Chapter 45 Urinary System: Upper And Lower Structures And Functions

Front 1

What does the upper urinary system consist of?

Back 1

Two kidneys and two ureters

Front 2

What is the lower urinary system consist of?

Back 2

Bladder and urethra

Front 3

What are the six primary functions of the kidneys?

Back 3

Regulate fluid and electrolyte balance

Excrete waste products from body

Secrete renin to regulate BP

Secrete erythropoietin to stimulate bone marrow to produce RBCs

Synthesize vitamin D for calcium absorption and regulation of parathyroid hormones

Maintain acid-base (pH)

Front 4

Nephrons

Back 4

Functional units of the kidneys, composed of glomerulus, Bowmans capsule and a tubular system.

Front 5

Glomerulus

Back 5

Tiny ball shaped strucutre compoased of capillary blood vessels that are actively involved in the filtration of blood to form urine.

Front 6

Bowman's Capsule

Back 6

Double walled capsule that surrounds the glomerulus. Serves as a filter to remove organic wastes excess inorganic salts and water.

Front 7

Tubules

Back 7

Filtered fluid is converted to urine in the tubules. Consists of proximal convoluted tubule, descending loop of Henle, ascending loop of Henle, and distal convoluted tubule

Front 8

Where does urine formation begin?

Back 8

The glomerulus

Front 9

What is the glomerular filtration rate?

Back 9

Amount of blood filtered each minute by the glomeruli

Front 10

What is a normal GFR?

Back 10

125 mL/minute

Front 11

How much of the GFR is excreted as urine?

Back 11

1 mL/minute (Out of 125 mL/minute GFR)

Front 12

What is solutions are reabsorbed in GFR?

Back 12

Water, electrolytes and solutes.

Front 13

What solutions are secreted in GFR?

Back 13

Creatinine, hydrogen ions, and potassium.

Front 14

What hormone is primarily responsible for reabsorption of water by the kidneys?

Back 14

ADH (Antidiuretic hormone)

Front 15

Where is ADH produced and where is it secreted?

Back 15

It's produced in the hypothalamus and secreted from the posterior lobe of the pituitary gland to the kidney's distal convoluted tube.

Front 16

What stimulates secretion of ADH?

Back 16

Dehydration, high sodium intake, and by decrease in blood volume.

Front 17

What happens when ADH is lacking?

Back 17

Diabetes insipidus

Front 18

What happens with water in the body when Na is increased?

Back 18

Extra water is reserved to preserve osmotic pressure

Front 19

An increase in water and sodium produces an increase in what?

Back 19

Increase in blood volume and BP

Front 20

When the BP increases the glomerular filtration increases or decreases?

Back 20

Increases

Front 21

Renin

Back 21

Enzyme secreted by kidneys, important regulator of BP.

Front 22

When is renin released into the blood stream?

Back 22

Decreased renal perfusion, decreased BP, decreased ECF, decreased Na, and increased urinary Na concentration.

Front 23

Renin converts ______________ into _________________

Back 23

Angiotensinogen (From liver) ---> Angiontensin I

Front 24

What does ACE (Angiotensin converting enzyme) do?

Back 24

Converts Angiotensin I to Angiotensin II

Front 25

Angiotensin II

Back 25

Stimulates the release of aldosterone from the adrenal cortex which causes Na and water retention. Leading to increased ECF.

Front 26

Aldosterone

Back 26

Steroid hormone produced by the adrenal cortex in the adrenal gland. It plays a major role in BP by causing reabsorption of water and sodium.

Front 27

With sodium retention what electrolyte is secreted?

Back 27

Potassium

Front 28

Water retention causes an increase or decrease in BP and blood volume?

Back 28

Increase in BP and blood volume.

Front 29

Aldosterone increases one electrolyte and decreases the other, which two electrolytes?

Back 29

Increase Na, and decrease in K

Front 30

Normal pH of body

Back 30

7.35-7.45

Front 31

Strong acids (<7.35) are neutralized by what?

Back 31

Sodium bicarbonate

Front 32

What controls sodium bicarbonate?

Back 32

Kidneys

Front 33

Strong bases >7.45 are neutralized by what?

Back 33

Carbonic acid

Front 34

What controls carbonic acid?

Back 34

Respiratory system

Front 35

What is erythropoietin? what is it secreted in response to? wheres it created

Back 35

Hormone produced by kidneys and secreted in response to hypoxia and decreased renal blood flow. Stimulates RBC production.

Front 36

What do adrenal glands do?

Back 36

Influence BP and Na and water retention.

Front 37

Ureters function

Back 37

Carry urine from renal pelvis to bladder

Front 38

Urinary bladder function

Back 38

Serve as a reservior for urine and to eliminate waste products from the body

Front 39

What is a normal output from body? (mL/dayz)

Back 39

Approx. 1500 mL/day.

Front 40

How many mL in the bladder will cause moderate distention and urge to urinate?

Back 40

200-250 mL

Front 41

How many mL in the bladder of urine will make the person feel uncomfortable?

Back 41

400-600 mL

Front 42

What's an average bladder capacity?

Back 42

600-1,000 mL

Front 43

What changes in assessment can be expected with gerontologic?

Back 43

Less palpable kidneys, increased BUN/creatinine, decreased ability to concentrate urine, nocturia, alterations in drug excretion, palpable bladder after urination because of retention, stress incontinence, frequency/urgency, overactive bladder, and hesistency.

Front 44

PMH to ask about r/t GU

Back 44

HTN, diabetes mellitus, gout (inability to excrete uric acid), lupus erythematosus, skin/upper respiratory infections of strept origin, TB and viral hepatitis.

Front 45

What medications should you ask about r/t GU?

Back 45

Diuretics, pyridium (UTI pain), macrodantin. Anticoagulants.

Front 46

What are some medicines that can affect the bladders ability to contract and relax?

Back 46

CCB, antihistamines, neurologic and muscoloskeletal disorder medications.

Front 47

What can anticoagulants cause to happen with urine?

Back 47

Hematuria

Front 48

What are some examples of nephrotoxic medications?

Back 48

NSAIDs, antibiotics, captopril and lithium

Front 49

What are some general symptoms of abnormal kidney function?

Back 49

"Feeling tired all the time", changes in weight or appetite, excess thirst, fluid retention, headaches, pruritus, and blurred vision.

Front 50

Why does itching occur with abnormal kidney function?

Back 50

High levels of phosphorus in the body.

*Dialysis does not effectively remove phosphorus, foods high in phosphorus is prescribed.

Front 51

What is a high risk factor for bladder cancer?

Back 51

Cigarette smoking

Front 52

What are some factors that increase chance of getting bladder tumors?

Back 52

Textile workers, hairdressers, painters and industrial workers.

Front 53

What areas of the U.S have a higher incidence of urinary calculi?

Back 53

Great Lakes, Southwest, Southeast

Front 54

What is the number one thing to do to monitor a pt w/ kidney problems?

Back 54

Daily weight, same time of day, same scale, same clothes.

Front 55

What color changes in skin can occur with kidney dysfunction?

Back 55

Pallor, yellow-grey cast, excoriations, changes in turgor, bruises, texture rough dry skin.

Front 56

When palpating the kidneys what is the landmark to help you find them?

Back 56

Costovertebral angle (CVA) formed by rib cage and vertebral column.

Front 57

Can a normal sized kidney be palpated?

Back 57

No.

Front 58

How do you palpate the right kidney?

Back 58

Place left hand behind and support the pts right side between the rib case and iliac crest. Elevate the right flank w/the left hand. Use your right hand to palpate deeply for the right kidney.

Front 59

How to percuss the kidney

Back 59

Strike the fist of one hand against the dorsal surface of the other hand which is placed flat along the posterior CVA margin.

Front 60

What is the name of the technique of percussing the kidney

Back 60

Kidney punch

Front 61

In a normal finding when percussing the kidney is pain normal?

Back 61

No

Front 62

How much urine has to be in the bladder for it to be percussed?

Back 62

150 mL

Front 63

What should you use to auscultate the kidneys?

Back 63

The bell of the stethoscope

Front 64

What is auscultated for a bruit?

Back 64

Abdominal aorta and renal arteries

Front 65

What does a auscultated bruit indicate in the GU system?

Back 65

Impaired blood flow to the kidneys

Front 66

Anuria

Back 66

No urination, 24 hr urine <100 mL.

Front 67

Etiology of Anuria

Back 67

Acute kidney injury, end-stage renal disease, and bilateral ureteral obstruction.

Front 68

Burning on urination etiology

Back 68

UTI, urethral irritation

Front 69

Dysuria

Back 69

Painful/difficult urination

Front 70

Etiology Dysuria

Back 70

UTI, interstitial cysts, and pathologic conditions

Front 71

Enuresis

Back 71

Involuntary nocturnal urinating

Front 72

Etiology of enuresis

Back 72

Lower urinary tract disorder

Front 73

Urinary Frequency Etiology

Back 73

Acutely inflamed bladder, retention w/ overflow, and excess fluid intake.

Front 74

Hematuria

Back 74

Blood in urine

Front 75

Hematuria Etiology

Back 75

Cancer of GU tract, blood dyscrasias, renal disease, UTI, kidney stones, and medications (anticoagulants)

Front 76

Etiology of Urinary Hesitancy

Back 76

Partial urethral obstruction

Front 77

Etiology of Incontinence

Back 77

Neurogenic bladder, bladder infection and injury to external sphnicter.

Front 78

Nocturia Etiology

Back 78

Renal disease with impaired concentrating ability, bladder obstruction, HF, diabetes mellitus, and after renal transplant

Front 79

Oliguria

Back 79

Diminished amount of urine in a given time (24 hour urine output of 100-400 mL)

Front 80

Etiology of Oliguria

Back 80

Severe dehydration, shock, transfusion reaction, kidney disease, and end-stage renal disease.

Front 81

Etiology of pain of suprapubic area (bladder), urethral area, and flank pain.

Back 81

Infection, urinary retention, foreign body in urinary tract, urethritis, pyelonephritis, renal colic or stones.

Front 82

Pneumaturia

Back 82

Passage of urine containing pus

Front 83

Pneumatria Etiology

Back 83

Fistula connections between bowel and bladder, gas-forming urinary tract infections.

Front 84

Polyuria

Back 84

Large volume in urine at once

Front 85

Etiology of polyuria

Back 85

Diabetes mellitus, diabetes insipidus, chronic kidney disease, diuretics and excess fluid intake

Front 86

Etiology of urinary retention

Back 86

After pelvic surgery, childbirth, catheter removal, urethral stricture or obstruction neurogenic bladder, postanesthesia

Front 87

Stress Incontinence

Back 87

Involuntary urination with increased pressure (Sneezing, coughing etc...)

Front 88

Etiology of stress incontinence

Back 88

Weakness of sphincter control

Front 89

Creatinine Clearance Test

Back 89

Common test used to analyze urinary system disorders, blood for creatinine should be determined. Closely approximates the GFR

Front 90

Creatinine

Back 90

Waste product of protein breakdown (primarily by body muscle mass)

Front 91

Normal Creatinine Clearance

Back 91

70-135 mL/minute

Front 92

After age 40 y/o how much does creatinine clearance begin to slow down?

Back 92

1 mL/min/year

Front 93

Urinalysis

Back 93

General examination of urine to establish baseline info or provide data to establish a tenative diagnosis and determine whether further studies are to be ordered

Front 94

What are nursing responsibilties of the urinalysis?

Back 94

Obtain first urinated specimen in the morning if possible. Ensure specimen is examined within 1 hour of urinating. Wash perineal area if soiled w/ menses or fecal material.

Front 95

How is creatinine clearance determined?

Back 95

urine creatinine (mg/dL) x urine volume (mL/minute)

----------------------------------------------------------

Serum creatinine (mg/dL)

Front 96

Nursing Responsibilities for Creatinine Clearance

Back 96

Obtain 24 hour urine specimen. Discard first urination when test is started. Collect subsequent urine.

Front 97

Urine Culture

Back 97

Confirms suspected urinary tract infection and identifies caustaive organisms. Normally bladder is sterile but urethra contains bacteria and few WBCs. "Clean catch"

Front 98

What usually indicates no infection in urine culture?

Back 98

<10

>10 indicates infection

Front 99

Residual Urine

Back 99

Determines amount of urine left in bladder after urinating. Finding may be abnormal in problems with bladder innervation, sphincter impairment, BPH or urethral stricture.

Front 100

Urine Culture Nursing Responsibility

Back 100

Use sterile container for collection. For women seperate labiaw/ one hand and clean meatus w/ other hand. For men retract foreskin if present, and cleanse glans. After cleaning instruct pt to begin to urinate into the sterile container.

Front 101

Residual Urine Nursing Responsibility

Back 101

If residual test is ordered catheterize pt immediately after urinating or use bladder ultrasound equipment. If large amounts of residual urine is obtained healthcare provider may want catheter may need to stay.

Front 102

Protein Determination "DipStick"

Back 102

Test detects protein (usually albumin) in urine. "0 trace"

Front 103

Nursing Responsibilty for Protein Determination (DipStick)

Back 103

Dip end of stick in urine and read result by comparision w/ color chart on label as directed. Grading from 0=4. Some medications can give false positives.

Front 104

Urine Cytology

Back 104

Identifies abnormal cellular structures that occur w/ bladder cancer and to follow the progress of bladder cancer

Front 105

Nursing Responsibility for Urine Cytology

Back 105

Specimens may be obtained by voiding, catheterization or bladder irrigation. Mornings first voided speicmen shouldn't be used. Specimen should be brought to the lab within the hour.

Front 106

BUN

Back 106

Blood urea nitrogen. Urea is the major nitrogenous end product of protein metabolism.

Front 107

Normal BUN

Back 107

6-20 mL/dL

Front 108

Nursing Reponsbility with BUN

Back 108

Be aware that when interpreting BUN, non renal factors may cause increase (ie rapid cell destruction from infections, fever, GI bleed, trauma, athletic activity, and excessive muscle breakdown, and corticosteroid therapy)

Front 109

Creatinine

Back 109

More reliable than BUN as a determinant of renal function. Creatinine is a end product of muscle and protein metabolism.

Front 110

Normal Creatinine

Back 110

0.6-1.3 mg/dL

Front 111

BUN/Creatinine Ratio

Back 111

12:1 to 20:1

Front 112

Uric Acid

Back 112

Waste product normally present in the blood as a result of the breakdown of purines.

Front 113

Why is uric acid tested?

Back 113

Used as a screening test primarily for disorders of purine metabolism but can also indicate kidney disease. Values depend on renal function, rate of purine metabolism and dietary intake of food rich in purines.

Front 114

Normal Na

Back 114

135-145

Front 115

Normal K

Back 115

3.5-5.3

Front 116

Normal Ca

Back 116

8.6-10.2

Front 117

Most pts w/ renal failure have metabolic alkalosis or acidosis?

Back 117

Acidosis

Front 118

Kidneys, ureters, bladder (KUB) (Radiologic test)

Back 118

X-ray exam of abdomen and pelvis and delineates size, shape, and position of kidneys. Radiopaque stones and foreign bodies can be seen. Nurse will need to give pt bowel prep.

Front 119

Intravenous pyelogram (IVP)

Back 119

Visualizes urinary tract after IV injection of contrast media. presence, position, size, and shape of kidneys, ureters, bladder can be evaluated. Cysts, tumors, lesions and obstruction can cause a distortion in nromal appearance. Pts w/ significantly decreased renal function should not have an IVP because contrast media can be nephrotoxic and worsen renal function.

Front 120

Nursing Responsiblity for IVP

Back 120

Prep bowel, assess for iodine senstivity, advice pt that warmth, flushed face or salty taste during injection of contrast media may occur. Force fluids post op to flush contrast media.

Front 121

Renal Arteriogram

Back 121

Visualizes renal blood vessels. Can assist in renal artery stenosis dx. Can differentiate between a cyst and tumor

Front 122

Nursing Responsibility for Renal Arteriogram

Back 122

Admin enema. Assess for iodine sensitivity. Advise pt that warmth, flushed face,, and salty taste is normal during injection of contrast. Force fluids post op.

Post op: Pressure dressing over femoral artery injection site. Observe for bleeding. Maintain bed rest w/ affected leg straight.

Front 123

Renal Biopsy Nursing Responsibilty

Back 123

Preop: Check anticoagulants, hold them

Postop: Apply pressure dressing, keep pt on affected side for, bedrest for 24 hours, Do not take anticoagulants until healthcare provider instructs

Front 124

Cystoscopy

Back 124

Inspects interior of bladder w/ a tubular lighted scope. Can be used to insert urethral catheters, remove calculi, obtain biopsy specimens of bladder lesions, and treat bleeding lesions. Lithotomy position is used. Can be done w/ anesthesia.

Front 125

Complications of Cytoscopy

Back 125

Urinary retention, urinary tract hemorrhages, bladder infection and perforation of bladder

Front 126

Preop Nursing Responsibility Cystoscopy

Back 126

Force fluids or give IV fluids, consent form, explain procedure, give preop meds.

Front 127

Postop Nursing Responsibility Cystoscopy

Back 127

Explain that burning on urination, pink-tinged urine and urine frequency are expected. Bright red bleeding is not normal. Orthostatic hypotension may occur. Offer warm sitz bath, heat, mild analgesics to relieve discomfort. Monitor temperature.

Front 128

What do nitrates in urine indicate?

Back 128

Bactera.

Front 129

What does dark smoky urine indicate?

Back 129

Hematuria

Front 130

What does yellow/brown to olvie green urine indicate?

Back 130

Excessive bilirubin

Front 131

What does orange/red or orange brown urine indicate?

Back 131

phenazopyridine (Pyridium)

Front 132

What does cloudiness indicate?

Back 132

Infection

Front 133

What does colorless urine indicate?

Back 133

Excessive fluid intake, renal disease, diabetes insipidus.

Front 134

What is normal color of urine?

Back 134

Amber yellow

Front 135

What does unpleasant odor of urine indicate?

Back 135

UTI

Front 136

What does aromatic urine indicate?

Back 136

Allowed to stand, ammonia like odor.

Front 137

What are some possible etiology behind proteinuria?

Back 137

Acute/chronic renal disease. HF, high-protein diet, strenuous exercise, dehydration, fever, emotional stress, contamination of vaginal secretions.

Front 138

What are some possible etiology behind glycosuria?

Back 138

Diabetes melltius, low renal threshold for glucose reabsorption, and pituitary disorders

Front 139

What are some possible etiology behind ketones in urine?

Back 139

Altered carbohydrate and fat metabolism in diabetes melltius and starvation, dehydration, vomiting and severe diarrhea.

Front 140

Etiology of bilirubin in urine?

Back 140

Liver disorders

Front 141

Specific gravity normal range

Back 141

1.003-1.030

Front 142

Etiology of low specific gravity

Back 142

Dilute urine, excessive diuresis, and diabetes insipidus.

Front 143

Etiology of high specific gravity

Back 143

Dehydration, albuminuria, and glycosuria

Front 144

Etiology of fixed specific gravity at 1.010

Back 144

Renal inability to concentrate urine, and end stage renal disease.

Front 145

Osmolality Normal range

Back 145

300-1300 mOsm/kg

Front 146

Etiology of low osmolality

Back 146

<300 mOsm/kg, Tubular dysfunction, kidney lost ability to concentrate or dilute urine.

Front 147

Normal pH

Back 147

4.0-8.0 (average of 6.0)

Front 148

Etiology of >8.0 pH

Back 148

UTI, urine allowed to stand at room temperature (bacterial growth)

Front 149

Etiology of <4.0 pH

Back 149

Respiratory or metabolic acidosis

Front 150

RBCs in urine normal range

Back 150

0-4/hpf

Front 151

Etiology of RBCs >4hpf in urine

Back 151

Calculi, cystitis, neoplasm, glomerulonephritis, tuberculosis, kidney biopsy, and trauma

Front 152

WBCS normal range in urine

Back 152

0-5/hpf

Front 153

WBCs >5hpf in urine etiology

Back 153

UTI and inflammation

Front 154

Etiology of casts present in urine

Back 154

Molds of renal tubules that may contain protein, WBCs, RBCs, or bacteria

Front 155

Culture for organisms normal range

Back 155

<10 organisms/mL

Front 156

Etiology for bacteria counts >10/mL in urine

Back 156

UTI, most common organisms are E Coli, enterococci, Klebsiella, Proteus and streptococci.

Front 157

Cystometrography

Back 157

Evaluation of bladder tone, sensations of filling, and bladder stability. Water/saline is instilled into the bladder through the urinary catheter.