Unit 7; Alteration In Urinary Elimination

Front 1

Describe the function of the kidneys:

Back 1

**to regulate the volumes and composition of ECf
**to excrete waste products from the body
-control BP
-produce erythropoietin
-activate vit D
-regulate acid-base balance
(**) symbolize the primary functions of the kidneys

Front 2

This gland lies on top of the each kidney:

Back 2

-Adrenal Gland

Front 3

The surface of the kidney is covered by a thin, smooth layer of fibrous membrane called the ______, which serves as a shock absorber.

Back 3

-Capsule

Front 4

The _____ is located on the medial side of the kidney and serves as the entry site for the renal artery and nerves, as well as the exit site for the renal vein and ureter.

Back 4

-Hilus

Front 5

The outer layer of the kidney is called:

Back 5

-the cortex

Front 6

The inner layer of the kidney is called:

Back 6

-the medulla

Front 7

The medulla of the kidney consists of pyramids called ______, through which urine passes to enter the calyces.

Back 7

-Papillae

Front 8

The _____ and ______ ______ transport urine to the renal pelvis, from which it drains via the ureter to the bladder.

Back 8

-minor and major calyces

Front 9

abdominal aorta -> renal artery -> secondary branches -> smaller branches -> afferent arterioles -> glomerulus -> efferent arteriole -> peritubular capillaries -> venous system -> renal vein -> inferior vena cava

Back 9

-The blood flow through to the kidney, through the kidney, and from the kidney

Front 10

The afferent arteriole divides into a capillary network termed the ______, this is a tuft of up to 50 capillaries.

Back 10

-Glomerulus

Front 11

The functional unit of the kidney; compromised of a glomerulus, Bowman's capsule, and tubular system:

Back 11

-Nephron

Front 12

This system consists of the proximal convoluted tubule, the loop of Henle, the distal convolute tubule, and a collecting tubule:

Back 12

-Tubular system

Front 13

The glomeruli, Bowman's capsule, proximal tubule, and distal tubule are located in the ______ of the kidney.

Back 13

-cortex

Front 14

The loop of Henle and the collecting tubules are located in the _____ of the kidney.

Back 14

-medulla

Front 15

Urine formation begins at which part of the kidney?

Back 15

-Glomerulus (where blood is filtered)

Front 16

This force from the blood within the glomerular capillaries causes a portion of the blood to be filtered across the semipermeable membrane into Bowman's capsule, where the filtered portion of the blood (the glomerular filtrate) begins to pass down to the tubule:

Back 16

-Hydrostatic pressure

Front 17

True or False:
Under normal conditions, the capillary pores are too small to allow the loss of these large blood components.

Back 17

-True:
Capillary permeability is increased in many renal diseases, permitting plasma proteins and blood cells to pass into the urine

Front 18

The amount of blood filtered by the glomeruli in a given time:

Back 18

-Glomerular filtration rate (GFR)

Front 19

The normal GFR is:

Back 19

-about 125 mL/min

Front 20

This action is the passage of a substance from the lumen of the tubules through the tubules cells and into the capillaries and involves both active and passive transport:

Back 20

-Reabsorption

Front 21

This action is the passage of a substance from the capillaries through the tubular cells into the lumen of the tubule:

Back 21

-Secretion

Front 22

_______ and ______ occur along the entire length of the tubule, causing numerous changes in the compostion of the glomerular filtrate as it moves through the tubule.

Back 22

-Reabsorption and Secretion

Front 23

Name the component of the nephron that has the function of selective filtration:

Back 23

-Glomerulus

Front 24

Name the component of the nephron that has the function of reabsorption of 80% of electrolytes and H2O; reabsorption of all glucose and amino acids; reabsorption of HCO3; secretion of H+ and creatinine:

Back 24

-Proximal Tubule

Front 25

Name the component of the nephron that has the function reabsorption of Na and Cl in ascending limb; reabsorption of H2O in descending loop; concentration of filtrate:

Back 25

-Loop of Henle

Front 26

Name the component of the nephron that has a function of secretion of K+, H+, ammonia; reabsorption of H2O (regulated by ADH); reabsorption of HCO3; regulation of Ca++ and PO4 by PTH, regulation of Na+ and K+ by aldosterone:

Back 26

-Distal Tubule

Front 27

Name the component of the nephron that has a function of reabsorption of H2O (ADH required):

Back 27

-Collecting Duct

Front 28

This hormone is required for H2O reabsorption in the kidney is very important in H2O balance; make the distal convoluted tubules and collecting ducts more permeable to water:

Back 28

-ADH

Front 29

This hormone is released by the adrenal cortex and acts on the distal tubule to cause reabsorption of Na+ and water; K+ ions are excreted:

Back 29

-Aldosterone

Front 30

This hormone acts on the kidneys to increase Na+ excretion; suppresses aldosterone secretion; results in the production of a large volume of dilute urine; causes relaxation of the afferent arteriole, thus increasing GFR:

Back 30

-Atrial Natriuretic Peptide (ANP)

Front 31

This hormone maintains serum Ca++ levels by causing increased tubular reabsorption of Ca++ ions and decreased tubular reabsorption of PO4:

Back 31

-PTH

Front 32

Produced and released in response to hypoxia and decreased renal blood flow; stimulates the production of RBCs; deficiency can lead to anemia:

Back 32

-Erythropoietin

Front 33

A patient with renal failure has a deficiency of the active metabolite of _______ and manifests problems of altered Ca++ and PO4 balance.

Back 33

-Vitamin D

Front 34

This hormone is important in the regulation of BP; is produced and secreted by juxtaglomerular cells of the kidney:

Back 34

-Renin

Front 35

Synthesis occurs primarily in the medulla; have a vasodilating action, thus increasing renal blood flow, and promoting Na+ excretion; counteract the vasoconstrictor effect; lowers BP by decreasing systemic vascular resistance:

Back 35

-Prostaglandins

Front 36

Normal adult urine output is approximately:

Back 36

-1500 mL/day

Front 37

How often do people urinate during the day?

Back 37

-5-6 times and occasionally at night

Front 38

This muscle is composed of layers of intertwined smooth muscle fibers capable of considerable distention during bladder filling and contraction during emptying:

Back 38

-detrusor muscle

Front 39

On average, what is the amount of urine in the bladder that causes moderate distention and the urge to urinate?

Back 39

-200-250 mL

Front 40

At what amount of urine in the bladder causes the person the feel uncomfortable?

Back 40

-400-600 mL

Front 41

What is the average bladder capacity for an individual?

Back 41

-600-1000 mL; though it varies with the individual

Front 42

The name of the mucosal lining; unique to the urinary tract; resistant to absorption of urine:

Back 42

-Transitional cell epithelium

Front 43

A small muscular tube that leads from the bladder neck to the external meatus:

Back 43

-Urethra

Front 44

A small muscular tube that leads from the bladder neck to the external meatus and serves as a conduit for urine from the bladder neck to outside the body during voiding:

Back 44

-Urethra

Front 45

This muscle surrounds a portion of the urethra and voluntarily contracts and prevents leaking when bladder pressure increases:

Back 45

-Rhabdosphincter

Front 46

An uncontrolled leakage of urine:

Back 46

-Urinary Incontinence (UI)

Front 47

The inability to empty the bladder despite micturition or the accumulation of urine in the bladder because of the inability to urinate:

Back 47

-Urinary Retention

Front 48

Urinary leakage or postvoid dribbling:

Back 48

-Overflow UI

Front 49

The total inability to pass urine via micturition; it is a medical emergency:

Back 49

-Acute Urinary Retention

Front 50

Defined as incomplete bladder emptying despite urination:

Back 50

-Chronic Urinary Retention

Front 51

Normal postvoid residual (PVR) is:

Back 51

-between 50-75 mL; findings over 100 mL indicate the need to repeat the measurement

Front 52

An abnormal PVR in the elderly patient is a measurement of > or = to _____ mL obtained on ______ ______ occasions and requires further evaluation.

Back 52

-200
-two separate

Front 53

Urinary retention is caused by two dysfunctions of the urinary system:

Back 53

1. bladder outlet obstruction
2. deficient detrusor contraction strength

Front 54

This diagnostic test is performed by asking the patient to urinate, followed by catheterization or ultrasound within a relatively brief period (10-20 min):

Back 54

-PVR volume

Front 55

Describe nursing measures used for patients with UI:

Back 55

-Maintaining the pt's dignity, privacy, and feelings of self-worth must be maintained or enhanced
-Teaching of lifestyle interventions:consumption of adequate fluids, reduction or elimination of alcohol and caffeine, maintain regular urination schedule, quit smoking, management of constipation, pelvic floor training
-Provide info on products specifically designed to contain urine
-Maximizing toilet access; offering the urinal or bedpan or assistance to the bathroom

Front 56

Describe treatment of urinary retention:

Back 56

-double voiding; intermittent catheterization
-drug therapy including alpha-adrenergic blockers to relax smooth muscles
-surgical therapy as last resort including transurethral or open surgical techniques; pelvic reconstruction

Front 57

Describe nursing measures for a patient with acute urinary retention:

Back 57

-insert catheter as ordered
-those with a history should be instructed to avoid intake of large volumes of fluid over a brief period; warm up prior to urinating; aboid large volumes of alcohol intake
-those currently should be encouraged to drink a cup of coffee or brewed tea; sit in a tub or shower in warm water and urinate

Front 58

Describe nursing measures for a patient with chronic urinary retention:

Back 58

-Manage behavior, indwelling or intermittent catheterization, surgery, or drugs
-Scheduled toileting and double voiding are primary behavioral interventions

Front 59

An enlargement of the prostate gland resulting from an increase in the number of epithelial cells and stromal tissue; most common urologic problem in adult males:

Back 59

-Benign prostatic hyerplasia (BPH)

Front 60

It is thought to result from endocrine changes associated with the aging process including excessive accumulation of dihydroxytestosterone, stimulation by estrogen, and local growth hormone action
-Develops in the inner part of the prostate; gradually compresses the urethra, eventually leading to partial or complete obstruction
-Location of enlargement is most significant in the development of obstructive symptoms
-Family history, environment, diet high in saturated fats, obesity

Back 60

-Etiology of BPH

Front 61

-Gradual in onset; gradually worsen as the degree of urethral obstruction increases; obstructive and irritative

Back 61

-Signs and Symptoms of BPH

Front 62

This symptom is caused by prostate enlargement include a decrease in the caliber and force of the urinary stream, difficulty in initiating voiding, intermittently (stopping and starting stream several times while voiding), and dribbling at the end of urination:

Back 62

-Obstructive symptoms

Front 63

This symptom includes urinary frequency, urgency, dysuria, bladder pain, nocturia, and incontinence, are associated with inflammation or infection:

Back 63

-Irritative symptoms

Front 64

This procedure is used by HCP and can estimate the size, symmetry, and consistency of prostate gland:

Back 64

-Digital Rectal Examination (DRE)

Front 65

This procedure allows for accurate assessment of prostate size and is helpful in differentiating BPH from prostate cancer:

Back 65

-Transrectal Ultrasound (TRUS)

Front 66

This procedure is a study that measures volume of urine expelled from the bladder per second, is helpful in determining the extent of urethral blockage and thus the type of treatment needed:

Back 66

-Uroflowmetry

Front 67

This procedure allows internal visualization of the urethra and bladder, is performed if the diagnosis is uncertain and in patients who are scheduled for prostatectomy:

Back 67

-Cystourethroscopy

Front 68

This drug therapy treats symptoms of BPH; works by reducing the size of the prostate gland; blocks the enzyme which is necessary for the conversion of testosterone to dihydroxytestosterone; results in regression of hyperplastic tissue through suppression of androgens
-40-50% efficacy; takes between 3-6 months to be effective
-Side Effects include: decreased libido, decreased volume of ejaculate, and ED:

Back 68

-5-alpha-reductase inhibitors

Front 69

This drug therapy used to treat symptoms of BPH; promote smooth muscle relaxation in the prostate; ultimately facilitates urinary flow through the urethra; most widely prescribed for the BPH patient
-50-60% efficacy; occurs within 2-3 weeks
-Side Effects include: orthostatic hypotension, dizziness, retrograde ejaculation, and nasal congestion
-Does not treat hyperplasia

Back 69

-alpha-adrenergic receptor blockers

Front 70

This therapy is indicated when there is a decrease in urine flow sufficient to cause discomfort, persistent residual urine, acute urinary retention because of obstruction with no reversible precipitating cause, or hydronephrosis:

Back 70

-Invasive Therapy

Front 71

A surgical procedure involving the removal of prostate tissue using a resectoscope inserted through the urethra; require hospitalization and 3-way catheterization:

Back 71

-Transurethral Resection of the Prostate (TURP)

Front 72

An outpatient procedure that involves the delivery of microwaves directly to the prostate through a transurethral probe in order to raise the temperature of the prostate tissue to about 113F; heat causes death of tissue, thus relieving obstruction:

Back 72

-Transurethral Microwave Thermotherapy (TUMT)

Front 73

An outpatient procedure that increases the temp of prostate tissue, thus causing localized necrosis; allows greater precision in removal of the target tissue; lasts only 30 min; becoming an attractive treatment option for men:

Back 73

-Transurethral Needle Ablation (TUNA)

Front 74

A narrowing of the lumen of the ureter or urethra:

Back 74

-Strictures

Front 75

Describe causes of ureteral strictures:

Back 75

-Unintended result of surgical intervention, usually secondary to adhesions or scar formation

Front 76

Describe the s&s of ureteral strictures:

Back 76

-mild to moderate colic
-pain moderate to severe intensity if the patient consumes a large amount of fluids over a brief period

Front 77

Describe methods of treatment for ureteral strictures:

Back 77

-Temporarily placed stent to divert urinary flow
-Definitive correction dilating with a balloon or catheter

Front 78

This results from fibrosis of inflammation of the urethral lumen:

Back 78

-Urethral Stricture

Front 79

Describe causes of urethral strictures:

Back 79

-Trauma, urethritis, iatrogenic (following surgical intervention or repeated catheterization), a congenital defect, or meatal stenosis

Front 80

Describe the s&s of urethral strictures:

Back 80

-Diminished force of the urinary stream, straining to void, sprayed stream, postvoid dribbling, split urine stream
-Reports of feeling incomplete bladder emptying with urinary frequency and nocturia
-May lead to acute urinary retention

Front 81

Describe treatment of urethral strictures:

Back 81

-Urethral sound may be placed, or a series of progressively enlarging stents
-Taught to self-catheterization every few day
-As last resort urethroplasty may be performed to provide a more durable solution

Front 82

Another name for kidney stone disease:

Back 82

-Nephrolithiasis

Front 83

Describe common clinical data regarding calculi:

Back 83

-Highest incidence in the Southeast and Southwest
-Except for struvite, stone disorders occur more in men than women
-Occur between ages 20-55 years of age
-More frequent in whites than African Americans
-Recurrence common
-More common in summer months

Front 84

When in supersaturated concentration, can precipitate and unite to form a stone:

Back 84

-Crystals

Front 85

Describe causes of the formation of calculi:

Back 85

-Urinary pH, solute load, inhibitors, urinary stasis, UTI, external urinary diversion, long-term indwelling catheter, neurogenic bladder, urinary retention, gentics

Front 86

_______ refers to the stone and _____ refers to stone formation.

Back 86

-Calculus

-Lithiasis

Front 87

Name the 5 different types of calculi:

Back 87

1. Calcium phosphate
2. Calcium oxalate
3. Uric acid
4. Cystine
5. Struvite

Front 88

Name the 2 most common sites for complete obstruction:

Back 88

1. UPJ (the point where the ureter crosses the iliac vessels)
2. UVJ (ureterovesical junction)

Front 89

Describe s&s of calculi:

Back 89

-Nausea and vomiting associated with pain; abdominal or flank pain; hematuria; renal colic; skin cool and moist
-Pain may be absent if stone is nonobstructing

Front 90

Describe treatment for a patient with calculi:

Back 90

-Treatment of symptoms of pain, infection, or obstruction
-Evaluation of the cause of the stone formation and the prevention of further development
-Adequate hydration, dietary Na restrictions, dietary changes, control of infection
-Lithotripsy, Surgical and Nutritional Therapy

Front 91

A chronic, painful inflammatory disease of the bladder characterized by symptoms of urgency/frequency and pain in the bladder and/or pelvis:

Back 91

-Interstitial Cystitis

Front 92

Suprapubic pain related to bladder filling, accompanied by other symptoms such as frequency, in the absence of UTI or other obvious pathology:

Back 92

-Painful Bladder Syndrome

Front 93

Onset of this disease is 40 years; occurs primarily in women; contributing factor is chronic inflammation with mast cell invasion of the bladder; defect of layer that protects the bladder mucosa from the irritating effects of urine exposure
-Individual with have evidence of UTI without the absence of bacteriuria, pyuria, or a positive urine culture:

Back 93

-Interstitial Cystitis

Front 94

Describe s&s of interstitial cystitis:

Back 94

-Pain is located in the suprapubic area, varies in intensity, and relieved by urination
-Very similar to lower urinary tract symptoms (LUTS)
-Women will report that pain occurs premenstrually and is aggravated by sex and/or emotional stress
-Symptoms can be both persistent and intermittent and depends on the individual

Front 95

Describe treatment of interstitial cystitis:

Back 95

-No single treatment has been identified that consistently reverses or relieves symptoms
-Diet low in acidic foods, avoiding beverages such as coffee, tea, and carbonated and alcoholic drinks
-Relaxation techniques (sitz baths)
-Antidepressants, agents may be instilled directly into bladder

Front 96

Describe nursing measures for a patient with interstitial cystitis:

Back 96

-Collection of bladder log
-Instruct patient on dietary changes, take multivitamins and avoid high-potency vitamins (avoid bladder irritants: caffeine, alcohol, citrus products, aged cheeses, nuts, and foods containing vinegar, curries, or hot peppers)
-Provide written educational materials concerning diet, coping with the need for frequent urination, and strategies for coping with the emotional burden

Front 97

An inflammation of the renal parenchyma and collecting system; most common cause is bacterial infection, but fungi, protozoa, or viruses sometimes infect the kidney; begins in the lower urinary tract; a preexisting factor is often present such as an obstruction or BPH; commonly starts in the renal medulla and spreads to the adjacent cortex; pregnancy induced:

Back 97

-Pyelonephritis

Front 98

Systemic infection arising from a urologic source:

Back 98

-Urosepsis

Front 99

______ _______ is the outcome of unresolved bacteremia involving a gram-negative organism.

Back 99

-Septic shock

Front 100

Describe s&s of pyelonephritis:

Back 100

-Vary from mild fatigue to the sudden onset of chills, fever, vomiting, malaise, flank pain, LUTS characteristic of cystitis, dysuria, urinary urgency and frequency
-U/A shows pyuria, bacteruria, and varying degrees of hematuria, WBC casts, leukocytosis, shift to the left (bands), urine cultures

Front 101

A term used to describe a kidney that has become small, atrophic, shrunken and has lost function owing to scarring or fibrosis; usually occurs as the outcome of recurring infections involving the upper urinary tract; less likely occurs in the absence of an existing infection, recent infection, or history of UTIs:

Back 101

-Chronic pyelonephritis

Front 102

Inflammation of the glomeruli; which affects both kidneys equally and is the third-leading cause of renal failure in the US:

Back 102

-Glomerulonephritis

Front 103

-The antibodies have specificity for antigens within the glomerular basement membrane (GBM)
-The antibodies react with circulating nonglomerular antigens and are randomly deposited as immune complexes along the GBM:

Back 103

-Two types of antibody-induced injury that can initiate glomerular damage and result in glomerulonephritis

Front 104

Describe s&s of glomerulonephritis:

Back 104

-Varying degrees of hematuria
-Varied elements are excreted in the urine including: RBCs, WBCs, casts
-Proteinuria and elevated blood BUN and serum creatinine levels

Front 105

-Inflammation of the glomeruli; most common in children and young adults although can occur at any age; develops 5-21 days after an infection of the tonsils, pharynx, or skin; tissue injury occurs as the antigen-antibody complexes are deposited in the glomeruli and complement is activated which then causes an inflammatory reaction; this injury decreases filtration of metabolic waste products from the blood and an increase in the permeability of the glomerulus to larger protein molecules:

Back 105

-Acute poststreptococcal glomerulonephritis

Front 106

Describe s&s of acute poststreptococcal glomerulonephritis:

Back 106

-Generalized edema resulting from decreased glomerular filtration, HTN, oliguria, hematuria, proteinuria, and may have abdominal or flank pain

Front 107

Describe nursing measures for a patient with acute poststreptococcal glomerulonephritis:

Back 107

-Rest
-Restricting Na and fluid intake and admin diuretics to treat edema
-Admin antihypertensives
-Dietary protein intake may be restricted
-Admin antibiotics and encourage to take the full course of antibiotics to ensure that the bacteria have been eradicated
-Early diagnosis and treatment of sore throats and skin lesions
-Good personal hygiene

Front 108

This disease occurs when the glomerulus is excessively permeable to plasma protein, causing proteinuria that leads to low plasma albumin and tissue edema; 1 in 3 adults patients will have a systemic disease such as DM or systemic lupus, the remainder will be categorized as having idiopathic:

Back 108

-Nephrotic Syndrome

Front 109

Describe s&s of nephrotic syndrome:

Back 109

-Peripheral edema, massive proteinuria, HTN, hyperlipidemia, hypoalbuminemia
-Decreased albumin, TP, and increased cholesterol
-ascites and anasarca (massive generalized edema)

Front 110

Describe nursing measures for a patient with nephrotic syndrome:

Back 110

-a major nursing intervention is related to edema; daily weights, I&O, measuring abdominal girth or extremity size, measure effectiveness of diuretic therapy
-Measures should be taken to avoid exposure to persons with known infections
-Support in dealing with an altered body image

Front 111

The most common life-threatening genetic disease in the world, affecting 600,000 people in the US and 12.5 million worldwide; accounts for 10-15% of renal disease; 2 forms: childhood and adulthood; childhood is recessive and rare; adulthood is dominant and manifests between 30-40 years:

Back 111

-Polycystic kidney disease (PKD)

Front 112

In this disease; cortex and the medulla are filled with large, thin-walled cysts that vary in size; these cysts enlarge and destroy surrounding tissue by compression; filled with fluid and may contain blood or pus

Back 112

-Polycystic kidney disease (PKD)

Front 113

Describe s&s of polycystic kidney disease:

Back 113

-Symptoms appear when the cysts begin to enlarge
-HTN, hematuria (from cyst rupture), a feeling of heaviness in the back, side, or abdomen
-Chronic pain
-Palpable bilateral enlarged kidneys
-Abnormal heart valves, aneurysms, and diverticulosis

Front 114

Main purpose of this diagnostic test is to inspect the interior of the bladder with a tubular lighted scope; can be used to insert ureteral catheters, remove calculi, obtain biopsy specimens of bladder lesions, and treat bleeding lesions; Lithotomy position is used; may be done with local or general anesthesia depending on needs and condition; Complications include urinary retention, urinary tract hemorrhage, bladder infection, and perforation of the bladder:

Back 114

-Cystoscopy

Front 115

Describe nursing measures for before and after a cystoscopy:

Back 115

-Before: force fluids or give IV fluids; ensure consent form is signed; explain procedure to pt; give preoperative meds

-After: explain that burning on urination, pink-tinged urine, and urine frequency are expected; observe for bright red bleeding, which is not normal; do not let pt walk alone immediately following; offer warm sitz baths, heat, and mild analgesics to relieve discomfort:

Front 116

During this diagnostic procedure, an xray is used to evaluate the urinary tract after IV injection of contrast material; the presence, position, size, and shape of the kidneys, ureters, and bladder can be evaluated; cysts, tumors, lesions,and obstructions cause a distortion in the normal appearance of these structures; this procedure should be avoided in pts with significantly decreased renal function due to the contrast worsening renal function:

Back 116

-Intravenous pyelogram (IVP)

Front 117

Describe nursing measures for before and after an IVP:

Back 117

-Before: give enema to empty colon of feces and gas; keep pt on NPO 8 hr prior; assess for iodine allergy; advise a warm, flushed feeling will occur when dye is injected

-After: force fluids to flush out contrast

Front 118

This diagnostic procedure is an xray of urinary tract taken after a contrast has been injected into the kidneys; can be given to pt with iodine allergy or decreased renal function because it does not enter the vascular system; a cystoscope is inserted and ureteral catheters are inserted through it into renal pelvis:

Back 118

-Retrograde pyelogram

Front 119

Describe the nursing measures for a patient during a retrograde pyelogram:

Back 119

-Prepare pt as for IVP; inform pt pain may be experienced from distention of pelvis and discomfort from cystoscope; inform pt anesthesia may be given for procedure

Front 120

This diagnostic procedure has a purpose of visualizing renal blood vessels; assist in diagnosing renal artery stenosis, additional or missing renal blood vessels, and renovascular hypotension; assist in differentiating between cyst and renal tumor; included in the workup for potential renal transplant donor; a cath is placed in the femoral artery and is threaded up the aorta to the level of the renal artery; contrast is injected at that level and outlines the renal blood supply:

Back 120

-Renal arteriogram (angiogram)

Front 121

Describe before and after nursing actions for a patient having a renal arteriogram:

Back 121

-Before: give enema the night before; assess for iodine allergy; pt may feel warm flush feeling when contrast is injected

-After: place a pressure dressing over femoral artery; observe site for bleeding; maintain bed rest with leg straightened; take peripheral pulses in effected leg every 30-60 min; observe for complications including thrombus, embolus, local inflammation and hematoma

Front 122

This diagnostic procedure is useful for visualization of the kidneys; not proven useful for detecting urinary calculi or calcified tumors; computer-generated films rely on radiofrequency waves and alteration in magnetic field

Back 122

-MRI (Magnetic Resonance Imaging)

Front 123

This diagnostic procedure provides excellent visualization of kidneys; size can be evaluated; tumors, abscesses, suprarenal masses, and obstructions can be detected; ability to distinguish subtle difference in density; use of IV-admin contrast:

Back 123

-CT scan

Front 124

Describe the nursing measures for a patient undergoing a MRI:

Back 124

-Explain procedure; have pt remove all metal objects; hx of claustrophobia may require sedation

Front 125

Describe the nursing measures for a patient undergoing a CT scan:

Back 125

-Explain procedure; assess iodine allergy; instruct pt to lie still; sedation may be required if pt does not cooperate

Front 126

This diagnostic procedure allows visualization of renal vasculature; does not require femoral puncture:

Back 126

-MRA- Magnetic Resonance Angiography

Front 127

Describe nursing actions for a patient undergoing a MRA:

Back 127

-Explain procedure; instruct to remove all metal objects; hx of claustrophobia may require sedation

Front 128

This diagnostic procedure is done to obtain renal tissue for examination to determine type of renal disease or to follow progression of renal disease; needle is inserted into lower lobe of the kidney with CT or US guidance; contraindicated for those with bleeding disorders, single kidney, uncontrolled HTN, suspected kidney infection, hydronephrosis, and possible vascular lesions:

Back 128

-Renal Biopsy

Front 129

Describe nursing measures for before and after a renal biopsy:

Back 129

-Before: type and crossmatch blood; assess pt has discontinued blood thinners; obtain CBC, HCT, PTT, Hx

-After: apply pressure dressing for 30-60min; VS every 5-10 min for first hour; assess for flank pain, urinary frequency, dysuria, and hematuria

Front 130

This diagnostic procedure is used to detect renal or perirenal masses, in differential diagnosis of renal cysts and solid masses, and in ID of obstructions; small external probe is placed on pt's skin; conductive gel is placed on skin; noninvasive procedure involves passing sound waves into body structures and recording images as they are reflected back; computer interprets tissue density based on sound waves and displays it in picture form; can be used safely in pts with renal failure:

Back 130

-Renal ultrasound

Front 131

Describe nursing measure for a patient undergoing a renal ultrasound:

Back 131

-Explain procedure to patient; patient can be in both prone and supine position; bowel prep is not needed

Front 132

This diagnostic test is most commonly used to identify presence of renal problems; concentration of urea in the blood is regulated by rate at which kidney excretes urea:

Back 132

-BUN

Front 133

This diagnostic test is more reliable than BUN as a determinant of renal function; it is end product of muscle and protein metabolism and is liberated at a constant rate:

Back 133

-Creatinine

Front 134

What is the normal value for BUN?

Back 134

-10-30 mg/dl

Front 135

What is the normal value for creatinine?

Back 135

-0.5-1.5 mg/dl (typically higher in men)

Front 136

A waste product of protein breakdown (primarily muscle mass); clearance by the kidney approximates GFR

Back 136

-Creatinine Clearance

Front 137

What is the normal value for creatinine clearance?

Back 137

-85-135 ml/min

Front 138

Describe nursing measures for a patient undergoing a creatinine clearing test:

Back 138

-Collect 24-hr urine specimen; discard first sample at the beginning of testing; instruct to urinate at the end of the 24-hr period

Front 139

A general examination of urine to est baseline info or provide data to est a tentative diagnosis and determine whether further studies are to be ordered:

Back 139

-Urinalysis

Front 140

Purpose is to examine or measure specific components, such as electrolytes, glucose, protein, catecholamines, creatinine, and minerals; collected over a period that may range from 2-24-hr:

Back 140

-Composite urine collection

Front 141

Done to confirm suspected UTI and identify causative organism:

Back 141

-Urine Culture

Front 142

At what value does a urine culture indicate no infection?

Back 142

-<10,000 organisms/ml

Front 143

At what value does a urine culture become not diagnostic and test may need to be repeated?

Back 143

-10,000 to 100,000 organisms/ml

Front 144

At what value does a urine culture indicate an infection?

Back 144

- >100,000 organisms/ml

Front 145

In women, what size of urinary catheter is used?

Back 145

-14F to 16F

Front 146

In men, what size of urinary catheter is used?

Back 146

-14F to 18F

Front 147

While the patient has a catheter in place, what nursing actions should be included in care?

Back 147

-Maintaining patency of catheter
-Managing fluid intake
-Providing for the comfort and safety of the patient
-Preventing infection

Front 148

When is catheter irrigation performed?

Back 148

-Irrigation is only performed when blood clots are suspected
-If frequent irrigation is necessary (i.e. TUNA) a triple lumen catheter is used for continuous bladder irrigation

Front 149

Which catheter is commonly used for men?

Back 149

-a coude-tip catheter

Front 150

When is a straight or intermittent catheter used?

Back 150

-Used as a replacement of indwelling catheter to reduce the possibility of infection
-One time use postoperatively
-Main goal is to prevent urinary retention, stasis, and compromised blood supply to the bladder caused by prolonged pressure
-Every 3-5 hours
-Used to measure residual urine
-Collection of sterile sample
-Instillation of meds into bladder

Front 151

True or False:
The urine volume from the ureteral catheter should be recorded separately from other urinary catheters.

Back 151

-True

Front 152

When is a ureteral catheter used and what nursing actions should be taken?

Back 152

-Catheter drains urine from the renal pelvis
-Placement should be checked frequently, and tension on the catheter should be avoided

Front 153

When is a suprapubic catheter placed and what nursing actions should be taken?

Back 153

-Used both temporarily (certain surgeries) and long-term (tetraplegics)
-Inserted either through a small incision through the abdomen wall or by the use of a trocar
-nurse responsibility to tape in place, prevent tube kinking by coiling excess tubing and maintaining gravity drainage, having the patient turn from side to side, and milk the tube

Front 154

This catheter is inserted on a temporary basis to preserve renal function when complete obstruction of a ureter is present; inserted directly into the pelvis of the kidney and attached to connecting tubing for closed drainage:

Back 154

-Nephrostomy Tubes

Front 155

What nursing actions should be taken when maintaining nephrostomy tube?

Back 155

-Actions should be the same as ureteral catheter
-Checked for patency
-Should never to be kinked, compressed, or clamped
-Irrigation should follow strict aseptic technique

Front 156

What nursing actions need to be taken when obtaining a sterile urine sample from a catheter?

Back 156

-Be sure to clamp tubing for 30 minutes
-Cleanse port with iodine or alcohol
-Aspirate sample with sterile syringe and 21 gauge-sterile needle

Front 157

What is the normal color of urine?

Back 157

-Range from a pale straw color to amber depending on concentration

Front 158

Where does bleeding come from when the urine becomes dark red?

Back 158

-Kidneys

Front 159

Where does bleeding come from when the urine become bright red?

Back 159

-Bladder or Urethra

Front 160

What is the normal pH for urine?

Back 160

- 4.6-8.0

Front 161

What is the normal amount of protein found in urine?

Back 161

- none or up to 8mg/100mL

Front 162

What is the normal amount of glucose found in urine?

Back 162

-None; if found indication of diabetes should be further investigated

Front 163

What is the normal amount of ketones found in urine?

Back 163

-None; if found indicates DM complications and help should be found

Front 164

What is the normal specific gravity of urine?

Back 164

- 1.010 to 1.030; though this value varies greatly with individuals

Front 165

Should RBCs be seen in microscopic findings of urine?

Back 165

-Yes, up to 2 can be seen. More can indicated trauma or disease has occurred. In women, it could indicate contamination of the menstrual cycle

Front 166

Should WBCs be seen in microscopic findings of urine?

Back 166

-Yes, 0-4 per low-power field can be seen; greater numbers can indicate an infection

Front 167

Should bacteria be seen in microscopic findings of urine?

Back 167

-No; indicates UTI if seen

Front 168

Should casts be seen in microscopic findings of urine?

Back 168

-No; presence indicates renal alterations

Front 169

Should crystals be seen in microscopic findings of urine?

Back 169

-No; they are the result of food metabolism and excess can result in renal stone formation

Front 170

This category of drug has a use of treatment of hypertension or edema due to CHF or other causes; some are used to conserve K; where as others are used to treat cerebral edema:

Back 170

-Diuretics
(Loop and thiazide are used for treating HTN and edema; K-sparing are used to conserve K when pt is on loop or thiazides; and osmotic is used for cerebral edema)

Front 171

This category of drug enhances the selective excretion of various electrolytes and water by affecting real mechanisms for tubular secretion and reabsorption:

Back 171

-Diuretics

Front 172

Nursing implications for this drug category include: assess fluid status, monitor daily weights, I&O, amount and location of edema, lung sounds, skin turgor, and mucous membranes; assess BP and pulse b4 admin, electrolytes (especially K):

Back 172

-Diuretics

Front 173

Side effects for this drug category include: dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, blurred vision, hyperglycemia, excessive urination:

Back 173

-Diuretics

Front 174

This category of drug has a use of treatment and prophylaxis of various bacterial infections:

Back 174

-Antibacterial (Anti-infective)

Front 175

This category of drug has an action to kill (bactericidal) or inhibit the growth of (bacteriostatic) susceptible pathogenic bacteria. It is not active against viruses or fungi:

Back 175

-Antibacterial (Anti-infective)

Front 176

A medication that lowers the incidence of or prevents seizures; medication that lowers the incidence of or prevents muscle spasms:

Back 176

-Antispasmodic

Front 177

Side effects for this drug category includes: slow heart beat, possibly leading to cardiac arrest
muscle weakness, muscle cramps, and muscle pain
convulsions
weak breathing, inability to breath
increased stomach acid and saliva
nausea and vomiting
dizziness, drowsiness, and headache

Back 177

-Cholinergics

Front 178

This medication produces the same effects as the parasympathetic nervous system.

Back 178

-Cholinergics

Front 179

This category of drug usually acts in one of two ways. Some directly mimic the effect of acetylcholine, while others block the effects of acetylcholinesterase. Acetylcholinesterase is an enzyme that destroys naturally occurring acetylcholine. By blocking the enzyme, the naturally occurring acetylcholine has a longer action.

Back 179

-Cholinergics

Front 180

This drug provides relief from the following urinary tract symptoms: pain, itching, burning, urgency, frequency:

Back 180

-Urinary Tract Analgesics (phenazopyridine)

Front 181

This drug acts locally on the urinary tract mucosa to produce analgesic or local anesthetic effects and has no antimicrobial activity:

Back 181

-Urinary Tract Analgesics (phenazopyridine)

Front 182

Side effects for this drug include: headache, vertigo, bright-orange urine, rash:

Back 182

-Urinary Tract Analgesics (phenazopyridine)