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N110 Exam #3 > Elimination: Urinary > Flashcards

Elimination: Urinary Flashcards

1
Q

Kidneys: Location, Protection, Operation

A
  • Location: behind/outside peritoneal cavity (retroperitoneal)
  • Protected by: ribs (externally), fatty tissue (internally)
  • Independent functions, blood supply, innervations
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2
Q

Kidneys: Renal Parenchyma

A

Medulla:
• loops of Henle, vasa recta, collecting ducts, juxtamedullary nephrons

Cortex:
• cortical nephrons

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3
Q

Kidneys: Blood Supply

A
  • 20-25% cardiac output
  • Supplied via renal artery
  • Artery–> atrioles–> glomerulus (glomerular filtration)
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4
Q

Kidneys: Nephrons

A
  • 1 million per kidney
  • Most are in cortex (80-85%)
  • Initial formation of urine
  • 2 parts: glomerulus and tubule
  • Filters fluids–> changes in composition according to body’s needs–> end product filtrate excreted as urine
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5
Q

Kidneys: Urine Formation

A
  • In nephron via glomerular filtration, tubular reabsorption, tubular secretion
  • Sodium, chloride, urea, creatinine, bicarbonate, glucose, uric acid
  • 1 - 1.5 L of urine produced daily
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6
Q

Kidneys: Ureters, Bladder, Urethra

A
  • Urine flows from kidneys to ureters
  • Ureters empty into bladder
  • Urethra at base of bladder drains urine
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7
Q

Renal and Urinary System Functions

A 
(RbcPVdWHFeBpAb)
• RBC production via synthesis of erythropoietin
• Prostaglandins
• Vitamin D synthesis
• Waste removal
• Homeostasis
• Fluid and electrolyte balance
• Blood pressure control via renin
• Acid-base balance
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8
Q

Factors Affecting Urinary Elimination: Food and Fluid

A

• Dehydration= ↓ in urine, more concentrated

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9
Q

Factors Affecting Urinary Elimination: Psychological

A
  • Individual, family, socio-cultural

* Daily schedule, privacy, time to void

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10
Q

Factors Affecting Urinary Elimination: Activity Level and Muscle Tone ↑↓

A
  • Exercise promotes urinary elimination

* Immobility= ↓ muscle, bladder, sphincter tone

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11
Q

Factors Affecting Urinary Elimination: Developmental

A

Elderly:
• loss of ability to concentrate urine
• ↑ urge/frequency to void

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12
Q

Factors Affecting Urinary Elimination: Pathological

A
  • Can affect quality and quantity or urine

* Hypertension, renal disease, diabetes mellitus, gout

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13
Q

Factors Affecting Urinary Elimination: Medication

A
  • Nephrotoxic= renal damage

* Can affect amount/color of urine

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14
Q

Assessment: Health History: Subjective Data

A
  • Onset
  • Pain
  • Voiding problems
  • Infection/Obstruction history
  • Fluid/Dietary intake
  • Pattern
  • Medications
  • Drug use
  • Childbirth
  • Family history of kidney disease
  • Recent change in weight
  • Other urinary/renal problems
  • Other health problems
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15
Q

Renal/Urinary Problems and Urinary Pain

A
  • Pain= distension
  • Distention caused by obstructed urine flow or inflammation
  • Pain location, quality, duration depends on where distention is
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16
Q

Location of Renal/Urinary Problem is Consistent with Site of Urinary Pain

A
  • Kidneys/ureter= CVAT; abdominal pain
  • Bladder= suprapubic and voiding pain
  • Urethral= voiding pain
  • Prostate= perineal and rectal pain
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17
Q

Assessment: Physical Exam

A
  • Kidneys should NOT be palpable
  • Palpate for CVA
  • Inspect abdomen for ascites
  • Palpate/percuss bladder for distension
  • Palpate inguinal area for enlarged lymph nodes and inguinal/femoral hernia
  • Genitalia
  • Edema/changes in body weight leading to fluid retention
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18
Q

Urine Color and Clarity

A
  • Food, medications, hydration can affect
  • Normal urine= straw/yellow
  • Severe infection= milky green/yellow
  • Cloudy/sediment/tissue shreds= infection
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19
Q

Urine Colors

A
  • Pale yellow= normal
  • Dark yellow= concentrated
  • Amber= dehydration
  • Orange= medications, liver/bile duct, food dye
  • Green= pseudomonas infection, bacteria, meds, genetic disease, food dye
  • Red= blood, food
  • Brown/cola= concentrated, liver disease
  • Fizzy= excess protein, kidney problem
20
Q

Urine Clarity

A
  • Clear= transparent
  • Hazy= few particles
  • Cloudy= many particles
  • Milky
21
Q

Urine Odor

A
  • Can be affected by foods, infections, medications, concentration
  • Foul odor= infection, concentrated from dehydration
22
Q

Urine Frequency

A
  • Adults 4-5 times/day
  • Day= no greater than every 2 hours
  • Night= 1-2 times
23
Q

Urine Volume

A
  • Adults 40-80 ml/hour (1500-2000/24 hour)

* MINIMUM 30 ml/hour

24
Q

Diagnostic Urine Tests: Urinalysis

A

• hematuria, proteinuria, glucosuria

25
Q

Diagnostic Urine Tests: Routine Urinalysis

A

•

26
Q

Diagnostic Urine Tests: Clean Catch/Midstream Specimen

A
  1. Self-clean
  2. Void
  3. Stop void
  4. Continue void into sterile specimen cup
  5. Cover without contaminating
27
Q

Diagnostic Urine Tests: Sterile/Catheterized Specimen

A

• Non-indwelling (straight) catheter

  1. Indwelling (foley) catheter clamped distal to injection port
  2. Clean with alcohol
  3. Aspirate amount of urine with sterile 5 mL syringe
  4. Unclamp and resume drainage
28
Q

Diagnostic Urine Tests: 24 Urine Specimen

A
  1. Inform all family/personnel of test
  2. Start of test: patient void, discard, and record time
  3. Collect all urine after start
  4. At 24 hour mark: have patient void and add to collection
  5. Send to lab
29
Q

Diagnostic Urine Tests: Urine Culture

A
  • Identifies bacteria (strain/concentration)

* > 100,000 CFU= Urinary Tract Infection

30
Q

Diagnostic Urine Tests: Post Void Residual Volume (PVR)

A
  • Measures urine in bladder after voiding

* Bladder scanner or catheter

31
Q

Renal/Urinary Diagnostic Studies: Bladder Scanner

A
  • Bladder volume, PVR, need for catheter

* No patient preparation, no discomfort, non-invasive

32
Q

Renal/Urinary Diagnostic Studies: Blood Urea Nitrogen (BUN)

A
  • Urea formed in liver from ammonia, diffuses freely, excreted by kidneys
  • BUN levels reflect the balance between production and excretion of urea
33
Q

How is BUN Used

A
  • Kidney function, kidney disease, acute/chronic kidney dysfunction/failure
  • General health status as BMP/CMP
34
Q

When is BUN Ordered

A
  • Non-specific complaints
  • Routine test
  • Checking kidney function before starting drug therapies
  • Acutely ill patient
  • During hospital stay
35
Q

Normal BUN Lab Values

A

14-adult: 8-21 mg/dL

Adult over 90: 10-31 mg/dL

36
Q

BUN Indications

A
  • Nutritional
  • Hydration
  • Hemodialysis
  • Lymphoma after chemotherapy
  • Liver function
  • Renal function
  • Nephrotoxic/Hepatotoxic drugs
37
Q

BUN Levels

A

• Increased: impaired kidney function (kidney disease/damage/failure, CHF, shock, sever burns, myocardial infarction, obstruction of urine flow, dehydration)
• Decreased: liver disease, malnutrition, over hydration
*Increased and Decreased levels seen in normal pregnancy

38
Q

BUN/Creatinine Ratio

A
  • Between 10:1 and 20:1
  • Increased: decreased blood to kidneys (CHF, dehydration), increased protein (GI bleed, diet)
  • Decreased: liver disease (lack of formation urea), malnutrition
39
Q

Creatinine, Blood

A

• Amount generated is proportional to mass of skeletal muscle unless muscle damage/disease
• Decreases with age
*DETERMINES RENAL CLEARANCE

40
Q

How is Creatinine Blood Used

A
  • Assess kidney function
  • Monitor progress of kidney dysfunction/effectiveness of treatments in patient’s with abnormal levels/diseases affecting kidneys (diabetes)
  • Prior to procedures (CT) that use drugs that affect kidneys
41
Q

How is Creatinine Blood Used: Creatinine Clearance

A
  • Measures how effectively kidneys are filtering small molecules out of blood
  • 24-hr urine creatinine levels
42
Q

How is Creatinine Blood Used: Correction Factor

A
  • UP/CR, A/CR
  • Evaluates kidney function
  • Detects other urinary tract disease
43
Q

How is Creatinine Blood Used: Serum Creatinine

A
  • Calculates estimated glomerular filtration rate (eGFR)

* Evidence of kidney damage

44
Q

Normal Creatinine Lab Values

A
  • Male: 0.6-1.2 mg/dL

* Female: 0.5-1.1 mg/dL

45
Q

Creatinine Indications

A
  • Disorder involving muscles

* Impairment of renal function

46
Q

Creatinine Levels

A

Increased: impaired kidney function
• damage to blood vessels in kidney (infection, auto-immune disease)
• Urinary tract obstruction (prostate disease, kidney stones)
• Death of cells in kidney (drugs, toxins)
• Bacterial Infection in kidney
• Reduced blood flow to kidney (shock, dehydration, CHF, atherosclerosis, diabetes)
• Muscle injury

Decreased
• Pregnancy
• Decreased muscle mass

N110 Exam #3 (6 decks)

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