Flashcards in Renal/Urologic System Deck (79):
1
Nephron Function
-filter blood
-reabsorb fluid
-forms filtrate of protein-free plasma
-maintain body fluid volume
-maintain electrolyte composition
-maintain body pH
2
Kidney receives _____& of cardiac output
-20%
3
Pathway
-blood vessel
-bowman's capsule
-glomerulus
-prox convoluted tubule
-Loop of Henle
-Distal convoluted tubule
-collecting duct
-urethra
4
____ of plasma is filtered into the renal tubules
20%
5
urinary output=____L/day
1.5L/day
(most fluid reabsorbed back from tubules)
6
GFR
-glomerular filtration rate
-rate of plasma filtration by glomerulus
7
Clearance
-volume from which all test substance is removed
8
______ is often used to measure GFR
-creatinine clearance
9
Creatine
-Mm metabolism byproduct
-has fairly constant plasma level
10
_________level alone is often used to monitor GFR
-plasma creatinine
11
Substantial GFR changes may be reflected in _______
-relatively small plasma creatinine changes
12
Normal Creatinine Levels
Male=0.7-1.3
Female=0.6-1.1
13
Tests of Renal System
-GFR
-Plasma Creatinine Concentration
-BUN
-Urinalysis
14
Urinalysis
-best test for infectious agents or foreign materials (toxins, drugs)
-color, turbidity, protein, pH, specific gravity, sediment)
15
Diuretics
-inhibit Na+ uptake
-->more water remains in tubule and urine
16
Diuretic Effects on Body
-decrease BP, edema, body fluid, CHF symptoms
17
Pathologies of Renal System
-Infection
-Cancer
-Renal Cystic Disease
-Renal Calculi
-Chronic Renal Failure
-Glomerulonephritis
-Neurogenic disorders
-urinary incontinence
18
UTI
-Urethritis
-Cystitis (bladder infection)
19
Urethritis Sx
-Inflamm/pain at urethral opening
-painful urination
20
Cystitis Sx
-bladder infection
-Painful urinatino
-frequent urination
-urgent need to urinate
-urine cloudy/red
-fever sometimes
-suprapubic/low back pain
-flank pain
21
Pyelonephritis Symptoms
-(Kidney infection)
-symptoms suggesting bladder infection
-abrupt onset
-high fever/chills
-back pain around kidney
-nausea/vomiting
22
Kidney/UTI Evaluation
-Urinalysis
-tender to percussion at costovertebral angle (pyelonephritis)
23
Prevention of Kidney/UTI
-post-void residual assessment to assess urinary retention
-sufficient fluid intake
-urogenital hygiene
24
Kidney/UTI Treatment
-antibiotics
-increase fluids
-consider lactobacillius acidophilus to prevent yeast growth when on antibiotics
-contact doc if not better in 48-72 hours
25
Renal Cell Carcinoma
-malignant tumor
-80-90% of all renal neoplasms
26
Renal Cell Carcinoma Incidence
-male (over 60) 2x > female
27
S/Sx Renal Cell Carcinoma
-bloody urine
-abdominal/flank pain
-palpable mass
-HTN
-hyperparathyroidism
28
Metastases of Renal Cell Carcinoma
-lungs
-bone (lumbar vert)
29
Eval/Treatment of Renal Cell Carcinoma
-radiographic imaging
-surgical removal of tumor
30
Risk Factors of Renal Cell Carcinoma
-tobacco use
-obesity
-HTN
-decreased fruits/veggies
-increased red meat
-occupational toxins
31
Bladder Cancer Incidence
-4th leading cause of cancer in men
-7th leading cause of cancer death in US
32
S/Sx Bladder Cancer
-hematuria
-frequency
-urgency
-dysuria (painful)
33
Metastases of Bladder Cancer
-bone
-pariaortic lymphnodes may cause low back pain
34
Prevention of Bladder Cancer
-tobacco cessation
35
_________& ______ may reduce recurrence of bladder cancer by 40%
-vitamin/zinc supplement & immunotherapy
36
Treatment of Bladder Cancer
-resection of pelvic lymph nodes/prostate/seminal vesicles/uterus
-radiation/chemo
-salvage cystectomy &/or transplantation
37
Bladder Cancer Screening
-screening of men at risk over 50 significantly lowers incidence & mortality
38
Nephrolithiasis
-kidney stones
39
Renal Calculi
-masses of crystals and proteins
40
Nephrolithiasis Cause
-unknown
41
S/Sx Nephrolithiasis
-pain along flank
-N/V
-hematuria
42
Eval/Treatment of Nephrolithiasis
-increase urine flow
-modify dietary intake of possible irritant substances
43
Renal Failure
-acute renal failure (ARF) (reversible)
-Chronic renal failure (irreversible)
44
causes of ARF
-many causes
-impaired renal blood flow (reversible)
45
Chronic Renal Failure Results in:
-loss of normal kidney function
46
Indicators of Chronic Renal Failure
-GFR falls
-Uremia
47
Uremia
-accumulation of toxins in blood
48
S/Sx of Chronic Renal Failure
-anorexia
-N/V
-fatigue
-HTN
-pruritis
-decreased urin output
-edema
-neurological changes
49
Eval/Treatment of Chronic Renal Failure
-regulate food/fluid intake
-Na+ & K+ restriction
-Dialysis
-Transplantation
50
Stages of Chronic Renal Failure
-Diminished Renal Reserve
-Renal Insufficiency
-Renal Failure
-End-Stage Renal Disease (ESRD)
51
Diminished Renal Reserve
-GFR: 50% normal rate
-no overt Sx due to kidney adaptation
52
Renal Insufficiency
-GFR: 20-35% normal rate
-possible azotemia, anemia, HTN
53
Renal Failure
(stage)
-GFR <20-25% normal rate
-edema, metabolic acidosis, hypocalcemia
54
ESRD
-GFR: <5% normal rate
-90% kidney function lost
-all body systems involved
55
Systemic Manifestations of Kidney Failure
-decreased urine w/ abnormal constituents
-CAD, HTN, CHF, pulm edema, pericarditis
-GI bleeding, nausea, - HA, irritability irritability impaired judgment & concentration, seizures, coma
-PNS tremors, cramps weakness
-pruritis, hyperpigmentation, pallor, bruising
-anemia, platelet dysfunction
-joint pain, osteodystrophy
-fertility impairment, hyperparathyroidism
56
Leading cause of kidney failure in US
-diabetic neuropathy
57
Prevention of Kidney Failure
-edu of risk factors
58
Risk Factors of Kidney Failure
-DM (#1 cause)
-HTN (#2 cause)
-CAD
-Decreased activity
-tobacco
-NSAIDs/analgesic combos
59
Dialysis
-hemodialysis or peritoneal dialysis
60
Hemodialysis
-3x/week for 3-4 hours
61
Peritoneal dialysis
-3x daily
62
Risk of Dialysis
-infection of immunocompromised pts
63
Dialysis Considerations
-HTN before dialysis but hypotensive after
-loss lean Mm mass masked by fluid retention & weight gain
64
dialysis will improve _____ & ______ peripheral neuropathy
-sensory & motor
65
PT Considerations in CRF
-co-morbidities (in CV system)
-immunosuppression
-fatigue
-impaired O2 transport
-ex's help ctrl BP
-VO2 max is 1/3 to 1/2 normal
-S/Sx of anemia, fatigue, Mm wasting, reduced work capacity, reduced cardiac performance
66
Neurogenic Bladder
-spastic bladder dysfunction
-hypotonic bladder dysfunction
67
Spastic Bladder Dysfunction
-functional urinary tract obstruction 2* to neurologic injury
68
Hypotonic Bladder Dysfunctino
-flaccid
-can be seen in spina bifida, cauda equina, similar disorders
69
Pathophysiology of Neurogenic Bladder
-interrupted innervation results in loss of control
-may result in partial/complete urinary retention, incontinence, urgency/frequency
70
S/Sx Neurogenic Bladder
-burning sensation (not pain)
-infection common in spastic bladder
71
Cause of Death in Kidney Failure
-heart failure
72
Eval/Treat of Neurogenic Bladder
-catheterization
-bladder training
-pharmacologic interventions
73
Urinary Incontinence
-Functional Incontinence
-Overflow Incontinence
-Stress Incontinence
-Urge Incontinence
74
Functional Incontinence
-normal control but difficulty getting to toilet
-insufficient mobility
75
Overflow Incontinence
-dribbling with constantly full bladder
-when urinary outlet obstructed
76
Stress Incontinence
-uncontrollable voiding when intravesicle pressure > extravesile pressure
-"giggle incontinence"
-insufficient/weak pelvic floor Mm
77
Urge Incontinence
-sudden/uncontrollable need to void
-suggests neurologic condition (spastic bladder)
-hyper tonicity of bladder/pelvic floor Mm
78
Suggested Ex's for ESRF
-4-6x/week at low capacity
-30 min
-resistance, aerobic
79