Kidney & Urinary Tract Function Flashcards
(171 cards)
1
Q
How many times per hour does total blood supply circulate through the kidneys?
A
12 times per hour
2
Q
how many liters of blood does the kidney receive per minute?
A
1.2-1.3 L
3
Q
what percent of Cardiac output goes the kidney pump?
A
25%
4
Q
what 3 parts is the kidney divided into? briefly describe if necessary
A
- cortex
- medulla (middle)
- pelvis (inner part; threads down the urine into the ureters)
5
Q
function of the afferent arteriole
A
supplies glomerulus w blood
6
Q
function of the efferent arteriole
A
drains blood from the glomerulus
7
Q
describe the nephron & its function
A
“the mall” of the kidney; fine tuning of where urine is created; functional unit of the kidney
8
Q
about how many nephrons is each kidney composed of?
A
1 million
9
Q
list & describe the roles of the 2 different types of nephrons
A
- Cortical (80%-85%): excretory & regulatory
- Juxtamedullary (15%-20%): concentration & dilution
10
Q
glomerulus
- what is it & where is it located?
- function
A
- specialized capillary loops at the beginning of the nephron
- site of filtration; first process in urine formation
11
Q
what is the rate of blood flow determined by?
A
BP
12
Q
explain the meaning of glomerurular filtration rate (GFR)
A
how fast the kidney is filtering (volume of plasma filtered from the glomerular capillaries into the Bowman’s capsule each minute)
13
Q
what is a normal GFR? what percentage of it is cardiac output?
A
125 ml/min; 20%-25% is CO
14
Q
where is the site of reabsorption in the kidney?
A
Proximal convoluted tubule
15
Q
where is the site of loop diuretic action in the kidney?
A
ascending Loop of Henle
16
Q
where is the site of thiazide diuretic action in the kidney?
A
distal convoluted tubule & collecting duct
17
Q
list 7 functions of the kidneys
“A WET BED”
A
A: acid-base balance
W: water balance
E: electrolyte balance
T: toxin removal
B: blood pressure control
E: erythropoietin
D: vitamin D metabolism
18
Q
what is the function of the RAAS? which drugs work here?
A
regulates blood flow to the kidneys, BP, & GFR
ACE & ARB drugs work here!
19
Q
list the 3 aldosterone functions & what this leads to
A
holds onto sodium, H2O follows sodium, releases K+ = increasing blood volume
20
Q
list the 3 parts of the tubules
A
- proximal convoluted tubule
- ascending loop of Henle
- Distal convoluted tubule & collecting duct
21
Q
what is the max capacity the bladder can hold? what is the acceptable amount of post void residual?
A
400-500 mL
<100 ml = acceptable post void residual
22
Q
how many cm long are both female & male urethras?
A
females: 3-5 cm
males: 20 cm
23
Q
when does a decline in kidney function typically begin?
A
35-40 years of age
24
Q
list 5 age related changes in the kidneys
A
- glomerular sclerosis
- decreased blood flow
- decreased GFR
- altered tubular function
- acid-base imbalance
25
list 4 things a patient could be at risk for if they have age related changes in their kidneys
1. adverse drug effects
2. hypernatremia
3. fluid volume imbalances
4. urinary tract infections
26
urinalysis (UA) / urine culture (C & S)
urine in cup
27
BUN
- normal range
- what does it measure?
normal range: 10-20
measures the nitrogen in blood
28
creatinine
- normal range
- what does it measure?
normal range: 0.7-1.4
best indicator of how the kidneys are functioning (clearing waste products)
29
GFR
- normal range?
- what does it measure?
normal range: 125 ml / min
best indicator of how kidneys are filtering!
30
24 hour creatinine clearance
- what does it compare?
- what must a nurse have from the patient?
compares how much creatinine is in your blood w how much is in the urine
nurse must collect urine for 24 hrs
31
what does HGB & HCT help to diagnose R/T kidneys?
kidney function
32
which part of the kidneys are electrolytes cleared by?
tubules
33
what is the normal range for specific gravity?
1.005-1.025
34
what does protein in the urine indicate?
damage to the glomerulus
35
what does glucose in the urine indicate?
blood sugars are crazy high
36
what do ketones in the urine indicate?
could be a sign of diabetic kedoacidosis; body begins to tear itself down to give nourishment
37
what do RBCs in the urine indicate?
indicates if there is a UTI
38
what do WBCs & bacteria in the urine indicate?
indication of infection
39
what does leukocyte esterase show?
shows inflammation in the urinary tract
40
what does a renal angiography diagnostic test show?
indicates a blood clot; tells how much blood flow is getting to the kidneys
41
list 2 pre test interventions for a renal angiography
1. kidney function
2. hydration to encourage excretion
42
post test interventions for a renal angiography
monitor for bleeding
43
list 3 complications from a renal angiography
1. hematoma
2. damage to kidneys from dye
3. blood clots
44
what should a patient be educated on after getting a renal angiography?
if still bleeding after 3 days, call MD!
45
what is a renal biopsy? what does it help diagnose? what is a patient usually given w this?
needle is stuck through back into the kidney; helps diagnose cancer or kidney failure; patient usually given a local anesthetic
46
what is a pre test nursing intervention for a renal biopsy?
look at clotting times; be sure patient is not at high risk for bleeding
47
list 5 post procedure interventions for a renal biopsy
1. bleeding
2. monitor BP & HR
3. make sure patient is urinating properly
4. if there is still blood in urine after 96 hours, call MD!
5. adequate fluid intake
48
what should a patient be educated on after getting a renal biopsy?
if still bleeding after day 3, call MD!
49
what is a cystoscopy? how can this be helpful?
scope is threaded up urethra to view both urethra & bladder; can sample stones or a part of the kidney
50
what is a pre nursing intervention before a cystoscopy?
UA must be done before to be sure urine is clean
51
what is a post nursing intervention after a cytoscopy?
monitor for urinary retention
52
list 2 complications after a cytoscopy
1. burning & painful urination
2. blood tinged urine
53
what is an intravenous pyelography (IVP)?
tells the shape & size of kidneys; xray but w dye to see things better
54
what are 2 pre nursing interventions for an intravenous pyelography?
make sure they have an IV & that the patient is hydrated
55
what is a post procedure nursing intervention for an intravenous pyelography?
adequate fluid hydration to flush dye out
56
what 2 things should we educate the patient on after an intravenous pyelography is done?
1. adequate fluid hydration
2. call doc if bleeding 3 days or after
57
what can an ultrasound show?
shows shape of kidney & can reveal a mass or tumor
58
what is a KUB?
(Kidneys, Ureters, Bladder): like x-ray w out dye
59
what is an AKI?
acute kidney injury; **sudden onset / reversible**
60
list 4 causes of AKI
prerenal (before kidneys due to low blood volume), intrarenal (inside of the kidneys due to infection or short term damage because of dye), post-renal (after the kidneys), & nephrotoxins
61
list 2 s/sx of AKI
increase in BUN & creatinine, decrease in GFR
62
what is the goal for a patient who has AKI? list 4 interventions
keep patient alive until renal lesion heals! give pt fluids, short term hemodialysis, look at meds (avoid nephrotoxic ones), & watch electrolytes
63
what is CKD?
chronic kidney disorder (kidney damage or decrease in GFR > 3 months) ; **slow progression / irreversible!**
64
list 2 causes of CKD
diabetes & HTN (from repetition of pounding on glomerulus)
- most causes are unknown
65
what is the goal for a patient w CKD?
slow or prevent progression of failure w dialysis or transplant
66
list 6 risk factors for developing CKD
**diabetes (primary cause)**, HTN (second leading cause), glomerulonephritis / pyelonephritis, polycystic kidney, heredity / congenital, renal cancers
67
list 6 s/sx of CKD
elevated serum creatinine & BUN, electrolyte abnormalities, anemia, metabolic acidosis, fluid retention, HF
68
list 4 interventions for CKD
**renal diet**, control HTN, control glucose levels, assess medications
69
what is a renal diet & what is the goal?
low protein, low potassium, low sodium (high causes HTN), low phosphorus
- fluid restriction in late stages (may be 1000-1500 ml/day)
goal: to decrease production of metabolism wastes & regulate electrolytes
70
list 8 sources of high K+
salt substitutes, potatoes (unless dialyzed), oranges & OJ, bananas, prune juice, tomato, dried beans & lentils, nuts, chocolate, coconut
71
list 8 sources of high phosphorus
milk, milk products, fish, chicken & beef liver, legumes, whole grain breads & cereals, peanut butter, colas
72
list 5 types of meds that are considered nephrotoxic
ACE inhibitors (-prils), common antibiotics (Aminoglycosides), thiazide diuretics (hydrochlorothiazide), furosemide, NSAIDS
73
list 6 nursing interventions / education for renal cancer patients
comfort measures, tube / drain management, assess incision (feel underneath patient), **I's & O's***, coughing & DB
74
list 3 tx options for renal cancer
surgery, radiation, chemotherapy (biologic response modifiers & immunotherapy
or combo of them all!
75
list 4 diagnostic tests for renal cancer
physical exam, labs (CBC, BUN, creatinine), UA, x-rays (cystoscopy, **renal biopsy: need actual tissue sample,** ultrasound, CT scan
76
where is renal cancer commonly found? what is it associated w?
commonly found in the renal pelvis & ureters; associated w bladder cancer
77
when is renal cancer usually found & why?
usually found at the late stage due to one kidney functioning properly & picking up all the work from the other one
78
list 4 tx options for glomerulonephritis
reduce inflammation w corticosteroids, immunosuppressive agents (stop clumps from forming), diuretics / antihypertensives, dietary restrictions (renal diet)
79
list 4 nursing considerations for a pt w glomerulonephritis
monitor weight, I's & O's, vitals, & maintain fluid & electrolyte balance (usually on heart monitor as well)
80
list 4 things that glomerulonephritis can be diagnosed w
UA, lab results (increased BUN & creatinine), elevated strep titer, decreased GFR
81
list 6 s/sx of glomerulonephritis
**hx of strep infection**, **periorbital & generalized edema (anasarca)**, edema, hematuria (cola colored urine), hypertension, azotemia (build up of toxins in the blood; gives itchy skin & neoemic frost)
82
list 4 risk factors / causes of glomerulonephritis
***strep infection, scarlet fever***, pneumococcal infections, staphylococcal infections, SLE (systemic lupus erythematosus)
83
explain the pathophysiology of glomerulonephritis
antigen antibody complexes get trapped in the glomeruli after injection (can be acute or chronic)
84
what is glomerulonephritis?
inflammation & increased cells in the glomeruli in both kidneys caused by an abnormal immune response
85
which lab value would you expect to find after dialysis?
decreased BUN
86
list 6 peritoneal dialysis nursing interventions
monitor "dry weight", assess vital signs, assess catheter insertion site, assess fluid color & consistency, record amount of dwell removal & amount instilled (normal to have more out than in), patient / family education
87
list 7 long-term problems from peritoneal dialysis
abdominal hernias, hiatal hernias, hypovolemia / hypervolemia, hyperglycemia, pain, respiratory distress, self concept
88
list 3 acute complications of peritoneal dialysis
**peritonitis: inflammation of the peritoneum; comes from bacteria introduced into the peritoneal cavity*** (s/sx: abdomen pain, fever, abnormal urine color), bleeding, & leaking (3 L of fluid in slowly)
89
list 7 advantages of peritoneal dialysis
**steady state blood chemistries**, convenience, patient / family can be taught process, **fewer dietary restrictions**, more control over daily life, can be used for hemodynamically unstable patients, circulatory system remains intact
90
how does peritoneal dialysis work?
peritoneal cavity via a catheter placed in
the abdomen using the peritoneum as the dialyzing membrane
91
what is the difference between continuous ambulatory peritoneal dialysis & continuous cyclic peritoneal dialysis?
continuous ambulatory peritoneal: patients can be mobile
continuous cyclic peritoneal: plugs into machine while patient is sleeping; it'll suck out fluid overnight (seen in many children & younger populations)
92
what medication should be avoided when a patient is on hemodialysis??
magnesium-based antacids (mylanta)
93
list 8 common medications in which a hemodialysis patient is on
erythropoietins, vitamin D analogs, renal vitamins, calcium & phosphate binders, iron replacement, electrolyte modifiers, anti-hypertensives, anticonvulsants
94
which med should not be given before dialysis?
anti-hypertensive
95
what is an electrolyte modifier in which patients that are on hemodialysis commonly take?
Kayexalate (poops out potassium)
96
list 6 nursing considerations of hemodialysis
monitor "dry weight" - goal weight after dialysis, access vital signs (esp BP), monitor diet / fluid intake, pre dialysis meds, patient / family education
97
what are meds that CAN be given before dialysis?
nausea meds, insulin if diabetic
98
list 7 complications of Hemodialysis
hypotension due to loss of fluid, N/V, hemorrhage, muscle cramps, infection, cardiac dysrhythmias (esp. K+ & phosphorus), disequalibrium syndrome (risk for seizures!)
99
when must a patient start dialysis?
in the ESKD stage or stage 5 kidney failure
100
how does ESKD affect fluid / electrolyte imbalances?
increased Na leading to HF, K+ retention leading to hyperkalemia, high phosphorus & high calcium leading to fractures, lack of RBC leading to anemia
101
how do labs change post dialysis?
decrease in weight, K+, phosphorus
102
difference between an AV fistula & synthetic graft
AV fistula: sew vein & artery together
synthetic graft: plastic placed to strengthen up vessels because of the poking
103
what 3 things MUST be assessed if a patient has an AV fistula?
bruit & thrill, radial pulse, & capillary refill
104
how long should a synthetic graft be kept in for?
should not be used >14 days
105
what is a high risk w a synthetic graft if not sutured in place?
bleeding
106
what is important if a patient's synthetic graft is placed in femoral area?
pt. should not be up in a chair due to possibility of rupturing a vessel
107
what is the most common nosocomial infection?
UTIs
108
what is the second most common infection in the body ?
UTIs
109
how are UTIs classified?
complicated & uncomplicated
110
list the 3 types of upper urinary tract infections & describe them
Pyelonephritis: inflammation of the renal pelvis
Nephritis: inflammation of the kidney
Renal abscesses
111
list the 3 types of lower urinary tract infections & describe them
Cystitis: inflammation of the urinary bladder
Prostatitis: inflammation of the prostate
Urethritis: inflammation of the urethra
112
describe pyelonephritis
bacterial infection of the renal pelvis, tubules, and interstitial tissues in the kidneys of one or both kidneys (can be acute or chronic)
113
describe the pathophysiology of pyelonephritis
- what is it associated with?
- what are nephrons replaced by in chronic infection?
- associated w abscesses, obstructions, and tumors
- nephrons are replaced by scar tissue in chronic infection
114
list 5 possible causes of pyelonephritis
1. E-coli infection
2. renal calculi
3. malignancy
4. catheter / cystoscopy
5. BPH
115
list 7 ACUTE symptoms of pyelonephritis
1. **high fever / chills**
2. leukocytosis
3. bacteriuria
4. pyuria
5. low back / flank pain
6. cloudy . bloody, foul smelling urine
7. painful urination
116
list 4 CHRONIC symptoms of pyelonephritis
1. may have no symptoms
2. may have fatigue, HA, poor appetite, polyuria, excessive thirst, & wt. loss
3. less painful
4. discovered when HTN is being evaluated
117
list 4 ways pyelonephritis can be diagnosed
1. symptoms
2. labs
3. UA / C & S
4. radiology
118
list 8 nursing interventions for pyelonephritis
1. vital signs
2. I's & O's
3. maintain fluid balance & electrolyte balance
4. **antibiotic therapy**
5. analgesics (phenazopyridine)
6. antispasmodics
7. **increase fluid intake (3-4 L/day)**
8. renal diet
119
describe cystitis
inflammation in the lining of the urinary tract caused by bacteria
"bladder infection"
120
what is the most common type of UTI?
cystitis
121
what type of common bacteria is cystitis associated w?
E. Coli (80%)
122
list 5 risk factors for cystitis
1. inability to empty bladder completely
2. obstructed urinary flow
3. instrumentation of the urinary tract
4. inflammation or abrasion of the urethral mucosa
5. poor hygiene practices
123
list 5 symptoms of cystitis
1. pain
2. burning
3. bladder spasms
4. frequency
5. **atypical for elderly**
124
list 3 diagnostic tools used for cystitis
1. UA / C & S
2. CT scan
3. US
125
which 3 types of medications are used to treat cystitis?
1. antibiotics
2. antispasmodics
3. analgesics
126
list 5 nursing interventions for cystitis
1. strict aseptic technique w catheter insertion
2. instruct on proper perineal hygiene
3. I & O's
4. **force fluids (3-4 L / day)**
5. educate
127
list the 2 main types of urinary incontinence
stress incontinence & urge incontinence
128
what are 5 possible causes of urinary incontinence in the elderly?
1. UTI
2. constipation
3. medications
4. decreased estrogen levels
5. diabetes
129
list 5 diagnostic tools used for urinary incontinence
1. history
2. I's & O's
3. radiologic tests
4. residual urine checks
5. UA / C & S
130
list 6 tx/nursing interventions for urinary incontinence
1. electrical stimulation
2. medications (oxybutynin, tolterodine)
3. bladder training / timed voiding
4. kegel exercises
5. surgery
6. fluid & dietary changes
131
describe urolithiasis / nephrolithiasis
presence of a stone anywhere in the urinary tract / kidneys
132
what can stones in the urinary tract / kidneys be composed of?
calcium oxalate, calcium phosphate, or uric acid
133
what percentage of stones in the urinary tract / kidneys are calcium based?
75%
134
list 9 risk factors of urolithiasis / nephrolithiasis
1. men 30-50 years of age
2. previous history
3. **dehydration**
4. living in "Stonebelt"
5. diet high in purines
6. UTI's
7. neurogenic bladder
8. immobilization / sedentary lifestyle
9. ***medications (esp. calcium supplements)***
135
list 10 S/Sx of urolithiasis / nephrolithiasis
1. ***PAIN, PAIN, PAIN!!! in the flank area
2. HTN
3. ***Hematuria***
4. ***Urine retention, frequency, urgency***
5. pyuria
6. fever / chills
7. diaphoresis
8. pallor
9. N/V
10. Oliguria / anuria
136
list 2 ways to diagnose urolithiasis / nephrolithiasis
1. UA
2. Radiologic testing (CT, IVP)
137
list 7 nursing interventions for urolithiasis / nephrolithiasis
1. ***analgesics & NSAIDS***
2. antispasmodics (oxybutynin)
3. antihyperurecemics (allopurinol)
4. I's & O's
5. ***strain urine***
6. antibiotics
7. diet therapy
- **** increased fluid intake***
- avoid causative foods (calcium, purines, uric acid)
138
list 4 tx procedures for urolithiasis / nephrolithiasis
1. stent placement
2. percutaneous lithotripsy
3. extracorporeal shock wave lithotripsy
4. open removal (rare)
- ureterolithotomy
- cystolithotomy
- pyelolithotomy
139
list 6 post procedural interventions for urolithiasis / nephrolithiasis
1. manage pain
2. monitor fluid / electrolyte balance
3. monitor S/Sx of infection
4. monitor kidney function
5. ***assess urine / strain***
6. educate on possibility of bruising in the flank area for ESWL
140
what age & gender is bladder cancer common in?
>55 years of age; more common in men
141
list 3 risk factors of bladder cancer
1. tobacco use
2. toxins
3. family history
142
list 3 s/sx of bladder cancer
1. painless hematuria
2. frequency, urgency, & dysuria
3. changes in voiding patterns
143
list 2 ways bladder cancer can be diagnosed
1. radiologic
2. ***Biopsy***
144
list 3 treatment options for bladder cancer
1. cystectomy
2. radiation therapy
3. chemotherapy
145
describe an ileal conduit
- most common, permament urinary diversion
- urine flows freely through stoma to a pouch
146
describe a cutaneous ureterostomy
ureters are brought out to skin in one or more stomas
147
describe a continent urostomy
- ureters drain into reservoir that has a valved stoma
- the stoma is cathed to remove urine
148
list 5 pre-op / patient education of expectations for urinary diversions
1. changes in body image
2. show stoma pouches
3. activities
4. exercise, diet, clothing
5. discuss site of ostomy
149
list 5 post op / patient education for urinary diversions
1. ***assess stoma site***
2. ***monitor I's & O's***
3. monitor for S/Sx of stoma obstruction
4. education
5. ostomy nurse
150
list 4 complications of urinary diversions
1. stoma ischemia / necrosis
2. ***infection***
3. ***stoma - irritation - yeast infection***
4. ***skin breakdown***
151
describe benign prostatic hyperplasia (BPH)
- who is it common in?
enlargement of the prostate gland (squeezes urethra so urine cannot pass through)
- men primarily over 40 years
152
list 8 s/sx of BPH
1. frequency / hesitancy
2. hematuria
3. inability to empty the bladder completely
4. post void dribbling
5. anuria
6. bladder distention
7. enlarged, firm, non elastic feeling upon digital exam
8. elevated PSA
153
describe a PSA (prostate-specific antigen) assay
what is normal?
blood work; enzyme that is released by the prostate
higher number = prostate enlarged
normal: <2.6
154
list 5 diagnostic tools used for BPH
1. digital rectal exam
2. PSA
3. Transrectal ultrasonography
4. CT / MRI
5. cystoscopy
155
how do alpha 1 adrenergic blockers treat BPH?
list the 2 meds
relax smooth muscle of the prostate, bladder neck, & proximal urethra; block enzymes
1. doxazosin
2. tamsulosin
156
how do alpha reductase inhibitors treat BPH?
list the med
slow production of DHT; stops growing prostate
1. finasteride
157
describe a transurethral heat ablation
shoots heat waves up into urethra & kills prostate tissue
minimally invasive
158
describe a transurethral incision of the prostate
incisions are made into the prostate so the urethra can expand more
159
describe a prostatic stent
holds everything open; does not work as well because it can slide out
160
prostate cancer is most common in what two types of ethnicities?
North American & north-western European men
161
which population is at the highest risk & twice as likely to die from prostate cancer?
African American men
162
list 7 risk factors for prostate cancer
1. increases w age (60s)
2. African American men at higher risk
3. family history
4. diet high in saturated animal fat
5. vitamin D deficiency
6. occupational risks (working w chemicals)
7. high levels of testosterone
163
what is considered an abnormal digital rectal exam for prostate cancer?
firm & nonelastic
164
what age do screenings for prostate cancer usually begin?
50
165
what can also be done during an ultrasound guided TRUS?
grabbing a biopsy as well
166
list 9 s/sx of prostate cancer
1. dysuria
2. nocturia
3. hematuria
4. frequency
5. abnormal prostate on digital exam
6. bone pain, back pain, nerve pain
7. bowel & bladder dysfunction
8. weight loss
9. fatigue
167
list 4 diagnostic tests used to diagnose prostate cancer
1. subjective s/sx
2. prostate specific antigen, DRE
3. TRUS exam
4. tissue biopsy
168
describe hormone deprivation therapy
androgen deprivation therapy; limits hormones & slows down growth of prostate
169
what is an orchiectomy?
removal of the testicles; takes away 95% of testosterone which feeds the growth of the prostate
170
list 7 complications of prostate cancer treatment
1. hemorrhage
2. infection
3. venous thromboembolism
4. catheter problems
5. erectile dysfunction
6. urinary incontinence
7. urethral stricture (tightening)
171
what is a transurethral resection of the prostate? (TURP)
goes into urethra & scraps out prostate tissue
