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73 Cards in this Set

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Functions of kidneys:
Urine formation, drug excretion, acid base balance, secretion of renin, activation of vitamin D, production of erythropoiten
Formation of urine:
Glomerular filtration
Tubular reabsorption
Tubular secretion
Describe urination reflex
Destention of the bladder muscle sends sensory impulses to spinal cord which activate the parasympathetic motor system to contract detrusor muscles & dialate the internal urethral sphincter allowing it to relax (voluntarly) resulting in urination
What is the point of incontinance in the urination reflex?
The point where the external urethral sphincter relaxes
When is the micturitionreflex activated?
It is initiated when 300 to 400 mL of urine form in the bladder, stimulating stretch receptors within the wall.
Nocturia
Urination during the night
Oliguria
decreased urination (less than 400mL/24hrs)
Enuresis
Bedwetting
Polyuria
Excessive urination (more than 2000mL/24 hrs)
Anuria
absence of urination
Nursing assessment of Urinary Elimination
Collection of data about the patient's voiding patterns, habits, and difficulties and a history of current or past urinary problems
Physical Assessment Nursing of Urinary Elimination
Palpation of bladder,skin color & texture, vitals, lung sounds, edema, orthostatic hypotension (<BP/>HR)
What is the normal daily Urine Output
1000 - 2000 mL every 24hrs
Characteristics of Urine; Color
A freshly voided specimen is pale yellow, straw-colored, or amber, depending on its concentration.
Characteristics of Urine; odor
Odor Normal urine smell is aromatic. As urine stands, it often develops an ammonia odor because of bacterial action.
Characteristics of Urine: Turbidity
Fresh urine should be clear or translucent; as urine stands and cools, it becomes cloudy.
Characteristics of Urine: pH
The normal pH is about 6.0, with a range of 4.6 to 8. (Urine alkalinity or acidity may be promoted through diet to inhibit bacterial growth or urinary stone development or to facilitate the therapeutic activity of certain medications.) Urine becomes alkaline on standing when carbon dioxide diffuses into the air.
Characteristics of Urine: Specific gravity
This is a measure of the concentration of dissolved solids in the urine. The normal range is 1.015 to 1.025.

a high specific gravity usually indicates dehydration and a low specific gravity indicates overhydration.
Renal function tests: Serum Creatintine
Measuring serum creatinine is a useful and inexpensive method of evaluating renal dysfunction. Creatinine is a non-protein waste product of creatine phosphate metabolism by skeletal muscle tissue. Creatinine production is continuous and is proportional to muscle mass
Renal function tests: BUN
Blood urea nitrogen (BUN) measures the amount of urea nitrogen, a waste product of protein metabolism, in the blood. Urea is formed by the liver and carried by the blood to the kidneys for excretion.

Adult: 7-20 mg/100 ml
Renal function tests: Uric Acid
Uric acid is the end product of purine metabolism. Purines are obtained from both dietary sources and from the breakdown of body proteins. Organ meats such as liver, kidneys, and sweetbreads, sardines, anchovies, lentils, mushrooms, spinach, and asparagus are all rich sources of purines. The kidneys excrete uric acid as a waste product.
Renal function tests: Creatinine clearance
A creatinine clearance test measures the rate at which the kidneys clear creatinine from the blood. A creatinine clearance test compares the serum creatinine with the amount of creatinine excreted in a volume of urine for a specified time. A 24-hour time frame is most common. At the beginning of the test, the patient empties his bladder and the urine is discarded. Then, all urine voided during the specific time period is collected
Nursing Diagnoses associated with Renal Function Tests
Potential Fluid Volume Deficit

Potential fluid volume deficit

Potential alterations in nutritional requirements for specific nutrients - potassium, sodium, and protein
Cystoscopy
Cystoscopy is the direct visual examination of the bladder, ureteral orifices, and urethra with a cystoscope. It is used to view, diagnose, and treat disorders of the lower urinary tract, interior bladder, urethra, male prostatic urethra, and ureteral orifices
Intravenous Pyelogram (Excretory Urography)
Intravenous pyelogram is the radiographic examination of the kidney and ureter after a contrast material is injected intravenously. It is used to diagnose kidney and ureter disease and impaired renal function.
Retrograde Pyelogram
Retrograde pyelogram is the radiographic and endoscopic examination of the kidneys and ureters after a contrast material is injected into the renal pelvis through the ureter.
Renal Ultrasound
A renal ultrasound is a noninvasive procedure that involves the use of ultrasound to visualize the renal parenchyma and renal blood vessels. It is used to characterize renal masses and infections, visualize large calculi; detect malformed kidneys; provide guidance during other procedures, such as biopsy; and monitor the status of renal transplants and kidney development in children with congenital processes
Renal Biopsy
It is an invasive procedure that involves obtaining a small piece of renal tissue for microscopic examination. Tissue sample may be obtained by needle and syringe through a skin puncture or small incision, during an open surgical procedure during which a wedge of tissue is removed, or through a cystoscope during which a brush is used to obtain a tissue fragment.
Total incontinence
Continuous and unpredictable loss of urine, resulting form surgery, trauma, or physical malformation.

Nursing Interventions: Keep skin clean & dry, condom cath
Stress incontinence
Involuntary loss of less than 50mL of urine. r/t increase in intra-abdominal pressure. Occurs during coughing, sneezing, laughing, or other physical activities. Childbirth, menopause, obesity, or straining from chronic constipation can also result in urine loss
Overflow incontinence
Involuntary loss of urine is associated with overdistention and overflow of the bladder. The signal to empty the bladder may be underactive or absent, the bladder fills, and dribbling occurs. It may be due to a secondary effect of some prostatic or neurologic conditions
Functional incontinence
is urine loss caused by the inability to reach the toilet because of environmental barriers, physical limitations, loss of memory, or disorientation.
Common cause in elderly; instituionalized
What are the causes of disorders of the urinary tract?
Infection, obstructions, cancer, heriditary diseases, chronic disease, traumatic diseases & metabolic diseases
Factors of UTI's
stasis, past history, contamination, female, reflux, instruments, aging
Signs & symptoms of UTI's
Dysuria, urgency, frequency, incontinence, hematuria, cloudy, foul smelling urine and confusion in the elderly
NANDA diagnoses of UTI's
Impaired urinary elimination; frequency
Pain/Discomfort
Health maintenance, altered
Urethral Strictures
Narrowing of urethral lumen by scar tissue
Renal Calculi
Nephrolithiasis is the formation of crystal aggregates in the urinary tract results in kidney stones, formed by one of four substances: (1) calcium, (2) uric acid, (3) magnesium ammonium phosphates (or struvite), or (4) cystine. More common in men, average onset 30-50yrs often w/ family history/dietary factors.
Signs and symptoms of Renal Calculi
Pain to the costrovertebral angele, groin, flank, genitala, renal colic. Hematuria, anuria, restlessness, absent bowel sounds, N/V, diarrhea
Nursing diagnoses for Renal Calculi
Acute pain, risk for infection, deficient knowledge
Hydronephrosis
Distention (dilation) of the kidney with urine, caused by backward pressure on the kidney when the flow of urine is obstructed. The elevated pressure from obstruction may ultimately damage the kidney and can result in loss of its function
Signs and symptoms Hydronephrosis
Can begin quickly causing renal colic, pain, pressure, and distention of the bladder.
Can also start of as asymptomatic & slowly progress
Nursing interventions for Hydronephrosis
Monitor I&O,
Glomerulonephritis
Most common following infections by strains of group A, beta-hemolytic streptococci. In this situation, there is an abnormal immune reaction, causing immune complexes to become entrapped in the glomerular membrane, inciting an inflammatory response. The capillary membrane swells and is then permeable to plasma proteins and blood cells. Usually follows a strep infection by 10 days to 2 weeks (the time needed for formation of antibodies).
Signs and symptoms Glomerulonephritis
Oliguria is an early symptom, Na and H20 retention causes edema, particularly of the face and hands, along with hypertension. Proteinuria and hematuria follow from the increased capillary permeability. This may give a smoky hue to the urine ("cola" colored).
Acute Renal Failure
Sudden interruption of kidney function resulting from obstruction, reduced circulation, or disease of the renal tissue
Results in retention of , fluids; UOP < 400mL/d or 30mL/hr
Build up of toxins on blood: end products of protien metabolism (azotemia). Usually reversible with medical treatment
May progress to end stage renal disease, uremic syndrome, and death without treatment
Chronic Renal Failure
Results form gradual, progressive loss of renal function
Occasionally results from rapid progression of acute renal failure
Symptoms occur when 75% of function is lost but considered cohrnic if 90-95% loss of function
Dialysis is necessary D/T accumulation or uremic toxins, which produce changes in major organs
Causes of Acute Renal Failure
PRERENAL
Hypovolemia, shock, blood loss, embolism, pooling of fluid d/t ascites or burns, cardiovascular disorders, sepsis
INTRARENAL
Nephrotoxic agents, infections, ischemia and blockages, polycystic kidney disease
POSTRENAL
Stones, blood clots, BPH, urethral edema from invasive procedures
Stages of Acute Renal Failure
Onset – 1-3 days with ^ BUN and creatinine and possible decreased UOP
OLIGURIC PHASE – UOP < 400/d, Longer the phase lasts poorer prognosis
DIURETIC PHASE – UOP ^ to as much as 1-3L/d but no waste products, can not concentrate urinr, excess waste eliminated in blood
RECOVERY PHASE – things go back to normal or may remain insufficient and become chronic lasting up to 1 yr
Acute Renal Failure Nursing interventions
Monitor I/O, including all body fluids
Monitor lab results
Watch hyperkalemia symptoms: malaise, anorexia, parenthesia, or muscle weakness, EKG changes
watch for hyperglycemia or hypoglycemia if receiving TPN or insulin infusions
Chronic Renal Failure signs and symptoms
Edema, SOB; cracles, wheezing. Blood vessle distention of neck, may be polyuric, oliguric, anuric.
Urethral Strictures
Narrowing of urethral lumen by scar tissue
Renal Calculi
Nephrolithiasis is the formation of crystal aggregates in the urinary tract results in kidney stones, formed by one of four substances: (1) calcium, (2) uric acid, (3) magnesium ammonium phosphates (or struvite), or (4) cystine. More common in men, average onset 30-50yrs often w/ family history/dietary factors.
Signs and symptoms of Renal Calculi
Pain to the costrovertebral angele, groin, flank, genitala, renal colic. Hematuria, anuria, restlessness, absent bowel sounds, N/V, diarrhea
Nursing diagnoses for Renal Calculi
Acute pain, risk for infection, deficient knowledge
Hydronephrosis
Distention (dilation) of the kidney with urine, caused by backward pressure on the kidney when the flow of urine is obstructed. The elevated pressure from obstruction may ultimately damage the kidney and can result in loss of its function
Signs and symptoms Hydronephrosis
Can begin quickly causing renal colic, pain, pressure, and distention of the bladder.
Can also start of as asymptomatic & slowly progress
Nursing interventions for Hydronephrosis
Monitor I&O,
Glomerulonephritis
Most common following infections by strains of group A, beta-hemolytic streptococci. In this situation, there is an abnormal immune reaction, causing immune complexes to become entrapped in the glomerular membrane, inciting an inflammatory response. The capillary membrane swells and is then permeable to plasma proteins and blood cells. Usually follows a strep infection by 10 days to 2 weeks (the time needed for formation of antibodies).
Signs and symptoms Glomerulonephritis
Oliguria is an early symptom, Na and H20 retention causes edema, particularly of the face and hands, along with hypertension. Proteinuria and hematuria follow from the increased capillary permeability. This may give a smoky hue to the urine ("cola" colored).
Acute Renal Failure
Sudden interruption of kidney function resulting from obstruction, reduced circulation, or disease of the renal tissue
Results in retention of , fluids; UOP < 400mL/d or 30mL/hr
Build up of toxins on blood: end products of protien metabolism (azotemia). Usually reversible with medical treatment
May progress to end stage renal disease, uremic syndrome, and death without treatment
Chronic Renal Failure
Results form gradual, progressive loss of renal function
Occasionally results from rapid progression of acute renal failure
Symptoms occur when 75% of function is lost but considered cohrnic if 90-95% loss of function
Dialysis is necessary D/T accumulation or uremic toxins, which produce changes in major organs
Causes of Acute Renal Failure
PRERENAL
Hypovolemia, shock, blood loss, embolism, pooling of fluid d/t ascites or burns, cardiovascular disorders, sepsis
INTRARENAL
Nephrotoxic agents, infections, ischemia and blockages, polycystic kidney disease
POSTRENAL
Stones, blood clots, BPH, urethral edema from invasive procedures
Stages of Acute Renal Failure
Onset – 1-3 days with ^ BUN and creatinine and possible decreased UOP
OLIGURIC PHASE – UOP < 400/d, Longer the phase lasts poorer prognosis
DIURETIC PHASE – UOP ^ to as much as 1-3L/d but no waste products, can not concentrate urinr, excess waste eliminated in blood
RECOVERY PHASE – things go back to normal or may remain insufficient and become chronic lasting up to 1 yr
Acute Renal Failure Nursing interventions
Monitor I/O, including all body fluids
Monitor lab results
Watch hyperkalemia symptoms: malaise, anorexia, parenthesia, or muscle weakness, EKG changes
watch for hyperglycemia or hypoglycemia if receiving TPN or insulin infusions
Chronic Renal Failure signs and symptoms
Edema, SOB; cracles, wheezing. Blood vessle distention of neck, may be polyuric, oliguric, anuric.
Chronic Renal failure pathophysiology
EARLY STAGE: Diminished renal reserve 50% nephron loss
Kidney function is mildly reduced while the excretory and regulatory function are sufficiently maintained to preserve a normal internal environment. The patient is usually problem free.

RENAL INSUFFCIENCY:75% impaired renal capacity decreased urinary concentrating ability, anemia, BUN/creatinine levels increase. Factors that can exacerbate the disease at this stage by increasing nephron damage are: infection, dehydration, drugs

ESRD:90% of the nephrons are damaged Renal function has so deteriorated that chronic and persistent abnormalities; Uremic Syndrome
Patient requires artificial support to sustain life, i.e. dialysis, transplant
Chronic Renal failure electrolyte distubances
Na+2 - Hypernatriemia >145mEq/L: fever, restless, increased fluid retention, ^BP, edema, decreased UOP
- hyponatremia
<135mEq/L lethargy, headache, CONFUSION, seizures

K+ - Hypokalemia
<3.5mEq/L fatigue, weak irregular pulse, poly uria, hyperglycemia, bradiacardia
- Hyperkalemia
>5.5mEq/L muscle weakness, urine changes (oliguria or anuria), respiratory distress, decreased cardiac contrantibility, EKG changes, reflexes flaccid

Ca+2 - Hypercalcemia
>11mg/dl anorexia, N/V, fatigue, constipation, dehydration, bradycardia

- Hypocalcemia
<8.5mg/dl convulsions, arrythmias, tetny,and spasms
Chronic renal failure symptoms:
Disturbance in removal of waste products - azotemia: weakness, fatigue, confusion, N/V, urea crystals (itching skin)
Disturbance in maintaining acid/base balance - Kussmaul’s respirations (deep & fast) from acidosis, headache, N/V, fatigue, weakness
Disturbance in hematolgic function -anemia, decrease in RBC survival time
Chronic Renal Failure Theraputic Interventions:
Fluid and dietary restrictions
Maintain E-lytes
Dialysis to jump start renal function
May need to stimulate production of urine with IV fluids, Dopomine, diuretics, etc. Ace inhibitors, calcium channel blokers > hypertension
Renal Failure Nursing Diagnoses
Skin integrity impairment, Potential alterations in nutritional requirements, Potential Fluid Volume Deficit, Potential for injury related to weakness and confusion
Uremic Syndrome
A cluster of symptoms related to the retention of nitrogenous substances in the blood. Symptoms include: fatigue, confusion, N/V, diarrhea, gastritis, itchy skin
Pre-End Stage Renal Disease Diet Guidelines
PROTIEN & PHOSPHORUS restriction SLOWS progression.
Protien - 0.6 to 1.0g/kg of ideal body weight. <5-6oz (men) & <4oz (women)

Phosphorus - 8-12mg/kg ideal weight or Limit milk to 1/2 cup, 1oz cheese or any other high phosphorus foods to 1 serving per day.