Fund 50 week 3 - day 1.2 - elimination Flashcards
Upper urinary system: (just amount per kg)
just ureter and Kidneys
Normal urine output: 0.5-1.5 mL/kg/hour.
women urethra - 2 inches
men - 6 - 8 inches
Lower urinary system
Bladder and urethra.
❖(he didn’t even discuss this #, don’t worry about it) Avg bladder 500 ml of urine in women and 700 ml in men.
function of kidneys(a wet bed p) (taking acid)
❖ A – Acid base balance (bicarbonate)
❖ W- Water balance
❖ E- Electrolyte balance via selective
reabsorption and excretion of electrolytes
and substances
❖ T –Toxin removal (Filters and excretes end
products of metabolic waste e.g. urea,
creatinine, ammonia, and uric acid)
❖ B- Blood pressure regulation via renin-
angiotensin system
❖ E- Stimulates Erythropoietin to produce
RBC
❖ D -Converts vitamin D on the skin to the
active form 1, 25- Vit D
❖ P – Protein regulation: albumin,
erythropoietin, and vitamin D-binding
protein.
❖ Neurogenic bladder
result of neurological condition
❖ Spinal cord injury, neurodegenerative d/o, cauda equina
Acute renal injury (AKI) (what drops, and what causes it - 2 things -either injuring it or blocking it)
❖ Acute drop in blood pressure
❖ Injury to the glomeruli or tubules
❖ Obstruction of kidney outflow leading to hydronephrosis
Chronic kidney disease (CKD) (diseases that cause it - diabetes is chronic)
❖ Slow loss kidney function over months and years
❖ Caused by HTN - high blood pressure, DM, glomerulonephritis, heart failure
ESRD - End Stage Renal Disease (what rises on blood test (what is always measured for kidneys), and what happens to ppl with ESRD?)
usually can’t make any urine
➢ chronic rise in serum creatinine leading renal failure
➢ requires life-long dialysis or renal transplant
diagnostic lab of renal function(comprehensive)
MOST important thing to remember is you need comprehensive tests to assess renal function
BUN Byproduct from protein catabolism.
Cleared by kidneys, Not specific to
renal function
8-25 mg/dl
Protein breakdown, dehydration,
overhydration, liver failure influence
value
Creatinine
Creatinine Byproduct of skeletal muscle cell
metabolism; evaluates nephron fcn
Men: 0.6-1.5 mg/dl
Women: 0.6-1.1
Creatinine clearance Indicates GFR Men
Creatinine clearance Indicates GFR Men: 95-135 ml/min
Women: 85-125 ml/min
GFR (what number is renal dysfunction)
GFR Identifies renal dysfunction > 60 ml/min. below 60 means kidney disease
chronic kidney injury main causes - (the 2 you know well)
Progressive, irreversible loss of
kidney function
▪ DM and HTN leading causes
▪ ESRD is when GFR < 15mL/min
(at least 90 ml/min)
▪ GFR measures kidney function
▪ Based on creatinine level, age,
body size, gender, ethnicity
Anuria (and when would you see this?)
Absence of urine production - End stage renal disease or sepsis
Oliguria (olga is small)
❖ Oliguria – Urine < 30mL/hr
❖ Etiologies: AKI, dehydration, enlarged prostate
❖ Polyuria (and what disorders)
Excessive urination
❖ May be associated with overhydration, DM, Diabetes
Insipidus, other kidney disease
❖ Dysuria (and what causes it)
Painful or difficult urination
❖ Assoc with infection or urine obstruction (kidney stones)
effects of aging (just loss of kidney function)
❖ Between ages 30 and 90
▪ Size and weight of kidneys ↓ by 20% to 30%
❖ By 7th decade
▪ Loss of 30% to 50% of glomerular function
❖ Atherosclerosis accelerates ↓ of renal size
effects of aging 2 (ability to do what with urine?)
Physiologic changes
▪ ↓renal blood flow → ↓GFR
▪ Altered hormonal levels
result in▪ ↓ability to concentrate urine
▪ Altered excretion of water, sodium, potassium, and acid
▪ Prostate enlargement
medications affecting urination
Nephrotoxic (capable of causing kidney damage)
❖ Diuretics: ↑ vol., frequency, urge incontinence
❖ Cholinergics stimulate bladder contraction
❖ Analgesics and sedatives impair CNS to control urination
❖ Anticoagulants may cause hematuria
❖ Some medications change the color of urine:
❖ Phenazopyridine (Pyridium): a urinary tract analgesic commonly used for UTI symptoms turns urine orange
❖ Amitriptyline and B-complex vit can turn urine green blue
❖ Levodopa for Parkinson can turn urine brown or black
urinary history assessment**(PAHML - the palm of my urine)
- Urinary Pattern (frequency, urgency, drippling, incontinence, inability to empty bladder)
- Appearance of Urine – color, odor, and clarity
- History of urinary problem- UTI, surgery, pain
- Current medications (many medications are nephrotoxic)
- Lifestyle Questions: how much fluid a day, smoker, caffeinated
drinks
urinary assessment
Person should be in dorsal recumbent position
Inspect:❖ Skin and mucosal membrane
❖ Skin turgor, oral mucosa for hydration status
❖ Perineum for incontinence related skin maceration
❖ Observe urethral orifice for discharge, lesions, inflammation
❖ Inspect urine output for color, clarity, odor
Palpate:❖ Normal bladder is positioned in the pelvic cavity around the symphysis pubis; not palpable when empty
❖ Bladder distended (palpable and well above symphysis pubis)Percuss:
❖ Costovertebral angle tenderness
❖ Formed by junction of 12th rib and the spine
❖ Tenderness may indicate pyelonephritis
Auscultate:❖ May hear renal artery bruit- turbulent blood flow through a narrowed artery
pathological urinary disorders (don’t need to know this)
❖ UTI
➢ Catheter-associated UTIs (CAUTI)
➢ Cystitis
➢ Pyelonephritis (infection of ureters and kidneys)
➢ Urethritis
❖ Benign Prostate Hypertrophy
(BPH)
➢ leads to incomplete emptying
and frequent urination
❖ Nocturnal enuresis
❖ Incontinence
❖ Renal calculi
alterations in urinary elimination: UTI
Lower UTI
S/S▪ Dysuria, frequency, urgency, burning, pyuria (white blood cells in urine)
▪ Older adults may initially p/w change in mental status ▪ May or may not have sx
Lab Urine analysis▪ + nitrite (nitrite forming bacteria)▪ ↑ in Leukocyte esterase Urine Cx▪ E. coli most common
**If untreated, infection can progress up to kidneys
Upper UTI/ Pyelonephritis
S/S
▪ Fever, chills, flank pain, n/v,
malaise, hematuria
▪ Urosepsis
Diagnostic
▪ UA C&S
▪ Blood cx
▪ CBC, lactate acid
▪ Creatinine and BUN level for AKI
collecting urine
Supplies:
• Sterile collection container
• Clamp
• Syringe
• Anti-septic swap
• Non-sterile gloves
Do not collect from foley bag
• Observe sterile technique
while collecting specimen
24 hour collection (to measure what? and detect what?)
Purpose:To detect abnormal renal disorders such as diabetic nephropathy, nephrotic syndrome, nephrolithiasis (kidney stone)
❖ UOP from a 24 hr period collected to see how much creatinine clears through the kidneys.
❖ Also done to measure amount of protein, hormones, minerals, and other chemical compounds in the urine
specimen collection***
• Ensure patient and all caregivers understand the importance of collecting all urine during the 24 hrs• Post sign in bathroom with start and end time and date of collection•
Have patient empty bladder and discard which will be the ”start time”• Put “ALL” UOP in 24hrs in the urine container (usually on ice)•
At the end of 24 hrs, have pt void again and place urine in container.
**If any urine gets discarded
bladder scanner***
Used to measure urinary retention or post void residual (PVR)
❖Bladder distention
❖May result from BPH (prostate problem) prostate CA, neurogenic bladder, after long period of foley catheter use
❖S/S include frequent voids with
uti prevention**
❖ Practice good personal hygiene
❖ **Always wipe from front to back
❖ Promote fluid intake (2000 to 2500mL/day)
❖ Empty bladder completely when you feel the urge (urinary stasis promotes bacterial growth)
❖ Wear moisture wicking underwear
❖ During sexual intercourse, use vaginal lubricants if needed (decreases vaginal friction and potential tear)
❖ Empty bladder after intercourse (flushes out bacteria that may have entered urethra)
❖ Change sanitary pads and tampons frequently during menstruation
CAUTI**
**80% of nosocomial UTI’s caused by urinary catheters (usually undetected and patient becomes septic)
❖Increases hospital stay, morbidity and mortality in patients
****Formation of biofilms by urinary pathogens common on the surfaces of catheters and collecting systems
**Bacteria with biofilms resistant to antimicrobials and host defenses
❖CAUTI rates often a benchmark measure in the National Healthcare Quality and Disparities Reports (NHQDR)
