INVESTIGATIONS OF THE

URINARY SYSTEM

GROUP 4
 INTRODUCTION

The urinary system is one of the excretory systems

and consists of the following:
1) 2kidneys which secrete urine.
2) 2ureters which convey the urine from the kidney
to the urinary bladder.
3) 1urinary bladder where urine is collected and
temporally stored.
4) 1 urethra through which the urine is discharged
from the urinary bladder to the exterior.
 
KIDNEYS: They lie on the posterior abdominal
wall, one on each side of the veterbrae column
behind the peritoneum and below the diaphragm,
kidneys are bean shaped organs or roughly oval with
a medical indentation or concave notch called hilum.
Average sized kidney measures about 11cm long, 6cm
wide and 3cm thickness and weighs about
150grs.They are embedded in and held in position by
a mass of fat and then a sheath of fibroelasticbfascia
encloses the kidney and renal fats.
 URETERS: Are tubes made of smooth muscle fibres
that propel urine from then kidneys to the urinary
bladder .In adults the ureters are usually 25-30cm long
and 3-4mm in diameter.
URINARY BLADDER: Is a muscular sac in the
pelvis, the above and behind the pubic bone. When
empty, the bladder is about the size and shape of a pear.
URETHRA: The duct by which urine is conveyed out
of the body from the bladder, and which in male
vertebrates also conveys semen because it’s a long tube
that runs in the penis.
In this assignment we will stipulate and explain the
roles of a nurse in urinary system procedures and
describe the procedures that can be done in urine
examination.
Urine examination

Urinalysis is the physical,

chemical and microscopic examination of urine .It
involves a number of tests to detect and measure various
compounds that pass through the urine. How it is tested
,a urine sample is needed, the health care provider will
tell you what type of urine sample is needed. The two
common methods of collecting urine are 24hours urine
collection and clean catch urine Specimen. The sample
is sent to the laboratory for the following examinations
Physical Examination
1. We will check for the physical color and
appearance, therefore a normal color of urine is
amber.
2. What the urine look like to the naked eye
3. Whether it’s clear or Cloudy
4. Is It Pale or Dark Yellow.
The Urine Specific Gravity Test Reveals How
Concentrated Or Dilute The Urine Is.
Microscopic Appearance
The Urine Sample Is examined Under microscope to
look at cells, urine crystals, mucus and other
substances in the sample, and to identify any
bacteria or other germs that might be present.
Chemical appearance
A special stick tests for various substance in the
urine .the stick contains little pads of chemicals that
change color when they come in contact with the
substance of interest.
Reasons to why it is done
1. as part of the routine medical exam to check for
early signs of disease.
2. If you have signs of diabetes or kidney problems
3. To check for blood in urine
4. To diagnose a urinary tract infection
A microscopic examination is typically done when
they are abnormal findings on the physical or
chemical examination. it is perfumed on urine
sediment ,urine that has been centrifuged to
concentrate on the substances in it at the bottom of
the tube .the fluid at the top of the tube Is then
discarded and the drops of fluid remaining are
examined under the microscope.
 Nurse’s role
The roles of a nurse in urine examination is
important because it gives appropriate knowledge
and instructions on how to go about during the
procedure undertaken, the nurse will have to instruct
the patient to void directly into a clean dry
container ,sterile
 specimen if a microscopic examination is ordered
.faces ,discharges ,vaginal secretion and menstrual
blood will contaminate the urine specimen.
A nurse will collect urine from infants and young
children into a disposable collection apparatus
consisting a plastic bag with a adhesive backing
around the penis ,if its in a male. To permit voiding
direct to the bag ,depending to the hospital policy the
collected urine can be transferred to an appropriate
specimen container to cover the entire specimen
tightly ,label properly and send immediately to the
laboratory .if the urine is collected from indwelling
catheter ,it may be necessary to clamp the catheter
for about 15 to 30mins before obtaining the
sample ,clean the specimen port with antiseptic
before apirating the urine sample with a needle and
syringe .
 Renal function test
This is an indication of the state of the kidney and its
roles in renal physiology.
1. Glomerular filtration rate describes the flow rate of
filtered fluid through the kidney
2. Creatinine clearance rate in the volume of blood
plasma that is cleared of creatinine per unite time
and is a useful measure for approximately the
glomerular filtration rate .creatinine clearance
exceeds glomerular filtration rate.
3. MONITORING INTAKE AND OUTPUT. If there is
imbalance between the intake and output it may
mean there is a problem with the kidneys. So we
monitor to detect that imbalance.
4. BLOOD UREA NITROGINE (BUN). The normal
approximately of BUN is 6 to 10 mg/dl. So if there is
more than this it may mean the kidney is not doing
its work as expected. Although some drugs may also
cause this rise.
 Nurses Roles

To explain the procedure to the patient and also the

importance of doing the procedure in order to gain
cooperation and trust from the patient.
Carthetalization of the patient is one of my
responsibilities. A I should also tell the patient to
avoid pulling the tube to avoid injuries to the
bladder. Also making sure that there are no leakage
of urine along the tube to the bug, to promote
patients hygiene.
I also advice the patient and relatives to report
before they give oral fluids so that they are measured
and counted at the end of the day.
In procedures like BUN that need a blood sample I
have a responsibility to explain to the patient that we
will you sterile equipment to avoid infection since
we will be entering the vein. I will also explain that
they will be a pain when pricking the skin with a
needle to correct some blood.
Recording the fluids the patient is taking both oral
and intravenously in order to use the data to see if
there is balance between the input and output.
During this period of examination I will make sure
there is no use of drugs that can increase or decrease
the urine out put.
I also have the responsibility reporting the findings
to the patient and also telling him/her the way
forward.
To monitor for potential complication
To asses for progress and response to treatment .
After the examination is done, a nurse should be
alert on the type of diet that maybe contra indicated
if the patients renal is disfunctioning.eg sodium
should be restricted.
 Radiological examination

This is a branch or specialty of medicine that deals with

the study and application of imaging technology like x-
ray and radiation to diagnosing and treating disease.
Plain x-ray
This includes a wide allay of general procedures such as
abdomen, spine, upper and lower extremities, pelvis,
hip, plain skull sinus and facial bone .To assess the
organs of the urinary or gastrointestinal system. An x-
ray maybe the first diagnostic procedure used to assess
the urinary system.
 Nurse’s role

The nurse will have to explain the procedure to the

patient in order to create a rapport and cooperation.
Escort the patient to the department
If the patient is unconscious, a nurse will have to
request for a mobile x-ray
 Intravenous pyelogram

A compression device belt containing the balloons

that can be inflated, maybe used to keep the contrast
material in the kidneys. you will need to remain still
during the procedure which may take up to one
hour .before the final image is taken, you will be
asked to urinate again ,to see how well the bladder
has emptied .you can resume normal diet and
medications after procedure. You need to take plenty
of fluids to help removal of all contrast dye from the
body .
 Nurse’s role

Assesses for allergic to contrast material

Ask if patient is Pregnant
Assesses if patient Has any drug allergies
The test may reveal kidney diseases, birth defects of
the urinary system, tumours, kidney stones or
damage of the urinary system
RISKS
There is a chance of an allergy reaction to the dye,
even if you have received contrast dye in the past
without any problem .if you have a known allergen to
iodine based contrast ,an alternative test should be
performed .alternative include retrograde
pyelography or ultra sound.
 RETROGRADE PYELOGRAM

contrast [up from the bladder up to the kidney ]is opposite the
usual flow of urine ,hence the retrograde name .The reason is
to delineate renal anatomy in preparation for surgery.
Nurses role
To ensure that the patient has been catheterized and if not
catheterize the patient
Ensure aseptic techinque
Explain to the patient that they will be irritation in the urethra
during catheterization.
After the procedure make sure the patient takes enough fluids
to clear out the dye
 CYSTOGRAM

Is an examination that takes pictures of your bladder

and urethra and is performed by radiologists.
Cryptography; is a procedure that uses x-ray to
examine the urinary bladder. During cryptography
contrast dye is injected into bladder. cystography
may indicate how well the bladder empties during
urination and whether any urine backs up into the
kidneys [vesicoureteral reflex].Other related
procedures that may be used to diagnose problems of
the bladder include kidney ,ureters and bladder x-
rays.
REASONS FOR THE PROCEDURE

It is performed to assess the cause of

haematura ,recovering urinary tract infections or to assess
the urinary system when there has been trauma to the
bladder
.Also used to asses problems with bladder emptying and
urinary incontinence.
.Also to detect obstructions and stricter of the urethra or
urethra maybe evaluated by cystography.
.cryptography maybe used to asses’ enlargement of the
prostate gland
 Nurse’s role

Explain the procedure to the patient to gain cooperation

To insert the catheter before the procedure
Asses the patient for pregnancy and lactating and if the
patient is pregnant or , the patient will be counseled
and asked to sign a consent form .
Pre medication should be given to patients allergic to
the contrast dye.eg prednisone 50mg per oral 7hrs prior
to the administration of the contrast
Encourage the patient to drink a lot of water after the
procedure
 URETHROGRAM

This is a diagnostic procedure performed most

commonly in male patients to diagnose urethral

pathology such as trauma to the urethra or urethral

stricture.it is done to show poor urinary flow thought
to be caused by narrowing of the urethra,the most
common cause of the narrowing of the urethra in
men is the benin enlargement of the prostate gland.
 Nurse’s role

Explain the procedure to the patient to gain

cooperation and to allay anxiety
Ensure that the narrow catheter is inserted
Ask the patient to empty the bladder and then
remove the clothes ,to put on the gawn and lay down
on an xray table and position the patient.
Help Make maintain aseptic technique
 
 CYSTOSCOPY

Cystoscopy is a procedure used to see inside your

urinary bladder and urethra ,the tube that carries urine
from your bladder to the outside of the body .During a
cystoscopy procedure ,the doctor uses a hollow
tube[cystoscope]equipped with a lens to carefully
examine the lining of your bladder and your urethra and
slowly advanced into your bladder. There are two types
of cytoscopy which are
 
1. Rigid cystoscopy is done under general anesthesia
2. Flexible is done under local anesthesia
REASONS FOR THE PROCEDURE
1. Investigating the cause of bladder signs and symptoms,
such as blood in urine, frequency urinary tract infection
and painful urination
2. Diagnosing bladder and urinary tract infections and
diseases such as bladder cancer, bladder stone and
bladder inflammation.
3. Treating bladder diseases and conditions, small bladder
tumors.
4. Diagnosing an enlarged prostate
 
RISKS
1. Infections
2. germs
3. irritation
4. worsening
5. pain and burning sensation when urinating
6. hematuria
 Nurse’s role

To ensure that the area around the urethra is clean

Ensure that the urinary bladder is emptied
In male its usually done under general anesthesia
due to pain caused by the probe, hence ensure that
anesthesia has been administered
Administer fluids 1liter in 2hours,inoder to relieve
the discomfort after the examination
Ensure that the patient takes a warm bath after the
procedure to relieve the burning sensation
 ULTRASOUND

An ultrasound scan, sometimes called a

sonography ,is a procedure that uses high frequency
sound waves to locate an image of part of the inside
of the body ,such as heart. ultra sound exams do not
use ionizing radiation [x-rays]because ultrasound
images are captured in real time, they can show the
structure and movement of the body’s internal
organs as well as blood flowing through blood vessels
.Most ultra sound examinations are painless ,fast
and easy.
. A registered diagnostic medical sonographrer will
position you on the table, apply gel on your skin
[over the area been imaged] and will then press on
the skin with a hand held transducer to obtain the
necessary images. The images are then analyzed and
interpreted by a board certified radiologists .The
radiologist will send a signed report to your referring
physician, who will share the results with you.
 Nurses roles.

Ensure that the patient is starved for 6hours prior to the

examination
Ensure that the patient takes alot of water before the
procedure
Ensure that the exposure to the frequencies is not in
excess and is not exceeding the required frequency .
1.if exceeded it might lead to hearing impairment
2.may produce heating effects that are harmful to the
human body
Explain the outcomes to the patient according to the
results
 PERITONIAL DIALYSIS

Is a treatment for patients with severev chronic kidney

failure. The process use patients peritoneum in the
abdomen as a membrane across which fluids and
dissolved substances [ electoryes, urea, glucose, albumin
and other small molecules] are exchanged from the blood.
 
METHOD
The abdomen is cleaned in preparation foe surgery and a
catheter is surgically inserted with one end in the
abdomen and the other protruding from the skin. Before
each infusion the
catheter must be cleaned and flow into and out of
the abdomen tested. A large volume of fluid is
introduced to the abdomen over the next 10 to
15minutes.After a variable period of time depending
on the treatment [usually 4 to 6hours]the fluid is
removed and replaced with fresh fluid .This can
occur automatically while the patient is sleeping or
during the day by keeping 2litres of fluid in the
abdomen at all times ,exchanging the fluids 4-
6times per day.
 Nurse’s role

Explain the procedure to gain cooperation and allay

anxiety
Ensure that there is no infection on the opening
,hence maintain aseptic technique
Ensure that they are no large abdominal scares on
the abdomen and abdominal henia.
Ensure that the water is changed 4 to 6 times a day
 HAEMODIALYSIS

Is a method that is used to achieve the extra

corporeal rernoval of waste products such as
creatinine and urea ,and free water from the blood
when the kidneys are in the state of renal failure
.Haemodialysis is one of the three renal replacement
therapies ,the other two being renal transplant and
peritoneal dialysis. An alternative method for
extracorporeal separation of blood components such
as plasma or cell is a spheresis.In a haemodialysis ,a
machine filters
wastes ,salts and fluid from your blood .When your
kidneys are no longer healthy enough to do this work
adequately haemodialysis is the most common way to
treat advanced kidney failure The procedure can help you
carry on an active life despite falling kidneys
 
SIDE EFFECTS AND COMPLICATIONS
Haemodialysis often involves fluid removal ,through
ultra filtration because most patients with renal failure
pass little or no urine .Side effects caused by removing
too much fluid or removing
fluid too much rapidly include low blood pressure,
fatigue, chest pains ,leg cramps, nausea and
headaches .These symptoms can occur during the
treatment and can persist post treatment ,they are
sometimes collecting referred to as the dialysis hang
over or dialysis washout.
Nurses role