Urinary ch45

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Urinary ch45
2011-11-10 23:51:46

Nursing assessment Urinary
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  1. Kidneys
    • The right kidney, at the level of the 12th rib is lower than the left kidney.
    • Each kidney weighs 4 to 6 oz and is about 5 inches long.
  2. Erythropoietin
    A hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen. A deficiency of erythropoietin occurs in renal failure, leading to anemia.
  3. Kidney Functions
    to regulate the volume & composition of extracellular fluid(ECF) & to excrete waste products from the body. In addition the kidneys function to control blood pressure, produce erythropoietin, activate Vit D & regulate acid base balance.
  4. Glomerular Function
    urine formation begins at the glomerulus, where blood is filtered.
  5. Glomerular Filtration Rate (GFR)
    is the amount of blood filtered by the glomeruli in a given time. The normal GFR is about 125 ml/min, however only 1 ml/min is excreted as urine because most glomerular filtrate is reabsorbed by the peritubular capillary network before it reaches the end of the collecting duct.
  6. Creatinine
    • 0.6 to 1.2 is normal level for creatinine
    • Creatinine is a chemical waste molecule that is generated from muscle metabolism. Creatinine is produced from creatine, a molecule of major importance for energy production in muscles. Approximately 2% of the body's creatine is converted to creatinine every day. Creatinine is transported through the bloodstream to the kidneys. The kidneys filter out most of the creatinine and dispose of it in the urine.
  7. Antidiuretic hormone (ADH)
    makes the distal convoluted tubules and the colecting ducts permeable to water, allowing water to be reabsorbed into the capillaries and be returned to circulation.
  8. Aldosterone
    acts on the distal tubule to cause reabsorption of Na+ & water. In exchange for Na+, ptassium ions (K+) are excreted. helps in reabsorption,if aldosterone is too high then bp is high and potassium gets too low causing muscle cramping.
  9. Acid Base Regulations
    involves reabsorbing & conserving most of the bicarbonate (HCO3-)& excreting excess H+.
  10. Atrial natriuretic peptide (ANP)
    is a hormone secreted from cells in the R atrium in response to atrial distention due to an increase in plasma volume. ANP acts on the kidneys to increase sodium excretion. ANP also inhibits renin, ADH, & the action of angiotensin II on the adrenal glands, thereby suppressing aldosterone secretion.
  11. The combined effects of ANP
    result in the production of large volume of dilute urine. In addition, secretion of ANP causes relaxation of the afferent arteriole, thus increasing the GFR.
  12. Parathyroid hormone (PTH)
    is released from the parthroid gland in response to low serum calcium levels. PTH maintains serum Ca2+ levels by causing increased tubular reabsorption of calcium ions and decreased tubular reabsorption of phosphate ions(PO4-). In renal disease the effects of PTH may have a major effect on bone metabolism.
  13. Activiation of Vit D
    the 1st step happens in the liver, 2nd happens in the kidney. Vit. D is essential for the absorption of calcium from the GI tract. Deficiency is manifested by problems of altered calcium & phosphate balance.
  14. Renin
    is important in regulation of BP. It is released into the bloodstream in response to decreased renal perfusion, decreased arterial blood pressure, decreased ECF, decreased serum Na+ concentration & increased urinary Na+ concentration.(sodium)Excessive renin production may be a contributing factor in the etiology of HBP.
  15. Angiotensin converting enzyme(ACE)
    is located on the luminal surface of all blood vessels, with especially high levels in the vessels of the lungs. Angiotensin II stimulates the release of aldosterone from the adrenal cortex, which causes Na+ & water retention leading to increase in ECF volume.
  16. Prostaglandins (PGs)
    regulate cell function & host defenses. Increase renal blood flow & promote Na+ excretion. Have a systemic effect in lowering blood pressure by decreasing systemic vascular resistance. In renal failure the renal vasodilator factors are lost which contribute to High blood pressure.
  17. Ureters
    10 to 12 inch, they are often the sites for urinary stones. One way flow of urine.
  18. Bladder
    Normal urine output is 1500ml/day. On average, 200 to 250ml of urine in the bladder causes moderate distention & the urge to urinate. 400 to 600 makes the person feel uncomfortable. Bladder capacity ranges from 600 to 1000ml.
  19. Urethra
    is to serve as a conduit for urine from the bladder neck to outside the body during voiding. Female 1 to 2inch, male 8 to 10 inch
  20. Bladder tumors
    Textile workers, paintes, hairdressers, and industrial workers have a high incidence of bladder tumors
  21. Magnesium citrate
    is contraindicated in pts with renal failure because kidneys cant excrete magnesium
  22. Creatinine clearance
    creatinine s a waste product prodced by muscle breakdown, urinary excretion is a measure of the amount of active muscle tissue in the body, not of body weight. Normal values 85 to 135 ml/min
  23. Renal scan
    a diagnostic study that indicates renal blood flow, glomerular filtration, tubular function, and excretion.
  24. Decreased function of the Loop of Henle and tubules means
    diminished ability to concentrate urine, associated with aging of the urinary system
  25. a renal stone in the pelvis of the kidney will alter the function of the kidney by interfering with
    collection and drainage of urine from the kidney
  26. Protein in urine
    acute or chronic renal disease, involving the glomeruli. High protein diet, strenouse exercise, dehydration, fever or emotional stress.
  27. Glucose in urine
    diabetes mellitus or low renal threshold for glucose reabsorption.
  28. Ketones in urine
    diabetes mellitus or starvation, dehydration, vomiting, and severe diarrhea
  29. Bilirubin in urine
    jaundice in detection of liver disorders.
  30. pH in urine 4.0-8.0 average norm
    if more than 8.0 finding may be the result of standing of urine or urinary tract infection because bacteria decompose urea to form ammonia. If less than 4.0 may indicate resp or metabolic acidosis.
  31. Specific gravity 1.003-1.030
    Low specific gravity indicates dilute urine and possibly excessive diuresis. High indicates dehydration.If it becomes fixed at about 1.010 this indicates renal inability to concentrate urine suggesting that kidney is proressing to end-stage renal disease.
  32. Osmolarity 300-1300
    for determining diluting and concentrating ability of kidneys. Deviations from normal indicate tubular dysfunction. Findings indicate if kidneys have lost ability to concentrate or dilute urine.
  33. RBC's 0-4
    bleeding in urinary tract is caused by calculi, cystitis, neoplasm, glomerulonephritis, tuberculosis, kidney biopsy, or trauma.
  34. WBC's 0-5
    increased WBC's in urine (pyuria)indicates urinary tract infection or inflammation.
  35. Casts
    are molds or the renal tubules and may contain protein, WBC's, RBC's, or bacteria. Indicate renal dysfunction or upper urinary tract infections.