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chp 45


costovertebral angle landmark for locating kidneys, it is formed by the rib cage & vertebral column. The normal-size left kidney is rarely palpable because the spleen lies directly on top of it
creatinine, a waste product produced by muscle breakdown. urinary excretion of creatinine is a measure of the amt of active muscle tissue in the body, not of body weight
cystometrogram evaluates bladder tone, sensations of filling and bladder. involves insertion of catheter and instilling water/saline into bladder. measurements of pressure excerted against bladder wall are recorded
nsg actions for cystometrogram explain procedure during infusion pt is asked about sensations of bladder filling, usually including the 1st desire to urinate, a strong desire to urinate & perception of bladder fullness. Observe pt for manifestation of urinary infection after procedure
cystoscopy inspects interior of bladder with cystoscope. Can be used to insert ureteral catheter, remove calculi, obtain biopsy specimens of bladder lesions & to treat bleeding lesions. lithotomy position is used
complications of cystoscopy urine retention, urinary tract hemorrhage, bladder infection, perforation of bladder
nsg actions for cystoscopy before: force flds or give IV flds, obtain consent and give pre procedure meds after: burning, frequency and pink-tinged urine are expected. Observe for bright red urine, offer sitz bath or analgesic to relieve pain
glomerular filtration rate (GFR) amt of bld filtered each minute by glomeruli. the normal GFR is about 125ml/min. The peritubular capillary network reabsorbs most of the glomerular filtrate before it reaches the end of the collecting duct therefore only 1ml/min
glomerulus afferent arteriole divides into a capillary network, the glomerulus which is a tuft of up to 50 capillaries
intravenous pyelogram (IVP) visualizes urinary tract after IV injection of contrast. Presence position, size & shape of kidneys, ureters & bladder can be evaluated. Cysts, tumors lesions and obstructions cause a distortion in normal appearance of these structures.
complications of IVP severe renal function
nsg actions for IVP night before: give enema. Before procedure: assess pt for iodine sensitivity to avoid anaphylactic reaction. Advice pt that warmth, flushed face & salty taste during injection of contrast may occur. After: force flds, watch for hematuria, infection,
nephron the functional unit of the kidney. Each kidney contains approx. 1 million nephrons.
where are the glomerulus, Bowman's capsule, proximal tubule and distal tubule located? cortex of kidney
where are the loop of Henle and collecting tubules located? medulla
renal biopsy obtains renal tissue to determine type of renal disease or follow progress of renal disease. done with needle inserted into lower lobe of kidney, can be done with CT or U/S to guide needle. contraindi: bleeding disorders & uncontrolled HTN
nsg action for renal biopsy type & cross for bld, CBC, H/H, PT, PTT, no aspirin or warfarin. AFTER: apply pressure dsg & keep on affected side for 30-60 mins, bedrest for 24hrs, v/s q15m x4, assess for flank pain, bleeding, hypotension, dysuria, no heavy lifting 5-7 days, check H/H
Bowman's capsule filtrate passes through to tubule
tubule proximal convoluted tubule, loop of Henle, distal convoluted tubule, collecting tubule
physiology elimination of waste products, flds & electrolytes balance regulator, production of bld cells, hormonal control of BP
ureters anatomy- hollow tubes, about 12 inches long physiology- propel urine to bladder from kidneys
urine color-yellow, consistency-clear, specific gravity- 1,000-2,000ml, BUN 7-18, creatinine- 0.7-1.4
promotion of normal urinary function adequate hydration, activity, regular voiding habits, children 2 1/2 to 3 1/2 bladder reflex control, 3 yrs- regular voiding habits, 4-independent bathroom activity, 5 yrs-nighttime control
enuresis lack of nighttime bladder control in school-aged child
s/s of enuresis voiding @ frequent intervals in small amts, suprapubic discomfort & bladder distention, appropriate hydration, specific gravity is elevated
causes of enuresis neurogenic bladder, stricture, calculi, trauma, Predisposing factors: bedrest, tremors, prostatic hypertrophy, decreased bladder tone, calculi, meds (nephrotoxicity)
complications of enuresis rupture of bladder, infection, uremia
nursing care stimulate voiding, pouring tepid water over perineum, positioning, catheterization, surgical: suprapubic cystostomy, surgery for kidney stones
ureteral catheterization avoid removing more than 500ml at one time, if more urine in bladder clamp after 500ml and wait 15-30 minutes, then continue
catheter irrigation to prevent obstruction of flow, use sterile technique, monitor I&O, monitor for s/s of infection,
incontinence involuntary loss of bladder control due to infection, neurogenic bladder, sphincter weakness or reduced muscle tone.
types of incontinence urge incontinence-strong & sudden urge, unknown cause, Stress- occurs with physical exertion such as lifting, sneezing, Overflow: constant dribbling of urine, diabetic neuropathy, prostatic hyperplasia, uterine prolapse, Reflex-large of urine retained,
Interventions for incontinence scheduling, bladder retraining, pelvic exercises, surgery, condom catheters, incontinence pads, avoid delay in assisting patient to bathroom
ureterosigmoidostomy ureters are attached to the sigmoid colon to allow drainage into rectum & eliminate ion control by anus, not as commonly used
cutaneous ureterostomy one or both ureters are brought to the skin surface to form a stoma to drain urine
ileal conduit both ureters are attached to a segment of ileum, which is brought to the surface of the lower abdomen to form a stoma to drain urine, most commonly used urinary diversion
cystitis inflammation of the bladder, may be infectious (bacteria, virus, fungal) or noninfectious (irritation)
s/s of cystitis urgency, frequency, burning during urination, cloudy, foul smelling urine, Predisposing factors: female is more prone, catheterization, instrumentation, hospital acquired infection
nsg management of cystitis force flds to 3L/day, urine C&S, antibiotics (trimethoprim/sulfamethoxazole) antifungal (ketoconazole), urinary analgesic (phenazopyridine), cranberry juice, no caffeine, carbonated drinks, no tomatoes, urinary antiseptics (nitrofurantoin)clean properly
pyelonephritis inflammation of the kidney, s/s: chills, fever, generalized malaise,urinary frequency, dysuria, flank pain, costovertebral angle tenderness
nsg management for pyelonephritis sterile urine culture, usually caused by. E. coli, bld tests, bedrest during acute phase, antibiotic therapy, antiseptic, analgesics,
renal & urethral stones mineral crystallization formed around organic matter, urolithiasis- urinary stones, nephrolithiasis- kidney stones
s/s of renal & urethral stones pain, depends on location, n/v, hematuria, WBCs & bacteria in urine, radiates from flank to abd, diaphoresis, low grade fever and chills, dx tests (IVP, CT, MRI, cystoscopy, KUB)
nsg management of renal & urethral stones monitor I&O, force flds, strain urine, check urine pH, monitor temp, pain mngmt, Surgery: lithotripsy, stent placement, nephrolithotomy, nephrostomy, retrograde ureteroscopy
Created by: cheychey26