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61 Cards in this Set
- Front
- Back
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A&P
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land marked at the costovertebral angle (CVA) 12th ribcomposed of the vascular system,intersitum, collecting system and nephrons. The compostion of nephron-glomerulus in bowman capsule, distal/proximal tubules, loop of henle
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Major functions of the Kidneys
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fluid volume control
electrolyte regulation acid-base balance excretion of metabolic waste, toxins and drugs regulation of BP-rennin Stimulation of RBC-EPO Regulation of calcium-phosphate metabolism |
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Where is Vit D activated?
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Kidney
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Another name for ADH
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Vasopressin
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Where does Renal function occur?
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At the kidneys
bladder only a holding tank |
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Aldosterone play a part in...
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sodium balance
Fluid volume control BP Electrolyte regulation |
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Physcial assessment
INSPECTION |
important to note amount of urine
how often urgency freq |
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Physcial assessment
Palpation |
be careful- start midline on abd should feel dome of bladder. do it when you suspect retention
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Physcial assessment
Percussion |
Dullness indicates bladder is full of urine
Used primarily |
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Anuria
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total urine output less than 50ml in 24h
Acute/chronic renal failure complete obstruction |
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Dysuria
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painful or difficult urination
Lower UTI, inflammation of bladder or urethra, acute prostitis, stones, foreign bodies, tumors in bladder |
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Creatinine
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Waste product of muscle energy metabolism
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Frequency.
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voiding more frequently than every 3h
infection, obstruction of lwr UT leading to residual urine and overflow, anxiety, diuretics, BPH, urethral sticture, diabetic neuropaathy |
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Glomerular filtration rate
GFR |
Volume of plasma filtered at the glomerulus into the kidney tubules each minute;normal rate is approximately 120ml/min
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hematuria
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red blood cell in the urine
CA of genitourinary tract, acute glomerulonephritis, renal stones, renal Tb, trauma, leukemia, sickle cell trait or disease |
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nocturia
Oliguria |
awakening at night to urinate-decreased renal concentrating ability, heart failure, DM, incomplete emptying, excess fluid intake at HS, nephrotic syndrome, cirrhosis with ascites
total urine output less than 400ml in 24h. acute or chronic renal failure, inadeq. intake |
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proteinuria
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protein in the urine
acute/chronic renal disease, nephrotic syndrome, vigorous exercise, heat stroke, severe heart failure, diabetic nephropathy, multiple myeloma |
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pyuria
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pus in the urine
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Specific gravity
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reflects the weight of particles dissolved in the urine;expression of the degree of concentration
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urea nitrogen
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nitrogenous end product of protein metabolism
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Urinalysis
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Determines if bacteria is present. WBC, RBC, crystals, pus. should be midstream and in early morning
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C&S
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Tells us antimicrobial therapy that is best suited for microbe
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Enuresis
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Involuntary voiding during sleep
delay in maturation of CNS, obstuctive disease of lwr UT, genetic, UTI and stress |
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Polyuria
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increased volume of urine voided
DM, diabetes insipidus, diuretics, excess intake, lithium toxicity, hypercalcemic and hypokalemic nephropathy |
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Changes in urine color and possible causes
colorless to pale yellow |
Dilute urine due to diuretics, etoh consumption, DM, glycosuria, excess intake, renal disease
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Changes in urine color and possible causes
Yellow to milky white |
Pyuria, infection, vaginal cream
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Changes in urine color and possible causes
Bright yellow |
Multiple vitamin preparations
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Changes in urine color and possible causes
Pink to red |
Hemoglobin breakdown, RBC, gross blood, menses, bladder or prostate surg. beets, blackberries, medications(phentoin, rifampin, senna)
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Changes in urine color and possible causes
Blue, blue green |
Dyes, methylene blue, PSEUDOMAONAS,medications (amitriptyline)
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Changes in urine color and possible causes
Orange to amber |
Concentrated urine due to dehydration, fever, bile, excess bilibrubin or carotene, medications
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changes in urine color and possible cause
brown to black |
old RBC, urobilinogen, bilirubin, melanin, extreme dehydration, medications
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Urine Osmolality
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concentrating ability is lost early in kidney disease;hence these test finding may disclose early defects in renal function
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Serum tests
Creatinine Level |
Measures effectiveness of renal function. Creatinine is end product of muscle energy metabolism. In normal function, level of creatinine, which is regulated and excreted by the kidneys, remains fairly constant in the body
0.5-1.5 |
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Serum test
BUN |
Serves as an index of renal function. Urea is nitrogenous end product of pf protein metabolism. Test values are affected by protein intake, tissue breakdown, and fluid volume changes.
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Cystoscopy
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Used with recurrent UTI's, Bladder CA, Gross hematuria when they don't know the why
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Nursing considerations DIET
cytoscopy |
usuall NPO with IV started if done in hospital
if outpatient usually clear liquid |
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RN considerations
SEDATION |
conscious sedation-versed
local-zilocaine used to numb the ureathra General |
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POST-op for cystoscopy
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Monitor output and color
pink tinge is normal-gross blood is not may c/o dysuria-r/t use of instruments. encourage fluids to flush out bladder |
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Renal angiography
use |
To check vascular system, stenoisi, clots, sclerosing
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Renal angiography
RN considertion |
NPO
Consent signed coag studies done |
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Renal angiography
Postop |
CSM, VS, check for hematuria
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Renal biopsy
2 types |
histological study done to see what is causing the damage
needle under flouroscopy open biopsy |
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Renal biopsy
Pre-op |
coag studies
type and cross have blood ready as kidney is very vascular |
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Renal biopsy teaching during procedure
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take a deep breath and hold. Done to immbolize the kidneys.
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Renal biopsy
Post-op |
4-6h bedrest,prone
pressure on area monitor VS s/s blood loss,urine may be pink but should not be red! no heavy lifting, no coughing call if change in output or pain charecteristics |
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What should you do if the patient c/o of flank pain?
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Assess for signs of hematuria. flank pain is a s/s of bleeding in the muscle
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What would you see in someone with BPH
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hesitancy
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Genitourinary pain: Location
Kidney |
location: CVA, may extend to umbilicus
Character: dull constant ache S/S:N/V, diaphoresis, pallor, signs of shock Etiology: acute obstruction, kidney stone, blood clot, acute pyelonephritis, trauma |
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Genitourinary pain: Location
Bladder |
location:suprapubic
Character:dull continuous pain, pain be intense with voiding, may be sever if bladder is full S/S:urgency, pain at end of voiding, painful strainig Etiology:overdistended bladder, infection, interstitial cystitis;toumor |
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Genitourinary pain: Location
Ureteral |
location:CVA, flank, lwr abd. testis or labium
Character:severe, sharp, stabbing pain colicky in nature S/S:n/v, paralytic ileus Etiology:ureteral stone, edema or stricture, blood clot |
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Genitourinary pain: Location
prostatic |
location: perineum and rectum
Character:vague discomfort, feeling of fullness in perineum,vague back pain S/S:suprapubic tenderness, obstruction to urine flow, freq, urgency, dysuria, nocturia EtiologyProstate CA, acute/chronic prostatistis |
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Genitourinary pain: Location
Urethral |
location:male: along penis to meatus. Female; urethra to meatus
Character:pain variable, most severe during and immediately after voiding S/S:freq.uregency, dysuria, nocturia, urethral discharge Etiology:irritation of bladder neck, infection of urethra, trauma, foreign body in lwr UT |
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NURSING ALERT!!!
why are daily weights so important? |
It is the most accurate indicator of fluid loss or gain in an acutely ill patient. An accurate daily weight must be obtained and recorded. A 1kg gain is equal to 1,000ml of retained fluid
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Cystitis
define |
inflammation of the bladder
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cystitis
patho |
for infection to occur bacteria must gain acceess to the bladder, attach to and colonize the epithelium of th eurinary tract to avoid being washed out with voiding, evade host defense mechanisms, and initiate inflammation
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cystitis
etiology |
most UTI's result of fecal organisms, E.coli then klebsella and pseudomonas
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Cystitis
Risk factors |
inability or failure to empty bladder completely.
urinaary stasis neurogenic bladder obstucted urinary flow decreased natural defenses or immunosupression instrumentation of the urinary tract ie foley cath inflammation or abraison of mucosa contributing conditions ie DM, preg |
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Cystitis- assessment
s/s |
frequency
urgency, dysuria, incont, suprapubic pain or pelvic pain. pyuria/foul odor may be asymptomatic esp elderly |
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cystitis
Nursing Diagnosis elimination patterns |
best prevention is voiding q2-3h and void at night. monitor charecteristics report s/s freq. urgency, dysuria
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cystitis
Nursing Diagnosis PAIN |
not treated with opiates,tx with motrin, tylenot. moist hot heat, pyredium helps with dysuria
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cystitis
Nursing Diagnosis Knowledge deficit |
take showere vs bath
no bubbles handwashing wipe front to back cotton undies no intercourse if active infection. void after intercourse. prophalactic antibiotics may be used |
