Care of Patients with Altered Elimination

ANATOMY & PHYSIOLOGY- URINARY SYSTEM 4. Urethra

a. Thin-walled tube that carries urine
LEARNING OBJECTIVES: (passageway of urine) from the urinary bladder
At the end of the discussion, the learners will be able to: to the outside of the body by peristalsis.
a. Function. Females: carries only urine.
1. identify the major structures of the Renal-Urinary Males: carries urine and sperm.
system. c. Length. Females: 3-5 cm or 1-1/2 inches.
2. relate the functions of the kidneys and the urinary Males : 20 cm or 8 inches.
structures in maintaining homeostasis. d. Catheter. Pedia: 8-10 fr. Females: 12-14
3. identify common genito-urinary disturbances that fr. Males: 16-18 fr.
affects elimination, fluid and electrolyte balance.
II. STRUCTURES OF THE KIDNEY
I. ANATOMY AND PHYSIOLOGY OVERVIEW A. Regions of the kidney.
A. Organs of the Urinary System The kidneys are divided into 3 regions:
1. Kidneys 1. Renal Cortex. Outer region of the renal
2. Ureters capsule, which contains glomeruli (blood filtering
3. Urinary Bladder mechanism)
4. Urethra 2. Renal medulla is the inner region, which
B. Parts/Structures contains the renal pyramids and renal tubules
1. Kidneys 3. Renal Pelvis. Funnel shaped tube that has
a. Each person has 2 kidneys. The kidneys are Calyces, cup-shaped “drains” that enclose the renal
situated at the level of the T12 to L3 vertebrae. pyramids. They collect urine and send it to the
b. The right kidney is slightly lower than the renal pelvis, on to the ureter, and to the urinary
left because of the position of the liver. bladder for storage.
c. An adult kidney is about 12 cm (5 in) long
and 6 cm (2.5 in) wide. B. Nephrons
d. An adrenal gland sits atop each kidney. 1. Structural functional units of the kidneys.
Each kidney contains over a million nephrons.
2. Ureters 2. Composed of glomerulus and tubules.
a. Slender tubes 25–30 cm (10–12 inches) 3. Primary function of the nephron is
attaching the kidney to the urinary bladder formation of urine. Nephrons selectively secretes
b. Continuous with the renal pelvis. Enter the and reabsorbs ions and filtrates, including fluid,
posterior aspect of the urinary bladder. Run behind wastes, electrolytes, acids, and bases.
the peritoneum. 4. Each nephron consists of 2 main
c. Peristalsis aids gravity in urine transport. structures, Renal Corpuscle and Renal Tubule.

3. Urinary Bladder C. Renal Corpuscle

a. Located behind the symphysis pubis 1. Each nephron contains Glomerulus,a tuft
b. Made up of muscular and elastic tissues and of semi-permeable capillaries which filter large
is distensible (smooth, collapsible muscular sac). plasma proteins and blood cells.
c. Serves as reservoir of urine. Stores urine 2. Blood flows into the glomerular capillaries
temporarily. from the afferent arteriole and flows out of the
d. Trigone—triangular region of the glomerular capillaries into the efferent arteriole.
urinary bladder base based on three openings. 3. Bowman’s capsule surrounds the
- Two openings from the ureters (ureteral glomerulus.
orifices)
- One opening to the urethra (internal D. Renal Tubules
urethral orifice) 1. Extends from the glomerular (Bowman’s)
e. In males, the prostate surrounds the neck of capsule and ends when it empties into the
the urinary bladder collecting duct.
f. Max: 1, 200 -1,800 ml of urine. Initiates 2. Subdivisions of the renal tubule are:
urination: 250-500 cc/ml. Proximal Convoluted tubule (PCT), Loop of Henle
 (Nephron Loop) and the Distal Convoluted Tubule d. Active Vitamin D is essential for absorption of
(DCT). Calcium in the GI tract.
3. The PCT receives filtrate from the
glomerular capsule and reabsorbs water and 2. Production of Erythropoietin
electrolytes through active and passive transport. a. Erythropoietin stimulates release and
4. The Descending Loop of Henle passively production of RBC’s in the bone marrow.
reabsorbs water from the filtrate. b. It is produced and released in response to
5. The Ascending loop of Henle passively hypoxia and decreased renal blood flow.
reabsorbs sodium and chloride from the filtrate c. Deficiency of erythropoietin occurs in renal
and helps maintain osmolality failure, leading to anemia.
6. The DCT actively and passively removes
sodium and water. 3. Production of Renin to regulate the blood pressure.
a. Renin is produced and secreted by the
III. BLOOD SUPPLY juxtaglomerular cells of the kidneys.
A. Blood Supply to the Kidneys b. Renin is released in the blood stream in
1. About 1200ml of blood flows to the response to low blood pressure (decreased renal tissue
kidneys, which is 20 to 25% of the cardiac perfusion, decreased arterial blood pressure, decreased
output. One quarter of the total blood supply of the ECF, decreased serum Na concentration and increased
body. urinary Na concentration)
2. Renal artery provides each kidney with c. Renin stimulates Liver to produce
arterial blood supply. Angiotensinogen. Pulmonary (Lungs) Angiotensin
3. Renal artery divides into segmental arteries Converting Enzyme (ACE) converts Angiotensinogen
→ interlobar arteries → arcuate arteries → cortical to Angiotensinogen I, then Angiotensinogen II.
radiate arteries. d. Angiotensinogen II causes
(1) Arteriolar Vasoconstriction and
B. Venous Blood flow (2) stimulates adrenal cortex to release
1. Cortical radiate veins → arcuate veins → Aldosterone.
interlobar veins → renal vein. e. Aldosterone promotes sodium and water
2. There are no segmental veins. retention, and increases (ECF) extracellular fluid
3. Renal vein returns blood to the inferior volume. This causes hypertension in renal failure.
vena cava

IV. FUNCTIONS OF THE KIDNEY-URINARY V. MAINTAINING HOMEOSTASIS

SYSTEM A. Excretion of waste/ end products of metabolism
A. Major Role of the Kidney-Urinary System 1. Through the formation of urine, the kidneys,
1. Maintain Homeostasis by: remove waste products from the body.
a. Excretion of waste/ end products of body 2. Urine formation has 3 steps:
metabolism. a. Glomerular Filtration
b. Maintain Fluid, Electrolyte, and - Water and solutes move from the
Acid-Base balance. blood to glomerular capsule. The fluid that
enters the capsule is called the glomerular
B. Other Regulatory Functions of the Kidneys filtrate.
1. Activation of Vitamin D - Glomerular filtration rate (GFR) is 125
a. Kidney is responsible for conversion of Vitamin ml/min, kidneys form 0.5 to 1ml of urine or
D to its active form. Vitamin D is necessary for 30 to 60 ml/ hr. Approximately, 1,500
maintaining normal calcium balance in the body and ml/day.
regulation of the parathyroid hormones. b. Tubular Reabsorption
b. Vitamin D can be obtained in the diet or - Water and other substances that are
synthesized by the action of ultraviolet radiation on useful to the body are reabsorbed. Water and
cholesterol in the skin. solutes that are not reabsorbed become
c. These forms are inactive and requires 2 steps to urine.
become metabolically active. 1st step occurs in the liver; c. Tubular Secretion
the 2nd steps occur in the kidneys.
 - Water and other solutes such as 2. Common congenital abnormalities include
creatinine, hydrogen ions, and potassium polycystic kidney and hypospadias.
are eliminated/ secreted. Ammonia, uric acid, 3. Common urinary system problems in children
some drug metabolites are likewise eliminated. and young to middle-aged adults include infections
caused by fecal microorganisms, microorganisms
B. Maintain Fluid and Electrolyte Balance causing sexually transmitted infections, and
1. Blood composition depends on three factors. Streptococcus.
a. Diet 4. Urinary tract infections (UTIs) are the only
b. Cellular metabolism common problems before old age. Escherichia coli (E.
c. Urine output coli), a bacterium, accounts for 80% of UTIs.
2. Fluid balance. 5. With age, filtration rate decreases and tubule
a. Sources of water output include: Lungs cells become less efficient at concentrating urine,
(insensible since we cannot sense the water leading to urgency, frequency, and incontinence.
leaving), Perspiration, Feces, and Urine. G. In men, urinary retention is another common
b. Hormones produced by the kidney problem (Prostate enlargement)
promotes reabsorption of water and electrolytes.
(1) Renin and (2) ADH. B. Problems associated with aging
3. Antidiuretic hormone (ADH) is primarily 1. Urgency. Feeling that it is necessary to void
responsible for the reabsorption of water by the 2. Frequency. Frequent voiding of small amounts
kidneys. Also known as vasopressin, it is a hormone of urine
that is secreted by the posterior portion of the pituitary 3. Nocturia. Need to get up during the night to
gland in response to changes in osmolality of the blood urinate
(dehydration, decrease blood volume) . 4. Incontinence. Loss of control
4. ADH makes the distal convoluted tubules 5. Urinary retention. Common in males, often
and collecting duct permeable to water = increase the result of hypertrophy of the prostate gland
water retention.
5. With excess water intake, the secretion of ADH VII. URINARY-RENAL DISORDERS
by the pituitary is suppressed; therefore, less water is 1. Urinary Incontinence
reabsorbed by the kidney tubule, leading to diuresis 2. Urinary Tract infections
(increased urine volume). When ADH is lacking, the 3. Urinary Calculi
client develops diabetes insipidus (DI). 4. Hypospadias and Epispadias
5. Polycystic Kidney Disease
C. Maintain Acid-Base Balance 6. Nephrotic Syndrome
1. Kidneys play greatest role in maintaining 7. Glumerulonephritis
acid-base balance. 8. Wilms’ tumor (Nephroblastoma)
2. Respiratory mechanisms. Respiratory rate can 9. Kidney Tumors
rise and fall depending on changing blood pH to retain 10. Acute Kidney Injury
CO2 (decreasing the blood pH) or remove CO2 11. Chronic Kidney Disease
(increasing the blood pH).
3. Renal mechanisms: VI. REFERENCES
a. When blood pH rises: Bicarbonate ions Cheever, K., Hinkle, J. & Overbaugh, K. Brunner
are excreted. Hydrogen ions are retained by and Suddarth's Textbook of Medical-Surgical Nursing.
kidney tubules. 15th ed. 2022
b. When blood pH falls: Bicarbonate ions Silvestri, A., et.al. Saunders Comprehensive
are reabsorbed. Hydrogen ions are secreted Review for the NCLEX RN Examination. 8th ed. 2020
c. Urine pH varies from 4.5 to 8.0 Keller, S., Marieb, M. Essentials of Human
Anatomy and Physiology. 12th ed. Pearson Education,
VI. ALTERATION IN URINARY SYSTEM Inc. 2018
A. Developmental Aspects
1. The kidneys begin to develop in the first few Prepared by: JOHN EMMANUEL C. MAGTIBAY, RN
weeks of embryonic life and are excreting urine by the / NCM 118n LEC / 1st Sem 2023-2024
third month of fetal life.