| Question | Answer |
| Blood filtered by a semi-permeable
membrane in the glomerulus | Glomerular filtration |
| Amount of blood filtered by glomeruli in a minute
is about 120-125 mL per minute | Normal GFR |
| Most accurate indicator of renal function | GFR |
| Most accurate method of GFR estimate
and is based on 24 hr urine collection and blood creatinine | Creatinine Clearance |
| Hormone that maintains Water balance and causes reabsorption of water (makes distal tubules /collecting ducts permeable to water) | ADH |
| causes reabsorption of Na+ and water; K+ excretion in distal tubules
secretion affected by circulating blood volume & plasma K+/Na+ | Aldosterone |
| Secreted by cells in right atrium in response to atrial distention due to increase in plasma volume. | Atrial natriuretic peptide (ANP) |
| Clears blood plasma of unnecessary substances | Nephrons |
| Acts on kidneys to increase Na+ excretion; Inhibits renin, ADH, and action of angiotensin II on adrenal glands, thus suppressing aldosterone large volume of dilute urine results. | ANP |
| Released in response to low serum calcium levels
Maintains serum Ca²+ by causing increased tubular reabsorption of Ca²+ ions and decreased tubular absorption of phosphate ions | Parathormone or Parathyroid hormone (PTH) |
| Erythropoetin and Vit D | Renal Hormones |
| Stimulates bone marrow to produce red blood cells | Erythropoetin |
| Propel urine by peristaltic one way flow | Ureters |
| Reservoir for urine | Bladder |
| Average volume of urine that causes bladder distention and the urge to urinate | 200-250 mL |
| Normal urinary output for an adult | 1500mL/day |
| Residual bladder volume | 50 ml |
| Tube that serves as a conduit for urine from the bladder neck to outside of the body through the urinary meatus during voiding | Urethra |
| The aging nephron decreases as a unit:
↓GFR (glomerulus function)
↓ability to conserve urine (tubular function) T or F | True |
| Some medications affect ability of bladder or sphincter to contract or relax normally (antidepressants, calcium channel blockers, antihistamines, neurologic and musculoskeletal disorder meds). T or F | True |
| Anticoagulants cause hematuria. True or False | True |
| Nephrotoxic antibiotic | gentamicin |
| Change the color of unrine | Pyridium and Macrodantin |
| Specific nephrotoxic drugs, i.e. garamycin; OTC preparations (NSAIDS) | Meds that can impair kidney function |
| Areas of residence in U.S.- Great Lakes, Southwest, Southeast with higher risk factors | stone belt area |
| 1-2 inches | Female urethra |
| 8-10 inches | Male urethra |
| exposure to industrial chemicals such as carbon tetrachloride, phenol, ethylene glycol, smoking | Environmental factors |
| Consider : Loss of elasticity & muscle tone of the bladder
Weakening of the urinary sphincter
Decreased bladder capacity
Prostatic enlargement and loss of _____________ mass with aging | Renal Mass |
| Blood/urine tests includes: Creatinine, Creatinine Clearance
BUN, GFR, Residual urine and 2 other tests | Urinalysis (UA) & Urine Culture and Sensitivity |
| Portable ultrasonic bladder scan
IVP
Renal ultrasound
Renal biopsy | Radiology/Imaging studies |
| Can show the size, shape, and position of the urinary tract, and it can evaluate the collecting system inside the kidneys | IVP |
| An X-ray test that provides pictures of the kidneys, the bladder, the ureters, and the urethra (urinary tract ) | IVP |
| A test used to check how well the kidneys are working | Glomerular filtration rate |
| Symphysis pubis is a Landmark for Physical Assessment of the Urinary System; what is another? | Costovertebral angle tenderness (+) |
| Hard rock-like deposits formed
in urinary tract -also known as calculi | Kidney stones |
| Stone formation | Lithiasis |
| Dietary issues that may increase incidence of stones:
Excessive intake of certain proteins & amino acids
Excessive intake of certain vegetables, fruits and tea
Excessive intake of calcium (controversial)
Low fluid intake | EEELs |
| form in kidney
-urinary tract in general: Urolithiasis | Nephro-lithiasis |
| Most common cause of upper urinary tract obstruction | Urinary calculi |
| Incidence and Risk Factors occur regionally, highest incidence in southern and Midwestern states (stone belt). True or False | True |
| Abnormalities that result in increased urine levels of calcium, oxalate, and uric acid are Metabolic Problems for stones. T or F | True |
| Males > Females and Blacks < Caucasians | True |
| ■ dehydration
■ immobility/calcium loss from bone
■ excess calcium, oxalate, protein intake
■ gout, hyperparathyroidism,
■ urinary stasis/recurrent UTIs | Predisposing Factors to stones |
| Formation of stones occurs with:
Nucleation
Lack of inhibitory substances
Super-saturation (…such as in dehydration) | NuLS |
| Calculus formation affected by:
Acidity or alkalinity of urine
presence/absence of inhibiting compounds T or F | True |
| An endocrine disorder characterized by high levels of calcium in the blood and excessive calcium excretion in the urine | Hyperparathyroidism |
| The most common stones | Calcium stones |
| calcium oxalate
calcium phosphate
struvite
uric acid
cystine | 5 types of stones |
| Relieve pain
Treat infection or obstruction
Eliminate the stone
Determine cause of stone formation
Prevent recurrence | Medical goals |
| urinary concentration of uric acid
Strong association with gout
Thrives in an acidic environment
Seen mostly in men | Uric acid stones |
| Obstruction -->Hydronephrosis -->Acute Renal Failure | Complications |
| Genetic autosomal recessive defect
Rare
Thrives in a acidic environment | Cystine Stones |
| Diagnosis includes UA
Urine test for: calcium, uric acid, oxalate, urates, phosphates
KUB, Renal Ultrasound
IVP & Retrograde Pyelogram
Labs, Renal function &Urine Culture | Renal Calculi Diagnosis |
| Stones formed from accumulation of magnesium-ammonium-phosphate agents
Common in women
Likes an alkaline environment | Struvite |
| Mostly associated with UTIs
Urease -producing bacteria: (Proteus Mirabilis, Klebsiella, Pseudomonas, species of staphylococci)
Make urine alkaline
appearance: staghorn | Struvite |
| dull, achy flank pain or silent | Kidney stone |
| Cause SEVERE PAIN due to obstruction; f/chills & hematuria | Ureteral stones |
| Percentage (%) that pass on their own | 90% |
| Force fluids (2-3 liters/day)
Encourage ambulation or frequent changes in position
Strain all urine
Analgesics for pain
Antibiotics if infection present
Watchful waiting | Treatment |
| Nephrolithotomy
Pyelolithotomy
Ureterolithotomy
Cystotomy
**Stents or drainage tubes may be placed | Surgical incision |
| Size of stones unlikely to pass the ureters | >4mm |
| Vital signs
Strict I&O
Force fluids IV/PO
Strain all urine
Monitor pain level
May have minimal bruising over shock site
Ureteral stent may be left in place | Lithotripsy Post Care |
| Percutaneous nephrolithotomy (laser/ultrasound)
Incisional lithotomy
Cystoscope/ureteroscope- laser/extraction | PIC - invasive treatment |
| blood in the urine
bruising on back or abdomen
bleeding around organs
discomfort as stone fragments pass through urinary tract
if stone doesn't shatter completely, a second round of ESWL or ureteroscopic stone removal may be needed. | ESWL Complications |
| Non-invasive:/external shock waves
Stents may be placed before or after lithotripsy
No incision, less pain | extracorporeal shock-wave lithotripsy (ESWL) |
| Use of sound waves to crush stones | Lithotripsy |
| NPO determine that consent obtained anesthesia – conscious procedural sedation ECG no anti-coagulants | ESWL - Pre-Procedure Nursing responsibilities |
| Monitor vital signs closely for s/sx of shock due to bleeding
Assess incision site
Strict I&O
Some hematuria during post-op expected
Force fluids | Urinary Calculi
Surgical Treatment Post Care |
| Once stones retrieved or passed - prevention is the focus
Force fluids 2-3 liters/day
Water, cranberry juice
Once composition of stone is known - further education may be necessary to alter the pH of the urine thus reducing instances of recurrence | Urinary Calculi- Patient Education |
| Encourage patient to finish all antibiotics given for UTIs
Force fluids
Acidify urine with foods that increase acidity (prunes, cranberries, asparagus, tomatoes, corn) | Struvite stones (Pt. Ed) |
| May be needed if urine can no longer pass from the kidneys through the bladder and out the urethra | urostomy tube |
| Reduce foods high in oxalate
Force fluids
Thiazide diuretics (Hctz)
Phosphates to prevent GI absorption | Patient Education Calcium oxalate stones |
| Predisposing factor: Hyperparathyroidism
Treat the underlying cause and the presence of other stones
Low sodium diet | Patient Education Calcium phosphate stones |
| Reduction of food high in purines such as small bone fishes, organ meats, sweet breads
May require K citrate to make urine more alkaline
Allopurinol given to reduce uric acid | Uric acid stones (Pt Ed) |
| Indicated when bladder removed d/t cancer, neurogenic bladder, obstruction,(calculi, tumor, stricture), urinary retention, etc. | Urinary diversion |
| All diversions ‘divert’ urine away from bladder/kidney with use of tubes or similar devices. True or False | True |
| Required when bladder requires removal or
for long term chronic conditions; (stoma formed from ileum) | Ileal Conduit |
| Continent ileal urinary reservoir | Indiana/Koch pouch |
| Post op - assess for bleeding at the site, Assure unobstructed drainage. If dislodged, CALL M.D. IMMEDIATELY
NEVER CLAMP – why????
may have order to irrigate
accurate I&O, If right or left--record each tube output separately
keep urine acidic | Nursing Care r/t stents/tubes |
| required when bladder requires removal or
for long term chronic conditions | Neobladder |
| Assessment: assess frequently, assess stoma, slight bleeding OK,access stoma - not sensitive, surrounding skin – why?? ;assess urine by stoma/tube NOT bag, foul smell? concentrated?
avoid asparagus, cheese, eggs; mucous in urine, on stoma | Care of stoma and ileal conduit |
| Pink--red--dark purple--dusky--cyanosis--want it
moist and red | Care of stoma and ileal conduit |
| Interventions ileal conduit:
increase fluid intake
urine pH < 6.5 because of alkaline encrustation, skin irritation
Appliance – Ostomy Care/Patient Education similar to colostomy/ileostomy | Nursing care of ileal conduit |
| 1-2 pc appliances; empty 1/3 to 1/2 full; watch for leakage; don’t ‘patch’ with tape, change appliance in AM; Use gauze/tampon to contain/absorb urine when cleaning; use soap and water; ensure skin dry; use skin prep/protectant; use foley bag at night | Ostomy Care/Patient Education |
| Kock or Indiana Pouch; a continent ileal conduit urinary reservoir
ascending colon/part of ileum made into ‘bladder’ reservoir exits thru abd. wall to make a stoma with a valve present
(ureters implanted into ”new bladder” ) | Continent Urinary Diversion |
| catheter inserted into ‘valve’ to drain reservoir at intervals
no appliance needed—could catheterize at night | Continent Urinary Diversion |
| Altered Urinary Elimination (risks?)
Potential for Sexual Dysfunction; Ineffective Coping
Risk for Ineffective Management of Therapeutic Regime
Knowledge Deficit;High Risk for Altered Skin Integrity & High Risk for Body Image Disturbance | Urinary Diversion Nursing Diagnoses |
