Assessment of Renal/Urinary System Flashcards
Renin
- what is it
- when is it activated
Hormone that helps regulate blood flow, GFR, and BP
secreted when sensing cells sense changes in blood volume, BP, or sodium levels are low
Renin converts to ___
renin converts angiotensinogen into angiotensin I, which causes secretion of aldosterone
condition that signals decreased tissue perfusion
pg 1468
low BP
low blood volume
low blood sodium
low blood oxygen
function of aldosterone
increases kidney reabsorption of sodium and water
restores BP, blood volume and sodium levels
also promotes excretion of potassium
angiotensin II
-what does it do
pg 1468
Rapid constriction of arteries and veins, increasing peripheral resistance and decreasing the size of vascular bed
construction of afferent arterioles in kidney nephrons
stimulates adrenal secretion of aldosterone
Angiotensin II –> constriction of afferent arterioles in kidney nephrons
this leads to what
decreased glomerular filtration
decreased urine formation and increased water and sodium reabsorption
increased blood volume
maintenance of adequate tissue perfusion
large particles that are normally too large to filter through the glomerular capillary walls
red blood cells
albumin
proteins
normal glomerular filtration rate
averages 125 mL/min
GFR is controlled by:
blood pressure and blood flow
afferent arteriole
-what does it do
pg 1469
delivers arterial blood from the branches of the renal artery into the glomerulus
augoregulation of renal blood flow via vasoconstriction or vasodilation
renin-producing granular cells
efferent arteriole
-what does it do
pg 1469
delivers arterial blood from the glomerulus into the peritubular capillaries or the vasa recta
auto regulation of renal blood flow via vasoconstriction or vasodilation
renin-producing granular cells
Chart on 1471
Renin action
raises blood pressure as result of angiotensin (local vasoconstriction) and aldosterone (volume expansion) secretion
Chart on 1471
prostaglandins action
regulate infrarenal blood flow by vasodilation or vasoconstriction
Chart on 1471
bradykinin action
increases blood flow (vasodilation) and vascular permeability
Chart on 1471
erythropoietin action
stimulates bone marrow to make RBCs
Chart on 1471
activated vitamin D action
promotes absorption of calcium in the GI tract
Chart on 1471
antidiuretic hormone (ADH, vasopressin) action
makes DCT and CD permeable to water to maximize reabsorption and produce a concentrated urine
Chart on 1471
aldosterone action
promotes sodium reabsorption and potassium secretion in DCT and CD; water and chloride follow sodium movement
Chart on 1471
natriuretic hormone action
cause tubular secretion of sodium
changes in renal/urinary system related to aging
Decreased GFR - nursing interventions
pg 1473
- Decreased GFR
- -monitor hydration status (ability of kidneys to regulate water balance is decreased
- -ensure adequate fluid intake (kidneys less able to conserve water
- -administer nephrotoxic agents or drugs carefully (dehydration results in decreased renal blood flow and increase toxicity potential
changes in renal/urinary system related to aging
nocturia - nursing interventions
g 1473
- ensure adequate nighttime lighting and hazard free environment
- ensure ability of toilet, bedpan, urinal
- discourage fluid intake 2-4 hr before bedtime
changes in renal/urinary system related to aging
weakened urinary sphincter muscles and shortened urethra in women
pg 1473
provide thorough peri care after each voiding
changes in renal/urinary system related to aging
decreased GFR nocturia decreased bladder capacity weakened urinary sphincter muscles shortened urethra in women tendency to retain urine
anuria
total urine output less than 100 mL/24 hr
azotemia
increased blood urea nitrogen and serum creatinine levels suggestive of kidney impairment but without outward symptoms of kidney failure
dysuria
discomfort or pain associated with urination
oliguria
decreased urine output; total urine output 100-400 mL/24 hr
polyuria
increased urine output; total urine output usually greater than 2000 mL/24 hr
Serum creatinine
- range
- significance of increase or decrease
0.5-1.2
increase: indicates kidney impairment
decrease: may be caused by a decreased muscle mass
males 0.6-1.2
females 0.5-1.1
older adults may be decreased
blood urea nitrogen (BUN)
-range
10-20
older adults: 8-23 (even up to 31 when over 90yrs)
BUN
significance of an increase
increased may indicate HEPATIC, RENAL, dehydration, decreased kidney perfusion, high protein diet, infection, stress, steroid use, GI bleeding
BUN:creatinine ratio
12:1 to 20:1
BUN
significance of a decrease
may indicate malnutrition, fluid volume excess, severe hepatic damage
BUN/creatinine ratio
significance of increased ratio
fluid volume deficit, obstructive uropathy, catabolic state, high protein diet
BUN/creatinine ratio
significance of decreased ratio
fluid volume excess
acute renal tubular acidosis
significance of brown urine
pg 1478
blood or increased urinary bilirubin level
specific gravity of urine
1.003-1.030
significance of increased urine specific gravity
decreased kidney perfusion, inappropriate antidiuretic hormone secretion, or CHF
significance of decreased urine specific gravity
chronic kidney disease, diabetes insipid, malignant HTN, diuretic administration, lithium toxicity
urine pH range
4.6-8
average of 6
when are ketones present in urine
reflect incomplete metabolism of fatty acids, like in DKA, prolonged fasting, anorexia nervosa
24 hr urine collection range for creatinine
why it would be increased/decreased
pg 1481
0.8-2
decreased amounts indicate deterioration of kidney function caused by kidney disease
increased amounts occur with infections, exercise, DM, and meat meals
24 hr urine collection range for urea nitrogen
why it would be increased/decreased
pg 1481
12-20
decreased occur when there is kidney damage or liver disease
increased amounts result form high protein diet, dehydration, trauma, sepsis
24 hr urine collection range for sodium
why it would be increased/decreased
pg 1481
40-220
decreased amounts are seen in hemorrhage, shock, hyperaldosteronism, pre renal acute kidney injury
increased amounts are seen with diuretic therapy, excessive salt intake, hypokalemia, acute tubular necrosis
24 hr urine collection range for chloride
why it would be increased/decreased
pg 1481
110-250
decreased amounts are seen n kidney diseases, malabsorption syndrome, pyloric obstruction, prolonged NG tube drainage, diarrhea, diaphoresis, HF, emphysema
increased amounts are seen with hypokalemia, adrenal insufficiency, massive diuresis
24 hr urine collection range for calcium
why it would be increased/decreased
pg 1481
100-400
decreased amounts are often associated with hypocalcemia, hypoparathyroidism, nephrosis, nephritis
increased amounts seen with calcium kidney stones, hyperparathyroidism, sarcoidosis, certain cancers, immobilization, hypercalcemia
24 hr urine collection range for protein
why it would be increased
pg 1481
indicate glomerular disease, nephritic syndrome, diabetic nephropathy, urinary tract malignancies, irritations
average urine osmolarity
300-900
questions to ask pt about to undergo a test using contrast medium
pg 1484
ever had reaction to contrast medium
Hx of asthma
allergies to seafood, shellfish, iodine, eggs, milk, chocolate
assess BP, HR, RR, mucous membranes, skin turgor, urine concentration
taking metformin (should be discontinued for 48 hr to prevent lactic acidosis)
any kidney impairment (diabetic nephropathy, class 4 HF, dehydration, cirrhosis, on drugs like ahminoglycosides or NSAIDs)
When caring for a client with uremia, the nurse assesses for which symptom
evolve
Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue.
A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns?
evolve
Arise slowly and call for assistance when ambulating
Captopril can cause severe hypotension during and after the procedure, so the client should be warned to avoid rapid position changes and about the risk for falling as a result of orthostatic (positional) hypotension.
