The document discusses urinary tract problems including kidney and bladder diseases. It outlines various urinary symptoms and disorders such as oliguria, polyuria, nocturia, dysuria, enuresis, urinary incontinence, hematuria, and kidney stones. Diagnosis involves physical examination, urine analysis, imaging tests like ultrasound, IVU, CT, and 24-hour urine collection. Treatment depends on the underlying cause but may include pain medication, increased fluid intake, and surgical removal of stones or tumors.

1. Urinary tract problems
:Outlines
:Definition
Primary problems in kidney and bladder
:diseases
Oliguria- Polyuria- Nocturia-
Dysuria- Enuresis-
Urinary incontinence- Pain-
Hematuria- Leukocyturia-
Pyuria- Proteinuria- Bacteriuria-

2. Disorders of the bladder, kidney, 
:urinary tract
Cystitis, Urethritis - Acute pyelonephritis- 
- Pyelonephritis- 
Abscesses in the region of the kidneys - 
Glomerulonephritis - Kidney stones- 
Acute renal failure- 
Chronic renal insufficiency - 
Renal tumors- 

3. Overview 
The urinary system is the organ system that 
produces, stores, and eliminates urine. In
humans it includes two kidneys, two ureters,
the bladder, and the urethra. The analogous
organ in invertebrates is the nephridium (in
(. animals
Physiology 

5. The kidneys are bean-shaped organs 
about the size of a bar of soap. The
kidneys lie in the abdomen, posterior or
retroperitoneal to the organs of
digestion, around or just below the
. lumbar spine ribcage and close to the
The kidneys are surrounded by what is 
called peri-nephric fat, and situated on
the superior pole of each kidney is an
. adrenal gland

6. The kidneys receive their blood supply of 1.25 
L/min (25% of the cardiac output(
from the renal arteries which are fed
by the Abdominal aorta. This is
important because the kidneys' main
role is to filter water soluble waste
products from the blood. the ureters,
which lies more medial and runs
.bladder down to the trigone of the

7. Functional the kidneys 
it concentrates urine, plays a crucial 
role in regulating electrolytes, and
.acid-base homeostasis maintains
The kidney excretes and re-absorbs 
electrolytes (e.g. sodium, potassium
and calcium) under the influence of
. hormones local and systemic

8. balance is regulated by the pH 
excretion of bound acids and
. ammonium ions
they remove urea, a nitrogenous 
waste product from the metabolism
. amino acids of proteins from
The end point is a hyperosmolar 
solution carrying waste for storage
. urination in the bladder prior to

9. :Definition 
:Altered URINARY ELIMINATION* 
, Urinary frequency, Nocturia, Urgency 
Dysuria , Hesitancy, Enuresis , 
:
Retention , Incontinence
liguria: Amount
– of urine eliminated 100
(ml ( normal urinary output 1 L1.5 500
,Anuria : Elimination of less than 100 ml
oliguria usually precedes

10. Causes:-Cardinal symptoms of acute 
renal failure
. Obstructive uropathy (e.g- 
enlarged prostate) - Dehydration , - 
frequent in the elderly
because of too little fluid intake - 
diarrhea or -vomiting- 
s - long term bladder catheterization 
Important : Anuria is an emergency 
situation and requires hospitalization

11. :Polyuria 
Definition : urinary output of more than 3 liters 
Causes - Most frequent cause : 
Hyperglycemia (glucose( in Diabetes mellitus
Specific phases in acute or chronic R - 
F Pollakiuria:Definition :-Frequent urge to
urinate, low output volume, normal output
volume within 24 hours
Causes: - Urinary tract infection or irritable 
bladder -possibly bladder tumor
In males, enlargement of the - 
prostate

12. )Nighttime Urination ( Nocturia 
Definition :Increase nighttime urination 
Causes- Cardiac insufficiency , kidney 
diseases
Large quantities of liquids taken in - 
the evening; use of diuretics
Complications during urination 
)( Dysuria
Definition:Difficulty on urination with 
pain or burning
Causes 
Urinary tract infection - 
Tumors in the bladder and /or - 

13. White blood cells in the urine 
(( Leukocyturia
: Definition 
Pathological elimination of red blood cells 
(leukocytes( in the urine
Causes: Urinary tract infection 
(Pus in the urine (pyuria 
Definition: Pus, cloudiness, and streaks in 
the urine
Causes: Severe inflammation of the 
kidneys and urinary tract

14. (Urinary Retention ( Anuresis 
Definition: Urination impossible 
despite full bladder
Causes 
Enlargement of prostate, - 
obstruction by calculi
Tumors of the urethra and / or - 
bladder near urethra opening
Disorders of the nerve supply - 
– to the bladder (disk prolapsed


16. Blood in the urine ( Hematuria ) 
Pathological blood cells with urine
elimination of red 
Causes- Tumors , calculi, and 
inflammation of kidneys and bladder 
,Increased bleeding tendency- 
, glomerulonephritis Renal tuberculosis 
enlarged prostate 
Foods and medicines may also color- 
the urine red

17.  The process of urine formation: 3 steps
includes.
 1- Glomerular filtration: Filtration of the
plasma a by glomerular as water, Na, Urea,
Cl, bicarbonate, K, Glucose , creatinine &
Uric acid 2) Tubular reabsorption. The
filtrate enters. Bowman's capsule through
tubular system of the nephron & either
reabsorbed or excreted as urine 3) Tubular
secretions the formed urine drains from
the collecting tubules into renal pelvis &
down to ureter. Then to the bladder. ]

18.  Assessment of patients with urinary
dysfunction:
 History: The nurse obtain baseline data
concerning a) general health, childhood ,
chronic family illness , D.M past medical
history, allergies, sexual & reproductive
health, exposure to toxic chemicals or gas
b) History of present complain c) Assess
risk factors for renal disorder d) Medication
history. E) Person's usual voiding patterns
as frequency and amount of urine F) Urine
characteristics e.g., hematuria risk.

19. Physical examination: a) Inspection) 
includes, abdominal scars, abdominal
movement & pulsation, inspection of back
for bulging & bruising, b) Ascult the
abdominal for bruits. (abnormal vascular
sounds of blood vessels) C) Percussion
above symphysis pubis and toward the
bladder (lymphatic or adult sound hered)
d) palpation: palpate suprapubic area,
assessing the kidneys for tenderness or
pain by lightly striking the first at the
). costovertebral angle (pain tenderness

21.  urine specimens for culture and
sensitivity to identify organisms are
usually midstream specimen (MSU)
or catheter specimen of urine.
 24 how urine collection: is the
collection of the total volume of
urine voided in 24 hrs period used in
diagnosis of renal tones & impaired
renal function.
 Urine specific gravity: to assess
kidney ability to concentrate

22.  B) Blood tests:
 Include, Hemoglobin, WBCs, urea, creatinine
& electrolyte estimation e.g., 9Na, potassium,
chloride, bicarbonate, calcium & phosphorus).
Liver function tests, blood group & Clotting
screen.
 C) Radiological investigation; i- Plain X-ray of
(KUB).
 ii- Intravenous urogram (IVU) iii- Renal
scanning .
 iv- Computerized tomography (Ct scanning)
V- ultrasound scan , VI- Cystoscop VII- Renal

23.  Assessing the chief complaint
 Voiding changes or disturbances .
 Urine volume changes.
 Irrigative voiding symptoms (frequency,
urgency, nocturia, dysuria)
 Obstructive voiding symptoms (hesitancy,
straining residual urine, retention, urinary
stream forece and size).
 Urinary incontinence (toal overflow, stress,
urge, functional )
 Urine characteristics changes (color,
hematuria, darity, odor, pH).

24. A) Preoperative nursing care the 
assessment under taken with
include: observation of the patient,
recording baseline observation
(temp, p, R, B.p, unanalyzed & WT)
medical / surgical history, pain,
breathing eating / drinking , level of
independence / dependence,
imbecility problems, elimination ,
sleeping, Body image GIT symptoms
(nausea & vomiting ) and assess for
. pain renal colic

25. Post operative Ng-care: Maintain 
safe environment pain control /
communication breathing,
elimination (I & O chart), eating &
dinking (I.V fluid replacement & diet
gradually when bowel complications
as (hemorrhage / shock,
pneumothorax, chest infection,
wound infection , UTI due to
uretheral catheter & deep vein
. thrombosis (DUT) due to immobility

26.  Patient education on discharge:
 Rest & activity: Return to normal
routine in 3-4 wks.
 Wound healing: observe s & s of w.
infection as (redness, discharge.)
applied appropriate dressing.
 Elimination: drink 2 L / 42 hrs.
Return to work : depend on type of 
work a manual sedentary work has a
longer period of convalescence than a

27.  Risk factor for various renal
or urologic disorders
 Risk factor
 Possible renal or urologic
disorder
 Childhood diseases step
throat impetigo, Nephrotic
syndrome

28.  Chronic renal failure
 Advanced age
 Incomplete emptying of
bladder, leading to urinary
tract infection
 Instrumentation of urinary
tract cystoxicity,
catheterization
 Immobilization

29.  Kidney stone formation
 Occupational, recreational or
environmental exposure to
chemicals plastics, patch, tar
rubber)
 Acute renal failure
 Diabetes mellitus
 Chronic renal failure , Neurogenic
bladder

30. Kidney Stones
dr/ amany lotfy 

31. Kidney Stones 
Formation of concretions in the 
urinary tract, frequently with
( cramp-like pains (colic
Stones formed when urine is 
supersaturated with a stone
forming salt


32. Causes 
Small crystals form when- 1• 
there is excessive concentration of
certain urine components: they
become larger, e.g. Calcium-
containing stones (calcium oxalate
or Phosphate(; uric acid calculi
Bacterial infection and urinary- 2 
retention

33. :-signs &Symptoms 
Difficult urination, blood in the urine• 
((injuries caused by calculi
, Nausea, vomiting• 
.persistent pain• 
constant irritation of the renal - 
mucosa
Inflammation and permanent - 
damage, as serious Kidney with
.chronic renal failure

34. signs &Symptoms
 Dysuria: burning on urination when passing
stones (rare). More typical of infection.
 Oliguria: reduced urinary volume caused by
obstruction of the bladder or urethra by
stone, or extremely rarely, simultaneous
obstruction of both ureters by a stone.
 Pyuria: pus (white blood cells) in the urine.
 Abdominal distension.
 Loss of appetite
 Loss of weight

35. :Risk factors 
The exact cause of stone formation is 
, unknown
Socioeconomic factors, renal stones 
are more common in industrialized
. countries
Diet, intake of foods high in purine, 
calcium, and oxalate. level of activity,
Persons who have a sedentary lifestyle
or limited mobility, because of calcium
loss from bones combined with urinary
. stasis

36. Climate, persons lived in warm 
weather develop calculi, to be a
result of higher chance for
Dehydration and more
.concentrated urine
,Positive family history 
Hypercalceamia (high 
concentration of blood calcium
compounds)  Hypercalciuria
(concentration of calcium in urin

37. Hypercalceamia (high concentration of 
blood calcium compounds) 
hypercalciuria (concentration of
calcium in urine)  precipitation of
.calcium and formation of renal stones
: Hypercalacemia may be caused by 
.  Hyperparathyroidism 
.  Excessive intake of vitamin C or D 
.  Antacids. Renal tubular acidosis 
 Excessive intake of milk 

38. :Types of urinary calculi 
:such as 
. Uric Acid-1 
. Cystine stones-2 
. Calcium oxalate-3 
. Calcium phosphate-4 
. Magnesium phosphate-5 
Struvite stones (ammonio--6 
)managesium phosphate stones

39. Types of calculi
calcium stones (Ca++ in complex 
with oxalate or phosphate or
both) – most common stone
)triple (Mg NH4 PO4 
struvite stones – quite common 
uric acid stones – 5% 
cystine or pure oxalate stones - 
inborn errors of metabolism

40. ?How urine PH affected calculus formation 
Normally the PH or urine fluctuates from 
slightly acidic to slightly alkaline over 24
hrs period. If urine PH is consistently
acidic or alkaline, the urine provides a
. medium suitable for stone formation
Acidic urine:  promotes formation of 
. cystine and uric acid calculi
Alkaline urine:  promotes formation of 
calcium phosphate & ammonic
. magnesium phosphate calculi
N.B: Calcium oxalate calculi can form in 
.urine of varying PH

44. Diagnosis
Physical examination 
the location and severity of the pain ,-1 
&which is typically colicky in nature
in spasmodic waves). Pain in the back ( 
. &produce an obstruction in the kidney
Diagnostics Investigation 
X-rays.1 
radio-opaque and they can be detected by a 
traditional X-ray of the abdomen that
includes the Kidneys, Ureters and Bladder
.KUB—

45. Diagnostics Investigation
Intravenous Pyelogram; Urogram( 2- IVP 
).(IntraVenous(IVU
About 50 ml of a special dye to be injected
into the bloodstream that is excreted by
the kidneys and by its density helps
outline an stone on a repeated X-ray
Computed tomography.2
All stones are detectable by CT except very
rare stones

46. Diagnostics Investigation
Ultrasound.3 
As it gives details about the presence of 
hydronephrosis (swelling of the kidney—
suggesting the stone is blocking the outflow
(.of urine
Used to detect stones during pregnancy 
.when x-rays or CT are discouraged

47.  Microscopic study of urine, which may show
proteins, red blood cells, bacteria, cellular
casts and crystals.
 Culture of a urine sample to exclude urine
infection (either as a differential cause of the
patient's pain, or secondary to the presence
of a stone(
 Blood tests: Full blood count for the
presence of a raised white cell count (
Neutrophilia( suggestive of infection, a
check of renal function & abnormally high
blood calcium blood levels hypercalcaemia(.

48.  24 hour urine collection to measure
total daily urinary volume, magnesium,
sodium, uric acid, calcium, citrate,
oxalate and phosphate.
 Catching of passed stones at home
(usually by urinating through a
tea strainer or stone screen( for later
examination and evaluation by a
doctor.

49. :Medical intervention 
, two primary goals 
removing the calculi-1 
preventing recurrence-2 
through correcting calculus-induced 
pathophysiologic changes,
eliminating urinary infection and
( . preventing renal damage

50. : Conservative treatment
of stones 4 mm or less in size 90% 
pass spontaneously without medical
. intervention
A- Treatment pain, nausea, and 
vomiting
B-if it the stone is not moving fluid 
, therapy is needed
C- pain management, antibiotics to 
prevent or treat infection caused by

51. Urologic interventions
Surgery is necessary when the pain is- 
persistent and severe 
non-invasive 
extracorporeal shock wave lithotripsy
((ESWL
Ureteroscopic fragmentation 
laser, ultrasonic or mechanical (pneumatic,
shock-wave( forms of energy to fragment
.the larger stones
Percutaneous nephrolithotomy open surgery
may be necessary for large or complicated

52. : Nursing management 
Assessment A( History taken; ask the patient 
. about; 1. Prior stone formation
Risk factors. .3- location, character, and . 2 
duration for current pain. 4. Current and
previous radiation
: B( Physical examination which include) 
Vital signs include increase pulse, respiration, . 1 
and blood pressure associated with colicky pain;
. fever indicates serious infection
Hyperactive bowel sounds occur with nausea .2 
.and vomiting hypoactive or absent bowel sounds

53. ; Nursing diagnosis 
Pain R / T irritation by presence of-1 
. obstruction, or movement of the stone
Knowledge deficit R /T Unfamiliarity-2 
with factors related to development of
urolithiasis, management, need for long
term management, diet therapy
according to type of stone, or need for
. prevention of recurrence of urolithiasis
High risk for infection R /T Urinary-3 
stasis, instrumentation of urinary tract,
, surgical incision

54. :Nursing intervention 
Releive of pain &Administer-1 
prescribed narcotic or analgesic
apply hot application to the pain area my 
relieve pain&encourage and assist the patient
to ambulate to "free" the stone
Supply fluid intake sufficient to-2 
urinary output of approximately 2000 ml to
30000 ml per day
: Health teaching-3 
Assesses the patient's understanding of 
. common risk factors. proper diet

55. A-Teach patients the following 
. regarding diet
For patients with stones R/T. 1 
: hypecalciuma
Calcium intake should be limited 
(diary products, beans, nuts, and
chocolate,VitaminD

56. For patients with stones related to-2 
uric acid, an alkaline ash diet is
recommended. include diary products;
fruits, except cranberries, plums, and
purnes and vegetables especially
.beans
for patients with Oxalates stones,-3 
foods encouraged on an acid ash diet
include meat, eggs, poultry, fish,
cereals, and most fruits and vegetables

57. B-Teach patient about 
medications used to prevent the
recurrence of renal stones
such as sodium cellulose phosphate 
(SCP), which binds calcium so that GI
.absorption of calcium is decreased
Cholestyamine binds oxalate and - 
enhances GI excretion and allopurinol
. reduce uric acid production


58. B-Teach patient about
medications
thiazides, potassium citrate, 
magnesium citrate and allopurinol,
(Zyloprim( depending on the cause
. of stone formation
Potassium citrate is also used in kidney . 
stone prevention 
increases urinary pH which helps reduce 
.calcium oxalate crystal

59. C-Teach patient to 
increase activity to prevent 
.stasis of urine
D-Teach patient to report any 
of the following signs of
infection; nausea, vomiting,
chills; change in appearance
. or odor of urine

60. :Follow up care 
After all treatment modalities the patient should 
be closely monitored for
signs of infection, renal dysfunction,-1 
. bleeding
postoperative serum electrolyte -2 
evaluations, 3-CBC counts and creatinine
studies
Continuous appropriate parentrally-4 
administered antibiotic. If an indwelling
ureteral stent was placed
infectious complications,( Pyelonephritis-5 