Chapter_36

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AlexisSheasMommy
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62678
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Chapter_36
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2011-01-28 21:56:13
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Eastern Suffolk Boces
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Urinary System
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  1. What are the functions of the kidneys?
    Regulate blood volume composition and pressure by the exfretion or conservation of water, regulate electrolytes, regulate acid-base balance, produce erythropoietin, and activation of vitamin D
  2. What is the outermost area of the kidney?
    The renal cortex
  3. What is contained in the renal cortex?
    Parts of the nephrons (renal corpuscles and convoluted tubules)
  4. What is the middle area of the kidney called?
    The renal medulla
  5. What is contained in the renal medulla?
    The loop of Henle and the collecting tubules, renal pyramids, and the renal pelvis, extensions of the renal pelvis called calyces enclose the papillae of the renal pyramids.
  6. What is the structural and function unit of the kidney?
    The nephron (1 million per kidney)
  7. What are the 2 parts of the nephron?
    The renal corpuscle and renal tubule.
  8. What does the renal corpuscle consist of?
    A glomerulus surrounded by a Bowmans or glomeurular capsule.
  9. The glomerulous as a capillary network that arrises from an _________ arteriole and empties into an __________ arteriole.
    Afferent/Efferent
  10. What 3 major processes is involved in the formation of urine?
    Glomerular filtration in the renal corpuscles, tubular reabsorption and tubular secretions.
  11. Define glomerular filtration.
    Process by which bp forces plasma and disolved materials and small proteins out of the glomeruli abd into Bowmans capsule.
  12. The bp in the glomeruli is relatively high; about __mmHg.
    55
  13. __% of the blood that enters glomeruli become renal filtrate.
    20
  14. Average globular filtration rate (GFR) is?
    100-125 mL/min
  15. If blood flow increases; ____ filtrate is formed and urinary output _______.
    Less/decreases.
  16. About __% of the renal filtrate's water is reabsorbed.
    99
  17. Normal urinary output is?
    1,000-2,000 mL / 24hours
  18. Active transport requires?
    ATP
  19. ATP is used to move what 4 things back to the blood?
    Glucose, vitamins, amino acids and ions.
  20. Aldosterone (renal cortex)
    Promoted reabsoption of sodium from the filtrate to the blood abd excretion of potassihm ions into the filtrate. Water is reabsorbed following the reabsorption of sodium.
  21. Antidiuretic hormone (posterior pituitary)
    Promotes reabsorption of water from the filtrate to the blood.
  22. Atrial natriuretic hormone (atria of the heart)
    Decreases reabsorption of sodium ions which remain in the filtrate. More sodium and water are eliminated in the urine.
  23. Parathyroid hormone (parathyroid gland)
    Promotes reabsorption of calcium ions from the filtrate to blood and excretion of phosphate ions into filtrate.
  24. Small filtrate's are absorbed by a process called _________.
    Pinocytosis
  25. If body fluids are becoming too acidic the kidneys release more ________ ions and return more __________ ions back to the blood.
    Hydrogen and bicarbonate.
  26. When body fluids become too alkaline the kidney returns ________ ions to the blood and excrete __________ ions in the urine.
    Hydrogren and bicarbonate.
  27. Additional functions of the kidneys include...
    Secretion of renin, activation of vitamin D, production of erythropoietin.
  28. When blood pressure decreases the juxtaglomerular cells in the walls of the afferent arterioles secrete the enzyme _______.
    Renin
  29. The kidneys convert vitamin C to
    Calcitrol
  30. The ________ extend from the hilus of the kidney to the lower posterior side of the urinary bladder.
    Ureters
  31. The _____ is the temporary storage site of urine.
    Urinary bladder
  32. The ________ carried urine from the bladder to the outside of the body.
    Urethra
  33. Urination is a _____ _______ ______.
    Spinal cord reflex
  34. The stimulus for urination is the stretching of the ______ _______.
    Detrusor muscle
  35. Normal amount of urine excreted in a 24 hour period.
    1,000-2,000mL's
  36. Normal color of urine.
    Straw (dilute) to amber (concebtrated)
  37. Normal specific gravity of urine.
    1.002-1.035. (distilled water is 1.000)
  38. Normal pH of urine.
    4.6-8.0
  39. Urine consists of...
    95% water; urea; creatinine; and uric acid.
  40. How is urea formed?
    By liver cells when excess amino acids are metabolized to be used for energy production.
  41. How is creatinine formed?
    Comes from the metabolism of creatinine phosphate an energy source in muscles.
  42. How is uric acid formed?
    Metabolism of nucleic acids- breakdown of DNA and RNA.
  43. Signs of aging reflected in the urinary system.
    Decrease in number of nephrons, decrease in GFR, arteriosclerosis and decreased renal blood flow (the reason for decreased GFR) bladder decreases in size, decrease in detrusor muscle tone, risidual in bladder after void.
  44. Uremia
    When the waste products are not filtered by the kidneys or with treatment, they can come out through the skin and look like a coating of frost.
  45. Nocturia
    Awakening from sleep at night to urinate.
  46. Health history for the urinary system consists of:
    Age gender ethnicity occupation health habits medical history family disorders r/t gu current meds (including otc and herbs) renal/urinary problems new onset of symptoms diet and fluid intake
  47. Objective assessment for GU
    Vitals neuro skin hair and nail assessment eyes ENT CV Resp Heme GI GU musculoskeletal and endo
  48. Urinalysis
    • Color-pale yellow-amber
    • Odor- aromatic
    • pH-4.6-8.0
    • Specific Gravity-1.002-1.035
    • Protein-0-18mg/dL or 0-150mg/24 hours
    • Glucose-none
    • Ketones-none
    • Bilirubin-none
    • Nitrate- negative
    • Leukocyte esterase- nagative
    • RBC's- 0-4/hpf
    • WBC's-0-5/hpf
    • Casts-none to occasional
  49. Medication to hold 24 pre and 48 hours post contrast media.
    Metformin aka Glucophage
  50. Labs to be drawn pre-admin of contrast media to check renal function.
    GFR or creatinine clearance
  51. _________ is used for 1 dose of pre-medication along with 2 doses post contrast media to help protect the kidneys.
    Mucomyst or acetykcysteine
  52. NMP22
    Bladder cancer marker
  53. BUN
    8-30mg/dL
  54. Serum creatinine
    0.6-1.5 mg/dL
  55. Uric acid
    2-7mg/dL
  56. Sodium
    135-145 mEq/L
  57. Potassium
    3.5-5.5 mEq/L
  58. Calcium
    9-11mg/dL
  59. Phosphorus
    2.8-4.5 mEq/L
  60. Bicarbonate (HCO3)
    22-28
  61. Magnesium
    1.3-2.1 mEq/L
  62. Albumin
    3.5-5.0 g/dL
  63. Renal Ultrasound or ultrasonography
    High frequency sound waves image the kidneys ureters and bladder or map the kidneys before a biopsy is done. Can show disorders of the kidney abcesses hydronephrosis kidney stones or tumors kidney enlargement structural changes with chronic infection.
  64. Bladder ultrasound
    Portable US computes bladder volume from 12 cross sectional readings. Used for residual urine volume bladder wall thickness bladder calculi tumors and diverticula.
  65. Kidney Ureter Bladder (KUB) flat plate of the abdomen
    Shows size shape and position of the kidneys ureters and bladder. Can show renal calculi kidney size and masses in the kidney
  66. CT scan
    Computer constructs images of the area scanned from a series of tomograms or cross-sectional slices. Contrast media may be given. Evaluates the kidneys ureters bladder abdominal and pelvis organs for kidney size tumors cysts abcesses malignant masses matasteces lymph node enlargement nonfunctioning kidneys renal stones obstructions and infections. (NPO 4 hours before procedure check allergies BUN and creat before contrast. Withold metformin)
  67. MRI
    Computer generated films produced by interaction of radio waves and magbetic fields of kidneys bladder prostate testes and retroperitoneum. Used to stage cancers of the kidney bladder and prostate. (contraindicated in patients with implanted metal devices, can use open MRI if pt is claustrophobic, may use contrast)
  68. Intravenous pyelogram (IVP)
    X-ray exam of renal tissues calyces pelvises ureters abd bladder after IV injection of contrast media or dye. Radiographs taken at frequent intervals to see dye filling the renal pelvis and going to the ureters into the bladder. Can show abnormal size or shape of kidneys absebt kidneys polycystic kidney disease tumors hydronephrosis renovascular hypertension. (prep- NPO 8 hours before, enemas to empty colon, check allergies, BUN creat, explain warm flush of dye. Post care- encourage fluids to flush out dye, monitor urine output)
  69. Renal angiography or arteriogram
    Visualizes renal blood vessels. Femoral artery is pierced with a needle, and a cath is threadded upward through the femoral and iliac arteries into the aorta and then the renal artery. Contrast agent is injected to make renal arterial supply visable on x-ray exam. Can show hypervascular tumors renal cysts renal artery stenosis, renak artery aneurysms, pyelonephritis, obstructions, renak infarction, renal trauma evaluation. (pre- NPO 4-8 hours prior check allergies BUN creat enemas may be given, post- bedrest up to 12 hours, check distal pulses every 30 minutes, do not bend leg, do not raise HOB more than 45*, monitor v/s and dsg frequently)
  70. Nephrotomogram
    Series of x-rays using IV contrast taken from different angles to create a 3-D picture. Used for renal cysts, tumors, areas of nonperfusion, renal fractures or lacerations following renal trauma. (monitor I&O same prep as IVP)
  71. Renal Scan
    Nuclear scan in which radioactive substance injected into the bloodstream is detected by a special camera similar to an x-ray machine. Isotope injected IV. Used for renovascular HTN, kidney function, renal blood flow, GFR, tubular function, excretion of urine, kidney size and shape, abcesses, cysts, tumors, dissecting aneurysm, and other disorders affecting bloodflow to the kidneys.
  72. Renal Biopsy
    Lab analysis of renal tissue. Percutaneous: local anesthetic needle though skin. Open: surgical incision. Ct scan done first to locate kidney. Microscopic exam of kidney tissue for diagnosis or treatment of a renal disorder.
  73. Cystoscopy and pyelogram
    Minor surgical procedure with lighted fiber optic cytoscope. Used to inspect thr inside of thr bladder, collect urine specimen from either kidney, take x-ray or biopsy growths. Therapeutic: to remove small bladder tumors, stones from bladder/ureters, dilation of ureters. Used to find calculi, infection, vesicoureteral reflux, enlarged prostate, bladder tumors, urethral strictures, polyps and congenital abnormalities. (surgical prep; measure urine to detect retention from swelling or urinary meatus; encourage fluids; expect dysuria and blood tinged urine for 24 hours post.
  74. Cystogram or voiding cystourethrogram
    X-ray of thr bladder and lower urinary tract with contrast media or radioisotope instilled into bladder via catheter or cytoscope to evakuate bladder filling and emptying. Used for incomplete bladder emptying, distention, reflux, obstruction to urine outflow. No prep urine may be pink for 1-2 days Bright red urine fever or persistant discomfort should be reported to MD
  75. Dysuria
    Burning, pain on urination
  76. Stress incontinence
    Involuntary loss of 50mL of urine associated with increased abdominal pressure during coughing, sneezing, laughing or other physical activities.
  77. Urge Incontinence
    Involuntary loss of urine associated with an abrupt and strong desire to void. "unable to make it to the bathroom"
  78. Incontinence
    Involuntary leakage of urine and is very common.
  79. Functional incontinence
    Inability to reach the toilet because of ebvironmental barriers, physical limitations, loss of memory, or disorientation.
  80. Overflow incontinence
    Involuntary loss if urine associated with overdistention of the bladder Occurs with acute or chronic urinary distension with dribbling of urine. (Can be caused by a spinal cord injury or enlarged prostate)
  81. Total incontinence
    Continous and unpredictable loss of urine. (usually a result from surgery, trauma, or malformation of the ureter) bladder training had be tried and ineffective. Usualoy these patients are neurologically impaired.
  82. Kegel exercises
    Strengthen the pubococcygeal muscle. Can help prevent uterus prolapse, enhanse sensation during sex, and hasten postpartum healing. May also be used by the older male patient to control dribbling.
  83. Urine retention management.
    Acute retention is a medical emergency and can lead to bladder rupture or acute renal failure. Chronic may be related to an enlarged prostate, diabetes, pregnancy, a medication effect, strictures, or other causes of obstruction of the urinary tract. Bladder scan will determine risidual volumr after void. <50mL is normal 150-200mL needs treatment for urine retention.
  84. Indwelling catheter
    Reasons: shock, heart failure, or urinary obstruction.
  85. Intermittent catheterization
    For the pt who is unable to void. May teach a patient how to self cath. (at home can use clean technique and use same cath multiple times if cleaned in between)
  86. Suprapubic catheter
    Inserted through the skin, needs a clean dry dressing and keep cath taped to prevent tension.
  87. Increased BUN
    Can indicate kidney disease; shock; severe heart failure; dehydration; high protein diet; GI bleeding or steroid use.
  88. Increased creatinine
    Higher level= higher impairment in kidney function.
  89. BUN-to-creatinine ratios
    Usually 10:1. Elevated ratio occurs in hypovolemia. Normal ratio with elevated BUN and creatinine occurs in intrinsic renal disease.
  90. Increased uric acid
    Can be caused by kidney disease, gout, malnutrition, leukemia, use of thiazide diuretics (because of impaired uric acid clearance by the kidneys)
  91. Sodium (effects)
    • Remains within normal range until the late stage of renal disease.
    • Decreases with fluid retention.
  92. Potassium (effects)
    • One of the first electrolyes to become abnormal with renal disease.
    • Level greater than 6mEq/L can lead to muscle weakness and arrythmias.
  93. Phosphorus (effects)
    • Inversely related to calcium balance.
    • Elevated in renal disease.
  94. Bicarbonate (effects)
    Most patients with renal disease have metabolic acidosis and low serum HCO3 levels.
  95. Magnesium (effects)
    • Elevated in chronic renal disease.
    • Symptoms of elevated mag levels include lethargy, N/V, and slurred speech.
  96. Albumin (effects)
    Low level occurs in neohrotix syndrome and renal disease and leads to edema.

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