Kidney - Paired bean-shaped organs located in the upper abdominal cavity, one on each side of the spine
Kidney function
Filtration: Remove waste products, excess ions, and water from the blood to form urine
Regulation: Maintain electrolyte balance, regulate blood pressure (RAAS), and produce hormones like erythropoietin and renin (EPO)
Ureters
Pair of narrow tubes that connect each kidney to the bladder
Ureters function
Transport urine from the kidneys to the bladder through peristaltic contractions of smooth muscle
Prevent backflow of urine using one-way valves and smooth muscle contractions
Bladder
Hollow muscular organ located in the pelvis, capable of expanding to store urine
Bladder function
Temporary storage of urine until it is expelled from the body
Sensation of fullness triggers the urge to urinate, controlled by the nervous system
Urethra
Tube that carries urine from the bladder to the outside of the body
Urethra function
Elimination: Allows urine to exit the body during urination
Micturition: Controlled by the internal and external urethral sphincters, allowing voluntary control over urination
Common signs of aging in kidney include decrease in kidney tissue, decrease in number of nephrons, hardening of kidney vessels, atrophy of kidney, and increased risk of kidney disease
Related blood work, diagnostics or nursing care for kidneys
Urinalysis
Specific gravity
Urine culture
"Normal" urine terminology
Little or no blood and protein present
Little urochrome present
Yellow/amber color
pH of 6.5-9
Normal urine output is 30 mL/hour or 1-2L/day, about 6-7 times per hour
Post-void residual volume (PVR)
The amount of urine retained in the bladder after a voluntary void, functions as a diagnostic tool
Normal PVR is 50 mL
Urination process
1. Bladder fills with urine, sensory nerves detect increased pressure and send signals to brainstem
2. Forebrain activity controls voluntary micturition, afferent signals result in simultaneous contraction of bladder and relaxation of sphincter
3. Ureters work with peristalsis and prevent reflux of urine back into kidneys
Common signs of aging in GU function/bladder
Decreased peristalsis
Bladder muscle weakness
Bladder capacity is decreased
Less stretch or increased rigidity
Increased PVR
Difficulties of emptying bladder, leaving a PVR of over 50 (normal)
Changes with aging in GU function or bladder
Increases the risk of UTI, incontinence, leakage, and chronic kidney disease
The urinary tract is shorter in females (3-4 inches) compared to male (18-20 inches) which increases the risk of UTI
Kidney damage
Pain in back, radiates to abdomen, under the ribs, groin
Fluid retention leading to edema (legs, arms, and lungs)
Decreased urine output (oliguria)
Absence of urine output (anuria)
In kidney damage, there are changes in urine composition (smell, odor, chemical composition)
In kidney damage, calcium is increased in the blood, renin is increased, and RBC is reduced (anemia)
URIA - urine
POLY - many
OLIG - few or little
HEME - BLOOD
DYS - abnormal
Factors that influence urination
Age
Food and fluid intake
Medication
Culture / environmental concerns
Stress / anxiety
Activity level
Common alterations in GU function
UTI
Urinary incontinence - involuntary leakage of urine
Nocturia - walking at night to urinate
Urinary retention - accumulation of urine caused by the inability of the bladder to empty
Urinary diversion - diversion of urine to source
Renal failure
Urinary Tract Infection (UTI)
Most common hospital acquired infection (HAI), typically caused by bacteria
Cystitis - lower UTI, most common UTI in women, inflammation of the bladder
Pyelonephritis - upper UTI that affects the kidneys
Bacteremia - presence of bacteria in the blood, occurs as a result of severe infections, including UTI
UTI risk factors
Pregnancy
Less estrogen
Diabetes
Urine retention or weakening of bladder and pelvic floor muscles
Signs and symptoms of UTI
Dysuria - pain or burning sensation when voiding
Nocturia
Urgency (cystitis)
Frequency
Hematuria
Fever, chills
Back/side/groin pain - pyelonephritis
Costovertebral angle tenderness - pain with pressure to the kidney area - pyelonephritis
Signs and symptoms of UTI in older adults
Sometimes may be asymptomatic
Change in LOC
Confusion
Delirium
Agitation
Behavior change
Falls
UTI treatment and prevention
Treatment: Fluids, Antibiotic
Prevention: Adequate hydration, Movement, Incontinent care, Caution with indwelling catheter