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glomerular filtration rate (GFR)
- amount of renal filtrate formed by kidneys in 1 min
- range: 105 - 125 mL/min
- affected by hypo/hypervolemia, affects urine output
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normal urine output
1000ml - 2000 ml
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characterisitics of urine
- specfic gravity: 1.002 - 1.035
- PH: 4.6 - 8.0
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Glomerular filtrate
- similar to blood plasma; no rbc and little protein
- blood pressure forces plasma and dissolved materials out of capillaries
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renal filtrate threshold level
the blood level of a substance is related to the amount shown in the urine
i.e. if blood glucose is normal, no glucose in urine
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What are the other functions of the kidneys
- renin secretion
- activationof vitamin D,
- erythropoietin production
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nitrgoneous wastes found in urine
- uric acid: metabolism of nucleic acids
- urea: created by liver cells when excess amino acids are deaminated for energy
- creatinine: metabolism of creatinine phosphate, energy for muscles
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how does age affect the urinary system
- GFR decreases
- number of nephrons decrease
- urinary bladder decreases in size, detrusor muscle tone decreases
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uremic frost
- crystals on the skin, late sign of uremia
- kidneys cant filter waste so it's excreted through the skin
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if a pt has renal diseases how should i asses her vitals
- orthostatic hypotension
- crackles and wheezing
- edema
- weight
- I&O
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When is the best time to collect a urine sample for urinalysis
morning; specimens are usually concentrated and are more likely to contain abmormal constituents
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when using contrast media which medication is contraindicated
metformin; 48 hrs before and after
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which medication is given to preven contrast media induced nephropathy
mucomyst if mild-moderate renal insufficiency is found after a GFR or creatinine level is done
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stress incontinence
- involuntary loss of urine (< 50 ml) related to increased abdominal pressure (sneezing, laughing, etc)
- kegels help
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urge incontinence
- involuntary loss of urine associated with an abrupt and strong desire to void
- "unable to make it to the bathroom in time"
- most common
- kegels can help
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functional incontinence
- no urincary problems
- environmental barriers, physical limitations, loss of memory, disorientation prevent use of toilet
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overflow incontinence
- involuntary loss associated with overdistention of bladder
- associated with spinal cord injuries or enlarged prostate
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total incontinence
continuous and unpredictable loss of urine
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urinary retention
- inablity to empty the bladder completely
- bladder usually holds less than 50 ml after urination
- 150 - 200 ml residual volume indicates need for intervention
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what causes acute urinary retention
anesthesia from surgery or local trauma to the urinary structure
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chronic urinary retention is related to
enlarged prostate, diabetes, pregnancy, medication, strictures, obstruction of the urinary tract
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is urinary incontinence a justification for insertion of a catheter
- no
- shock, heart failure and urinary obstruction are
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best method to minimize infection from an indwelling catheter
- normal daily genital hygiene with soap and water
- dont clamp the tubing
- encourage fluids unless contraindicated
- keep it taped or fastened to the pt leg
- collect specimens and irrigate through the specimen port
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Aseptic technique is required when emptyin the drainage bag of an indwelling catheter
- wash hands
- wear clean gloves
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intermittent catherization
- best for a pt who is unable to void, post op or with neurologic disorder
- inserted into bladder every 3 hrs
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pyelonephritis
- inflammation of kidney
- usually starts with infection of lower urinary tract
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cystititis
- inflammation of bladder
- symptoms: dysuria, frequency, urgency and cloudy urine
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lower urinary tract infection
urethritis, prostatitis, cystitis
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name predisposing factors for UTIs
- stasis of urine in bladder
- contamination in the perineal and urethral areas (sex, fecal soiling, infection in the area)
- instruments in the urinary meatus i.e. catheter
- previous uti
- age
- faulty valves
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Signs and symptoms of UTI
- dysuria, urgency, frequency, incontinence, nocturia, hematuria, back pain, cloudy urine, foul-smelling urine
- elderly may experience cognitive changes
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urethritis
- inflammation of the urethra
- commonly associated with bladder or prostatic infections
- S&S: frequency, urgency and dysuria
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pyridium is used to treat dysuria. what is an exepected side effect while a pt is using pyridium?
orange urine
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what's contraindicated for pts with a history of UTIs
bubble bath and bath salts
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medications used to treat cystitis
- sulfa meds i.e. bactrim or septra
- ciprofloxacin (cipro)
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signs and symptoms of pyelonephritis
- fatigue, urgency, dysuria, flank pain, fever, chills
- costovertebral tenderness
- cloudy urine, increased wbc, bacteria, casts, RBC, postivie nitrites
- usually shows signs of systemic disease
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what are casts
- microscopic particles formed in the kidney from abnormal constituents in the urine such as wbc, rbc or pus
- always indicates a kidney problem
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urosepsis
when septicemia results from a urinary cause
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nursing care for a pt with UTI
- fluids at 2 - 3 L/day
- antispasmodics
- encouraging voiding every 3 hours
- cranberry juice or capsules
- apply heat to suprapubic area
- empty bladder when urge is felt and after sex
- avoid bubble baths and scented toilet paper
- avoid cola, coffee, tea and alcohol
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urethral stricture
- lumen of urethra is narrowed by scar tissue
- acquired from injury or infection
- pts prone to UTI and have diminshed stream
- mostly seen in elderly men
- treated with mechanical dilation, pt needs pain meds
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renal calculi
- kidney stones
- created from concentrated urinary salts (calcium oxalate, calcium phosphate, magnesium ammonia, uric acid, cystine)
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nephrolithiasis
stones in the kidney
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causes of renal calculi
- family history, chronic dehydration and infection
- immobility which causes urinary stasis and increased blood calcium
- risk peaks between 30 and 50
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prevention of renal calculi
- encourage pt to walk which promotes stone excretion and reduce bone calcium resorption
- diet modification
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complications of renal calculi
urine flow is obstructed which may cause uti or hydronephrosis
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lithotripsy
- use of sound, laser, dry shock wave energy to break up stones
- blood in urine is common after treatment
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hydronephrosis
- urine backs up into and distends the kidney
- caused by stricture, kidney stone, tumor or enlarged prostate
- pt usually exhibits uti symptoms and flank or back pain
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cancer of the bladder
- most common cancer of the urinary tract
- common metastasis sites are liver, bones and lungs
- smokers 2x risk
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signs and symptoms of bladder cancer
- painless hematuria is the most common sign
- fistula, urine retention, dysuria, changes in bladder habits
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bladder cancer treatments
- chemotherapeutic agents instilled into bladder
- bacille calmette-guerin vaccine prevents recurring tumors
- photodynamic therapy
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ileal conduit
- urinary diversion; 6 - 8 in. section of ileum or colon used to drain urine
- contains mucus and pt must wear an ostomy bag at all times
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3 classisc symptoms of kidney cancer
dull pain the flank area, mass in the area, hematuria
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polycystic kidney disease
- multiple cysts form in the kidney and replace normal kidney structures
- no treatment to stop it
- hereditary
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diabetic nephropathy
- most common cause of chronic kidney disease
- complication of diabetes, damages blood vessels in kidneys
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risk factors for diabetic nephropathy
htn, genes, smoking, chronic hyperglycemia
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symptoms of diabetic nephropathy
- microalbuminuria advancing to proteinuria
- leads to chronic kidney disease
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nephrotic syndrome
- excretion of 3.5g or more of protein in the urine per day
- low levels of protein cause ascites and widespread edema
- sodium intake is restricted and pt is on a low to moderate protein diet
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nephrosclerosis
- hypertension damages the kidneys
- damaged blood vessels cause necrosis
- treating the htn stops the damage
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glomerulonephritis
- glomerulus is inflammed and proteins, wbc and rbc leak into urine
- associated with beta-hemolytic streptoccocal infection of throat or skin
- edema, oliguria and htn develop
- usually happens 6 - 10 days after infection
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