Genitourinary System Flashcards
What are the functions of the kidneys?
Create urine Rid the body of waste in the form of urine: urea, bacterial toxins, water-soluble drugs, drug metabolites Excrete or conserve fluid Keep electrolytes balance Acid-base balance Activate vitamin D Produce erythropoietin Produce renin (for RAAS) Regulates blood pressure
What is the purpose of the kidneys activating vitamin D?
Vitamin D must be in its active form so that the body can absorb calcium
What type of calcium imbalance is present when there is decreased renal function? Why?
Hypocalcemia
The kidneys cannot activate vitamin D
Without the active form of vitamin D, calcium cannot be absorbed
What is the purpose of erythropoietin?
Erythropoietin stimulates the bone marrow to produce red blood cells
What blood condition is present when there is decreased renal function?
Anemia
The kidneys are not producing erythropoietin. Bone marrow is not stimulated to make red blood cells
When is erythropoietin production increased? Why?
Living at an increased altitude
COPD
There is a lack of oxygen within the body/blood stream. The body produces more red blood cells so there will be more hemoglobin available to carry oxygen. To make more red blood cells, erythropoietin production is required by the kidneys.
What conditions will activate RAAS?
Decreased renal perfusion Decreased blood pressure Decreased extracellular fluid (intravascular volume) Decreased serum sodium Increased urine sodium
What is the end production of RAAS?
Aldosterone causes vasoconstriction of the arteries, thus increasing blood pressure
Aldosterone causes the kidneys to increase sodium retention, water follows. Extracellular fluid increases, which increases blood pressure
What labs assess kidney function?
BUN
Creatinine
eGFR
Creatinine Clearance (aka Glomerular Filtration Rate)
What diagnostic test is the best indicator of kidney function?
Creatinine Clearance (aka Glomerular Filtration Rate)
What is the normal range for Creatinine Clearance (aka Glomerular Filtration Rate)?
About 120 mL/min
What does Blood Urea Nitrogen measure?
BUN measures the amount of urea nitrogen within the blood
Urea-nitrogen is a waste by product of protein
What does Creatinine measure?
The amount of creatinine within the blood
Creatinine is a waste by product of creatine
Which lab is more indicative of kidney function? BUN or Creatinine? Why?
Creatinine. Creatinine solely measures kidney function
BUN can be elevated for non-kidney related issues (example: high protein diet)
What does aldosterone do?
Aldosterone acts on the kidneys to retain sodium. Water follows.
Sodium and water are reabsorbed into the body
Potassium is excreted into the filtrate/urine
What does Antidiuretic Hormone (ADH) do?
Promotes the reabsorption of water from the filtrate into the body
What does Atrial Natriuretic Hormone do?
Blocks aldosterone when the atria are stretched / fluid overloaded
What does Parathyroid Hormone (PTH) do?
Promotes the reabsorption of calcium from the filtrate into the blood
Excretes phosphate into the filtrate/urine
What is the normal amount of urine production in 24 hours?
1,000 mL - 2,000 mL
What is the normal specific gravity of urine?
1.005 to 1.030
If specific gravity is low (less than 1.005), what does that tell us?
The urine is very dilute
There is more fluid in the urine than waste/particles
The person may have increased their fluid intake
The person may be taking a diuretic
If specific gravity is high (greater than 1.030), what does that tell us?
The urine is very concentrated
There is more waste/particles than fluid
The patient may be dehydrated
How does aging affect the kidneys?
Decreased ability to concentrate urine
Glomerular filtration rate decreases
Number of nephrons decrease
How does aging affect the bladder?
Decrease bladder size and muscle tone. This causes: Dysuria Increased frequency Incontinence Urine retention
How does aging affect males?
Prostate enlarges
How does aging affect females?
Pelvic floor muscles weaken
Incontinence is common
Prone to UTIs
What is Benign Prostatic Hyperplasia?
BPH is when the prostate grows
Urinary obstruction is common
What are signs and symptoms of Benign Prostatic Hyperplasia?
Decreased amount of urine Decreased force of the stream Difficulty starting urine stream Dribbling after urination is complete Urine retention Feelings of bladder fullness after urination Overflow incontinence Interrupted stream
How is Benign Prostatic Hyperplasia diagnosed?
Prostate Specific Antigen blood test
What therapeutic measures are taken when a patient has Benign Prostatic Hyperplasia?
Administer medications that relax the smooth muscles of the prostate and the bladder
Tamsulosin (Flomax)
When a patient has Benign Prostatic Hyperplasia, what other issues is the patient at risk for developing?
Frequent UTIs
Chronic Kidney Disease
What will daily weights tell the provider?
Fluid balance
What symptoms may be present if the patient is fluid overloaded?
New onset edema
Shortness of breath
Weight gain
How does a provider assess for costovertebral tenderness? What does it tell us?
Place a flat hand on the costovertebral angle (CVA)
Using the other hand, make a fist, and thump the flat hand.
If tenderness is present, there may be pyleonephritis, kidney disease, kidney stones
What is stress incontinence?
Involuntary urine loss from increased abdominal pressure
What is urge incontinence?
Involuntary urine loss with strong desire to void
What is functional incontinence?
Involuntary urine loss from impairment of physical and/or mental function
What is overflow incontinence?
Involuntary urine loss associated with bladder distention
What is total incontinence?
Involuntary urine loss continuously
Unpredictable loss of urine
What causes acute urine retention?
Anesthesia
Medications
Local trauma
What causes chronic urine retention?
Enlarged prostate
Medications
Urinary strictures
Tumors
What should be monitored if a patient is at risk for or has urine retention?
Urine output
Bladder distention
Bladder scan
What are signs and symptoms of Chronic Kidney Disease?
Fluid overload Electrolyte imbalances Retention of waste products Acid-Base imbalances Anemia
What is the nurses priority when the patient has an AV fistula or AV graft?
Check for a bruit and a thrill
What is the difference between a bruit and a thrill?
Feel a thrill
Listen for a bruit
