NURS 280 EXAM:URINARY SYSTEM NOTES LATEST
UPDATE 2022/2023 A+ SUCCESS GUARANTEED
What does the urinary system really do?
• Functions of the kidney
o Regulate ECF volume and composition
o Excrete wastes
o Affect Acid-Base balance
o Produce Erythropoietin
o Activate Vitamin D
• Function of ureters, bladder, and urethra
o Provide pathway, holding chamber, and propulsion of urine
Let’s start with INFECTION
• UTI
• Lower system, urethra and bladder
o Cystitis
o Urethritis- think STD
• Upper system, kidneys and ureters
o Pyelonephris
• Systemic
o Urosepsis
• Clinical Picture
o Ouch! What will they say? Burning, change in LOC, pain in flank area increase
urination
o Phew! What will they smell? Foul smelling, fecal odor, cloudy urine, blood tinged
,NURS 280 EXAM:URINARY SYSTEM NOTES LATEST
UPDATE 2022/2023 A+ SUCCESS GUARANTEED
o OMG! How do you feel? Nothing at all to worse they ever felt
o Oh yea. What do you see? Cloudy or tinge blood urine, fever, odor,
CVA tenderness
o Now, what are the differences in cystitis and pyelonephritis? Cystitis
lower bladder infection pyelonephritis kidney infection
o And what about the elderly client…. Loss of defensive abilities to kill the
bad bacteria… Change in LOC is the first thing we will see
What would cause this?
• How long is you urethra? Males are long women are shorter
• What happens when any fluid is stored in a nice warm, dark place?
• Add a circuitous pathway
• Add sugar
• Add sex
• Add poor neuromuscular control (Retention)
• Add poor self-defense- who’s this?
• Add a foreign body
• Add a continuous open pathway
,NURS 280 EXAM:URINARY SYSTEM NOTES LATEST
UPDATE 2022/2023 A+ SUCCESS GUARANTEED
• Add A 4# laying on top of it!
What do we do?
• Consider s/s and causes. This should guide you history taking, assessment, and teaching
• Urinalysis
• Culture and sensitivity
• Empiric treatment- we treat based on history and assessment
o Antibiotic therapy for uncomplicated UTI vs complicated UTI
▪ Trimethoprim/sulfamethoxazole (TMP/SMX), nitrofurantonin,
cephalosporins
▪ Fluoroquinolones for CX INFX- ciprofloxacin, levofloxacin
▪ Fluconazole
• Pyelonephritis- may also result from fungal, viral, or protozoal INFX
o May manage OUTOT or In-PT. Short hospital stay or rapid initiation with IV Antbx
to discharge with oral regime for 2-3 wks. Also consider N/v, dehydration issues.
o Monitor for urosepsis and septic shock
• Pain MGMT
o Phenazopyridine (Pyridium, AZO Standard)- topical analgesic effect on bladder
mucosa
o Strange Side effect? Stain anything orange urine
Interstitial cystitis- The bladder from HELL
• Chronic symptoms of a UTI without the presence of infection or stone
• More common in females
, NURS 280 EXAM:URINARY SYSTEM NOTES LATEST
UPDATE 2022/2023 A+ SUCCESS GUARANTEED
• Etiology often unknown
o Neurogenic hypersensitivity
o Mast cell alterations within bladder wall (Remember these guys from your
study of inflammation?)
o Strange infection- slow growing virus?
• Leads to scarring of bladder wall with ulcerations
• Treatment
• Avoid irritants- bladder diary
o Caffeine, alcohol, nuts, aged cheese, some fruits, EXP cranberries and citrus
• OTC supplement- glycerophosphate alkalinizes foods
• Stress mgmt..
• Lube during sex, consider alternate positions
• Tricyclic antidepressants- relief over time
• Pentosan- protective action on bladder wall
• For persistent cases, instillation of medications to the bladder to desensitize
pain receptors
Urinalysis
UPDATE 2022/2023 A+ SUCCESS GUARANTEED
What does the urinary system really do?
• Functions of the kidney
o Regulate ECF volume and composition
o Excrete wastes
o Affect Acid-Base balance
o Produce Erythropoietin
o Activate Vitamin D
• Function of ureters, bladder, and urethra
o Provide pathway, holding chamber, and propulsion of urine
Let’s start with INFECTION
• UTI
• Lower system, urethra and bladder
o Cystitis
o Urethritis- think STD
• Upper system, kidneys and ureters
o Pyelonephris
• Systemic
o Urosepsis
• Clinical Picture
o Ouch! What will they say? Burning, change in LOC, pain in flank area increase
urination
o Phew! What will they smell? Foul smelling, fecal odor, cloudy urine, blood tinged
,NURS 280 EXAM:URINARY SYSTEM NOTES LATEST
UPDATE 2022/2023 A+ SUCCESS GUARANTEED
o OMG! How do you feel? Nothing at all to worse they ever felt
o Oh yea. What do you see? Cloudy or tinge blood urine, fever, odor,
CVA tenderness
o Now, what are the differences in cystitis and pyelonephritis? Cystitis
lower bladder infection pyelonephritis kidney infection
o And what about the elderly client…. Loss of defensive abilities to kill the
bad bacteria… Change in LOC is the first thing we will see
What would cause this?
• How long is you urethra? Males are long women are shorter
• What happens when any fluid is stored in a nice warm, dark place?
• Add a circuitous pathway
• Add sugar
• Add sex
• Add poor neuromuscular control (Retention)
• Add poor self-defense- who’s this?
• Add a foreign body
• Add a continuous open pathway
,NURS 280 EXAM:URINARY SYSTEM NOTES LATEST
UPDATE 2022/2023 A+ SUCCESS GUARANTEED
• Add A 4# laying on top of it!
What do we do?
• Consider s/s and causes. This should guide you history taking, assessment, and teaching
• Urinalysis
• Culture and sensitivity
• Empiric treatment- we treat based on history and assessment
o Antibiotic therapy for uncomplicated UTI vs complicated UTI
▪ Trimethoprim/sulfamethoxazole (TMP/SMX), nitrofurantonin,
cephalosporins
▪ Fluoroquinolones for CX INFX- ciprofloxacin, levofloxacin
▪ Fluconazole
• Pyelonephritis- may also result from fungal, viral, or protozoal INFX
o May manage OUTOT or In-PT. Short hospital stay or rapid initiation with IV Antbx
to discharge with oral regime for 2-3 wks. Also consider N/v, dehydration issues.
o Monitor for urosepsis and septic shock
• Pain MGMT
o Phenazopyridine (Pyridium, AZO Standard)- topical analgesic effect on bladder
mucosa
o Strange Side effect? Stain anything orange urine
Interstitial cystitis- The bladder from HELL
• Chronic symptoms of a UTI without the presence of infection or stone
• More common in females
, NURS 280 EXAM:URINARY SYSTEM NOTES LATEST
UPDATE 2022/2023 A+ SUCCESS GUARANTEED
• Etiology often unknown
o Neurogenic hypersensitivity
o Mast cell alterations within bladder wall (Remember these guys from your
study of inflammation?)
o Strange infection- slow growing virus?
• Leads to scarring of bladder wall with ulcerations
• Treatment
• Avoid irritants- bladder diary
o Caffeine, alcohol, nuts, aged cheese, some fruits, EXP cranberries and citrus
• OTC supplement- glycerophosphate alkalinizes foods
• Stress mgmt..
• Lube during sex, consider alternate positions
• Tricyclic antidepressants- relief over time
• Pentosan- protective action on bladder wall
• For persistent cases, instillation of medications to the bladder to desensitize
pain receptors
Urinalysis
