Test #4 Chapter 68 Assessment of Renal/Urinary System Flashcards Preview

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Flashcards in Test #4 Chapter 68 Assessment of Renal/Urinary System Deck (85):

What are the 5 main functions of the kidneys?

(Could be Multiple)

1. -To maintain body fluid balance.

2- Filters waste products.

3- Regulates the acid base balance.

4-Produces Erythropoeiton

5-Converts vitamin D to the Active form.


What is the renal system composed of?

Urinary Tract,
and urethra.


How much do normal kidneys weigh?

About 8 oz


How long are normal kidneys?

About 5 inches long


***What happens if the kidneys get too big or too small?

Polycystic Kidney Disease causes the kidneys to be too big (hypertrophy)..


Chronic Kidney Disease causes the kidneys to be too small (atrophy).


Which kidney is bigger and why?

The right kidney is a little larger than the left because of the liver.


Is Kidney variation in size, shape or number uncommon?

No, some people can be born with just one. Others can be born with 3. The shapes might be a little different from person to person, but as long as the function is there we are ok with that.


Where do the adrenal glands sit?

On top of the kidney.


What do the adrenal glands secrete?

Responsible for secreting aldosterone among other things.


*** When a patient gets a kidney transplant, do they take the diseased kidney out?

Not typically. They will leave the diseased kidneys in there and put the new kidney some place else like the groin or femoral area. This means that they may have 3 kidneys but only one is probably working.


*** If someone tells you that they have 3 kidneys, what should you ask them?

Have you had a transplant or were you born with them


If you are going to palpate a kidney, which side would you be able to palpate easier?

The right side, because it sits lower. Don’t be alarmed if you cannot palpate the left. It is situated a little deeper and is harder to palpate.


**** Read, This is important

There are several layers of tissue in the kidney. They are responsible for protection, support, and filtering.

If the kidney was injured, where it was injured would depend of the type of function that you might lose.

If the kidney was injured right at the ENTRY of the kidney, the WHOLE kidney would be effected because the blood couldn’t get to it.


How much of your cardiac output do the kidney’s get?

About 25%. There is a lot of blood flow. Gets around 1000ml a min.


***If the kidneys were not getting enough cardiac output, what S/S would the patient have?

Low urine output. Minimum urine output in order to successfully remove waste products is >30ml per hour. Less than this is not good.


What is the functional unit in the kidneys?

The nephron. Urine is formed from the blood. There are about 1 million nephrons per kidney. This is why people are able to live with just one kidney.


How many types of nephrons are there?



What are the 2 types of nephrons?

1. Cortical Nephrons


2. Juxtamedullary Nephrons


What does the first step in filtration of urine take place?

Bowman’s Capsule. Blood comes into the kidneys and goes into this area, which causes the first step of filtration and urine formation.


What is Bowman’s Capsule responsible for?

Cleaning and filtering the blood to form urine.


***What is the glomerulus and where is it located?

There are specialized capillary roots that filter water and small particles. There are particles that are too big to be filtered here such as protein and glucose. The glomerulus is located within Bowman’s Capsule.


**What is normal GFR?

125 ml/min. The lower it gets, the worse your kidneys are functioning.


The functional or working unit of the Kidneys:

a) Erythropoietin
b) Renin-System
c) Adrenal Glands
d) Nephrons

d) Nephrons


Kidney function includes the following: (select all that applies)

a) Maintain body fluid and volume

b) Filters Potassium and Magnesium

c) Larger than normal kidneys are related to chronic kidney disease

d) Regulates BP and Acid-Base Balance

e) Kidneys have no variation in shape or size

a) Maintain body fluid and volume

b) Filters Potassium and Magnesium

d) Regulates BP and Acid-Base Balance


Where is renin produced and stored within the kidneys?

In the Juxtaglomerular Complex.


What is renin?

It is a hormone that helps to regulate blood flow which in turn regulates blood pressure, and GFR.


Renin-Angiotensin Pathway-

Condition that signals decreased tissue perfusion such as low blood volume, low blood pressure, decreased sodium levels ect....Stimulates secretion
of Renin In the Juxtaglomerular Complex.


**What does aldosterone do?

Helps increase kidney reabsorption of sodium and water to help restore blood pressure or blood volume issues, but in doing this, it also causes excretion of POTASSIUM.


***Just know that if a patient has really low blood pressure of like 58/ 30, you cannot rely on the renin system to help this.

They need medical intervention such as dopamine and saline.


*** If the renin system if overactive, what can it cause?



*** What are the conditions that can cause decreased tissue perfusion?

(Could be Multiple)

Low Blood Pressure,
Low blood volume,
low sodium,
and low oxygen.

**Whenever you have any of these conditions, it is going to stimulate the renin system to take action. (if the kidneys are functioning correctly)


Renin -> Angiotensinogen ->

Angiotensin I -> Angiotensin II
-> Aldosterone


**Angiotension I-

hormone that causes vasoconstriction and stimulates the release of aldosterone.

Aldosterone increases our sodium, and water follows it...so this increases our volume and causes blood pressure to increase. (remember...excretes potassium)

Angiotension I converts to Angiotension II.


Angiotensin II-

Most powerful vasoconstrictor (increases PVR) in the body WITHOUT adding more volume.

So it will constrict, hold on to urine (causes urine output to decline) resulting in more water in the circulating tissue and vascular space.

Also causes the adrenal gland to secrete the aldosterone.


Renin is produced in response to the following: (Select all that apply)

a) low blood pressure
b) high blood oxygen
c) high sodium levels
d) low blood volume
e) low blood oxygen

a) low blood pressure
d) low blood volume
e) low blood oxygen


Aldosterone helps regulate _______, ________ & ________ in the body

a) Sodium, Renin and Water
b) Sodium, Water and Potassium
c) Sodium, Water and Magnesium
d) Sodium, Potassium and Magnesium

b) Sodium, Water and Potassium


Regulatory/Hormonal Functions of the Kidneys….

What are the Regulatory Functions?

Controls Fluid, Electrolyte and Acid-Base balance .


Normal GFR is 125 ml/ min.

*** When a person has a GFR of 85ml/min and the are 100 years old, are we ok with this?

we are ok with that due to their advanced age.


Glomerular Filtration -

It can filter things such as electrolytes, waste products such as ammonia as well as glucose.

Large particles such as protein, albumin, are normally to large to be filtered so not typically seen within the urine.

If they are, it should be in trace amounts.


**What is the normal level of protein in the urine?

Protein >0.8mg/dL

- protein is a larger particle. You might a just a touch in the urine, but should never be greater than 0.8


**On a UA, if the patient has a protein level of 1, what does that mean to you?

That there is something wrong that is causing it to spill out into the urine.


**Tubular Reabsorption -

This is the second phase or process in urine formation. There is a glucose renal threshold which means that the kidneys can only handle so much. If your patient has a Glucose >220 it will spill into urine which can be found on a UA. If this happens, you must check the patients blood glucose level. Then determine an intervention to manage it.


**Tubular Secretion-

This is the 3rd phase or process behind urine formation.

This causes electrolyte manipulation such as determines whether potassium is going to be pulled off or held on too ect... K+ (Potassium) and H+ (Hydrogen).

This is where we try to maintain homeostasis of electrolyte/acid-base balance.


**What happens when someone has severe vomiting, what will the kidneys do?

Throwing up causes you to lose all of your H+ (hydrogen) and the kidneys will try to fix the problem by holding on to H+ and letting go of K+.

The kidneys are not able to hold on to K+ and H+ at the same time.

This can cause hypokalemia.


**What S/S will you see in a patient who has Hypokalemia?

Cardiac issues, Weakness.


Antidiuretic Hormone-

regulates the amount of water excreted by the kidneys.

Increases PVR, Vasoconstricts, keeps water onboard.

Also called Vasopressin.


When someone gets dehydrated which hormone will that trigger?



What inhibits ADH?



What do the Hormonal Functions of the kidneys control?

Controls RBC formation,
and Vitamin D activation.. Renin



a group of lipid compounds that are derived enzymatically from fatty acids that are located all over the body.

Prostaglandins are not endocrine hormones, but are autocrine or paracrine, which are locally acting messenger molecules.

**With the kidneys, their job is to manage and to increase renal blood flow. That is its function.



(Could be Multiple)

this releases in response to Angiotension II, ADH, and Prostaglandins.

It is responsible for dilating the peripheral blood vessels, increases capillary permeability, all to increase kidney blood flow.



controls RBC production. If someone has poor kidney function, they can develop Anemia.


Vitamin D Activation-

The kidney aides the body in absorbing the calcium and phosphorus as well, so if we have kidney failure or problems, they cannot activate vitamin D anymore.

If this is not caught in time, your body will require more calcium in order to fix the problem and pull it from your bones until that is depleted, resulting in more issues.


A patient comes to the ER after vomiting for 5 days. The renal system will compensate by:

a) holding onto potassium at the expense of hydrogen.

b) holding onto magnesium at the expense of hydrogen.

c) holding onto hydrogen at the expense of potassium.

d) holding onto potassium at the expense of magnesium.

c) holding onto hydrogen at the expense of potassium.


How many Ureters do we have?

1 for each kidney. Their responsible for moving the urine from the kidneys into the bladder via the contractions of smooth muscles.


What is the responsibility of the bladder?

To store the urine. It also determines whether or not someone will be continent or not.



the ability to void voluntarily. Once the bladder is filled, it stretches resulting in the sensation that it is time to urinate.



narrow tube, lined with epithelial cells. Its purpose is to help eliminate urine from the bladder.

The two things that make this site important are the mens length and the woman’s length.

Men= 6-8 inches and women = 1- 2 inches.

This matters because of putting in catheters as well as UTI’s.

Women get more UTI’s then men because of their short urethra.


**** Kidney/Urinary Changes with Aging-

(Could be Multiple)

as you age, your kidneys decrease in size.

Blood flow decreases 10% every decade.

GFR will decrease as you age as well.

If you have HTN, Obese, Diabetes, CHF, your GFR will really decline as you age.

Sphincter over time becomes weaker resulting in some incontinence issues.

Men get an enlarged prostate which can lead to UTI from urinary retention.


Assessment Methods

Demographic Information-
Socioeconomic Status-
Medication History-
Nutrition History-
Current Health Problems-
Family History-
Physical Assessment


Demographic Information-

general blanket statement- age, gender, race.

Females more prone to UTI than men.


Socioeconomic Status-

money, language barriers. The lower socioeconomic status they have, the less apt that they are to come in for prevention or come promptly for treatment. May or may not have insurance.



the need to urinate more often than usual.



or hypouresis, is low output of urine.



The absence of urine. Less than 50 ml/day



Painful Urination


**** Nutrition History-

What is most important is the patients fluid intake. (Fluid meaning water). 2-3 liters a day is standard. When a patient has kidney stones, it increases to 3-4 liters a day. This will prevent UTI or Bladder problems.


True or False

Sometimes when people are having a build up of waste products because their kidneys are not functioning well, it can alter their taste.



***Medication History-

NSAID’s, Aleve Antibiotics can decrease kidney function because they are metabolized by the kidneys.


*** Family History-

if a patients family member has Polycystic Kidney Disease, they have a greater chance at developing it.


*** Current Health Problems-

Assessing Kidney function by UA. A UA assesses kidney function.

Need to chart color, sediment, odor, how much.

The lab generally needs about 10 cc’s in order to run it.

Minimum urine output an hour is 30ml


***Physical Assessment-

What is the Order of Assessment on Kidney exam?

Inspect the abdomen, Auscultate, Palpate. Assess the flank to see if they are having bruising.

LOC- waste can build up when the kidneys decline in function and they can become confused. If they are elderly (especially women), and they are confused and falling. Could mean UTI, need to get UA.

CVA- Costal Vertebral Angle. Tap area with your fist to check for tenderness. If there is tenderness usually means kidney infection.

Grey Turner’s Sign-

Cullen’s Sign-


Grey Turner’s Sign-

Flank bruising. Usually caused by pancreatitis. Something serious such as internal bleeding.


Cullen’s Sign-

Bruising of the belly button. First found with ectopic pregnancy.


Diagnostic Tests:

Urine Osmolarity-
BUN/Creat ratio-

Bladder Scanners-

Imaging (CT/Urography)-



Blood Urea Nitrogen. Normal range is 10-20.

If it goes up, think ok this person is dehydrated.

Interventions include increasing fluids. If at home, drink more water PO. If at hospital, need to hang more fluids. (Check IV)


**Creatinine levels-

Normal range 0.5 - 1.2 This increases related to kidney functioning. It will increase as kidney function declines.


Urine Osmolarity-

Normal is 300-900. This is related to urine concentration.

As it increases, this means the person is dehydrated. The more it increases, the more dehydrated the person is.

Interventions include increasing fluids. If at home, drink more water PO. If at hospital, need to hang more fluids. (Check IV)


** BUN/Creat ratio-

same concept. It increases related to dehydration.

****If you do not have an increase in the ratio, but you do have an increase in both BUN and Creatinine, you start to be concerned about renal impairment.



Normal 125 ml/min if it decreases means that kidneys are not functioning properly.


Normal Urinalysis Results
(Could Be Multiple)

pH- 4.5 to 8 is normal.

Specific Gravity- 1.005-1.030 is normal - if this level is increased, it is usually related to dehydration or low blood flow to the kidney. Interventions include increasing fluids. If at home, drink more water PO. If at hospital, need to hang more fluids. And teach not to drink sodas.

Protein- less than 0.8- if it gets high, it means the GFR is not filtering correctly and it is spilling protein and large particles over into the urine.

Glucose- neg or none. if seen in the urine means patient has < 220 in their blood. Need to check them

Nitrates/Ketones/WBC/ Bacteria = Should be 0. If in urine suspect a UTI.


A client’s UA shows all of the following results. Which result does the nurse report to the health care provider?

a) pH 6
b) Protein 0.8mg/dL
c) Specific Gravity 1.005
d) Nitrates present

d) Nitrates present


*** Bladder Scanners-

measures the amount of urine within the bladder. (Bladder volume)

Standard rule is that we do 2 complete scans for accuracy.

The main thing that is important is that you have to select male or female on the machine.

***A female who has a hysterectomy must choose male on the machine.


Imaging (CT/Urography)-

uses dye, it flows through the veins and lights up to show us what we need to see.

It is potentially damaging to the kidneys because it is hard to filter.

***Must check the creatinine level to determine how the kidneys are functioning.
Must run before scan.

Once the creatinine is elevated above 1.8-2 they will not use Dye.

**The other rule is that when a patient is on Metformin, they are supposed to discontinue it 24 hours before their CT and they cannot start it again for 48 hours.

***Educate them to increase PO fluids (water) and at least a liter IV at hospital.


**** What level is the gold standard for evaluating kidney functioning?

Creatinine. Normal range 0.5 - 1.2