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NURS3313 Adult Health > Chapter 47: Assessment of Kidney & Urinary Function > Flashcards

Chapter 47: Assessment of Kidney & Urinary Function Flashcards

1
Q

Functions of the Kidneys

A

Control BP & H2O Balance

Excrete waste products & renal clearance

Regulate electrolytes, acid-base balances, & RBC production

Secrete prostaglandins

Synthesize vitamin D to active form

Form urine

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2
Q

Renal Clearance

A

The ability of the kidneys to clear solutes from plasma

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3
Q

Organs of the Urinary System

A

Kidneys, ureters, bladder, & urethra

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4
Q

Kidneys

A

Pair of brownish-red, bean-shaped structures located retroperitoneally (behind & outside peritoneal cavity) that remove waste & extra fluid from the body
-Also critical in maintaining acid-base balance, synthesizing hormones to control BP, & stimulating the bone marrow for RBC production

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5
Q

Hilum

A

Rounded outer convex surface of the kidneys

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6
Q

Why is the RT kidney slightly lower than the LT kidney?

A

The RT kidney is slightly lower than the LT kidney due to location of the liver

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7
Q

What provides external protection for the kidneys?

A

The ribs & muscles of the abdomen & back

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8
Q

What provides internal protection for the kidneys?

A

Fat deposits (surround each kidney-> protect from jarring)

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9
Q

Medulla

A

Inner portion of the kidney

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10
Q

What does the medulla contain?

A

It contains the loops of Henle, vasa recta, & collecting ducts from the juxtamedullary nephrons

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11
Q

Where do the collecting ducts from both the juxtamedullary nephrons & cortical nephrons connect to?

A

They connect to the renal pyramids

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12
Q

Where do the renal pyramids drain to?

A

They drain to the minor calyces-> major calyces-> opens directly into the pelvis

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13
Q

Renal Pelvis

A

Beginning of the collecting system
-Composed of structures that are designed to collect & transport urine

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14
Q

Once the urine leaves the renal pelvis…

A

…the composition does NOT change

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15
Q

Nephrons

A

Structural & functional units of the kidneys responsible for urine formation

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16
Q

If the total number of functioning nephrons is <20% of normal, what interventions should be taken?

A

If the total number of functioning nephrons is <20% of normal, kidney replacement therapy is recommended
-Also if 80% is damaged

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17
Q

The length of a tubular component of the nephron is directly related to…

A

…its ability to concentrate urine

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18
Q

Glomerulus

A

Tuft of capillaries forming part of the nephron where filtration occurs

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19
Q

Blood Supply to the Kidneys

A

Blood flows through the glomerulus-> leaves via efferent arteriole & flows back to inferior vena cava via network of capillaries & veins

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20
Q

Bowman Capsule

A

Encapsulates the glomerulus & afferent & efferent arterioles

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21
Q

Where does the filtrate of the bowman capsule go to?

A

It travels to the proximal tubule-> loop of Henle-> distal tubule-> either the cortical or medullary collecting ducts

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22
Q

Juxtaglomerular Apparatus

A

Site of renin production

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23
Q

Renin

A

Works to regulate BP (increases via RAAS system)

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24
Q

Tubular Components of the Nephron

A

Bowman capsule, proximal tubule, descending & ascending limbs of the loop of Henle, & cortical & medullary collecting ducts

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25
Q

Ureter

A

Moves urine to bladder

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26
Q

Urothelium

A

Inner lining of the ureters
- Prevents reabsorption of urine

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27
Q

Bladder

A

Houses urine to be excreted & prevents urine reflux into the kidneys

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28
Q

Usual Capacity of Adult Bladder

A

400-500 mL

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29
Q

Micturation

A

Voiding or Urination

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30
Q

Steps of Urine Formation

A

1) Glomerular filtration

2) Tubular reabsorption

3) Tubular secretion

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31
Q

Urethra

A

Eliminates urine from the bladder

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32
Q

Antidiuretic Hormone (ADH)

A

AKA Vasopressin

Hormone secreted from the posterior section of the pituitary gland in response to changes in osmolality of the blood

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33
Q

Effect of ADH on the Renal System

A

1) Decreased H2O intake-> blood osmolality increases, stimulates ADH release

2) ADH acts on the kidney-> increases reabsorption of H2O & return osmolality of blood to normal

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34
Q

What happens to ADH secretion in response to excess water intake?

A

ADH secretion becomes suppressed & less H2O is reabsorbed by the kidney tubule-> diuresis

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35
Q

Diuresis

A

Increased urine volume

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36
Q

Osmolarity

A

Ratio of solute to H2O

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37
Q

Osmolality

A

Degree of dilution/concentration of urine

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38
Q

Aldosterone

A

Hormone synthesized by adrenal cortex that causes the kidney to reabsorb Na+2

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39
Q

Creatinine

A

Endogenous waste product of skeletal muscle that is filtered at the glomerulus , passed through w/ min change & excreted in urine

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40
Q

Glomerular Filtration Rate (GFR)

A

Amount of plasma filtered through the glomeruli per unit of time

41
Q

As renal function declines…

A

… GFR & renal clearance drops

42
Q

Erythropoietin

A

Glycoprotein from the kidney that stimulates the bone marrow to produce RBCs

43
Q

Nocturia

A

Awakening during the night to urinate

44
Q

Gerontological Considerations for Kidney & Urinary Function

A

GFR decreases starting between 35-45 years of age

More susceptible to acute kidney injury & CKD due to structural & physiological changes:
- Glomerulus sclerosis
- Renal vasculature sclerosis
- Decreased Blood flow & GFR
- Altered tubular function
- Acid- base imbalance

Renal reserve is decreased

More prone to develop hypernatremia & fluid volume deficit due to decreased thirst

Decreased bladder wall contractility

Vaginal & urethral tissue atrophy due to estrogen decrease

Increased risk for developing UTIs

45
Q

Bacteriuria

A

Bacteria in the urine (bacterial count >100,000 colonies/ml: infection is present)

46
Q

Dysuria

A

Pain or difficulty w/voiding

47
Q

Urinary Frequency

A

Voiding more than every 3 hrs

48
Q

Hematuria

A

Presence of RBCs in the urine

49
Q

Urinary Retention

A

Inability to completely empty the bladder

50
Q

Anuria

A

Decreased urine output of < 50 mL w/in 24 hrs

51
Q

Enuresis

A

Involuntary voiding during sleep

52
Q

Hesitancy

A

Delay, difficulty in intitiating voiding

53
Q

Nursing Assessment for Kidney & Urinary Function

A

Healthy Hx:
- Ask about risk factors
- Previous UTIs or kidney stones

Family Hx:
- Genetically passed disorders
Ex) Polycystic kidney disease (PKD), renal cystic disease, diabetes, CAD, pulmonary HTN
- Infertility/Cystic fibrosis
- Renal carcinoma

Head-to-Toe Focus: Abdomen, suprapubic region, genitalia, lower back, & lower extremities

Palpation of kidneys is unusual (may indicate enlargement)
-Costovertebral angle, may extend to umbilicus

Physical Symptoms:
1) Pain
- Kidneys: Dull constant ache, (sudden distention of capsule: sharp, stabbing, & colicky in nature)
* Location: Costovertebral angle, may extend to umbilicus
* Associated w/ N/V
* Possible causes: acute obstruction, kidney stone

     - Bladder: Dull, continuous pain that may be intense w/voiding
          * Location: Suprapubic region
          * Possible causes: Over distended bladder, interstitial cystitis

     - Uretral: Severe, sharp, stabbing pain, colicky in nature
            * Location: Costovertebral angle, flank, lower abdominal area, testis or labium
             * Possible causes: Uretral stone, blood clot

    2) Changes in voiding patterns or urine appearance

     3) Are GI symptoms present? N/V, diarrhea, abdominal pain or discomfort

     4) Unexplained anemia
54
Q

Risk Factors for Chronic Kidney Disease (CKD)

A

Diabetes
Sickle Cell disease
Nephrotic syndrome
HTN
Lupus

55
Q

Risk Factors for Renal Insufficiency

A

HTN

56
Q

Risk Factors for Oliguria/Anuria

A

Benign prostatic hyperplasia/hypertrophy (BPH)

57
Q

Risk Factors for Acute Kidney Injury (AKI)

A

Exposure to chemical
UTI
Calculi
Diabetes
Old age

58
Q

Risk Factors for Urinary Tract Infections (UTI)& Incontinence

A

Advanced age (incomplete emptying) Spinal cord injury
Procedures: cystoscopy and catheterization
Multiple Sclerosis (MS),
Vaginal childbirth (incontinence only)

59
Q

Risk Factors for Neurogenic Bladder/Retention

A

Diabetes,
MS
Stroke
BPH
Mass/tumor, calculi
Trauma, spinal cord injury

60
Q

Risk Factors for Renal Calculi

A

Gout
Crohn’s
hyperparathyroidism
Ileostomy, immobilization
Cancer
Renal tubular acidosis
Granulomatous diseases
PKD

61
Q

Risk Factors for Structural Trauma

A

Recent pelvic surgery, radiation therapy to pelvis

62
Q

Pre-Procedure for Urodynamic Testing

A

Interview on patient’s urologic symptoms & voiding habits

63
Q

During the Procedure Measures for Urodynamic Testing

A

Ask patient to:
- Describe sensations they felt
- Change positions (from supine to sitting up)
- Cough/ Perform Valsalva maneuver (bear down)

Anticipate inserting 1 or 2 urinary catheters: To measure bladder pressure & filling
- May have to insert another catheter in the rectum or vagina to measure abdominal pressure
- Bladder will be filled via catheter 1 or more times

Anticipate possible electrode application for electromyography
- Warn the client they may be uncomfortable initially during insertion & later during position changes

64
Q

Patient Education Post-Urodynamic Testing

A

Patient may experience this after urinary catheter insertion:
- Frequency
- Urgency
- Dysuria

Avoid caffeinated, carbonated, & alcoholic beverages (will worsen symptoms)
- Symptoms usually decrease by the day after the procedure

Slight hematuria
- Drink fluids will help clear it

Watch for UTI signs & symptoms! Contact provider immediately if patient is experiencing:
- Fever
- Chills
- Lower back pain
- Continued dysuria & hematuria

If taking an antibiotic prior to procedure, continue use to clear infection

65
Q

Normal Urine Output

A

1 mL/kg/ hr or 1-2 L/day

66
Q

Urinalysis

A

Checks urine color, clarity, pH, specific gravity, & presence of proteins/cells/glucose/ ketones

67
Q

Colorless to Pale Yellow Urine Color Meaning

A

Dilute urine due to:
- Diuretic agents
- Alcohol consumption
- Diabetes insipidus
- Glycosuria
- Excess fluid intake
- CKD

68
Q

Yellow to Milk White Urine Color Meaning

A

Pyuria, infection, & vaginal cream

69
Q

Bright Yellow Urine Color Meaning

A

Multiple vitamin prep

70
Q

Pink to Red Urine Color Meaning

A

Hemoglobin breakdown

RBCs

Gross blood

Menses

Bladder/ prostate surgery

Beets & blackberries

Meds: phenytoin, rifampin, thioridazine, cascara sagrada, & senna products

71
Q

Blue to Blue Green Urine Color Meaning

A

Dyes, methylene blue

Psuedomonas organisms

Meds: Amitryptylince HCL, triamterene

72
Q

Orange to Amber Urine Color Meaning

A

Concentrated urine due to:
- Dehydration
- Fever
- Bile
- Excess bilirubin or carotene
- Meds: Phenazopyridine, hydrochloride, nitrofurantoin

73
Q

Brown to Black Urine Color Meaning

A

Old RBCs

Urobilinogen

Bilirubin

Melanin

Porphyrin

Extremely concentrated urine due to:
- Dehydration
- Medications: iron prep, cascada sagrada, methyldopa

74
Q

Urine Culture

A

Identifies which antimicrobial therapy that is best suited for particular strains

75
Q

Osmolality

A

Measures the presence of solutes in urine

MOST ACCURATE measurement of the kidney’s ability to DILUTE & CONCENTRATE urine

76
Q

Normal Urine Osmolality Range

A

200-800

Less is best!

77
Q

Specific Gravity

A

Measures density compared to H2O

78
Q

Normal Urine Specific Gravity Range

A

1.005- 1.025

79
Q

Abnormally Low Specific Gravity Reading Causes

A

Diabetes insipidus, glomerulonephritis, & hyperhydration

80
Q

Abnormally High Specific Gravity Reading Causes

A

Diabetes mellitus, nephritis, & dehydration

81
Q

24- Hour Urine Collection

A

Picture of the kidney’s ability to clear solutes from plasma
- Usually measuring creatinine in urine

82
Q

BUN (Blood Urea Nitrogen)

A

Urea is the nitrogenous end product of protein metabolism
- Test values are affected by protein intake, tissue breakdown, & fluid volume changes

83
Q

Normal BUN Range

A

8-20 mg/dL

High levels indicate the kidneys are not filtering well

Patients > 60 years: 8-23 mg/dL

84
Q

Creatinine

A

Creatinine is the end product of muscle energy metabolism
- Regulated & excreted via kidneys

85
Q

Normal Creatine Range

A

Male: 0.6 -1.2 mg/ dL
Female: 0.4 -1 mg/ dL

Waste product that is not filtered appropriately in presence of renal damage

86
Q

BUN to Creatinine Ratio

A

Evaluates hydration status
-Elevated: Hypovolemia
- Normal ratio w/ elevated BUN & creatinine: Intrinsic kidney disease

10: 1

87
Q

Glomerular Filtration Rate (GFR)

A

Used to identify the stage of kidney disease

88
Q

Stage 1 Glomerular Filtration

A

Possible kidney damage (e.g., protein in the urine) w/ normal kidney function

eGFR: 90 or above
Kidney Function: 90-100%

89
Q

Stage 2 Glomerular Filtration

A

Kidney damage w/ mild loss of kidney function

eGFR: 60-89
Kidney Function: 60-89%

90
Q

Stage 3a Glomerular Filtration

A

Mild to moderate loss of kidney function

eGFR: 45-59
Kidney Function: 45-59%

91
Q

Stage 3b Glomerular Filtration

A

Moderate to severe loss of
kidney function

eGFR: 30-44
Kidney Function: 30-44%

92
Q

Stage 4 Glomerular Filtration

A

Severe loss of kidney function

eGFR: 15-29
Kidney Function: 15-29%

93
Q

Stage 5 Glomerular Filtration

A

Kidney failure

eGFR: Less than 15
Kidney Function: Less than 15

94
Q

In which stages would you see a patient on dialysis?

A

If a patient is between stage 3b & 4, usually they would be put on dialysis.

95
Q

Renal System Gerontological Considerations

A

GFR begins to decrease 1 point/yr
starting at age 35-40

Increased risk for AKI due to
changes of the kidney (sclerosis of
the renal tissues, decreased blood
flow or perfusion, decreasing GFR,
etc…)

About 50% of AKI cases are in
patients aged 60 and older

Increased risk for dehydration and
hypernatremia associated with a
decreased stimulation of thirst

96
Q

Urological Gerontologic Considerations

A

Increased likelihood of nocturia
- Decreased bladder muscle tone, increased residual urine, and decreased vasopressin levels

Increased likelihood of urinary incontinence
-Many causes, but sometimes related
to mobility concerns

Older patients may begin to limit fluid intake when this happens, watch for dehydration
- Often have incomplete emptying of the bladder or urinary stasis which increase the risk of a UTI and urinary urgency

Symptoms may appear as other GI issues making diagnosis difficult

97
Q

Ultrasonography

A

Noninvasive procedure that uses soundwaves passed into the body via transducer to detect abnormalities of internal tissues & organs

98
Q

Bladder Ultrasonography

A

Noninvasive method of measuring urine volume in the bladder

99
Q

Nursing Considerations for CT Scan & MRI

A

Prep:
- Teaching relaxation techniques
- Inform the patient they will be able to communicate w/staff via microphone inside the scanner
- Obtain allergy hx: shrimp, iodine, shellfish (contrast contains iodine)
-

NURS3313 Adult Health (27 decks)

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