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56 Cards in this Set

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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
hematuria
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
Dysuria
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
Hydonephrosis
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
Azotemia
condition where the patient's blood contains uncommon levels of urea, creatinine, and other compounds rich in nitrogen
pyuria
pus in urine
oliguria
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