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Nursing 314: Assessing and Promoting Wellness > Exam 3: Urinary system assessment > Flashcards

Exam 3: Urinary system assessment Flashcards

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1
Q

Key anatomical components of renal system

A 
Kidneys 
Ureters 
Bladder 
Sphincters 
Urethra
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2
Q

Primary function of renal system is to

A

maintain homeostasis by controlling the composition and volume of extracellular fluid

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3
Q

___% of cardiac output circulates through the kidneys

A

25%q

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4
Q

Formation of urine requires 3 steps:

A

Glomerular filtration
tubular reabsorption
tubular secretion

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5
Q

Filtration

A

Pressure forces liquids and dissolved substances through anatomical filtration –> filtrate created

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6
Q

Glomerular filtration rate (GFR):

A

Amount of filtrate formed/minute

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7
Q

GFR is directly relates to

A

Renal perfusion

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8
Q

Low bp/low volume =

A

low perfusion

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9
Q

High bp/high volume =

A

Increased perfusion

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10
Q

Impaired circulation =

A

low perfusion

~125 mL/min

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11
Q

Urine output at least

A

30 mL/hr

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12
Q

Urine output calculation

A

0.5-1.5ml/kg/hr

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13
Q

Bladder smooth muscle is supplied by

A

many parasympathetic fibers

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14
Q

The internal urethral sphincter is also

A

Smooth muscle

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15
Q

Internal urethral sphincter is under ____ control

A

Parasympathetic control

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16
Q

The external urethral sphincter is

A

composed of skeletal muscle

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17
Q

External urethral sphincter is under ____ control

A

Voluntary

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18
Q

External urethral sphincter can be tightened to

A

prevent urination even when the bladder is contracting and the internal sphincter is open

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19
Q

When relaxed and filled, both sphincters are

A

Closed to keep urine from dribbling out

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20
Q

Motor neuron inhibits external sphincter:

A

Relaxes and opens

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21
Q

Under voluntary control, impulses from cerebral cortex override

A

the reflex input from stretch receptors

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22
Q

Adults bladder capacity

A

600 mL

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23
Q

Adult urge to urinate is at

A

250 mL

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24
Q

Why are women more at risk for UTIs

A

because women have a 2 inch urethra while men have an 8 in

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25
Q

Children bladder capacity

A

50-60 ml

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26
Q

Pregnant women experienced increased frequency of urination due to

A
  • Increased GFR secondary to increased blood volume

- Pressure of gravid (pregnant) uterus on bladder

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27
Q

Older male adults experience

A

Prostate enlargement which causes urination frequency and retention

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28
Q

How does menopause impact urination

A

frequency, nocturne, loss bladder tone, retention, residual urine–> increase UTI

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29
Q

By age 80, ____ of glomeruli are not function

A

40% of glomeruli

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30
Q

Th darker the urine, the more

A

concentrated

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31
Q

I & O

A

Intake/output

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32
Q

UA

A

urinalysis

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33
Q

What is in urinalysis

A

Albumin creatinine ratio

urine specific gravity

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34
Q

Urine specific gravity range

A

1.010 - 1.025 WNL

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35
Q

Urine specific gravity measures

A

Concentration/density

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36
Q

High number of urine specific gravity =

A

concentration urine = heavier weight/ml.

-indiacator of hydration

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37
Q

Blood tests of renal function and urinary status

A

BUN (blood urea nitrogen)

Serum Creatinine

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38
Q

Serum blood urea nitrogen

A

BUN

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39
Q

Serum blood urea nitrogen (BUN) normal

A

10-20 mg/dl

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40
Q

Urea:

A

End-product of protein metabolism

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41
Q

Urea is formed in the

A

Liver

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42
Q

Urea is eliminated by

A

Kidneys

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43
Q

Serum blood urea nitrogen (BUN) reflects

A

Liver’s ability to make urea AND kidney’s GFR

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44
Q

is serum blood urea nitrogen (BUN) as reliable as creatinine lab?

A

NO! not as reliable

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45
Q

Serum blood urea nitrogen (BUN) is usually measured in conjunction with

A

creatinine

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46
Q

Key factors that influence Serum blood urea nitrogen (BUN)

A

Impaired LIVER function
Hydration status
Nephrotoxic drugs

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47
Q

Why is BUN not the best measure of kidney function?

A

Because of the impact of the liver

48
Q

Normal ranged of serum creatinine

A

0.5 - 1 mg/dL

49
Q

Creatinine is a product of

A

Metabolism

50
Q

Creatinine is produced and released into plasma at a

A

Constant rate and freely filtered glomerulus

51
Q

Serum creatinine is a ___ estimate of ___ than BUN

A

Better estimate of renal function and GFR THAN BUN

52
Q

Blood creatinine and GFR relationship

A

Inversely related

53
Q

Low GFR means less creatinine filtered out to urine =

A

Blood creatinine levels are HIGH

54
Q

Higher GFR means more creatinine filtered out =

A

Blood creatinine levels are low

55
Q

Factors that influence creatinine levels

A 
Impaired renal function
Muscle mass/wasting
Nephrotoxic drugs
Exercise (break down muscle)
Any state that decreases GFR will increase serum creatinine
56
Q

BUN to creatinine ratio is usually

A

10 : 1

57
Q

Creatinine clearance estimates

A

GFR; amount of blood the kidneys make creatinine-free / minute

58
Q

Measuring creatinine present in a

A

24- hour sample of urine

59
Q

the time for sampling urine starts immediately

A

AFTER emptying the bladder!

60
Q

How to calculate creatinine clearance

A

Use a normal serum creatinine level & plug it into a formula

61
Q

Urinary Albumin to creatinine ratio is a newer method for

A

detecting protein excretion

62
Q

Is albumin creatinine ratio impacted by hydration?

A

Less impacted because it is not a concentration/mL

63
Q

Microalbuminuria

A

ACR 30-300 mg/g

64
Q

Microalbuminuria refers to

A

Albumin excretion above normal range but below the level of detection by tests for total protein

65
Q

Macroaluminuria

A

ACR >300

66
Q

Macroaluminuria refers to

A

higher elevation of albumin associated with progressive decline in glomerular filtration rate

67
Q

What is reported with renal infection

A

Flank pain during costovertebral angle assessment

68
Q

Tenderness/sharp pain during costovertebral angle assessment may indicate

A 
pyelonephritis (kidney infection)
renal calculi (renal stones)
hydronephrosis (distention of the kidney with urine as a result of obstruction of the outflow of urine)
69
Q

Noninvasive diagnostic TEST! (not lab)

A

Abdominal Roentgenogram: x-ray
Computerized Axial tomography (CT): imagery via cross-sectional imaging
Intravenous pyelogram (IVP): Image via x-ray using contrast dye
Ultrasound: sound waves

70
Q

Invasive diagnostic TEST (not labs)

A

Endoscopy-cystoscopy: scope through urethra to visualize, obtain specimen, instill treatment

71
Q

Common Urinary diagnosis

A 
Urinary Retention
UTI
Incontinence
Diversions (not discussed here)
Renal Failure (not discussed here)
BPH
Pelvic Organ Prolapse (POP) (less common, but worth mentioning)
72
Q

Urinary retention

A

Partial or complete inability to empty bladder

73
Q

Urinary retention can lead to

A

UTI/Sepsis

Overflow incontinence

74
Q

Urinary retention can often happen after

A

Catheter removed

75
Q

Monitor for urinary retention by using

A

Post Void Residual machine (PVR)

Straight catheterization

76
Q

Benefits for women of pelvic floor exercises

A 
Strengthen pelvic floor muscles and restore vaginal tone
Prevent/treat stress incontinence
Prevent/treat fecal incontinence
Recover from childbirth
Improve sexual sensation/function
77
Q

Benefits of pelvic floor exercises for men

A 
Strengthens pelvic floor muscles especially after prostatectomy
Prevent/treat stress incontinence
Prevent/treat fecal incontinence
Helps with erectile dysfunction
Improves sexual sensation/function
78
Q

Pelvic organ prolapse

A
  • Muscles and ligaments supporting a woman’s pelvic organs weaken
  • Pelvic organs can drop lower in the pelvis, creating a bulge in the vagina (prolapse).
  • Women most commonly develop pelvic organ prolapse years after childbirth, after a hysterectomy, or after menopause.
79
Q

Intermittent urinary catheterization

A

Bladder decompression, sterile specimen, assessing residual, spinal cord injury

80
Q

urinary catheterization indwelling; short term

A

inter-operative/immediate post-op; critical care, BPH, bladder irrigation

81
Q

urinary catheterization indwelling; long term

A

severe urinary retention, avoidance of urine contact with skin, terminal illness

82
Q

Risks of urinary catheterization

A

Trauma to urethra: urethritis

Infection

83
Q

___ % of UTIs are related to an indwelling catheter

A

80% of UTI

84
Q

Infection risk of infections increases ________ catheter is in place

A

increases 3 - 10 % each day

85
Q

Safety guidelines to follow for urinary catheterization

A

Catheter - associated urinary tract infections (CAUTI) guidelines

86
Q

UTI is an infection in

A

ANY part of the urinary system

87
Q

In older adults, UTIs clinical manifestations

A

Asymptomatic OR

Change in LOC/confusion

88
Q

UTI in elder w/indweliing catheter is usually

A

Poly-microbial

89
Q

Microbes ascend urethra and infect

A

Bladder (Cystitis)

Kidneys (Pyelonephritis)

90
Q

UTI may progress into

A

Septic shock

91
Q

treatment for UTI

A

Antibiotics, hydration

92
Q

Efficacy of cranberry products for UTI is

A

heavily debated

93
Q

Benign prostatic hyperplasia (sometimes called hypertrophy) occurs when

A

prostate cell proliferation exceeds programmed cell death (apoptosis) as a result of stimulated cell growth, inhibition of apoptosis, or both

94
Q

Most common benign tumor in men

A

Bengin prostatic hyperplasia

95
Q

As prostatic enlargement occurs, mechanical obstruction results

A

Can progress to complete obstruction

96
Q

Benign prostatic hyperplasia and prostate cancer are

A

Genetically distinct, one is NOT at risk for the other

97
Q

Medications for BPH

A

Alpha adrenergic antagonists

98
Q

DRE =

A

Digital rectal examination for swelling

99
Q

DRE =

A

Digital rectal examination for swelling

100
Q

PSA

A

Prostate specific antigen in blood

101
Q

BPH

A

Benign prostatic hyperplasia

102
Q

TUIP

A

Transurethral incision of the prostate

103
Q

TURP

A

Transurethral resection of the prostate

104
Q

Urine can change color due to different

A

Drugs or conditions

105
Q

Etiology of functional incontinence

A

person’s physical ability to get to the toilet is underlying cause
- NOT related to urinary function

106
Q

Causes/examples of functional incontinence

A 
Sensory impairment 
Cognitive impairment 
Mobility issues 
Dexterity issues 
Environmental barriers 
Neglect
107
Q

Population most affected by functional incontinence

A

Frail elderly
Nursing home residents
Persons with dementia
Neglect at any age

108
Q

Etiology of overflow incontinence

A

Over-distended bladder r/t functional/mechanical obstruction of outflow
– may be secondary to poor muscle tone

109
Q

Causes/examples of overflow incontinence

A

Enlarged prostatic, fecal impaction, DM neuropathy

ex) dribbling or constant loss

110
Q

Population most affected for overflow incontinence

A

Men w/ large prostate
Those on C+ channel blockers, anticholinergics, adrenergic
Diabetics in advanced stages OR easier with HX poor BG control

111
Q

Stress incontinence etiology

A

Weak EXTERNAL sphincter/pelvic floor overwhelmed by intra-abdominal pressure

112
Q

Causes/examples of stress incontinence

A

Cough
sneeze
laugh
exercise

113
Q

Stress incontinence: population most affected

A

women: During/post pregnancy
Obese persons
Men AFTER prostatectomy

114
Q

Urgent/urgency incontinence etiology

A

Detrusor instability and weak INTERNAL sphincter

-Neurological issues, bladder inflammation (UTI)

115
Q

Urge/urgency causes/examples

A 
Strong NEED/URGE with involuntary contractions w/ passage of urine.
Overactive Bladder (OAB)
116
Q

Population most affected: urge/urgency incontinence

A

Often idiopathic.
UTI
Older persons (men somewhat more affected)

Nursing 314: Assessing and Promoting Wellness (26 decks)

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