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NRSG 102: Med Surg 1 > Exam 1: Chapter 53: Assessment of Kidney Functions > Flashcards

Exam 1: Chapter 53: Assessment of Kidney Functions Flashcards

1
Q

Functions of Kidney

A 
Urine Formation
Excertion of Waste Products
Regulation of Electrolytes
Regulation of Acid-Base
Control of Water Balance
Control of Blood Pressure
Renal Clearance
Regulation of RBC Prod
Synthesis of Vitamin D to Active Form
Secretion of Prostaglandins
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2
Q

Urine Formation: Formed in

A

Nephrons through glomerular filtration -> tubular reabsorption and tubular secretion

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3
Q

Urine Formation: What is usually excreted in urine?

A

Sodium, Chloride, Bicarbonate, Potassium, Glucose, Urea, Creatine, and Uric Acid

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4
Q

Antidiuretic Hormone: Also known as

A

Vasopressin

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5
Q

Antidiuretic Hormone: What is this?

A

Secreted by posterior portion of pituitary gland is response to changes in osmolality in blood .

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6
Q

Antidiuretic Hormone: With decreased water intake, what happens to blodo osmolaity?/

A

Increased. This stimulates ADH reelase

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7
Q

Antidiuretic Hormone: Acts on what organ ____ and does ___

A

kidney, increase reabsorption fo water and returning osmolality of blodo to normal

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8
Q

Antidiuretic Hormone: Excess water intake leads to

A

secretion of ADH, and leads to diuresis (increased urine volumme)

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9
Q

Antidiuretic Hormone: A dilute urine with SpG of 1.010 and osmolality of 300 mOsm/L indicates

A

inability to concentrate and dilute urine

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10
Q

Osmolarity: This refers to

A

the ratio of solute to water

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11
Q

1 lb of fluid equal to ? mL

A

500 mL

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12
Q

Regulation of Electrolyte Excretion: With increased aldosterone in the blood.

A

less sodium is excreted in the urine

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13
Q

Regulation of Electrolyte Excretion: Release of Aldosterone form adrenal cortex largely under control of

A

Angiotensin II

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14
Q

Regulation of Electrolyte Excretion: RAAS activated when

A

pressure in the renal arterioles falls below nromal levels . Occurs with shock, dehydration, or decreased sodium chloride delivery

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15
Q

Regulation of Acid-Base: Normal serum pH is

A

7.35 - 7.45

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16
Q

Regulation of Acid-Base: One of kidneys function to keep this balanced is to

A

reabsorb and reutrn ot the body circulation any bicarbonate from the urinary filtrate

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17
Q

Autoregulation of Blood Pressure: Specialized vessels of the kidney called vasa recta monitor

A

blodo pressure as blood begins passage into the kidney

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18
Q

Autoregulation of Blood Pressure: When vasa recta detect decrease in blood pressure,

A

afferent artiole, distal tibule and juxtaglomerular cells secrete renin

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19
Q

Autoregulation of Blood Pressure: Renin convets

A

Angiotensinogen into Angiotensin I, which is then converted in Angiotensin II. This causes blood pressure to increase

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20
Q

Autoregulation of Blood Pressure: Adrenal cortex secretes aldosterone in response to

A

stimulation by pituitary gland , which occurs asresponse to poor perfusion or increasing serum osmolality. results in increase of bp

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21
Q

Autoregulation of Blood Pressure: Failure to stop Renin is one of the primary causes of

A

hypertension

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22
Q

Renal Clearance: This refers to

A

the ability of the kidney to clear solutes from the plasma

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23
Q

Renal Clearance: Primary test?

A

24 hour collection of urine used to evaluate how well the kidney performs

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24
Q

Renal Clearance: Renal clearance depends on what several factors?

A

How quickly substance is filtered across the glomerulus
how much the substance is reabsorbed along the tubules
how much the substance is secreted into tubules

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25
Q

Renal Clearance: One measure that is partically useful is?

A

Creatinine clearance

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26
Q

Renal Clearance: Creatinine is

A

an endogenous waste product that is filtered at the glomerulus. Hence why its a good measure of GFR, the amount of plasma filtered through the glomeruli per unit of time

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27
Q

Renal Clearance: Adult GFR can vary from

A

125-200 mL/min

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28
Q

Renal Clearance: AS renal function decline, what happens to creatinine and renal clearance?

A

decrease

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29
Q

Regulation of RBC Production: When kidneys detect decrease in oxygen tension in renal blood flow because of anemia, arterial hpoxia, or inadequate blood flow, they reelase

A

erythropoietin

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30
Q

Regulation of RBC Production: What is Erythropoietin?

A

Glycoproetin from the kidney that stimulates the bone marrow to produce red blood cells

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31
Q

Vitamin D Synthesis: Kidneys response for final conversionof

A

inactive vitamin d to its active form 1,25-dihydroxycholecalciferol

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32
Q

Vitamin D Synthesis: Vitamin D is necessary for maintaining

A

normal calcium balance in the body

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33
Q

SEcretion of Prostaglandins and other substances: What do this do?

A

Help afferent and efferent arterioles maintain renal blood flow by causing selective vasodilation or vasoconstriction

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34
Q

Excretion of Waste Products: Major waste product of body?

A

Urea. 25-30 g excreted daily.

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35
Q

Urine Storage: Filling and emptying of the bladder are mediated by coordinated

A

sympathetic and parasympathetic nervous system control of mechanisms involving the detrouser muscles and the bladder outlet

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36
Q

Urine Storage: At night, the reelase of vasopressin causes

A

decrease in the production of urine and makes it more concentrated. Thats why we dont pee at night

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37
Q

Common Symptoms - Pain: Genitourinary pain usually caused b

A

distention of some portion of urinary tract bc of obstructed urine flow or inflammation and swelling

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38
Q

Urinalysis: What does this provide?

A

Clinical information about kdiney function and helps diagnose other diseases such as diabetes

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39
Q

Urine Culture: Determines whether

A

bacteria are present in urine, as well as their strains and concentration

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40
Q

Urinalysis and Urine Culture: Hematuria common causes include

A

acute infection (cystitis, urethritis, or prostatitis), renal calculi or neoplasm

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41
Q

Urinalysis and Urine Culture: What test should be done to test for protein?

A

Dipstick examination, because urine concentration, pH, hematuria, and radiocontrast materials all affect the results

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42
Q

Urinalysis and Urine Culture: Causes of persistent proteinuria include

A

glomerular diseases, malignancies, collagen dsieases, diabetes, preeclampsia, hypothyroidism, heart failure, exposure to heavy metals and use of medications

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43
Q

Specific Gravity: SpG of water?/

A

1.000

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44
Q

Specific Gravity: When fluid intake decreaes, SpG..

A

increases

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45
Q

Specific Gravity: With high fluid intake, SpG…

A

decreaes

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46
Q

Specific Gravity: Methods for Testing?

A

Multiple Test Dipstick (Most Common)
Urinometer (Least)
Refractometer

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47
Q

Specific Gravity: Patients with kidney disease and fluid intake

A

it does not vary and patients urine is said to have fixed specific gravity

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48
Q

Specific Gravity: Disorders that cause decreased SpG include

A

diabetes, glomerulonephritis, and severe renal damage

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49
Q

Specific Gravity: Increased SpG caused by

A

diabetes, nephritis, and fluid defific

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50
Q

Osmolaity: Most accurte measurement of

A

kidneys ability to dilute and concentrate urine . Measures number of solute molecules in a kilogram of water

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51
Q

Osmolaity: Serum osmolality is usually

A

280-300

52
Q

Osmolaity: Urine osmolality is usually

A

200-800

53
Q

Osmolaity: 24 Hour urine sample osmolality is usully

A

300-900

54
Q

Renal Function TEsts: Used to evaluate

A

severity of kidney disease and to assess the status of the patients kidney function. Provide information about effectiveness of kidney in carrying out its excretory function

55
Q

Renal Function TEsts: Specific Gravity normal value

A

1.010 - 1.025

56
Q

Renal Function TEsts: Normal Creatinine Level

A

0.6-1.2

57
Q

Renal Function TEsts: Normal BUN Level?

A

7-18 > 60 years

8-20 normally

58
Q

Renal Function TEsts: BUN-to-Creatinine Ratio Level

A

10:1

59
Q

What falls under Diagnostic Imaging?

A 
Kidney, Ureter, and Bladder Studies
General Ultrasonography
Bladder Ultrasonography
CT and MRI
Nuclear Scans
Intravenous Urography
Retrograde Pyelography
Cytography
Voiding Cystourethrography
Renal Angiography
MAG3 Renogram
60
Q

Kidney, Ureter, and Bladder Studies: What is this?

A

X-Ray study of abdomen or KUB to delineate size, shape and position of kidney and reveal urinary abnormalities

61
Q

General Ultrasonography: What is this?

A

Noninvasive procedure that uses sound waves pases into body through a transducer to detect abnormalities of internal tissues and organs

62
Q

General Ultrasonography: Abnormalities in body may include

A

fluid accululation, masses, congenital malformations, changes in organ size, and obstructions

63
Q

General Ultrasonography: During test, lower …

A

abdomen and genitalia may need to be exposed

64
Q

General Ultrasonography: This requires a full

A

bladder, therefore fluid intake encouraged before procedure

65
Q

Bladder Ultrasonography: What is this?

A

Noninvasive method of measuring urine volume in the bladder

66
Q

Bladder Ultrasonography: May be indicated for

A

urinary frequency, inability to void after removal of catheter, measurement of postvoiding residual volume, inability to void postoperative, or assessment of need for catheterization

67
Q

Bladder Ultrasonography: How is this test performed?

A

Scan head placed on patietns abdomen and directed toward bladder. DEvice automatically calculates and displayes urine volume

68
Q

CT and MRI: What is this?

A

Noninvasive techniques that provide excellend cross-sectional views of the anatomy of the kidney and urinary tract

69
Q

CT and MRI: Used to evaluate

A

genitourinary masses, nephrolithiasis, chronic renal infection, renal or urinary trauma, and soft tissue abnormalities

70
Q

CT and MRI: Occassionally, what is used to enhance visualization?

A

Oral or IV Radiopaque

71
Q

CT and MRI: Preparation includes educating patient about

A

RElaxaiton Techniques

And how they’ll be able to communicate with stuff

72
Q

Why are contrast agents problematic?

A

Some patients are nephrotoxic and allergenic to contrast agents

73
Q

Contrast Agents: What allergies should be watched out for?

A

Iodine, Shellfish, and other seafood because many agents contain iodine

74
Q

CT and MRI: Before patient enters rom, all what must be removed?

A

Metal objects and credit cards because magnetic field can erase them

Patches with metal backings as well bc they can cause burns

75
Q

CT and MRI: Prior to MRI of Urinary Ssytem, patients is informed to avoid

A

Caffeine, Smoking, Alcohol for two hours.

Food for at least one hour

Iron supplements interfere with imaging

76
Q

Nuclear Scans: These require

A

injection of a radioisotope (technetium 99m - labeled compound or Iodine 123 Hippurate) into the circulatory system

77
Q

Nuclear Scans: Isotope is monitored as it moves through

A

blood vessels of the kidney

78
Q

Nuclear Scans: What is placed behind the kidney with the patient in a supine, prone, or seated position?

A

Scintillation Camer

79
Q

Nuclear Scans: Technetium scan provides

A

information about kidney perfusion

80
Q

Nuclear Scans: I-Hippurate renal scan provides information about

A

kidney function such as GFR

81
Q

Nuclear Scans: Used to evaluate

A

acute and chronic kidney injury, renal masses and blood flow before and after kidney transplant.

82
Q

Nuclear Scans: After procedure, patient is encouraged to

A

drink fluids to promote excretion of the radioisotope y the kidney

83
Q

Intravneous Urography: Includes various tests such as

A

excretory urography, (IVP) and infusion drip pyelography

84
Q

Intravneous Urography: IVP shows

A

the KUB via x ray imaging as the dye moves through the upper and then lower urinary system

85
Q

Intravneous Urography: A nephrotomogram may be carried out as

A

part of the study to visualize different layers of the kidney and diffuse structures within each layer

86
Q

Intravneous Urography: IV Urography may be used as the initial asessment of many

A

urologic ocnditions, especially lesions in the kidneys and ureters . Also provides aproximate estimate of renal function

87
Q

Intravneous Urography: After IV is given, multiple

A

x-rays are obtained to visualize drainage of structures in upper and lower urinary systems

88
Q

Intravneous Urography: Infusion drip pyelography requires

A

IV infusion of a large volume to dilute contract agent to opacify the renal parenchyme and fills teh urinary tract

89
Q

Intravneous Urography: Any restrictions?

A

fludis not restricted

90
Q

Retrogrgade Pyelography: What is this?

A

Catheters advanced through ureters into renal pelvis by means of cytoscopy. Contrast agent then injected

91
Q

Retrogrgade Pyelography: This usually performed if

A

IV urography provides inadequate visualization of collecting system

92
Q

Retrogrgade Pyelography: may also be used before

A

before extracorporeal shock wave lithotripsy and patients with urologic cancer who need follow up and are allergic to IV contrast agents

93
Q

Retrogrgade Pyelography: Complications?

A

Infection, Hematuria and performation of the ureter

94
Q

Retrogrgade Pyelography: Is this used a lot??

A

No because of improved techniques in excretory urography

95
Q

Cytography: What is this?

A

Aids in evaluating vesicoureteral reflux and in assessing for bladder injury

96
Q

Cytography: How is this done?

A

catheter inserted into bladder, contrast agent instilled to outline bladder.

97
Q

What is Voiding Cystourethrography: What is this?

A

Uses fluroscopy to visualize lower urinary tract and asses urine storage in bladder

98
Q

What is Voiding Cystourethrography: Commonly used as diagnostic tool to identify

A

vesicoureteral reflux

99
Q

What is Voiding Cystourethrography: How is this done?

A

Uretheral catheter is inserted and a contrast agent is instilled into the bladder. When badder is full and patient feels the urge to void, catheter is removed and patienet voids

100
Q

REnal Angiography: What is this?

A

Provides image of the renal arteries.

101
Q

REnal Angiography: How is this done?

A

Femoral artery pierced with a needle and catheter is threded through femoral and iliac arteries into aorta or renal artery. Contract agent is injected.

102
Q

REnal Angiography: This is used to evaluate what?/

A

Renal blood flow in suspected renal trauma, to differentiate renal cysts from tumors adn to evaluate hypertension

103
Q

REnal Angiography: Is it used preoperatively for

A

renal transplation

104
Q

REnal Angiography: Before procedure, what may be prescribed?/

A

Laxative to evacuate colon so unobstructed x-rays can be obtained.

105
Q

REnal Angiography: Possible complications include

A

hematoma formation, arterial thrombosis or dissection, false aneurysm formation and altered renal function

106
Q

MAG3 Renogram: What is this used for?

A

Scan used to further evaluate kidney function in some center by permitting visualization of renal clearance

107
Q

MAG3 Renogram: How is this done?

A

Patient given injection containing small amount of radioactive material, which will show how kidney function. Pt lies still for 35 minutes while special camera takes image

108
Q

Endourology or Urologic Endoscopic procedures can be performed in what two ways?

A

Using a cytoscope inserted into the urethra

Percutaneously, thorugh a small incision

109
Q

Urologic Endoscopic Procedure: Cytoscopic examination used to directly ivisualize

A

ureathra, and bladder

110
Q

Urologic Endoscopic Procedure: Cytoscope inserted through what?

A

Urethra into the bladder

111
Q

Urologic Endoscopic Procedure: What can be removed form urethra, bladder, and ureter using cytoscopy?

A

Calculi

112
Q

Urologic Endoscopic Procedure: If lower tract cytoscopy performed, patient is usally

A

conscious.

113
Q

Urologic Endoscopic Procedure: To minimize urethral discomort what is given

A

viscous lidocaine minutes before study

114
Q

Urologic Endoscopic Procedure: If cytoscopy includes examiniation of upper tracts, what is given?

A

General anesthesia to ensure theyre no involuntary muscle spasms

115
Q

Urologic Endoscopic Procedure: If an upper cytoscopy is to be performed, patient is restricted to

A

NPO serveral hours befrehand

116
Q

Renal and Urethral Brush Biopsy: This techniques provides information when

A

abnormal x-ray finding of the ureter or renal pelvis raise questions of what it is.

117
Q

Renal and Urethral Brush Biopsy: What is first done?

A

Cytoscopic examination is conducted

118
Q

Renal and Urethral Brush Biopsy: Second step?

A

Urethral catheter is intrdocued followed by biopsy brush that is passed through catheter. Suspected lesion brushed back and forth

119
Q

Kidney Biopsy: Biopsy used to help

A

diagnose and evaluate the extent of kdiney disease.

120
Q

Kidney Biopsy: Indications for biopsy include

A

unexplained AKI, persistent proteinuria, transplant rejection

121
Q

Kidney Biopsy: Small section of renal cortex obtained by

A

percutaneously (needle biopsy) or by open biopsy through small flank incision.

122
Q

Kidney Biopsy: Before biopsy is carried out, what is done?

A

Coagulation studies are conducted to identify risk of post biopsy bleeding

123
Q

Kidney Biopsy: Contradictions include

A 
bleeding tendencies 
untroller hypertension
sepsis
UTI
Obesity
124
Q

Kidney Biopsy: Regimen before test?

A

Fasting regimen 6-8 hours before test. IV line established and urine specimen saved to compare

125
Q

Kidney Biopsy: If needle biopsy is to be performed, patient is instructed to

A

breathe in and hold breath to prevent kidney from moving while needle is inserted

NRSG 102: Med Surg 1 (52 decks)

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