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Nursing 314: Assessing and Promoting Wellness > Exam 3: Urinary system assessment > Flashcards

Exam 3: Urinary system assessment Flashcards

(116 cards)

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1
Q

Key anatomical components of renal system

A 
Kidneys 
Ureters 
Bladder 
Sphincters 
Urethra
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2
Q

Primary function of renal system is to

A

maintain homeostasis by controlling the composition and volume of extracellular fluid

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3
Q

___% of cardiac output circulates through the kidneys

A

25%q

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4
Q

Formation of urine requires 3 steps:

A

Glomerular filtration
tubular reabsorption
tubular secretion

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5
Q

Filtration

A

Pressure forces liquids and dissolved substances through anatomical filtration –> filtrate created

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6
Q

Glomerular filtration rate (GFR):

A

Amount of filtrate formed/minute

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7
Q

GFR is directly relates to

A

Renal perfusion

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8
Q

Low bp/low volume =

A

low perfusion

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9
Q

High bp/high volume =

A

Increased perfusion

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10
Q

Impaired circulation =

A

low perfusion

~125 mL/min

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11
Q

Urine output at least

A

30 mL/hr

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12
Q

Urine output calculation

A

0.5-1.5ml/kg/hr

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13
Q

Bladder smooth muscle is supplied by

A

many parasympathetic fibers

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14
Q

The internal urethral sphincter is also

A

Smooth muscle

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15
Q

Internal urethral sphincter is under ____ control

A

Parasympathetic control

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16
Q

The external urethral sphincter is

A

composed of skeletal muscle

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17
Q

External urethral sphincter is under ____ control

A

Voluntary

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18
Q

External urethral sphincter can be tightened to

A

prevent urination even when the bladder is contracting and the internal sphincter is open

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19
Q

When relaxed and filled, both sphincters are

A

Closed to keep urine from dribbling out

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20
Q

Motor neuron inhibits external sphincter:

A

Relaxes and opens

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21
Q

Under voluntary control, impulses from cerebral cortex override

A

the reflex input from stretch receptors

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22
Q

Adults bladder capacity

A

600 mL

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23
Q

Adult urge to urinate is at

A

250 mL

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24
Q

Why are women more at risk for UTIs

A

because women have a 2 inch urethra while men have an 8 in

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25
Children bladder capacity
50-60 ml
26
Pregnant women experienced increased frequency of urination due to
- Increased GFR secondary to increased blood volume | - Pressure of gravid (pregnant) uterus on bladder
27
Older male adults experience
Prostate enlargement which causes urination frequency and retention
28
How does menopause impact urination
frequency, nocturne, loss bladder tone, retention, residual urine--> increase UTI
29
By age 80, ____ of glomeruli are not function
40% of glomeruli
30
Th darker the urine, the more
concentrated
31
I & O
Intake/output
32
UA
urinalysis
33
What is in urinalysis
Albumin creatinine ratio | urine specific gravity
34
Urine specific gravity range
1.010 - 1.025 WNL
35
Urine specific gravity measures
Concentration/density
36
High number of urine specific gravity =
concentration urine = heavier weight/ml. | -indiacator of hydration
37
Blood tests of renal function and urinary status
BUN (blood urea nitrogen) | Serum Creatinine
38
Serum blood urea nitrogen
BUN
39
Serum blood urea nitrogen (BUN) normal
10-20 mg/dl
40
Urea:
End-product of protein metabolism
41
Urea is formed in the
Liver
42
Urea is eliminated by
Kidneys
43
Serum blood urea nitrogen (BUN) reflects
Liver's ability to make urea AND kidney's GFR
44
is serum blood urea nitrogen (BUN) as reliable as creatinine lab?
NO! not as reliable
45
Serum blood urea nitrogen (BUN) is usually measured in conjunction with
creatinine
46
Key factors that influence Serum blood urea nitrogen (BUN)
Impaired LIVER function Hydration status Nephrotoxic drugs
47
Why is BUN not the best measure of kidney function?
Because of the impact of the liver
48
Normal ranged of serum creatinine
0.5 - 1 mg/dL
49
Creatinine is a product of
Metabolism
50
Creatinine is produced and released into plasma at a
Constant rate and freely filtered glomerulus
51
Serum creatinine is a ___ estimate of ___ than BUN
Better estimate of renal function and GFR THAN BUN
52
Blood creatinine and GFR relationship
Inversely related
53
Low GFR means less creatinine filtered out to urine =
Blood creatinine levels are HIGH
54
Higher GFR means more creatinine filtered out =
Blood creatinine levels are low
55
Factors that influence creatinine levels
``` Impaired renal function Muscle mass/wasting Nephrotoxic drugs Exercise (break down muscle) Any state that decreases GFR will increase serum creatinine ```
56
BUN to creatinine ratio is usually
10 : 1
57
Creatinine clearance estimates
GFR; amount of blood the kidneys make creatinine-free / minute
58
Measuring creatinine present in a
24- hour sample of urine
59
the time for sampling urine starts immediately
AFTER emptying the bladder!
60
How to calculate creatinine clearance
Use a normal serum creatinine level & plug it into a formula
61
Urinary Albumin to creatinine ratio is a newer method for
detecting protein excretion
62
Is albumin creatinine ratio impacted by hydration?
Less impacted because it is not a concentration/mL
63
Microalbuminuria
ACR 30-300 mg/g
64
Microalbuminuria refers to
Albumin excretion above normal range but below the level of detection by tests for total protein
65
Macroaluminuria
ACR >300
66
Macroaluminuria refers to
higher elevation of albumin associated with progressive decline in glomerular filtration rate
67
What is reported with renal infection
Flank pain during costovertebral angle assessment
68
Tenderness/sharp pain during costovertebral angle assessment may indicate
``` pyelonephritis (kidney infection) renal calculi (renal stones) hydronephrosis (distention of the kidney with urine as a result of obstruction of the outflow of urine) ```
69
Noninvasive diagnostic TEST! (not lab)
Abdominal Roentgenogram: x-ray Computerized Axial tomography (CT): imagery via cross-sectional imaging Intravenous pyelogram (IVP): Image via x-ray using contrast dye Ultrasound: sound waves
70
Invasive diagnostic TEST (not labs)
Endoscopy-cystoscopy: scope through urethra to visualize, obtain specimen, instill treatment
71
Common Urinary diagnosis
``` Urinary Retention UTI Incontinence Diversions (not discussed here) Renal Failure (not discussed here) BPH Pelvic Organ Prolapse (POP) (less common, but worth mentioning) ```
72
Urinary retention
Partial or complete inability to empty bladder
73
Urinary retention can lead to
UTI/Sepsis | Overflow incontinence
74
Urinary retention can often happen after
Catheter removed
75
Monitor for urinary retention by using
Post Void Residual machine (PVR) | Straight catheterization
76
Benefits for women of pelvic floor exercises
``` Strengthen pelvic floor muscles and restore vaginal tone Prevent/treat stress incontinence Prevent/treat fecal incontinence Recover from childbirth Improve sexual sensation/function ```
77
Benefits of pelvic floor exercises for men
``` Strengthens pelvic floor muscles especially after prostatectomy Prevent/treat stress incontinence Prevent/treat fecal incontinence Helps with erectile dysfunction Improves sexual sensation/function ```
78
Pelvic organ prolapse
- Muscles and ligaments supporting a woman's pelvic organs weaken - Pelvic organs can drop lower in the pelvis, creating a bulge in the vagina (prolapse). - Women most commonly develop pelvic organ prolapse years after childbirth, after a hysterectomy, or after menopause.
79
Intermittent urinary catheterization
Bladder decompression, sterile specimen, assessing residual, spinal cord injury
80
urinary catheterization indwelling; short term
inter-operative/immediate post-op; critical care, BPH, bladder irrigation
81
urinary catheterization indwelling; long term
severe urinary retention, avoidance of urine contact with skin, terminal illness
82
Risks of urinary catheterization
Trauma to urethra: urethritis | Infection
83
___ % of UTIs are related to an indwelling catheter
80% of UTI
84
Infection risk of infections increases ________ catheter is in place
increases 3 - 10 % each day
85
Safety guidelines to follow for urinary catheterization
Catheter - associated urinary tract infections (CAUTI) guidelines
86
UTI is an infection in
ANY part of the urinary system
87
In older adults, UTIs clinical manifestations
Asymptomatic OR | Change in LOC/confusion
88
UTI in elder w/indweliing catheter is usually
Poly-microbial
89
Microbes ascend urethra and infect
Bladder (Cystitis) | Kidneys (Pyelonephritis)
90
UTI may progress into
Septic shock
91
treatment for UTI
Antibiotics, hydration
92
Efficacy of cranberry products for UTI is
heavily debated
93
Benign prostatic hyperplasia (sometimes called hypertrophy) occurs when
prostate cell proliferation exceeds programmed cell death (apoptosis) as a result of stimulated cell growth, inhibition of apoptosis, or both
94
Most common benign tumor in men
Bengin prostatic hyperplasia
95
As prostatic enlargement occurs, mechanical obstruction results
Can progress to complete obstruction
96
Benign prostatic hyperplasia and prostate cancer are
Genetically distinct, one is NOT at risk for the other
97
Medications for BPH
Alpha adrenergic antagonists
98
DRE =
Digital rectal examination for swelling
99
DRE =
Digital rectal examination for swelling
100
PSA
Prostate specific antigen in blood
101
BPH
Benign prostatic hyperplasia
102
TUIP
Transurethral incision of the prostate
103
TURP
Transurethral resection of the prostate
104
Urine can change color due to different
Drugs or conditions
105
Etiology of functional incontinence
person's physical ability to get to the toilet is underlying cause - NOT related to urinary function
106
Causes/examples of functional incontinence
``` Sensory impairment Cognitive impairment Mobility issues Dexterity issues Environmental barriers Neglect ```
107
Population most affected by functional incontinence
Frail elderly Nursing home residents Persons with dementia Neglect at any age
108
Etiology of overflow incontinence
Over-distended bladder r/t functional/mechanical obstruction of outflow -- may be secondary to poor muscle tone
109
Causes/examples of overflow incontinence
Enlarged prostatic, fecal impaction, DM neuropathy | ex) dribbling or constant loss
110
Population most affected for overflow incontinence
Men w/ large prostate Those on C+ channel blockers, anticholinergics, adrenergic Diabetics in advanced stages OR easier with HX poor BG control
111
Stress incontinence etiology
Weak EXTERNAL sphincter/pelvic floor overwhelmed by intra-abdominal pressure
112
Causes/examples of stress incontinence
Cough sneeze laugh exercise
113
Stress incontinence: population most affected
women: During/post pregnancy Obese persons Men AFTER prostatectomy
114
Urgent/urgency incontinence etiology
Detrusor instability and weak INTERNAL sphincter | -Neurological issues, bladder inflammation (UTI)
115
Urge/urgency causes/examples
``` Strong NEED/URGE with involuntary contractions w/ passage of urine. Overactive Bladder (OAB) ```
116
Population most affected: urge/urgency incontinence
Often idiopathic. UTI Older persons (men somewhat more affected)

Nursing 314: Assessing and Promoting Wellness (26 decks)

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