Urinary A&P & Assessment

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mthompson17
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244905
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Urinary A&P & Assessment
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2013-11-04 19:22:01
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urinary system nursing
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Urinary A&P & Assessment - Brantley
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  1. What can cause plasma proteins & blood cells to pass into the urine?
    increased capillary permeability that may be caused by man y renal diseases
  2. Normal GFR?
    125mL/min
  3. Function of the proximal convoluted tubule?
    reabsorption (back to body) of nutrients:  most electrolytes & all glucose, amino acids, and small proteins

    secretion (out of body) of: H+ ions & creatinine
  4. Function of loop of Henle?

    Ascending limb?
    water conservation - concentration of urine

    reabsorbtion of Cl- & some Na+
  5. Function of distal convoluted tubules?
    final regulation of water & pH balance
  6. How is reabsorption of water performed in the distal convoluted tubule?
    ADH is required for water reabsorption -> makes tubules permeable to water
  7. What area of the nephron is responsive to aldosterone?

    What are aldosterone's effects?

    What 2 things affect aldosterone secretion?
    distal convoluted tubules

    reabsorption of Na+ & water & excretion of K+

    blood volume & Na+ & K+ concentrations
  8. Kidneys acid/base function?

    Normal blood pH?

    Normal bicarb?
    reabsorbing (back into body) bicarb (HCO3) & excreting excess H+

    7.35 - 7.45

    22-26
  9. ANP?
    atrial natriuretic peptide - hormone released from R atrium of heart in response to atrial distention r/t increase in BV -> inhibits renin, ADH, & action of angiotensin II/aldosterone -> large volume of dilute urine

    also causes relaxation of BV -> increases GFR
  10. 2 roles of renal tubules in Ca balance?

    How does renal failure affect this?
    • 1. PTH works on renal tubules to increase Ca reabsorption & decrease reabsorption of phosphate 
    • 2. converts vitamin D to active form -> vitamin D needed for Ca+ absorption in GI

    person with renal failure will have Ca & phosphate imbalances
  11. Kidney funtion in blood cell production?

    How does renal failure affect this?
    produces erythropoietin in response to hypoxia & decreased renal blood flow -> stimulates RBC production

    renal failure can cause anemia
  12. When is renin secreted & what effects does it have?
    released in response to decreased renal perfusion, decreased arterial blood pressure, decreased ECF, decreased serum Na+ conc. & increased urinary Na+ conc.

    renin -> angiotensin I -> I converted to angiotensin II by ACE -> stimulates aldosterone secretion  -> Na+ & water retension & vasoconstriction
  13. 2 primary prostaglandins produced by the kidney?

    3 Effects?
    PGE2 & PGI2

    • 1. vasodialtion -> increase renal BF
    • 2. promote Na+ excretion
    • 3. counteract vasoconstrictor effect of substances:  angiotensin & NE
  14. Ureters?
    carry urine from the kidneys to bladder
  15. Ureteropelvic junctions?
    point where each ureter joins the renal pelvis
  16. Ureterovesical junctions?
    point where each ureter joins the bladder
  17. Where do most urinary obstructions occur?
    at the ureteropelvic junctions & ureterovesical junctions b/c they are the narrowest part of the ureteral lumens
  18. Renal colic?
    acute pain that can occur with passage of a stone or clot
  19. Normal adult urine output per day?
    1500mL/day
  20. ____ mL of urine in the bladder causes moderate distention & the urge to urinate
    200-250mL
  21. Bladder capacity?
    600 to 1000mL
  22. Length of F & M urethra?
    • F: 1-2inches
    • M: 8 to 10 inches
  23. Urethrovesical unit is includes the ___, ____, & ___ ____ _____.

    What is its function?
    bladder, urethra, & pelvic floor muscles

    voluntary control of urination/continence
  24. Stimulation of urination?

    What areas of the spinal cord are involved?
    distention of bladder -> stretch receptors in bladder -> brain -> spinal cord -> desire to urinate

    T11 to L2 & S2 to S4
  25. How can neurological disorders affect urinary system?

    What medical conditions can cause this?
    any disease/trauma that affects brain, spinal cord, or innervation of GU system can affect bladder function

    DM, MS, paralysis/paraplegia, drugs that affect nerve transmission
  26. Effects of aging on the urinary system?

    In F & M?
    • 1. decreased amount of renal tissue (starts decreasing at age 30)
    • 2. decreased glomeruli functioning:  decreased # of nephrons & renal BV/BF
    • 3. decreased function of nephron tubules
    • 4. alterations in hormone levels -> decreased concentrating ability, alterations in excretion of water & electrolytes (ADH, ANP, & aldosterone)
    • 5. constipation - can affect urination - can cause urethral obstructions r/t rectum close proximity to urethra
    • 6. Ureter, bladder, & urethra:  decreased elasticity & muscle tone
    • 7. weakening of sphincter
    • 8. decreased bladder capacity

    • F:
    • 1. GU system losses elasticity, vascularity, & structure -> more prone to urethral irritation & bladder infections
    • 2. incontinence higher in menopausal women who use HRT
    • 3. thin, dry vaginal tissue r/t decreased estrogen

    M: prostate enlarges
  27. Assessment findings r/t decreased kidney function r/t aging?
    • 1. decreased creatinine clearance
    • 2. increased BUN & serum creatinine
    • 3. alterations in drug excretion
    • 4. nocturia & loss of normal diurnal excretory pattern b/c of decreased ability to conc urine
    • 5. less concentrated urine
  28. Menopausal women who use HRT are at risk for _____.
    incontinence
  29. How may constipation affect urinary system?
    partial urethral obstruction may occur because of the rectum's close proximity to the urethra
  30. Subjective data need for urinary assessment?
    • 1. Hx of diseases that effect the urinary system
    • 2. specific urinary problems:  cancer, infections, BPH, calculi
    • 3. medications that may alter urinary output quantitiy, quality, or color or that may cause other urinary changes
    • 4. previous hospitalizations or Tx with radiation or chemo
    • 5. changes in weight or appetitie
    • 6. excess thirst or fluid retention
    • 7. complaints of HA, pruritus, or blurred vision may be r/t kidney dysfunction
    • 8. occupational Hx - exposure to chemicals can damage kidneys
    • 9. smoking Hx
    • 10. location where pt lives
    • 11. family Hx
    • 12. lifestyle:  nutrition, fluid, activity, sleep/rest
    • 13. urination patterns & changes in urination/urine'
    • 14. cognition, self-perception, & role performance
    • 15. sexuality & reproductive pattern
  31. 10 medical conditions that may affect the urinary system?
    • 1. HTN
    • 2. DM & other met. probs
    • 3. gout
    • 4. connective tissue disorders:  systemic lupus erythematosus, systemic sclerosis
    • 5. skin or upper resp infection of strep
    • 6. TB
    • 7. viral hep
    • 8. congenital disorders
    • 9. neuro conditions
    • 10. trauma
  32. 13 common drugs that are nephrotoxic?
    • 1. amphotericin B
    • 2. bacitracin
    • 3. cephalosporins
    • 4. micin/mycin drugs:  gentamicin, kanamycin, neomycin, tobramycin, vancomycin
    • 5. sulfonamides
    • 6. captopril
    • 7. cimetidine
    • 8. lithium
    • 9. methotrexate
    • 10. NSAIDs
    • 11. quinine
    • 12. rifampin
    • 13. salicylates in lg quantities
  33. 2 illegal drugs that are nephrotoxic?
    cocaine & heroin
  34. Meds that may alter the quantity and quality of urine output?
    diuretics
  35. Meds that change the color of urine?
    nitrofurantoin/Macrodantin & pyridium
  36. 4 types of drugs that may affect the ability of the bladder or sphincter to contract or relax normally?
    • 1. antidepressants
    • 2. Ca channel blockers
    • 3. antihistamines
    • 4. neurologic & MS disorder drugs
  37. S/S of UTI in elderly?
    may report malaise & abd discomfort as only s/s & may have cognitive changes
  38. 2 chemicals that are nephrotoxic?
    • 1. phenol
    • 2. ethylene glycol
  39. Aromatic amines may increase the risk of _____ cancer.

    4 occupations that increase risk or exposure to these chemicals?
    bladder

    • 1. textile workers
    • 2. painters
    • 3. hairdressers
    • 4. industrial workers
  40. Major risk factor in the development of bladder cancer?
    smoking
  41. Why is it necessary to know the location where a pt lives?
    some areas have higher incidence of urinary calculi:  Great Lakes, Southwest, & Southeast

    travel to Middle Eastern or African areas -> parasites that can cause cystitis or bladder cancer
  42. Large intake of certain foods such as ____ & ____ can contribute to development of renal calculi.
    dairy & protein
  43. What food can cause urine to smell musty?
    asparagus
  44. Foods that are bladder irritants?
    caffeine, alcohol, carbonated beverages, spicy foods
  45. How may herbal teas affect the urinary system?
    can cause diuresis
  46. How may urinary system issue cause weight gain?
    fluid retention secondary to a renal problem
  47. If there is a problem with fecal incontinence along with urinary issues what may be the cause?
    may be a neurologic cause
  48. What problems with urinary system may occur r/t being sedentary?
    • 1. urinary stasis -> infections & calculi
    • 2. demineralization of bones -> increased urine calcium
  49. What problem may occur with physical activity if a man has had prostate surgery?
    may leak urine during activities like running

    may develop chronic inflammatory prostatitis or epidiymitis after heavy liftin or long-distance driving
  50. 5 causes of nocturia r/t urinary system?
    • 1. polyuria r/t renal disease
    • 2. poorly controlled DM
    • 3. alcoholism
    • 4. excessive fluid intake
    • 5. obstructive sleep apnea
  51. Why is absence of pain when other urinary s/s exist a significant finding?
    tumors are painless in early stages
  52. Costovertebral angle (CVA)?
    angle formed by the rib cage & the vertebral column
  53. Palpation of the bladder?
    normally not palpable unless distended with urine - smooth, round, firm organ & is sensitive to palpation
  54. How may tenderness in the flank area be detected?
    percussion (kidney punch) - normally should not cause pain
  55. Auscultation of the urinary system?
    use bell of stethoscope to listen to CVAs & abd upper abd quadrants:  listen for bruit at abd aorta & renal arteries that indicateds impaired BF to the kidneys

    bruit- abnormal blood flow
  56. Inspection for urinary system?
    inspect abd & urinary meatus for inlammation or discharge
  57. Anuria?

    3 possible causes?
    no urination:  24h urine output <100mL

    AKI, ESRD, & bilat ureteral obstruction
  58. 2 causes of burning on urination?
    • 1. urethral irritaion
    • 2. UTI
  59. Dysuria?

    Causes?
    painful or difficult urination

    UTI & interstitial cystitis & many others
  60. Enuresis?

    Cause?
    involuntary nocturnal urinating

    symptomatic of lower urinary tract disorder
  61. Frequency?

    3 causes?
    increased incidence of urination

    • 1. acutely inflamed bladder
    • 2. retention with overflow
    • 3. excess fluid intake
  62. Hematuria?

    6 causes
    blood in urine

    • 1. cancer of GU tract
    • 2. blood dyscarsias
    • 3. renal disease
    • 4. UTI
    • 5. stones in kidney or ureter
    • 6. meds: anticoagulants
  63. Hesitancy?

    Cause?
    delay or difficulty in initiating urination

    partial urethral obstruction
  64. Incontinence?

    3 causes?
    inability to voluntarily control discharge or urine

    • 1. neurogenic bladder
    • 2. bladder infection
    • 3. injury to external sphincter
  65. Nocturia?

    5 causes?
    frequency of urination at night

    • 1. renal disease with impaired concentrating ability
    • 2. bladder obstruction
    • 3. heart failure
    • 4. DM
    • 5. post-renal transplant
  66. Oliguria?

    5 causes?
    diminised amnt of urine in a given time:  24h urine output of 100-400mL

    • 1. severe dehydration
    • 2. shock
    • 3. transfusion reaction
    • 4. kidney disease
    • 5. ESRD
  67. What does pain in the suprapubic area, urethral pain, & flank pain indicate?

    What are 6 causes of pain in the urinary system?
    • suprapubic pain - bladder pain
    • urethral pain - irritation of bladder neck
    • flank pain = CVA pain - kidneys

    • 1. infection
    • 2. urinary retention
    • 3. foreign body in urinary ract
    • 4. urethritis
    • 5. pyelonephritis
    • 6. renal colic or stones
  68. Pneumaturia?

    2 causes?
    passage of urine containing gas

    • 1. fistual b/t bowel & bladder
    • 2. gas-forming UTI
  69. Polyuria?

    5 causes?
    lg volume of urine in a given time

    • 1. DM
    • 2. DI
    • 3. CKD
    • 4. diuretics
    • 5. excess fluid intake
  70. Retention?

    6 causes?
    inability to urinate even though bladder contains excessive amnt of urine

    • 1. post-pelvic surgery
    • 2. childbirth
    • 3. catheter removal
    • 4. urethral stricture or obstruction
    • 5. neurogenic bladder
    • 6. postanesthesia
  71. Stress incontinence?

    Causes?
    involuntary urination with increased pressure

    weakness of sphincter control
  72. What bowel preparations are contraindicated in pt with renal failure?

    Why?
    Mg citrate & fleet enema - any that contain Mg

    b/c cannot excrete Mg
  73. Important consideration if a pt is having Dx studies on consecutive days?
    must prevent dehydration:  pt NPO & may not eat/drink much after test then will be NPO again that evening

    Make sure get adequate nourishment b/t studies
  74. When is best time to get UA sample?j

    When should it be examined?
    first specimen urinated in am - most concentrated

    exam within 1 h of collection - should refridgerate if not possible
  75. What is creatinine?
    waste product produced by muscle breakdown that is excreted in urine
  76. What does creatinine clearance show?
    gives close approximation of GFR
  77. When should blood samples for the serum creatinine be collected?
    during period of urine collection

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