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61 Cards in this Set

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A&P
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
Major functions of the Kidneys
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
Where is Vit D activated?
Kidney
Another name for ADH
Vasopressin
Where does Renal function occur?
At the kidneys
bladder only a holding tank
Aldosterone play a part in...
sodium balance
Fluid volume control
BP
Electrolyte regulation
Physcial assessment
INSPECTION
important to note amount of urine
how often
urgency
freq
Physcial assessment
Palpation
be careful- start midline on abd should feel dome of bladder. do it when you suspect retention
Physcial assessment
Percussion
Dullness indicates bladder is full of urine
Used primarily
Anuria
total urine output less than 50ml in 24h

Acute/chronic renal failure
complete obstruction
Dysuria
painful or difficult urination

Lower UTI, inflammation of bladder or urethra, acute prostitis, stones, foreign bodies, tumors in bladder
Creatinine
Waste product of muscle energy metabolism
Frequency.
voiding more frequently than every 3h
infection, obstruction of lwr UT leading to residual urine and overflow, anxiety, diuretics, BPH, urethral sticture, diabetic neuropaathy
Glomerular filtration rate
GFR
Volume of plasma filtered at the glomerulus into the kidney tubules each minute;normal rate is approximately 120ml/min
hematuria
red blood cell in the urine

CA of genitourinary tract, acute glomerulonephritis, renal stones, renal Tb, trauma, leukemia, sickle cell trait or disease
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
proteinuria
protein in the urine
acute/chronic renal disease, nephrotic syndrome, vigorous exercise, heat stroke, severe heart failure, diabetic nephropathy, multiple myeloma
pyuria
pus in the urine
Specific gravity
reflects the weight of particles dissolved in the urine;expression of the degree of concentration
urea nitrogen
nitrogenous end product of protein metabolism
Urinalysis
Determines if bacteria is present. WBC, RBC, crystals, pus. should be midstream and in early morning
C&S
Tells us antimicrobial therapy that is best suited for microbe
Enuresis
Involuntary voiding during sleep
delay in maturation of CNS, obstuctive disease of lwr UT, genetic, UTI and stress
Polyuria
increased volume of urine voided

DM, diabetes insipidus, diuretics, excess intake, lithium toxicity, hypercalcemic and hypokalemic nephropathy
Changes in urine color and possible causes

colorless to pale yellow
Dilute urine due to diuretics, etoh consumption, DM, glycosuria, excess intake, renal disease
Changes in urine color and possible causes

Yellow to milky white
Pyuria, infection, vaginal cream
Changes in urine color and possible causes

Bright yellow
Multiple vitamin preparations
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)
Changes in urine color and possible causes

Blue, blue green
Dyes, methylene blue, PSEUDOMAONAS,medications (amitriptyline)
Changes in urine color and possible causes

Orange to amber
Concentrated urine due to dehydration, fever, bile, excess bilibrubin or carotene, medications
changes in urine color and possible cause

brown to black
old RBC, urobilinogen, bilirubin, melanin, extreme dehydration, medications
Urine Osmolality
concentrating ability is lost early in kidney disease;hence these test finding may disclose early defects in renal function
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
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.
Cystoscopy
Used with recurrent UTI's, Bladder CA, Gross hematuria when they don't know the why
Nursing considerations DIET
cytoscopy
usuall NPO with IV started if done in hospital
if outpatient usually clear liquid
RN considerations
SEDATION
conscious sedation-versed
local-zilocaine used to numb the ureathra
General
POST-op for cystoscopy
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
Renal angiography
use
To check vascular system, stenoisi, clots, sclerosing
Renal angiography
RN considertion
NPO
Consent signed
coag studies done
Renal angiography
Postop
CSM, VS, check for hematuria
Renal biopsy
2 types
histological study done to see what is causing the damage
needle under flouroscopy
open biopsy
Renal biopsy
Pre-op
coag studies
type and cross
have blood ready as kidney is very vascular
Renal biopsy teaching during procedure
take a deep breath and hold. Done to immbolize the kidneys.
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
What should you do if the patient c/o of flank pain?
Assess for signs of hematuria. flank pain is a s/s of bleeding in the muscle
What would you see in someone with BPH
hesitancy
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
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
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
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
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
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
Cystitis
define
inflammation of the bladder
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
cystitis
etiology
most UTI's result of fecal organisms, E.coli then klebsella and pseudomonas
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
Cystitis- assessment
s/s
frequency
urgency, dysuria, incont, suprapubic pain or pelvic pain.
pyuria/foul odor
may be asymptomatic esp elderly
cystitis
Nursing Diagnosis
elimination patterns
best prevention is voiding q2-3h and void at night. monitor charecteristics report s/s freq. urgency, dysuria
cystitis
Nursing Diagnosis
PAIN
not treated with opiates,tx with motrin, tylenot. moist hot heat, pyredium helps with dysuria
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