Unit 3 Urinary Flashcards
(66 cards)
1
Q
What are the generic functions of the urinary system?
A
Vit D production (if low then leads to bone issues) BP regulation (aldosterone/renin) RBC production (erythropoietin) Elec balance (phos, calcium) Filters (urea) Ph balance
2
Q
What are the 3 steps to filtration?
A
Glom filtration
Tubular Reabsorption
Tubular secretion
3
Q
What substances are secreted and reabsorbed in the kidney, and where?
A
PROX tubule: Reabsor-Na, Cl, HCO3, K, H20, glucose, AA Secretes-H, organic acids/bases DEC LOOP HENLE: Reabsor-H2O ASC LOOP HENLE: reabsor-Na, Cl, K, Ca, HCO3, Mg Secretes-H DISTAL: Reabsor-Na, Cl, Ca, Mg LATE DISTAL: reabsor-Na, Cl Secretes-K ADH mediated H2O reabsorption
4
Q
Describe the normal statistics/rates of the glomerular filtration with normal blood flow.
A
Blood flow thru kidney 1200ml/min 20% filtered to nephron 80% back into circulation 180L/day filtrate 125ml/min filtrate formation High pressure system
5
Q
What is renal glycosuria?
A
Tubular failure of glucose Reabsorption.
6
Q
What is hormonal response with too much or too little fluid?
A
Too much-inc hormone secretion
Too little-inc hormone secretion
7
Q
What are normal tubular filtration rates?
A
180L/day into tubules
99% reabsorbed into bloodstream
1-2 L of Urine produced daily
Filtrate becomes concentrated in distal tubule and collecting ducts.
8
Q
What is the job of ADH (vasopressin)?
A
Hormone released by post. Pit in response to blood Osmolality.
Acts on kidney, increases water Reabsorption decreasing blood Osmolality, dec urine output.
Note: dilute urine w/ fixed sp. grav 1.010 indicates inability to concentrate urine=kidney dz
9
Q
What is the job of aldosterone?
A
Steroid Hormone synthesized by adrenal cortex By angiotensin 1 and 2 controls (which are controlled by renin enzyme). Regulates sodium volume excretion. Inc aldosterone allows reabsorbs Na. Dec Na in urine.
Note: allows k excretion to maintain BP also.
10
Q
When ANP or BNP are produced, what occurs, and how is BP affected?
A
ANP- present when atria overstretched
BNP-Present when ventricles are overworked
Both cause kidney to stop reabsorbing NaCl, so NaCl and H2O are lost in urine decreasing volume therefore dec stretch and workload of the heart. (shuts down renin-angio-Aldos sys)
11
Q
How long are the ureters? How much urine does the bladder need to stimulate an urge?
A
12 inches
200 ml (detrusor muscle)
12
Q
Define the following terms: Anuria Dysuria Enuresis Frequency Oliguria Pyuria
A
Anuria:output less than 50ml/day Dysuria: painful/difficulty urinating Enuresis: invol. Voiding during sleep Frequency: voiding more than q 3hr Oliguria:output less than 0.5 ml/kg/h Pyuria: pus in urine (wbc's)
13
Q
What are some common urinary changes in the older adult?
A
Dec of 1ml/min annually Dec renal reserve Dec med excretion Prone to hypernatremia and hypovolemia Dec muscle mass=urinary leakage Dec GFR and tubular function Incontinence
14
Q
What are post cytoscopic expectations?
A
UTI, Hematuria, edema, pain, antibiotics.
15
Q
What stimulates urination?
Urine storage?
A
Stretch receptors in bladder detrusor muscle stims urination by pons spinal reflex. PNS (micturition center) stims bladder contraction, external sphincter relaxes.
Cortical inhibition, stim SNS, relax detrusor, stim sphincter contraction.
16
Q
What are the lower spinal cord centers that are stimulated for the urinary system?
A
T11-S4
Detrusor and bladder neck trigone
17
Q
How much urine stims micturition reflex? How often times a day is normal?
A
150-250ml
8x/day
18
Q
Diff the types of incontinence.
A
Stress:losing invol with intact urethra from cough/sneeze (pressure, dec estrogen, urethral wall thinning, prostate)
Urge:
Functional:no physical urinary issue, caused by other factors (immobility, dementia)
Iatrogenic:medication factors causing alpha adrenergic mimics stress incont (hypertensives and cholinergics)
19
Q
What are the causes of urinary incontinence?
A
Neurological d/o Spinal cord injury/dysfunction Non neuro d/o: Bashful bladder Overactive bladder Overflow incont Surgery/radiation/interstitial cystitis
20
Q
Diff neurological urinary incont for spastic and flaccid bladder.
A
Spastic:cannot store.
Upper motor neuron dysfunction
Flaccid: failure to empty.
Lower motor neuron dysfunction (stroke, sc injury, MS)
21
Q
That bladder is only under _______ control. Visceral organs are under ______ control.
A
Autonomic
CNS
22
Q
What is the causes of reversible urinary incont?
A
DIAPPERS Delirium Infection Atrophic vaginitis, urethritis Pharmacologic agents (iatrogenic) Psychological factors (bashful) Excessive urine production Restricted activity (functional) Stool impaction
23
Q
What are the clinical manifestations for incont? Tx?
A
UTI/infection Constipation Dec fluid intake Dec bladder tone, capacity Inc residual urine Inc in urgency
Urodynamic
Bahavioral therapy-move q2hr
Pharm-overactive: anticholin (dec SNS), tricylates (dec contractions)
Surgery
24
Q
How is a urodynamic performed?
A
Full bladder then urinate then insert Cath to measure bladder and then fill bladder with fluid to measure strength of bladder and voiding.
No caff/carbonation
25
What are some causes of urinary retention?
```
Poor contraction of detrusor
Obstruction (BPH, stones, inflam)
Aging over 60-dec det muscle, inc resid 50-100ml commonly, inc prostate
Antidep, anticholin, antihyperten
Pain
Neuro d/o
Pregnancy
```
26
What are clinical manifestations of retention?
```
(Retention and UTI s/s same)
Frequency
Dribbling
Bladder fullness (sometimes)
Distention
Pain (low abd/back)
Restlessness, agitation
UTI s/s
Poor stream
Straining
Inc BP, diaphoresis=call to dr for bladder scan, may need Cath
```
27
What are some comps of retention?
```
UTI
Renal calculi
Sepsis
Pyelonephritis (renal infection)
Hydronephrosis (renal swelling w/backup)
Perineal skin breakdown
ACUTE:FIXABLE
CHRONIC: DAMAGE, RIGID, THICKENING
```
28
What is nurse management for retention?
```
Voiding diary (amount, frequency)
Post void residual Cath or scan
Voiding pattern
Warmth/sitz
Analgesics
Mon v/s q4hr
```
29
For neurogenic bladder caused by CNS dysfunction, diff the manifestations of both spastic and flaccid bladder.
Spastic:overactive. Loss of sensation and motor control, empties on reflex. Spasms (detrusor/sphincters), dec bladder volume, above T12 (lesions), leakage.
Flaccid:overflow (under active).Distended bladder, sensory loss of muscle contraction. No discomfort. Below T12. can't tell if need to void. Leakage.
30
What are some comps of neurogenic bladder (spastic/flaccid)?
```
Infection
Stones
Ureterovesical reflux: uretervesical valve allows urine to flow into ureters during voiding.
Hydro nephrotic: kidney swelling
Renal failure
```
31
What are nursing management for neurogenic bladder?
```
Caths
Bladder training
Low calcium (dec stones)
Infection prevention
Inc fluids
Stoma care
```
32
```
Explain the pharm tx's for urinary:
Parasympathomimetic:bethanecol
Antispasmodics:flavoxate
Antiinfective:nitrofurantoin
Analgesic:phenazopyridine
Diuretics:furosemide
Alpha-adrenergic blocker:tamsulosin
```
Bethanecol:alleviate dry mouth, tx of retention, long duration, stims muscularinic receptors. Contra:ASTHMA
Flavoxate:tx bladder infection symptoms! Relax smooth muscle/bladder= dec leakage
Phenazopyridine:pain of UTI (relieves UTI) Orange urine, take w/ food. Changes urinary diagnostics/glucose) check kidney function.
Tamsulosin:tx prostate enlargement, wear gloves, relaxes smooth muscle prostate. SE: lightheaded
33
Explain the use of CCP (Indiana pouch).
Bladder removed, intestine used for tube/Stoma. Can control. No bag. Will use in/out Cath based on fullness feeling. Q2hrs until healed then q3-4hrs. Irrigate w/200mls saline daily or when mucus build up.
34
Explain neo-badder use.
New bladder implant (internal diversion). Sm intestine used and ureter attached to new bladder normal urethral use.
Weeks to months to detect fullness, no nerve control, dec sensation.
35
What is important to remember about a nephrostomy?
Never clamp
Never irrigate unless dr says
Measure output (if both kidney) separately
Notify dr if tube dislodges
36
What is the difference between complicated and uncomplicated UTI? What are the upper and lower UTI's?
Complicated-abnormality, Cath
Uncomp-com acquired
Lower:cystitis (bladder), prostatitis (prostate), urethritis (urethral)
Upper:pyelonephritis (renal pelvis), interstitial nephritis (kidney), renal abscess/peri renal abscess
37
What are s/s for cystitis vs pyelonephritis.
Cystitis:
Frequency, urgency, suprapubic pain, dysuria, Hematuria, fever, confusion (elderly)
Pyelonephritis: (sicker)
Flank pain, dysuria, pain at costovertebral angle, and all cystitis s/s
38
Diff acute vs chronic pyelonephritis. Can this be caused by systemic infections like TB?
Acute:(looks sicker)
Chills, fever, low back pain, n/v, ha, malaise, painful urination, leukocytosis, bacteriuria, Pyuria
Chronic: (less symptoms)
Fatigue, ha, poor appetite, polyuria, thirst, weight loss. Inflammation/fibrosis lead to scarring/kidney failure.
YES! And chronic from persist at autoimmune infection
39
What can the following diagnostics detect?
c&s: bacteria
U/s or ct:obstruction
IV pyelogram: structure/function abnormalities
Radionuclide imaging: infection hotspots
40
How are nephritic syndrome caused? What occurs? What s/s present with this acutely?
```
Post infection: strep, staph, viral, cause antigen-antibody complex leading to clogged caps, and then inflam responses impeding blood flow (RBC epithelial losses) and filtration.
Oliguria
Proteinuria (minor)
*Hematuria w/ casts (packed cells dislodged from tubule),sediment
Azotemia (nitrogen in blood)
Edema
HTN
Inc BUN/Creat
Anemia (loss of RBC in urine)
INFLAMMATION
```
41
What are treatments for acute nephritic syndrome?
Dietary modifications: restrict protein and sodium. (Kidney not filtering, dumping, kidney damage inc w/ protein. Sodium contributes to inc BP)
0.7g/kg/day protein (fish, poultry, eggs) need to inc cal 35 cal/kg because weak and dec appetite. Fluids may worsen edema.
Tx underlying infection causing issue.
42
What causes chronic glomerularnephritis?
Over 3 mths repeated episodes of acute nephritis.
Hypertensive nephro sclerosis
Hyperlipidemia (serum lipids kidneys cannot excrete)
Lupus
Diabetes
Amyloidosis (protein deposited into organ tissue)
Good pasture syndrome (antibody to glom basement membrane)
43
What are s/s of chronic nephritis?
```
Weight loss
Weakness
Irritability
Nocturia
Ha/dizzy/yellow gray skin (dec filt inc toxin build up)
Depend edema
Eye hemorrhage
Pale mucus membrane
Jvd
Cardiomegaly/gallop cardiac rhythm
Crackles
Dec DTR
Confusion
MONITOR FOR: weight, BP, neuro, cardiac
Elec imbalances (potassium if above 6 then emerg dialysis)
```
44
How is nephrotic syndrome caused? What occurs?
BM/podocytes malfunction/disappear and lose protein in glomerulus losing up to 3.5G protein/day stim lipoproteins syn (liver compensating) leading to hyperlipidemia. Protein loss leads to hypoproteinuria then dec osmotic pressure inc edema then renin angio sys and sodium reten inc edema.
45
What are the s/s for nephrotic syndrome?
```
Protein loss.
Frothy urine
Severe edema (waist down)
Inc lipids serum
Dec protein serum INC in urine
ATIII dec-hyper coag (inc risks for DVT, PE)
Ascites
Pleural effusion
Muehrckes line (nails)
Confusion
```
46
What are some complications of nephrotic syndrome?
Infection (immune sys affected dec response/normal defenses. Thromboembolism (renal vein, but can travel)
PE (dyspnea)
Acute renal failure
Atherosclerosis
47
How is nephrotic syndrome treated?
treat the Cause
Diuretic (furosemide)
Lipid lowering (statins)
Corticosteroids
Immunosuppressants (since at risk for infection)
Enalapril (ace I-SE COUGH, dec protein in urine)
48
What are the s/s for nephrotic syndrome?
```
Protein loss.
Frothy urine
Severe edema (waist down)
Inc lipids serum
Dec protein serum INC in urine
ATIII dec-hyper coag (inc risks for DVT, PE)
Ascites
Pleural effusion
Muehrckes line (nails)
Confusion
```
49
What are some complications of nephrotic syndrome?
Infection (immune sys affected dec response/normal defenses. Thromboembolism (renal vein, but can travel)
PE (dyspnea)
Acute renal failure
Atherosclerosis
50
How is nephrotic syndrome treated?
treat the Cause
Diuretic (furosemide)
Lipid lowering (statins)
Corticosteroids
Immunosuppressants (since at risk for infection)
Enalapril (ace I-SE COUGH, dec protein in urine)
51
What are the 4 types of kidney stones and their causes/tx?
Calcium (oxalate/phosphate)-hypercalcemia, PTH d/o, bone dz, immobile. *inc fluid, thiazides, tx cause, Dec ca/oxalate in diet.
Mg ammonium phosphate-urea split UTI. *inc fluid, inc acid (cranberry juice, vit c, coffee, tea), tx UTI.
Uric acid-acidic urine (pH 5.5), high purine diet, gout. *inc fluid, alkalinize urine, allopurinol.
Cystine-inherited. *inc fluid, alkalinize urine. Common in kids.
52
What is important to remember post op for extra corporeal shockwave lithotripsy and percutaneous nephrolithotomy for nephrolithiasis?
Lithotripsy-hematuria X 4-5 days common
Percutaneous-infection/bleeding. F/U urine cultures 2-3 months.
Call dr w/ fever (101), retention/oliguria, chills.
53
What is urolithiasis? Cause/tx?
Bladder stone.
Concentrated urine d/t retention/Stasis (inc sediment).
S/s:low ab/penile pain, dysuria/nocturia, diff w/ flow, hematuria, cloudy/dark urine.
54
What are important post op measures for a radical nephrectomy?
```
BLEEDING!
V/s, ab distention, I/o, daily weight, output 30-50ml/hr, spec grav, hypoten, consciousness, bs for paralytic ileus, adrenal glad insuff-large output, hypo, then oliguria.
Semi fowlers
C, T, DB
No irrigating nephrostomy tube
```
55
Diff acute vs chronic renal failure.
Systemic d/o
Acute:reversible, dec GFR, oliguria (may have high output initially then lead to hypovolemia, then dec urine output)
Chronic:nonreversible, renal damage, azotemia (nitrates), inc bun/creat/toxins
*sicker
56
What are the types of acute renal failure? Causes? Tx?
PreRenal-dec blood supply (shock, dehydration, vasoconstriction, s/p surg *dec GFR) Inc fluid (fluid challenge-500ml IV-good output indicates)
IntraRenal-DAMAGE, tubule dysfunction (ischemia, necrosis, toxins, obstruction *dec GFR, azotemia, F/E imbal)
PostRenal-urine flow blocked (stones, tumor, stricture, prostate)
*pre and post can lead to intra. >3mths=chronic=irreversible
57
For intra renal acute renal failure, toxins can contribute. What nephrotoxic agents are key?
```
Amino glycoside antibiotics (gentamicin, tobramycin, Vanco)
Contrast dye
Heavy metal (lead, mercury)
Solvents/chemo (arsenic)
NSAIDs
ACE I's
```
58
What are the phases of ARF?
Initial insult to kidney
HIGH OUTPUT-hypovolemia *some
Oliguria:Uremic symps-hyperkalemia, dec u/o <400ml/day (cardiac)
Diuresis: Dehydration-GFR inc (dumping toxins)
Recover: 3-4 months
59
What are manifestations of ARF?
```
N/V/D
Skin/mucus dry
drowsy, sz, ha
Dec u/o, hematuria, dec spec grav (toxins staying in serum)
Hyperkalemia (dysrythmias)
Anemia (rbc loss, lack of erythro)
Inc BUN/creat
Metab acid (not making bicarbonate)
Inc phosphate (not absorbing in intestine), dec calcium
```
60
What are the post op managements for renal transplant?
Output occurs immed. Rejection meds for life.
Hyper acute rejection occurs w/I 24hrs
Acute rejection w/I 3-14 days
Glucocorticoids (adrenal removed too)-prednisone
Leukocyte mods-azathioprine (Imuran), cyclosporine
Infection prevention(chills, fever, tachypnea/tachycardia, inc WBC)
61
```
What do the following diagnostic tests do?
PSA
Transracial ultrasonography
Prostate fluid/tissue analysis
Tests of male sex function
```
PSA-protein produced by prostate-checking if in blood (norm:0-4, BPH 4-8, CA >10)FALSE results by: age, rectal exam, bike riding, recent ejaculation, finestiride (ED))
TU-inflammation/ca -stage
Fluid-psa level/mass
Male sex-nocturnal penile termescence-circumference during sleep.
62
```
What are the following:
Hematocele
Varicocele
Spermatocele
Testical torsion
```
Hemat:blood in scrotum
Vari: veriscosities in veins that support testes.
Sperm:cyst at end of epididymis
Test tors:twisting of spermatic cord.
63
What causes prostatitis? S/s? Tx meds?
(4 types) inflammation caused by infectious agent (e.coli)
Sudden fever, dysuria, prostatic pain, UTI symps (freq, urg, hes, noc, hemat), painful BM, malaise.
Antibiotic (TMPSMZ-sepra)
Antispasm Alpha adren block (tamsulosin, doxa)
Sitz, encourage fluids, avoid irritants (coffee, tea, choc, cola, spices), avoid arousal/intercourse during acute.
F/u 6-12months
64
What is used to treat BPH?
Cath
Alpha adren blocker (relax smooth muscle) doxazosin, tamsulosin
5 alpha reductase inhib (dec pros size) finasteride
TU microwave heat tx
TU needle ablation
TURP
At risk: obesity, smoking, inc estrogen, dec testosterone, htn, alcoholism
65
What are manifestations of prostate ca?
No symptoms early.
Urinary obstruction symps
Hematuria and semen
Painful Ejaculation
Metastasis usually brings about symptoms
Stage 4-lymph nodes affected
66
What are some complications of prostatectomy?
Very vascular.
```
Hemorrhage shock
Infection (dressing)
DVT
Cath obstruction
Incontinence
Sex dysfunction
```
