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120 Cards in this Set
- Front
- Back
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What are some symtoms of hyperkalemia?
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fatigue, muscle weakness, paresthesia, confusion, dyspnea, peaked T waves, depressed ST segments, prolonged QT segments, widened QRS complexes, loss of P waves, and cardiac arrhythmias
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What are some symptoms of hypokalemia?
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weakness, fatigue, arrhythmias, flat or inverted T waves, prominent U waves
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What are symptoms of fluid overload?
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dyspnea, rales/crackles, jugular venous distention, peripheral edema
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What is Kayexalate (sodium polystyrene solfonate/SPS)used for?
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Reduction of serum potassium levels by exchanging sodium ions for potassium ions in the intestines (1g Na+ for 1 mEq K+)
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What is sorbitol?
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An osmotic laxative
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What is RenaGel (sevelamer) used for?
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It decreases serum phosphate levels by binding to them in the intestine and preventing absorption.
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What is PhosLo (calcium acetate) used for?
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To control hyperphosphatemia in ESRD
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What is Epogen (epoetin-alpha) used for?
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To stimulate production of RBCs.
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What is Fosrenol (lanthanum carbonate) used for?
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To decrease serum phosphates by forming an insoluble complex with phospage in the GI tract.
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What is important to know about taking Fosrenol (lanthanum carbonate)?
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Take with or immediately after food. Chew tablet completely.
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What does ARB stand for?
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Angiotension II Receptor Blocker
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What medications are ARBs?
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The "artans". Atacand, Teveten, Avapro, Diovan, Cozaar, Benicar, Micardis
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What are the structures of the renal system?
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kidneys, ureters, bladder, urethra
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What are the functions of the kidney?
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* Regulate volume & composition of ECF
* Excrete waste products * Regulate BP --> Renin * Erythropoietin production * Vit D activation * Acid-base regulation |
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What does erythropoietin do?
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stimulates RDC production in bone marrow
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What is Vitamin D needed for?
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To absorb calcium from the GI tract
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What does GFR stand for?
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Glomeruler Filtration Rate
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What is the normal GFR?
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125 mL/min
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About how much blood travels through the kidney per minute?
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1200 mL/min
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How much urine do the kidneys normally produce per minute?
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1 mL/min
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What does resorption mean in the kidney?
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Fluid from tubules go back into the capillaries
kidney --> body |
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What does secretion mean in the kidneys?
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fluid or stuff from capillaries go into the tubules
body --> kidney |
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What is Dysuria?
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burning with urination
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What is pyuria?
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Pus in the urine
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What is a term for difficulty in initiating urination
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hesitancy
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What is hesitancy? (urination)
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Difficulty in initiating urinationg
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What is urgency in regards to urination?
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Feeling like you will wet your pants if you cannot urinate immediately.
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What is the feeling like you will wet your pants if you cannot urinate immediately?
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Urgency
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What is frequency? (urination)
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The feeling like you have to pee all the time
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What is the term for the feeling like you have to pee all the time?
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Frequency
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What is another term for urinary stone?
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calculi (plural = calculus)
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What does CVT stand for?
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costovertebral tenderness
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What does CVA stand for? (not a stroke)
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costovertebral angle
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What kind of pain is located laterally on the torso beneath the ribs? What does it indicate?
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Flank pain. It can indicate a problem with the kidneys like kidney stone.
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What does BPH stand for?
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Benign Prostate Hypoplasia
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What does TURP stand for?
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Transurethral Resection of the Prostate
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What is a pessary?
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A device that supports the pelvic organs
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What is the term for leakage of urine from the urinary bladder?
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Incontinence
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Define incontinence
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Leakage of urine from the urinary bladder
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What is the normal GFR?
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125 mL/min
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How many mL/min of urine do the kidneys produce?
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1 mL/min
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What are some of the gerentologic changes in the renal system?
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1. Decreased glomeruli function
2. Decreased renal size 3. Low GFR 4. Loss of reserve to fight changes 5. No estrogen + childbirth = prolapse + urethral irritation 6. Loss of sphincter control 7. Loss of bladder capacity |
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What kind of wastes do urine eliminate?
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urea, amonia, drugs, toxic substances
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What main parts of the kidney would you see if you cut it in half?
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- Renal Capsule - a thin outer membrane that helps protect the kidney
- Cortex - a lightly-colored outer region - Medulla - a darker, reddish-brown, inner region - Renal Pelvis - a flat, funnel shaped cavity that collects urine into the ureters |
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What are the parts of a nephron? (not including blood supply)
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Bowman's Capsule
Proximal convoluted tubule Loop of Henle Distal convoluted tubule Collecting Duct |
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Describe the blood supply to and around the nephron
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renal artery -> Afferent arteriole -> glomerulus -> efferent arteriole -> peritubular capillaries -> interlobular veins -> renal veins
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What 3 main processes do the kidneys do in order to regulate blood composition?
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1. Filtration
2. Reabsorption 3. Secretion |
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What is erythropoetin?
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A hormone produced in the kidneys in response to hypoxia and decreased renal blood flow. Stimulates production of RBCs in the bone marrow.
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What is renin?
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Renin is an enzyme released by the kidney. It is released when there is decreased perfusion of the juxtaglomerular apparatus.
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What does renin do?
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Renin cleaves angiotensinogen and turns it into angiotensin I. Ultimately leads to higher BP.
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Where is angiotensinogen produced?
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The liver
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What is ACE and what does it do?
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Angiotensin Converting Enzyme. Found mainly in lung capillaries. Converts angiotensin I -> angiotensin II.
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What does Angiotensin II do?
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Increases BP. Vasoconstricts arterioles, causes release of aldosterone from adrenal cortex, causes release of ADH
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What is creatinine?
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Waste product of protein breakdown.
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What is a renal arteriogram?
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A study used to visualize renal blood vessels?
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What is the main purpose of cytoscopy?
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The main purpose of this study is to inspect the interior of the bladder with a tubular lighted scope.
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What is a retrograde pyelogram?
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a surgical procedure used to visualize the renal pelvis and ureter in which an edoscope is placed through the urethra into the urinary bladder and a catheter is placed into the ureter to instill a contrast medium.
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What is an intravenous pyelogram?
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a pyleogram in which a radiopaque material is given intravenously. Provides info about the structure and function of the kidney, ureter, and bladder. Can be used to detect kidney stones.
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What is erythropoietin produced in response to?
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Hypoxia and decreased renal blood flow.
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Which kidney is slightly higher than the other kidney?
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Left kidney higher.
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Which gland lies above the kidney?
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The adrenal gland.
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What is the filtrate in the tubules like after it goes through the glomerulus?
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It is like blood but without blood cells or proteins because the pores in the membrane are too small to allow these to cross over
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What do loop diuretics do?
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Prevent the reabsorption of sodium, potassium, chloride and water. -> Lasix
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What do thiazide diuretics do?
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Prevent the reabsorption of sodium, chloride and water. Potassium is reabsorbed. -> Hctz.
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Where is ADH secreted and produced by?
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Produced by hypothalamus and secreted by posterior pituitary.
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How does renin cause increased BP? (generally)
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Makes us retain sodium and water and vasoconstrict.
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Which classes go against the RAA system?
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ACE inhibitors and ARBs
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What is ADH triggered by and what does it do?
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Triggered by low BP & high osmolality. Regulates the amount of water reabsorbed into the capillaries from tubules.
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Why shouldn't patients with HTN and Diabetes receive NSAIDs?
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Prostaglandins produced in the kidneys can lower systemic vascular resistance and further protect the renal vasculature. NSAIDs are prostaglandin inhibitors and take away this protection against increased BP.
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Why are peaks and troughs monitored when giving nephrotoxic medications?
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Trough levels are a reflection of potential drug toxicity. Peak levels are an indicator of therapeutic dosing.
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What are some gerentolic changes in the renal system?
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1. Decrease kidney mass (20-30%)
2. Loss of nephrons (30-50%) 3. Low GFR 4. Loss of reserve to fight changes. 5. No estrogen + childbreath --> prolaspse & urethral irritation 6. BPH --> hesitancy, retention, slow stream, UTI 7. Loss of external sphincter control 8. Loss of bladder capacity |
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What are some simple nursing interventions you can do to help a patient void?
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Turn on water faucet. Relax patient.
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What past medical history conditions could affect the renal system?
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Hypertension, diabetes, lupus, poor nutrition, CVA, back injury, childbirth, strep infections, TB, cancer, BPH, UTIs/pyelonephritis, calculi, loss of a kidney, mailaise, headache, vision problems, urine pattern change/color change/incontinence
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What subjective data would you ask your patient about their GI system?
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PMH, Meds, Allergies, Surgery, Tx, Family Hx, Functional Health patterns
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What kind of objective data will you collect for the GU system?
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Inspection, Auscultation, Percussion, Palpation, VS, WT
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Non-normal inspection results of GU?
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edema, scars, bruising (from decreased erythropoiten from kidneys), pallor of anemia, asymmetry of belly
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Non-normal ausculutation results of GU?
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bruits in upper quadrants --> decreased renal flow
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What can a kidney punch tell you?
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If there is pain and it radiates to the front, there might be an infection or polycystic kidney disease.
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What do you expect to hear when you percuss a full bladder?
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Tympany
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What should you be able to palpate on the abdomen? (GU)
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First, make sure the patient has voided. The right kidney might be palpable. The bladder is midline above pubis symphysis, it is palpatable if distended.
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What could be a reason why a bladder is distended?
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Neoplasm or serious renal pathologic condition.
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In the elderly, what should you assess for and not really rely on?
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There may not be any temp. Assess for fatigue, letherage, altered LOC. Think UTI!!!
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What is anuria?
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No urine or less than 100 mL/24 hours
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What is oliguria?
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Decreased urine output (100-400 mL/24 hrs)
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What is nocturia?
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Frequent voiding at night (more than twice)
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What is Heamturia?
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Blood in urine
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What is urgency?
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The feeling that you have to urinate
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What is hesitancy?
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You feel like you have to urinate but it is hard to start.
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What is dysuria?
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It hurts to urinate
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What is enuresis?
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bedwetting
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What is urge incontinence?
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Urine is released with little warning when bladder "seems full"
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What is stress incontinence?
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Urine is released by increased intra-abdominal pressure i.e. laughing, sneezing, coughing
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Normal value for creatinine clearance?
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85 - 135 mL/min
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Normal pH of urine?
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4-8 (average 6)
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Specific gravity of urine?
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1.010 - 1.030
The weight of a substance compared to the weight of an equal volume of water. |
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Osmolality of urine?
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300 - 1300 mmol/kg
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What is osmolality in regards to urine?
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The amount of "stuff" in urine; osmotic concentration
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How would you instruct a patient to do a 24-hour urine test?
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The patient voids into the toilet and marks down the time. This is the beginning of the test. Every void after that goes into a special jar, that is kept in the refridgerator or in a cooler. The test ends after 24 hours. The patient must void one last time and the urine put into the jar.
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What is the normal post-void residual amount?
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< 50 mL
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What is the normal value for BUN/Cr? What can affect it?
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10-20 / 0.5-1.5
Can be affected by cell destruction. |
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What is the normal value for uric acid? What can affect it?
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2.5 - 5.5 mg/dL in women
4.5 - 6.5 in men Can be affected by diet. |
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What is the normal value for sodium?
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135 - 145
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Normal value for potassium?
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3.5 - 5.5 mEq/L
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Normal value for calcium?
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9 - 11mEq/L
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Normal value for phosphorus?
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2.8 - 4.5
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Normal value for bicarbonate?
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20 - 30
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What is hydronephrosis?
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Swelling/enlargement of the kidney due to backup of urine
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What are intrinsic causes of hydronephrosis?
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1. BPH
2. Strictures 3. Stenosis 4. Diet |
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What are extrinsic causes of hydronephrosis?
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1. Tumors
2. Adhesions 3. Uterine Prolapse 4. Medications 5. Diet |
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What is a hydroureter?
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enlargement of the ureter due to backup of urine
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What diagnostic test can be used to view hydronephrosis and hydroureter?
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IVP - Intravenous Pyelogram
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What are the signs/symptoms of hydronephrosis and hydroureter?
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Depends on the cause, location, and duration of the obstruction. There can be colicky flank pain or a dull aching discomfort. Maybe nausea/vomiting.
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Who does renal calculi usually affect?
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Men more than women, usually between ages 20-55, caucasions > African Americans
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What are some possible causes for renal calculi formation?
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1. Poor hydration
2. Urine pH too low or high 3. Diet-purines, fruit juice, tea, calcium 4. Sedentary lifestyle 5. Family history 6. Infections - these people have increased incidence |
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What are the 3 types of renal calculi?
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1. Calcium
2. Struvite/Staghorn 3. Uric Acid |
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What type of renal calculi is the most common?
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Calcium oxalate
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What are the 2 kinds of calcium renal calculi?
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1. Calcium oxalate
2. Calcium phosphorus |
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Which type of renal calculi do women get more than men?
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Struvite/Staghorn
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What is the risk factor for getting the struvite type of renal calculi?
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UTIs
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What are risk factors for the uric acid type of renal calculi?
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Men > Women, often jewish, gout, low urine pH, inherited
"Big Red Toe" |
