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Genitourinary #1
| Question | Answer |
|---|---|
| What are the functions of the kidney? | Form urine, balance solute and water transport, excrete metabolic waste products, conserve nutrients, regulate acid-base balance, secrete hormones that regulate BP/erythrocyte production/calcium metabolism |
| List the processes of urine formation (there's 3). | Glomerular filtration, tubular reabsorption, tubular secretion |
| What is glomerular filtration rate (GFR)? | Amount of fluid filtered from the blood per minute. Normal range is 120-125 mL/min (adults). |
| Describe tubular reabsorption. | Tubules regulate rate and degree of water and ion reabsorption according to hormonal signals |
| Describe tubular secretion. | Basically the reverse of reabsorption. Substances move from the blood into the tubules to be filtrated. |
| What happens when tubular secretion is not as effective? | Substances (like ammonia) are not filtrated out of the blood resulting in toxicity. |
| How is solute balance and water transport regulated? | ADH (Anti-diuretic hormone) secretion causes pores of collecting tubules to enlarge -> water in interstitial spaces then reabsorbed and urine is concentrated. |
| What waste products increase when kidneys are not functioning? | Urea, uric acid, creatinine, ammonia, potassium, phosphate |
| What waste products decrease when kidneys are not functioning? | Sodium (due to diluted urine) and calcium (inverse of phosphate) |
| What are the functions of renal hormones? | Activate vit D (allows absorption of calcium and phosphate) and secrete erythropoietin (stimulates bone marrow to produce RBCs) |
| List the types of nephrotoxic medications (there's 6). | NSAIDs, antibiotics (aminoglycosides, sulfonamides), chemotherapy/immunosuppressants, heavy metals, antihyperlipidemics ("statins"), street drugs |
| What can cause incontinence? | Low fluid intake, fecal impaction, UTI, CNS depressants, calcium channel blockers, tumors |
| Describe stress incontinence and treatments. | Loss of urine with increased abdominal pressure (ex. coughing). Tx = kegels, wt loss, estrogen, anticholinergics/antispasmodics, surgery, estrogen, electrical stimulation |
| Describe urge incontinence and treatments. | Strong desire to void with large loss of urine. Tx = anticholinergics, tricyclic antidepressants, bladder training |
| Describe overflow incontinence and treatments. | No urge to void-usually caused by spinal cord lesions. Tx = surgery, urecholine, bladder compression, intermittent self-catherization (most common). |
| Describe functional incontinence and treatments. | Leakage in socially unacceptable circumstances. Tx = applied devices (caths, diapers), environmental alterations (raise toilet seat), surgery, bladder training, kegels |
| What is benign prostatic hypertrophy (BPH)? | Enlargement of the prostate gland that causes bladder outlet obstruction. |
| List s/s of BPH. | Difficulty in starting (hesitancy) and continuing urination, reduced force, incomplete bladder evacuation, dribbling, nocturia |
| List diagnostic tests for BPH. | Prostate gland exam and blood studies (increased BUN, creatinine, and WBC [if infection], may have increased PSA) |
| What medications treat BPH? | 5-alpha reductase inhibitor (5-ARI), alpha-blocking agents, and herbs or foods (saw palmetto or tomato for lycopene) |
| What surgery corrects BPH? | Transurethral resection of the prostate (TURP). Criteria = chronic UTIs, hematuria, hydronephrosis, and acute urinary retention. |
| Describe post-op care for BPH sx. | Monitor for s/s infection, hemorrhage, and pain. If obstruction, turn off irrigation and irrigate catheter with 30-50 mL of NS with lg piston syringe. Increase fluid intake to 2-2.5 L/d |
| What causes urolithiasis? | Caused by calcium phosphate, calcium oxalate, struvite, and cystine/uric acid. Either by diet or tumors, gout, or hyperparathyroidim. |
| What are the s/s of kidney stones? | PAIN! N/V, diaphoresis, pallor, oliguria or anuria. |
| List meds to relieve pain from kidney stones. | Morphine (preferred) or other opiod analgesic, NSAIDs, antispasmodics, antiemetics |
| What is percutaneous nephrolithotripsy? | Key hole surgery that uses energy to break up calculi. NPO 4 hrs before and no anticoagulant meds at least 1 wk before. |
| What should be included in discharge teaching after percutaneous nephrolithotripsy? | Strain urine so composition of stone can be identified and prevented, no driving for 1-2 wks, no tub baths, follow-up appt in 1-4 wks, return to work in 4d-6 wks. If stent placed-critical to have it removed. |
| What are important interventions to remember for a percutaneous nephrostomy tube? | Do not clamp-look for kinks, secure tubing to skin, keep drainage bag below kidney, keep site and surrounding skin clean and dry, irrigate regularly. |
| What are important interventions to remember for a lithotripsy? | Uses multiple shock waves without damaging surrounding tissue, synchronize shock waves with EKG,admin antibiotics for 2 wks, and insert stent with nephrostomy tube |
| What are contraindications for a lithotripsy? | Exaggerated spinal curves, calcium deposits in the ureters, stone that cannot be seen by contrast,or a very large stone over 1 1/4" |
| What are normal post-op findings after a lithotripsy? | Bruising, colicky pain (stone not removed), and bright red or tea-colored urine |
| List other treatments for stones. | Increase fluid to 3 L/d, drink water at bedtime, avoid excessive sweating/dehydration, treat UTIs promptly, and diet restrictions (depends on composition) |
| Name which medications treat each type of stone. | Thiazide diuretics for hypercalciuria. Allopurinal for hyperoxaluria and gout. AMPG and Captopril for cystinuria. |
| What is polycystic kidney disease? | Inherited disorder in which grape-like cysts form within the nephrons. S/s can appear at 30 y/o |
| What are the s/s of polycystic kidney disease? | Steady dull or colicky abd/flank pain, proteinuria, hematuria, HTN, and increased abd girth. |
| What are the potential complications of polycystic kidney disease? | HTN, ineffective breathing pattern, or renal failure |
| Describe management of polycystic kidney disease. | Limit protein intake (only high biologic value protein) to lower uremia, restrict sodium according to OP, restrict fluid, limit phosphorus, and admin antihypertensives/diuretics/analgesics. |
| What should you teach a pt with polycystic kidney disease? | Avoid tight clothing around waist, no contact sports, how to take BP, and advise to have genetic counseling as each child has a 50% chance of having gene |
| What are the s/s of acute post-streptococcal glomerulonephritis? | Onset of 5-21 d after strep infection (throat, tonsils, or skin), generalized edema, HTN, oliguria, hematuria. RARELY leads to renal failure! |
| What are the s/s of chronic glomerulonephritis? | Onset of 20-30 yrs with unknown cause, mild proteinuria/hematuria, HTN, occasional edema, and fatigue. ALWAYS leads to renal failure! |
| Which labs increase or decrease in chronic glomerulonephritis? | Increase: BUN, creatinine, potassium, phosphorus. Decrease: GFR, Na (may also be normal), calcium, pH (acidosis) |
| What is nephrotic syndrome? | Condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine to be excreted. |
| What are the s/s of nephrotic syndrome? | Severe proteinuria, edema, HTN, low albumin, high serum lipid levels. |
| Describe tx of nephrotic syndrome. | Steroids and/or immunosuppressive meds if immunological cause. ACE inhibitors for proteinuria, cholesterol-lowering meds for hyperlipidemia, diuretics/Na restriction for edema and HTN. Protein restriction based on GFR |
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