RENAL SYSTEM

 The renal system consists of all the organs

involved in the formation and release of

urine. It includes the kidneys, ureters,
bladder and urethra

URINE - is fluid produced by the kidney. Urine is

stored in the bladder, and leaves the body
through the urethra.
RENAL SYSTEM FUNCTION:
 Is responsible for excreting water,

soluble wastes, stimulating RBC

production, and maintaining the
balance of pH, plasma water, and
electrolytes.
URINARY FUNCTION:
 Is responsible for the transportation,

storage, and elimination of urine

KIDNEY
 The kidneys are bean shaped organs, which

help the body produce urine to get rid of

unwanted waste substances.
 When urine is formed, tubes called ureters

transport it to the urinary bladder, where it is

stored and excreted via the urethra
 The kidneys are also important in controlling

our blood pressure and producing

red blood cells.   
Kidneys, Ureters, and Bladder
Kidneys:
 Regulation of blood volume:
The kidneys conserve or eliminate water from
the blood, which regulates the volume of blood
in the body.
 Regulation of the pH of the blood:

The kidneys excrete H+ ions (hydrogen atoms

that lack their single electron), into urine. At the
same time, the kidneys also conserve
bicarbonate ions (HCO3-), which are an
important buffer of H+.
 Regulation of blood pressure:
The kidneys regulate blood pressure in 3
ways, by:-
◦ Adjusting the volume of blood in the body
(by regulating the quantity of water in the
blood),
◦ Adjusting the flow of blood both into, and out
of, the kidneys, and
◦ Via the action of the enzyme renin. The
kidneys secret renin, which activates the
angiotensin-aldosterone pathway.
 Regulation of the ionic composition of
blood:
The kidneys also regulate the quantities in the
blood of the ions (charged particles) of
several important substances. Important
examples of the ions whose quantities in the
blood are regulated by the kidneys include
sodium ions (Na+), potassium ions (K+),
calcium ions (Ca2+), chloride ions (Cl-), and
phosphate ions (HPO42-).
 Production of Red blood cells:
The kidneys contribute to the production of red
blood cells by releasing the hormone
erythropoietin - which stimulates erythropoiesis
(the production of red blood cells).
 Synthesis of Vitamin D:

The kidneys (as well as the skin and the liver)

synthesize calcitrol - which is the active form of
vitamin D.
 Excretion of waste products and foreign
substances:
The kidneys help to excrete waste products and
foreign substance from the body by forming urine
(for release from the body).
Examples of waste products from metabolic
reactions within the body include ammonia (from
the breakdown of amino acids), bilirubin (from
the breakdown of haemoglobin), and creatinine
(from the breakdown of creatine phosphate in
muscle fibres). Examples of foreign substances
that may also be exceted in urine include
pharmaceutical drugs and environmental
toxins.
 Glomerular Filtration also called "Ultra-
filtration",
 Tubular Reabsorption also called

"Selective Re-Absorption" and

 Tubular Secretion
Renal hilus:
 This is the area of the kidney through

which the ureter leaves the kidney and

the other structures including blood
vessels (illustrated), lymphatic vessels,
and nerves enter/leave the kidney.
Renal capsule:
   The renal capsule is a smooth,

transparent, fibrous membrane that

surrounds, encloses, and protects the
kidney.
 Which helps to maintain the shape of the

kidney as well as protecting it from

damage.
 Also helps to protect the kidney by

damage by cushioning it in cases of

impact or sudden movement
Renal cortex:
   The renal cortex is the outer part of

the kidney and has a reddish colour

(shown as very pale brown above).
 It has a smooth texture and is the

location of the Bowman's Capsules

and the glomeruli.
Renal medulla:
   The renal medulla is the inner part of the

kidney. "Medulla" means "inner portion".

This area is a striated (striped) red-brown
colour.
Renal pyramids:
   There are approx. 5 - 18 striated triangular

structures called "Renal Pyramids" within

the renal medulla of each kidney. The
appearance of striations is due to many
straight tubules and blood vessels within the
renal pyramids.
Renal pelvis:
   The renal pelvis is the funnel-shaped basin (cavity)

that receives the urine drained from the kidney

nephrons via the collecting ducts and then the
(larger) papillary ducts..
Renal artery:
   The renal vein delivers oxygenated blood to the

kidney. This main artery divides into many smaller

branches as it enters the kidney via the renal hilus.
These smaller arteries divide into vessels such as
the segmental artery, the interlobar artery, the
arcuate artery and the interlobular artery. These
eventually separate into afferent arterioles, one of
which serves each nephron in the kidney
Renal vein:
   The renal artery receives deoxygenated blood

from the peritubular veins within the kidney.

These merge into the interlobular, arcuate,
interlobar and segmental veins, which, in turn,
deliver deoxygenated blood to the renal vein,
through which it is returned to the
systemic blood circulation system.
Interlobular artery:
   The interlobular artery delivers oxygenated

blood at high pressure to the glomerular

capillaries
Interlobular vein:
   The interlobular vein receives

deoxygenated blood (at lower pressure)

that it drains away from the glomerular
filteration units and from the Loops of
Henle.
Kidney nephron:
   Kidney nephrons are the functional units

of the kidneys. That this, it is the kidney

nephrons that actually perform the kidney's
main functions. There are approx. a million
nephrons within each kidney
Collecting Duct (Kidney):
   The collecting duct labeled in the diagram

above is part of the kidney nephron. The

distal convoluted tubules of many
nephrons empty into a single collecting
duct. Many such collecting ducts unite to
drain urine extracted by the kidney into
papillary ducts, then into a minor calyx,
then the major calyx (at the centre of the
kidney), and finally into the ureter through
which the urine leaves the kidney en-route
to the urinary bladder
Ureter:
   The ureter is the structure through

which urine is conveyed from the kidney

to the urinary bladder.
 Glomerular region (renal corpuscle; about
0.2 mm diameter)
1) glomerulus (capillary tuft)
2) Bowman's capsule (blind end of the
nephron)
Note:
 Bowman's capsule and the glomerulus

together are named the Malpigian

corpusle, but often referred to simply as
the "glomerulus")
 Proximal convoluted and straight tubule
(about 15 mm long, 0.05 mm diameter);
sometimes divided into segments S1, S2,
and S3
 Loop of Henle - dips deeply (juxtamedullary

nephron) or slightly (cortical nephron) into the

medulla; each has thick (12 mm long) and
thin (2-15 mm long) segments
1) descending limb
2) hairpin turn
3) ascending limb (thin and thick segments)
 Distal convoluted and straight tubule (5
mm long), divided into:
1) early segment, functions as extension
of Loop of Henle
2) later segment, functions as beginning
of collecting tubule (connecting
segment)
 Collecting tubule/duct (20 mm long)
 Kidney nephrons are the functional units of the
kidneys.
 There are typically over 10,000 kidney nephrons

in each of the two kidneys in the body

 There are two ureters, one leading from
each kidney to the urinary bladder. Each of
these transports urine from the renal pelvis
of the kidney to which it is attached, to the
bladder
 Both of the ureters pass beneath the urinary

bladder, which results in the bladder

compressing the ureters and hence
preventing back-flow of urine when pressure
in the bladder is high during urination
 The purpose of the urinary bladder is to
store urine prior to elimination of the urine
from the body.
 The bladder also expels urine into the

urethra by a process called micturition

(also known as urination). Micturition
involves the actions of both voluntary and
involuntary muscles. Lack of voluntary
control over this process is referred to as
incontinence.
 The urethra is the passageway
through which urine is discharged
from the body.
 In males the urethra also serves as

the duct through which semen is

ejaculated
Male Reproductive System
 Patient knowledge
 Psychosocial and emotional factors; fear,

anxiety
 Urologic function; include voiding

habits/pattern
 Fluid intake, hygiene, allergies
 Presence of pain or discomfort
URINALYSIS and C&S:
 is used as a screening associated with

different metabolic and kidney diseases

 It is used to detect

urinary tract infections (UTI) and other

disorders of the urinary tract.
 It will be perform if you have symptoms

like: Abdominal pain, Back pain, painful or

frequent urination, blood in the urine.
Preparation:
 Advise client to save the first AM

specimen.
 Clean external meatus with betadine or

soap and water prior to test.

Nursing Consideration:
 Overnight specimen is more

concentrated.
 Obtain midstream specimen
Characteristics of urine:
 Color – amber yellow
 Consistency – clear, transparent
 Specific Gravity – 1.010 – 1.030
 pH – 4.5 – 8
 24 production – 1000 to 1500 cc
Culture
 Is done to find out what kind of organism

(usually a bacteria) is causing an illness

or infection.
 is done by collecting a sample of fluid or

tissue and then rubbing the sample onto

a special plate with prepared gelatin
(culture)
 If there are bacteria in the sample, they

will grow in the culture, usually within 2

days.
Sensitivity test
 Checks to see what kind of medicine,

such as an antibiotic, will work best to

treat the illness or infection.
Culture and Sensitivity test
 May be done on many different body

fluids, such as urine, mucus, blood, pus,

saliva, breast milk, spinal fluid, or
discharge from the vagina or penis.
Creatinine clearance
 It measures GFR in the diagnosis of renal

disease.
Blood chemistries
 Blood Urea Nitrogen (BUN) – 10-20mg/dl

◦ Reflex urea nitrogen in the blood.

◦ Urea is the product of protein metabolism
◦ Renal diseases decreases the excretion of urea,
thus increasing the BUN level
◦ Formed in the liver and excreted in the kidney
◦ Used to diagnose impaired renal function.
◦ Strenuous activity, GI bleeding, fever and steroids
may increase level.
 Creatinine (0.5-1.2mg/dl)
◦ A by-product of protein metabolism in the
blood.
◦ Results are more reliable and diagnostic
of renal function than BUN
 Uric Acid

◦ Product of purine metabolism used to primarily

detect disorders of purine metabolism such as
gout.
◦ Excreted by the kidney and intestines
◦ May also be used in detecting renal disease
SODIUM (135-145 mEq/L)
 Major cation in the extracellular space
 Level remains constant until end-stage

renal disease.
POTASSIUM (3.5-5.5mEq/L)
 Major cation in the intracellular space
 Excreted primarily by the kidneys
 Altered level is first indication of renal

disease and cardiac disease.

CALCIUM (9-10.5mg/dl
 Major mineral in bone
 Responsible for the contraction of

muscle, neurotransmission and clotting

factors.
 Evaluates parathyroid function and

calcium metabolism
 Used in monitoring in renal failure
 Absorption is decrease in renal disease
PHOSPHOROUS (3-4.5 mg/dl)
 Inverse relationship between phosphorous

and calcium balance

 Primarily excreted by the kidneys
 Levels increase with renal failure

BICARBONATE (20-30 mg/dl)

 Kidneys reabsorbed filtered bicarbonate
 Kidneys produce more bicarbonate when

needed
 Metabolic acidosis and low bicarbonate

levels result from renal failure

 Ultrasound scan of the abdomen and
pelvis
 Images of renal structures obtained bu

sound waves
Preparations:
 Non-invasive procedure
 No preparation

Nursing Considerations:
 No preparations or post-test care required
 Is a radiological procedure used to
visualise disturbances of the urinary
system, including the kidneys, ureters, and
bladder.
 It provides X-Ray visualization of kidneys,

Ureters and Bladder.

 It is done as a series of X-rays before and

after a contrast agent is injected into a

vein
Preparations: (IVP)
 Bowel preparations
 NPO after midnight
 Burning may occur during injection of

radiopaque dye into vein.

 X-Rays are taken at interval after dye.

Nursing considerations:
 Post-procedure x-ray usually done
 Client should be alert to signs of dye

reaction (edema, itching, wheezing,

dyspnea)
 Is a test that allows your doctor to look at
the inside of the bladder and the urethra
using a thin, lighted instrument called a
cystoscope
 It is a direct visualization into the bladder
 Tiny surgical instruments can be inserted

through the cystoscope that allow your

doctor to remove samples of tissue
(biopsy) or samples of urine.
 Small bladder stones and some small
growths can be removed during
cystoscopy.
It can be done:
 If you have hematuria
 painful urination (dysuria), urinary

incontinence
 urinary frequency or hesitancy, an inability

to pass urine (retention)

 a sudden and overwhelming need to

urinate (urgency).
 Find the cause of problems of the urinary tract,
such as frequent, repeated urinary tract
infections or urinary tract infections that do not
respond to treatment.
 Look for problems in the urinary tract, such as

blockage in the urethra caused by an enlarged

prostate, kidney stones, or tumors.
 Evaluate problems that cannot be seen on X-ray

or to further investigate problems detected by

ultrasound or during intravenous pyelography,
such as kidney stones or tumors.
 Remove tissue samples for biopsy.
 Remove foreign objects.
 Place ureteral catheters (stents) to help

urine flow from the kidneys to the bladder

 Treat urinary tract problems. For

example, cystoscopy can be done to

remove urinary tract stones or growths,
treat bleeding in the bladder, relieve
blockages in the urethra, or treat or
remove tumors
 Place a catheter in the ureter for an X-ray
test called retrograde pyelography. A dye
that shows up on an X-ray picture is
injected through the catheter to fill and
outline the ureter and the inside of the
kidney.
 Bowel preparations
 Forced fluids
 Teach patient to deep-breathe to decrease

discomfort
Nursing interventions:
 Monitor character and volume of urine
 Check for abdominal distention,

frequency, fever
 Check for bleeding
 Provide antimicrobial prophylaxis
 Kidney tissue obtained by needle
aspiration for pathological evaluation
 A renal biopsy is the removal of a small

piece of kidney tissue for laboratory

examination
 Ultrasound will be used to find the proper

biopsy site.
 a tiny cut in the skin and inserts a biopsy

needle into the area and to the surface of

the kidney.
 If you have an unexplained drop in
kidney function.
 If you have persistent blood in the

urine, or protein in the urine

 The test is sometimes used to evaluate

a transplanted kidney.
 X-Ray taken prior to the procedure
 Skin is marked to indicate lower pole

of the kidney (fewer blood vessels)

 Position (Prone or bent at diaphragm
 Client is instructed to hold breath

during needle insertion

Nursing interventions: (Post-test)
 Pressure is applied to site for 20

minutes
 Pressure dressing is applied
 Client kept flat in bed
 Bed rest for 24 hours
 Observe for hematuria and site

bleeding
 Knowledge deficiency
 Pain
 Fear
 Patient teaching: provide a description of the
tests and procedures in language the patient
can understand
 Use appropriate, correct terminology.
 Encourage fluid intake unless
contraindicated.
 Instruct patient in methods to reduce
discomfort: sitz baths, relaxation techniques.
 Administer analgesics and antispasmodics
as prescribed.
 Assess voiding and provide instruction
related to voiding practices and hygiene.
 Provide privacy and respect.
Urethral Catheter (Indwelling)
 May be used to drain the bladder
 Complications of catheter use may

include: urinary tract or kidney infections,

blood infections (septicemia), urethral
injury, skin breakdown, bladder stones,
and blood in the urine (hematuria)
 After many years of catheter use, bladder

cancer may also develop.

 Doublelumen with inflatable balloon
towards the tip
 Is basically an indwelling catheter that is
placed directly into the bladder through the
abdomen.
 The catheter is inserted above the pubic bone.
 This catheter must be placed by a urologist

during an outpatient surgery.

 A suprapubic catheter may be recommended

in people who require long term

catheterization, after some gynecological
surgeries, and in people with urethral injury or
obstruction.
A nephrostomy is a surgical procedure by
which a tube, stent, or catheter is inserted
through the skin and into the kidney.
 It is anchored in renal pelvis through flank

incision
 It is placed as temporary basis when the

ureter is blocked and urine back up to

kidney. Can cause serious complication
Nephrostomy is performed in several
different circumstances:
 The ureter is blocked by a kidney stone.
 The ureter is blocked by a tumor.
 There is a hole in the ureter or bladder and

urine is leaking into the body.

 As a diagnostic procedure to assess kidney

anatomy.
 As a diagnostic procedure to assess kidney

function.
 Is the temporary placement of a catheter
(tube) to remove urine from the body.
 Straight Catherization
 It is used for bladder outlet obstruction in male
 Post-op after surgical problems in

reproductive organs
 This is usually done by placing the catheter

through the urethra (the tube that leads from

the bladder to the outside opening) to empty
the bladder.
Short-term (intermittent) catheterization
may be necessary for:
 Anyone who is unable to properly empty

the bladder
 People with nervous system

(neurological) disorders
 Women who have had certain

gynecological surgeries
Goal (Intermittent)
 Completely empty the bladder
 Prevent further bladder or kidney

damage
 Prevent urinary tract infections
Reasons:
 bladder cancer or other pelvic

malignancies, birth defects, trauma,

strictures, neurogenic bladder, chronic
infection or intractable cystitis; used as
a last resort for incontinence
◦ Cutaneous urinary diversion:
 ileal conduit,
 Cutaneous ureterostomy,
 Vesicostomy and nephrostomy

◦ Continent urinary diversion:

 Indiana pouch
 Kock pouch
 ureterosigmoidostomy
 Anxiety

 Imbalanced nutrition

 Deficient knowledge
 Risk for impaired skin integrity

 Acute pain

 Disturbed body image

 Potential for sexual dysfunction

 Deficient knowledge
 AZOTEMIA – Toxic condition where there
is an excess of nitrogenous waste in the
blood.
 DIFFUSION – The movement of solutes

across the semipermeable membrane

from an area of higher concentration to an
area of lower concentration until an equal
distribution is established between the 2
areas.
 GFR – the amount of fluid that is passed
through all of the nephron in minute.
 HOMEOSTASIS – A balance or

consistency in the internal functioning of

the body.
 OSMOSIS – The movement of pure

solvent such as water across the

semipermeable membrane, from an area
with a lower solute content to a higher
solute content.
 UREMIA – Presence of excess urea and
other waste in the blood.
 DYSURIA – Painful urination
 EFFLUX – Movement of urine from the

kidneys, through the ureter to the bladder.

 FREQUENCY – The feeling of a need to

void often.
 INCONTINENCE – Uncontrolled leakage

of urine from the bladder.

 MICTURATION – Urination, voiding; the
process of emptying the bladder.
 REFLUX – Movement of urine in a

backward motion from the bladder into the

ureters and possibly to the kidneys.
 RETENTION – Inability to empty the

bladder completely.
 URGENCY – The feeling of a need to void

immediately.
COMMON
HEALTH
PROBLEMS
(Genito-urinary system)
 Aninflammation of the glomerular
capillaries

 Acute glomerulonephritis

 Chronic glomerulonephritis

 Nephrotic syndrome
 Also called as Acute Glomerulonephritis
 Is a relatively common bilateral

inflammation of the glomeruli, the

kidney’s blood vessels.
 It follows a streptococcal infection of the

respiratory tract or less often, a skin

infection such as impetigo.
CAUSES:
 Trapped antigen-antibody complexes in

the glomerular capillary membranes,

inducing inflammatory damage and
impending glomerular function.
 Untreated pharyngitis (inflammation of

the pharynx)
ASSESSMENT FINDINGS:
 Azotemia, Edema, fatigue
 Hematuria, oliguria, Proteinuria

DIAGNOSTIC TEST:
 Increase serum creatinine level
 24 hour urine sample decrease creatinine

clearance and impaired glomerular

filtration.
 Renal biopsy – may confirm the diagnosis

(APSGN)
 Renal UTZ – may show a normal or
slightly enlarged kidney.
 Throat culture – may show GABHS
 Urinalysis – reveals proteinuria,

hematuria.
 KUB X-Ray – shows bilateral kidney

enlargement.
TREATMENT:
 Bed rest
 Fluid restriction
 High calorie, low sodium, low potassium,

low protein diet.

 Dialysis (occasionally necessary)
INTERVENTION:
 Check V/S, electrolyte values
 Monitor fluid I and O, and daily weight
 Assess renal function daily through serum

creatinine and BUN levels and urine

creatinine clearance
 Watch for signs of acute renal failure

(azotemia, Oliguria, acidosis)

 Consult the dietitian – to provide a diet for

the patient.
 Provide good nutrition, use good hygienic
technique, and prevent contact with
infected people.
 Bed rest is necessary during an acute

phase.
 Encourage the patient to gradually resume

normal activities as symptoms subside –

to prevent fatigue
 Provide emotional support for the patient

and family if the patient is on dialysis,

explain the procedure fully.
 Patient assessment

 Maintain fluid balance

 Fluid and dietary restrictions

 Patient education

 Follow-up care
 Any condition that seriously damages the
glomerular membrane and results in
increased permeability to plasma proteins
 Results in hypoalbuminemia and edema
 Causes:

◦ Chronic glomerulonephritis, diabetes

mellitus with intercapillary
glomerulosclerosis
◦ Lupus erythematosus, multiple myeloma
◦ Renal vein thrombosis
 Resultswhen the kidneys cannot
remove wastes or perform regulatory
functions.
A systemic disorder that results from
many different causes or the kidneys
cease to function.
ACUTE RENAL FAILURE
 Rapid onset generally occurring over

hours to day that has the potential to be

reversible with supportive care.

CAUSES: (other)
 Nephrotoxic agent
 Glomerulonephritis
 Pyelonephritis, BPH
 Prostate cancer, tumors
 Hypovolemia

 Hypotension over an extended period of

time.

 Reduced cardiac output and heart failure

 Obstruction of the kidney or lower urinary

tract

 Obstruction of renal arteries or veins

Clinical Manifestation of (ARF)
 Initially decreased urinary output that may

be less than 400ml in a 24 hour period.

 Proteinuria
 Fluid retention
 Decreases serum bicarbonate
 Increased serum potassium, sodium,

creatinine and BUN

 Multisystem disease with gradual onset
over months to years resulting in an
irreversible destruction of as much as 95%
of the nephrons found in the ESRD.
CAUSES:
 Unsuccessful treatment of Acute renal

failure.
 Cystic kidney disease
 Diabetes mellitus
 Hypertension
 Chronic glomerulonephritis
 Pyelonephritis or other infections
 Obstruction of urinary tract
 Hereditary lesions
 Vascular disorders
 Medications or toxic agents
COMPLICATIONS:
 Acute Renal failure

◦ Depends on the client’s overall state of

health, pre-renal failure with hyperkalemia
being the most severe.
 Chronic Renal failure
◦ Progressive azotemia and uremia leading to
ESRD. (increased nitrogenous wastes in the
blood).
NEUROLOGICAL
 Lethargy, Decreased concentration
 Muscular irritability
 Seizures, Confusions, Coma

CARDIOVASCULAR
 Hypertension, Cardiomayopathy
 CHF, Pericarditis
 Pleural effusion, Arrhythmias
RESPIRATORY
 Uremic fector or halitosis (urine smelling

breath odor)
 Tachypnea, hyperpnea
 Suppressed cough reflex
 Pulmonary edema
 Uremic lung or pneumonitis

HEMATOLOGIC
 Anemia
 Bleeding
METABOLIC
 Increase BUN, serum creatinine
 Hyperglycemia, hyperinsulinemia
 Hyperkalemia, hypernatremia
 Metabolic acidosis

INTEGUMENTARY
 Yellow discoloration of the skin
 Dry skin, Pruritus, Ecchymosis, Purpura
 Uremic frost (urea crystal occurring on

the face, axilla, and groin from

evaporated perspiration.
MUSCULOSKELETAL
 Renal osteodystrophy – skeletal

changes including:
◦ Osteomalacia (lack of bone
mineralization
◦ Osteitis fibrosa (bone resorption),
and
◦ calcification of the soft tissue of the
body.
GASTROINTESTINAL
 Stomatitis, N/V
 Metallic taste in the mouth
 Diarrhea or constipation
 Uremic gastritis

URINARY
 Polyuria and nocturia early
 Oliguria leading to anuria late
 Proteinuria, hematuria
 Dilute pale yellow urine
REPRODUCTIVE
 Decreased libido
 Infertility
 Amenorrhea

DIAGNOSTIC TEST:
 Serum electrolytes
 Serum creatinine and BUN
 Urinalysis
 24 hour urine for creatinine clearance
 Renal UTZ, CT-Scan
 Hemodialysis

 Peritoneal dialysis

 Continuous renal replacement therapies

(CCRT)
 Protectvascular access; assess site for
patency and signs of potential infection,
and do not use it for blood pressure or
blood draws
 Monitorfluid balance indicators and
monitor IV therapy carefully; keep
accurate I&O and IV administration pump
records
 Assess for signs and symptoms of uremia
and electrolyte imbalance; regularly check
laboratory data
 Monitor cardiac and respiratory status
carefully
 Monitorblood pressure; antihypertensive
agents must be held on dialysis days to
avoid hypotension
 Monitor all medications and medication dosages
carefully; avoid medications containing
potassium and magnesium
 Address pain and discomfort
 Implement stringent infection control measures
 Monitor dietary sodium, potassium, protein, and
fluid; address individual nutritional needs
 Provide skin care: prevent pruritus; keep skin
clean and well moisturized; trim nails and avoid
scratching
 Provide CAPD catheter care
 Fluid status

 Nutritional status

 Patient knowledge

 Activity tolerance

 Self-esteem

 Potential complications
 Excess fluid volume

 Imbalanced nutrition

 Deficient knowledge

 Risk for situational low self-esteem

 Hyperkalemia
 Pericarditis
 Pericardial effusion
 Pericardial tamponade
 Hypertension
 Anemia
 Bone disease and metastatic

calcifications
 Assess for signs and symptoms of fluid
volume excess; keep accurate I&O and
daily weight records
 Limit fluid to prescribed amounts
 Identify sources of fluid
 Explain to patient and family the rationale

for the restriction.

 Assist patient in coping with the fluid

restriction.
 Provide or encourage frequent oral hygiene
 Assess nutritional status, weight changes, and
lab data
 Assess patient nutritional patterns and history;

note food preferences

 Provide food preferences within restrictions
 Encourage high-quality nutritional foods while

maintaining nutritional restrictions

 Assess and modify intake related to factors that

contribute to altered nutritional intake, ie,

stomatitis or anorexia
 Adjust medication times related to meals
 Assess patient and family responses to
illness and treatment
 Assess relationships and coping patterns
 Encourage open discussion about

changes and concerns

 Explore alternate ways of sexual

expression
 Discuss role of giving and receiving love,

warmth, and affection

 It is the infection of the urinary bladder.
 It is common in women, children and older

man.
CAUSES:
 DM, Incorrect aseptic technique during

catherization
 Incorrect perineal care, Kidney infection
 Obstruction of the urethra, pregnancy
 Sexual intercourse, stagnation of urine in the

bladder
ASSESMENT FINDINGS:
 Burning or pain on urination
 Dribbling, dysuria, foul-smelling urine
 Flank tenderness or suprapubic

tenderness
 Lower abdominal discomfort
 Low grade fever, nocturia
 Urge to bear down on urination
 Urinary frequency
 Urinary urgency
DIAGNOSTICS
 Cystoscopy – shows obstruction or

deformity
 Urine Chemistry - shows hematuria,

pyuria, and increased protein, leukocytes

and urine specific gravity
 Urine C&S – positively identified

microorganism (E. coli, Streptococcus

fecalis, proteus vulgaris)
Nursing Diagnosis
 Impaired urinary elimination
 Urge urinary incontinence
 Acute pain

TREATMENT:
 Diet modification
 Increased intake of fluid
 Intake of Vitamin C
DRUG THERAPY
 Antibiotics (Bactrim, Levofloxacin,

ciprofloxacin)
 Antipyretic (Tylenol)
 Urinary antiseptic (pyridium)
Nursing interventions:
 Assess renal status – to determine

baseline and detect changes.

 Monitor and record V/S, I&O, Laboratory

studies – to assess patient status and

detect early complications.
 Maintain the patient’s diet – to promote

nutrition.
 Force fluids (cranberry or orange juice
3L/day) – because dilute urine lessens the
irritation to the bladder mucosa and
lowering urine pH with orange juice and
cranberry juice consumption helps
diminish bacterial growth
 Administer medications as prescribed – to

maintain or improve patient’s condition.

 Perform sitz bath and perineal care – to

relieve perineal or suprapubic discomfort.

 Encourage voiding every 2 to 3 hours –
frequent bladder emptying decreases
bladder irritation and prevents stasis of
urine.
Teaching topics:
 Avoiding coffee, tea, alcohol and

carbonated beverages
 Increase intake to 3L/day using orange

juice and cranberry juice

 Voiding every 2 to 3 hours and after

intercourse
 Performing perineal care correctly
 Avoiding bubble baths, vaginal deodorants

and tub baths

 Recognizing that urine maybe orange

while taking phenazopyridine

 Also called as painful bladder
syndrome.
 Is a chronic condition characterized by

a combination of uncomfortable
bladder pressure, bladder pain and
sometimes pain in your pelvis, which
can range from mild burning or
discomfort to severe pain.
 Most affected are women
SIGNS AND SYMPTOMS:
 The signs and symptoms of interstitial

cystitis vary from person to person. If

you have interstitial cystitis, your
symptoms may also vary over time,
periodically flaring in response to
common triggers such as menstruation,
seasonal allergies, stress and sexual
activity.
Interstitial cystitis symptoms include:
 A persistent, urgent need to urinate.
 Frequent urination, often of small

amounts, throughout the day and night.

People with severe interstitial cystitis
may urinate as often as 60 times a day.
 Pain in your pelvis (suprapubic) or

between the vagina and anus in women

or the scrotum and anus in men
(perineal).
 Pelvic pain during sexual intercourse.
Men may also experience painful
ejaculation.
 Chronic pelvic pain.
 Some people affected by interstitial

cystitis experience only pain, and

some experience only frequent, urgent
urination
CAUSES:
 Autoimmune reaction
 Heredity
 Infection or allergy.
 Defect in the protective lining

(epithelium) of their bladder

RISK FACTORS:
 Sex. Women receive a diagnosis of

interstitial cystitis far more often than do

men or children. Men can have nearly
identical symptoms to those of
interstitial cystitis, but they're more often
associated with an inflammation of the
prostate gland (prostatitis)
 Age. Most people with interstitial
cystitis are diagnosed in their 30s or
40s.
 Other chronic disorders. Interstitial

cystitis may be associated with other

chronic pain syndromes, such as
irritable bowel syndrome and
fibromyalgia. Any common connection
between these syndromes is unknown.
COMPLICATIONS:
 Reduced bladder capacity. Interstitial

cystitis can lead to a stiffening of the wall

of your bladder and reduced bladder
capacity, meaning your bladder holds
less urine.
 Lower quality of life. Frequent urination

and pain may interfere with social

activities, work and other activities of
daily life.
 Relationship troubles. Frequent urination
and pain may strain your personal
relationships, and sexual intimacy is
commonly affected.
 Emotional troubles. The chronic pain

and interrupted sleep associated with

interstitial cystitis may cause emotional
stress and can lead to depression.
Likewise, having depression or anxiety
can worsen symptoms of interstitial
cystitis.
Diagnostic Test:
 Complete pelvic exam. During this exam,

your doctor examines your external

genitals, vagina and cervix and feels
(palpates) your internal pelvic organs.
Your doctor may also examine your anus
and rectum.
 Urine test. A sample of your urine will be

analyzed for evidence of a urinary tract

infection.
 Potassium sensitivity test.In this test, your
doctor places two solutions — water and
potassium chloride — into your bladder one
at a time. You're asked to rate on a scale of
0 to 5 the pain and urgency you feel after
each solution is instilled. If you feel
noticeably more pain or urgency with the
potassium solution than with the water, your
doctor may diagnose interstitial cystitis.
People with normal bladders can't tell the
difference between the two solutions.
 Cystoscopy. Doctors sometimes use
this test to rule out other causes of
bladder pain. Cystoscopy involves an
examination of your bladder through a
thin tube with a tiny camera (cystoscope)
inserted through the urethra. Cystoscopy
allows your doctor to see the lining of
your bladder. In conjunction with
cystocopy, your doctor may instill a liquid
into your bladder to help measure your
bladder capacity.
 Biopsy. During cystoscopy under
anesthesia, your doctor may remove a
sample of tissue (biopsy) from the
bladder and the urethra for examination
under a microscope. This is to check for
bladder cancer and other rare causes of
bladder pain.
TREATMENT: (DRUGS)
 Ibuprofen (Advil, Motrin, others) and other

nonsteroidal anti-inflammatory drugs, to

relieve pain
 Tricyclic antidepressants, such as

amitriptyline or imipramine (Tofranil), to

help relax your bladder and block pain.
 Antihistamines, such as diphenhydramine

(Benadryl, others) and loratadine (Claritin,

others), which may reduce urinary urgency
and frequency and relieve other symptoms
OTHER TREATMENT:
 Nerve stimulation
Transcutaneous electrical nerve stimulation
(TENS) - uses mild electrical pulses to relieve
pelvic pain and, in some cases, reduce urinary
frequency. Electrical wires are placed on your
lower back or just above your pubic area, and
pulses are administered for minutes or hours,
two or more times a day, depending on the
length and frequency of therapy that works best
for you. In some cases a TENS device may be
inserted into a woman's vagina or a man's
rectum.
 Bladder distention
Some people notice a temporary
improvement in symptoms after
undergoing cystoscopy with bladder
distention. Bladder distention is the
stretching of the bladder with water or
gas. The procedure may be repeated as
a treatment if the response is long
lasting
 Medications instilled into the bladder
In bladder instillation, the prescription medication
dimethyl sulfoxide, or DMSO, (Rimso-50) is
placed into your bladder through a thin, flexible
tube (catheter) inserted through the urethra. The
solution sometimes is mixed with other
medications, such as a local anesthetic. After
remaining in your bladder for 15 minutes, the
solution is expelled through urination. Delivering
DMSO directly to your bladder may reduce
inflammation and possibly prevent muscle
contractions that cause frequency, urgency and
pain.
SURGERY:
 Bladder augmentation. In this

procedure, surgeons remove the

damaged portion of the bladder and
replace it with a piece of the colon, but
the pain still remains and some women
need to empty their bladders with a
catheter multiple times a day.
 Fulguration. This minimally invasive
method involves insertion of
instruments through the urethra to burn
off ulcers that may be present with
interstitial cystitis.
 Resection. This is another minimally

invasive method that involves insertion

of instruments through the urethra to
cut around any ulcers
INTERVENTIONS:
 Dietary changes - The most irritating foods
can be summarized as the "four Cs." The four
Cs include carbonated beverages, caffeine in
all forms (including chocolate), citrus products
and food containing high concentrations of
vitamin C.
 Bladder training - may involve learning to

control the urge to urinate by using relaxation

techniques, such as breathing slowly and
deeply, or distracting yourself with another
activity.
Self care approach:
 Wear loose clothing. Avoid belts or

clothes that put pressure on your abdomen.

 Reduce stress. Try methods such as

visualization and biofeedback, and low-

impact exercise.
 Try pelvic floor physiotherapy. Gently

stretching and strengthening the pelvic

floor muscles, possibly with help from a
pelvic floor physiotherapist, may reduce
muscle spasms.
 Ifyou smoke, stop. Smoking may worsen
any painful condition, and smoking is
harmful to the bladder
 Is a scar in or around the urethra,
which can block the flow of urine, and
is a result of inflammation, injury or
infection.
 Are more common in men because

their urethras are longer than those in

women. Thus men's urethras are more
susceptible to disease or injury.
CAUSES:
 May occur anywhere from the bladder to

the tip of the penis.

 Unknown
 Trauma to the urethra and gonorrheal

infection
 Stricture of the posterior urethra is often

caused by a urethral injury associated

with a pelvic bone fracture (e.g., motor
vehicle or industrial accident)
 Patients who sustain posterior urethral
injuries from pelvic fracture generally
suffer a disruption of the urethra, where
the urethra is cut and separated.
 Catheter is inserted until the repair can be

perform.
 Trauma such as straddle injuries, direct

trauma to the penis and catheterization

can result in strictures of the anterior
urethra.
Signs and symptoms:
 painful urination
 slow urine stream
 decreased urine output
 spraying of the urine stream
 blood in the urine
 abdominal pain
 urethral discharge
DIAGNOSTICS:
 Physical Examination
 Urethral Imaging (X-Ray or UTZ) – with

contrast dye
 Urethroscopy
 Retrograde Urethrogram – to determine

strictures
 Antegrade urethrogram – to determine the

length of the strictures

PREVENTION:
 Avoid injury to the urethra and

pelvis.
 Avoid STD, Chlamydia, Gonnorhea
 Use of condom during sexual

intercourse and avoid contact with

infected individuals
Treatment options:
 Dilation - enlarging the stricture by

gradual stretching
 Urethrotomy - A knife blade or laser

operating from the end of the

cystoscope is then used to cut the
stricture, creating a gap in the narrowing
 Urethral Stent
This procedure involves placement of a
metallic stent that has the appearance of
a circular chain link fence. The lining of
the urethra eventually covers the stent,
which remains in place permanently.
UROLITHIASIS
 Refers to the formation of urinary

stones; urinary calculuses are formed

in the ureters.
NEPHROLITHIASIS
 Refers to the formation of kidney

stones; kidney stones are formed in the

renal parenchyma
DESCRIPTION:
 Calculuses or stones can form anywhere

in the urinary tract; however, the most

frequent site is the kidney.
 The problems that can occur as a result of

calculuses are pain, obstruction, and

tissue trauma with secondary hemorrhage
and infection.
 KUB film, IVP, CT-Scan and Renal UTZ

will determine the stone location

A stone analysis will be done after passage
to determine the type of stone and assist in
determining treatment.
 When a calculus occludes the ureter and

blocks the flow of urine, the ureter dilates,

producing a condition known as
hydroureter.
 If the obstruction is not removed, urinary

stasis results in infection, impairment of

renal function on the side of the blockage,
and resultant hydronephrosis and
irreversible kidney damage.
CAUSES:
 Family history of stone formation
 Diet high in calcium, Vit.D, Milk, Proteins,

oxalate, purines or alkali

 A high intake of purine-rich foods
 Obstruction and urinary stasis
 Dehydration
 UTI, and prolonged catherization
 Immobilization
 Hypercalcemia and hyperparathyroidism
 Elevated uric acid, such as gout
Assessment findings:
 Renal colic, which originates in the lumbar

region and radiates around the side and

down towards the testicles in men and to
the bladder in women.
 Ureteral colic, which radiates towards the

genitalia and thigh

 Sharp severe pain of sudden onset
 Dull, aching pain in the kidney
 N/V, pallor and diaphoretic during acute

pain
 Urinary frequency with alternating
retentions
 Signs of a UTI, Low grade fever
 High number of RBC, WBC, and

bacteria in the urine

 Hematuria
Nursing Interventions:
 Monitor V/S, I&O
 Assess for fever chills and infection
 Monitor for N/V and diarrhea
 Encourage fluid intake up to 3000ml/day

unless contraindicated, to facilitate

passage of the stone and prevent
infection.
 Strain all urine for the presence of stones
 Send stones to the laboratory for analysis
 Provide warm baths and heat to the flank
area.
 Administer analgesics at regularly

scheduled intervals as prescribed to

relieved pain
 Assess the client’s response to pain

medication
 Administer fluids intravenously as

prescribed to increase the flow of urine

and facilitate the passage of the stone
 Assist the client in performing relaxation
techniques in relieving pain
 Instruct the client in the diet specific to the

stone formation
 Maintain urinary pH depending on the type

of stone
 Turn and reposition immobilized patients
 Prepare the client for surgical procedures

if prescribed