Med Surg Chapter 43 Renal And Urinary

Front 1

Where are the kidneys located?

Back 1

12T to 3L vertebrae, with right slightly lower then then left

Front 2

What does the renal pelvis contain?

Back 2

renal artery that enters kidneys and ureters and renal vein that exit kidneys

Front 3

How is blood supplied to the kidneys?

Back 3

abdominal aorta to renal artery to afferent artioles to glomerlus

Front 4

How does blood leave the kidneys?

Back 4

glomerulus to the efferent arteriole through capillaries and veins to inferior vena cava

Front 5

How many nephrons are there in each kidney? What do they do? At what percentage does one need replacement therapy?

Back 5

1 ml
form urine
<20% a replacement therapy is needed

Front 6

What are the two components of the nephron?

Back 6

glomerus- filtration of fluids and small molecules
attached tubule- makes adjustments in filtration and site of renin production

Front 7

What is the path/flow of urine?

Back 7

nephron, renal pelvis, ureters, bladder, urethra

Front 8

How much urine is the bladder capable of holding? At what amount do we have the urine to void and what is level is there marked discomfort?

Back 8

1500-2000 mL (anatomic capacity)
150-200 mL
350 ml or more

Front 9

What happens when we void?

Back 9

efferent pelvic nerve stimulates the bladder to contract, resulting in relaxation of urethral sphincter, dec in urethral pressure, contraction of detrusor muscles, opening of the vesicle neck and proximal urethra and flow of urine

Front 10

What is filtered by the kidneys and excreted in the urine?

Back 10

sodium, chloride, bicarbonate, potassium, glucose (in small amounts), urea (25-30g/day), creatinine, uric acid, phosphates, sulfate, and drug metabolites

Front 11

What is renal glycosuria?

Back 11

there is so much glucose in the blood that the glomerular filtrate exceeds the amount the tubules are able to reabsorb, thus glucose appears in the urine

Front 12

What is proteinuria?

Back 12

protein molecules found in the urine

Front 13

What is normal blood flow through the kidneys and what is it dependent on?

Back 13

1200 ml/min
dependent on adequate blood flow and pressure through the glomerulus (hypotension, dec oncotic pressure in the blood, inc pressure in renal tubules from obstruction)

Front 14

How much of the filtrate gets reabsorbed into the blood stream? What where does most of the reabsorbtion occur?

Back 14

99%
proximal tubule (but throughout the entire tubule)

Front 15

How much urine is formed normally in a day?

Back 15

1000-1500 ml

Front 16

What is ADH?

Back 16

Antidiuretic hormone, vasopressin, released by pituitary gland in response to increase blood osmolality

Front 17

How does ADH work?

Back 17

Acts on kidney to increase reabsorbion of water

Front 18

What level is dilute urine and fixed osmolality? What does this indicate?

Back 18

urine specific gravity 1.010
fixed osmolality 300 mOsm/L
indicates sign of early kidney disease

Front 19

What is the most reliable means of determining overall fluid status?

Back 19

daily weight measurements

Front 20

1 lb equals how many ml?

Back 20

500 ml

Front 21

What are normal sodium levels?

Back 21

135-145 mmol/l

Front 22

what is the significance of sodium to water?

Back 22

Where sodium goes water follows

Front 23

how much sodium is normally reabsorbed in the proximal tubules?

Back 23

90%

Front 24

What determines regulation of sodium excretion?

Back 24

aldosterone

Front 25

Where is aldosteronine released from, what controls it and what does it do?

Back 25

adrenal cortex, under control of angiotensin I-II/renin, with an increase in aldosteronine in the blood there is less sodium excreted in the urine

Front 26

What is the result of increased aldosterone?

Back 26

increased retention of water, expansion of intravascular fluid vol, resulting in enough pressure within the glomerulus to ensure adequate filtration

Front 27

What is aldosterone's effect on potassium?

Back 27

kidney excretion of potassium

Front 28

How much potassium is excreted and what is the most life-threatening effect of renal failure?

Back 28

90%, RETENTION OF POTASSIUM IS THE MOST LIFE THREATENING EFFECT OF RENAL FAILURE

Front 29

What is normal serum pH?

Back 29

7.35-7.45

Front 30

How do the kidneys regulate pH?

Back 30

reabsorbion of bicarbonate, excretes acid in the urine

Front 31

What do the renal tubules do to aid in a balanced pH level?

Back 31

actively reabsorb bicarbonate from urinary filtrate, but can also generate new bicarbanate through chemical rx

Front 32

How does the body produce acid?

Back 32

as a result of catabolism (protein breakdown)

Front 33

What two acidic materials must be excreted via urine (as opposed to CO2 via the lungs)?

Back 33

phosphoric acid and sulfuric acid

Front 34

How much acid is excreted each day via the kidneys? What does this make urine pH?

Back 34

70 mEq
4.5

Front 35

How can excess acid be excreted without raising urines pH?

Back 35

Through the buffering process of phosphate ions and ammonia, combining these with acids allows the excess acid to freely be excreted without affecting the pH of urine

Front 36

How do the kidneys regulate BP?

Back 36

vasa recta (specilized structures in the kidneys) monitor pressure and when they sense a dec renin is secreted, which releases angiot I to angiot II which causes vasocontriction. Adrenal cortex also gets the message to release aldosterone (inc. BP). To dec BP renin stimulation stops

Front 37

What is renal clearance and what is the best test for measuring this?

Back 37

ability of kidneys to clear solutes from the plasma
24 hour collection

Front 38

What is creatinine?

Back 38

endogenous waste product of skeletal muscles that filter through the golmerulus

Front 39

What does creatinine clearance measure?

Back 39

glomerular filtration rate (GFR)
GFR IS AN EXCELLENT MEAURE OF RENAL FX, BETTER INDICATOR OF RENAL FX THAN BUN, as renal fx dec, creatinine clearance dec and serum creatinine levels increase
urine test varies on age
serum test 0.6-1.2 mg/dl

Front 40

What is the formula to estimate creatinine clearance?

Back 40

(vol of urine X urine creatinine) / serum creatinine

Front 41

What is normal GFR?

Back 41

125 - 200 mL/min

Front 42

What do the kidneys do when they sense a decrease in O2 tension in renal blood flow?

Back 42

release erythropoietin, which stimulates RBC to be produced by the bone marrow, increasing hemoglobin available to carry O2

Front 43

What are the kidneys role in Vit D?

Back 43

they are responsible for converting inactive Vit D to active Vit D, and Vit D is necessary for maintaining Ca+ balance

Front 44

Kidneys produce prostaglandin E and prostacyclin, what do they do?

Back 44

maintain renal blood flow

Front 45

To maintain adequate kidney filtetion rates what pressure must the bladder during filling be lower than?

Back 45

40 cm H2O

Front 46

What is our average fluid intake per day?

Back 46

1500-2000 mL

Front 47

What keeps us from having nocturia?

Back 47

vasopressin and dec in fluid intake slow production of urine

Front 48

What are normal residual urine amounts?

Back 48

50 mL
50-100 mL for older adults

Front 49

What happens to our kidneys as we age?

Back 49

GFR dec, renal response dec, stim of thirst dec--fluid vol deficit and hypernatremia, tissue atrophy, mobility limitations inhibit fluid intake and voiding

Front 50

What are risk factors for urologic problems?

Back 50

multiparous women, diabetic neuropathy, MS, Parkinson's, family hx, BPH, SLE, immobilization, spinal cord injury, HYN, cystic fibrosis, sickle cell anemia, AML/CML

Front 51

Define urine frequency

Back 51

voiding more then every 3 hours

Front 52

Define dysuria

Back 52

painful voiding

Front 53

Difine enuresis

Back 53

voiding during sleep

Front 54

Define oliguria

Back 54

less than 400 mL/d

Front 55

Define anuria

Back 55

less than 50 mL/d

Front 56

What do you check in an urinalysis?

Back 56

color, clarity, odor, pH, specific gravity, proteinuria, glycouria, ketonuria, hematria, WBC, crystals, bateriuria, pyuria (pus)

Front 57

What could be potential causes of hematuria?

Back 57

acute infection (cystitis, urethritis, prostatitis) renal calculi, neoplasm, bleeding disorders, lesions, medications (warfarin, heparin)

Front 58

What is an early detection sign of diabetic nephropathy?

Back 58

microalbuminuria- 20-200 mg/dl of protein in the urine

Front 59

What are potential causes of persistant proteinuria?

Back 59

glomerular disease, malignancies, collagen disease, DM, preeclampsia, hypothyroidism, HF, exposure to heavy metals, use of meds (NSAIDS, ACE inhib)

Front 60

What are possible causes of colorless to pale yellow urine?

Back 60

diuretics, alcohol, diabetes insipidus, glycosuria, excess fluid intake, renal disease

Front 61

What are possible causes of yellow to milky white urine?

Back 61

pyuria, infection, vaginal cream

Front 62

What are possible causes of bright yellow urine?

Back 62

multiple vitamin

Front 63

What are possible causes of blue-green urine?

Back 63

dyes, methylene blue, pseudomonas organisms, meds

Front 64

What are possible causes of pink to red urine?

Back 64

hemoglobin breakdown, RBC, blood, menses, bladder or prostate surgery, beets, blackberries, meds

Front 65

What are possible causes of orange and amber urine?

Back 65

conc urine due to dehydration, fever, bile, excess bilirubin, meds

Front 66

What are possible causes of brown to black urine?

Back 66

old RBC, urobilinogen, bilirubin, melanin, porphyrin, extreme conc due to dehydration, meds

Front 67

What is specific gravity of urine?

Back 67

amount of blood, protein, and casts in the urine compared to the density of water
1.003-1.030

Front 68

What does specific gravity of urine depend on?

Back 68

hydration
incr hydration, dec gravity
dec hydration, inc gravity

Front 69

What disorders cause an increase in specific gravity of urine?

Back 69

DM, nephritis, fluid deficit

Front 70

What disorders cause a decrease in specific gravity of urine?

Back 70

diabetes insipidus, glomerulonephritis, severe renal damage

Front 71

What is urine osmolality?

Back 71

the kidneys ability to dilute and concentrate urine
may detect early renal fx defects

Front 72

What is normal serum osmolality?

Back 72

275-300 mOsm/kg

Front 73

What is normal urine osmolality?

Back 73

50-1200 mOsm/kg
300-900 mOsm/kd for 24 hours

Front 74

What is BUN?

Back 74

blood urea nitrogen (end product of protein metabolism)
7-18 mg/dl
inc in BUN--dec in real fx, GI bleeding, dehydration, incr protein intake, fever, sepsis
Dec BUN--ESRD, low protein diet, starvation, expanded fluid vol

Front 75

What is a normal BUN to creatinine ration and what does it evaluate?

Back 75

10:1
hydration status
elevated ration--hypovolemia
normal ration with elevated BUN and creatinine--renal disease

Front 76

Renal function tests may be normal until GFR is what?

Back 76

50%

Front 77

List some of the diagnostic tests of renal fx?

Back 77

KUB (xray of kidney, ureter, bladder, ultrasonography, CT, MRI, nuclear scan, IVP (IV pyelography-dye with xray) retrograde pyelography (catheters in ureters), renal angiography, biopsy, cystoscopic (direct look into urethra, bladder and urine from kidney)

Front 78

Nursing diagnosis for patient undergoing renal urologic testing

Back 78

acute pain r/t infection, edema, obstructio, bleeding along UT
Fear r/t potential alteration in renal fx embarassment secondary to discussion of urinary fx
Defient knowledge about procedure and diagnostic test

Front 79

What are the functions of the kidneys?

Back 79

urine production and waste elimination
erythropoietin secretion
vit D metabolism
exretion of excess potassium
bicarbonate production and acid secretion