Urinary System Study Guide Nurs 131 Exam I

Front 1

List the Functions of the Urinary Tract? (P.574-)

Back 1

- Formation of Urine; Maintain Acid-Base Balance
- Secretion of Renin; Activation Vitamin D
- Production of Erythropoietin (Stimulates Stem Cells in Marrow to Produce RBC);
- Elimination of Urine

Front 2

List the Normal Characteristics, Constituents and Parameters of a Urine-Analysis? (P.577)

Back 2

Normal Characteristics:
- Color of Straw Amber
- Output of 1000 – 2000 ml per 24 hrs; Straw or Amber Color
- pH 4.6 to 8.0 (Vegetarian more Alkaline; Protein more Acidic)

Constituents:
- 95% H20; Nitrogenous Waste (Urea, Creatinine, & Uric Acid)
- Urea fromed by Liver from Protein Metabolism
- Ceatinine from Creatinine Phosphate (Muscle Energy)
- Uric Acid from Metabolism of Nucleic Acids

Parameters: (See Page 579)
- Color, Odor, pH, Specific Gravity, Protein, Glucose, Ketones, Bilirubin, Nitrite
- Leukocyte Esterase, RBC, WBC

Front 3

Describe Lab and Diagnostic Tests Used to Diagnosis Acute Renal Failure? (P.580)

Back 3

- Serum (Blood) Creatinine – Waste Product from Muscle Metabolism Released to Blood
- BUN – Urea Waste Product of Protein Metabolism
- Uric Acid – End Product of Purine Metabolism
- Creatinine Clearance – Compares Creatinine in Blood to Urine (Excellent Indicator)

Front 4

Describe Implications of Increased Serum Creatinine Compared to BUN and Urine Creatinine? (P.580)

Back 4

- Serum Creatinine – Waste Product of Muscle Metabolism in Blood Stream
- Higher Serum Creatinine Indicates Impaired Kidney Function
- BUN – Urea Waste of Protein Metabolism;
- Elevated BUN Indicates: Dysfunction; Decreased Kidney Blood Supply; Dehydration
- Urine Creatinine – Unable to Find Specifically Urine Creatinine
- Creatinine Clearance - Blood and Urine Creatinine Clearance in Specified Period
- Excellent Test of Renal Function

Front 5

Describe the Purpose of a Renal Angiogram? (P.581)

Back 5

- Visualize Renal Arteries & Determine Blood Flow
- Cause and Treatment of Kidney Disease

Front 6

Describe the Purposes of a Cystoscopy? (P.581)

Back 6

- Minor Surgical Procedure Involving Rigid or Fiberoptic Instrument
- Inserted into Bladder through Urethra
- Allows Physician to Visualize Inside of Bladder

Front 7

Describe the Pathophysiology of Pyelonephritis? (P.589)

Back 7

- Infection of the Kidneys
- Formation of Small Abscessess & Gross Enlargement
- Typically Caused by Bacterial Infections
- Typically Enter Kidneys through Bloodstream

Front 8

Describe the % of Nephron Function Lost in Renal Insufficiency and ESRD? (Notes)

Back 8

- Renal Insufficiency 75%
- End State 90%

Front 9

Describe the Normal Changes of the Renal System Associated with Aging and how the Changes may Increase Risk of Cystitis? (P.577??)

Back 9

- Number of Nephrons Decrease with Half the Original by Age 70-80
- Urinary Bladder and Detrusor Muscle Decrease
- Renal Mass Becomes Smaller; Renal Flow Decreases 50% with Decreased GFR
- Cystitis – Inflammation & Infection of Bladder Wall

Front 10

Describe the Best Intervention for Someone in Acute Distress with Significant Urinary Retention? (P.585-586)

Back 10

- Indwelling Urinary Catheter (Foley Catheter)

Front 11

Describe the Procedure to Assess for Residual Urine (Post Void Residual)? (P.585)

Back 11

- Catheterization (Gold Standard to Determine Urine Retention)
- Bladder Scan is a Non-Invasive Procedure Can also be Used

Front 12

Differentiate Between Stress, Urge and Total Incontinence Plus the Risk Factors Associated with Each? (P.582-583)

Back 12

- Stress - Increased Abdominal Pressure During Coughing, Sneezing, Laughing;
Typically Weak Perineal Muscles
- Urge - Involuntary Loss of Urine Asscociated with Abrupt Strong Desire to Void;
Weak Perinieal or Pubococcygeal Muscle
- Functional – Chronic Impairment or Physical Function or Ability to Think
- Total – Neurologically Impaired Patients

Front 13

Describe the Most Common Cause of Urge Incontinence? (P.583)

Back 13

- Weak Perineal Muscles (Teach Kegel)

Front 14

Describe the Teaching for a Client Experiencing Nocturnal Enuresis? (P.584)

Back 14

- Keep Records of Voiding and Incontinence
- Wear Clothing for Easy Voiding
- Proper Night Time Lighting and Easy Access
- Void Frequently & Before Sleeping

Front 15

Describe the Most Common Causative Organism of UTI’s. Explain Why? (P.589)

Back 15

- Majority UTIs are Caused by E. Coli (Typically Found in Stool)
- Female Patients more Likely to Develop UTI

Front 16

Describe why it is Important to Collect a Sample of Urine Before Beginning Antibiotics? (P.589)

Back 16

- Sensitivity Test Can Identify which Antibiotics will be Effective Against Organism

Front 17

Describe the Teaching Associated with Treatment of Cystitis Including the Use of Pyridium? (P.589)

Back 17

- Cystitis – Infection of Bladder caused by Bacterial Infection
- Uncomplicated is Treated with Sulfa; Complicated is Treated with Cipro
- Based on Infection, Other Antibiotics Maybe Used; Complete all Treatment Regimen
- Drink Plenty of Fluids; Have Follow-Up Urine Analysis to Ensure Infection Gone
- Pyridium is Used to Treat Pain NOT Antibiotic; Causes Reddish Colored Urine

Front 18

Describe Preventative Teaching for Decreasing the Risk of UTI’s? (P.590)

Back 18

- Void Frequently; Drink Plenty of Fluids
- Drink 10 oz Cranberry Juice; Take Showers NOT Baths
- Wipe Perineum from Front to Back; Urinate After Intercourse

Front 19

Describe the Risk Factors, S/S of Acute Glomerulonephritis? (P.599)

Back 19

- Risk Factors: Group A Beta-Streptococcal Infection of Throat; Antibodies from Streptococcal Antigen are Deposited in Basement Membrane of Glomerulus
- S/S: Fluid Overload; Oliguria; Hypertension; Electrolyte Imbalances; Edema
Flank Pain; Dark or Cola Colored Urine; Ascites; Pleural Effusion

Front 20

Describe the Expected Lab Findings for a Client with Chronic Glomerulonephritis? (P.599)

Back 20

- BUN and Creatinine Levels may be Elevated
- Oliguria, Hypertension, Electrolyte Imbalance, and Edema (Around Eyes)

Front 21

Describe the Preparation and Follow-Up Care for a Client who has a ESWL Procedure? (P.592)

Back 21

- Extracorporeal Shockwave Lithotripsy
- Out Pt. Procedure where Pt. is Anesthetized
- Pt. Immersed in Tube of H20; Ultrasound Used to Break Stones
- After Procedure Drink Plenty of H20; Pt. will Urinate Stone
- Blood in Urine is Common; Notify Doctor of Any Concerns

Front 22

Describe the Dietary Implications of Clients with Urolithiasis Caused by Specific Types of Stones? (P.593)

Back 22

- Urolithiasis – Stones in the Urinary Tract
- Drink Sufficient Fluid to Produce 2000 ml Urine Per Day
- Increase Calcicum Intake;
- Decrease Animal Protein; Increase Potassium Take

Front 23

Describe the Warning Signs of Bladder Cancer? (P.595)

Back 23

- Painless Hematuria; Initially Intermittent
- Progressess to Frank Hematuria; Bladder Irritability
- Urinary Retention from Clots; Fistula Formation (Opening to Adjoining Structure)

Front 24

Describe the Characteristics of a Healthy Stoma and Nursing Responsibilities if Assessment of Stoma is Abnormal? (P.526)

Back 24

- Healthy Stoma – Moist, Pink to Red in Color
- Bluish – Inadequate Blood Supply
- Black – Necrosis

Front 25

Describe the Goals of Medical Management for a Client with Polycystic Kidney Disease? (P.597)

Back 25

- Treat Hypertension, and Eventual Renal Failure
- Disease is Hereditary, Pt. Need to be Counseled Children May also Inherit

Front 26

Describe the Medical Treatment for Post Renal, Acute Renal Failure (ARF) and for Prerenal ARF? (P.601)

Back 26

- Prerenal – Arteriogram of Renal Arteries to Determine Blood Supply to Kidneys
- Intrarenal – Caused by Nephrotoxic Agents; Insecticides, Paint
- Postrenal – Obstruction Blocks Urine; Kidney Stones & Tumors

- Continuous Renal Replacement Therapy – Used to Remove Fluids (Uremia)
- Temporary Hemodialysis is Indicated for Severe Symptoms of Uremia
- CRRT is Not as Complex as Hemodialysis

- Monitor I/O; Daily Weights; Hourly Vital Signs; Vascular Access

Front 27

List the Drugs/Classifications Considered Nephrotoxic (From the Text): (P.600)

Back 27

- Aminoglycosides – Antibodies

Front 28

Describe Nursing Considerations for a Person Undergoing Hemodialysis? (P.606)

Back 28

- Typically Meds are Held Before Hemodialysis
- Ensure Pt. Weighed Morning, Before, and After Procedure
- Coordinate Blood Draws to Avoid Unnecessary Sticks
- After Dialysis, Assess Site and Administer Meds

Front 29

Review the Considerations for Medication Administration Before Hemodialysis? (P.606)

Back 29

- Consult Physician; Hold Antihypertensives
- Other Meds Maybe be Dialyzed and Thus become Ineffective

Front 30

Describe the Color of the Returned Dialysate Following Peritoneal Dialysis Session. Explain the Mechanism of Action and Nursing Considerations? (P.606)

Back 30

- Unable to Find Color
- Waste Products Pass through Blood to Peritoneal Membrane to Dailysate Solution

Front 31

Identify a Potential Complication for a Client on Peritoneal Dialysis? (P.607)

Back 31

- Peritonotis – Infection of Peritoneum
- Caused by Poor Technique of Connecting Bag of Dialyzing Solution to Catheter

Front 32

Describe Signs/Symptoms of UTI in a Patient with a Kidney Transplant

Back 32

- Unable to Find

Front 33

Describe Signs/Symptoms of Kidney Transplant Rejection? (P.1003)

Back 33

- Renal Failure; Low Grade Fever

Front 34

List Conservative Treatments for Managing a Renal Stone? (P.592)

Back 34

- Patients can Urinated Stones Smaller than 5mm
- Intravenous Fluids can be given to Hydrate and Flush Stone
- Urine is Strained and Monitored

Front 35

Explain Why it is Important to Strain the Urine of Clients Experiencing a Renal Stone? (P.592)

Back 35

- To Detect Passage of Stones and Pain Medications (Morphine)
- If Patient is Unable Pass Stone, Intervention is Needed

Front 36

Describe Predisposing Factors Associated with UTI’s? (P.590)

Back 36

- Patients who have UTI Develop Repeat Infections
- Another Infection such as Vaginitis or Prostatitis

Front 37

Describe Hydroneprhosis and Potential Causes? (P.593)

Back 37

- Untreated Obstruction of Urinary Tract
- Obstruction can be in Ureter or Urethra
- Causes Include Obstruction from Strictures, Stones, Tumor, or Enlarged Prostate

Front 38

Describe Why a Client with DM Should Have Renal Functions (BUN, Serum Creatinine) Evaluated Periodically? (P.597)

Back 38

- Diabetic Nephropathy is Most Common Cause of Renal Failure
- Diabetes Results in Damage to Small Blood Vessels of Kidneys

Front 39

List the Most Common Cause of Chronic Renal Failure? (P.602)

Back 39

- Diabetes Mellitus; Diabetic Nephropathy;
- Chronic High Blood Pressure Causing Nephrosclerosis, Glomerulonephritis, and Autoimmune Disease

Front 40

Explain why the Early Stages of Chronic Renal Failure are Often Asymptomatic? (P.602)

Back 40

- As Nephrons Die Off, Undamaged Ones Increase Work Capacity

Front 41

Describe the Signs/Symptoms of ESRD? (P.602)

Back 41

- Disturbances in H20 Balance; Assess Edema; Lung Sounds; Daily Weights
- Disturbances in Electrolyte Balance – Hypernatremia; Hyperkalemia
- Disturbances in Removal of Waste Products – Increase in Urea, BUN, and Creatinine
- Too Many Refer to P.603

Front 42

Describe the Process of Assessing an Arterio-Venous Shunt. Describe Other Nursing Considerations Regarding the Arterio-Venous Shunt Including Patient Teaching? (P.606)

Back 42

- Per Policy, Assess Site for Clotting or Problems
- Early Detection means a Simple De-clotting rather than Total Revision

Front 43

Describe the Preparation and Teaching for a Client Undergoing a IVP?

Back 43

- Intra-Venous Pyelogram

Front 44

Describe the Signs and Symptoms of Cystitis (Bladder Infection)? (P.589)

Back 44

- Dysuria, Frequency, and Urgency
- Cloudy Urine, Presence of WBC, Bacteria, and RBC

Front 45

Describe the Assessment Data that Most Accurately Indicates the Fluid Balance in the Patient with Renal Failure? (P.602)

Back 45

- Experience Disturbances in Removal and Regulation of H2O
- Early Symptoms Include Edema of Extremities, Sacral Area, and Abdomen
- Crackles and Wheezes on Auscultation of Lungs
- Blood Vessels of Neck Maybe Distended

Front 46

Describe the Electrolyte Imbalance and Acid/Base Imbalance Associated with Chronic Renal Failure? Explain Why? (P.602)

Back 46

- Kidneys Lose Ability to Absorb & Excrete Electrolytes
- Electrolytes such as Sodium, Potassium, and Magnesium Accumulate
- High Levels Become Life Threatening

- Renal Failure Affects Hydrogen Ion Excretion
- Can Result in Metabolic Acidosis

Front 47

Explain the Purpose of Erythropoietin? (P.576)

Back 47

- Secreted During Stages of Hypoxia
- Hormone that Stimulates Stem Cells in Bone Marrow to Produce RBC

Front 48

Explain Why Fluid Restriction is an Appropriate Intervention for a Client with ESRD? (P.604)

Back 48

- To Prevent Fluid Overload