GU System
Lecture Notes 3 – Renal System Part 1
Behavioral Objectives: By the end of this lecture the student will be able to:






I.
Review the anatomy and physiology of the genito-urinary systems
Describe the physical assessment of the GU systems
Discuss the application of the nursing process as it relates to patients with disorders of
the GU system
Describe the purpose and methods for collecting sterile and “clean-catch” urine
specimens.
Discuss the importance of monitoring and maintaining intake and output and
appropriate documentation
Discuss common diagnostic tests, procedures and related nursing responsibilities for
the patient with GU disorders.
Introduction
A. Essential to _________________
B. Every head to toe assessment must include _____________& ____________
urinary tract function
II.
Anatomy of the urinary systems
A. Kidneys
1.Shape: _______________________________
2.Color: ________________________________
3.How many / #: __________________________
4.Location
a. Posterior wall of ________________
b. Base of the ____________ _______________
c. Surrounded by ________________ ___________
d. ________ kidney is lower than the ________ kidney
5.What lies on tip of each kidney? ______________________________
6.Two distinct regions:
a. Renal parenchyma
b. Renal pelvis
106733145
2/13/2016
1
7.Renal Parenchyma
a. Divided into ____ parts: _______________ & _____________
1) Medulla
a)
___________ portion
b)
Contains:
1. Loops of ____________
2. Vasa ___________
3. Collecting _____________
a. Connect to the __________ ____
i. Shape: __________
ii. Point toward: _____
iii. Ea. Kidney has: _____
c)
Function: Drain ________ from the _________
to the renal _________________
2) Cortex
a)
Contains
1. _____________________
a. _______________ unit of the
kidneys
8.Renal Pelvis (contains)
a. _______________
1) Renal __________________ drain urine into the ureter
b. Renal______________________:
c. Renal _____________
9.Blood supply to the kidney
a. ___________________________ 
b. Renal _______________ 
c. ____________ arteriole 
d. ___________________________ ( capillary _________)
e. ____________ arteriole 
f. ____________ & veins
106733145
2/13/2016
2
g. Inferior _______________________
h. ?? Where does filtration take place? _____________________
10.
Nephrons
a. __________________ unit
b. Contains
1) ________________________
2) ____________________ capsule
3) _________________ convoluted tubule
a)
Hoops of Henle
b)
Distal convoluted tubule
B. Ureters
1. __________: nephrons  Renal ___________  renal ___________ 
ureter
2.Long, narrow ______________________ _____________:
3.Extends from the renal pelvis  _______________
4.#____________
5.________________ urinary tract
6. Three (3) ________________ area’s
a. Promote _______________
b. Prevent ________________
c. Micturition
d. Propensity for _________________ by renal ______________
7.Lining = _____________________ prevents: ____________________
8.Movement is facilitated by ______________ _________________
C. Bladder
1.Description: _____________________ hollow sac
2.Location: Just behind _______________ bone
3.Function: _____________________ for urine
a. Normal capacity: ____________-___________mL
b. Capable of holding: ____________ - ___________ mL
c. CNS stim. “need to void”: __________ - __________ mL
106733145
2/13/2016
3
4.Detrusor muscle
5.Neck of the Bladder
a. ______________ urinary sphincter
1) ______________ control
D. Urethra
1.Carries urine from ______________  __________________
2._____________ urinary SPHINCTER
a. __________________ control
III.
Physiology of the urinary systems
A. The urinary system is responsible for several essential bodily functions. They
include:
1. Urine formation
2. Excretion of waste products
3. Regulation of excretion of electrolytes, acid-base control, RBC
production, CA+ & Ph
4. Control water balance and blood pressure
5. Renal clearance
6. Synthesis of Vit. D
B. Urine formation
1.The nephrons form urine through a complex 3-step process
a. Glomerular filtration
b. Tubular reabsorption
c. Tubular secretion
2.Glomerular filtration
a. Most of the blood (except ______________ & ____________)
forced out of the blood (Capillaries of the) ______________ 
_______________________________  ______________
1) High capillary _____________in the Glomerulus
b. Filtration at Glomerulus
1) Water, Na+, Cl-, Bicarbonate, K+, Glucose, Urea,
Creatinine, uric acid
c. Factors the can alter the process
1) Blood _________________ & Blood ______________
106733145
2/13/2016
4
3.Tubular reabsorption
a. Filtrate  ________________ convoluted tubule  Reabsorption
(back into ________________)
1) Most: Water, Na+, Cl-, Bicarbonate, K+, Urea, uric acid
2) All of the ________________
3) None of the ___________________
4.Tubular secretion
a. Elements secreted from the ___________________ back into the
________________________ for excretion in urine
1) Some: Water, Na+, Cl-, Bicarbonate, K+, uric acid
2) Most: Urea
5.Filtrate
a. filtrate  __________________  collecting ___________ 
renal _____________  ________________ 
_______________  ________________  __________
6.glucose
a. Normally _________ the glucose filtered by the glomeruli will be
_________________ back into the blood stream
b. Normal: ______ glucose in the urine
c. Glycosuria
1) Diabetes __________________
2) _________ serum glucose levels overwhelm the Nephrons
ability to ________________ glucose
7.Protein / proteinuria
a. Filtered by the ____________________ & returned to the blood by
tubular _______________________
b. Slight proteinuria (occasionally): __________________
1) Globulin, albumin
c. Persistent proteinuria = Glomerular ______________________
C. Anti-diuretic Hormone
1.AKA:_______________________
106733145
2/13/2016
5
2.Secreted by: _________________________________
3.Secreted in response to: changes in blood ____________________
4.Water intake   _____ blood osmolality  stim. the pituitary to _____
ADH  (ADH receptor site) ____________  (action) ______
reabsorption of water  _______ urine volume / output  returns blood
osmolality to normal
5.Water intake   _____ blood osmolality  stim. the pituitary to _____
ADH  (ADH receptor site) ____________  (action) ______
reabsorption of water  _______ urine volume / output  returns blood
osmolality to normal
D. Osmolarity & Osmolality
1.Osmolarity: # of ___________________ dissolved in solution
2.Osmolality: __________________ of solution
3.Urine & Serum/blood
E. Regulation of water excretion
1.The amount of urine formed is related to the amount of ____________
 fluid intake  ______ urine volume: ________________
a.
b.  fluid intake  ______ urine volume: ________________
2.Normally, the kidneys rid the body of about _____________of all the
fluids taken in.
F. Regulation of electrolyte excreteion
1.Sodium
a. Normal serum Na+ levels: ________________
b. Na+ is _____________ from the blood and _________________
from the tubules back into the blood.
c. Na+ excretion is controlled by __________________________
d. ______ aldosterone  ______ Na+ reabsorption ______ serum
Na+ levels
e. Na+ is the most abundant electrolyte found ___________ the cell:
(____________________)
2.Potassium
106733145
2/13/2016
6
a. K+ is the most abundant electrolyte found ___________ the cell:
(____________________)
b. ______ aldosterone  ______ K+ excretion  ______ serum K+
levels
3.Kidney’s not functioning normally
a. Na+ & K+ will not be ____________________ from the blood
b. Retention of ________ is the most life-threatening effect of renal
failure
1) Retention of ______  ____________________ 
cardiac ___________________
G. Regulation of acid excretion
1.Proteins are broken down into __________, particularly, phosphoric acid
and sulfuric acid.
2.Acids in the blood  _____________pH
3.Normally kidneys filter these acids
a. Tubular filtration
1) Acid is excreted into the urine through tubular
_____________________
2) Used until the bladder pH is ______________
3) Any excess acids must be ____________________
b. Neutralize acids
1) ___________ to Chemical buffers
2) Can be excreted without ______________ the pH
3) Most important buffers
a)
________________________
b)
________________________
H. Renal Clearance
1.Purpose
a. Assess ability to clear _____________ from the plasma
2.Procedure:
a. _________________ urine collection
106733145
2/13/2016
7
b. _________________ serum Creatinine level
3.Creatinine: waste product of skeletal muscle _______________
4.  renal function  ________________ creatinine clearance
5.Creatinine clearance evaluates __________________________(GFR)
6.Detects & evaluates _______________ of renal disease
I. Regulation of Red Blood Cell Production
1.Kidneys measure ________________ of the blood
a. ________ PaO2  Hormone ______________________ 
(receptor site) ___________________  (action)  production of
__________   _________  _________ PaO2
2.Normal RBC – Erythrocytes:
a. Male: ________________________ million/mm3
b. Female: ______________________ million/mm3
3.Normal Hgb
a. Male: ________________________ g/dl
b. Female: ______________________ g/dl
J. Vitamin D Synthesis
1.Kidney activiate ingestion of vitamin _________ aids in the absorption of
_____________
K. of Excretion of waste products
1.Urea (waste product of ___________________________ metabolism)
a. BUN _________________________________
b.  BUN = renal _________________
2.Other waste products of metabolism are
a. Creatinine
b. Phosphates
c. Sulphates
d. Ketone
3.Uric acid ( ______________________ metabolism)
a. Hyperuricemia  ________________
106733145
2/13/2016
8
4.The kidneys also are the primary means of ridding the body of
________________________
L. Auto-regulation of Blood Pressure
1.vasa recta constantly monitors _____________________________
2.If there is a _________ in blood pressure  (hormone) ______________
(converts to)  _____________________  (receptor site) blood vessels
 (Action) ___________________  _______ blood pressure
3.  blood pressure  ________ Renin
4.Vasta recta failure to recognize ___ BP & stop Renin secretion is the
primary cause of ___________________
IV.
Gerontologial Considerations
A. Function of Urinary tract ___________________
B. GFR _______________
C. Prone to develop ________________________ and fluid volume __________
D. At risk for adverse ___________________ effects
V.
Assessment
A. General
1.History
2.Risk Factors
a. Age
b. instrumentation
c. immobility
d. DM; HTN; gout; BPH
3.Information you want to obtain during the health history meeting:
a. The chief complaint
b. Pain:
c. History of UTI’s
d. Fever or Chills
e. Any previous instrumentation of the urinary tract:
f. History of kidney stones
g. Females
106733145
2/13/2016
9
h. History of vaginal infections
i. History of STD’s
j. Use of tobacco, alcohol or recreational drugs
k. List of all meds being used (Rx and OTC)
B. Physical Exam
1.Palpation
C. Medical terms matching
1. Urgency
2. Pyuria
3. Proteinuria
4. Polyuria
5. Oliguria
6. Nocturia
7. Incontinence
8. Hesitancy
9. Hematuria
10.
Frequency
11.
Euresis
12.
Dysuria
13.
Anuria
1) Frequent voiding – more than every 3 hours
2) Strong desire to void
3) Painful or difficult voiding
4) Delay, difficulty in initiating voiding
5) Excessive urination at night
6) Involuntary loss of urine
7) Involuntary voiding during sleep
8) Increased volume of urine voided
9) Urine output less than 400 ml/day
10) Urine output less than 50 ml/day
11) Red blood cells in the urine
12) Abnormal amounts of protein in the urine
13) Pus in the urine
D. Diagnostic Evaluation: Urinalysis
1.Color; clarity; odor; urine pH and specific gravity
a. Colorless to pale yellow: __________________________
b. Yellow to milky white____________________________
c. Bright yellow ___________________________________
d. Pink to red _____________________________________
106733145
2/13/2016
10
e. Blue, blue green _________________________________
f. Orange to amber ________________________________
g. Brown to black _________________________________
E. Diagnostic eval: Urine culture and sensitivity
1.ID _________________________
2.______________ report
3.Time: __________________________________
F. Specific Gravity
1.__________________ of urine
2.Sp. Gravity of distilled water: ____________________
3.Normal urine sp. Gravity: _______________________
4.Urine sp. Gravity is related to level of _____________________
a. _______ fluid intake  _______ H2O excretion  ____ sp.
Gravity of urine
b. _______ fluid intake  _______ H2O excretion  ____ sp.
Gravity of urine
VI.
Collection of sterile and “clean-catch” urine specimens
A. Safety
1._________________ precautions
2._______________ bag for transport
B. Sterile specimen
1.Collection
a. Indwelling foley catheter: _________________________
b. Straight cath
C. Clean-catch or Clean-voided specimen
1.Uncontaminated by _______________ flora
a. female: cleanse:_______________ to _____________
b. male: cleanse: tip of _________ downward
2.Collection
a. Start to _______________
b. __________________ catch
106733145
2/13/2016
11
c. Collect _____________ ounce of urine
VII.
Intake and Output
A. Input
1.All fluids taken
a. Time
b. Amount
B. Output
1.Urine
2.___________
3._________ tubes
4._____________ tubes
5._____________ tubes
VIII.
Dialysis
A. Purpose
1.Remove _________________ & _________________ from the body
B. Definition
1._____________________ means of removing waste from the blood
C. Types:
1.Hemodialysis
2.Peritoneal dialysis
D. Process
1.____________________ & ____________________ across a semi
permeable __________________ into a dialysate solution
a. specific to the individual
2.Diffusion
a. _____________ & ____________are removed by diffusion
b. Move from an area of ____________ concentration to an area of
______________concentration
3.Osmosis
a. Excess ______________ is removed by osmosis
106733145
2/13/2016
12
b. Water move from an area of higher ___________ concentration
(____________) to an area of lower _________ concentration
(________________)
E. Hemodialysis
1.A _____________ or _____________is surgically prepared to access the
clients circulatory system
2.With each ________________ treatment, the ___________is inserted into
the graft of fistula
3.Nursing interventions: hemodialysis
a. ____________before and after
b. Strict ________________ technique
c. Assess fistula or graft
1) _________________: _______________
2) _________________ : ________________
3) Pulse _______________________
d. Protect Grafts
1) Not _______________________
2) No ___________________ graft arm
e. Meds are given _____________________
f. Usually performed __________________
g. Usually take _________________
F. Peritoneal dialysis
1.Uses the peritoneal lining of the __________________ cavity
2.A ______________ is placed by the MD into peritoneal space
3.Usually _____________________ liters of dialysate
4.Less expensive, easier to perform and less stressful
5.Complication: _____________________________
6.Usually performed: ____________________________________
106733145
2/13/2016
13
IX.
Some study questions for Quiz 3 – Renal system
A. Describe the formation of urine
B. Describe the blood flow through the renal system
C. What does the cortex and medulla of the kidney contain?
D. What does the ureter do during micturition
E. How much urine does the normal bladder hold?
F. What muscles surround the bladder and helps with micturition?
G. Describe the sphincters of the urinary system
H. What are the three steps of urine formation?
I. What happens to glucose normally during urine formation?
J. What can cause glucose in the urine?
K. What happens to protein normally in the urine?
L. What promotes the excretion of sodium?
M. What promotes the excretion of potassium?
N. What affect does Aldosterone have on electrolytes?
O. What affect does ADH have on urine and blood Osmolality
P. What is urea
Q. What does a BUN measure
R. What does a high BUN mean
S. What does a low BUN mean
T. Along with a BUN what other diagnostic lab value is frequently ordered to assess
filtration?
U. Elevated Uric acid leads to what (in the blood)
V. How does the renal system regulate urine pH (two methods and explain each)
W. Know the relationship between Osmolality, specific gravity, fluid intake and urine
concentration
106733145
2/13/2016
14