Alterations in GU function

Question 1

UTI

Answer 1

infection of any part of urinary tract, usually from e coli, seen with bacteriuria (greater than 100,000 bacteria/ml fresh midstream urine). More common in women than men. Obstructions, pregnancy, reflux of urine, catheterization, chronic analgesic use, renal disease, and neurogenic bladder from mult. sclerosis all increase the risk of acquiring UTI

Question 2

Cystitis

Answer 2

inflammation of the bladder, most common type of UTI. Many are asymptomatic. Manifestations include frequency, urgency, dysuria, suprapubic and low back pain, hematuria, cloudy urine and flank pain

Question 3

Acute pyelonephritis

Answer 3

infection of the renal pelvis (opening to kidneys) and interstitium. Can be one or both kidneys and often due to ascending infectious organisms along ureters. Manifestations include pain at costovertebral angle, flank or groin, fever and chills, dysuria, frequency, urgency, malaise. Acute pyelonephritis rarely causes a UTI

Question 4

Chronic pyelonephritis

Answer 4

persistent or recurrent autoimmune infections of the kidney with inflammation and scarring of the kidney. The disease progresses from inflammation to atrophy or dilation and diffuse scarring–> impaired concentrating ability–> RENAL FAILURE

Question 5

Urinary Tract Obstruction (definition and consequences of)

Answer 5

interference with the flow of urine. Consequences include increased hydrostatic pressure and dilation of structures behind the site, a decrease in GFR, and obstruction can cause ischemia over time. Complications include infection and renal failure

Question 6

Urolithiasis

Answer 6

the presence of renal calculi or kidney stones. Most stones (80%) are calcium containing (hypercalcemia), tend to reoccur and have familial association.

Question 7

struvite stones

Answer 7

stones composed of magnesium, ammonium, and phosphate. They are formed by urea-splitting (urease producing) bacteria, like proteus or staphylococci. These stonesare problematic b/c they can become quite large and branch into staghorn calculi.

Question 8

Uric acid stones

Answer 8

Found in patients with hyperuricemia (gouty arthritis) and diseases involving rapid cell turnover. They excrete excessive uric acid in the urine. Also, a consistently acidic urine urine greatly increases risk of formation.

Question 9

manifestations of urinary tract obstruction

Answer 9

ureteral colic (acute excruciating pain in the flank and UQ of abdomen), cool and clammy skin, N&V, hematuria, may be asymptomatic and pass sand-like stones

Question 10

Glomerulonephritis (including Acute Post-Streptococcal “ APSGN)

Answer 10

inflammation of the glomerulus. Post-streptococcus occurs 1-2 weeks after a streptococcal infections of throat/skin. With this type, Ab-Ag complexes get trapped in the basement membrane of the glomerulus which results in inflammation, injury, and greater porosity of glomerular capillaries, permitting leakage of protein and blood cells. Manifestations include proteinuria, hematuria, pyuria, oliguria, edema, HTN, and azotemia

Question 11

Differences between nephritic syndromes and nephrotic syndromes

Answer 11

Nephritic syndromes result in hematuria, oliguria, azotemia, and HTN. Nephrotic syndromes cause severe proteinuria, hypoalbuminemia, generalized edema (due to decreased colloid osmotic pressure from loss of albumin) and Hyperlipidemia

Question 12

Nephrotic syndrome diseases are defined as excretion of…..?

Answer 12

3.5g or more of protein in the urine/day.

Question 13

Minimal change disease (nephrotic)

Answer 13

Nephrotic syndrome in children (incidences peak at age 2-3). Etiology and pathogenesis are unknown but manifestations include proteinuria, hypoalbuminemia, edema, insidious weight gain, puffiness in face, protuberant abdomen, diarrhea, anorexia and poor intestinal absorption (due to edema), increased plasma lipids, decreased volume/concentrated urine, skin pallor, lipiduria, BP may be low, and increased susceptibility to infection due to loss of immunoglobulins in urine.

Question 14

Chronic glomerulonephritis

Answer 14

long term inflammation of the glomerular cells caused by DM and chronic HTN (accelerated atherosclerosis). Manifestations include hematuria, oliguria, HTN, azotemia, edema and proteinuria. This condition can lead to renal failure

Question 15

Acute renal failure

Answer 15

sudden oliguria or anuria from severe trauma, hemorrhage, toxic agents and drugs, septicemia and septic shock, premature seperation of placenta, and chronic glomerulonephritis. The person will have 50-100 ml/day output, hypervolemia, hyponatremia, N&V, hyperkalemia, increased creatinine, phosphates, BUN, acidosis, and hypocalcemia. This condition is REVERSIBLE

Question 16

Stages of Acute Renal failure

Answer 16

1. Onset- including necrosis of convoluted tubules
2. Oliguria- 50-100ml/day output and specific gravity of urine of 1.010 (nml= 1.035) with protein leaking into urine. F&E imbalances.
3. Diuretic stage- 1000 ml urine op/day. Where lab values begin to return to nml. Person still has hypovolemia and hypokalemia
4. Recovery- up to 12 months, op=normal, F&E=balanced

Question 17

Chronic renal failure

Answer 17

IRREVERSIBLE condition due to progressive destruction of nephrons resulting in decreased GFR, renal blood flow, tubular function, and resorption ability

Question 18

What 2 adaptive mechanisms are stimulated in the kidney with chronic renal failure?

Answer 18

The remaining normal nephrons will hypertrophy in response to an increased workload. The nephrons will also increase filtration rate, and there is increased tubular reabsorption.

Question 19

Stages of chronic renal failure

Answer 19

1. Decreased renal reserve- loss of renal function without build up of metabolic wastes.
2. Renal insufficiency- more than 75% of normal tissue destroyed. BUN and Creatinine ratio imbalanced.
3. End stage renal disease or uremia- kidneys no longer able to maintain excretory functions or volume and electrolyte regulation, F&E imbalances, oliguria, systemic symptoms.

Question 20

Prerenal syndromes

Answer 20

Syndromes resulting from diminished renal perfusion (usually from decreased blood volume or CO). Decreased renal perfusion is caused by shock, CHF, hemorrhaging, dehydration, trauma, and decreased CO

Question 21

Renal syndromes

Answer 21

Syndromes resulting from damage or disorder to actual kidneys (ie- changes that damage the nephrons). Conditions include glomerulonephritis, acute pyelonephritis, nephrotoxic substances like antibiotics or other drugs, blood transfusion rxns, and post-op ischemia.

Question 22

Postrenal syndromes

Answer 22

Syndrome due to obstruction of the urinary tract. This can be a urethral obstruction, calculi, benign prostatic hypertrophy, tumors, or from diagnostic catheterization of the ureters.

Question 23

For this class, normal BUN values are? What are normal creatinine values? what is the normal ratio?

Answer 23

BUN- 10-20mg/dL and creatinine 1.0-1.7mg/dL. The normal ratio for healthy kidney functioning is 10:1

Question 24

Traditional teaching is that a BUN:Creatinine ratio of greater than 20:1 leads you towards a diagnosis of ….?

Answer 24

prerenal failure. The abnormally high BUN indicates that renal blood flow is insufficient, which can be a result of CHF or dehydration.

Question 25

Your patient has lab values BUN-45mg/dL and creatinine- 4.5mg/dL. Given this data you would suspect these abnormally high values are due to?

Answer 25

A renal syndrome in which actual kidney damage has occurred (b/c the BUN:creatinine ratio is still normal). Damage could be due to infection, drugs, HTN, or DM

Question 26

Effects of Renal Failure (uremia) on the urinary system. What can nurse/providers do?

Answer 26

Kidneys have deranged volume regulation. There is a decrease in GFR and thus, output which leads to retention of water and Na(–> dilutional hyponatremia). Nurses can give diuretics, restrict sodium in diet and restrict fluids

Question 27

How does renal failure alter products of protein metabolism? What can nurses do?

Answer 27

Renal failure will increase urea, BUN and Creatinine serum levels. There is also an increase in uric acid. The problem with urea is that it splits into ammonia which can lead to intestinal ulcers and hemorrhaging. Nurses can decrease protein intake, intake should be based on body weight and GFR.

Question 28

What happens to carbohydrate metabolism in p’s with renal failure?

Answer 28

The peripheral tissues become insensitive to insulin leading to moderate hyperglycemia. The response is increased insulin levels, and hyperinsulinemia stimulates triglyceride production and accelerates atherosclerosis

Question 29

What happens to potassium levels in a patient with renal failure (uremia)? How is this treated?

Answer 29

the patient will have excess K+ (hyperkalemia) which causes general weakness, muscle aches and malaise. This is treated with Kayexalate, along with restricted dietary intake of K+. You should not give IV’s cause they affect K levels.

Question 30

A patient with end stage renal failure may have metabolic acidosis. Why? What might you also see?

Answer 30

Metabolic acidosis is caused by the inability of the kidneys to excrete acid metabolites, and b/c of impaired bicarbonate reabsorption. The patient may also have N&V, altered mental functioning, and kussmaul respirations.

Question 31

Why might the person with renal failure have HTN?

Answer 31

because of: Na and H2O retention, increased renin secretion, and decreased prostaglandin secretion from renal medulla which normally dilates arteries and lowers BP.

Question 32

Pericarditis secondary to renal failure.

Answer 32

excess of pericardial fluid and fibrin formation in the epicardium. The patient will have chest pain, pericardial friction rub, and low grade temperature

Question 33

CHF secondary to renal failure

Answer 33

A result of fluid overload and HTN, may also be a result of anemia, accelerated atherosclerosis, and vascular calcification

Question 34

Anemia secondary to renal failure

Answer 34

normocytic, normochromic anemia caused by decreased production of erythropoietin in the kidneys, and hemolysis from hyperuricemia and chemicals in dialysate.

Question 35

Alterations in thrombocytes and phagocytes with renal failure lead to…?

Answer 35

bleeding tendencies and prolonged bleeding times, as well as, impaired humoral and cell mediated immunity. Patient will have leukopenia from decreased bone marrow functioning and hypocomplementemia.

Question 36

Uremic fetor

Answer 36

characteristic of renal failure patient’s whose breath smells of ammonia and urine

Question 37

hydroureter

Answer 37

dilation of the ureter due to accumulation of urine

Question 38

hydronephrosis

Answer 38

enlargement of the renal pelvis and calyces proximal to a blockage

Question 39

ureterohydronephrosis

Answer 39

dilation of both the ureter, renal pelvis, and calyces

Question 40

Renal colic

Answer 40

severe pain in the flank and groin that indicates obstruction of the renal pelvis or proximal ureter.

Question 41

Neurogenic bladder

Answer 41

neurologic impairment that interferes with normal bladder contractions resulting in residual urine and ascending infection. this is a common cause of pyelonephritis

Question 42

Vesicoureteral relfux

Answer 42

chronic relfux of urine up the ureter and into the kidney during urination. This is a common cause of pyelonephritis

Question 43

Causes of acute renal failure (due to decreased renal perfusion)

Answer 43

trauma or hemorrhage,

imcompatible blood transfusion

toxic agents and drugs

septicemia and septic shock

premature separation of placenta

glomerulonephritis

Question 44

Azotemia

Answer 44

increased levels of serum urea and other nitrogenous waste compounds, related to decreased kidney function

Question 45

Uremia

Answer 45

systemic symptoms associated with the accumulation of nitrogenous wastes and accumulation of toxins in the plasma caused by diminished renal function

Question 46

Renal insufficiency

Answer 46

stage of progressive renal failure in which more than 75% of the tissue has been destroyed and only 25% of renal function (GFR) remains normal. With this stage BUN and creatinine levels begin to increase and ratio will become imbalanced.

Question 47

End stage renal failure/uremia

Answer 47

condition in which 90% of a kidney’s nephrons are destroyed and only 10% of renal function (GFR) remains normal. Manifestations= BUN and creatinine is increased, oliguria, various systemic symptoms

Question 48

What two conditions will result if parathyroid hormone secretion is stimulated in a patient with renal osteodystrophy (renal failure)?

Answer 48

osteitis fibrosa (loss of cortical bone and replacement with fibrous tissue) and osteomalacia (excessive quantity of uncalcified bone matrix; renal rickets in children)

Question 49

Dermatologic effects of renal failure

Answer 49

pruritus, neuropathy, dry skin, easy bruising, petechiae, purpura, pallor, brittle/dry hair, uremic frost (hyperparathyroidism and uremic skin residues)

Question 50

hypospadias (pediatric renal diseases)

Answer 50

congenital condition in which the urethral meatus is located on the ventral side or underside of the penis.

Question 51

epispadias (pediatric renal disease)

Answer 51

congenital condition in which the urethral meatus is on the dorsal side of the penis. If this condition is extensive, the newborn may also have bladder exstrophy (herniation of bladder through skin)

Question 52

Chordee

Answer 52

Bending of the penis often seen with hypospadias and resulting in ejaculatory dysfunction and may prevent female penetration.

Question 53

Nephrotic syndrome in children

Answer 53

Kidney is most often the principle organ involved. Manifestations= oliguria, edema of the lungs, abdomen (ascites), genitalia, and intestinal mucosa (which can lead to diarrhea, anorexia), protein deficiencies, pallor, impaired immune function, and fatigue.

Question 54

Enuresis

Answer 54

Involuntary urination by a child who should have voluntary bladder control. (2.5-3 years) Causes of enuresis include diabetes, impaired concentrating ability of kidneys, genetics, quality of sleep and physical deformities.