Study for Renal exam
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| What makes up the upper urinary tract? | The kidneys, renal pelvis, and ureters
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| What makes up the lower urinary tract? | (lower= "urethrovesical unit," made up of the bladder, urethra, and pelvic floor muscles
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| Where is the urinary tract located? | Level of 12th thoracic - 3rd lumbar vertebrae
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| fibrous capsule | A capsule of fibrous cells or tissue, as that surrounding the kidney and thyroid.
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| retro-peritoneal | is the anatomical space in the abdominal cavity behind (retro) the peritoneum.
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| How do kidneys receive their bld supply? | kidneys receive their bld supply of 1.25 L/min (25% of the cardiac output) from the renal arteries which are fed by the abd aorta. Important because kidneys' main role is to filter water soluble waste products from the bld.
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| What is the inner structure of the kidney called? | the perenchyma; which has the cortex (which contains nephrons: clayces (pyramids), and pelvis), and the medulla
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| What makes up the nephron? | The glomerulus, bowman's capsule, afferent and efferent arteriole, proximal and distal convoluted tubules, loop of henle, and collecting tubule
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| In the urethrovesical unit, what does the bladder do? | Is hollow and muscular; holds 300-500 ml; the urethra has a bladder neck (meatus), in a male it is 24 cm, in a female it is 4 cm; the pelvic floor contains muscles that form a sling to support internal organs.
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| What are the 3 steps in urine formation? | Glomular filtration, tubular reabsorption, and tubular secretion
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| What happens during the glomerular filtration step of urine formation? | Plasma is filtered; H2O Na, Cl, HCO3, K, glucose, urea, creatinine, uric acid
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| what happens during the tubular reabsorption step in urine formation? | filtrate enters Bowman's capsule, flows through tubules (reabsorbed or excreted in urine)
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| What happens during the tubular secretion step of urine formation? | urine drains through ureters into the bladder
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| When amino acids, glucose, and proteins are reabsorbed; if you find transient proteinuria is it okay? | yes
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| When amino acids, glucose, and proteins are reabsorbed; if you find persistent proteinuria is it okay? | No, it indicates glomerular damage
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| What might glucosuria indicate? | diabetes
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| what do peristaltic waves help with? | urine flow to the bladder
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| Why would reflux occur? | r/t overdistended bladder
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| When does the sensation of fullness (in the bladder) begin? | at about 150 mL
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| How do you know if someone has kidney stones? | Often present with severe flank pain
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| What is a function of the kidney? | Regulation of acid-base balance
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| What does a cystoscopy examine? | Gives visual examination of inner bladder using cyctoscope using a lighted tube with a lens
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| What does creatinine result from? | The breakdown of phosphocreatine from muscle tissue (increased r/t renal failure, muscle necrosis)
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| Normal range for BUN? | 7-18 mg/dL
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| Normal range for creatinine for males? | 0.7-1.3 mg/dL
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| Normal range for creatinine for females? | 0.6-1.1 mg/dL
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| Pharmacologic considerations for nephrotoxicity? | aminoglycosides (gentamicin)
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| With pyleonephritis, what is the pathophysiology and etiology? | 85% E. Coli, ascends from urethra and bladder
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| What are S&S of pyleonephritis? | flank pain, chills, fever, malaise, urinary freq and burning
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| What kind of diuretics are more effective for someone with impaired renal function? | Thiazide diuretics are more effective in patients with NORMAL kidney function, loop diuretics are more effective in patients with IMPAIRED kidney function.
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| What is hemodialysis? | heparinized bld removed from pt pumped thru dialyzer and returned, waste and water move into dialysate, 4-6 hrs three times per week
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| What is peritoneal dialysis? | dialysate instilled into abd cavity per special catheter, dwells for a specified time, then is drained
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| What precautions would a nurse take for a pt that had hemodialysis? | no venipunctures, BP, or injections on affected arm
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| Pt education for pt who had hemodialysis? | avoid carrying heavy items, loose sleeves, do not sleep on affected arm, rprt impaired bld flow to access device immediately (no thrill or bruit) (thrill-feel vibration when you put your hand over it/ bruit- can hear bld flw w/stethescope
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| Where is the access for hemodialysis/peritoneal dialysis? | hemodialysis is vascular access, peritoneal uses the peritoneum
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| What are the objectives for renal failure? | reduce nitrogen level, HTN, edema. Prevent catabolism, complications
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| What are dietary interventions for renal failure? | protein 0.6-0.8 g/Kg/day from animal sources; Dec K and Na; limit phosphorus (dairy, dried beans, soft drinks)
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| What does increased renin cause? | HTN
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| What does decreased calcitriol (vit. D) cause? | demineralization of bone
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| What does decreased erythropoietin cause? | anemia (admin epoetin alfa-Epogen, Procrit)
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| Why would doses need to be reduced if a patient is in renal failure? | impaired renal function means impaired elimination of drugs
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| Just before dialysis, should you administer meds? | NO
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| What is urine osmolality? | reflects the ability of the kidney to concentrate and dilute urine
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| What is the effect of urine osmolality on a ct with kidney disease? | do not concentrate urine effectively= decreased urine osmolality
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| What does urine sp gr measure? | kidney's ability to concentrate and excrete urine
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| What is urine sp gr compared to? | compares density of urine to distilled water (1ml of distilled water weighs 1 g)
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| If someone is dehydrated, what would we find r/t urine sp gr? | high sp gr (concentrated urine, dark color)
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| If someone is overhydrated, what would we find r/t urine sp gr? | low sp gr (dilute, light color)
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| If someone has renal dx, what would we find r/t urine sp gr? | nearly constant sp gr r/t inability of kidney to respond to ADH and other regulators
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| With a 24 hour urine collection, what is the procedure? | discard first voiding (this is start time), collect ALL urine for 24 hours, have pt void exactly 24 hours after first void
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| What does protein in the urine identify? | salt depletion, glomerulonephritis, trauma, heavy exercise, cancer, CHF, fever. DO NOT WANT PROTEIN IN THE URINE
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| What does creatinine clearance test measure? | measures kidney function and creatinine excretion
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| How can dietary intake affect urine? | acid ash or basic ash diet, alters urine pH, less effective than meds, Meat, fish, poultry, eggs, grains, corn, lentils, cranberries, prunes, plums
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| What can the atkins diet lead to? | high protein/ low carb diets can lead to ketonuria
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| What can megadoses of Vit C interfere with? | may interfere with tests for glycosuria and guiac
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| Nx considerations r/t weak diuretics? | caffeine, asparagus (gives urine a bad odor)
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| What drugs can affect urine pH? | thiazide diuretics (alkaline)
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| What affect can diuretic therapy cause? | increased Na, Cl, Mg per 24 hour urine
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| What would you find with urine analysis of pyleonephritis? | pyuria (bacteria + WBC's); casts, RBC's, proteinuria
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| What is an example of an antispasmodic drug? | oxybutynin (Ditropan)
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| What is an example of an anticholinergic drug? | propantheline (Pro-Banthine)
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| What are S&S of acute glomerulonephritis? | inflammatory, but NON-infectious. Most often in children, more male than female. Most recover with minimal therapy. 2-3 wk after infection-> antigen antibody complex (URI w/group A beta-hemolytic strep, Impetigo, Mumps, Hep B, HIV)
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| What are diagnostic findings for acute glomerulonephritis? | Hematuria and proteinuria (dark, bloody appearance); Dec HgB, Inc BUN, Creat, ESR, anti-streptolysin O titer; renal insuff (inc serum K, Mg and Dec serum Na, Ca); Percut renal biopsy-> cellular dmg
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| What is the medical mngmnt for acute glomerulonephritis? | No specific treatment, symptomatic only. Bed rest, Low Na and protein diet, ABX, Vit w/Fe, Steroids, Anti HTN meds. When urine is free of protein for 1 month, may resume normal activity.
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| What is the pathophysiology and etiology of chronic glomerulonephritis? | slowly progressive chronic inflamm dmgs glomeruli/ nephrons -> renal failure; accts for 40% of pts on dialysis; often assoc w/ autoimmune connective tissue disorders- Goodpasture's syndrome, lupus
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| S/S for Chronic Glomerulonephritis? | may be none until severe dmg, fatigue, HA, HTN, dyspnea, visual disturbance
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| What is anasarca r/t chronic glomerulonephritis? | severe generalized edema r/t loss of protein via dmgd nephrons
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| Diagnostic findings for chronic glomerulonephritis? | Dec RBC r/t hematuria, dec hemopoetin; Azotemia-inc BUN, Creat, uric acid, albuminuria, casts from accum of N waste products in bld; eval heart w/CXR, ECG; percutaneous kidney biopsy to diagnose early and determine severity
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| Medical management for chronic glomerulonephritis? | cntrl HTN, correct fld/lyte imbalance, reduce edema w/ diuretics, prevent CHF, prevent UTI's, dialysis, transplant
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| Expected outcomes for chronic glomerulonephritis treatment? | UO greater than 650 mL/day; systolic BP less than 132, normal bilateral breath and heart sounds, understanding of diet, eval of support system
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| Ct education for chronic glomerulonephritis? | diet and fld regimen, take meds as prescribed, daily wt and TPR, rest periods, contact phys if worsening, fever, chills, bld in urine, wt gain, swelling of legs, arms or periorbital
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| Polycystic disease | congenital or hereditary (autosomal dominant- 1 gene from 1 parent, 50/50 chance of inheritance
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| Patho/etiology for polycystic disease? | form of mult bilat kdny cysts, impaird fx->eventual renal fail; inc size of kdny -> comp of renal vssls-> HTN; inc rsk of infections and stones; pain r/t bldng into cysts; cycsts on pancreas & liver, enlrged heart, mitral valve prolapse, Brain aneurysm
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| assessment findings for polycystic disease? | 75% HTN, colic- acute, severe spasmotic pain, hematuria r/t UTI and stones; commonly experience renal stones
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| diagnostic findings for polycystic disease? | family hx, proteinuria, hematuria, pyuria; inc RBC and Hct r/t inc erythropoietin; BUN and Creat - current renal fx, imagining reveals cysts
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| med/surgical mngmnt for polycystic disease? | no cure, goal is to slow progression; HTN diff to cntrl, treat UTI promptly; Low RBC r/t hematuria - Fe, erythropoietin, transfusion; Avoid nephrotoxic meds (NSAIDS, cephalosporins); diet mods to prevent stones, dialysis & surgical removal of kidneys
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| What is urolithiasis? | a stone anywhere in the urinary tract, all contain calcium, may be smooth or jagged
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| What is nephrolithiasis? | stone in the kidney
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| What is a ureterolithiasis? | stone in the ureter
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| diagnostic findings for kidney and ureteral stones? | hematuria, inc sp gr, minerals, casts; WBC r/t UTI -> urine culture
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| When would you do vigorous hydration r/t stones? | (pass naturally), if stone is small and pain is tolerable; analgesics, antimicrobials, drugs that dissolve calculi
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| When would you do extracorporeal shock wave lithotripsy? | (shatters stone), light anesthesia, water bath or cushions
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| How is laser lithotripsy done? | (pulverizes stones); per cysto laser wire is passed into ureter
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| medical mngmnt for stones? | ureteroscopic- scope is inserted per urethra into ureter to grasp and remove stone/ ureteral stent left in for 3 days to maintain patency of ureter; cath may also be left in place
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| What would you expect with extracorporeal shock wave lithotripsy (ESWL)? | grossly bloody urine/ ecchymosis on flank, relieve pain post procedure
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| What would you expect with cystoscopy? | pink urine, encourage 3000 mL/ day of flds
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| What happens with a percutaneous nephrolithotomy? | endoscopic procedure, general anesth, ultrasound crushes stone and fragments are removed
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