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NURS 350 > Exam 3 - Alterations of Renal and Urinary Tract Function > Flashcards

Exam 3 - Alterations of Renal and Urinary Tract Function Flashcards

1
Q

What is a urinary tract obstruction?

A

blockage of urine flow within the urinary tract

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2
Q

What 2 things can an obstruction be caused by?

A
  1. anatomic defect

2. functional defect

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3
Q

What are 4 complications associated with upper urinary tract obstructions?

A
  1. hydrometer
  2. hydronephrosis
  3. ureterohydronephrosis
  4. tubulointerstitial fibrosis
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4
Q

define hydroureter

A

dilation of ureters

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5
Q

define hydronephrosis

A

dilation of renal pelvis and calyces

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6
Q

define ureterohydronephrosis

A

dilation of both ureters and the renal pelvis and calyces

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7
Q

define tubulointersitial fibrosis

A
  1. deposition of excess amounts of extracellular matrix

2. leads to cellular destruction and death of nephrons

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8
Q

define compensatory hypertrophy

A

partially counteracts the negative consequences of unilateral obstruction

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9
Q

What are the 2 types of growth with compensatory hypertrophy?

A
  1. obligatory growth

2. compensatory growth

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10
Q

what is caused by relieve of an upper urinary tract obstruction?

A

post obstructive diuresis

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11
Q

What can post obstructive diuresis cause?

A

fluid and electrolyte imbalance

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12
Q

What are kidney stones also called?

A

renal calculi or urolithiasis

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13
Q

what are kidney stones?

A

masses of crystals, protein or mineral salts form and may obstruct the urinary tract

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14
Q

What are 4 risk factors for kidney stones?

A
  1. male
  2. most develop before 50 years of age
  3. inadequate fluid intake
  4. geographic location
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15
Q

What are kidney stones mostly composed of?

A

calcium oxalate or calcium phosphate

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16
Q

How can genetic disorders of amino acid metabolism lead to kidney stone formation?

A

low pH

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17
Q

What are stag horn calculi?

A

large kidney stones

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18
Q

What does a alkaline urinary pH increase the risk for?

A

it increases risk for calcium phosphate stone formation

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19
Q

What does an acidic urine increase the risk for?

A

uric acid stone

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20
Q

What is 1 clinical manifestation of kidney stones?

A

renal colic (pain)

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21
Q

what is a process where crystals grow from a small nidus or nucleus to larger stones?

A

growth into a stone via crystallization or aggregation

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22
Q

What are 5 common treatments for kidney stones?

A
  1. parenteral and/or oral analgesics for acute pain
  2. medical therapy that promotes that stone passage
  3. high fluid intake
  4. alteration in urine pH
  5. removal of stones
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23
Q

What is a neurogenic bladder?

A

bladder dysfunction caused by neurologic disorders

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24
Q

What are two syndromes associated with dysfunction of the upper motor neurons?

A
  1. detrusor sphincter dyssynergia

2. overactive bladder syndrome

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25
Q

What is 1 syndrome associated with dysfunction of the lower motor neurons?

A

detrusor areflexia (underachieve bladder)

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26
Q

What are 4 common causes of lower urinary tract obstruction?

A
  1. prostate enlargement
  2. urethral stricture
  3. severe pelvic organ prolapse
  4. low bladder wall compliance
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27
Q

What are some clinical manifestations of lower urinary obstructions?

A
  1. frequent daytime voiding
  2. nocturne: night-time voiding
  3. urgency
  4. dysuria
  5. poor force of stream
  6. feelings of incomplete bladder emptying
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28
Q

What is overactive bladder syndrome chronic syndrome of?

A

detrusor overactivity

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29
Q

What are the symptoms of overactive bladder syndrome?

A
  1. syndrome of urgency, with or without urge incontinence

2. frequency and nocturne

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30
Q

What is underactive bladder syndrome?

A

bladder contraction of reduced strength and/or duration

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31
Q

What is underactive bladder syndrome associated with?

A

prolonged bladder emptying or incomplete bladder emptying, or both

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32
Q

What is an underactive syndrome caused by?

A
  1. spinal cord injury
  2. stroke
  3. multiple sclerosis
  4. parkinson disease
  5. diabetic neuropathy
  6. aging
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33
Q

What are symptoms of an underactive bladder?

A
  1. weak stream
  2. intermittency
  3. hesitancy
  4. straining
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34
Q

What is a benign renal tumor?

A

renal adenomas

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35
Q

What is the rarest renal tumor?

A

renal transitional cell carcinoma

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36
Q

what is the most common renal tumor?

A

renal cell carcinoma

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37
Q

where is the mutation with renal cell carcinoma?

A

mutation of gene on chromosome 3p

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38
Q

what are manifestations of renal cell carcinoma?

A

hematuria, dull and aching flank pain

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39
Q

What is the most common bladder tumor?

A

urothelial (transitional cell)

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40
Q

What is a urinary tract infection?

A

inflammation of the urinary epithelium after invasion and colonization by some pathogen in the urinary tract

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41
Q

how is a urinary tract infection classified?

A

location and complicating factors

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42
Q

True or false: UTI’s can be either complicated or uncomplicated

A

true

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43
Q

define cystitis

A

bladder inflammation

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44
Q

define pyelonephritis

A

inflammation of upper urinary tract

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45
Q

Define the pH and osmolality of urea that helps protect against UTI’s:

A

low pH and high osmolality of urea

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46
Q

What kind of effect do secretions from the uroepithelium?

A

bactericidal effect

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47
Q

what does the ureterovesical junction do to protect against UTI’s?

A

closes to prevent reflux of urine to the ureters and kidneys

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48
Q

What do women have that protect against UTI’s?

A

mucus-secrting glands

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49
Q

What do men have that protect against UTI’s?

A

length of the male urethra

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50
Q

What are the 2 most common pathogens that cause UTI’s?

A
  1. escherichia coli

2. staphylococcus saprophyticus

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51
Q

What are 3 ways that uropathogens are virulent?

A
  1. ability to evade or overwhelm host defense mechanisms and cause disease
  2. adherence to uroepithelium
  3. ability to resist the host’s defense mechanisms
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52
Q

define cystitis?

A

inflammation of the bladder

53
Q

What are 2 clinical manifestations of cystitis?

A
  1. asymptomatic

2. frequency, dysuria, urgency, and lower abdominal and/or suprapubic pain

54
Q

define acute pyelonephritis:

A

acute infection of the ureter, renal pelvis, and/or renal parenchyma

55
Q

What are 3 contributing factors to

A
  1. cystitis
  2. urinary tract obstruction with reflux infection
  3. women are 5 times more likely to develop pyelonephritis
56
Q

What are 4 clinical manifestations of acute pyelonephritis?

A
  1. flank pain
  2. fever, chills
  3. costovertebral tenderness
  4. purulent urine
57
Q

What is chronic pyelonephritis?

A

persistent or recurrent infection of the kidneys, leading to scarring

58
Q

Where is inflammation and fibrosis of chronic pyelonephritis located?

A

in interstitial spaces between tubules, leading to chronic kidney failure

59
Q

What is glomerulopathies?

A

disorders that directly affect the glomerulus

60
Q

What are glomerulopathies a significant cause of?

A
  1. chronic kidney disease

2. end-stage renal failure worldwide

61
Q

What is glomerulonephritis?

A

inflammation of the glomerulus

62
Q

What are the most common problems associated with glomerulonephritis?

A

immunologic abnormalities

63
Q

What is the most common form of acute glomerulonephritis?

A

IgA nephropathy

64
Q

What is the most rapidly progressive form of acute glomerulonephritis?

A

crescentic glomerulonephritis

65
Q

What is the most common cause of acute glomerulonephritis?

A

membraneous nephroptahty

66
Q

What are 2 other types of acute glomerulonephritis?

A
  1. membranoproliferazive glomerulonephritis

2. mesangial proliferative glomerulonephritis

67
Q

What is the patho of acute glomerulonephritis?

A
  1. Formation of immune complexes (antigen/antibody) in the circulation with subsequent deposition in glomerulus
  2. Antibodies produced against the strep organism cross-react with the glomerular endothelial cells (may be related to inadequately treated strep)
  3. Activation of complement
  4. Recruitment/activation of immune cells and mediators
68
Q

What is decreased glomerular filtration rate?

A

decreased glomerular perfusion as a result of inflammation

69
Q

What does decreased glomerular filtration rate result on?

A

glomerular scarring

70
Q

What happens to the basement membrane with GFR?

A

thickening, and increased permeability to proteins and RBCS

71
Q

What are the manifestations of acute glomerulonephritis?

A
  1. hematuria with RBC casts

2. proteinuria

72
Q

What are 2 types of urinary sediment changes with acute glomerulonephritis?

A
  1. nephrotic sediment

2. nephritic sediment

73
Q

What is characteristic of nephrotic sediment?

A

contains massive amounts of protein and lipids and sometimes trace blood

74
Q

What is characteristic of nephritic sediment?

A

blood is present in urine with red cell casts, white cell casts

75
Q

What is chronic glomerulonephritis?

A

glomerular diseases with a progressive course, leads to chronic kidney failure

76
Q

What are secondary causes of chronic glomerulonephritis?

A
  1. diabetic neuropathy

2. lupus nephritis

77
Q

What are the 2 clinical manifestations of chronic glomerulonephritis?

A
  1. proteinuria

2. hypercholesterolemia

78
Q

What happens with protein excretion in nephrotic syndrome?

A

exertion of 3 g or more of protein in the urine

79
Q

What is protein excretion the result of nephrotic syndrome?

A

result of glomerular injury

80
Q

What are 3 clinical manifestations of nephrotic syndrome?

A
  1. hypoalbuminemia
  2. peripheral edema
  3. prone to infection
81
Q

How can you classify kidney dysfunction?

A
  1. acute or chronic

2. reversible or irreversible

82
Q

define renal insufficiency

A

decline of renal function to approximately 25% of normal

83
Q

define renal failure

A

significant loss of renal function

84
Q

define end-stage renal failure

A

less than 10% of renal function remains

85
Q

What is a syndrome of renal failure?

86
Q

which levels are elevated with uremia?

A

blood urea and creatinine

87
Q

What happens in the body with uremia?

A
  1. retention of toxic wastes
  2. deficiency states
  3. electrolyte disorders
  4. pro inflammatory state
88
Q

Which levels are elevated with azotemia?

A

serum urea and creatinine

89
Q

what causes azotemia

A
  1. renal insufficiency

2. renal failure

90
Q

What do azotemia and uremia have in common?

A

accumulation of nitrogenous waste products in the blood

91
Q

What is acute kidney injury

A

sudden decline in dinner function with decrease in glomerular filtration and accumulation of nitrogenous waste products in blood

92
Q

What lab values increase with acute kidney injury?

A

serum creatinine and BUN

93
Q

How can you classify (diagnose) renal failure

A

RIFLE: Risk; Injury; Failure; Loss; End-state disease

94
Q

What causes prerenal acute kidney injury?

A

renal hypoperfusion: most common cause

95
Q

What causes intrarenal acute kidney injury?

A
  1. disorders involving the renal parenchymal or interstitial tissue
  2. acute tubular necrosis (ATN) caused by ischemia: MOST COMMON CAUSE
96
Q

What causes postrenal acute kidney injury?

A

disorders associated with acute urinary tract obstruction

97
Q

postrenal acute kidney injury rare or common?

98
Q

What is the initiation phase of acute kidney injury?

A

reduced perfusion or toxicity, during which renal injury is evolving

99
Q

How long does the initiation phase of acute kidney injury last?

A

24 to 36 hours

100
Q

Is prevention of injury possible during the initiation phase of acute kidney injury?

101
Q

What is the maintenance or oliguric phase of acute kidney injury?

A

Period of established renal injury and dysfunction after the initiating event has been resolved.

102
Q

How long does the maintenance or oliguric phase last for acute kidney injury?

A

weeks to months

103
Q

What are some symptoms of the maintenance phase for acute kidney injury?

A

Urine output is lowest, and serum creatinine, blood urea nitrogen, and serum potassium increase, metabolic acidosis develops, and salt and water overload occurs.

104
Q

What is the recovery phase for acute kidney injury?

A

Renal injury is repaired, and normal renal function is reestablished.

105
Q

What returns to normal with the recovery phase for acute kidney injury?

A

GFR returns toward normal, but the regenerating tubules cannot concentrate the filtrate.

106
Q

What is common with the recovery phase for acute kidney injury?

A

Diuresis is common

107
Q

What is chronic kidney disease?

A

progressive loss of renal function associated with systemic disease

108
Q

In order to be diagnosed with CKD, what levels do you have to report?

A

GFR less than 60 ml/min/1.73 m2 for 3 months or more, regardless of cause

109
Q

Clinical manifestations for CKD do no occur until when?

A

until renal function declines to less than 25% of normal

110
Q

What is the intact nephron hypothesis for CKD?

A

Loss of nephron mass with progressive kidney damage causes surviving nephrons to sustain normal function

111
Q

What are factors that advance CKD?

A
  1. proteinuria

2. angiotensin II

112
Q

What are factors that contribute to CKD progression?

A

Glomerular hypertension; hyperfiltration; tubulointerstitial injury; fibrosis

113
Q

CKD affects what part of the body?

A

every body system

114
Q

What is uremic syndrome?

A

pro inflammatory state with accumulation of urea and other nitrogenous compounds

115
Q

What does uremic syndrome cause?

A

alterations in fluid and electrolyte and acid-base balance

116
Q

What lab values does CKD increase?

A
  1. serum creatinine

2. urea

117
Q

How does CKD affect fluid and electrolyte balance?

A

mention of sodium, water, and potassium in late stages

118
Q

How does CKD affect calcium, phosphate, and bones?

A
  1. decreases calcium

2. increase phosphate levels

119
Q

How does CKD affect acid-base imbalance?

A

metabolic acidosis is common

120
Q

How does CKD affect protein, carb and fat metabolism?

A
  1. negative nitrogen balance, serum protein decreases
  2. glucose intolerance
  3. high ratio of LDL to HDL, high triglycerides
121
Q

How does CKD affect cardiovascular system?

A

CV disease, anemia, hypertension

122
Q

How does CKD affect pulmonary system?

A

dyspnea; kussmaul

123
Q

How does CKD affect hematologic system?

A
  1. normochromic normocytic anemia

2. impaired platelet function and hyper coagulability

124
Q

How does CKD affect the immune system?

A
  1. immune suppression
  2. deficient response to vaccination
  3. increased risk for infection
125
Q

How does CKD affect eh neurologic system?

A
  1. impaired concentration
  2. memory loss
  3. impaired judgement
  4. seizures, coma
126
Q

How does CKD affect the gastrointestinal system?

A
  1. uremic gastroenteritis: bleeding ulcer and sig blood loss
  2. anorexia, nausea, vomiting, constipation or diarrhea
  3. uremic fetor: bad breath
  4. malnutrition: common
127
Q

How does CKD affect the endocrine and reproductive system?

A
  1. Decreased libido
  2. Insulin resistance
  3. Low thyroid hormone levels
128
Q

How does CKD affect the integumentary system?

A
  1. Anemia
  2. Bleeding
  3. Retained urochromes: sallow skin color
  4. Hyperparathyroidism and uremic skin residues (uremic frost)
129
Q

How do you treat CKD?

A
  1. Manage protein intake
  2. Supplement vitamin D
  3. Maintain sodium & fluid
  4. Restrict potassium
  5. Manage dyslipidemia
  6. Maintain adequate caloric intake
  7. Erythropoietin as needed
  8. ACE inhibitors/receptor blockers (control HTN and protect kidneys)

NURS 350 (6 decks)

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