Mosby s PATHOLOGY for Massage Therapists. Lesson 12.1 Objective. Chapter 12 Urinary Pathologies. Urinary System (cont. Urinary System. (cont d.

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1 Mosby s PATHOLOGY for Massage Therapists Lesson 12.1 Objective Discuss anatomic structures and physiologic processes related to the urinary system. Chapter 12 Urinary Pathologies 2 Urinary System Urinary system consists of: Kidneys Ureters Urinary bladder Urethra From HerlihyB, Maebuis NK: The human body in health and illness, ed 3, Philadelphia, 2007, Saunders. 3 4 Kidney functions: Regulate blood levels of ions Regulate blood ph Adjust blood volume Regulate blood pressure Produce hormones Produce and excrete urine (filtering wastes) Kidneys: A, from Brundage DJ: Renal disorders, St. Louis, 1992, Mosby. B, from Abrahams P, Hutchings RT, Marks SC: McMinn s color atlas of human anatomy, ed 4, St. Louis, 1999, Mosby. 5 6

2 7 Nephrons Filter substances out of the blood Return useful substances to the blood Form urine Nephron: From Applegate E: The anatomy and physiology learning system, ed 3, St. Louis, 2006, Saunders. 8 Renin-angiotensin angiotensin-aldosteronealdosterone system Juxtaglomerular apparatus located in nephron secretes renin in response to low blood pressure Renin converts angiotensin from liver to angiotensin I Renin-angiotensin angiotensin-aldosteronealdosterone system Angiotensin I goes through lungs and becomes angiotensin II Angiotensin II causes aldosterone secretion which increases sodium and water reabsorption; ; this increases blood volume The increase in blood volume elevates blood pressure and improves blood flow to kidneys 9 10 Lesson 12.2 Objectives Kidney Disorders Define disorders of the kidneys and list appropriate massage considerations. Define disorders of the bladder and urinary tract and list appropriate massage considerations. Discuss renal dialysis and include appropriate massage considerations. Glomerulonephritis Nephrotic syndrome Kidney stones Pyelonephritis Polycystic kidney disease Renal failure 11 12

3 13 Glomerulonephritis Inflammation of the glomeruli in the kidneys Massage is contraindicated in acute cases; otherwise, obtain medical clearance and avoid deep or vigorous massage over lumbar area Nephrotic Syndrome Caused by damage to glomeruli in the kidneys; usually from local or systemic disease Obtain medical clearance; if granted, avoid deep or vigorous massage over lumbar area From Zitelli BJ, Davis HW: Atlas of pediatric physical diagnosis, ed. 2, London, 1992, Gower Medical Publishing. 14 Kidney Stones Stones located in the kidney, renal pelvis, or ureters Massage is contraindicated in acute cases; if client has history of kidney stones but none currently, avoid percussion over kidneys Pyelonephritis Inflammatory condition of one or both kidneys Massage is contraindicated in acute cases; otherwise, obtain medical clearance and, if granted, suggest voiding before massage and avoid deep and vigorous massage over lumbar area From Lewis SL et al: Medical Surgical Nursing, ed 7, St. Louis, 2007, Mosby Polycystic Kidney Disease Renal Failure Formation of multiple grapelike cysts in kidneys Obtain medical clearance; if granted, suggest voiding before massage and avoid deep, vigorous massage over lumbar area Failure of kidneys to perform their physiologic functions adequately Renal insufficiency only about 25% of renal capacity remains End-stage renal failure 10% or less of renal function remains Massage is contraindicated From Lewis SL et al: Medical Surgical Nursing, ed 7, St. Louis, 2007, Mosby

4 19 Renal Dialysis Renal Dialysis (cont Removal of toxins from blood when kidneys are unable; two main types: Hemodialysis Peritoneal dialysis Hemodialysis external machine filters blood Peritoneal dialysis peritoneum serves as the filtration membrane From Lewis SM, Heitkemper MM, Dirksen SR: Medical-surgical nursing: assessment and management of clinical problems, ed 5, St. Louis, 2000, Mosby. 20 Renal Dialysis (cont Disorders of the Bladder and Urinary Tract Obtain medical clearance Avoid arm where shunt or catheter is located (for clients of hemodialysis) ) or abdomen (for clients of peritoneal dialysis) Use lighter-than than-normal normal pressure Reduce treatment time to 30 min Urinary tract infection Cystitis Urethritis Urinary incontinence Urinary Tract Infection Cystitis Infection of one or more urinary structures; usually from bacteria; UTIs are classified by location Cystitis: urinary bladder Urethritis: : urethra Pyelonephritis: : upper urinary tract Since UTIs relates to aforementioned diseases, follow massage recommendations for those specific diseases Inflammation of urinary bladder; also called bladder infection Massage is contraindicated in acute cases; otherwise suggest voiding before massage and avoid deep and vigorous massage over lumbar and abdominopelvic areas if sensitive 23 24

5 25 Urethritis Urinary Incontinence Inflammation of the urethra Suggest voiding before massage; avoid abdominopelvic area if sensitive Involuntary loss of control of bladder Stress incontinence: urine loss during activities such as coughing, sneezing, laughing, and physical exercise Urge incontinence: strong, sudden urge to urinate, bladder contracts, and then urine loss Suggest voiding before the massage; avoid abdominopelvic area if pressure causes uneasiness or discomfort 26

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