Exam 3 Study Guide - Renal/Urinary System

Question 1

Renal Aged Related Changes

Answer 1

• Dcrd glomerular filtration rate (GFR)
• Nocturia
• Dcrd bladder capacity
• Weakend urinary sphincter muscles & shortened urethra in women
• Tendency to retain urine

Question 2

Assessment

nutrition
meds
family
current

Answer 2

• Hx
• Nutrition
  > diet or recent changes in diet
  > daily fluid intake (2L/day unless fluid restriction)
• Medications
  > prescription drugs
  > antibiotics
  > OTC drugs: high-dose or long-term of NSAIDs or acetaminophen can seriously reduce kidney func
• Family hx & genetic risk
• Current health problems
  > document current health problems
  > assess changes in appearance of urine, pattern of urination, ability to initiate or control voiding, other unusual symps

Question 3

Physical Assessment

Answer 3

• General appearance
• Skin assessment
• Edema
• Lung sounds
• Weight, BP
• LOC & alertness
• Abd assessment: check for bladder distension

Question 4

Serum Creatinine

Answer 4

• produced when muscle & other proteins are broken down
• excreted by kidneys
• no common pathologic condition other than kidney diseases incrs the lvl
• doesn’t incr until at least 50% of kidney func is lost
• Males: 0.6-1.2mg/dL
• Females: 0.5-1.1mg/dL
  > incrd lvl: kidney impairment
  > dcrd lvl: dcrd muscle mass

Question 5

Serum Blood Urea Nitrogen (BUN)

Answer 5

• Measures the effectiveness of kidney excretion of urea nitrogen, a by-product of protein breakdown in liver
• Kidneys filter urea nitrogen from blood & excrete waste in urine
• Other factors influence BUN level
  > an elevation doesn’t always mean kidney disease is present
• 10-20mg/dL
  > incrd: liver or kidney disease, dehydration, dcrd kidney perfusion, infection, high-protein diet, GI bleeding, etc
  > dcrd: malnutrition, fluid vol excess, severe hepatic damage

Question 6

Glomerular Filtration Rate (GFR)

Answer 6

Dcrd lvls indicative of kidney failure

Question 7

Lab Assessment

Answer 7

• Urinalysis
• Urine culture & sensitivity
• Composute urine collections (24hr)
  > all urine in the designated time frame must be collected
• Creatinine clearance
  > measure of glomerular filtration rate & kidney function

Question 8

Bladder Scanners

Answer 8

• Used to screen for post-void residual volumes
• Non invasive method to determine the need for intermittent catheterization

Question 9

Imaging Assessment

Answer 9

• KUB; x-ray of kidneys, ureters, & bladder
• CT of abdomen
  > oral & IV dye usually given
  > when dye used ensure incrd fluid intake to dilute & excrete dye
  > may use diuretics immediately after dye is injected to enhance dye excretion in pts who are well hydrated
  > hold Metformin (Glucophage) 24hrs prior & 48hrs after procedure or until adequate kidney func has been determined
• MRI
• Ultrasonography
  > requires a full bladder
  > to identify size of kidneys or obstruction in kidneys or lower urinary tract
• Renal Scan
  > radioisotope injected IV to examine perfusion, func, & structure of kidneys

Question 10

Cystoscopy or Cystourethroscopy

Answer 10

• Endoscopic procedure performed for diagnosis or treatment
• Operative procedure & informed consent required
• General or under local anesthesia w/ sedation
• Prep: light evening meal, NPO after mid, bowel prep
• PostOp Care:
  > observe for changes in VS & urine output
  > monitor for bleeding & infection
  > oral or IV fluids to incr urine output
  > may have a catheter postop

Question 11

Cystography & Cystourethrography

Answer 11

• X-rays using contrast dye/medium instilled directly into bladder
• enhances visibility of lower urinary tract
• dye is not nephrotoxic bc it doesn’t enter bloodstream & doesn’t reach kidney
• voiding cystourethrogram: x-ray taken during voiding
• monitor for infection, urine output
• encourage fluid intake

Question 12

Retrograde Procedures

Answer 12

• Retrograde
  > going against normal flow of urine
  > x-rays are taken after dye instilled in urinary tract
• Pyelogram
  > retrograde examination of ureters & pelvis of both kidneys
• Cystogram
  > retrograde examination of bladder
• Urethrogram
  > retrograde examination of urethra
• Instill dye into lower urinary tract using a cystoscope
• Prep: same as cystoscope
• Post: monitor for infection

Question 13

Urodynamic Studies

Answer 13

• Examines process of voiding & includes:
  > tests of bladder capacity, pressure, & tone
  > studies of urethral pressure & urine flow
  > tests of perineal voluntary muscle func

Question 14

Kidney Biopsy

Answer 14

• Most are performed percutaneously (through skin & other tissues)
  > guided by ultrasound or CT
• Informed consent required
• NPO for 4-6hrs b4 procedure
• Coagulation studies completed prior bc of risk for bleeding
• Local anesthesia w/ sedation

Question 15

Nursing Interventions Post Biopsy

Answer 15

• For 24hrs monitor dressing site, VS, urine output, H/H
  > major risk for bleeding
• Monitor for internal bleeding
  > suspected w/ flank pain, dcrd BP, dcring urine output
• Strict bed rest in a supine position w/ a back roll for 2-6hrs post biopsy
• Monitor for hematuria
  > most common comp
• If bleeding occurs, IV fluids & PRBCs may be required
• If bleeding is extensive, surgery or a nephrectomy may be required