Genitourinary Overview And Assessment Flashcards
Kidney function
Regulate the volume and composition of ECF
Excrete waste products from the body
Control BP
Erythropoietin production
Vitamin d activation
Acid base balance regulation
Glomerular filtration
Catch the beads and now its going to go through tubes to filter some more
GFR
125ml/min
ADH
Important in water balance
Regulated by posterior pituitary gland
Aldosterone
Reabsorptiom of na & water
Released from adrenal cortex
Ureters
Carry urine from renal pelvis to bladder
Ureteral lumens are narrow
Some occlusion can happen here
Urethra
Women 1-2 inches
Men 8-10 inches
Women higher risk for UTI
Bladder
Reservoir for urine
Capacity 600-1000ml
Detrusor (bladder muscle)
Urination,micturition, voiding
Contincence
Voluntary control
Stress incontinence
Like when you sneeze or do activity and accidentally pee
Why is it important to assess gender
Women high risk of uti
Assessment history collection
Are they taking baths, homeless
Gender/age
Dietary habits
Previous surgeries /hospitalization
Family / personal health history
What can antibiotics cause
Yeast infections(kills good flora)
Nephrotoxic (check kidney function
Medication use
Prescription/otc
(Antibiotics , nsaids)
Vitamins herbal supplements
Potential nephrotoxic agent
Diuretics
Watch i&o
Anuria
Inability to urinate
Oliguria
Production abnormally small
Nephrotoxic drugs
Amphotericin , vancomycin, gentamicin , chemo therapy drugs, cocaine , heroine
Polyuria
Going more than normal
Excessive
Frequent
Health perception / management pattern
Assess how pt takes care of them selves and assess where they see themselves going from here
Nutritional metabolic pattern
How’s apetite, weight loss (dehydration, tumor)
weight gain ( fluid retaining)
Elimination pattern
Activity - exercise pattern
Functional incontinence when they get up and start walking
Sleep rest pattern
Are they getting up and going to the rest room at night interrupting sleep
Sexuality reproductive pattern
Changes in sexual activity?
Physical examination
Inspection
Auscultation
Palpation( shouldn’t feel kidney , maybe the right but if you can palpate it its concerning)
Percussion
If BUN is elevated by its self
Could be dehydrated
If BUN and creatine are up together
Possibly mean that kidneys aren’t functioning properly
If kidneys are affected we may see
Hyperkalemia (so assess heart)
Creatine
.6-1.3
BUN
7-21
Urinalysis
First morning void
Examine urine within one hour
Urine culture and sensitivity
Will tell us what antibiotic we will use
Composite urin collection
Measures specific components in urine
Creatine clearance
24 hour urin collection
Approximates GFR
Discard first urination
Save urin from all subsequent urinations for 24 hours
Have pt urinate at the end of 24 hours and add specimen to collection
Creatine is a
Waste product of protein
KUB (kidneys ureters bladder )
Helps see size and shape
X-ray examination
Intravenous pyelogram (IVP)
Contraindicated in pt who have poor kidney function
Injection of Contrast medium
Renal ultra sound
Uses sound waves
Cystography/cystourethrography
Picture
Cyst or tumor may be causing issues so they want a picture
Ct scan
Without contrast (not as good image but will give you a good picture)
Cystoscopy
scope of bladder
Renal biopsy
Get consent form signed and make sure they know they are at high risk of bleeding (kidneys are vascular)
Needle will go through (CT or ultrasound will guide it )
Contraindicated of bleeding isorders, single kidney, uncontrolled hypertension
Renal angiogram
Helps look at blood vessels in your kidney
Before biopsy
Type and cross match pt for blood
Consent sign
Assess coagulation status
Pt history and me history
Review lab values -cbc h&h clotting factors
Make sure they aren’t taking blood thinners
After biopsy
Apply pressure dressing
Keep pt positioned on affected side for 30-60 min
Bed rest for 24 hours
VS 5-10 min for first hour
Assess frequently signs of bleeding infection
Renal arteriogram before
Cathartic or. Emma maybe used the night before
Before injection of contrast material assess for iodine sensitivity
Prior to contrast media injection, notify pt of possible transient warm feeling along the course of blood vessels
Enema
Cleanse
After renal arteriogram
Place a pressure dressing over femoral artery injection site
Observe site for bleeding and inflammation
Have pt maintain bed. Rest with affected leg straight
Take peripheral pulses in the involved leg every 30 - 60 min to detect occlusion of blood flow (from thrombus or emboli)
What happens if femoral starts bleeding out after angiogram
Put fist in artery for pressure and call for help
