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68C Urinary

test 7

Anasarca severe, generalized edema
Anuria urine output < 100 ml/day
Asthenia a general feeling of tiredness and listlessness
Kidneys Excrete waste products Regulate fluid and electrolytes Maintain acid-base balance
Placement of the Kidneys Retroperitoneum, below the diaphragm on each side of the vertebral column Right kidney is slightly lower than the left due to the location of the liver Surrounded by a layer of adipose tissue
what is a Nephron Functional unit of the kidney Maintains fluid balance Regulates pH Removes toxins More than 1 million per kidney
Two main structures of the Nephron renal corpuscle renal tubule
Glomerulus Tightly bound network of capillaries  Blood enters via the afferent arteriole Blood exits via the efferent arteriole The difference in diameter between the afferent and efferent arteriole controls the rate of glomerular filtration
what is Bowman's Capsule Cup-like structure that collects the glomerular filtrate/ filtration of H2O/Blood.
Renal Tubule consists of: proximal convoluted tubule, loop of Henle, distal convoluted tubule collecting duct
H2O and NA are absorbed where in the tubule? proximal convelouted tubule
decending limb in the loop of henle absorbs what? H2O/ Passive transport used
asending limb in the loop of henle absorbs what? NA+, CL-, K+/ active transport used
distal convoluted tubule NA+ and CL-
Renal capsule: the outer covering of the kidney which consists of a layer of strong connective tissue.
Medulla; empty urine into calyces
phases of urine filtration filtration reabsorption secretions
What age related change in males makes them more prone to UTIs? Prostate enlargement
Elements of a UA physical characteristics Evaluates: pH Specific gravity Presence of blood cells WBC RBC
Pyleo= Kidney
Cysto= bladder
Elements of a UA Detect and measure Protein Glucose Ketones Crystals
24-hour Urine diagnostic test Provides better overall measure of kidney function Process Discard first void and note time at the beginning of the 24-hour collection period
24-hour Urine substances measured Total protein Creatinine Urea Uric acid levels Catecholamines
Urine Culture and Sensitivity Purpose Confirm suspected infections Identify causative organisms Determine appropriate antimicrobial therapy Periodically screen urine when the threat of a UTI persists
Urine Creatinine Generated during muscle contraction Excreted in glomerular filtration Levels directly related to muscle mass Excellent indicator of renal function
Normal creatinine clearance male 107-139 ml/min (male)
Normal creatinine clearance female 87-107 ml/min (female)
What blood test is the most reliable indicator of kidney function? Serum Creatinine.
blood test Serum Creatinine Normal range is 0.5 to 1.2 mg/dl Abnormal elevation caused by Glomerulonephritis Polynephritis Acute tubular necrosis Urinary obstruction
Blood Urea Nitrogen (BUN) Normal range is 10 to 20 mg/dl Urea results from protein catabolism May be elevated due to CHF, catabolic state, starvation or GI blood loss
Prostate Specific Antigen Normal less than 4 ng/ml
Kidney-Ureter-Bladder (KUB) Radiological procedure Used to evaluate General status of abdomen Size, structure and position of the urinary tract structures
Kidney-Ureter-Bladder(KUB) detects what abnormalities? Abnormal findings may indicate Tumors Calculi Glomerulonephritis Cyst
Intravenous Pyleography/ Intravenous Urography requires informed consent Evaluates structures of the urinary tract Locates urinary tract obstructions Assists in the investigation of flank pain, hematuria, or renal calculi *Allergic reaction to iodine
Retrograde Pyleography: Examines lower urinary tract with a sterile cystoscope Contrast injected into ureters to visualize UPPER urinary tract
Voiding Cystourethrography Used in conjunction with other diagnostic studies Detects abnormalities of the bladder and urethra Contrast injected to outline the lower urinary tract and radiographs taken
Ultrasonography ( NON Invasive) Identifies the kidney's shape, size, location, collecting systems, and adjacent tissues Identification of renal cysts or obstruction sites, assistance in needle placement, and drainage of a renal abscess
Endoscopic Procedures Visual examinations of hollow organs using an instrument with a scope and light source. Informed consent is necessary.
Cystoscopy Visual examination to inspect, treat, evaluate or diagnose disorders of the urinary bladder and proximal structures
Brush Biopsy Performed with nylon brush via ureteral catheter during cystoscopy  Specimens obtained from the renal pelvis or calyces
Nephroscopy Performed using percutaneous route Provides direct visualization of upper urinary structures Biopsy or urine specimens obtained and/or calculi removed
Computed Tomography Scan (CT Scan) Non-invasive procedure to determine kidney size and differentiate kidney masses Visualization of the adrenals, bladder and prostate
Magnetic Resonance Imaging (MRI) Nuclear magnetic resonance used to obtain visual assessment of urinary structures
Renal Angiogram Evaluates Blood supply to the kidneys, Masses Detects potential complications after renal transplant
Renal Biopsy (Percutaneous biopsy) Open biopsy Surgical procedure requiring general anesthesia and routine pre- and post-operative care
Post procedure care for an Renal Angiogram Hydration Bedrest Neurovascular check *Catheter passed through femoral artery to instill contrast
Nephritis Inclusive of several kidney disorders characterized by inflammation and abnormal function of the kidney. Acute and chronic glomerulonephritis are included in this syndrome
What are three signs that characterize nephrotic syndrome? Marked proteinuria, hypoalbuminemia and edema.
what kind of dier would a patient with glomularnephritis be on? High protein diet (meat, fish, poultry,cheese,eggs)
: Name one nursing diagnosis appropriate for a patient with an immunologic disorder of the kidney? Fluid volume excess/Activity intolerance/ Knowledge deficit
Acute Renal Failure Inability of the kidneys to remove wastes, concentrate urine and absorb or secrete electrolytes
Acute Renal Failure Causes Thrombosis of the renal arteries Severe/prolonged hypotensive/Loss of intravascular volume/ Blood transfusion reactions Myocardial infarction/heart failure/Nephrotoxins/Crushing injuries/Rhabdomyolysis Nephrotoxins/ Other altered health states
Acute Renal Failure (ARF) Phases: Oliguric phase Diuretic phase Recovery phase
Chronic Renal Failure Advanced failure leads to destruction of nephrons, decreased blood flow, and decreased glomerular filtration
The terminal stage of renal failure is called_________ uremia
Drug therapy for chronic kidney failure Anticonvulsants/Antiemetics/Antipruritics/Synthetic erythropoietin
Hemodialysis process by which blood is circulated with dialysate through a semi-permeable membrane to remove nitrogenous waste products, control fluid and electrolyte balance and maintain acid-base balance
Peritoneal Dialysis Administration of a dialysis solution (dialysate) via a surgically implanted catheter into the peritoneal cavity
Peritoneal Dialysis procedure stage 1 Installation stage: actual administration of the dialysate solution 1-2 liters in 10-15 minutes
Peritoneal Dialysis procedure stage 2 Equilibration stage: the period of time the dialysate is left to sit in the peritoneal cavity, usually 15-45 minutes
Peritoneal Dialysis procedure stage 3 Drainage stage: the time required to allow the dialysate to drain from the peritoneal cavity by gravity should take no longer than 10-15 minutes
kidney function filtration,secretion,reabsorption
Which is not an example of a nursing intervention for preventing UTI? Void every 2 to 3 hours while asleep
What might be a nursing diagnosis for a patient with pyelonephritis(Kidney infection)? Ineffective Renal Tissue Perfusion Impaired Urinary Elimination
What is the duration of antibiotic therapy for a patient with prostatitis? recommend that antibiotic therapy be continued for 3-4 weeks to prevent relapse, although a longer course is sometimes necessary
when reading a urinalysis report,the nurse recognizes this result as abnormal: red blood cells, 15-20
after renal angiography, the patient assessment priority is the: puncture site
the nursing care plan includes teaching the patient Kegal exercises. This teaching includes what muscle group? perineal floor
what activity would be harmful for the incontinent patient? restricting fluid intake
the nurse recognizes that the most causative organism in the pyelonephritis is: Escherichia coli (E.Coli)
the most important factor to foster patient compliance with the treatment plan is provide the patient with: an active role in the planning.
when scheduling the administration of furosemide (lasix), it would be in the patients best intrest to schedule the medication to be given at what time? 9am
which patient report indicates that phenazopyridin hydrochloride (Pryidium) is being effective? decrease in burning.
when calculating actual urine output during continous bladder irrigations, the nurse would: measure the total output and deduct the amount of irrigation solution used.
what statment made by the patient indicate the need for further teaching before renal angiography? "Im glad I dont have to stay in bed after this test!"
the nurse catheterizes immediatly after the patient voids and obtains 30mL residule urine. the next step would be to: document the procedure with outcome data.
which goal would have priority in planning care of the aging patient with urinary incontinance? recognize the urdge to void.
The goal for peritoneal dialysis is to: remove toxins and metabolic waste
in postoperative care of a patient with an arteriovenous shunt, the nurse should: use STRICT surgical asepsis for dressing changes.
the teaching priority for a patient with acute renal failure is: prevention of infection
the patient with ERSD receiving hemodialysis is at risk for: anemia
the primary function of the kidney is: filtration of water and blood products
the priority short term goal for disorders of the urinary system is: normal patterens of urinary elimination.
assessment of the patient with a urinary disorder may be complicated by: social taboos surrounding sexuality
which problem contributes to a medical emergency? Anuria
most common cause for renal failure is: diabetes mellitus
the clinical findings in the oliguric phase of acute reneal failure include: BUN and creatine levels
during post operative care of a patient with an ileoconduit, which finding represents an emergency? absents of bowel sounds
Patient teaching for cystitis include: *educating patient on benifits of cranberry juice to prevent UTIs* teach females on cleaning front to back to prevent rectal E.Coli contamination of urethra.*2000ml of H2O unless contraindicated.
Renal calculi may result from: *infection of urinary tract infection *Hyperparathyroidism, which causes increase in calcium metabolism.
collective and subjective data collected from a patient with acute glomerulonephritis could include: periorbital edema*anorexia*frankly sanguineous urine.
careful preparation of a patient for an IVP is necessary.Nursing intervention would include; NPO for 8hrs before examination* Giving prescribed NON-gas forming laxitives.* instruct patient concerning IVP.
different Renal diets renal PHOSPHORUS diet renal POTASSIUM diet renal SODIUM diet renal PROTIEN diet
DM+HTN=__?___ RENAL DAMAGE; blood carrying waste gets weighted down by the sugar molecules connected to the RBCs. over time, kidneys get clogged/work extra hard and protien stays in blood stream. protien spills into urine and is seen in urine test.
Causes of ACUTE renal failure(ARF) 3 H's Hypotension Hypovolemia Hypoprofusion
3 phases of ARF Oliguric phase Diuretic phase Recovery phase
what is MAP? Mean Arterial Pressure; how much oxygen carrying blood your kidneys are getting.
BUN and Creatinine BUN and creatinine are the primary tests used to check how well the kidneys are able to filter waste products from your blood
Question: What is the limit of irrigation volume that can safely be instilled into a nephrostomy tube? 5 ml
Transurethral incision of the prostate(TUIP) in which incisions are made in the prostate that cause it to press less on the urethra
Laser therapies in which a laser is used to make incisions in or remove a portion of the prostate
Transurethral microwave therapy(TUMT) in which microwave energy is used to destroy a portion of the prostate through heating
Transurethral needle ablation(TUNA) in which a heated needle is used to destroy a portion of the prostate.
Transurethral resection of the prostate(TURP) is the surgery for benign prostatic hyperplasia that has been studied the most. It is the surgery that is used the most to treat symptoms of BPH. All other surgeries are compared to TURP
Hydronephrosis Unilateral hydronephrosis is swelling of one kidney due to a backup of urine.
Treatment of hydonephrosis Treatment depends on the cause of the kidney swelling. Treatment may include; •A ureteral stent •A nephrostomy tube (allows the blocked urine to drain out of the body into a drainage bag) •Antibiotics for infections
Stress Incontinence Stress incontinence may happen when there is an increase in abdominal pressure -- such as when you exercise, laugh, sneeze, or cough
Urge incontinence is often referred to as overactive bladder: You have an urgent need to go to the bathroom and may not get there in time, leaking urine
You may have ______ ________ if you are not able to empty your bladder appropriately overflow incontinence
With _______ ________, physical problems such as arthritis, or cognitive problems such as dementia, prevent you from getting to the bathroom in time. functional incontinence
two main types of dialysis hemodialysis and peritoneal dialysis
water and blood filtration in nephron bowmans capsule
what is an IVP test structure and function of the urinary tract
side effects for thiazide diuretics hypergylcemia
medication for Post Op urinary retention neostigmine(prostigin)
cystitis inflammation of bladder wall
robinson catheter is used An intermittent catheter/Robinson catheter is a flexible catheter used for short term drainage of urine. Unlike the Foley catheter, it has no balloon on its tip and therefore cannot stay in place unaided.
diagnosticcally which findings indicate pyelonephritis UA+ pyuria
Thrill of an AV fistula Outflow assessment, pulsation of the fistula when felt with 3-4 fingers
Bruit of an AV Fistula is the sound or the murmur heard over the • Normal bruit fistula
Changes and Effects on the urinary system in the Elderly include. •Overall amount of kidney tissue decreases. •Number of filtering units (nephrons) decreases. Nephrons filter waste material from the blood. •Blood vessels supplying the kidneys can become hardened. This causes the kidneys to filter blood more slowly.
Urinary Tract Infections in the Elderly Elderly people are more vulnerable to UTIs for many reasons, overall susceptibility to all infections due to the suppressed immune system that comes with age. UTIs can lead to acute or chronic kidney infections, permanently damage or kidney failure.
Indwelling Catheters (Urethral or Suprapubic Catheters) An indwelling catheter is a catheter that is left in the bladder,suprapubic catheter; urinary catheter through abdominal wall.
External Catheters (Condom Catheters) A condom catheter is a catheter that is placed outside the body. They are typically used for men who do not have urinary retention problems, but have serious functional or mental disabilities, such as dementia.
IV Pyelogram purpose structure and function of urinary tract
Osmitrol (mannitol) osmotic diuretics
Calcium sparing diuretic Aldactone (spironolactone)
Created by: charlie1010