Exam #6 Flashcards
1
Q
urinary system
A
- upper: kidneys and urethra
- lower: bladder and urethra
2
Q
fxn of urinary system
A
- regulate volue and composition of ECF
- excrete waste products
- Control BP: renin production
- produce erythropoietin: RBC production
- Activate Vit D
- Regulate acid-base balance
- filter the blood
- maintain homeostasis
- nephron is the functional unit: golmerulus, bowman’s capsule, tubular system
- Blood supply: receives 20-25% of cardiac output - renal artery arises from the aorta
- glomerular function: blood is filtered by hydrostatic pressure
- glomerular filtration rate GFR: normal is 125 ml/min
3
Q
structures of urinary system
A
- ureters: join the renal pelvis to the bladder
- bladder: serves as resevoir for urine, capacity 600-1000ml, detrusor is the muscle, urination/micturation/voiding
4
Q
urinary system gerontologic considerations
A
- lose 30-50% of glomeruli fxn by age 70
- atherosclerosis accelerates decrease in kidney size
- decreased renal blood flow, decreased GFR
- decreased urinary concentrating ability
- alterations in excretion of water, sodium, potassium and acid
- loss of elasticity, vascularity, and structure of the female genitalia
- enlarged prostate for men
- decreased: filtration, GFR, concentration
5
Q
urinary system assessment data
A
- color changes in urine
- tired all the time
- bladder tumors: higher incidence in textile workers, painters, smokers, hairdressers, industrial workers
- kidney stones: higher risk in great lakes, southwest, southeast (minerals in water)
- family history
- pneumonia breath
- midline mass in lower abdomen: urinary retention
- unilateral mass: enlargement of kidnye
- kidneys are usually not palpable
- bladder is usually not palpab
- CVA tenderness: finds kidney issues
- use bell of scope to listen over both CVAs and in upper abdomen
- bruit = renal artery issue
6
Q
diet and urination
A
- dietary intake and effects on urine output
- dehydration: increased risk of UTI, stones and renal failure
- large daily intake of dairy products or foods high in protein increase risk of stone formation
- asparagus makes urine smell musty
- beets make urine pink
- caffeine, alcohol, carbonated drinks, spicy foods can aggravate inflammation
- herbal teas cause diruesis
7
Q
other urinary problems
A
- bleeding: infection, bladder irrigation
- nocturia: normal once a night or twice if older
- creed’s method: push down on bladder to urinate
- valsalva maneuver: pushes down
- heavy lifting and driving can cause issues in men
8
Q
normal kidney assessment
A
- no costovertebral angle tenderness
- nonpalpable kidney and bladder
- no palpable masses
- r. kidney is lower than left
9
Q
kidneys and drugs
A
- NSAIDs: decrease renal perfusion
- increased sodium: sodium and water retention
- contrast can injure kidneys
- OTCs that are toxic to kidneys/nephrotoxic: bacitracin, gentamicin, neomycin, captopril, ccaine, heroin, NSAIDs, ibuprofen, rifampin, salicylates, gold, heavy metals
- color changes: pyridium, macrodantin
- anticoags: may cause blood
- many antidepressants/calcium channel blockers/antihistamines/neuro and musculoskeltela drugs can affect the bladder sphincters and contractility
10
Q
important urinary terms
A
- dysuria: painful urination
- nocturia: frequency of urination at night
- hematuria: blood in urine
- enuresis: involunaty nighttime urination
- anuria: no urination
- oliguria: decreased amount of urine (100-400)
- polyuria: large volume or urine
11
Q
urine studies
A
- UA: first study to be done, first void of morning, examine within 1 hour
- creatinine clearance: most accurate indicator of renal function, closely approximates GFR, must also get a blood specimen for creatinine during the 24 hr test
- 24 hr studies: discard first void to start the test, save urine for 24 hrs, have pt void at the end of the collection to compete the test
- culture: after cleaning have pt start urinating and then void into sterile container (mid stream)
- residual: catheterize patient imediately after voiding or use bladder ultrasound
- cytology: done if bladder cancer is suspected, do NOT use mornings first voided specimen, looks for abnormal cells related to cancer
12
Q
urinalysis
A
- color: straw, clear is normal
- protein: increased by renal failure and nonrenal causes
- specific gravity: 1.003-1.030
- PH 4-8
- RBCs, WBCs, glucose, ketones, bilirubin, casts: should all be negative in urine
13
Q
Urinary Blood studies
A
- BUN 6-20: can be affected by non-renal factors - dehydration, fever, GI bleed, trauama
- creatinine 0.6-1.3: end product of muscle and protein metabolism, more reliable than BUN
- potassium 3.5-5.0: 1st electrolyte to appear abnormal with kidney issues
- sodium 135-145
- biacrbonate 22-26
14
Q
urinary radiologic studies
A
- KUB: kidneys ureters bladder - xray exam of abdomen and pelbis shows size, shape and position of kidneys
- Intravenous Pyelogram IVP: shows IV tract after IV injection of contrast media - don’t do if pt has renal failure, need bowel prep, force fluids after procedure, watch urine output carefully after procedure
- retrograde pyelogram: contrast injeted and xray taken of urinary tract. cycstscope is inserted and ureteral catheters are inserted through it into renal pelvis, done in urology office, takes 15-30 minutes
- renal arteriogram (angiogram): visualizes renal blood vessels. catheter inserted into renal arteries, contrast media is injected, post procedure care is like cardiac cath (pressure dressing, watch for bleeding, check for pulses)
- renal ultrasound: no bowel prep is needed, looks at UA tract
- CT/MRI: looks for stones, obstructions
- cystogram: radioactive solution injected into bladder via cystoscop or catheter; visualizes bladder and evaluates vesicouretal reflux, neurogenic bladder, recurrent UTIs
- urethrogram: contrast media is injected into urtehtra to look for strictures, diverticular, may do this before catheterization if trauma is expected
- VCUG voiding cystourethrogram: voiding study of the bladder opening and urethra, bladder is filled with contrast media then films are taken, antoher film is taken during and after urination to look for residual urine
- contrast is bad for failing kidneys
15
Q
cystoscopy
A
- looks at interior of the bladder with lighted scope
- can also be used to insert uretral catheters, remove stones, obtain biopsies, treat bledding lesions
- lithotomy position
- force fluids before procedure
- post procedure expect burning, pink tinged urine, urinary frequency
- call for bright red bledding or temperatue
16
Q
urodynamics
A
- urodynamic stidies measure urinary tract function
- study the storage of urine within the bladder and the flow of urine through the urinary tract to the outside of the body
- combination of techniques may be used to provide a detailed assessment of urinary function
- exps: urine flow study, cystometrogram, sphincter electromyography, voiding pressure flow study, videourodynamics
17
Q
urinary diagnostic scans
A
- renal scan: looks at structure and perfusion of kidneys, IV radioactive isotopes are given, increase fluid post op to rid contrast
- renal biopsy: puncture lower lobe of kidney, dont do it if they have a bleeding disorder, single kidney or uncontrolled HTN, post procedure apply pressure dressing, keep on affected side for 30-60 minutes, bed rest for 24 hours, frequent vital signs, watch for hematuria
18
Q
Normal CBC ranges
A
- Hgb, hemoglobin: gas carrying capacity of RBCs - 11.7-17.3
- Hct, Hematocrit: measure of packed cell volume of RBCs expressed as percentage of total blood volume, 35-50%
- Total RBC count: 3.8-5.7
- WBC count: 4-11, 4000-11000
- platelet count: 150-400, 150000-400000
- Activated Clotting Time, ACT: coagulation status, 70-120 sec
- Activated partial thromboplastdin time, aPTT: coagulation by measuring intrinsic clotting factors, 25-35 secs
- International normalized ratio, INR: prothormbin time compared with controled value, 2-3
- Prothorbin time, PT: extrinsic coagulation factors, 11-16 secs
- thrombin time: adequacy of thrombin, 17-23 secs
19
Q
Urinary Tract Infection
A
- very common, esp in women
- escherichia coli most common pathogen
- upper UTI: renal parenchyma, pelbis, ureters, causes fever/chills/flank pain, pyelonephritis
- lower UTI: usually no systemic manigestations; dysuria, frequency, urgency, hematuria, cloud urine; cystitis, urethritis
- elderly: diffuse abdominal pain. cognitive impairment
- UTI can develop into septic shock and urosepsis
- uncomplicated UTI: occurs in otherwise normal urinary tract, usually involves only the bladder
- complicated UTI: coexists with presence of obstruction, stones, catheters, diabetes/neurologic diseases, pregnancy induced changes, recurrent infection
20
Q
UTI diagnosis
A
- dipstick: looks for nirtrites, WBCs, leukocyte esterase
- urine C&S: specimen by catheter or suprapubic needle aspriation more accurate
- CT urography or US when obstruction suspected
21
Q
UTI treatment
A
- uncomplicated: short course of antibiotics 1-3days
- complicated: longer term- 7-14 days
- TMP/SMX bactrim bid: give morning and evening
- Nitrodurantoin, macrodantin 2-4 x day: avoid sunlight, use sunscreen, wear protective clothing
- ampicillin, amoxicillin, cephalosporins
- pyridium is better than tylenol for pain: turns urine red/orangce
- may take prophylactic abx before intercourse or something that makes you prone to UTIs
- fluoroquinolones: treat complicated UTIs, cipro (acciles tendon rupture)
- antifungals for UTIs due to fungi: amphotericin or fluconazole
22
Q
UTI prevention
A
- empty ladder regularly and completely, q 3-4 hrs
- evacuate bowel regularly
- wipe from front to back
- drink lots of fluids
- daily cranberry juice
- take al abx as ordered
- empty bladder before and after intercourse
- no douches, soaps, powders, sprays, bubble baths
- avoid caffeinie, alcohol, citris juices, chooocalte, spicy foods
- local heat or warm bath, temporarily stop using diaphragm
- Hospital acquired infections: avoid caths if possible, remove caths ASAP, wash hand
23
Q
acute pyelonephritis
A
- inflammation of renal parenchyma (fxn part of kidney that makes urine) and collecting system
- causes: bacterial infection, fungi, protozoa, viruses
- usually starts with lower UTI and a preexisting factor
- most common caused by bacteria
- reoccuring infections can cause scaring, kidney malfunction, chornic pyelopnephritis
- S/S: mild fatigue, chills, fever, vomitin, malaise, flank pain, dysuria, urgency, frequency, CVA tenderness
24
Q
acute pyelonephritis diagnosis
A
- labs:
- pyuria (WBCs and pus in urine), bacteriuria, hematuria, WBC casts, positive urine culture
- Urine culture and sensitivity
- CBC leukocytosis
- radiology
- renal ulrasound
- CT urography
- do NOT do an IVP, contrast can cause infection
25
Q
acute pyelonephritis treatment
A
- severe with complications –> hospitalization (n/v, dehydration)
- mild –> treat as outpatient, abx 14-21 days, symptoms improve within 2-3 days
- if relapse, another 6 weeks of abx
- fluids, rest, risk of septic shock
26
Q
urosepsis
A
- systemic infection from urologic source: close observation and vital sign monitoring
- prompt diagnosis and treatment critical: can lead to septic shock and death
- septic shock: outcome of unresolved bacteremia involving gram-negative organism
27
Q
chronic pyelonephritis
A
- kidneys become small, atrophic, shrunken, and lose fxn due to scarring or fibrosis/scarring
- caused by recurring infections
- diagnosed by imaging, not by symptoms
- often progresses to end stage renal disease esp if both kidneys are involved
28
Q
urethritis
A
- inflammation of urethra
- most common cause in men is STDs
- gonococal: prulent discharge
- can cause stricture
- hard to diagnose in women
- tx: bactrim, macrodantin, other ABX specific for infection
- important to avoid intercourse until symtoms subside and treat sexual partners from last 60 days
29
Q
urerthral stricture
A
- usually result of fibrosis or inflammation from trauma, gonococall urethritis, surgery or frequent caths, congenital defects, BPH
- S/S: diminished forec of urine stream, straining to void, spraying streatm, post-void dribbling, split urine stream, incomplete bladder emtpying, frequency nocturia
- risk of acute urinary rentention, an emergency
- diagnosis: retrograde urethrography, VCUG
- tx: dilation, self cath every few days if reoccurance
30
Q
interstitial cystitis
A
- painful bladder syndrome, chronic, not infection but inflammation
- S/S: bladder pain, urgency, frequency, pain during intercourse
- pain is worsened with bladder filling, post poning urination, physical exertion, pressure against suprapubic area, eating certain foods, stress
- pain temporarily relieved by urination
- diagnosis of exclusion
- UTI can be a complication
31
Q
interstitial cystitis tx
A
- avoid bladder irritants (coffee, OJ, multivitamins)
- prerelief with OTC meds to alkalinize the urine
- elavil or nortriptuline for burning pain
- no drugs provide immediate relieve so may need opioids
- can give meds directly into the bladder (lidocaine, BCG)
- avoid tight wastebands, tight belts
32
Q
glomerulonephritis
A
- immune disorder caused by antibody-induced injury or deposition of immune complexes
- S/S: hematuria, prtoeinuria, urinary excretion of RBCs, WBCs, casts, elevated BUN and creatinine, swollen face, blood in urine, decreased urine output, increased BP
- oftentimes have history of drug exposure, infections, immune disorders
- most commonly associated with strep
33
Q
acute poststreptococcal glomerulonephritis
A
- develops 5-21 days after strept throat infection
- S/S: body edema, HTN, smoky or rust colored urine, proteinuria, oliguria, abdominal/flank pain (no UTI symptoms of burning)
- diagnosis: positive ASO titers, erythrocyte casts
- do renal biopsy
- tx: rest, restricted sodium and fluid intake, dieuretics, HTN meds, may restrict protein, only give abx if strep infection is still present
- 95% recover completely
34
Q
goodpasture syndrome
A
- rare autoimmune disease seen mostly in young, male smokers
- s/s: flu like symptoms with pulmonary symptoms, hematuria, weakness, pallor, anemia
- diagnosis: serum anti-gbm antibodies, low hgb/hct (due to decreased EPO made in kidneys), elevated BUN and creatinine
- tx: corticosteroids, plasmapheresis, immunosuppressants, dialysis, renal transplant
35
Q
nephrotic syndrome
A
- glomerulus is excessively permeable to protine causing proteinuria, hyperlipidemia, hypoalbuminemia, weight gain, dereased serium protein
- causes: lupus, DM, infections, lymphoma, tumors, leukemias, bee sting, heroin
- s/s: edema (anasarca, head to toe massive amts of edema), HTN, proteinuria, hyperlipidemia, weight gain, hypoalbuminemia, decreased serum protein
- cx: infection, thromboembolisms, wasting, edema, rickets, altered blood lipids
- tx: symptom control, low sodium diet, low to moderate protein diet, corticosteroids
36
Q
obstructive uropathies
A
- anatomic or functional condition that blocks urine flow: congenital or acquied
- infection increaesd risk of irreversible damange
- can lead to reflux, hydroureter, hydronephrosis
- tx: relieve blockage
37
Q
urinary tract calculi
A
- kidney stones
- 1-2mil in US have nephrolithiasis (kidney stones)
- more common in men
- avg age of onset: 20-55
- increased incidence: white, family history, previous history (reoccurs in 50%), summer months (suggests dehydration)
38
Q
nephrolithiasis (kidney stones)
A
- more common with urinary diversions, long term catheters, neurogenic bladder, urinary retention
- can get infected
- calculus: stone
- lithiasis: stone formation
- calcium stones are the most common type
- keep urine dilute and free flowing
