Urinary System

Outlines
➢ Introduction ➢ Renal failure
➢ Nursing care of Renal failure
➢ Anatomy Of Urinary System
➢ Renal dialysis
➢ Physiology of the urinary system ➢ Urinary diversion

➢ Function of the urinary system ➢ Nursing care of Urinary diversion

➢ References
➢ Common diseases of urinary system

➢ Urinary tract infection

Introduction:-
 Metabolism of nutrients by the body produces wastes that must be
removed from the body.

 Although excretory processes involve several organ systems (e.g.,

lungs excrete carbon dioxide), it is mainly the urinary system that
removes nitrogenous wastes from the body.

 The urinary system is also responsible for maintaining the

electrolyte, acid-base, and fluid balances of the blood and is thus a
major, if not the major, homeostatic organ system of the body.
Anatomy Of Urinary System:-
It consists of the following structures :
1) 2 Kidneys which secrete urine.
2) 2 ureters which convey the urine from the kidneys
to the urinary bladder.
3) 1 urinary bladder where urine collects and is
temporarily stored.
4) 1 urethra through which the urine is discharged from
the urinary bladder to extra the body.
1- Kidneys:-
 The kidneys lie on the posterior abdominal wall, one on each side of the
vertebral column, behind the peritoneum and below the diaphragm.

 They extend from the level of the 12th thoracic vertebra to the 3rdlumbar
vertebra.

 The right kidney is usually slightly lower than the left, probably because of
the considerable space occupied by the liver.

 Kidneys are bean-shaped organs, about 11 cm. long, 6 cm. wide and 3 cm.
thick.
Anatomy of kidney
The kidney contains three main areas:
1) The renal cortex:

The cortex is the outer rim of the kidney; it contains

all of the glomeruli and approximately 85% of the
nephron tubules.
2)The medulla:
3)The re The medulla is the middle portion of the kidney that
contains 8-18 renal pyramids.
nal pelvis:
The renal pelvis is positioned within the renal sinus and composed of
cuplike structures called calices.
 2-ureters:-
 Once urine is formed by the
nephrons and passed into
collecting ducts, it drains Form
the pelvis into the ureters.
3-urinary bladder:
 The bladder has two main parts: the neck and the
body.

 Urine is deposited by the ureters into the body of the

bladder where it is collected.

 The body of the bladder is made up of smooth muscle

known as the detrusor muscle.

 The muscle extends throughout the bladder allowing it

to contract and empty out urine in one contraction.
4- Urethra:-
 This tube allows urine to pass outside the body. The
brain signals the bladder muscles to tighten. This
squeezes urine out of the bladder.

At the same time, the brain signals the sphincter

muscles to relax to let urine exit the bladder through
the urethra. When all the signals happen in the
correct order, normal urination happens.
Physiology of the urinary system:
 Coming off the aorta are the right and left renal arteries. These two large arteries
quickly branch into smaller arteries (arterioles), which, in turn, branch off into
millions of capillaries that surround the kidney tubule to form a small ball-like
structure called the glomerulus. Each kidney has about 1 million glomeruli that form
the basic filtering unit of the kidneys. The waste materials are collected into a small
cup-like structure called a Bowman’s capsule.

 After leaving the Bowman’s capsule. After leaving the Bowman’s capsule and proximal
renal tubule, the renal tubule goes through a looped area called the loops of Henle
where more balancing of body fluids takes place, mostly

 made up from water, and finally goes into the distal kidney tubule where hormones
like renin cause the balance of blood pressure throughout the body.
 Ninety percent of the blood pressure balance control takes
place in the distal kidney tubule. The remaining 10 percent is a
function of the respiratory system that responds to our
activities and heart rate.

 Finally, the kidney tubule goes into thousands of collecting

ducts that join together at the renal pelvis. Exiting the renal
pelvis area is the tube called the ureter. The ureter removes
the fluids from the kidney to the urinary bladder. Going out
from the urinary bladder is a similar tube called the urethra
that execrates urine to outside the body .
Function of urinary system:-
 Urine formation

 Excretion of waste products

 Regulation of electrolytes

 Regulation of acid–base balance

 Control of water balance

 Control of blood pressure

1-Urine formation 2-Excretion of waste
products
 Urine is formed in the
• The kidney functions as the
nephrons through a complex
body’s main excretory
three-step
organ, eliminating the
 Process: glomerular filtration,
body’s metabolic waste
tubular reabsorption, and
products.
tubular

 Secretion.
3-Regulation of electrolytes
 When the kidneys are functioning normally,
the volume of electrolytes excreted per day is
exactly equal to the amount ingested.

 Electrolyte excretion includes sodium and

potassium.
4-Regulation of acid–base 5-Control of water
balance balance

 The catabolism, or
Regulation of the amount of water
breakdown, of proteins
excreted is also an important
results in the production of
Function of the kidney.
acid compounds.
6-Control of blood pressure

 Regulation of blood pressure is also

a function of the kidney.
Common diseases of urinary system: -
(Urinary Tract Infection UTIs)
 Definition:
 Chronic renal failure: loss of kidney function that
occurs over a prolonged course of time as opposed
to acute renal failure last more than 3 months.

 Or It is a state of progressive loss of kidney function

ultimately resulting in the need for renal
replacement therapy (dialysis or transplantation)..
Etiology:
 Chronic kidney disease may result from any
cause of renal dysfunction of sufficient
magnitude The most common causes in the US
in order of prevalence are Diabetic
nephropathy Hypertensive nephrosclerosis
Various primary and secondary
glomerulopathies
Phathophysiology:
 Chronic kidney disease (CKD) is initially described as diminished
renal reserve or renal insufficiency, which may progress to renal
failure (end-stage renal disease). Initially, as renal tissue loses
function, there are few noticeable abnormalities because the
remaining tissue increases its performance (renal functional
adaptation). Decreased renal function interferes with the kidneys’
ability to maintain fluid and electrolyte homeostasis. The ability to
concentrate urine declines early and is followed by decreases in
ability to excrete excess phosphate, acid, and potassium.
Signs and symptoms:
 blood in urine
 dark urine
 decreased urine output
 edema – swollen feet, hands, and ankles (face if edema is severe)
 fatigue (tiredness)
 hypertension (high blood pressure)
 insomnia
 loss of appetite
 more frequent urination, especially at night
 nausea
 pain on the side or mid to lower back
 panting (shortness of breath)
 protein in urine
 anemia
Diagnosis:
 Urine culture and sensitivity

 Urine electrolytes and urine osmolarity

 24-hour urine for creatinine clearance

 Renal ultrasound scanning

 Chest x-ray

 Renal biopsy

 Kidney-ureters-bladder (KUB) x-ray

Stages of chronic kidney disease:
 Staging CKD is a way of quantifying its severity. CKD has
been classified into 5 stages. Stage 1: Normal GFR (≥ 90
mL/min/1.73 m2) plus either persistent albuminuria or
known structural or hereditary renal disease Stage 2: GFR
60 to 89 mL/min/1.73 m2 Stage 3a: 45 to 59 mL/min/1.73
m2 Stage 3b: 30 to 44 mL/min/1.73 m2 Stage 4: GFR 15
to 29 mL/min/1.73 m2 Stage 5: GFR < 15 mL/min/1.73 m2
Treatment of renal disorders:
 Renal replacement therapy (RRT):
It’s a treatment that takes over
 is a general term used to describe the
your kidney functions if those
various substitution treatments
organs stop doing their job.
available for severe, acute, and end
There are two types of dialysis:
stage chronic renal failure (ESCRF),
including dialysis (hemodialysis and
peritoneal dialysis), hemofiltration,
and renal transplant.
What’s Dialysis?

 It’s a treatment that takes over your

kidney functions if those organs stop
doing their job. There are two types
of dialysis:
 Hemodialysis: Your blood is put
through a filter outside your body,
cleaned, and then returned to you.
This is done either at a dialysis
facility or at home.
Peritoneal dialysis
 Your blood is cleaned inside your body. A
special fluid is put into your abdomen to
absorb waste from the blood that passes
through small vessels in your abdominal
cavity. The fluid is then drained away. This
type of dialysis is typically done at home.
Phathophysiology of hemodialysis:
 to perform filtering and excretion
functions that the kidney can no
longer do Hemodialysis involves
passing the client’s blood through an
artificial semipermeable membrane
effectively.
Hemodialysis complications:
1- Hypotension (Low blood pressure)
 This is related to the speed and amount of
fluid removed from your blood.
2-Fluid Overload
 Between sessions, patients can some
times develop a condition called fluid
overload. This is due to excess fluid
building up in your body.
3-Bleeding From Access Point 4-High Potassium
 After dialysis, the needles will be removed In medical terms, this is
from your fistula or graft. Your nurse will take known as hyperkalaemia.
every care to ensure that bleeding has This means that there is too
stopped before you leave the unit.. much potassium in the blood.
This can be dangerous.
Nursing care of Renal failure
Nursing Assessment
Assessment usually focuses on the characteristics of the urine.

Assess urine output: urine output varies from scanty to a

normal volume

Assess blood in the urine: Hematuria may be present in

patients with ARF

Assess laboratory results: laboratory results may increase,

decrease, or stabilize and these may indicate each phase of ARF
Nursing Diagnosis

Electrolyte imbalance: related to

increased potassium levels

Risk for deficient volume:

Related to increased in urine output
Nursing Care Planning & Goals
Main Article: Acute Renal failure Nursing Care Plans
The goals for a patient with ARF are:
• Improve nutritional intake
• Restore fluid balance
• Reduce metabolic rate
• Promote pulmonary function
• Prevent infection
Nursing Interventions
Monitor fluid and electrolyte balance: The nurse monitors the patient’s
fluid and electrolyte levels and physical indicators of potential complications during all
phases of the disorder

Reducing metabolic rate: Bed rest is encouraged and fever and infection are
prevented or treated promptly

Promoting pulmonary function: The patient is assisted to turn, cough, and

take deep breaths frequently to prevent atelectasis and respiratory tract infection
Preventing infection: Asepsis is essential with invasive lines and

catheters to minimize the risk of infection and increased metabolism

Providing skin care: Bathing the patient with cool water, frequent

turning, and keeping the skin clean and well moisturized and keeping the

fingernails trimmed to avoid excoriation are often comforting and prevent

skin breakdown

Provide safety measures: Patient with CNS involvement may be

dizzy or confused
Evaluations
❖ A successful nursing care plan has achieved the
following:

❖ Improved nutritional intake

❖ Restored fluid balance

❖ Reduced metabolic rate

❖ Promoted pulmonary function

❖ Prevented infection
Urinary Diversions:
 Urinary diversion procedures are performed to divert
urine from

 the bladder to a new exit site, usually through a

surgically createdopening (stoma) in the skin

 These procedures are primarily performedwhen a

bladder tumor necessitates removal of the entirebladder
(cystectomy).
What is urinary reconstruction and diversion?
 When your urinary bladder is removed (due to
cancer, other medical conditions or because
the organ no longer works), you need another
way to pass urine through your body (pee).
What are the urinary diversion options?
 There are three main types of urinary diversion surgeries:

1. Ileal conduit urinary diversion.

2. Indiana pouch reservoir.

3. Neobladder-to-urethra diversion.

 For all of these procedures, a portion of the small and/or large bowel
is disconnected from the fecal stream and used for reconstruction.
Ileal conduit urinary diversion
Ileal conduit urinary diversion(urostomy): A segment of the
intestine directs urine through a stoma into an external
collecting bag.
With this procedure, the ureters (the tubes that carry urine
from the kidneys to the bladder) drain freely into part of the
ileum (the last segment of the small intestine). The end of the
ileum into which the ureters drain is then brought out through
an opening in the abdominal wall. This opening, called a
stoma, is covered with a bag that gathers the urine as it drains
from the ileal conduit.
Indication of urostomy:
 Bladder cancer requiring cystectomy.

 Neurogenic bladder conditions that threaten renal

function.

 Severe radiation injury to the bladder.

 Intractable incontinence in females.

 Chronic pelvic pain syndrome.

Advantages and disadvantages:
1. The advantages of the ileal conduit urinary diversion
surgery are:

2. It is a relatively simple surgery.

3. It requires less surgical time (compared with other

surgical methods).

4. There is no need for occasional catheterization (use

of a tube to drain the urine).
The disadvantages of the ileal conduit
urinary diversion are:
1. There’s a change in body image.
2. It uses an external bag to collect urine, which might leak or have odors.
Urostomy complications:
 Leakage of urine .

 Thick Mucus .

 Stoma gradually shrinks in size.

 Light bleeding from the stoma tissue.

NURSING PROCESS: THE PATIENT UNDERGOING
URINARY DIVERSION SURGERY
 Preoperative Assessment
 The following are key preoperative nursing assessment concerns:
1. Cardiopulmonary function assessments are performed be-cause patients
undergoing cystectomy (excision of the uri-nary bladder) are often older people who
may not be able to tolerate a lengthy, complex surgical procedure.

2. A nutritional status assessment is important because of pos-sible poor nutritional

intake related to underlying health problems.
3. Learning needs are assessed to evaluate the patient’s and the
family’s understanding of the procedure and the changes in
physical structure and function that result from the surgery.

The patient’s self-concept and self-esteem are assessed, in

addition to methods for coping with stress and loss.

The pa-tient’s mental status, manual dexterity and coordination,

and preferred method of learning are noted because they will
affect postoperative self-care.
Preoperative Nursing Diagnoses

• Based on the assessment data, the preoperative

nursing diagnoses for the patient undergoing
urinary diversion surgery may include the
following
1.Anxiety related to anticipated losses associated with the surgical
procedure

2.Imbalanced nutrition, less than body requirements related to inadequate

nutritional intake

3.Deficient knowledge about the surgical procedure and post-operative care

Postoperative Nursing Interventions
 Postoperative management focuses on monitoring
urinary function, preventing postoperative
complications (infection and sepsis, respiratory
complications, fluid and electrolyte imbalances,
fistula formation, and urine leakage), and promoting
patient comfort. Catheters or drainage systems are
observed, and urine output is monitored carefully.
 MAINTAINING PERISTOMAL SKIN INTEGRITY
 Strategies to promote skin integrity begin with reducing and con-
trolling those factors that increase the patient’s risk for poor nu-
trition and poor healing.
 RELIEVING PAIN
 Analgesic medications are administered liberally postoperatively to
relieve pain and promote comfort, thereby allowing the patient to
turn, cough, and do deep-breathing exercises. Patient-controlled
analgesia and administration of analgesic agents regularly around
the clock are two options that may be used to ensure adequate
pain relief. A pain-intensity scale is used to evaluate the adequacy
of the medication and the approach to pain management.
 IMPROVING BODY IMAGE
The patient’s ability to cope with the changes
associated with the surgery depends to some degree
on his or her body image and self-esteem before the
surgery and the support and reaction of others.
Any questions
Thank you