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48 Cards in this Set

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  • Back
List the Functions of the Urinary Tract? (P.574-)
- 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
List the Normal Characteristics, Constituents and Parameters of a Urine-Analysis? (P.577)
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)

- 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
Describe Lab and Diagnostic Tests Used to Diagnosis Acute Renal Failure? (P.580)
- 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)
Describe Implications of Increased Serum Creatinine Compared to BUN and Urine Creatinine? (P.580)
- 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
Describe the Purpose of a Renal Angiogram? (P.581)
- Visualize Renal Arteries & Determine Blood Flow
- Cause and Treatment of Kidney Disease
Describe the Purposes of a Cystoscopy? (P.581)
- Minor Surgical Procedure Involving Rigid or Fiberoptic Instrument
- Inserted into Bladder through Urethra
- Allows Physician to Visualize Inside of Bladder
Describe the Pathophysiology of Pyelonephritis? (P.589)
- Infection of the Kidneys
- Formation of Small Abscessess & Gross Enlargement
- Typically Caused by Bacterial Infections
- Typically Enter Kidneys through Bloodstream
Describe the % of Nephron Function Lost in Renal Insufficiency and ESRD? (Notes)
- Renal Insufficiency 75%
- End State 90%
Describe the Normal Changes of the Renal System Associated with Aging and how the Changes may Increase Risk of Cystitis? (P.577??)
- 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
Describe the Best Intervention for Someone in Acute Distress with Significant Urinary Retention? (P.585-586)
- Indwelling Urinary Catheter (Foley Catheter)
Describe the Procedure to Assess for Residual Urine (Post Void Residual)? (P.585)
- Catheterization (Gold Standard to Determine Urine Retention)
- Bladder Scan is a Non-Invasive Procedure Can also be Used
Differentiate Between Stress, Urge and Total Incontinence Plus the Risk Factors Associated with Each? (P.582-583)
- 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
Describe the Most Common Cause of Urge Incontinence? (P.583)
- Weak Perineal Muscles (Teach Kegel)
Describe the Teaching for a Client Experiencing Nocturnal Enuresis? (P.584)
- Keep Records of Voiding and Incontinence
- Wear Clothing for Easy Voiding
- Proper Night Time Lighting and Easy Access
- Void Frequently & Before Sleeping
Describe the Most Common Causative Organism of UTI’s. Explain Why? (P.589)
- Majority UTIs are Caused by E. Coli (Typically Found in Stool)
- Female Patients more Likely to Develop UTI
Describe why it is Important to Collect a Sample of Urine Before Beginning Antibiotics? (P.589)
- Sensitivity Test Can Identify which Antibiotics will be Effective Against Organism
Describe the Teaching Associated with Treatment of Cystitis Including the Use of Pyridium? (P.589)
- 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
Describe Preventative Teaching for Decreasing the Risk of UTI’s? (P.590)
- Void Frequently; Drink Plenty of Fluids
- Drink 10 oz Cranberry Juice; Take Showers NOT Baths
- Wipe Perineum from Front to Back; Urinate After Intercourse
Describe the Risk Factors, S/S of Acute Glomerulonephritis? (P.599)
- 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
Describe the Expected Lab Findings for a Client with Chronic Glomerulonephritis? (P.599)
- BUN and Creatinine Levels may be Elevated
- Oliguria, Hypertension, Electrolyte Imbalance, and Edema (Around Eyes)
Describe the Preparation and Follow-Up Care for a Client who has a ESWL Procedure? (P.592)
- 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
Describe the Dietary Implications of Clients with Urolithiasis Caused by Specific Types of Stones? (P.593)
- 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
Describe the Warning Signs of Bladder Cancer? (P.595)
- Painless Hematuria; Initially Intermittent
- Progressess to Frank Hematuria; Bladder Irritability
- Urinary Retention from Clots; Fistula Formation (Opening to Adjoining Structure)
Describe the Characteristics of a Healthy Stoma and Nursing Responsibilities if Assessment of Stoma is Abnormal? (P.526)
- Healthy Stoma – Moist, Pink to Red in Color
- Bluish – Inadequate Blood Supply
- Black – Necrosis
Describe the Goals of Medical Management for a Client with Polycystic Kidney Disease? (P.597)
- Treat Hypertension, and Eventual Renal Failure
- Disease is Hereditary, Pt. Need to be Counseled Children May also Inherit
Describe the Medical Treatment for Post Renal, Acute Renal Failure (ARF) and for Prerenal ARF? (P.601)
- 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
List the Drugs/Classifications Considered Nephrotoxic (From the Text): (P.600)
- Aminoglycosides – Antibodies
Describe Nursing Considerations for a Person Undergoing Hemodialysis? (P.606)
- 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
Review the Considerations for Medication Administration Before Hemodialysis? (P.606)
- Consult Physician; Hold Antihypertensives
- Other Meds Maybe be Dialyzed and Thus become Ineffective
Describe the Color of the Returned Dialysate Following Peritoneal Dialysis Session. Explain the Mechanism of Action and Nursing Considerations? (P.606)
- Unable to Find Color
- Waste Products Pass through Blood to Peritoneal Membrane to Dailysate Solution
Identify a Potential Complication for a Client on Peritoneal Dialysis? (P.607)
- Peritonotis – Infection of Peritoneum
- Caused by Poor Technique of Connecting Bag of Dialyzing Solution to Catheter
Describe Signs/Symptoms of UTI in a Patient with a Kidney Transplant
- Unable to Find
Describe Signs/Symptoms of Kidney Transplant Rejection? (P.1003)
- Renal Failure; Low Grade Fever
List Conservative Treatments for Managing a Renal Stone? (P.592)
- Patients can Urinated Stones Smaller than 5mm
- Intravenous Fluids can be given to Hydrate and Flush Stone
- Urine is Strained and Monitored
Explain Why it is Important to Strain the Urine of Clients Experiencing a Renal Stone? (P.592)
- To Detect Passage of Stones and Pain Medications (Morphine)
- If Patient is Unable Pass Stone, Intervention is Needed
Describe Predisposing Factors Associated with UTI’s? (P.590)
- Patients who have UTI Develop Repeat Infections
- Another Infection such as Vaginitis or Prostatitis
Describe Hydroneprhosis and Potential Causes? (P.593)
- Untreated Obstruction of Urinary Tract
- Obstruction can be in Ureter or Urethra
- Causes Include Obstruction from Strictures, Stones, Tumor, or Enlarged Prostate
Describe Why a Client with DM Should Have Renal Functions (BUN, Serum Creatinine) Evaluated Periodically? (P.597)
- Diabetic Nephropathy is Most Common Cause of Renal Failure
- Diabetes Results in Damage to Small Blood Vessels of Kidneys
List the Most Common Cause of Chronic Renal Failure? (P.602)
- Diabetes Mellitus; Diabetic Nephropathy;
- Chronic High Blood Pressure Causing Nephrosclerosis, Glomerulonephritis, and Autoimmune Disease
Explain why the Early Stages of Chronic Renal Failure are Often Asymptomatic? (P.602)
- As Nephrons Die Off, Undamaged Ones Increase Work Capacity
Describe the Signs/Symptoms of ESRD? (P.602)
- 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
Describe the Process of Assessing an Arterio-Venous Shunt. Describe Other Nursing Considerations Regarding the Arterio-Venous Shunt Including Patient Teaching? (P.606)
- Per Policy, Assess Site for Clotting or Problems
- Early Detection means a Simple De-clotting rather than Total Revision
Describe the Preparation and Teaching for a Client Undergoing a IVP?
- Intra-Venous Pyelogram
Describe the Signs and Symptoms of Cystitis (Bladder Infection)? (P.589)
- Dysuria, Frequency, and Urgency
- Cloudy Urine, Presence of WBC, Bacteria, and RBC
Describe the Assessment Data that Most Accurately Indicates the Fluid Balance in the Patient with Renal Failure? (P.602)
- 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
Describe the Electrolyte Imbalance and Acid/Base Imbalance Associated with Chronic Renal Failure? Explain Why? (P.602)
- 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
Explain the Purpose of Erythropoietin? (P.576)
- Secreted During Stages of Hypoxia
- Hormone that Stimulates Stem Cells in Bone Marrow to Produce RBC
Explain Why Fluid Restriction is an Appropriate Intervention for a Client with ESRD? (P.604)
- To Prevent Fluid Overload