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182 Cards in this Set
- Front
- Back
Describe the function of the kidneys:
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**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 |
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This gland lies on top of the each kidney:
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-Adrenal Gland
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The surface of the kidney is covered by a thin, smooth layer of fibrous membrane called the ______, which serves as a shock absorber.
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-Capsule
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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.
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-Hilus
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The outer layer of the kidney is called:
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-the cortex
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The inner layer of the kidney is called:
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-the medulla
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The medulla of the kidney consists of pyramids called ______, through which urine passes to enter the calyces.
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-Papillae
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The _____ and ______ ______ transport urine to the renal pelvis, from which it drains via the ureter to the bladder.
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-minor and major calyces
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abdominal aorta -> renal artery -> secondary branches -> smaller branches -> afferent arterioles -> glomerulus -> efferent arteriole -> peritubular capillaries -> venous system -> renal vein -> inferior vena cava
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-The blood flow through to the kidney, through the kidney, and from the kidney
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The afferent arteriole divides into a capillary network termed the ______, this is a tuft of up to 50 capillaries.
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-Glomerulus
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The functional unit of the kidney; compromised of a glomerulus, Bowman's capsule, and tubular system:
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-Nephron
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This system consists of the proximal convoluted tubule, the loop of Henle, the distal convolute tubule, and a collecting tubule:
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-Tubular system
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The glomeruli, Bowman's capsule, proximal tubule, and distal tubule are located in the ______ of the kidney.
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-cortex
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The loop of Henle and the collecting tubules are located in the _____ of the kidney.
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-medulla
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Urine formation begins at which part of the kidney?
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-Glomerulus (where blood is filtered)
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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:
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-Hydrostatic pressure
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True or False:
Under normal conditions, the capillary pores are too small to allow the loss of these large blood components. |
-True:
Capillary permeability is increased in many renal diseases, permitting plasma proteins and blood cells to pass into the urine |
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The amount of blood filtered by the glomeruli in a given time:
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-Glomerular filtration rate (GFR)
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The normal GFR is:
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-about 125 mL/min
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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:
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-Reabsorption
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This action is the passage of a substance from the capillaries through the tubular cells into the lumen of the tubule:
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-Secretion
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_______ 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.
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-Reabsorption and Secretion
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Name the component of the nephron that has the function of selective filtration:
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-Glomerulus
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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:
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-Proximal Tubule
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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:
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-Loop of Henle
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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:
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-Distal Tubule
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Name the component of the nephron that has a function of reabsorption of H2O (ADH required):
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-Collecting Duct
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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:
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-ADH
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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:
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-Aldosterone
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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:
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-Atrial Natriuretic Peptide (ANP)
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This hormone maintains serum Ca++ levels by causing increased tubular reabsorption of Ca++ ions and decreased tubular reabsorption of PO4:
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-PTH
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Produced and released in response to hypoxia and decreased renal blood flow; stimulates the production of RBCs; deficiency can lead to anemia:
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-Erythropoietin
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A patient with renal failure has a deficiency of the active metabolite of _______ and manifests problems of altered Ca++ and PO4 balance.
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-Vitamin D
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This hormone is important in the regulation of BP; is produced and secreted by juxtaglomerular cells of the kidney:
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-Renin
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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:
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-Prostaglandins
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Normal adult urine output is approximately:
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-1500 mL/day
|
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How often do people urinate during the day?
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-5-6 times and occasionally at night
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This muscle is composed of layers of intertwined smooth muscle fibers capable of considerable distention during bladder filling and contraction during emptying:
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-detrusor muscle
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On average, what is the amount of urine in the bladder that causes moderate distention and the urge to urinate?
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-200-250 mL
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At what amount of urine in the bladder causes the person the feel uncomfortable?
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-400-600 mL
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What is the average bladder capacity for an individual?
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-600-1000 mL; though it varies with the individual
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The name of the mucosal lining; unique to the urinary tract; resistant to absorption of urine:
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-Transitional cell epithelium
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A small muscular tube that leads from the bladder neck to the external meatus:
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-Urethra
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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:
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-Urethra
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This muscle surrounds a portion of the urethra and voluntarily contracts and prevents leaking when bladder pressure increases:
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-Rhabdosphincter
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An uncontrolled leakage of urine:
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-Urinary Incontinence (UI)
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The inability to empty the bladder despite micturition or the accumulation of urine in the bladder because of the inability to urinate:
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-Urinary Retention
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Urinary leakage or postvoid dribbling:
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-Overflow UI
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The total inability to pass urine via micturition; it is a medical emergency:
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-Acute Urinary Retention
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Defined as incomplete bladder emptying despite urination:
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-Chronic Urinary Retention
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Normal postvoid residual (PVR) is:
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-between 50-75 mL; findings over 100 mL indicate the need to repeat the measurement
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An abnormal PVR in the elderly patient is a measurement of > or = to _____ mL obtained on ______ ______ occasions and requires further evaluation.
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-200
-two separate |
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Urinary retention is caused by two dysfunctions of the urinary system:
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1. bladder outlet obstruction
2. deficient detrusor contraction strength |
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This diagnostic test is performed by asking the patient to urinate, followed by catheterization or ultrasound within a relatively brief period (10-20 min):
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-PVR volume
|
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Describe nursing measures used for patients with UI:
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-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 |
|
Describe treatment of urinary retention:
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-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 |
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Describe nursing measures for a patient with acute urinary retention:
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-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 |
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Describe nursing measures for a patient with chronic urinary retention:
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-Manage behavior, indwelling or intermittent catheterization, surgery, or drugs
-Scheduled toileting and double voiding are primary behavioral interventions |
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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:
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-Benign prostatic hyerplasia (BPH)
|
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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 |
-Etiology of BPH
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-Gradual in onset; gradually worsen as the degree of urethral obstruction increases; obstructive and irritative
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-Signs and Symptoms of BPH
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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:
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-Obstructive symptoms
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This symptom includes urinary frequency, urgency, dysuria, bladder pain, nocturia, and incontinence, are associated with inflammation or infection:
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-Irritative symptoms
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This procedure is used by HCP and can estimate the size, symmetry, and consistency of prostate gland:
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-Digital Rectal Examination (DRE)
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This procedure allows for accurate assessment of prostate size and is helpful in differentiating BPH from prostate cancer:
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-Transrectal Ultrasound (TRUS)
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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:
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-Uroflowmetry
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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:
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-Cystourethroscopy
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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: |
-5-alpha-reductase inhibitors
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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 |
-alpha-adrenergic receptor blockers
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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:
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-Invasive Therapy
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A surgical procedure involving the removal of prostate tissue using a resectoscope inserted through the urethra; require hospitalization and 3-way catheterization:
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-Transurethral Resection of the Prostate (TURP)
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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:
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-Transurethral Microwave Thermotherapy (TUMT)
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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:
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-Transurethral Needle Ablation (TUNA)
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A narrowing of the lumen of the ureter or urethra:
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-Strictures
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Describe causes of ureteral strictures:
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-Unintended result of surgical intervention, usually secondary to adhesions or scar formation
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Describe the s&s of ureteral strictures:
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-mild to moderate colic
-pain moderate to severe intensity if the patient consumes a large amount of fluids over a brief period |
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Describe methods of treatment for ureteral strictures:
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-Temporarily placed stent to divert urinary flow
-Definitive correction dilating with a balloon or catheter |
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This results from fibrosis of inflammation of the urethral lumen:
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-Urethral Stricture
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Describe causes of urethral strictures:
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-Trauma, urethritis, iatrogenic (following surgical intervention or repeated catheterization), a congenital defect, or meatal stenosis
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Describe the s&s of urethral strictures:
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-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 |
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Describe treatment of urethral strictures:
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-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 |
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Another name for kidney stone disease:
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-Nephrolithiasis
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Describe common clinical data regarding calculi:
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-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 |
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When in supersaturated concentration, can precipitate and unite to form a stone:
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-Crystals
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Describe causes of the formation of calculi:
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-Urinary pH, solute load, inhibitors, urinary stasis, UTI, external urinary diversion, long-term indwelling catheter, neurogenic bladder, urinary retention, gentics
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_______ refers to the stone and _____ refers to stone formation.
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-Calculus
-Lithiasis |
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Name the 5 different types of calculi:
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1. Calcium phosphate
2. Calcium oxalate 3. Uric acid 4. Cystine 5. Struvite |
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Name the 2 most common sites for complete obstruction:
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1. UPJ (the point where the ureter crosses the iliac vessels)
2. UVJ (ureterovesical junction) |
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Describe s&s of calculi:
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-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 |
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Describe treatment for a patient with calculi:
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-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 |
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A chronic, painful inflammatory disease of the bladder characterized by symptoms of urgency/frequency and pain in the bladder and/or pelvis:
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-Interstitial Cystitis
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Suprapubic pain related to bladder filling, accompanied by other symptoms such as frequency, in the absence of UTI or other obvious pathology:
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-Painful Bladder Syndrome
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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: |
-Interstitial Cystitis
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Describe s&s of interstitial cystitis:
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-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 |
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Describe treatment of interstitial cystitis:
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-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 |
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Describe nursing measures for a patient with interstitial cystitis:
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-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 |
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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:
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-Pyelonephritis
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Systemic infection arising from a urologic source:
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-Urosepsis
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______ _______ is the outcome of unresolved bacteremia involving a gram-negative organism.
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-Septic shock
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Describe s&s of pyelonephritis:
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-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 |
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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:
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-Chronic pyelonephritis
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Inflammation of the glomeruli; which affects both kidneys equally and is the third-leading cause of renal failure in the US:
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-Glomerulonephritis
|
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-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: |
-Two types of antibody-induced injury that can initiate glomerular damage and result in glomerulonephritis
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Describe s&s of glomerulonephritis:
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-Varying degrees of hematuria
-Varied elements are excreted in the urine including: RBCs, WBCs, casts -Proteinuria and elevated blood BUN and serum creatinine levels |
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-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:
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-Acute poststreptococcal glomerulonephritis
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Describe s&s of acute poststreptococcal glomerulonephritis:
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-Generalized edema resulting from decreased glomerular filtration, HTN, oliguria, hematuria, proteinuria, and may have abdominal or flank pain
|
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Describe nursing measures for a patient with acute poststreptococcal glomerulonephritis:
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-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 |
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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:
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-Nephrotic Syndrome
|
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Describe s&s of nephrotic syndrome:
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-Peripheral edema, massive proteinuria, HTN, hyperlipidemia, hypoalbuminemia
-Decreased albumin, TP, and increased cholesterol -ascites and anasarca (massive generalized edema) |
|
Describe nursing measures for a patient with nephrotic syndrome:
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-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 |
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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:
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-Polycystic kidney disease (PKD)
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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
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-Polycystic kidney disease (PKD)
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Describe s&s of polycystic kidney disease:
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-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 |
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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:
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-Cystoscopy
|
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Describe nursing measures for before and after a cystoscopy:
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-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: |
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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:
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-Intravenous pyelogram (IVP)
|
|
Describe nursing measures for before and after an IVP:
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-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 |
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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:
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-Retrograde pyelogram
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Describe the nursing measures for a patient during a retrograde pyelogram:
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-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
|
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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:
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-Renal arteriogram (angiogram)
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Describe before and after nursing actions for a patient having a renal arteriogram:
|
-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 |
|
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
|
-MRI (Magnetic Resonance Imaging)
|
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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:
|
-CT scan
|
|
Describe the nursing measures for a patient undergoing a MRI:
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-Explain procedure; have pt remove all metal objects; hx of claustrophobia may require sedation
|
|
Describe the nursing measures for a patient undergoing a CT scan:
|
-Explain procedure; assess iodine allergy; instruct pt to lie still; sedation may be required if pt does not cooperate
|
|
This diagnostic procedure allows visualization of renal vasculature; does not require femoral puncture:
|
-MRA- Magnetic Resonance Angiography
|
|
Describe nursing actions for a patient undergoing a MRA:
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-Explain procedure; instruct to remove all metal objects; hx of claustrophobia may require sedation
|
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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:
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-Renal Biopsy
|
|
Describe nursing measures for before and after a renal biopsy:
|
-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 |
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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:
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-Renal ultrasound
|
|
Describe nursing measure for a patient undergoing a renal ultrasound:
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-Explain procedure to patient; patient can be in both prone and supine position; bowel prep is not needed
|
|
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:
|
-BUN
|
|
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:
|
-Creatinine
|
|
What is the normal value for BUN?
|
-10-30 mg/dl
|
|
What is the normal value for creatinine?
|
-0.5-1.5 mg/dl (typically higher in men)
|
|
A waste product of protein breakdown (primarily muscle mass); clearance by the kidney approximates GFR
|
-Creatinine Clearance
|
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What is the normal value for creatinine clearance?
|
-85-135 ml/min
|
|
Describe nursing measures for a patient undergoing a creatinine clearing test:
|
-Collect 24-hr urine specimen; discard first sample at the beginning of testing; instruct to urinate at the end of the 24-hr period
|
|
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:
|
-Urinalysis
|
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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:
|
-Composite urine collection
|
|
Done to confirm suspected UTI and identify causative organism:
|
-Urine Culture
|
|
At what value does a urine culture indicate no infection?
|
-<10,000 organisms/ml
|
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At what value does a urine culture become not diagnostic and test may need to be repeated?
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-10,000 to 100,000 organisms/ml
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At what value does a urine culture indicate an infection?
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- >100,000 organisms/ml
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In women, what size of urinary catheter is used?
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-14F to 16F
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In men, what size of urinary catheter is used?
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-14F to 18F
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While the patient has a catheter in place, what nursing actions should be included in care?
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-Maintaining patency of catheter
-Managing fluid intake -Providing for the comfort and safety of the patient -Preventing infection |
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When is catheter irrigation performed?
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-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 |
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Which catheter is commonly used for men?
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-a coude-tip catheter
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When is a straight or intermittent catheter used?
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-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 |
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True or False:
The urine volume from the ureteral catheter should be recorded separately from other urinary catheters. |
-True
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When is a ureteral catheter used and what nursing actions should be taken?
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-Catheter drains urine from the renal pelvis
-Placement should be checked frequently, and tension on the catheter should be avoided |
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When is a suprapubic catheter placed and what nursing actions should be taken?
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-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 |
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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:
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-Nephrostomy Tubes
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What nursing actions should be taken when maintaining nephrostomy tube?
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-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 |
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What nursing actions need to be taken when obtaining a sterile urine sample from a catheter?
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-Be sure to clamp tubing for 30 minutes
-Cleanse port with iodine or alcohol -Aspirate sample with sterile syringe and 21 gauge-sterile needle |
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What is the normal color of urine?
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-Range from a pale straw color to amber depending on concentration
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Where does bleeding come from when the urine becomes dark red?
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-Kidneys
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Where does bleeding come from when the urine become bright red?
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-Bladder or Urethra
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What is the normal pH for urine?
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- 4.6-8.0
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What is the normal amount of protein found in urine?
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- none or up to 8mg/100mL
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What is the normal amount of glucose found in urine?
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-None; if found indication of diabetes should be further investigated
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What is the normal amount of ketones found in urine?
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-None; if found indicates DM complications and help should be found
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What is the normal specific gravity of urine?
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- 1.010 to 1.030; though this value varies greatly with individuals
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Should RBCs be seen in microscopic findings of urine?
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-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
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Should WBCs be seen in microscopic findings of urine?
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-Yes, 0-4 per low-power field can be seen; greater numbers can indicate an infection
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Should bacteria be seen in microscopic findings of urine?
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-No; indicates UTI if seen
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Should casts be seen in microscopic findings of urine?
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-No; presence indicates renal alterations
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Should crystals be seen in microscopic findings of urine?
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-No; they are the result of food metabolism and excess can result in renal stone formation
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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:
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-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) |
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This category of drug enhances the selective excretion of various electrolytes and water by affecting real mechanisms for tubular secretion and reabsorption:
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-Diuretics
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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):
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-Diuretics
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Side effects for this drug category include: dehydration, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, blurred vision, hyperglycemia, excessive urination:
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-Diuretics
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This category of drug has a use of treatment and prophylaxis of various bacterial infections:
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-Antibacterial (Anti-infective)
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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:
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-Antibacterial (Anti-infective)
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A medication that lowers the incidence of or prevents seizures; medication that lowers the incidence of or prevents muscle spasms:
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-Antispasmodic
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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 |
-Cholinergics
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This medication produces the same effects as the parasympathetic nervous system.
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-Cholinergics
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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.
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-Cholinergics
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This drug provides relief from the following urinary tract symptoms: pain, itching, burning, urgency, frequency:
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-Urinary Tract Analgesics (phenazopyridine)
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This drug acts locally on the urinary tract mucosa to produce analgesic or local anesthetic effects and has no antimicrobial activity:
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-Urinary Tract Analgesics (phenazopyridine)
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Side effects for this drug include: headache, vertigo, bright-orange urine, rash:
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-Urinary Tract Analgesics (phenazopyridine)
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