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151 Cards in this Set

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Reabsorb Bicarb
Secrete H+
Acid Base Balance
Creatinine
Urea
Electolytes
Excreation of Metabolic wastes
Volume (ADH)
Aldosterone/Renin
Control BP
Renin
Erythropoeitin Secretion
Ca+/Phosphate
-metabolism and reabsorption
Conversion of Vitamin D to active form
Don't excrete, build up, become toxic
Drug excretion
Below 12th rib next to the spine. High back off to the side
CVA Costovertebral Angle
Suprapubic, Groin, Perineum
Pain from Urinary disorders
Urination increases with?
Urination or Abdominal Distention
pain/burning
Dysuria
less than 100 ml/day
Anuria
less than 400 ml/day
Oliguria
night time voiding
Nocturia
blood in urine
Hematuria
Greater than 2500ml/day
Polyuria
below 12th rib next to the spine, high back pain off to the side
CVA- Costovertebral angle
Sites for Urinary pain
Suprapubic, Groin, Perineum
Pain increases with
Urination or Abdominal distention
pain/burning
Dysuria
less than 100ml/per day
Anuria
Less than 400ml/per day
Oliguria
Nightime Voiding
Nocturia
Blood in urine
Hematuria
Greater than 2500 ml/day
polyuria
first morning specimine
if not going to the lab must refrigerate
Urinalysis
Start with empty bladder(throw away), End with final voiding. 2-24hrs. Use this for creatinine clearance test
composite urines
85-135 ml/min
Creatinine Clearance
7-18 mg/dl
Serum Bun
Incresed nitrogen excretion, Dehydration, Protein Excess
Serum Bun
If the Serum Bun and Creatinine are elevating together and maintaining a 20:1 ratio what does this mean?
Renal disease
Looks at protein and muscle metabolism
Serum Creatinine
0.7-1.3 mg/dl
Creatinine, male
0.6-1.1 mg/dl
Creatinine, female
Indicates fluid balance
Hypovalemic if higher
Hypervalemic if lower
specific gravity
1.005-1.035
specific gravity
-Used to diagnose Uti

-Bacteria count of greater than 100,000/ml

-Identify's organism and perscribe antibx

check to see if pt. antibiotic is listed as sensitive on lab sheet
Urine culture and sensitivity
should be less than 50ml

requires cath or bladder scan

If high = stasis, UTI, Infection
Residual urine
If emptying and get greater than 1000cc clamp, stop and wait so body can adjust to changes in bp

500-1000 is a good range
Catheterization
Continuous Catheter
Foley
temporary catheter

used for specimins or to check residual
Straight
-Used to diagnose Uti

-Bacteria count of greater than 100,000/ml

-Identify's organism and perscribe antibx

check to see if pt. antibiotic is listed as sensitive on lab sheet
Urine culture and sensitivity
should be less than 50ml

requires cath or bladder scan

If high = stasis, UTI, Infection
Residual urine
If emptying and get greater than 1000cc clamp, stop and wait so body can adjust to changes in bp

500-1000 is a good range
Catheterization
Continuous Catheter
Foley
temporary catheter

used for specimins or to check residual
Straight
through abdomen

used after gyn/gu surgeries

lower infection rate

causes natural edema, so urethra swells=problem

Used in bladder sx- need to keep urine out as much as possible, promote healing

used with spinal injury, more comfortable than foley
Suprapubic
Looks at kidney's, Ueters, and bladder
KUB
Is used to evaluate the structure and excretory function of the kidneys, ureters, and bladder

Assess allergies: iodine, shellfish
IVP- Intraveneous Pyleogram/ dye
X-rays passed thru kidney's at many angles gives detailed picture of renal tissue densities and composition.
Cat scan, ct scan
Reflected sound waves are used to assess kidney size and to identify, locate, and differentiate renal masses such as cysts, tumors, and calculi
Renal Ultrasound
Done in artery- can easily bleed out of site

Put on groin sandbag

Freq checks Q4, next few days

Can bleed back b/c of internal bleed
Angiogram: Vascular xray
direct visulization of the urethra and bladder through a cytoscope
causes hematuria
Cytoscopy: bladder scope
If blood pressure decreases and pulse pressure increases what does this mean?
Arterial bleed
Nursing Assessment for Bladder scope?
Hematuria
pain
I&O
Force fluids (not with CHF)
Pecutaneous biopsy
Needle through skin to kidney
Open Biopsy
Surgery to get to kidney
Nursing assessment for Biopsy
Supine for 24hrs
Why does a patient need to be in supine position after a biopsy?
trying to accomp. increased pressure on kidneys

kidneys have alot of vasculature and blood flow which increases risk for hemorrage
Congenital

can be fatal b/c it destroys kidneys
PKD polycystc kidney disease
Where are the cysts in PKD?
in all segments of kidney, they are fluid filled sacs
What is being compressed in PKD and what does it lead to?
tubules, nephrons, and renal blood vessels. Leads to ischemia b/c of obstruction and necrosis
What does PKD progress to?
End stage renal failure/disease

It is slowly progressive
What is the nursing care related to PKD?
No contact sports
Fluid intake 2000-25000 daily
Monitor: UO, creatinine, bun, and GFR-using creatine cleance test
What do u expect the GFR to do in kidney disease?
Go DOWN!

This is a measure of how much urine can filture thru. With PKD less is filtured.
Expanding,distention distention of the renal pelvis and calyces

blocked urine dilates renal pelvis
Hyedronephrosis
What causes hydronephrosis?
Obstrution- stones, infection
Signs and symptoms of hydronphrosis?
Rising BUN and Creatinine
Goal of Hydronphrosis treatment?
reestablish drainage asap
done by putting in a urinary stenz
UTI
Infection of any portion of tract
Can a uti be acute or chronic or both?
BOTH!
What is the common cause of UTI?
Ecoli
What are the symptoms of UTI
Burning, Urgency, Burning
How do u diagnoses a UTI?
Culture and sensitivity
Bactim, Ditropan, Pyridium
treatment of uti
Anti infective- used to prevent reocurrence
Bactrim
Spasms
Ditropan
Urinary tract analgesic for burning

relief from pain buring frequency and urgency

orange urine
Pyridium
Inflammation of kidney and renal pelvis

Infection of kidney itself, not urinary tract

Acute vs chronic

may lead to chronic renal failure due to damage of the kidney
pyelonephritis
Pyelonephritis risk factors?
UTI
Poor immune system
Poor hydration
Symptoms of Pyelonephritis?
Fever, chills, malaise, flank pain, dysuria(pain,burings), cva tenderness, elevated serum wbc's, rbc's, and bacteria
Antibiotics for 14 days and force fluids
Tx for pyleonephritis
Inflammation of glumerulous which causes a distruption of glumerular filtration
Glomerulonephritis
What is caused by infection, antigen/antibody reaction(step throat) or systemic disease(SLE,DM,HTN)
Glomerulonephritis
Necrosis of glomerulus, Decreases GFR, Dropping UO, Sx of fluid overload
what u will see in glomerulonephritis
Symptoms of glomerulonephrosis
Hematuria, Proteinuria, Azotemia

Appearance is brown, salt&water retention, edema in periorbital, N/V/Anorexia/fatigue/hypertension
Treatment of glomerulonephrosis
Antibiotics, Diuretics, HTN meds
What is prostatitis?
Inflamed prostate
Treatment of Prostatitis?
Antibiotics, forced fluids 3L per day, Analgesic(nsaids), Sitz bath, special diet (no spice, caffine, or etoh)
Can be an autoimmune disorder or r/t DM,SLE, or glommerulonephritis
Nephrotic syndrome
Change in glomerular capillay
1st step in pathology of nephrotic syndrome
Protein/lipids in urine
2nd step in pathology of nephrotic syndrome
Proteinuria, Hypoalbuminemia, Hyperlipidemia, and edema
3rd step in nephrotic syndrome
Fluid Overload, edema crackles
4th step in nephrotic syndrome
50-75% progress to CRF
Nephrotic syndrome
Monitor BUN, creatinine, output, watch for infections, may need protein supplements b/c leaking protein
NursingCare for nephrotic syndrome
Renal arterioles slowly narrow(stenosis) or
Acute obstruction(aneurysm,emboli--stationary, thrombi--moves)
2 pathways for arterial occlusion
Treatment of Renal vein occlusion
Anticoagulant therapy (heparin), TPA (clot busters)
Major loss of perfusion to the kidney

It activates your renin angiotensin and aldosterone system
Renal Artery stenosis
S&S of hypertension, kidneys atrophy due to lack of blood supply
Renal atery stenosis
What will be heard with renal artery stenosis?
Epigastric bruit
What is the tx for renal artery stenosis
Antihypertension meds, angioplasty, dietary
Renal artery occlusion symptoms?
Severe flank pain, HTN, N/V, fever
Treatment of renal artey occlusion (severe blockage)
treated by surgery
Necrosis of teh arterioles
Necrosis
MAJOR cause of hypertension
Nephrosclerosis
HTN,Hematuria, Proteinuria, Creatininie/Bun elevations
Sx that Nephrosclerosis is worsening
Rx of Nephrosclerosis?
Potent Vasodilatiors
-they decrease hypertension, open them up and BP drops
Leading cause of ESRD

Kidneys atrophy
Diabetic Nephropathy
Lipids leak and settle onto
vessels
Renal Arterioles narrow
Nephrosclerosis
Capillary loop scar then the kidneys do what?
Atrophy
Treatment of diabetic nephropathy
only treatment is control of DM
Made of crystal, pus, and blood
Urolithiasis
What is Urolithiasis?
Kidney stones
Treatment goes twoard what type of stone it is. What types of stones are there?
Ca, Sturvite, Uric Acid, Cystine
Symptoms of renal colic
severe pain at
flank
groin
labia
testicles
Symptoms of Urolitiasis
Renal colic, N/V, Urine, Radiology exams, Hydronephrosis is possible if untreated
Treatments for kidney stones
fluids, pain/infection, ESWL, Surgical Tx lithotomy, Stents, ambulation, meds, strain urine
sound waves, break up stone
urinate granules out
red urine up to 72hrs
EWSL (extracorporeal shock wave lithotripsy)
open up are get pass the stone to drain urine out
Lithotomy
Types of lithotomy's
Cystoscopy, Ureterostomy, Nephrostomy
dilates urethra or ureter
cytoscopy
tube through skin to ureter
Ureterostomy
tube through skin to kidney
Nephrosomy
Used to keep ureter open
stents
Why shoud u ambulate a person with urolithiasis
Ambulation helps move the stone
What are some meds that help with urolitiasis?
Prevent stone formation

Diuretics
what is done to catch stone and send to lab to be analyzed
strain
Ureterostomy-ureter
Nephrostomy-kidney
inserted through abdomen
No kinking of tube, aseptic irrigation 5-10 ml of sterile NS,empty bag q4/prn, note amount and color,aseptic dressing and anchor with tape
teachin of kidney stones
Primary sign fo bladder cancer
hematuria
how do u diagnose bladder cancer?
cytoscopy
treatment of bladder cancer
Biopsy, chemotherapy, radiation treatment, surgery(bladder/urethra:removed)
A illeal conduit and Continent Ileal bladder coduit (kock's pouch) are what?
Urinary diversions
In and Ileal conduit a piece of ileum connects to what?
The ileum connects to the stoma
How do u assess the stoma
Size, color(beefy red),condition
When u have an ileal why would u see mucoid(mucus shreds)?
Because the illeum makes mucus
a segment of ileum is separated from small intestine and formed into pouch, ureters are connected to the pouch
Continent Ileal Bladder Conduit
What is the diff between ileal conduit and continet conduit?
the continent conduit has nipple valves at each end. The nipple is so that urine is held into the illium and not drained
Patient teaching for Continet Conduit?
Clean self cath every 2-4 hours

Stoma assessment

Monitor output
Non-malignant enlargment of the prostate gland?
BPH Benign Prostatic hyperplasia
BPH Benign Prostatic hyperplasia is an obstruction of what?
Urinary outflow from the bladder
Sx of BPH?
Weak urinary stream
Incresed time to void
Hesitancy-stops and starts
Nocturia
Incomp. bladder emptying/powst void dribble
Irritation
Treatment of BPH
TURP- transurethral resection of the prostate

B&O suppositories for spasms
Nursing for BPH
Monitor for bleeding-three way foly irrigation

Pain- bladder spasms, incisonal pain,abd cramps,

monitor output closely

monitor urine for color/clots
How do u diagnose cancer of the prostate?
DRE & Prostate Specific Antigen (PSA)
What is DRE?
Direct rectal exam of prostate surface
Normal- <4ng/ml
IF >10ng/ml, 2/3 have prostate cancer
PSA
Symptoms of prostate cancer
May be asymptomatic

Hematuria

Bph Symptoms
Treatment of prostate cancer
Surgical: Prostatectomy

Radiation Therapy
-external beam
-brachytherapy- radioactive seeds(implanted)
Nursing of prostate cancer
Suprapubic Catheter
MO
Pain

Risk for infection b/c of surgery

Teaching
Care of tubes and dressings
MO
Effect on erection