Renal part 1 Flashcards
(160 cards)
1
Q
What is the basic anatomy of the kidney
A
several layers of tissue surrond the kidney, providing protection and support
2
Q
what is the rich blood supply in the kidneys
A
renal artery
3
Q
what is the basic functions of the kidney
A
urine formation, regulatory function, hormonal function
4
Q
how does glomerular filtration work in the kidneys
A
Begins as blood is filtered across the membrane of the glomerulus.
Filters particles by size.
5
Q
what is hydrostatic pressure work in glomerular filtrate in the kidneys
A
Forces electrolytes, water, and particles such as nitrogen, creatinine, and glucose from the blood across the glomerular membrane and into the Bowman’s capsule.
6
Q
what is glomerular filtration rate
A
Amount of blood filtered by the glomeruli in a set amount of time.
7
Q
what is normal GFR
A
125mL/min
8
Q
what is glomerular filtration dependent on
A
Blood Pressure
Blood Flow
Blood Volume
9
Q
Pressures at or below 70 mmHg systolic, result in what GFR
A
decreased it cannot usually compensate
10
Q
Dilation and Constriction of afferent and efferent arterioles can change what in the kidneys
A
the pressure
11
Q
can GFR be compensatory
A
yes but it does have limits
12
Q
what is the tubular reabsorption in the kidenys
A
-Second phase of urine production
-Movement of water and solutes from tubular filtrate back into blood
Selective on what substances are removed during this phase
13
Q
what controls the permeability of the membrane with tubular reabsorption
A
Antidiuretic hormone (ADH) and aldosterone
14
Q
when dose urine concentration need to happen
A
prior to be excreted if it cannot then the body will dehydrate
15
Q
what does the loop of henle do for urine
A
reabsorbs additional water that is required to concentrate the urine
16
Q
what maintains water balance
A
kidney
17
Q
what is the last mechanism to activate in the kidneys
A
renal regulation of pH
18
Q
what organ has the only capability to fully excrete H+ from the body
A
the kidneys
19
Q
what does the hormone renin regulate
A
blood pressure regulation
20
Q
the hormone erythropoietin is found only where
A
kidney
21
Q
when would erythropoietin be released
A
- Produced in response to decreased renal blood flow and hypoxia
- Stimulated the bone marrow to produce RBCs.
22
Q
what happens when there is renal impairment and erythropoietin is released
A
In renal impairment or failure, becomes produced in insufficient amounts, resulting in anemia.
23
Q
how is vit D obtained
A
die and exposure to UV radiation
must be activated to be useful
24
Q
how is vit D changed in the body
A
Transported from liver as calcidiol, then converted into calcitriol.
Activated form of Vitamin D required for calcium to be absorbed into the GI tract.
25
Renal impairment results in what deficiency
deficiencies of Vitamin D, decreased serum calcium levels -> thus serum phosphate increased.
26
what does the hormone prostanglandins do
- These prostaglandins trigger vasodilation, resulting in increased blood flow and water excretion.
- They also play a role in lowering systemic blood pressure as a result of decreasing vascular resistance.
27
how does diminshed functional kidney tissue effect prostanglandins
Diminished functional kidney tissue = deficient production of these prostaglandins
28
when would the hormone bradykinin be released
Released in response to the presence of PGs, ADH, and angiotensin II
29
what does the hormone bradykinin do
Increases the permeability of the capillary membrane to certain solutes and dilates the afferent arteriole to ensure adequate reabsorption of solutes and blood flow to the kidneys.
30
Narrowing portion of ureter known as the
ureteropelvic junction
31
Narrowing of ureter into the bladder known as the
uterovesical junction
32
how is urine moved in the bladder
Contraction of smooth muscle in the ureter moves urine from the kidney to the bladder.
33
the act of releasing urine from the body
Micturition
34
Total capacity of the bladder varies
600 – 1000 mL of urine
35
what does the detrusor of the bladder do
Detrusor consists of smooth muscle that distends as bladder fills, contract to empty bladder.
36
what is included for the assessment: Demographics and Personal Data
```
Age
Gender
Race
Socioeconomic Status
Occupational History
Dietary and Personal Habits
```
37
what is included for personal health assessment
```
Overall health status
Alterations in functioning of renal and urinary systems
Fatigue
Changes in weight
Excessive thirst
Fluid retention symptoms
Neurological deficits
Frequent UTIs
Trauma
Kidney disease
Sexual and Reproductive History
```
38
what is included for medication assessment
- Collect a thorough history of current prescriptions and Over-the-Counter medications.
- Duration of medication use
- Dosage of medication
- This includes Herbal supplements and vitamins.
39
what is included in a urine assessment
Appearance of urine
Odor
Pattern of urination
Ability to voluntarily control voiding
40
what will you assess for when percussing
Costovertebral Angle
41
what will you assess during inspection
```
Skin
Mouth
Abdomen
Extremities
Urethral meatus
```
42
what will you assess when auscultation
Abdominal aorta & each renal artery
43
what labs will you assess for the kidneys
```
Creatinine
Blood Urea Nitrogen (BUN)
BUN/Creatinine Ratio
Uric Acid
Bicarbonate
Electrolytes
```
44
what are some urine tests you could perform
```
Bedside Urine Dipsticks
Urinalysis
Culture and Sensitivity
Composite Urine Collection
Creatinine Clearance
Urine Cytology
```
45
what can be tested for during an urianlysis
```
Color, Turbidity, Odor
Specific Gravity
Osmolality
pH
Protein
Glucose
Ketones
Bilirubin
Red Blood Cells
White Blood Cells
Bacteria
```
46
what are some imaging studies that can be performed for the kidneys
```
Bedside Sonography
X-ray
Intravenous Urography
Renal Ultrasound
CT Scan
MRI
Cystography and Urethrography
Arteriography
Renography (Kidney Scan)
Renal Biopsy
Cystoscopy
```
47
what does a bedside sonography do
- Sonogram of kidneys
- Can be performed at bedside
- Measures amount of urine in bladder
48
what is an x-ray used for the kidneys
- Kidneys, ureters, bladder (KUB)
- Reveals the size and anatomy of the renal and urinary system structures
- Can identify obstructions, masses, and calculi within the kidneys
- No discomfort to the client
49
how does an intravenous urography work
- AKA IV Pyelography
- Contrast injected through IV line
- Following dye injection, x-rays are taken at specific times
- Final x-ray is taken after the patient voids to measure the volume of any residual urine in bladder.
50
what is the pre op for intravenous urography
- bowel prep evening before then NPO
- - 30-45 min
- - IV contrast before initiation
- informed consent
- baseline serum creatine before
- allergies
- metformin consideration
51
what is the during and post-op for intravenous urography
- increase fluid intake to flush the contrast
| - monitor for changes in output, IV site, and delayed signs of contrast reaction
52
what can a renal ultrasound be used to test for
- Identifies masses, cysts, and obstructions
- Determines kidney size
- Differentiate between renal cysts and renal tumors
53
what is the pre-op for renal ultrasound
May be ordered to drink up to 24 oz of fluid 1 hour prior to procedure, instructed not to void
54
how does cystography and urethrography work
- Dye is injected into bladder via a urinary catheter
- Cystoscope inserted into urethra and slowly advanced into bladder.
- Assesses the bladder for abnormalities or trauma.
- Voiding cystourethrogram (VCUG) can also be performed to determine abnormalities.
- Client voids after contrast is inserted into bladder
- X-rays are taken as client voids
55
what does an arteriography test for
Visualizing the renal vasculature to assess for strictures, bleeding, renovascular hypertension, and other vascular abnormalities.
56
what is used during an arteriography
- Requires catheter placement into the femoral artery.
| - Advanced to the level of the renal arteries and IV contrast is injected
57
what is the pre-op for arteriography
- Educate indication of study and bowel prep
- NPO PMN
- Informed Consent on chart
- Allergies
58
what is the post op for arteriography
- When complete: Apply pressure to femoral site following removal of catheter until bleeding is stopped.
- Pressure dressing should be placed and monitored FREQUENTLY
- VS frequently
- Neurovascular status of extremity
- Lie with affected leg straight for 8-12 hours
59
how does a renal biopsy work
- Removing a tissue sample via small percutaneous site
- Ultrasound or CT guided
- Local anesthesia
- Used to rule out malignant processes
60
what meds should be stopped before a renal biopsy
Aspirin, warfarin (Coumadin), and other agents that affect clotting stopped
61
what is the pre-op of a renal biopsy
- Educate patient regarding procedure
- Informed Consent signed and on chart
- NPO 4-6 hours prior
- Type and screen ordered and collected
- Coagulation labs
- -Platelet, Prothrombin Time, and aPTT
- Vitals
- -Baseline
- -Frequent monitoring during the biopsy
62
What is the post-care after renal biopsy
- Apply manual pressure until bleeding stopped.
- Pressure dressing in place
- Monitor dressing frequently
- Hematocrit and Hemoglobin levels post-procedure
- -Internal bleeding can occur
- Bedrest up to 24 hours
- Some local discomfort
- Increase fluids
- Will have hematuria 48 – 72 hours after procedure
- Avoid heavy lifting for 1 week
- Do not resume anticoagulant medications until told by provider.
63
what are the s/s of internal bleeding
Flank pain, decreased UO, decreased BP, other signs of hypovolemia
64
what is a cystoscopy used for
-Surgical procedure to diagnose and/or treat bladder problems
-Assesses for bladder trauma, urethral trauma, or urinary tract obstructions
-Can be used to remove an enlarged prostate gland, bladder tumors, or renal calculi.
-
65
how is a cystoscopy performed
Inserted through urethra while patient is sedated
66
what is the post care after a cystoscopy
Educate about normal findings post procedure
- -Hematuria
- -Mild analgesics and topical measures may be used
- -S/S infection
67
what is the post care after a cystoscopy
Educate about normal findings post procedure
- -Hematuria
- -Mild analgesics and topical measures may be used
- -S/S infection
68
what are some age related changes to the kidney
- kidneys decrease on size so they are less palpable
- # of nephrons decrease as well as their function
- increase bun and creatine
- blood flow decreases
- change of loop of henle so decrease concentration of urine, urinary frequency and risk for dehydration
- loss of muscle tone and elasticity so incontinence
- decreased bladder size
enlargement of prostate gland
69
anuria
less the 100ml in 24 hr
70
dysuria
difficulty or pain with urine
71
enuresis
involuntary urination at night
72
hematuria
blood in the urine
73
hesitancy
difficulty starting the flow of urine
74
incontinence
inability to voluntary control peeing
75
nocturia
frequent peeing at night
76
oliguria
decreased urine output less then 400ml in 24 hours
77
polyuria
increase urine output more then 2000 ml in 24 hours
78
renal colic
pain radiating to groin area
79
retention
inability to completely empty the bladder of urine
80
urgency
sudden onset of the urge to void immediately
81
what is normal creatine
0.5-1.2
82
what would increase creatine mean
kidney impairment
83
what would decrease creatine mean
decreased muscle mass
84
what is normal BUN
10-20
85
what would an increase in BUN mean
liver or kidney disease, dehydration, decreased kidney perfusion, high-protein diet, infection, stress, steroid use, GI bleeding.
86
what would decrease in BUN mean
malnutrition, fluid volume excess, or severe hepatic damage.
87
what is normal bun/creatine ration (bun divided by creatine)
6-25
88
what would increase bun/creatine ratio mean
fluid volume deficit, obstructive uropathy, catabolic state, or high-protein diet.
89
what would decrease bun/creatine ratio mean
fluid volume excess
90
what is normal uric acid
3.5-8
91
what does above 12 uric acid mean
critical and warrant immediate intervention
92
what does increase in uric acid mean
renal failure, can result s/t alcoholism
93
what does decrease uric acid mean
folic acid anemia, pregnancy, can be s/t medications
94
what is normal bicarbonate
22-26
95
what does a decrease in bicarbonate mean
renal failure. Can occur s/t DKA, severe diarrhea, malnutrition, burns
96
what does a decrease in bicarbonate mean
renal failure. Can occur s/t DKA, severe diarrhea, malnutrition, burns
97
what is normal specific gravity of urine
1.005-1.030
98
what is normal pH of urine
4.5-8
99
what is normal protein in urine
2-8
100
what is normal RBC in urine
0-4
101
what is normal WBC in urine
0-5
102
what is normal bacteria in urine
less then 1,000
103
Injuries above S2– S4 result in
hyperreflexic bladder.
104
what are the causes and risk factors of stress incontinence
- women
- child birth
- post menopausal women
- smoking obesity
105
what are the causes and risk factors of stress incontinence
- women
- child birth
- post menopausal women
- smoking obesity
106
what are the causes and risk factors for urge incontinence
exposure to bladder irritants such as caffeine, artifical sweetners, or nicotine
107
what are the causes and risk factors for overflow incontinence
enlarged bladder due to obstrucion, spinal cord injury, stroke, diabetes, neurological diseases
108
what are the causes and risk factors for functional incontinence
inability to get to the toliet or communicate the need to do so
109
what are the ss of stress incontinence
urine leakage occurs when abdominal pressure increases like laughing, coughing, lifting ect
110
what are the ss of stress incontinence
urine leakage occurs when and
111
what are the ss of urge incontinence
strong urge to pee followed by uncontrolled leakage
112
what are the ss of overflow incontinence
frequent urination
113
what are the ss of reflex incontinence
bladder muscle contracts on its own, urethral sphincters exhibit varying control
114
what are the ss of reflex incontinence
bladder muscle contracts on its own, urethral sphincters exhibit varying control
115
how would you diagnose urinary incontinence
-Diagnosed with a thorough history
(Include questions about medical, urological, voiding, neurological, and reproductive history.)
-Assess how the client has been managing their incontinence (Identify routines and patterns)
-Labs (C or UA) to r/o infection and/or illness
-Ultrasound
-Diagnostic Tests
116
what is the treatment for urinary incontinence
- Goal is to prevent or stop urinary leakage
- If not possible, skin care and odor control becomes goal
- Prevention or reduction of damage to upper tracts or the kidneys.
- Medications, nonsurgical measures, or surgical measures can be used for management.
117
what is the purpose of Anticholinergics ( Oxybutynin (Ditropan); tolterodine (Detrol); darifenacin (Enablex); trospium (Sanctura); salifenacin (Vesicare). )
Used to calm an overactive bladder. Anticholinergics block nervous stimulation from the parasympathetic nervous system to help relax and control bladder muscle contractions.
118
what is the purpose of Topical estrogen
Used in stress incontinence in peri and postmenopausal women to help restore tone in urethra and vaginal areas.
119
what is the purpose of Tricyclic antidepressant ( Imipramine (Tofranil). )
Used to treat mixed-urge and stress incontinence; decreases bladder contractility and has an antispasmodic effect on the bladder
120
what is the purpose of Beta-3 adrenergic agonist
Mirabegron (Myrbetrig)
Used to treat frequent and/or urgent uncontrolled urination; relaxes bladder muscles.
121
what is the purpose of Beta-3 adrenergic agonist
Mirabegron (Myrbetrig)
Used to treat frequent and/or urgent uncontrolled urination; relaxes bladder muscles.
122
what are kegel exercises
- Strengthen pelvic floor muscles
| - Specific for strengthening external urinary sphincter
123
what is intermitten catheterization
- Involves the intermittent placement of a catheter through the urethra into the bladder.
- Done to completely empty the bladder to prevent UTIs or kidney damage s/t urinary retention
124
what assessment will be involved to diagnose urinary incontinence
```
Vital Signs
What causes incontinence
Urinalysis
Urine Culture
Voiding Diary
```
125
what are the ss of UTI
```
Dysuria
Urinary frequency
Urgency
Urinating in small volumes
Gross hematuria
Suprapubic pain
Fever
N/V
Flank pain
```
126
how are UTI diagnosed
Urinalysis
Culture & Sensitivity
Appearance of urine
127
what antimicrobials are used to treat UTI
- Trimethoprim/sulfamethoxazole (Bactrim DS)
| - Ciprofloxacin (Cipro)
128
what bladder analgesics are used to treat UTI
Phenazopyridine (Pyridium)
129
what is a bladder prolapse
Wall between the bladder and vagina are weakened, allowing the bladder to descend into the vagina.
130
what can a benign prostatic hyperplasia cause
means a large prostate gland so it can cause urinary retention, which increases the risk for urinary tract infection
131
what nursing interventions are used for UTIs
- Report elevated temperature, flank pain, nausea, and vomiting
- Increase fluid intake
- Signs and symptoms of UTI
- UTI prevention
- med education
132
what is UTI prevention
```
3L fluid daily
Good hygiene
Empty bladder every 3-4 hours
Urinate before and after intercourse
Drink cranberry juice to minimize infections
```
133
what is urolithiasis
- Calcifications in the urinary system
- Commonly referred to as kidney stones
- Can occur in the kidneys, ureter, or bladder
- Renal stones are the most common
134
what gender and race is urolithiasis more common in
white males
135
what are the ss of urolithiasis
- Severe pain (When stone lodges into ureter)
- N/V if pain severe enough
- Location of stone influence's location of pain
- Gross hematuria with any stone location and occurs in 95% of patients
136
what diagnostic tests are used to diagnosis urolithiasis
- Noncontrast CT scan (Can assess for hydronephrosis s/t obstruction)
- KUB (Does not reflect uric acid stones)
- Ultrasound (Recommended in children and pregnant females )
137
what is the treatment for urolithiasis
- Narcotics
- Nonsteroidal anti-inflammatory medication
- Alpha-adrenergic blockers
- If stone doesn’t pass, surgical management is required
138
what alpha-adrenergic blockers
tamsulosin (Flomax)
139
what alpha-adrenergic blockers
tamsulosin (Flomax)
140
what surgical management is used for urolithiasis
- Stenting
- Ureteroscopy
- Percutaneous nephrolithotomy
- Extracorporeal shock wave lithotripsy
141
what is a ureteroscopy used for and what kind of anesthesia
Used for mid/distal ureteral stones
| General anesthesia
142
why would a stent be placed during a ureterocopy
The placement of small tubes in the ureter during a ureteroscopy to dilate the ureter and allow passage of a calculus. An indwelling urinary catheter can be used to facilitate the passage of the calculus.
143
what is a Percutaneous ureterolithotomy/nephrolithotomy used for
- Used for stones larger than 2cm
- Stones located in the renal pelvis and branching into the calyces
- General anesthesia
- Access is gained to the kidney percutaneously to remove stone
144
what is the pre-op for urolithiasis
- Explain the procedure
- Maintain NPO status
- Ensure bowel prep if needed
145
what is the post-op for urolithiasis
- Monitor for bleeding
- Maintain adequate fluids
- Initiate infection control measures
- Monitor for passage of stone fragments
146
what analgesics are used for urolithiasis
```
hydromorphone (Dilaudid)
morphine sulfate (Morphine)
```
147
what alpha blockers are used for urolithiasis
tamsulosin (Flomax)
148
what meds are used for urolithiasis
- Administer analgesics
- Administer antiemetics
- Administer alpha blockers as ordered
149
what teaching and assessment is onvolved for urolithiasis
- Educate client on kidney stone prevention
- Hydration
- Encourage urine output of 2L a day
- Monitor urine color
- Low-sodium diet
- Increase dietary intake of citrate
- Decrease dietary oxalate
150
what are the ss of benign prostatic hyperplasia
- Difficulty starting the flow of urine
- Weak stream of urine
- Multiple interruptions during urination
- Dribbling once urination starts
- Incontinence may result
- Bed-wetting
151
what are the complications of benign prostatic hyperplasia
acute urinary retention, UTI, bladder stones, bladder damage, kidney damage
152
what is the treatment of benign prostatic hyperplasia
- watchful waiting
- used in patients w/ minimal symptoms
- yearly provider exams using DRE
153
what 5-alpha reductase inhibitors are used for benign prostatic hyperplasia
finasteride (proscar)
154
what alpha adrenergic bloackers are used for benign prostatic hyperplase and what do they do
- tamsulosin (flomax)
- act on alpha receptors in prostate, cause relaxation of smooth muscles
- 2-4 weeks to notice improvement
155
what does Androgen inhibitor do
Androgens are the group of male sex hormones (Testosterone) that mediate the normal development and maintenance of the primary and secondary male sex characteristics.
first line for benign prostate hyperplasia
156
what is a Coude
speciality catheter used to treat benign prostatic hyperplasia
157
what kind of surgical treatment is used for benign prostatic hyperplasia
- Transurethral Resection of the Prostate (TURP) (Used to treat BPH, but must be a smaller prostate)
- Lighted resectoscope is passed into the urethra.
- Small cutting tool is used to remove the entire inner prostate, leaving the outer layer.
- Symptoms are usually relieved quickly, resulting in a stronger flow of urine.
- Risk of bleeding and infection post-procedure.
158
what is the most common risk factor for bladder cancer
smoking
159
what is the diagnosis of bladder cancer
- Thorough history and physical (Special attention to risk factors)
- Urine cytology (40% accuracy)
- Blood and Urine test (Identify tumor markers)
- Urine cultures
- Cystoscopy (Definitive diagnosis)
160
what is the treatment for bladder cancer
- Chemotherapy
- Targeted drug therapy
- Surgical management
- -Surgical excision
- -Radical cystoprostatectomy
