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NURS 313R > Exam 3: Disorders Of The Renal/Urinary System > Flashcards

Exam 3: Disorders Of The Renal/Urinary System Flashcards

1
Q

What is the kidney?

A
  • Paired, bean shaped organ
  • Retroperioneal, at the level of T12 and L3
  • Primary function is to eliminate toxic waste
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2
Q

Renal Cortex

A

Outer

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3
Q

Renal Medulla

A

Inner

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4
Q

Nephron

A

Functional unit of the kidney

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5
Q

The nephron consists of

A

Glomerulus
Bowman’s Capsule
Tubular System

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6
Q

Diagnostic Studies of the Urinary System include

A
  • Urinalysis
  • Creatinine Clearance
  • Urine Culture
  • Blood Chemistries: BUN, BUN/Creatinine ration, Electrolytes
  • Radiologic Procedure: KUB, IVP, Renal Arteriogram
  • Renal Biopsy*
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7
Q

Urinary Tract Infections

A

-Infection involving the upper and lower urinary tract

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8
Q

What is the most common pathogen that causes UTI’s?

A

E. Coli

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9
Q

What are the classifications of UTI’s?

A
  • Upper UTI
  • Lower UTI
  • Complicated vs. Uncomplicated UTI
  • Inital vs recurrent UTI
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10
Q

What is the difference between a complicated and uncomplicated UTI?

A

..

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11
Q

What are predisposing factors of UTI’s?

A
  • Tumor
  • Urinary Retention
  • Urinary calculi
  • Indwelling Catheter
  • Congenital Defect
  • Fistula
  • Shorter urethra
  • Immuno-compromised condition
  • Constipation
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12
Q

What are clinical manifestations of UTI’s?

A 
LOWER UTI S&S:
•	dysuria
•	urgency/ frequency of urination
•	suprapubic discomfort
•	gross hematuria
•	cloudy urine
UPPER UTI S&S:
•	flank pain
•	chills / fever
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13
Q

What are clinical manifestations of UTI’s in older adults?

A

S/s UTI are often absent in older adults
• cognitive impairment
• less likely to experience fever

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14
Q

What diagnostic studies are indicated for UTI’s?

A
  • Dipstick urinalysis
  • Urinalysis
  • Urine culture and sensitivity
  • IVP/ CT Scan
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15
Q

How would you treat an uncomplicated UTI?

A
  • 1-3 day treatment of ABT
  • Adequate fluid intake
  • Urinary analgesic
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16
Q

How would you treat a recurrent/uncomplicated UTI?

A

ABT for 3-5 days

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17
Q

Nursing Therapeutics for UTI’s

A
  • early removal of catheter, avoid unnecessary catheterization
  • local heat at suprapubic area or lower back
  • observe color or changes of urine
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18
Q

What foods/drinks should a patient with a UTI avoid?

A 
Caffeine
Alcohol
Citrus juice
Chocolate
Spiced food
Beverages
They are bladder irritants!!
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19
Q

What should the nurse teach the patient about managing or preventing a UTI?

A
  • emptying bladder regularly and completely
  • regular BM
  • wiping perineal area from front to back
  • adequate daily fluid intake 8-10 glass / day
  • warm shower. Or sit on tab of warm water
  • complete ABT
  • urinating after intercourse
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20
Q

What is glomerulonephritis?

A
  • Inflammation of the glomeruli of both kidneys.

- Immunologic process involving the urinary tract affecting the glomeruli

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21
Q

What are clinical manifestations of glomerulonephritis?

A
  • hematuria
  • presence of WBC in the urine
  • proteinuria
  • increase BUN and creatinine
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22
Q

What are clinical manifestations of acute postrepococcal glomerulonephritis?

A
  • generalized body edema
  • hypertension
  • oliguria
  • hematuria / smoky or rusty
  • abdominal or flank pain
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23
Q

What is the collaborative therapy/nursing therapeutics of glomerulonephritis?

A
  • Rest
  • Sodium restriction diet d/t fluid retention (edema)
  • Antihypertensive therapy
  • Diuretics d/t fluid retention
  • Low protein diet (to decrease level of proteinuria and uremia, kidneys unable to excrete urea a byproduct of protein breakdown)
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24
Q

Nephrolithiasis

A

Kidney stone disease

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25
Q

What are risk factors for urinary tract calculi?

A
  • increase urine level of calcium
  • warm climate
  • large intake of dietary protein
  • increase juice, tea intake
  • decrease fluid intake
  • family history of stone, gout
  • sedentary occupation, immobility
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26
Q

What are the clinical manifestations of urinary tract calculi?

A
  • abdominal or flank pain
  • hematuria
  • nausea , vomiting
  • mild shock due to pain, cool moist skin
  • s/s of UTI
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27
Q

Diagnostics Studies of Urinary Tract Calculi

A
  • urinalysis
  • pyelogram, IVP
  • ultrasound
  • cystoscopy
  • BUN / serum creatinine
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28
Q

What is the goal for collaborative care of urinary tract calculi?

A
  • Treatment system of pain, infection

- Evaluate the cause of stone formation

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29
Q

What collaborative care is implemented when treating patients with urinary tract calculi?

A
  • adequate hydration (urine output of 2 L/day)***
  • dietary sodium restriction (high calcium intake increases calcium excretion in urine)***
  • lithotripsy - used to eliminate calculi from urinary tract
  • strain all urine voided by the patient
30
Q

Urinary Diversions include

A
  • Ileal Conduit
  • Ureterostomy
  • Nephrostomy
31
Q

Ileal Conduit

A

Ureters are implanted into part of the ileum or colon, stoma is created

32
Q

Ureterostomy

A

Ureter are excised from the bladder and brought through abdominal wall, stoma is created

33
Q

Nephrostomy

A

Catheter is inserted in the renal pelvis brought out to drain to a collecting bag.

34
Q

Acute Renal Failure

A

Clinical syndrome characterized by a rapid loss of renal function with progressive anorexia and increasing level of creatinine.

35
Q

Azotemia

A

accumulation of nitrogenous waste product such as BUN

36
Q

Oliguria

A

Decreased urine output less than 400 ml/day

37
Q

What are the types of acute renal failure?

A
  1. Prerenal Failure
  2. Intrarenal Failure
  3. Postrenal Failure
38
Q

Prerenal Failure

A

Factors external to the kidney

39
Q

Causes of Prerenal Failure include

A
  • Hypovolemia
  • Decreased CO
  • Decreased peripheral vascular resistance
  • Decreased renovascular blood flow
40
Q

Intrarenal Failure

A

Condition that causes direct damage to the renal tissue

41
Q

Causes of Intrarenal Failure includes

A
  • Prolonged ischemia
  • Nephrotoxins
  • Hgb release from hemolyzed RBC
  • Myoglobin release from necrotic muscle cell
  • Primary renal disease
  • Others: Thrombotic disorders, toxemia and pregnancy
42
Q

Postrenal Failure

A

Involves the mechanical obstruction of Urinary outflow leading to urine reflux into the urinary pelvis impairing kidney function.

43
Q

Causes of Postrenal Failure include

A
  • BPH
  • Prostatic CA
  • Calculi
  • Trauma
  • Extrarenal tumor
44
Q

Acute Tubular Necrosis

A

A type of intrarenal failure caused by ischemia and nephrotoxins

45
Q

Pathophysiology of Acute Renal Failure

A
  • hypovolemia
  • decrease renal blood flow
  • stimulate rennin-angiotensin-aldosteron mechanism
  • constriction of the peripheral arteries/ renal arterioles
  • decrease renal blood flow / ischemia
  • decrease glomerular capillary pressure / damage to glomerular epithelial
  • decrease capillary permeability * necrotic cell accumulate in the tubule (cast) leads to obstruction
  • decrease GFR
  • tubular dysfunction * increase tubular pressure
  • glomerular filtrate leaks back to plasma
  • oliguria
46
Q

What are the phases of ARF?

A

I. Initiating Phase
II. Oliguric Phase
III. Diuretic Phase
IV. Recovery Phase

47
Q

ARF: Initiating Phase

A

Begins at the time of insult, until s/s becomes apparent

48
Q

ARF: Oliguric Phase

A

Most common manifestations of ARF is oliguria.

Prerenal and Intrarenal Oliguria

49
Q

Signs and Symptoms of Oliguric Phase

A
  • Urinary changes
  • Fluid volume excess
  • Metabolic acidosis
  • Sodium balance
  • Potassium excess
  • Hematologic disorder
  • Calcium/phospahate excess
  • Waste product accumulation
  • Neurologic disorders
50
Q

ARF: Diuretic Phase

A
  • gradual increase of urine output to 1-3 L/day – 3-5L/day

- caused by osmotic diuresis due to increase urea concentration in the filtrate and inability to conc. urine

51
Q

ARF: Recovery Phase

A
  • GFR begins to increase, BUN, creatinine decrease
52
Q

Diagnostic Studies for ARF

A
  • history and physical
  • identify precipitating factor
  • serum creatinine / BUN level
  • serum electrolyte
  • urinalysis
  • renal ultrasound
  • renal scan
  • retrograde peylogram
  • CT scan
53
Q

Collaborative Care for ARF

A
  • Treatment of precipitating cause
  • Fluid restriction
  • Nutritional therapy
54
Q

Nursing Therapeutics for ARF Includes

A
  • Health Promotion
  • Acute Intervention
  • Ambulatory Care
55
Q

Nursing Therapeutics of ARF: Health Promotion

A
  • monitor I & O in hospitalized patient

- streptococcal infection treated with ABT

56
Q

Nursing Therapeutics for ARF: Acute Intervention

A
  • emotional support
  • monitor and manage fluid and electrolyte during oliguric and diuretic phase
  • monitor s/s of hypervolemia
  • monitor arrhythmia
  • practice meticulous aseptic technique
57
Q

Ambulatory Care for ARF

A
  • Rest

- Good nutrition

58
Q

REVIEW VOICE OVER POWER POINT ON RENAL SYSTEM PART 1 AND 2

A

ON WEBCAMPUS

59
Q

Secondary function of the kidney is to

A
  • Control BP
  • Produce erythropoietin
  • Active vitamin D
  • Regulate acid-base balance
60
Q

Glomerulus

A
  • Urine function begins here, where blood is filtered.
  • Hydrostatic pressure of the blood within the glomerular capillaries causes a portion of the blood to be filtered across the semipermeable membrane into Bowman’s capsule.
61
Q

Bowman’s Capsule

A

Where the filtered portion of the blood begins to pass into the tubule system.

62
Q

Tubular System

A

Where reabsorption of essential materials and excretion of nonessential materials occur.

63
Q

Dipstick urinalysis

A

Used to identify presence of nitrites, WBCs and leukocyte esterase

64
Q

In a urine culture, no

A

No antiseptic is used as it could contaminate the specimen and cause false positives

65
Q

Phenazopyridine (Pyridium)

A

Urinary analgesic
Stains urine reddish orange**
Avoid long term use -> can cause hemolytic anemia**

66
Q

Treatment for complicated UTI

A

ABT for 7-14 days - Ciprofloxacin

67
Q

Pyelonephritis

A

Inflammation of the renal parenchyma, collecting ducts and pelvis

68
Q

Pyelonephritis: Common causes

A
  • Bacterial infection
  • Bacteria normally found in intestinal tract such as E. Coli
  • Vesicoureteral reflux (backward movement of urine from lower to upper urinary tract)
  • Dysfunction of lower urinary tract d/t obstruction.
  • Catheterization in long term care facilities
69
Q

Etiology of Pyelonephritis

A

Colonization and infection of the lower urinary tract via ascending urethral route

70
Q

Clinical Manifestations of Pyelonephritis

A 
Fatigue and malaise
Chills and fever
Flank pain
Vomiting
Dysuria, urgency and frequency
Costovertebral Tenderness
71
Q

Collaborative care for Pyelonephritis

A

14-21 days ABT
Parenteral ABT given in hospital THEN PO medications for 14-21 days.
S&S resolve 48-72 hours after starting therapy.
Relapses treated with a 6 week course of ABT

72
Q

What are the common causes of glomerulonephritis?

A

Commonly happens after group A streptococcal infection.

NURS 313R (18 decks)

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