Ch. 14 Urinary System and Venipuncture Flashcards
this kidney is generally lower or more inferior than the other
right
how do the ureters lie in respect to their kidney
anterior
what aspect of the bladder do the ureters enter into it
posterolateral aspect
how much does the average adult kidney weigh
5 1/4 oz (150 g)
what are the measurements of an average adult kidney
4-5” long, 2-3” wide, 1” thick
this kidney is a little longer, but more narrow than the other
left
the two psoas major muscles on either side of the vertebral column cause the longitudinal plane of the kidneys to form a vertical angle of what to the midsagittal plane
20 degrees
what pole of the kidney is closer to the midline of the body
upper pole
which aspect of the kidney is more anterior
medial border
what is the normal kidney rotation
30 degrees from coronal plane
what muscle is found on each side, just posterior to the kidneys
quadratus lumborum muscles
what is the group of deep muscles of the back called
erector spinae muscles
what body position places the kidney parallel to the IR
30 degree posterior oblique
each kidney is surrounded by a mass of fatty tissue called what
adipose capsule or perirenal fat
these permit radiographic visualization of the kidneys on plain abdominal radiographs
adipose capsule/ perirenal fat
with patient supine and taken on expiration, where do the kidneys normally lie
midway between xiphoid and iliac crest
how much higher is the left kidney compared to the right
1 cm higher
what level is top of left kidney at about
T11-T12 interspace
what level is the bottom of the right kidney at
superior endplate of L3
how far do the kidneys drop on deep inhalation
1”
how far do the kidneys drop when one stands upright
1 lumbar vertebrae (2”)
a condition when the kidneys drop farther than normal
nephroptosis
the kidneys perform these 3 functions during urine production
- removes nitrogenous waste
- regulate water levels
- regulate acid-base balance and electrolyte levels of the blood
these nitrogenous waste products are formed during the normal metabolism of proteins
urea and creatinine
buildup of nitrogenous waste products, urea and creatinine, in the blood results in this clinical condition and may indicate renal dysfunction
uremia
how much blood pumped form the heart with each beat passes through the kidneys
at least 25%
what do the renal veins connect directly to
inferior vena cava
what is more anterior, the renal veins or the renal arteries
renal veins
along the medial border of each kidney is a centrally located, longitudinal fissure called what
hilum
this serves to transmit the renal artery, renal vein, lymphatics, nerves and ureters
hilum
each kidney is generally divided into these two parts
upper pole and lower pole
what is the average water intake for humans during a 24 hour period
2.5 L
at rest, how much blood flows through the kidneys every 60 seconds this also results in removal of how much filtrate from the blood every 24 hours
- more than 1 L
- 180 L
how much of the filtrate volume is reabsorbed by the kidneys and returned to the blood stream
more than 99%
from the large amount of blood that flows through the kidneys each day, an average of how much urine is formed
1.5 L
what is the outer covering of the kidney called
renal (fibrous) capsule
directly under the renal capsule, surrounding each kidney; this forms the peripheral or outer portion of each kidney
cortex
under the cortex is this internal structure, composed of 8-18 conical masses
medulla
what are the conical masses within the medulla called
renal pyramids
the cortex periodically drips between the pyramids to form these
renal columns
what do the renal columns extend to
renal sinuses
the renal pyramids are primarily a collection of tubules that converge at an opening called what
renal papilla
what does the renal papilla drain into
minor calyx
these appear as hollowed flattened tubes
calyces
4-13 minor calyces unite to form this
2-3 major calyces
the major calyces unite to form this; which appears in the shape of a larger flattened funnel
renal pelvis
each expanded renal pelvis narrows to continue as this
ureter
this general term is used to describe the total functional portions of the kidneys, such as those visualized during an early phase of intravenous (IV) urographic procedure
renal parenchyma
what is the structural and functional unit of the kidney
nephron
how many nephrons exist within each kidney
1 million
small arteries in the renal cortex form tiny capillary tufts called what
glomeruli
blood initially is filtered through this
many glomeruli
these supply blood to the glomeruli
afferent arterioles
these take blood away to a secondary capillary network in close relation to the straight and convoluted tubules
efferent arterioles
each glomerulus is surrounded by this, which is the proximal portion of each nephron collecting filtrate
glomerular capsule (Bowman capsule)
what is the filtrate termed by the time it reaches the minor calyx
urine
what is the order of travel of glomerular filtrate
- glomerular capsule
- proximal convoluted tubule
- descending and ascending limbs of the loop of Henle
- distal convoluted tubule
- collecting tubule
- minor calyx
between the bowman capsule and the minor calyces how much filtrate is reabsorbed into the kidneys venous system
more than 99%
what parts of the nephron are located within the cortex of the kidney
- glomeruli
- glomerular capsule
- proximal and distal convoluted tubules
what parts of the nephron are located primarily within the medulla
- loop of Henle
- collecting tubules
what are the renal pyramids within the medulla primarily
collection of tubules
what is the average length of ureters
11-13” (28-34 cm)
what are the 3 constricted points along the ureter
- ureteropelvic (UP) junction
- brim of the pelvis (iliac blood vessels cross over ureters)
- ureterovesical (UV) junction
where do most kidney stones that pass down the ureter tend to hang up at
ureterovesical (UV) junction
what is the triangular portion of the bladder along the inner, posterior surface called; the muscular area formed by the entrance of the two ureters from behind and the exit site of the urethra
trigone
this portion of the trigone is smooth
mucosa
the remaining aspect of the inner mucosa of the bladder has numerous folds called what rugae
as the bladder fills, how does the bladder expand
as the bladder fills, how does the bladder expand
top of bladder expands upward and forward
in males, what is the gland that surrounds the proximal urethra
prostate gland
how big does the prostate gland measure
1.5” diameter, 1” in height
the desire to void arises when the bladder reaches how much urine
250 mL
retention of urine in the bladder is maintained through these two things
- involuntarily controlled internal urethral sphincter (IUS)
- voluntarily controlled external urethral sphincter (EUS)
this is located at the junction of the bladder to the urethra (neck of bladder)
involuntarily controlled internal urethral sphincter (IUS)
in males, where is the EUS located
distal to the prostate
females EUS is more elaborate than males and is composed of these 3 areas
- urethral sphincter
- compressor urethrae
- urethrovaginalis sphincter
what is the total capacity of the bladder
350-500 mL
weakening or damage to the EUS can lead to involuntary urination called what
incontinence
the urinary bladder in females lies posterior and just superior to what
upper margin of symphysis pubis
how long is the female urethra
1.5”
where is the urethra embedded in females
anterior wall of the vagina
what kind of sac do males have
closed sac
what does most of the bladder of the male lie directly posterior to
superior margin of symphysis pubis
how long is the male urethra
6.5-7.5”
the female reproductive organs include what
- pair of ovaries (female gonads)
- uterine (fallopian) tubes
- vagina
the male reproductive organs include what
- testes ( male gonads)
- seminal vesicles and related ducts
- ejaculatory ducts and ductus deferens (vas deferens)
- penis
- scrotum
what is the single function of the female urethra
passage of urine to the exterior
what are the 2 functions of the male urethra
- eliminate urine
- serve as passageway for semen
the percutaneous puncture of a vein for withdrawal of blood or injection of a solution
venipuncture
this contrast medium is used for radiographic exams of the urinary system
water-soluble iodinated contrast medium
injection in which the entire dose of contrast medium is injected into the venous system at one time
bolus injection
method where contrast medium is introduced into the venous system via connective tubing attached to the IV site; specified amount is introduced over a specified period
drip infusion
in the event of an adverse contrast reaction what must be on hand
- epinephrine
- benadryl
for most IV urograms what veins are ideal
antecubital fossa
veins found within the antecubital fossa commonly used during venipuncture include what
- median cubital
- cephalic
- basilic
what are some other common IV access sites if veins in the antecubital fossa can’t be used
- cephalic vein of the lateral wrist
- cephalic or basilic veins of posterior hand/forearm
what type of veins should the tech aboid
- sclerotic (hardened)
- tortuous (twisted)
- rolling
- overused
for bolus injections of 50-100 mL what type of needle is used
18-22 gauge needle
for pediatric patients what type of needle is used
23-25 gauge needle
how long is the needle typically
1-1.5”
what finger should the tech use when selecting the injection site
finger of the nondominant hand
where should tourniquet be placed
3-4” above site
how do you cleanse the selected site of injection
alcohol (70% isopropyl) in circular motion from center out 2-3”
what direction does bevel of needle face
forward
what angle should you approach the bein
20-45 degrees
you decrease the angle of the needle once in the vein, to run parallel with it and advance the needle how much further
1/4”
for over the needle catheter placement where should you apply pressure when inserting catheter
1.5” above insertion site on vein
when should sharps containers be replaced
when half full
general radiographic exam of the urinary system is called what
urography
the opacifying element used in intravenous contrast media for urography
iodine
what is the atomic number of iodine
53
contrast agents containing one tri-iodinated benzene ring
monomer
contrast agent containing two tri-iodinated benzene rings
dimer
the number of dissolved particles in a solution
osmolality
what does HOCA stand for
high osmolar contrast agent
what are 2 common side effects that may occur after an IV injection of iodinated contrast medium
- temporary hot flash
- metallic taste in the mouth
normal creatinine levels for the adult
0.6-1.5 mg/dL
what is a normal BUN level range
8-25 mg/100mL
what is a normal eGFR for adults
60 mL/min or greater
a drug that is given for the management of non-insulin dependent diabetes mellitus
metformin hydrochloride
nonfunctional examination of the urinary sustem
retrograde urography
nonfunctional radiographic exam o the urinary bladder
retrograde cystrography
routine positioning for a cystogram
- AP 15 degree caudal angle
- bilateral posterior obliques
this exam provides a study of the urethra and evaluates the patients ability to urinate; functional study of the bladder and urethra
voiding cystourethrography (VCU)
position of choice for retrograde urethrography
30 degree RPO CR pubic symphysis
