Exam 3 Flashcards
Components of urine list
96% water, Uric acid, hormones, electrolytes: Na, Cl, K, Mg, etc; urea, enzymes
Critical thinking: let’s say a pt is using daily diuretics for chronic condition, he would urinate a lot (hyperuricemia) and cause dehydration, hyperglycemia (due to induced of K depletion of non potassium diuretics that decrease insulin secretion and/or decrease in insulin sensitivity causing high blood sugar), 3 hypos = hyponatremia, hypokalemia, hypochloremia, orthostatic hypotension (dizziness, fainting and light headache)
Urinalysis = why specific gravity urine is high = dehydration (too much solutes out bc keep water retain)
= if low = maybe drink too much water or person has underlying disease and cause of extreme thirst
Urea in urine = high = just eat a lot of proteins or increase protein breakdown
= low = kidney problems, malnutrition (lack of protein in diet)
What ADH do?
ADH is being released by the posterior pituitary glands that is produced by the hypothalamus. It will be triggered to release when there is dehydration (renal tubules reabsorption of more water back inside body), and not or stop release when there is hypervolemic state.
Critical thinking:
Diabetes insipidus cause pt to urinate a lot and cause losing a lot of electrolytes due to problems with posterior pituitary glands or hypothalamus that can’t produce or not releasing enough ADH (vasopressin).
What is normal osmolarity serum range? What does it mean when increasing and when decreasing?
Normal osmolarity serum level is 275-295.
If increasing = dehydration = high sodium level
If decreasing = overhydrate = low sodium level
Alterations in urinary elimination may alter body image causing what to people?
Cause people to feel decrease in self-esteem, depression, isolation, etc
Critical thinking: pt has alterations in urinary elimination and they don’t want to change frequently bc they don’t have enough financial.
Pt might feel decrease in self-esteem bc they need to wear an ostomy bag outside after a colostomy
2 functions of the urinary system
+ filters and eliminates waste products
+ maintain fluid and Na level
Critical thinking: pt who needs dialysis due to kidney disease (eGFR < 60), kidney failure (eGFR < 15) and they need dialysis = can’t filter waste properly and is building up of solutes serum level, especially sodium and potassium. Pt can also have metabolic acidosis due to kidney not properly work to reabsorb bicarbonate and low RBCs (anemia) due to not secrete erythropoietin to stimulate more production of RBCs.
2 parts of upper urinary tract and their function
+ kidneys: remove wastes from blood to form urine
+ ureters: move urine in peristaltic wave and transport urine into the bladder
Critical thinking: if let’s just say that the bladder and ureters are not working well, they can do nephrostomy = tube collection drainage of urine from the renal pelvis
If only the bladder is not working, they can do a ureterostomy
3 parts of the lower urinary system
+ urinary bladder: stores urine (around 600 mL to 1L). When bladder has around 200 mL, they would cause the stress receptors in the trigone area to be triggered and cause the urge to urinate.
+ urethra: male = ~20 cm, female = ~4 cm = easier to get UTI. Urine travels from the bladder through the urethra and out. Try to have a turbulent flow of urine to wash out all bacteria.
+ urethral sphincter: internal and external sphincter. Should have voluntary control. When contracts = narrow or stop outflow urine.
Critical thinking: if urethra is not working, but the bladder is working, they can do vesicostomy. Rare in adult, usually in children.
If the pt lose voluntary control of urethra, can be incontinent.
If want to form new bladder, then can do continent = kock pouch and neonbladder, if incontinent = can do ileal conduit
How to have a voluntary control of urination? (Hint: 5 things)
- Intact spinal cord tracts to the bladder, urethra
- Intact central nervous system
- Good functioning genitourinary system. Must have perfusion of 20-25% from the CO (HR x SV) so like around 4-6L
- Good functioning cardiovascular system: must have enough RPP= renal perfusion pressure. To do that, must have enough of SBP of 90 or MAP of 65 mmHg = (SBP + 2 DBP)/3
- Intact motor area of cerebellum
7 factors affecting urination
- Disease conditions
- Fluid balance
- Surgical procedures
- Sociocultural factors
- Psychological factors
- Muscle tone
- Medications
How many percentage pre renal stage makes up renal failures?
30%
What cause pre renal failure stage? Give 3 examples
Decrease in the RPP (renal perfusion pressure) = either decrease in blood or pressure
+ sepsis (excessive vasodilation of BVs due to cytokines, kitins, etc called distributive shock)
+ dehydration
+ shocked (can be hypovolemic shock due extreme low BP can be due to burns, diuretics, extreme blood loss, etc; cardiogenic shock due to arrhythmias, heart attack, blood clots, etc)
How many percentage intra-renal stage makes up renal failures?
65%
What cause intra-renal failure stage?
Mainly acute tubular necrosis (ATN) due to hypertension, DM or drinking toxic meds or chemicals
How many percentage post renal stage makes up renal failures?
5%
What cause post renal failure stage? Give 4 examples
Mainly outflow obstruction
Ex: BPH (benign hypertrophy prostate- enlarged prostate), any types of masses, any types deposits or like renal calculi, neurogenic bladder (bladder can’t feel urge to void and retain urine cause easier to get UTI = decrease in urine)
What happened to body pre-op?
Generally cause GAS (General adaptation Syndrome) = increase ADH = decrease urine output.
Usually can’t drink the day or the night before some procedure
What happened to body post op & involve in narcotics and anesthesia?
Decrease in urinary output bc anesthesia has not yet all wear out so decrease eGFR (however should not be lower than 60 = kidney problems, eGFR <15 = kidney failure)
Critical thinking: check for sites if there is pain, inflammation, redness. Depending on the area of surgical procedure but mostly would cause decrease in urine output due to decrease sensation and mobility
HOWEVER, post op, promoting mobility is always a good thing!!
What medications cause decrease in urination?
Anti cholinergic, antihistamines, antidepressants, narcotics/opioids
What is pyridium? What color change in urination this meds cause?
Pyridium is analgesic meds giving for pt who needs to wear off or release symptoms that the patient has for UTI like discomfort/ painful when urinating (dysuria) before starting antibiotics.
Color change: dark orange to light red color
What is levodopa? What color change in urination this meds cause?
Levodopa is meds given for Parkinsonism. Usually given with carbidopa for synergistic effects
Color change: dark red to brownish color
What is amitriptyline? What color change in urination this meds cause?
An antidepressant meds
Color change: blue or green color
Critical thinking: if pt is taking any meds listing above, need to educate before hand bc they might freak out.
What is more at risk of decrease in muscle tone?
Muscle tone (detrusor muscle) decrease = atrophy= difficult urinating & possible incontinent = urinary retention
- Prolonged immobile pts (incontinence)
- menopause women at 50-51 age
- vaginal delivery due to damage
Critical thinking: teaching kegel exercise TID and 10 times per session
Who needs a Foley catheter based on CDC? (Hints: 9 situations)
- Patient has acute urinary retention or bladder outlet obstruction (Ex: BPH, any types of masses, any types of deposits, renal calculi, neurogenic bladder)
- Need for accurate measurements of urinary output in critically ill patients (Critical I &O)
- Perioperative use for selected surgical procedures: Patients undergoing urologic surgery or other surgery on contiguous structures of the genitourinary tract.
- Anticipated prolonged duration of surgery (catheters inserted for this reason should be removed in PACU).
- Patients anticipated to receive large-volume infusions or diuretics during surgery.
- Need for intraoperative monitoring of urinary output.
- To assist in healing of open sacral or perineal wounds in incontinent patients.
- Patient requires prolonged immobilization (e.g., potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures).
- To improve comfort for end of life care if needed.
What is 3 Ex not appropriate use of Foley catheter?
- As a substitute for nursing care of the patient or resident with incontinence.
- As a means of obtaining urine for culture or other diagnostic tests when the patient can voluntarily void.
- For prolonged postoperative duration without appropriate indications (e.g., structural repair of urethra or contiguous structures, prolonged effect of epidural anaesthesia, etc.).
What is routine hygiene?
- Wear gloves for any contact with body fluids and mucous membranes
How often one should have a full bed bath or and if they are able to take a shower?
Once a day and if they have any feces or urine incontinence then change right away.
How many hours later you should have perineal care for Foley catheter or purewick catheter?
Every 12 hours
T or F: Infants urinate small amounts but more frequently at an average of 10-20 times per day and it is because they have immature kidneys
True
T or F: Infants urine is concentrated
False. It is not that concentrated
At what age you should train infants to potty trained?
Age range 2-4
How long does it take for potty train for infants?
About 18 months
What age infants should be fully independence urination?
4 or 5
How to teach children: girls and boys to wipe?
Girls: front to back to decrease UTI (less contaminations to more contaminations)
Boys: usually tell them shake
How pregnancy (specifically second and third trimester) cause alteration in urination?
- cause increase in frequency of urination = small leak at a time = little bit incontinence = decreased in urine emptying = urine retention increase = more likely to get UTI
What age is renal function starts to decrease clearly and might have nocturia?
40 year old
What condition male 40 year old usually get?
BPH
What 3 things BPH increase?
increased frequency and retention and nocturia
What condition menopause (50-51) women usually have and why?
UTI (bc there’s estrogen decrease and change in the urethral mucosa)
What to teach UTI pt?
- don’t wear nylons. Wear COTTONS instead and change daily
- Void after vaginal intercourse or when urge to void is perceived
- Take a shower instead of bath bc everything will go down through gravity
- wipe from front to back after having BM
- Perform Kegel exercise three times per day 10 times per session
What is polyuria?
Polyuria is more than 3L of urine output with normal fluid intake per day (24hrs)
3 cause of polyuria?
- Alcohol intake
- Diuretics
- Diabetes poorly controlled (DM or Diabetes insipidus)
What is oliguria?
Less than 500 mL in 24 hrs with normal fluid intake
If have Foley catheter = less than 30 mL/hr or less than 720 mL/24 hrs
Cause of oliguria? (hint: pre renal & post renal)
Pre-renal stage: due to decrease in RPP = dehydration, sepsis, shock
Post-renal stage: outflow obstructive = BPH, any types of masses, deposits, renal calculi, neurogenic bladder
Anuria
No output with normal fluid intake = end stage renal disease (eGFR < 15 )
Best index of kidney function
eGFR= 90-120
Kidney disease problems eGFR?
eGFR < 60
How many stages of CKD?
5
T or F: Is eGFR divided into NAA (non-African American) or AA (African American) category
True
How to detect an AV graft or AV fistula?
Usually pt will tell you
However, if not, an X-ray can confirm it
How to assess an AV fistula or an AV graft?
Can feel a thrill when palpating
When auscultating, should hear swoosh sound = a bruit = a functioning sound = should be turbulent flow
For normal people= blood should be laminar flow
What is a no done in AV graft or AV fistula?
Signs should be saying no venapuncture, no IV, no BP, no ABG, no sticks lab in the arms of AV fistula or AV graft
Why AV graft or AV fistula is needed?
For long term hemodialysis = to prevent CAUTI from temporarily Quinton catheter
What should be cautious of Quinton catheter
It is a temporary central IV line that is using for hemodialysis hopefully only taken couple of weeks. However, can taken up to 3-4 months.
Be careful not to bonus your pt thousands of unit of heparin. Must use 5 mL to inject heparin until see blood on both sides first then can administer whatever meds prescribed.
How long does it take for AV graft or AV fistula to heal?
Usually 3-4 weeks but some say it can go up to 6 months
How long is hemodialysis sessions? How often?
Generally it takes 3-4 hrs and pt usually need 3 treatments per week (depending on the severity)
What is hemodialysis machine called?
Dialyzer
How does hemodialysis work?
One needle on one vein and one needle on the artery. Blood from vein will go to machines, and their high concentration of solutes will go through the selective barrier membrane to help cleaning blood. Then clean blood will be back to the body to the artery.
Pros and cons of peritoneal dialysis vs. hemodialysis
Pros: peritoneal dialysis: can do at home, in long time, can be comparable to hemodialysis
Cons: peritoneal dialysis: can cause peritonitis (infection of the membrane around the abdomen organs, malnutrition of proteins
Pros: hemodialysis: effective quick, need fewer treatments per week than peritoneal dialysis
Cons: can cause infection; have to do AV graft or AV fistula for long term treatment
What is in dialysate bag?
Depend on what is lacking in each individual
Can be Na, K, Ca Mg, Cl, HCO3-, dextrose or non electrolyte glucose
How procedure of peritoneal peritoneal being carried out?
Need physician to do flexible soft catheter inserting into the abdomen to the peritoneum membrane (usually takes 10-20 days for healing)
