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Nsg 210 Ch. 43
Renal & Urinary Tract Fx
| Question | Answer |
|---|---|
| Which kidney is lower and why? | Right is lower than left r/t liver location |
| Name the two parts of the kidney and what each contains | cortex:glomeruli, proximal/distal tubules, collecting ducts Medulla: pyramids(loops of Henle) |
| What is in the hilum of the kidney? | renal aa/vv enter and leave the pelvis |
| what is the working unit of the kidney? | nephrons |
| What is unique about the urethras and ureters that can be a problem if urine flows backwards? | no spincters or valves, so urine can flow backwards up into the kidney. Urine moves thru peristalsis and ureters have narrowed areas |
| What are the fx of the kidney? | 1.excrete end products of body metabolism(waste) 2.acidify urine(protect from inf and excrete excess acid) 3.reabsorbs electrolytes 4.reg body fluid/volume from vasculature into kidney and out |
| The renal artery eventually forms the (afferent, efferent) arteriole of a glomerulus? | arteriole forms glomerulus. Blood leaves glomerulus thru efferent arteriole back to inf vena cava |
| the initial formation of urine happens in the? | nephron |
| The glomerulus _______________ fluid out of the blood and is encased by ________? | filters, Bowman's Capsule |
| There are two types of nephrons: cortical and juxtamedullary, which ones make up the loops of Henle and surround by the vasa recta? | juxtamedullary are surrounded by capillary loops called the vasa recta which constantly monitor BP |
| The glomerulus and the tubules are two basic components of the what structure? | nephron |
| what facilitates the passage of passage of fluids and various substances(filration) from the blood vessels into the Bowman's Capsule? | pressure changes and permeability of the glomerular membrane |
| the juxtaglomerular apparatus is the site of what hormone? | renin, controls arterial BP and essential for proper glomerulus fx. |
| Describe the blow of fluid through the nephron to the bladder | begins at Bowman's Capsule to proximal tubules in cortex to Henle's loop in medulla to distal tubules to collecting ducts to pelvis to ureters to bladder to urethra |
| Of the 180L(45 gallons) of filtrate that the kidneys produce each day, how much is formed as urine ea day? | 1-2L |
| A dilute urine with a fixed specific gravity of 1.010 or fixed osmolality of 300mOsm/L indicates early | kidney disease and that protein/glucose is passing through when normally they do not. |
| The ratio of water to solute is termed | osmolality |
| What is the major waste product | urea(protein metabolism) |
| Amt ingested of Na & K = amt excreted because of aldosterone. When this cycle is disturbed, and incr aldosterone is secreted, what does this do to Na? What triggers the whole mechanism? | less Na and decr BP, dehydration, shock, decr NaCl triggers renin to trigger angiotensin II to trigger aldosterone |
| Renin is secreted with a decr in BP then it does what? | Renin converts angiotensin to angiotensin I, which is then converted to II, the most powerful vasoconstrictor and incr BP which then stops renin secretion(feedback mechanism) |
| When poor perfusion or incr serum osmolality what hormone is released | aldosterone |
| Renal clearance is the ability of the kidneys to clear ________ from the plasma | solutes |
| what is the best test for renal clearance? | 24h collection of urine |
| The normal GFR is 125ml/min, so what is the best indicator of testing this? | creatinine clearance |
| creatinine is | endogenous waste product of skeletal muscle filtered at glomerulus and excreted with urine Norm: 0.6-1.2mg/dl |
| So a pt with renal failure will show a (decr, incr) level of creatine clearance? What about BUN | decr, but serum creatinine incr If Bun incr, ca n mean dehydration. If Bun & creatinine incr, can mean kidney disease |
| What is important about erythropoietin and how is it fx in the kidney? | erythropoietin is released by kidney with a decr in oxygen tension in renal blood flow and it stimulates the bone marrow to produce RBCs |
| how is Vit D important in the kidney? | the kidney is responsible for final conversion of inactive vit D to its active form. Vit D allows Ca to be absorbed in the gut |
| What is important about prostaglandin E and protacyclin in the kidney | the kidneys produce prostaglandin E and prostacyclin which has vasodilatory effect and help maintain blood flow |
| Why can NSAIDs like salicylates and ibuprofen incr BP? | They inhibit prostaglandin E synthesis so decr in blood flow to kidney which will cause damage and will release renin and incr BP. |
| What other products are excreted as waste | creatinine, phosphates, sulfates, uric acid from purine metabolism |
| A pt is told to be on a purine free diet to decr formation of uric acid, what foods should they avoid? | shellfish, anchovies, asparagus, mushrooms, organ meats. |
| The sensation of fullness of the bladder is usually sent when the bladder has _________ml | 150-200ml, capacity is 300-500ml and micturation usually occurs about 8 x in 24h |
| One of the four layers of the bladder is the urothelium, what is the purpose of this? | water tight membrane to prevent urine from reabsorbing in the bladder |
| A typical female urethra is how long? male? | female: 3-5cm male: 20-25cm |
| What is the fx of urine's specific gravity and what is normal? | measures kidney ability to concentrate urine. Normal: 1.010 - 1.025 |
| What is dysuria | painful urination |
| List some age considerations changes in kidney | loss of tiss, not fx decr sp. gravity pelvic muscle decr = incontinence weak detrusor muscle = frequency hypernatremia r/t loss of osmotic sense of thirst |
| childhood strep, impetigo, DM, sickle cell anemia can lead to what kidney dysfx | chronic kidney disease |
| age, spinal cord injury, catheterization can lead to | UTI, incomplete emptying, neurogenic bladder, incontinence |
| Immobilization, gout, hyper parathyroidism, Crohn's, ileostomy can lead to | kidney stone formation |
| radiation therapy can lead to | cystitis, fibrosis of ureter, fistula or urinary tract |
| Pain that is dull, constant ache in costovertebral angle and extend to umbilicus can mean where? | kidney |
| dull continuous pain intense on voiding in suprapubic area means pain where? | bladder |
| Flank, lower abd pain thatis severe, sharp, stabbing pain, colicky in nature means where? | ureteral |
| vague back pain, discomfort, feeling of fullness in perineum is pain where | prostatic |
| pain during and after voiding is where | urethra |
| Diff bn oliguria and anuria | oli: <500ml/24h an: 50ml/24h |
| If blood is seen in urine or a spike in temp after renal/kidney biopsy what is nsg mgmt? | call Dr. |
| What does BUN to Creatinine ratio evaluate? | hydration status and incr ratio is found in hypovolemia. Normal ratio with incr BUN and cratinine = renal disease. Norm: 10:1 Norm BUN: 7-18mg/dl |
| Dx tests: IV urography, retrograde pyelography, cystography, renal angiography, cystoscopic exam, biopsy | IV: IVP w/ dye to show blood vessels, ret: flow bkwds into bladder, cys: flow of urine angio: vessels of kidney cystosc: direct view of bladder |
Created by:
palmerag
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