Dx studies, Abnormalities, Renal Failure, Kidney Transplant Flashcards
How long are the female and male urethras?
1) Female - 2 inches
2) Male - 8 to 10 inches
What is the normal output per day for the bladder?
1,500mL/day
Define Anuria
24 Hr urine output < 100mL
Define Dysuria
Painful or difficult urination
Define Nocturia
Frequent urination at night
Define Stress Incontinence
Urination with pressure
Define Oliguria
Diminished urine output (100-400mL/24Hrs
Define Polyuria
Large urine output ( > 3 L/day)
What are the 4 characteristics of a Urinalysis?
1) First study done to obtain baseline information
2) Routine - collected anytime of day but best in AM
3) Examined within 1hr of collection or refrigerated
4) Wash perineal area if soiled
What is the method used to collect a Urine Culture and Sensitivity specimen?
Clean catch midstream using a sterile container
Which 7 things does a 24 Hr Composite urine collection test for?
1) Electrolytes
2) Glucose
3) Protein
4) 17-Ketosteroids
5) Creatinine
6) Catecholamines
7) Minerals
What is Creatinine?
Creatinine is a waste product of protein from muscle breakdown
What are the 6 characteristics of a 24 Hr Creatinine Clearance specimen collection?
1) Most accurate test of renal function
2) Resembles GFR
3) 24hr collection (discard 1st specimen, keep last void at 24 hr mark)
4) Blood serum level drawn at the same time
5) Creatinine clearance = Urine creatinine X Urine volume divided by Serum creatinine
6) Normal value = 85-135mL/min
What are the 3 characteristics of a Urine Concentration Test?
1) Evaluates renal concentration ability
2) Patient NPO at midnight
3) Collect 3 urine specimens at hourly intervals in mornig
What are the two ways to measure Residual Volume and what amount is a normal finding?
1) Residual volume can be monitored using a bladder scan or catheterize the patient immediately after voiding.
2) Normal Residual Volume = <50mL but increases with age.
what is the normal range for Creatinine?
0.5 to 1.5 mg/dL (higher in men)
what is the normal range of Uric Acid in men and women?
1) Women - 2.5 to 5.5 mg/dL
2) Men - 4.5 to 6.5 mg/dL
What is the normal range for Phosphorous?
2.8 to 4.5 mg/dL
What is the normal range for Bicarbonate?
22 to 26 mEq/L
What is an Intravenous Pyelogram (IVP)?
An X-ray of the urinary tract after IV injection of contrast material
Why should patients with renal problems not receive Intravenous Pyelogram (IVP)?
Because IVP can be nephrotoxic and worsen renal function
What 5 things must be done before an IVP can be done?
1) Enema to empty colon of feces and gas
2) NPO 8 hours before procedure
3) Assess iodine sensitivity (shellfish)
4) Consent signed?
5) BUN and creatinine results on chart
What should you teach your patients to expect during an IVP and what should they do after an IVP?
1) PT will feel warmth, a flushed face, and a salty taste during injection
2) PT should drink lots of fluids after IVP, to flush out contrast
What is Antegrade Pyelogram?
Same as an IVP, but the dye is injected directly into the kidney. It is used when there is an allergy to iodine.
What is a Retrograde Pyelogram?
An X-ray of urinary tract after injection of contrast material into ureters. A cystoscope is used for visualization.
What are the 4 indications for a Cystoscopy that were discussed?
1) To insert ureteral catheters
2) Remove renal calculi
3) Obtain biopsy
4) Tx of bleeding
What 2 things must be done in order to prepare for a Cystoscopy?
1) NPO for 8 hours before test
2) Consent signed?
Which three side effects of Cystoscopy should you teach your patients about?
1) Burning on urination
2) Pink tinged urine (bright red bleeding is abnormal)
3) Urinary frequency
After a Cystoscopy procedure, which 5 possible complications should the patient be monitored for?
1) Orthostatic hypotension
2) Urinary retention
3) Hemorrhage
4) Bladder infection
5) Perforation of bladder
What is a Renal Arteriogram (Angiograph) and what is it used for?
1) Angiography - When a catheter id inserted into the femoral artery and passed up through the aorta to the level of the renal arteries.
2) Used to visualize the renal blood vessels and locate any stenosis. It can also be used to distinguish between renal cysts and tumors.
What are the 4 nursing considerations to implement for a patient post-op for a Renal Anteriogram?
1) Pressure dressings of femoral artery injection site
2) Bed-rest with affected leg straight for 6 hrs
3) Observe site for bleeding every 30 mins
4) Take peripheral pulses every 30 mins
What is a Cystometrogram used for?
Used to measure bladder tone under pressure.
What is the normal rate for GFR and what rate is indicative of End Stage Renal Disease (ESRD)?
1) Normal GFR - 125mL/min
2) ESRD - < 15mL/min
What are the 8 skin changes that occur as a result of ESRD?
1) Dry, pale skin
2) Dry, brittle hair
3) Pruritus
4) Petechiae and Ecchymosis
5) Uremic frost
6) Thin nails
7) Yellow-gray discoloration of the skin
What are the 4 reproductive complications that happen as a result of ESRD?
1) Infertility
2) Decreased libido
3) Low sperm counts
4) Sexual dysfunction
Why should patients with ESRD not use salt substitutes?
Because they contain potassium chloride and ESRD patients are limited to 2-4g each day.
What is the daily restriction for patients with ESRD regarding protein?
0.6 to 0.8 g/kg of body weight per day
What is the daily restriction for patients with ESRD regarding phosphate?
1000 mg/day
What are the 4 phases of Acute Renal Failure (ARF)?
1) Initiation or Onset
2) Oliguric
3) Diuretic
4) Recovery
What are the 5 Risk Factors for ESRD?
1) Diabetes
2) Hypertension
3) Proteinuria
4) Family Hx
5) Increasing age
Which electrolyte imbalances are manifested on a patient with renal failure?
1) Hyperkalemia
2) Hypermagnesemia
3) Hypocalcemia
4) Hyperphosphatemia
5) Hypochloremia
During hemodialysis, toxins and wastes in the blood are removed by which method?
Diffusion - particles move from an area of higher concentration in the blood to an area of lower concentration in the dialysate.
The presence of which substance in the urine is hallmark of the diagnosis of nephrotic syndrome?
Protein (predominantly albumin) exceeding 3.5 g/day is the hallmark of the diagnosis of nephritic syndrome.
(T/F) Tea-colored urine is a typical symptom of Glomerulonephritis.
True
Why is not treatment administered for metabolic acidosis in in patients with chronic renal failure?
Because metabolic acidosis usually produces not symptoms in patients with chronic renal failure and requires no treatment.
Which 4 situations are indications for acute dialysis?
1) Hyperkalemia
2) Fluid overload
3) Impending pulmonary edema
4) Increasing acidosis
