot ay
makapagbibigay ng tumpak na datos upang mas higit na maunawaan at makapagbigay
ng nararapat interbensiyon patungkol sa paksang ito.)

CONTENT YES MAYBE NO

(2)
(3) (1)
1. I have background knowledge about the topic.
(Mayroon na akong konting kaalaman tungkol sa paksa.)
2. I can analyze the content to deepen my understanding.
(Kaya kong suriing mabuti ang paksa upang mapalawak pa ang
aking kaalaman.)
3. I can give my own examples.
(Kaya kong magbigay ng sarili kong halimbawa.)
4. I can summarize the content and information that I have
learned.
(Kaya kong lagumin ang paksa at ang kaalamang aking
natutunan.)
5. I clearly understood the topic.
(Lubos kong naunawaan ang paksa ng aralin.)
6. I understand the direction of each activity and answered it
correctly.
(Nauunawan ko ang panuto ng bawat gawain at nasagutan ito ng
tama.)
7. I can enumerate the necessary steps and procedures related
to the lesson.
(Kaya kong hanayin ang mga hakbang at proseso na may
kaugnayan sa paksang tinalakay.)
8. I can independently perform the skill, strategy, or process.
(Kaya kong i-apply ang aking natutunan upang magsagawa ng
isang kasanayan, pamamaraan, o proseso.)
9. I can relate the topic to real-life situations.
(Kaya kong iugnay ang paksa sa totoong buhay.)
10. I accomplished the task on time.
(Natapos ko ang mga gawain sa itinakdang oras.)

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