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56 Cards in this Set

  • Front
  • Back
What are the functions of the kidneys
1. regulate pH, 2. eliminate metabolic wastes, 3. regulate osmolality of ECF, 4. blood pressure regulation; 5. activates vit D & regulates Ca & P; 6. production of RBCs
How do the kidneys regulate pH?
through reabsorption & elimination or conservation of Na, K, Cl, H, & bicarb
How do the kidneys regulate osmolality?
through the action of antidiuretic hormone (ADH) ... limit amount of H2O lost in urine/ increase qty of H2O absorbed
How do the kidneys function to regulate BP?
through the renin - antiotensin - aldosterone mechanism + regulation of salt & H2O elimination
BP drop = increase renin = increase angiotensin (vasoconstrictor) = increase aldosterone (increase Na & H2O = increase in volume = increase BP
What is BUN?
by product of protein metabolism in liver & eliminated entirely by kidneys .... related to GFR but also protein intake & hydration
What is creatinine?
product of creatine metabolism in muscles .... its formation & release are relatively constant & proportional to amount of muscle mass present .... serum levels depend closely on GFR
What lab value is the best indicator of renal function?
creatinine level & BUN: creatinine ratio
What does a BUN: Creat ratio of 15:1 suggest?
CHF or UGI bleed
What could cause the BUN: Creat ratio to be out of balance?
decrease blood flow to kidney m/b result of shock, severe dehydration, increase protein, sudden or acute kidney failure
How do K+ levels change w/ renal function?
will elevate in renal disease
How do Ca levels change w/ renal function?
will decrease in renal disease
How do Phosphate levels change w/ renal function?
will elevate in renal disease .... eliminated as part of buffer system in urine w/ H & HPO4
How do CO2 levels change w/ renal function?
reflects changes in bicarb
What is the relationship btwn GFR & Creat?
GFR drops by 75% = Creat value increases 3x
What does a urinalysis assess?
1. urea; 2. ammonia; 3. RBC & WBCs; 4. protein; 5. glucose; 6. specific gravity; 7. pH ... also looking at color & turbidity
Presence of RBCs, WBCs & protein in urine is .....
always abnormal ... presence indicates some disease process
RBCs in urine
Presence of glucose in urine is ....
always abnormal
What causes a drop in specific gravity?
loss of concentrating ability or w/ dehydration
How interpret pH values w/ regard to kidney function?
increase acid puts at risk for kidney stones .... pH decreases w/ kidney failure .... pH increases w/ build up of ammonia
Role of prostoglandin?
in partnership w/ SNS regulate constriction & dilation of vasculature .... affect GFR
How do Motrin, Advil & NSAIDS affect prostoglandin?
Motrin & Advil are prostoglandin inhibitors ... NSAIDS dilate so alter vascular regulation
What contributes to UTIs?
1. bacteria - e-coli; 2. BR wiping habits; 3. sexual activity
What are S&S of a UTI?
burning when urinate, pass small & frequent; cloudy/ bright pink; strong smell; women - pelvic pain; men - rectal pain
What contributes to UTIs in elderly?
1. immobility; 2. bladder outflow obstruction; 3. bladder ischemia; 4. senile vaginitis; 5. constipation; 6. diminished bactericidal activity of urine & prostitic secretions; 7. decreased fluid intake
What is cystitis?
inflammation of bladder; q20min or more
painful urination
S&S of cystitis
dysuria, increase frequency & urgency of urination, purulent abnormal cells in urine; blood in urine
What is pyelonephritis?
infection of the kidney and the ureters, the ducts that carry urine away from the kidney ... often a UTI complication
What is most common cause of pyelonephriitis?
obstruction that causes backflow of urine into the ureters or kidney pelvis ...m/b kidney stone
neurogenic bladder
bladder is always full - not able to empty
6 Urinary tract obstructions
1. kidney stone; 2. scar tissue on ureter; 3. neurogenic bladder; 4. bladder outflow obstruction; 5. pregnancy or tumor; 6. uretero-vesicle junction stricture
Assessing for a UT obstruction
1. location ... 2. unilateral/ bilateral ... 3. partial or complete - H & P/ labs ... 4. acute or chronic
S&S of kidney stones
EXTREME pain .. 12/10; bleeding; pale; diaphoretic
What is a kidney stone?
crystalline structures that form from components of urine ....Ca+2 is most common; need environment that supports growth
enlargement (distention) of the urine collecting structures and pelvis of kidney - can be unilateral or bilateral ... NOT a disease: a physical result of whatever disease is keeping urine from draining out of the kidneys, ureters, and bladder
Clinical manifestations of Urinary Tract Stones
#1!! PAIN: caused by intense smooth muscle constriction & peristalsis elicited in response to obstructing ureteral stone; #2 urine volume may decrease due to ureterorenal reflex (vasoconstriction of renal arterioles)
Urinary tract pain is refered to ...
dermatome of the nerves carrying the pain & skin sensory fibers
What tests are used to diagnosis urinary tract stones?
1. X-ray: only Ca stone are visible; 2. Scans like CT & MRI: see size of organs & internal fluid spaces; 3. Stone analysis: determine chem composition of expelled/ removed stone
Preventing urinary tract stones ...
1. avoid related pathophysiology - excess parathyroid hormone + acidosis + gout exacerbation; 2. avoid dehydration; 3. increase fluid intake
How do excess parathyroid hormone & acidosis contribute to urinary tract stones?
increase blood levels of calcium & phosphate
How are urinary tract stones treated?
1. pass if < 5mm; 2. narcotics for ureteral pain; 3. reduce size of stone so can pass; 4. surgical removal
What is Altered Glomerular Dysfunction?
glomerular capillary membrane becomes permeable to plasma proteins & blood cells
Altered Glomerular Dysfunction leads to ....
proteinuria - albuminuria = more important evidence of glomerular injury; hematuria, pyuria, oliguria, edema - by loss of albumin & retention of Na & H2O, HTN, azotemia
condition where the patient's blood contains uncommon levels of urea, creatinine, and other compounds rich in nitrogen
pus in urine
decreased amount of urine
What are the S&S of Altered Glomerular Dysfunction?
asymptomatic ... found w/ abnormal urinalysis proteinuria & an elevated BP
Glomerular Disorder: Nephritic Syndrome A
caused by diseases that produce proliferative inflammatory responses that DECREASE permeability of glomerular capillary membrane
Glomerular Disorder: Nephritic Syndrome B
caused by disorders that INCREASE permeability of glomerular capillary membrane, causing massive loss of protein in urine
Glomerular Disorder: Nephritic Syndrome B ... manifestations
Proteinuria + Hypoproteinemia + interstitial edema + hyperlipidemia
4 reasons for Incontinence
1. involuntary - no control; 2. stress - increased abdominal pressure (sneeze); 3. functional - unable to get to bathroom fast enough; 4. total - continuous & involuntary
Risk Factors for Incontinence
female - multiparity - white - age - menopause/ hypoestrogenism - obesity - neurological disease - smoking - chronic cough - diabetes - chronic constipation
Causes of Incontinence
1. increased bladder pressure: a. overactive bladder, b. overflow or overfilling bladder; 2. decreased ablity of vesicourethral sphincter to prevent escape of urine
Transient causes of Incontinence
D - delirium, depression, dementia, dehydration
R - restricted mobility, rectal impaction, retention
I - irritation, infection, inflammation
P - polyuria, pharmacotherapy
Types of Urinary Incontinence
1. Stress - involuntary loss of urine associated w/ activities that increase intra-abdominal pressure; 2. Overactive Bladder - urgency & frequency/ hyperactivity of detrusor muscle; 3. Overflow - loss of urine when vesicular pressure > urethral pressure