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Renal > Assessment of Renal/Urinary System > Flashcards

Assessment of Renal/Urinary System Flashcards

1
Q

Renin

  • what is it
  • when is it activated
A

Hormone that helps regulate blood flow, GFR, and BP

secreted when sensing cells sense changes in blood volume, BP, or sodium levels are low

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2
Q

Renin converts to ___

A

renin converts angiotensinogen into angiotensin I, which causes secretion of aldosterone

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3
Q

condition that signals decreased tissue perfusion

pg 1468

A

low BP
low blood volume
low blood sodium
low blood oxygen

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4
Q

function of aldosterone

A

increases kidney reabsorption of sodium and water
restores BP, blood volume and sodium levels
also promotes excretion of potassium

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5
Q

angiotensin II

-what does it do

pg 1468

A

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

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6
Q

Angiotensin II –> constriction of afferent arterioles in kidney nephrons

this leads to what

A

decreased glomerular filtration

decreased urine formation and increased water and sodium reabsorption

increased blood volume

maintenance of adequate tissue perfusion

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7
Q

large particles that are normally too large to filter through the glomerular capillary walls

A

red blood cells
albumin
proteins

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8
Q

normal glomerular filtration rate

A

averages 125 mL/min

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9
Q

GFR is controlled by:

A

blood pressure and blood flow

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10
Q

afferent arteriole

-what does it do

pg 1469

A

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

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11
Q

efferent arteriole

-what does it do

pg 1469

A

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

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12
Q

Chart on 1471

Renin action

A

raises blood pressure as result of angiotensin (local vasoconstriction) and aldosterone (volume expansion) secretion

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13
Q

Chart on 1471

prostaglandins action

A

regulate infrarenal blood flow by vasodilation or vasoconstriction

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14
Q

Chart on 1471

bradykinin action

A

increases blood flow (vasodilation) and vascular permeability

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15
Q

Chart on 1471

erythropoietin action

A

stimulates bone marrow to make RBCs

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16
Q

Chart on 1471

activated vitamin D action

A

promotes absorption of calcium in the GI tract

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17
Q

Chart on 1471

antidiuretic hormone (ADH, vasopressin) action

A

makes DCT and CD permeable to water to maximize reabsorption and produce a concentrated urine

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18
Q

Chart on 1471

aldosterone action

A

promotes sodium reabsorption and potassium secretion in DCT and CD; water and chloride follow sodium movement

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19
Q

Chart on 1471

natriuretic hormone action

A

cause tubular secretion of sodium

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20
Q

changes in renal/urinary system related to aging
Decreased GFR - nursing interventions

pg 1473

A
  • 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
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21
Q

changes in renal/urinary system related to aging
nocturia - nursing interventions

g 1473

A
  • ensure adequate nighttime lighting and hazard free environment
  • ensure ability of toilet, bedpan, urinal
  • discourage fluid intake 2-4 hr before bedtime
22
Q

changes in renal/urinary system related to aging
weakened urinary sphincter muscles and shortened urethra in women

pg 1473

A

provide thorough peri care after each voiding

23
Q

changes in renal/urinary system related to aging

A 
decreased GFR
nocturia
decreased bladder capacity
weakened urinary sphincter muscles
shortened urethra in women
tendency to retain urine
24
Q

anuria

A

total urine output less than 100 mL/24 hr

25
Q

azotemia

A

increased blood urea nitrogen and serum creatinine levels suggestive of kidney impairment but without outward symptoms of kidney failure

26
Q

dysuria

A

discomfort or pain associated with urination

27
Q

oliguria

A

decreased urine output; total urine output 100-400 mL/24 hr

28
Q

polyuria

A

increased urine output; total urine output usually greater than 2000 mL/24 hr

29
Q

Serum creatinine

  • range
  • significance of increase or decrease
A

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

30
Q

blood urea nitrogen (BUN)

-range

A

10-20

older adults: 8-23 (even up to 31 when over 90yrs)

31
Q

BUN

significance of an increase

A

increased may indicate HEPATIC, RENAL, dehydration, decreased kidney perfusion, high protein diet, infection, stress, steroid use, GI bleeding

32
Q

BUN:creatinine ratio

A

12:1 to 20:1

33
Q

BUN

significance of a decrease

A

may indicate malnutrition, fluid volume excess, severe hepatic damage

34
Q

BUN/creatinine ratio

significance of increased ratio

A

fluid volume deficit, obstructive uropathy, catabolic state, high protein diet

35
Q

BUN/creatinine ratio

significance of decreased ratio

A

fluid volume excess

acute renal tubular acidosis

36
Q

significance of brown urine

pg 1478

A

blood or increased urinary bilirubin level

37
Q

specific gravity of urine

A

1.003-1.030

38
Q

significance of increased urine specific gravity

A

decreased kidney perfusion, inappropriate antidiuretic hormone secretion, or CHF

39
Q

significance of decreased urine specific gravity

A

chronic kidney disease, diabetes insipid, malignant HTN, diuretic administration, lithium toxicity

40
Q

urine pH range

A

4.6-8

average of 6

41
Q

when are ketones present in urine

A

reflect incomplete metabolism of fatty acids, like in DKA, prolonged fasting, anorexia nervosa

42
Q

24 hr urine collection range for creatinine

why it would be increased/decreased

pg 1481

A

0.8-2

decreased amounts indicate deterioration of kidney function caused by kidney disease

increased amounts occur with infections, exercise, DM, and meat meals

43
Q

24 hr urine collection range for urea nitrogen

why it would be increased/decreased

pg 1481

A

12-20

decreased occur when there is kidney damage or liver disease

increased amounts result form high protein diet, dehydration, trauma, sepsis

44
Q

24 hr urine collection range for sodium

why it would be increased/decreased

pg 1481

A

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

45
Q

24 hr urine collection range for chloride

why it would be increased/decreased

pg 1481

A

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

46
Q

24 hr urine collection range for calcium

why it would be increased/decreased

pg 1481

A

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

47
Q

24 hr urine collection range for protein

why it would be increased

pg 1481

A

indicate glomerular disease, nephritic syndrome, diabetic nephropathy, urinary tract malignancies, irritations

48
Q

average urine osmolarity

A

300-900

49
Q

questions to ask pt about to undergo a test using contrast medium

pg 1484

A

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)

50
Q

When caring for a client with uremia, the nurse assesses for which symptom

evolve

A

Manifestations of uremia include anorexia, nausea, vomiting, weakness, and fatigue.

51
Q

A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns?

evolve

A

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.

Renal (5 decks)

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