GU Flashcards
Functions of the Kidneys
- Remove metabolic waste from blood in the form of urine
- Regulate electrolytes and acid-base balance
- Control of blood pressure
- Regulates RBC production
- Synthesis of vitamin D to active form
Glomerulus
Network of capillaries that act as filter for filtrate to proximal tubules
Bowman’s capsule
Contains the glomerulus and acts as filter for urine
Proximal tubule
Site of reabsorption
Loop of Henle
U-shaped nephron tubule, site for further concentration of filtrate through reabsorption. This is where loop diuretics work (Lasix)
Distal tubule
Site where filtrate enters collecting tubule
Collecting tubule
Releases urine
Risk Factors for GU disorders
- Strep disorders => chronic renal failure
- Increased age => UTI’s, BPH
- Invasive procedures (cysto, foley) => UTI’s
- Immobilization => stones
- Diabetes => renal failure, neurogenic bladder
- Hypertension => renal failure
- Multiparous women => stress urinary incontinence
- Neurologic Disorders => MS, Parkinson’s
S/Sx of Urinary Tract Disease
- Pain
- Changes in voiding
- GI symptoms
What kind of pain can there be in a urinary tract disease?
- Kidney
- Ureteral
- Bladder
- Urethral
- Prostatic
Describe kidney pain
Dull ache in costovertebral angle (CVA) radiates to umbilicus
Describe ureteral pain
Pain in costovertebral angle (CVA) and/or flank which can radiate to abdomen, thigh, and genital area
Describe bladder pain
Pain in lower abdomen and suprapubic area
Describe prostatic pain
Pain in perineum and rectum
Urinary Frequency
Voiding more often, associated with infection, disease, diuretics
Urinary Urgency
Strong desire to void, associated with prostate, infection
Dysuria
Pain or difficulty voiding
Nocturia
Excessive urination at night (usually getting up more than twice a night)
Urinary Retention
Inability to empty the bladder
Urinary Incontinence
Involuntary loss of urine
Urinary Hesistancy
Delay in voiding
Enuresis
Involuntary voiding during sleep
Hematuria
Blood in the urine
Proteinuria
Proteins in the urine
Bacteriuria
Bacteria in the urine
Normal urine output per hour
30 mL per hour
Anuria
Output is less than 50 mL in 24 hours
*Hemodialysis patients
Oliguria
Output is less than 400 mL per 24 hours
Polyuria
Output is more than 2500 mL per 24 hours
*DKA and CHF patients
What kind of GI symptoms can one have if there is urinary tract disease present?
- N/V
- Abdominal discomfort or distention
- Diarrhea
* GI symptoms occur because the GI tract and urinary tract have shared autonomic and sensory innervations and reflexes
Physical examination of the kidneys
- Inspect the skin for edema, skin turgor, hydration, and pallor
- Attempt to palpate but you shouldn’t be able to due to costovertebral angle tenderness
- Listen for bruits (renal artery stenosis)
Physical examination of bladder
Palpate for fullness and location of bladder (usually can only do this if it is distended)
Physical examination of the meatus
Inspection for edema, redness, and drainage
Physical examination of prostate
Digital rectal exam (done by MD); done to detect hyperplasia of prostate in older men
Urinalysis
Analysis of urine. Analysis is used to identify abnormalities. Clean catch or mid-stream specimen may be used - want it clean as possible
Urine C & S
Identify if bacteria are present and treat with appropriate antibiotics
Normal urine specific gravity
1.005 - 1.030
A decrease in specific gravity can indicate what?
- Diabetes insipidus
- Glomerulonephritis
- Renal failure
An increase in urine specific gravity can indicate what?
- CHF
- Hepatic disorders
- Dehydration
Normal osmolality of urine
250 - 900
*Tells diluting and concentrating ability of kidneys
Normal pH of urine
5.0 - 8.0
A urine pH greater than 7.0 can indicate what?
- UTI
- Alkaline diet
- Alkalosis
- Medications
A urine pH less than 5.0 can indicate what?
- High protein diet
- Fever
- Acidosis
If glucose, ketones, and/or proteins are positive in the urinalysis what can this indicate?
- Severe infection
- Renal disease
- Diabetes
If RBCs and WBCs are present in the urinalysis what can this indicate?
- UTI
2. Stones
Normal GFR
125 mL/min (varies per age)
Glomerular Filtration Rate (GFR)
Rate at which glomeruli filter blood. Most accurate measure of GFR is creatinine clearance - that is because creatinine filtered by glomeruli but is not reabsorbed by tubules
Creatinine Clearance
Most accurate measure of glomerular filtration. Do a 24 hour urine collection and check the volume of urine and the urine creatinine level. Also do a serum creatinine halfway through the test.
Serum Creatinine
Endogenous waste product of skeletal muscle
- Reflects balance between production and filtration by glomerulus
- Best serum indicator of renal function. If elevated, indicates a decrease in GFR
Normal serum creatinine
0.7 - 1.4 mg/dL
Blood Urea Nitrogen (BUN)
Urea is nitrogenous end product of protein metabolism; test the ability of kidneys to excrete nitrogenous wastes; it’s an estimate of GFR
- Can be affected by medications and dehydration
- Can also be affected by protein intake, tissue breakdown, and fluid volume changes
Normal BUN
10 - 20 mg/dL
For patient over 60 (8 -20 mg/dL)
Types of X-ray/Imaging of GU system
- KUB
- Ultrasonography
- Bladder U/S
- CT/MRI
- Nuclear Scans
KUB X-ray
(Kidney, Ureter, Bladder)
X-ray shows kidney, ureters, and bladder size, position, and shape of structure. May show calculi or lesions. Limited purposes
Ultrasonography
Noninvasive, uses high frequency sounds and reveals depth of a structure below the skin. Usually done with a full bladder for better visualization. No special care afterwards.
Bladder U/S
Noninvasive, measures urine volume in bladder
CT/MRI
Provides cross sectional views of kidney and urinary tract, can use oral or IV contrast
Nuclear Scans
Injection of radioisotope, shows kidney perfusion, encouraged increase fluids to promote excretion of isotope
Intravenous Pyelogram (IVP)
Visualizes the entire urinary tract. Will show calculi, size and shape of structures, tumors, and pyelonephritis
Nursing Implications of Intravenous Pyelogram
- Check for allergies because of contrast
- Give laxative the night before
- NPO 8 hours or clear liquids
- May feel flushed, warm with salty taste when dye is injected
Voiding Cystourethrography
Urinary catheter allows instillation of contrast into the bladder, X-rays are taken while client is voiding. Shows stricture, ureteral reflux
Renal Angiogram
Catheter is advanced up femoral-iliac arteries and dye is injected. Can detect tumors or cysts. Femoral stick so check for bleeding and color, pulse, temp of extremities, frequent VS
Cystoscopy
Cystoscope with a lens is inserted into the urethra up to the bladder. Magnifies a view of the urethra, bladder, and orifices
Nursing Implications of cystoscopy
- NPO after midnight
- Monitor for UTI
- May have slight pink-tinged urine post procedure
- Relieve discomfort with warm, moist heat. Sitz bath
- Observe for complications: bleeding, infection, and pain with urination
- Urinary retention
Ureteroscopy
Scope through ureter; general anesthesia
Percutaneous Renal Biopsy
MD uses needle to excise tissue. Used to diagnose presence or progression of disease. Not done as much now because of CT and ultrasound tests.
Nursing Implications for Percutaneous Renal Bx
- NPO after midnight
- Post-op VS
- Prone immediately after procedure and then bedrest for 8 hours
- Need IVF after to prevent clots
- Post-op pain/responsive to analgesics
- Assess s/sx bleeding and inspect urine
- Avoid strenuous activity for 2 weeks
- Report backache, flank pain radiating to groin (clot in ureter)
Renal and ureteral brush biopsy
Provides specific info when abnormal xray findings of the ureter or renal pelvis is detected
*Cystoscope/ureteral catheter introduced and brush biopsy done
Risk Factor for Chronic Kidney Disease
- CAD
- DM
- HTN
- Obesity
Causes of Chronic Kidney Disease
- DM
- HTN
- Glomerulonephritis/pyelonephritis
- Hereditary or congenital disorders
- Renal cancer
Clinical Manifestations of Chronic Kidney Disease
- Increased creatinine
- Anemia
- Metabolic acidosis
- Calcium and phosphorus imbalances
- Fluid retention
- As the disease progresses abnormalities in electrolytes occur, heart failure worsens, and hypertension becomes more difficult to control
What is nephrosclerosis?
Hardening of renal arteries - most often due to HTN, DM
Treatment of nephrosclerosis
Control of BP and BG, renal replacement therapy
What is acute glomerulonephritis (AGN)?
Inflammation of kidney that affects the capillary bundles in glomeruli. Changes the permeability of glomeruli. Onset usually follows URI (strep), impetigo, mumps, hepatitis B, HIV infections, varicella
*Strep infection 2-3 weeks before glomerulonephritis. The strep product acts as an antigen and stimulates antibodies and results in deposits of molecules in glomeruli which injures the kidney
S/Sx of acute glomerulonephritis
- Hematuria (urine may be cola colored because of RBC’s)
- Edema
- Azotemia
- Proteinuria
- Malaise
- Also decreased output, CVA tenderness and flank pain
Diagnostic Tests for acute glomerulonephritis
- UA
- CBC (may have low H/H from blood loss)
- Strep titer
- May need renal bx
Potential Complications of Acute Glomerulonephritis
- End stage renal disease (ESRD)
- Hypertensive encephalopathy
- HF
- Pulmonary edema
- Elderly patients - circulatory overload with dyspnea, cardiomegaly, pulmonary edema, atypical neuro changes
Medical Management of acute glomerulonephritis
- Antibiotics - if residual strep infection, PCN unless allergic - erythromycin
- Bed Rest - during acute phase until hematuria and proteinuria subside
- Steroids - May be given to decrease inflammation
- Diet - low protein, low sodium, high calories, high carbs, fluids may be restricted
- Diuretics may be given if HTN
- May have to go on dialysis or may recover
Nursing Management of Acute Glomerulonephritis
- Ensure carbs given liberally for energy and reduce catabolism of protein
- I and O
- Fluids as ordered
- Education
Patient Education of Acute Glomerulonephritis
- Fluid and diet restrictions
- Notify HCP for s/sx of renal failure (fatigue, N/V, decreased urine output)
- Notify HCP for s/sx of infection
- F/U labs
What is Chronic Glomerulonephritis?
May present first time with chronic from hypertension, hyperlipidemia, or diabetic nephrosclerosis. Kidney tissue becomes fibrous and shrinks to 1/5th normal size. Renal arteries thicken.
*Acute may progress to chronic
S/Sx of chronic glomerulonephritis
- HTN
- Edema
- Weight loss
- Nocturia
- Headache, dizziness
- Increased BUN and creatinine
- Retinal changes
- Peripheral neuropathy and confusion late in the disease
Laboratory Abnormalities of chronic glomerulonephritis
- Hyperkalemia
- Metabolic acidosis
- Anemia
- Hypoalbuminemia
- Increased phosphorus
- Decreased calcium
Nursing Interventions of Chronic GLomerulonephritis
- Monitor weight daily
- HBV (High Biological Value)proteins (dairy products, eggs, meats)
- Adequate calories to spare protein
- Detection of UTI promptly
- Patient teaching = diet
Discharge Teaching for Chronic Glomerulonephritis
- F/U appointments
- BP control
- Teaching about long-term dialysis, care for access site, dietary and fluid restrictions
- Report s/sx, N/V, decrease urine output, hematuria, edema
- Compliance with medications
What is nephrotic syndrome?
Not a specific syndrome, but a cluster of clinical findings.