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59 Cards in this Set

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Describe the organs of the urinary system and their function. What is the overall function of the urinary system as a whole?
Kidneys:Remove waste from the blood to form urine. Ureters:
Drain urine from the kidneys to the bladder. Bladder:Reservoir for urine until the urge to urinate develops. Urethra:Urine travels from the bladder & exits through the urethral meatus. Overall function:Removes waste products & water from blood &Helps maintain constant body fluid volume & composition.
Kidneys receive what type of blood and from where and return what type of blood to where?
Kidneys receive unfiltered blood from the heart via abdominal aorta; it branches to L & R renal arteries.
Filtered blood returns by the L & R renal veins to inferior vena cava for return to the heart.
What is the job of aldosterone?
Aldosterone is a hormone is what "fine tunes" reabsorption of the remaining Na+ back into the blood (so that it doesn't go out of our body. If our blood pressure/volume is low, or if Na+ low/or K+high the the adrenal cortex releases aldosterone to the blood by turning on the renin-angiotensin mechanism. Aldosterone will target principal cells of collecting ducts and cells of the distal DCT to input mor ion channels to allow Na+ back in. So usually very little Na+ will leave the body in urine, unless of course, there is an absence of aldosterone. Naturally with more Na+ higher solute concentration will pull in more water too.
What is the name of the substance that contrasts the function of aldosterone, thereby decreasing blood volume and blood pressure?
Atrial Natriuretic Peptide, which reduces blood Na+ and because water will naturally follow will decrease blood volume and blood pressure. This is released when the cardiac atrial cells detect elevation and respond to lower it with ANP.
What are the normal blood gas values (ABG).
Values at sea level*:
Partial pressure of arterial oxygen (PaO2) : 80 - 100 mm Hg *
Partial pressure of carbon dioxide (PaCO2) 35 - 45 mm Hg, pH: 7.35 - 7.45, Oxygen saturation (SaO2) : 96 - 100% *,Bicarbonate - (HCO3) : 22 - 26 mEq/liter,Base Excess: + 2.0 mEq/L:referring to bicarb excess that the the kidney is producing.
At what points on the pH scale is death.
6.8 and 7.8
The three systems that help regulate pH in the body?
There are 2 physiological buffer systems: renal, respiratory; and 1 biological chemical buffer system.
What are the 3 important hormones produced by the kidney
Erethropoeitin: stimulate red bone marrow to make RBC and released in response to hypoxia and decreased renal blood flow; Renin in the angiotensin system to stimulate aldosterone that regulates blood pressure in response to decreases in sodium, and other volume decreases; and Calcitriol, an active form of vitamin D helps to maintain calcium for bones & chemical balance in the body.
What are the visual symptoms of respiratory acidosis and what can cause it?
Hypoventilation causes build up of CO2, and lowered pH (more acidic) ,which causes rapid shallow respirations, decreases BP with vasodilation, dyspnea, headache, hyperkalemia, which will cause dysrhythmia, drowsiness, dizziness, disorientation, and muscle weakness. Respiratory acidosis canc be caused by decreased resp. stimuli like anesthesia, drug overdose, COPD, Pneumonia, and Atelectasis.
What are the visual symptoms of respiratory alkalosis and what can cause it?
Hyperventilation, causes lowered CO2, and increased pH (more basic) Deep rapid breathing, tachycardia, lowered or normal BP, hypokalemia, lethargy, numbness and tingling, confusion, light headedness, nausea, and vomiting. Causes: Hyperventilation from anxiety, fear, and mechanical ventilation.
What are the visual symptoms of Mebabolic Acidosis and what are the causes?
A decrease in pH, and a decrease of base because the kidneys cannot excrete enough acid or hang on to enough base (HCO3). Signs will include headache, decrease BP, hyperkalemia, muscle twitching, warm flushed skin (vasodilation), nausea, vomit, diarrhea, confusion and increase drowsiness, and kussmaul respirations(compensatory resp). Things that cause this are diarrhea, renal failure and shock.
What is metabolic alkalosis, what are the visual signs, and what can cause it?
Decrease in acid or increase in base. Basically system becomes more basic, which makes your pH go up and HCO3 go up. Signs include: restlessness-lethargy, dysrrhythmias (tachycardia), compensatory hypoventilation, confusion, nausea, vomiting, diarrhea, tremors, muscle cramps, tingling of fingers and toes. and kypokalemia. Causes: severe vomiting, excessive GI suctioning, diuretics, and excessive NaHcO3.
What are some common alterations that can happen in urinary elimination?
Urinary retention: accumulation of urine due to the inability of the bladder to empty. UTI which can result from catheterization or procedure. Urinary incontinence-involuntary leakage of urine. Urinary diversions: diversion of urien to external source via stoma.
what is the effect of chloride in acid base balance?
chloride combetes
What is ANP?
ANP is diuretic that is made in the heart in response to high volume of blood. It goes to inhibit Aldosterone by antagonizing the renin-angiotensin cycle, and ADH from putting in their ion channels to pull out water and sodium, so the water and sodium get to flush out of the system through the collecting duct.
What are the gerentologic considerations in the urinary system?
1) Structural changes cause the decreased ability to conserve water
What is insensible water loss, and sensible water loss?
Insensible water loss comes from lungs, skin(not sweat glands) and gi tract in response to high body temp. 600-900 mls a day. It only loses water.
Sensible water loss is water and electrolyte loss through sweating.
What regulates our intake and what should the normal values of intake be?
Thirst regulates our fluid intake. Thirst indication comes from the hypothalamus. Intake should be 2200 to 2700 mls. Intake can be given in different forms: blood, iv, tube feedings and water. Have to account for everything they drank and ate.
What regulates output? What are the normal values of output?
Fluid is lost as output through kidneys, skin, lungs, and gi tract. We put out 1200-1500 ml a day normally. Need to monitor catheter bags, stools, colostomy bag.
When a person has hypovolemia what does the body do in response and what does it mean in relation to osmolality in the plasma?
A person who has loss of body fluid volume will have an increase in plasma osmolality. This person will have low bp, low cap refill, low o2 sat, weak pulse, thready, flat JVD, hypoxia. To compensate body with activate sympathetic nervous system will try to increase ventilations to get oxygen to tissues, and to increase blood returned to the heart with vasoconstriction, which also increases heart rate and bp. Hypothalamus will also tell you are thirsty. Increase of ADH secretion to get more water back into the body.
When a person has hypervolemia what does the body do in response and what does it mean in relation to osmalality in the plasma?
Excess fluid is retained and kidneys are not getting rid of it, increased bp, strong pulse 4+ jvd, edema, crackles in lungs, forced fluid into lungs into vessels and hypoxia in the alveoli, irritating cough, excess fluid in brain, cerebral edema, do they make sense, will not respond to the sternal rub,decreased pupils, can they squeeze hand, skin warm and leaky or cool if extreme, skin breakdown in sacral area.
What is hyperkalemia? What is hypokalemia?
Hyperkalemia is excess potassium in the blood in response to metabolic or resp or acidosis, low pH, where H+ ions are going into the cells keeping potassium K+ out and into the serum, which can cause arrhythmias. Hypokalemia is low potassium in the blood, from alkalosis or high pH, it's going into the cells and being excreted.
What is BUN and what is creatinine and what are the normal levels for each?`What should the ratio be of BUN/Creatinine
BUN is a blood chemistry test that measures the flow rate of urea in blood. Normal level is 10-30mg/dl. Creatinine blood test measures creatinine (the end product of muscle and protein metabolism) that is liberated at a constant rate with normal values of 0.5-1.5 mg/dl. Bun/Creatinine ratio is 10:1
What is a uric acid test?
A uric acid test is measuring purine metabolism. Values will depend on the amount of purines ingested or metabolized. Can indicate a kidney disease too. High levels can indicate gout. Uric acid levels should be 2.5-5.5 or 4.5-6.5 mg/dl.
What is the bicarbonate or HCO3- test?
Most patients that are in renal failure are in metabolic acidosis (H+++) and and have a low blood serum of HCO3-
Normal values for HCO3- are 22-26 meq/L
Renal blood flow makes up how much of our cardiac output?
1/3 of our cardiac output
What secretions and re-absorptions happen in the proximal tubule
80% of all electrolytes and water that came out of glomerular filtration are reabsorbed back into the capillaries. They include:glucose, amino acids and small proteins. At the same time Hyrdogen ions and creatinine are secreted into the filtrate of the proximal tubules.
What secretions and reabsorptions happen in the loop of henle?
REABSORPTION:In the DESCENDING loop of henle, only water leaves through aquaporins, to be reabsorbed back into the blood, But not ions, not until the filtrate gets to the ascending limb do the Na+, Cl- get reabsorbed. After the water and electrolytes are aborbed the filtrate is more concentrated.
What is the normal reserve and output values of urine?
Normal bladder capacity 600 ml
Urges may be felt at 150-200 ml
Normal hourly output ≥ 30 ml
Normal daily output ≤ 2500 ml
What factors can influence urination?
Multiple factors influence urination
Diabestes, Alzheimers, Parkinsons, Socioeconomic factors, Outhouses, Protate hypertrophy
What is reabsorbed/secreted in the distal tubule?
The distal tubule reabsorbs even more water (after descending limb), but this time by the help of ADH. Bicarb(HC03- is also reabsorbed.There is secretion of K+, H+, and NH3+. 2 hormones also carry out secretion/absorption with ion regulation in the distal tubule: PTH regulates Ca++/PO4-, and Aldosterone regulates Na+/K+.
What reabsorption/secretion happens in the collecting tubule?
Reabsorbtion of water happens in the collecting duct, but only with the help of ADH or antidiuretic hormone.
What organ in the body influences bladder function?
The brain: cerebral cortex, thalamus, hypothalamus, and brain stem. But just because the bladder is able to function, does not mean that urination will happen: there are multiple factors that influence urination: from socioeconomic, outhouses, to peeing in public, diseases, having children....
How does pregnancy affect urination?
Urinary frequency is common;
Susceptibility to urinary tract infection increases;Decreased perineal muscle tone may lead to temporary or permanent urgency & stress incontinence.
What gerontologic considerations shoud be made in regard to the urinary system?
1)Structural changes in kidneys: 2)↓ability to conserve water,3)less ability to handle acid load,4)Hormonal changes:↓ in renin & aldosterone 5)↑ ADH & ANP (a sodium hormone that is produced by cardiomyocytes that works against or is antagonistic against renin/angiot/aldosterone system);6)Loss of subcutaneous tissue leads to increased ↑ loss of moisture via skin. 7) Decreased thirst mechanism leads to decreased fluid intake and decreased renal blood flow resulting in urine concentration.8) Impaired renal elimination of drugs results in accumulation in the plasma & toxicity
9) Elderly often experience nocturia.
10) Prostate enlargement in males begins in 40s & continues through- out life.11) Females: changes in urethral mucosa contribute to increased susceptibility to UTIs
12) Bladder looses muscle tone resulting in increased urinary frequency.13) Bladder looses contract-ility: can lead to incontinence. 14) Often experience urinary retention post voiding (PVRpost void residual): an ultrasound that estimates volume of urine left in bladder. 15) Chronic diseases & related conditions create risks for bladder control problems.
What are the characteristics and limitations of the urinary system in children?
Infants:Cannot effectively concen- trate urine. They excrete large volumes of urine in relation to their body size; means greater risk for dehydration & fluid imbalance (use tenting assessment). Their neuro- logical system is immature; they R unable to recognize feelings of bladder fullness. Electrolyte imbalance can happen quickly because of relation of volume of fluid to size of the person.Toddlers 1-3 years: they do associate sensations of bladder filling and urination. Able to control external sphincter so
toilet training begins.Children 4-5 years: Some R able to establish nighttime control of urine.
What are the changes and ratios of water content related to age levels?
Infants: made of 70-80% water/ 20-30% solids; Adults: made of 50-60% water/40-50% solids; Older adult made of 45-55%water/45-55% solids. A baby is more prone to dehydration because they are mostly made of water.
What are the 2 major body fluid compartments and their ratios?
There is extracelluar fluid (ECF which is composed of plasma(5%) and interstictial fluid 15%)), and intracellular fluid (ICF). The ECF makes up about 20% of body weight, and the ICF makes up about 40% of body weight.
What is the electrolyte composition in ICF and ECF? What are their ratios and what does this mean in regulation of the osmolality/circulating fluid rhythms in the body?
ICF is intracellular fluid. It is composed mostly of potassium K+ cations and phosphate PO43- anions.; ECF: the prevalent cation is Na+ and prevalent anion is Cl-. The sodium potassium pump is constantly moving (with help of ATP) sodium and potssium across the cell membrane. But you are always going to see a high amount of sodium in ecf and high amount of potassium in icf. If there is too much sodium in ecf the result is edema. Remember: if you have a decreased ECF osmolality, you have excess of water, which is diluting the solute to make a decrease proportion. This means edema. If you have increased plasma osmolatlity (more solute in ratio to water) then ADH will be secreted to pull in more water. If you have an increase in circulating fluid volume (decreased plasma osmolarity), then ADH and thirst will be inhibited to flush water out of system.
Name the different cations of the urinary system and their normal levels. Name the different anions and their normal levels.
Cations:
The cations are: Sodium (Na+) 135-145 mEq/L;Potassium (K+): 3.5-5.0 mEq/L;Calcium (Ca2+): 9-11 mg/dl; Magnesium (Mg2+): 1.5-2.5 mEq. The Anions are: Chloride (Cl-) 95-110, Bicarbonate (HCO3–) 22-26 mEq/L, Phosphate (PO43-) 2.8-4.5 mg/dl
Explain the renin-angiotensin system:
Renin is secreted in the kidneys by the juxtaglomerular cells in response to too much urinary sodium or decreased serum Na+, decreased arterial blood pressure or decreased ECF. Renin is a catalyst that can split angiotensinogen (from liver) into angiotensin 1, which is converted to angiotensin2 with help of another catalyst. A2 stimulates release of aldosterone from adrenal cortex. Aldosterone causes Na+ to come back into blood, (water will follow) which will increase ECF, and aldosterone also causes peripheral vasoconstriction.
Explain the carbonic acid and bicarbonate ratio in regards to pH, the compensatory mechanisms involved in this acid/base balance.
There should be a metabolic ratio of 1 carbonic acid (H2CO3) to 20 bicarbonate (HCO3) for normal pH. If bicarbonate value goes down/carbonic up then there is metabolic acidosis (excess of ketones, chloride..._The body will compensate with help of lungs and kidneys. The lungs will try to blow off the carbonic acid (as CO2 & H2O), and the kidneys will try to concerve bicarbonate and excrete H+ ions that are in the urine. There is also medical intervention that can increase pH (make more basic). A lactate solution can be given, which will convert into bicarbonate ions in the liver.
What are the medications and substances that can affect urinary elimination?
Diuretics that ↑ production of urine:
Caffeine & alcohol & therapeutic medications.Nephrotoxic agents (includes: antibiotics, pharmacologic agents, and various metals and contrast medium),Meds for incontinence (to ↓ bladder contractions),Meds for urinary retention (to ↑ bladder contractions),
and Cranberry juice (prevents urinary infections by inhibiting e. Coli bacteria).
What are the physical assessment visual signals from the urinary system that an nurse could inspect?
1)Skin & Mucous Membranes
Assess hydration with tenting/edema inspection. 2) Kidneys: Flank pain may occur w/ infection or inflammation;3) Bladder: distended bladder rises above symphysis pubis; 4) Urethral Meatus: observe for discharge, inflammation, and lesions.
What are the polys, olys, and annies of altered urine production, and what are their related values?
Polyuria in DM, DI, CRF, diuretics, excess fluid intake
Oliguria (100-400 ml/24*)
Anuria no urine or < 100 ml/24* in ARF, end-stage renal disease, obstruction
What are the number values for very concentrated urine and very dilute urine?
1.025 is very concentrated;
1.010 is very dilute.
What are some urine lab studies that performed?
Urinalysis (UA): includes blood tests: BUN (blood urea nitrogen) norms: 10-30mg;Creatinine blood test norm:0.5-1.5mg/dl, & Specific gravity, which weighs levels of solute.
Urine tests: Creatinine Clearance: how much is secreted in the urine 85-135 ml/min; Urine Culture, involves a clean catch used for uti detection;Concentration test is measured by specific gravity of solutes in the concentration of urine;
Post void residual (PVR) should only have around 50 ml or less (this increases with age).
What is KUB diagnostic procedure and prep?
Involves xray examination of abdomen and pelvis and delineates size, shape and position of kidneys, stones and foreign bodies can also be seen.
Prep: bowel prep
What is IVP diagnostic procedure and prep?
Intravenous pyelogram, xray exam that visualizes urinary tract after IV injection of contrast material. The urinary system is inspected. Cysts tumors, lesions and obstructions will cause distortions to be visible. Warning: a patient with decreased renal function should not have an IVP because the contrast medium is nephrotoxic. Prep: enema, and NPO status 8hr before, and check for iodine sensitivity. Tell patient they will feel warm, flushed face and salty taste during injection of contrast. Afterwards-force fluids.
What is the Renal Arteriogram and prep?
The purpose of the renal arteriogram is to look at renal blood vessels to check for narrowing, missing, or additional blood vessels and to detect renal hypertension. Procedure involves a catheter into the femoral artery up to arteries of kidney where contrast medium is injected. Prep: give enema, test for iodine sensitivity, may feel warm feeling. Need pressure dressing over femoral artery injection site, taking peripheral pulses checking for thrombus.
What is the Renal ultrasound and prep?
used to detect renal or perirenal masses. It is a noninvasive procedure that passes sound waves into body structures. Can be used safely in patients with renal failure (no dye). Prep: no radiation, Images are take supine and prone, no bowel prep required.
What is a renal CT scan and prep?
Excellent visualization of the kidneys, check of tumors, abscesses, masses. Injection of contrast medium. Prep; iodine sensitivity check, patient has to lie very still, sometimes need sedation.
What is a Cystogram and prep?
Helps visualize bladder to evaluate vesicoureteral reflux, abnormalities, diverticula, tumors, recurrent uti. Prep:Uses contrast material into bladder with a cystoscope or catheter. If using a scope may need general anesthesia. Burning on urination or pink tinged urine are normal. Observe for bright red bleeding (not normal) Off warm stiz baths...
What is a cystoscopy and prep?
Inspects interior of the bladder. Can be used to insert catheters, removed caliculi and obtain biopsy specimens of bladders lesions, and treat bleeding lesions. Lithotomy position is used. Can use local or general anesthesia. Complications can include urinary retention, urinary tract hemorrh. bladder infection and perforation of bladder. Prep: before force fluids for anesthesia, get consent form, After: warn about burning pink tinged urine, urine frequency, ...
What is a renal biopsy and prep?
Done to obtain renal tissue for examination to determine type renal disease or follow progress of disease. Needle is inserted into lower lobe of kidney where tissue is taken. Absolute contraindications of this procedure are: bleeding disorders, a single kidney and uncontrolled hypertension. Prep: Cross-match patient's blood type, consent form Before: coagulation status, After: apply pressure dressing for 30-60 minutes, bed rest for 24 hours, vital signs every 5-10 min in first hour, assess for flank pain, hypotension, low hematocrit, raised temp, chills, urinary frequency, disuria, serial urine specimens, inspect site for bleeding. Patient must avoid lifting for a week.
What should we asses in urine?
Intake/output, color: should be pale-straw to amber; clarity: transparent; odor: should have amonia nature.
What is a urinary alternative to urethral catheterization?
Client can have a continent urinary diversion in chich case a urinary stoma is used to divert the flow of urine formt he kidneys directly to the abdominal surface due to trauma or cancer of the bladder....) can be temp or perm. They use the ilium is the conduit for the urine. And a leakproof bag is attached outside.
What are the 2 types of catheters?
Intermittent (as needed) and indwelling (foley) catheters for Longer periods. Catheterization requires a physician order and sterile technique.
A person came in from a renal biopsy and what is first intervention the nurse would do? a) put pressure w/ a sandbag on the kidney and have the patient lay on top b)analgesics prn, c) DVT socks prevention.
a) put pressure w/ a sandbag on the kidney and have the patient lay on top
This procedure can cause bleeding, and this could help stop bleeding.