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test 4 notes - urinary

Topic: Foundations of Nursing Practice—Urinary System
Objective: Upon completion of this topic, the student will utilize knowledge of anatomy and physiology, assessment
data, diagnostic studies and selected urinary medications in the nursing care of adult medical surgical patients.
Student Preparation Prior to Class: Read Lewis 11th ed., Chapter 44 and
Potter and Perry 10th ed. Chapter 46 Skills 46.2, 46.3, 46.4.
Evolve Clinical Skills Module: Inserting indwelling urinary catheter for male and female
Independent Lab assignment: ATI Pharmacology Made Easy Reproductive and Genitourinary System Module and test
Learning Activities: Completion of ATI Medication Template during class; ATI Skills module Urinary Catheter Care
Videos. Review insertion removal and irrigation of indwelling urinary catheter skills.
Content Objectives
Content Topics
1. Review of anatomy and physiology ofA. A. Structures and Function
the urinary system and its function.
1. Kidneys (2)  forms urine
2. Ureters (2)  drains urine
D. 3. Bladder  stores urine
4. Urethra  urine leaves body
F. B. Effects of Aging
2. Explore essential assessment data A. A. Subjective Data
related to the urinary system.
1. Health Information
 Ask about NSAID use like Ibuprofen – nephrotoxic; these
should not be taken if the patient has impaired kidney function
B. B. Objective Data
1. Physical examination
a. Inspection, palpation, percussion and
 Kidneys are protected by abdominal organs, ribs, and muscles
of the back – they may not be palpable under normal
circumstances and this should not be a cause for worry
2. Bladder Scan
 C. Manifestations/Assessment Abnormalities
 Dysuria – painful urination
1. Table 44.5  see below
2. Table 44.7  see below
3. Discuss commonly used diagnostic G. A. Diagnostic Studies
studies of the urinary system and nursing
1. Urine Studies
 Urinalysis normally shows zero to tiny amounts of protein, but
some medications may give false-positive readings. Be sure to
ask the patient about what medications they are currently
 Creatinine Clearance Test  24-hour urine sample; need to
have a large container specifically for urine collection in the
patient’s room.
• Approximates the GFR.
 Clean-catch Urine Specimen  teach females to clean the
urethral area, void a small amount into the toilet, and then void
into a sterile specimen cup
 Red-orange color in urine is normal with some OTC meds like
Phenazopyridine (Pyridium).
• Always be sure to ask about current medications to
determine the cause for any abnormal urine colors.
Increased WBC’s in the urine indicates presence of urinary
tract infection or inflammation and the nurse should notify the
2. Blood Studies
 Elevated BUN and Creatinine  avoid fleet enemas because
phosphate cannot be excreted by patients with renal failure.
3. Endoscopic Studies
a. Cystoscopy  cystoscope is inserted into the bladder through
the urethra for direct visualization, then contrast solution is
injected through the scope so that x-rays can be taken.
i. Pink-tinged urine and urinary frequency are
expected after the procedure.
ii. Encourage good fluid intake after
iii. Notify the HCP of any elevation in temperature
– can indicate a bladder infection
4. Radiologic Studies
a. Kidney Ureter Bladder (KUB)
b. CT scan with/without contrast
c. Intravenous Pyelogram (IVP)
a. Allergies  Iodine-based contrast is used; need to
notify the HCP before the procedure if the patient is
allergic to shellfish and penicillin
i. Notify the HCP immediately if you notice an
increased respiratory rate after the procedure,
which could indicate an allergic reaction
b. Kidney function
i. Patients with impaired renal function are at
risk for decreased renal function after IVP
because the contrast medium used is
nephrotoxic. Be sure to monitor the patient’s
I&Os after!
c. Bowel Prep
d. PO fluids
4. Identify commonly prescribed
H. A. Medications Affecting Urinary System
medications affecting the urinary system
1. 5-Alpha Reductase Inhibitor
and the nursing implications for
a. Finasteride
administration utilizing the nursing
a. Interest in sexual activity may decrease due to
androgen suppression
b. Orthostatic hypotension may occur if taken with
medication for erectile dysfunction
2. Alpha-adrenergic receptor agonists
a. Tamsulosin
Drug Therapy for Incontinence/ Overactive Bladder
a. Oxybutinin
Drug Therapy for Urinary Retention
a. Bethanechol
5. Demonstrate appropriate skills
A. Urinary Catheter Skills
required to initiate, maintain, and
discontinue a urinary catheter.
Nocturia & BPH  leave a light on in the bathroom during the night;