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Nsg 210 Ch. 43

Renal & Urinary Tract Fx

QuestionAnswer
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