urinary
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| 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
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| 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
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| 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
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| 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
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| 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
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| complications of cystoscopy | urine retention, urinary tract hemorrhage, bladder infection, perforation of bladder
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| 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
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| 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
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| glomerulus | afferent arteriole divides into a capillary network, the glomerulus which is a tuft of up to 50 capillaries
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| 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.
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| complications of IVP | severe renal function
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| 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,
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| nephron | the functional unit of the kidney. Each kidney contains approx. 1 million nephrons.
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| where are the glomerulus, Bowman's capsule, proximal tubule and distal tubule located? | cortex of kidney
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| where are the loop of Henle and collecting tubules located? | medulla
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| 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
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| 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
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| Bowman's capsule | filtrate passes through to tubule
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| tubule | proximal convoluted tubule, loop of Henle, distal convoluted tubule, collecting tubule
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| physiology | elimination of waste products, flds & electrolytes balance regulator, production of bld cells, hormonal control of BP
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| ureters | anatomy- hollow tubes, about 12 inches long
physiology- propel urine to bladder from kidneys
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| urine | color-yellow, consistency-clear, specific gravity- 1,000-2,000ml, BUN 7-18, creatinine- 0.7-1.4
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| 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
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| enuresis | lack of nighttime bladder control in school-aged child
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| s/s of enuresis | voiding @ frequent intervals in small amts, suprapubic discomfort & bladder distention, appropriate hydration, specific gravity is elevated
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| causes of enuresis | neurogenic bladder, stricture, calculi, trauma, Predisposing factors: bedrest, tremors, prostatic hypertrophy, decreased bladder tone, calculi, meds (nephrotoxicity)
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| complications of enuresis | rupture of bladder, infection, uremia
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| nursing care | stimulate voiding, pouring tepid water over perineum, positioning, catheterization, surgical: suprapubic cystostomy, surgery for kidney stones
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| 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
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| catheter irrigation | to prevent obstruction of flow, use sterile technique, monitor I&O, monitor for s/s of infection,
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| incontinence | involuntary loss of bladder control due to infection, neurogenic bladder, sphincter weakness or reduced muscle tone.
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| 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,
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| Interventions for incontinence | scheduling, bladder retraining, pelvic exercises, surgery, condom catheters, incontinence pads, avoid delay in assisting patient to bathroom
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| ureterosigmoidostomy | ureters are attached to the sigmoid colon to allow drainage into rectum & eliminate ion control by anus, not as commonly used
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| cutaneous ureterostomy | one or both ureters are brought to the skin surface to form a stoma to drain urine
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| 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
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| cystitis | inflammation of the bladder, may be infectious (bacteria, virus, fungal) or noninfectious (irritation)
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| s/s of cystitis | urgency, frequency, burning during urination, cloudy, foul smelling urine, Predisposing factors: female is more prone, catheterization, instrumentation, hospital acquired infection
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| 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
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| pyelonephritis | inflammation of the kidney, s/s: chills, fever, generalized malaise,urinary frequency, dysuria, flank pain, costovertebral angle tenderness
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| nsg management for pyelonephritis | sterile urine culture, usually caused by. E. coli, bld tests, bedrest during acute phase, antibiotic therapy, antiseptic, analgesics,
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| renal & urethral stones | mineral crystallization formed around organic matter, urolithiasis- urinary stones, nephrolithiasis- kidney stones
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| 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)
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| 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
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