GU Final

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GU Final
2013-12-03 21:02:53
Chapters 36 37 43
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  1. S/S of Prostatitis
    • Mimic UTI symptoms:
    • ↑ Urgency
    • ↑ Frequency
    • Hesitancy
    • Dysuria
    • Low back,perineal, or postejaculation pain
    • Fever/chills
  2. Risk factors for Prostatitis
    • Increased age
    • Any bacteria that can cause a UTI (E. Coli, Staph aureus, STD)
    • Bacteria ascending urethra
    • Bacteria in bloodor lymphs
    • Urethral trauma
    • Excess alcohol (>2-3 oz/day)
    • Multiple sexual partners
  3. TURP - Transurethral resection of prostate
    • Treatment to relieve obstruction caused by enlarged prostate
    • Rectoscope inserted into urethra and prostate chipped away a piece at a time
    • After: Foley inserted, 30-60 mL water to inflate balloon to stop bleeding 
    • Irrigation done regularly during first 24 hours
    • May need to save serial urines for progressively less blood in each void
    • Complications: Clot formation, bladder spasms, infection
    • After: drink up to 2500 mL fluid/day
  4. Paraphimosis
    • When uncircumcised skin is pulled back and not replaced in forward position
    • Causes constriction of dorsal veins, which leads to edema and pain
    • May lead to gangrene
  5. Priapism
    • Painful erection lasting longer than 4 hours
    • Permanent tissue damage may result
    • May be complete loss of erection ability after
    • Causes: sickle cell anemia, leukemia, cancer, spinal cord injury, meds for erectile dysfunction
    • Treatment: Ice packs, sedatives, injection into penis to relax veins spasms, aspiration, shunt
  6. Peyronie's disease
    • Penis is curved when erect
    • Plaques form in tissue surrounding corpora cavernosa
    • May be caused by injury or inflammation
    • Treatments: Vit E, Colchicine, surgery, injection into scar tissue to break it down
    • Not life threatening
  7. Orchitis
    • Inflammation or infection of testicles (rare)
    • Caused by: trauma, epididymis infection, UTI, STD, systemic disease
    • S/S: Swollen, tender, red, fever
    • Treatments: bed rest, scrotal support, antibiotics, analgesics
    • Sterility from mumps can be prevented by giving vaccine young
  8. Epididymitis
    • Inflammation of epididymis 
    • Painful, scrotal skin tender, red & warm
    • Risks: STD, backflow of urine, prostate infections
    • Treatment: antibitics, ice packs. Usually goes away in about a week
    • Complications: Chronic epididymitis, abcesses, steriliity
  9. Hydrocele
    • Collection of fluid in scrotal sac
    • Not dangerous, usually no pain
    • Cause unknown
    • No treatment unless discomfort or threat to blood supply. 
    • Surgically drain fluid
  10. Varicocele
    • Varicose veins in scrotum
    • Area in scrotum feels like bag of worms
    • S/S: pulling sensation, dull ache, scrotal pain. Sensations felt when standing up
    • Usually occur on left side
    • May increase temp of testicles, damaging sperm
    • Treatment: surgical repair of varicose veins
  11. Transurethral suppository for erectile dydfunction
    • Urinate before
    • may increase absorption
    • Pellet inserted in urethra
    • Usually works w/in 5-10 min and lasts 30-60 min
  12. Therapeutic measures for erectile dysfunction
    • Medication change
    • Oral meds (cialis, viagra, levitral)
    • Hormones
    • Injections to penis
    • transurethral suppository
    • Vacuum device/penile ring
    • Implants
    • Surgery
  13. Pretesticular infertility
    • Inproper functioning of hypothalamus, pituitary gland, testicles
    • Causes: Pituitary or adrenal tumors, thyroid problems, uncontrolled diabetes
    • Rare
  14. Testicular infertility
    • 2 most common: varicoceles and idiopathic causes
    • Other causes: Klinefelter's syndrome  or cryptochordism
    • High fever or viral infection
    • Excessive use of hot tubs, tight clothing and long haul truck driving
  15. Post-testicular infertility
    Most common: Surgery or injury along pathway from testicles to outside of body (vasectomy, bladder neck reconstruction)
  16. How long must you try to conceive before considered infertile?
    1 year
  17. Gentamicin
    • Antibiotic 
    • Used to treat sever bacterial infections
    • Nephrotoxic.  (Intrarenal injury) When taken, blood levels of the drugs are monitored to avoid toxic levels
  18. Nursing care for chronic kidney disease
    • Daily weight
    • Look for: JVD, SOB, crackles, frothy sputum.
    • HOB raised to 30 degrees
    • Monitor: vital signs, albumin and protein levels
    • Sodium and fluid constrictions
  19. Prostatitis
    • Inflammation of prostate gland
    • 4 types: Acute bacterial, chronic bacterial, chronic pelvic pain syndrome, asymptomatic
    • Prevention: regular and complete emptying of bladder
    • EPS and DRE for diagnostic tests
  20. Patient teaching for prostatitis
    • Bladder log for 3-7 days
    • Educate about avoiding urine retention (anticholinergics, alpha-adrenergics)
    • Fluids and cranberry juice
  21. BPH
    • (Benign Prostatic Hyperplasia)
    • Enlargement of prostate gland leading to urine retention and kidney distention
    • S/S: ↓ in size/force of stream, dribbling
    • Dx: DRE, urinalysis, BUN, transrectal ultrasound, urodynamic flow study
    • Treatment: alpha or testosterone blockers, transurethral microwave antenna, prostate balloon, incision of prostate, resection of prostate
    • Herbal: Saw Palmetto
  22. What kind of meds could cause ED?
    • Most common are those prescribes for high blood pressure and cardiovascular disease
    • Most common cause of ED is circulatory problems
  23. Flomax
    • Alpha adrenergic blocker
    • Relaxes muscles in prostate and bladder neck 
    • Used to improve urination with benign prostatic hyperplasia
  24. Drug used to treat cancer by suppressing release of testosterone
    • Leuprolide
    • Goserelin
    • Flutamide
  25. What should sperm count be to get woman pregnant
    20 million per millimeter of semen
  26. Cryptorchidism
    • Congenital condition where 1 or both testes don't descend into scrotum
    • If not descended by age 2, surgery is needed
    • If not by then, surgery should be done
  27. DRE
    • Digital rectal exam
    • Gloved finger is inserted into rectum to examine prostate
  28. Complications of BPH
    • Untreated it can cause:
    • Hydronephrosis
    • Renal insufficiency
    • Urosepsis
    • Bladder dysfunction
    • Stones
  29. Retrograde ejaculation
    • Common side effect of prostate surgery
    • Semen falls back into the bladder
    • Causes no harm and is urinated out
  30. Prostate cancer
    • Found most often in men over 65
    • High testosterone
    • High fat diet
    • Family history
    • S/S: Hematuria, urinary obstruction
  31. Urea
    Nitrogenous waste product excreted in the urine; end product of protein metabolism
  32. Renal Cortex
    • The outer layer of kidney tissue
    • Contains the renal corpuscles and convoluted tubules of nephrons
  33. Renal Medulla
    • The inner layer of kidney tissue
    • Contains the wedge shaped pieces called renal pyramids
    • Contains the loops of Henle and the collecting tubes of nephrons
  34. Renal Pelvis
    • A funnel shaped basin that forms the upper end of ureter.
    • Cuplike extension of the pelvis that collect urine are calyces
    • Urine enters from the papillae of the renal pyramids.
  35. Glomerulus
    • Cluster of capillaries surrounded by the nephron's glomelular capsule. 
    • At the beginning of the nephron, the glomerulus is a network (tuft) of capillaries that performs the first step of filtering blood.
  36. Location of kidneys in relation to peritoneum and backbone
    • They are not in the peritoneal cavity, but in the retroperitoneal space, behind the peritoneum
    • At level of last thoracic and first 3 lumbar vertebrae
  37. How do the kidneys regulate BP?
    • When bp falls, it may limit filtration.
    • The cells release renin which activates angiotensin. Angiotensin constricts blood vessels, causing BP to raise
    • ANP is released when blood pressure is too high to lower
  38. Erythropoietin
    • Produced when kidneys don't have enough O2
    • Stimulates red cell production in the bone marrow
  39. Retroperineal
    Behind the peritoneum
  40. Structure of kidney
    • Right kidney lower than left to accommodate liver
    • Enclosed in renal capsule on outside, then adipose capsule
    • fascia anchors kidney to peritoneum and abd wall
  41. Blood path of the kidney
    • Renal artery
    • Afferent arteriole
    • Glomerulus
    • Efferent arteriole
    • Peritubular capillaries
    • Renal vein
  42. Tubular resportion takes place where
    From the renal tubule to the peritubular capillaries
  43. Where does filtration take place in the kidney?
    the glomerulus and glomerular capsule
  44. What part of nephron drains to the loop of Henle?
    • Renal tubule
    • (distal convoluted tubule)
  45. Afferent arteriole
    Supplies the gomerulus with blood
  46. Efferent arteriole
    carries blood from the glomerulus
  47. Functional unit of the kidney
  48. What drives materials out of glomerulus into glomelurlar capsule?
    • Blood pressure
    • (3-4 times higher than in other capillaries)
  49. Normal components of urine
    • 1000 - 2000 mL/day
    • Straw or amber color
  50. Where does reabsorption take place?
    Proximal convoluted tubules
  51. Where does secretion take place?
    Peritubrular capillaries in the renal tubules
  52. Pinocytosis
    Reabsorption of small proteins
  53. Process which water is reabsorbed by renal filtrate
  54. Substances are reabsorbed from the distal convoluted tube into what?
    The interstitial fluid, then peritubular capillaries, then return to circulation
  55. Where is urine formed?
    Begins with the glomerulus and into the renal tubule
  56. How the kidneys regulate acid-base balance (PH) of body fluids
    Active secretion of hydrogen ions and bicarbonate. when body fluids become too acidic kidneys secrete more hydrogen into renal filtrate and return bicarbonate ions back into blood. when too alkaline bicarbonate is excreted to renal filtrate and hydrogen into blood
  57. Average PH of urine
    4.6 - 8.0, with an average of 6.0
  58. Kidneys respond to increased acidity in body fluids by doing what?
    They secrete more hydrogen ions into renal filtrate and return more bicarbonate ions back into the blood
  59. Normal glomerular filtration rate (GFR)
    • 105 - 125 mL/min
    • It is the amount of renal filtrate formed by the kidneys in 1 min.
    • If blood increases, GFR increases, urinary output increases
  60. Location of urinary bladder
    • Inside the peritoneum behind the pubic bones.
    • In women: bladder is inferior to uterus
    • In men: bladder is superior to the prostate gland
  61. Ureters go from what to what?
    from the hilus of the kidney to the lower, posterior side of the urinary bladder
  62. In men, what does the urethra pass through?
    It is 7-8 inches long and extends through the prostate gland and penis.
  63. What sphincter provides voluntary control of urination reflex?
    External urethral sphincter
  64. How much urine does the bladder contain after urination?
    <50 mL
  65. Substances normally found in urine
    • Urea
    • Uric acid
    • Creatinine
    • Electrolytes
    • Pigment (Urochrome)(bilirubin)
  66. Specific gravity measures what
    • The amount of dissolved solids and gases.
    • Range is 1.002 (very dilute) - 1.040 (very concentrated)
  67. ADH does what
    Increases water reabsorption in the kidney to dilute the excess sodium
  68. Normal characteristics of urine
    • 1000 - 2000 mL/day
    • Straw or amber colored
    • Specific gravity: 1.002 - 1.035
    • PH 4.6 - 8.0
    • 95% water
  69. Where does creatinine in urine derive from?
    The metaboilism of creatine phosphate, an energy source in muscles
  70. Uremia
    Waste products building up in the blood
  71. Single best indicator of fluid balance
  72. 11 Things that are tested in Urinalysis
    • Color
    • Odor
    • PH
    • Specific gravity
    • Protein content
    • Glucose
    • Ketones
    • Bilirubin
    • Nitrate
    • RBC
    • WBC
  73. Good indicator of renal disease
    • Protein in urine
    • High creatinine level
    • Potassium level
  74. If older patient has ↑ BUN, what could be the reason?
    • Dehydration
    • high-protein diet
    • GI bleeding
    • heart failure
  75. What would be considered abnormal if found in urine?
    • Protein
    • Glucose
    • Ketones
    • Bilirubin
    • Nitrate
    • RBC and WBC's
  76. Normal urinary output per hour
    • 30-60 mL
    • or 1 mL/kg per hour
  77. Calyces
    • Funnel shaped extensions of the renal pelvis
    • They enclose the papillae of the renal pyramids
  78. Structures at the hilus of kidney
    • Renal artery
    • Renal vein
    • Ureter
  79. What provides energy for filtration?
    • Blood pressure
    • (active transport is energized by ATP or stored energy)
  80. What enzyme does Juxtaglomelular apparatus secrete?
    • Renin
    • (stimulated by low blood pressure)
  81. How to collect a mid-stream urine specimen
    • Clean perineum from front to back
    • Separate labia
    • Start urinating in toilet
    • Move collection container under urine stream 
    • Need at least 10 mL
    • If menstruating, specify on lab form
  82. High specific gravity could mean what?
    • Diabetes
    • Nephrosis
    • CHF
    • Dehydration
  83. Renal biopsy
    • NPO 6-8 hours, no anticoagulants
    • Position: Prone, with sandbag under abdomen
    • Hold breath while needle is inserted to keep kidney from moving
    • Bedrest for 24 hours
  84. Nursing interventions after arteriogram
    • Bedrest up to 12 hours to prevent bleeding at injection site
    • Check distal pulse in leg every 30-60 min
    • Do not bend or raise HOB >45°
  85. Process of forming urine in kidneys
    • 3 regulated processes of nephrons: filtration, reabsorption, and secretion
    • Filtration: blood from heart to nephrons
    • Reabsorption: Essential solutes and water move back into blood from nephron
    • Secretion: Move substances from blood into tubules, where they mix with water and other wastes and converted to urine
  86. Complications of renal biopsy
    • Grossly bloody urine
    • Falling blood pressure
    • ↑ pulse indicates bleeding and must be reported immediately

    • Flank pain
    • Hematuria
    • Light headedness
    • Fainting
  87. Stress incontinence vs.
    Urge incontinence vs.
    functional incontinence
    • Stress:  Involuntary loss of urine <50 mL assoc w/coughing, sneezing, laughing.  Seen after menopause, child-birth for women. Prostatectomy and radiation
    • Urge: Unable to make it to bathroom in time. Most common
    • Functional: Inability to reach toilet because of environment, memory or physical limitations 
  88. How much urine for urinalysis
    10 mL
  89. Why would renal failure patient have low hemoglobin
    • Damaged kidneys don't produce adequate erythropoetin (stimulates RBC production)
    • Blood loss during dialysis
  90. What foods should you avoid with a calcium oxalate kidney stone?
    • Restrict protein and sodium
    • beets
    • rhubarb
    • spinach
    • cocoa
    • instant coffee
    • milk
    • cola
    • beer
  91. Pyelonephritis
    • Infection of the renal pelvis, tubules and interstitial fluid of both kidneys
    • Urinalysis shows casts
  92. What labs to look at in renal failure patient
    • BUN
    • Creatinine
    • BUN/Creatinine ratio
    • Cystatin
    • Uric acid
  93. Why would patient with foley develop UTI
    • Bacteria ascend catheter
    • Usually develop w/in 2 weeks
  94. Nursing actions for renal calculi
    • I&O
    • Observation of urine abnormalities such as hematuria, pyuria or passage of stone
    • Obstruction
    • Temperature
    • BP
  95. How to prevent crystals from forming in the urine
    • Encourage fluid intake to around 3000 mL
    • Encourage walking
    • Avoid offending foods
  96. Teaching for patient with UTI on antibiotics
    • Take all antibiotics
    • Many UTI infections are recurrent, teach what to do to avoid in future
    • Pyridium - purple skin discoloration, urine orange
  97. Best determinant of fluid volume status
    Daily weight
  98. Symptoms of fluid overload
    • Edema
    • SOB
    • Crackles & weezes
    • Tachypnea
    • JVD
  99. Most common symptom of cancer of the bladder
    Painless hematuria
  100. How much fluids should pt. with UTI have
    • 3000 mL
    • 10 oz cranberry juice
  101. What hourly output should be reported
    <400 mL/day
  102. Things to look for in urine if trauma to kidney
    • Hematuria
    • Inability to void
  103. Med to give for UTI pain
    • Antispasmodic agents
    • Antipyretics
    • Heat to puprapubic area
    • Pyridium
  104. Teaching for Pyridium
    • Urine color changes to red-orange
    • Blue-to purple skin discoloration
    • Changes urine glucose testing
    • Avoid in renal insufficiency
  105. Hydronephrosis
    Abnormal dilation of kidneys caused by obstruction of urine flow
  106. Nephrolithotomy
    • Surgical incision into the kidney to remove a stone
    • Pyelolithotomy is to remove stones in renal pelvis
  107. Teaching to avoid UTI's
    • Void every 3 hours while awake
    • Drink up to 3000 mL water/day
    • One glass cranberry juice/day
    • Avoid baths
    • Wipe front to back
    • Urinate after sex
    • Avoid constricting clothing
  108. Patient has acute renal failure and hypovolemic shock, what might be very significant?
    • 24 hour cratinine clearance test
    • Anxiety
    • Cool, clammy skin
    • Confusion
    • ↓ or no urine output
    • Pale skin
    • Rapid breathing
    • Unconciousness
  109. Most common urinary sale that makes up renal calculus
    • Calcium oxalate
    • Calcium Phosphate
    • Magnesium ammonia
    • Uric Acid
    • Cystine
    • Most contain calcium
  110. Polycystic kidney disease
    • Hereditary
    • Grapelike cysts
    • No treatment
    • Hematuria, hypertension
  111. Substitutes for sodium to flavor food
    • Garlic
    • Onion
    • Pepper
    • Lemon juice
    • Seasoning blends
    • Vinegar
    • Dry mustard
  112. Primary nursing action before IVP
    • Xray of kidneys after contrast medium injected
    • NPO 8 hours before procedure
    • Explain warm, flushing sensation and maybe strange taste
    • After: encourage fluids, measure urine output
  113. Most common complication of renal biopsy and symptoms pt would show
    • Bleeding
    • s/s: bloody urine, flank pain, falling BP
  114. Symptoms of UTI in elderly
    • Change in cognitive functioning
    • Decline in mental status
    • Fever
  115. Teaching for functional incontinence
    • Keep voiding log
    • Determine any acute causes and fix
    • Is clothing inhibiting?
    • Obstacles to bathroom?
    • Initiate schedule
    • Use environmental cues
  116. How to collect 24 hour urine test
    • Urinate and discard specimen
    • Time is noted and this is start
    • All voidings are saved in a container.
    • Incomplete specimens aren't accurate
  117. If you're emptying urine from ileal conduit and it has strands of mucus, what do you do?
    Document.  Normal to have mucus because it comes through the ileum
  118. Nursing care for nephrostomy tube
    • Never clamped - will create pressure that destroys kidney function
    • Make sure it's draining adequately
  119. Interventions after IVP
    • Encourage fluids to remove contrast media
    • Monitor urine output
  120. Patient has catheter, what instructions to prevent UTI
    • Encourage fluid consumption
    • Wash perineum with soap and water once a day
    • Remove catheter as soon as possible
    • Keep catheter securely taped to patient, preventing back and forth movement of catheter
  121. Normal PH of Urine
    4.6 - 8.0 with an average of 6.0
  122. Normal specific gravity
    • 1.002 - 1.035
    • Low specific gravity indicates excessive fluid intake
    • High indicates dehydration
  123. Creatnine clearance
    • Minimum level of 10 mL per min to live w/out dialysis
    • Reference value: 85-135 mL/min
  124. BUN-to-creatinine ratio
    • Evaluates hydration status
    • Elevated occurs in hypovolemia
  125. Diabetic nephropathy
    • Glomerular capsules get damaged, edema
    • S/S: Microalbuminuria, ↓urine output
    • Smaller doses of insulin needed
    • Risk of CVD ↑
    • Therapeutic measures: Strict control of blood sugar & BP, ACE inhibitors

  126. Nephrotic syndrome
    • Serum albumin and total serum protein ↓
    • Excretion of 3.5 g or more of protein in urine per day
    • Edema
    • ↑ cholesterol
    • ↑ blood coagulation
    • Low protein and sodium diet
  127. Nephrosclerosis
    • Hardening of renal blood vessels
    • S/S: proteinuria, hyaline casts in urine
    • Treatment: reduce BP and treat hypertension, low sodium diet
    • May you prone to MI or CVA
  128. Glomerulonephritis
    • Inflammation of glomerulus
    • Most commonly assoc. with Group A strep
    • S/S: Protein, casts or RBCs in urine, fluid volume overload, hypertension, periorbital edema, flank pain, dark urine
  129. 3 stages of acute kidney injury
    • Oliguric phase: <400 mL urine in 24 hours. Low sodium level.Lasts 2 wks - several months
    • Diuretic phase: 1-3L urine/day. BUN & Creatnine high. Lasts 1-3 weeks
    • Recovery phase: BUN & creatnine decrease. Can take up to a year
  130. 3 classifications of acute kidney injury  (causes)
    • Prerenal injury: Interruption of blood supply to kidneys. (dehydration, blood loss, shock, NSAIDS)
    • Intrarenal: Inside kidneys. (ischemia, toxins, aminoglycosides)
    • Postrenal injury: Obstruction of urine flow out of body. (stones, tumors, enlarged prostate)
  131. Chronic kidney disease
    • Nephrons are damaged or destroyed
    • End stage renal disease occurs when 90% of nephrons are lost
    • S/S: edema, Uremia, ↓ urine output, Fatigue, Nausea/vomiting, SOB, Anemia
  132. Nursing care for hyperkalemia patients
    Should be placed on cardiac monitor and observed for cardiac dysrhythmias
  133. Diet for chronic kidney disease
    • Restricted sodium
    • Restricted potassium
    • Increased calcium
    • Restricted phosphorus
    • Restricted fluids
  134. How does hemodialysis work
    Blood is removed from the kidney and filtered through a dialyzer. The waste products from the blood move into the dialysate by diffusion.  Then the cleansed blood is returned to the body
  135. Purpose of dialysis
    • Filters waste
    • Removes extra fluid  
    • Balances electrolytes (sodium, potassium, bicarbonate, chloride, calcium, magnesium and phosphate).
  136. How long does hemodialysis take and how often do you need it
    • 3-4 hours
    • 3-4 times a week
  137. What can/does occur after dialysis
    • Patient is very tired/weak
    • Dysrhythmias and angina may occur
    • Hypotension
  138. What medication is given to patients during dialysis?
    Heparin to prevent clotting in artificial kidney
  139. 3 types of vascular access for hemodialysis
    • Arteriovenous (AV) fistula: (best option) Made by sewing a vein and artery together under the skin. May take 2-6 months to mature
    • AV graft: Uses tube of synthetic material to attach to an artery and vein.  
    • Central venous catheter: Temporary. Can't be used long because of risk of infection. Placed in subclavian vein, jugular vein, or femoral vein.
  140. How are fistulas and grafts checked for patency?
    • Palpating for a thrill (tremor) and auscultating for a bruit (swishing sound)
    • Any decrease in either indicates occlusion
  141. Severe pain after vascular surgery may indicate what?
    Occlusion of the graft
  142. Steal syndrome
    When AV grafts cause distal ischemia
  143. Nursing care after vascular surgery
    • Neurovascular checks every hour
    • Extremity is elevated
    • Range of motion exercises encouraged
    • Teaching of care of access point
  144. Peritoneal dialysis
    • Provides continuous dialysis 
    • Dialysate solution instilled into peritoneal cavity (usually 1500 - 2000 mL)
    • 3 steps of exchange: filling, dwell time (left for several hours), draining
    • Repeated 3-4 times a day
  145. Advantage of a fistula over a two-tailed subclavian catheter
    There is a larger blood flow, and dialysis is more efficient
  146. Foods high in potassium
    • Citrus fruits and juices
    • Bananas
    • Raisins
    • Lima beans
    • Tomato products
    • Salt substitutes
    • Potatoes
    • Excessive dairy products
    • Excessive meats
    • Chocolate
  147. Cytoscopy
    • Inspects inside of bladder with fiber optic cytoscope
    • Expect dysuria for 24 hours after
  148. Risk factors for bladder cancer
    • Cigarette smoking
    • Industrial pollutants
  149. Hormones that affect kidney function
    • Aldosterone: reabsorption of sodium and excretion of potassium
    • ADH (pituitary): Promotes reabsorption of water from filtrate
    • ANH: Decreases reabsorption of sodium
    • Parathyroid: reabsoprtion of calcium and excretion of phosphate
  150. After having a vasectomy, how long should you use alternate birth control?
    6 weeks
  151. Continuous renal replacement therapy
    • There are few cardiovascular effects
    • The therapy is continuous
    • Temporary vascular access is required
  152. Functions of the kidney
    • Production of erythropoetin
    • Secretion of renin
    • Maintenance of normal PH of blood and tissue
  153. Causes of infertility in men
    • Epididymititis
    • Varicocele
    • Exposure to diethylstibestrol
    • Mumps orchitis