Genitourinary System (Exam One) Flashcards
Where does urine form?
Kidneys
What amount of urine is stored by the renal pelvis?
3mL to 5mL
What is the purpose of the capsule that covers the kidneys?
- Shock absorber
- Protection
What is the difference between a child’s kidneys and an adults kidneys? Children are at an increased risk for what because of this difference?
- Children lack renal capsule for kidney protection
- More susceptible to kidney injury
What is the first step in the process of urine production?
Glomerular filtration
Which calculation determines how well the blood is being filtered by the kidneys?
- Glomerular filtration rate (GFR)
- Estimated glomerular filtration rate (eGFR)
What is the normal value for glomerular filtration rate?
120 mL/minute
A glomerular filtration rate of what value may indicate kidney failure?
<15 mL/minute
What cellular mechanism is responsible for selective reabsorption?
Hormones
The proximal tubules are the only site for what?
Glucose reabsorption
The proximal tubules are responsible for the reabsorption of what solutes?
- Glucose
- Amino acids
- Phosphate
- Citrate
The proximal tubule is considered what?
Metabolic organ
Inflammation of the bladder is known as what?
Cystitis
Decreased kidney function is denoted by what amount of urine output per hour?
<30 mL
What is the normal amount of urine production in 24 hours?
1,500 mL
What disease will accelerate the decrease of renal size with age?
Atherosclerosis
What does proper anatomy of the ureteropelvic junction (UPJ) help prevent?
- Urine reflux
- Infection
What is the functional unit of the kidney?
Nephron
List the functions of the kidneys. Identify which function is considered the primary function.
- Filtration of blood (primary)
- Create urine
- Rid the body of waste
- Excrete or conserve fluid
- Maintain electrolyte balance
- Acid-base balance
- Activate Vitamin D
- Produce erythropoietin
- Produce renin
- Regulate blood pressure
What is the normal value for estimated glomerular filtration rate?
> 60 mL/minute
Which substances are reabsorbed into the blood after filtration?
- Water
- Sodium
- Chloride
- Calcium
- Bicarbonate
Which substances are filtered out into the urine?
- Potassium
- Hydrogen ions
- Ammonia
What is the purpose of the kidneys activating vitamin D?
Vitamin D must be in its active form so the body can absorb calcium
What is the purpose of erythropoietin?
Stimulates bone marrow to produce red blood cells
What blood condition is present when there is decreased renal function?
Anemia
The loop of Henle is responsible for what body function?
Homeostasis
If a patient is receiving a diuretic medication, there should be an increase in what?
Urine output
If calcium absorption is decreased, which hormone will increase in order to correct this deficit?
Parathyroid hormone
Which part of the urinary system is responsible for carrying urine to the bladder?
Ureters
What is hydronephrosis?
Backflow of urine into the kidneys
If a patient has urine discoloration, such as red, orange, or blue, what question should the nurse ask the patient?
Are they currently taking any medications?
List normal physical assessment findings of the urinary system.
- No costovertebral angle (CVA) tenderness
- Non-palpable kidney and bladder
- No palpable masses
How does a provider assess for costovertebral tenderness? What does it tell us?
- Place a flat hand on the costovertebral angle (CVA)
- Make a fist using other hand
- Thump the flat hand using fist
-Tenderness may be indicative of pyelonephritis, kidney disease, or kidney stones
What is the normal range for serum creatinine?
0.6 - 1.2 mg/dL
What is the normal range for blood urea nitrogen (BUN)?
10 - 20 mg/dL
What is known about the urinary system and aging?
Function and muscle tone decreases
Serum creatinine can only be increased by what pathological disease?
Kidney disease
An elevation of blood urea nitrogen (BUN) may be indicative of what condition(s) or disease(s) besides renal disease?
- Upper GI bleed
- High-dose steroid consumption
- Heart failure
- Dehydration
- High-protein diet
- Infection
- Stress
Where is urea made?
Liver
Why might high ammonia levels be seen in a patient with kidney failure and liver failure?
-Liver may be unable to convert ammonia to urea during liver failure
A urine specimen collected at which time of day is most desirable as it is the most concentrated and the best indication of kidney function?
- Morning void
- First void of the day
What will daily weights tell the provider?
Fluid balance
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
What substances should not cross into the renal tubules?
- Blood cells
- Platelets
- Protein
What is the most common laboratory test for urine?
Urinalysis
What laboratory test is used to identify specific organisms present in the urine?
Urine culture
Describe the process of a clean catch specimen. What must females do specifically regarding a clean catch?
-Clean urethral area
-Void small amount in toilet
-Void in sterile cup
Women must keep labia open during entire process
Describe the process of a clean catch specimen. What must females do specifically regarding a clean catch?
- Clean urethral area
- Void small amount in toilet
- Void in sterile cup
A creatinine clearance most closely approximates what other laboratory value?
Glomerular filtration rate (GFR)
What does a creatinine clearance evaluate?
How well kidneys remove creatinine from blood
Describe the process of a creatinine clearance diagnostic study. What must be done specifically regarding the first void?
- Collect 24-hour urine specimen
- Continuously add all voided urine to large specimen container
- Keep urine on ice or refrigerated
- Send to lab at end of collection
-Must discard the first voided sample
What must be done after a creatinine clearance diagnostic study has been completed? Why?
- Draw blood sample
- Compare serum creatinine to creatinine clearance results
What is the primary regulatory system for magnesium?
Urinary excretion
Phosphorus causes vascular calcification leading to what conditions?
- Decreased perfusion
- Heart failure
How does serum albumin related to kidney failure?
Protein is spilled along with albumin in the urine
What will be elevated on a urinalysis if the patient has a urinary tract infection?
- Leukocytes
- Bacteria
- Nitrites
Describe the process of a cystoscopy.
- Tube inserted into bladder through urethra
- Inspect inside of bladder
- Possible bladder tissue obtained for biopsy
What education should the nurse provide to a patient following a cystoscopy regarding what to expect?
- Pink/tea-tinged urine
- Urinary frequency
- Burning upon urination
The nurse should immediately notify the health care provider if what conditions arise following a cystoscopy?
- Bright red urine or clots
- Fever
- Increase in WBC
Describe the process of an intravenous pyelography.
- IV contrast injected into the veins
- X-ray imaging performed to examine kidneys, ureters, and urinary bladder
Before the patient receives an intravenous pyelography study, what should the nurse assess or obtain?
- Allergies
- Informed consent
Following an intravenous pyelography study, what should the nurse monitor?
- Urinary output
- Hydration
- Vital signs
- Allergic reaction
When should vital signs be obtained on a patient undergoing a renal biopsy?
- Before
- During
- After
Following an intravenous pyelography study, list the interventions to be performed by the nurse.
- Obtain vital signs
- Apply pressure to site for 30 minutes
- Monitor hemoglobin and hematocrit
- Promote bed rest
A patient who underwent a renal biopsy 9 hours ago currently has a temperature of 100.3 and hematuria. What is the priority nursing intervention?
Notify HCP!
Describe the intended use of a single lumen catheter.
Simple draining or irrigation
Describe the intended use of a double lumen catheter.
Permit addition of a retention balloon
Describe the intended use of a triple lumen catheter.
Simultaneous drainage and irrigation of thick fluids such as pus or blood
What is the normal range for pH on a urinalysis?
4 - 8
What is the normal range for specific gravity on a urinalysis?
1.003 - 1.030
List over-the-counter nephrotoxic medications.
- Aspirin
- Naproxen
- Ibuprofen
List the signs and symptoms of an upper urinary tract infection.
- Fever
- Chills
- Flank pain
An upper urinary tract infection involves what anatomical structures?
- Renal parenchyma
- Pelvis
- Ureters
List the signs and symptoms of a lower urinary tract infection.
- Stinging/burning urination
- Frequency
- Urgency
- Cloudy/dark urine
- Malodorous urine
- Blood in urine
- Nocturia
- Bladder distention
- Retention
- Dysuria
Why is urine acidic?
Prevents infection
List natural defense mechanisms for preventing a urinary tract infection.
- Complete emptying of bladder
- Proper ureterovesical junction (UVJ) anatomy
- Ureteral peristaltic activity
- Urine pH
Describe an uncomplicated urinary tract infection.
Usually only involves the bladder
Describe a complicated urinary tract infection.
Coexists with another complication or disease process
A complicated urinary tract infection may be accompanied by what other complications or diseases process’?
- Obstruction
- Calculi
- Catheter
- Diabetes
- Pregnancy
- Recurrent infection
What is the most common symptom of a urinary tract infection in an older adult?
Confusion
What education should the nurse provide to a patient with a urinary tract infection?
- Finish all prescribed antibiotics
- Completely empty bladder every 3-4 hours
- Empty bowel regularly
- Wiping front to back
- Adequate fluid intake
- Avoid bladder irritants
- Cranberry juice
What is the most common causative organism in cystitis?
E. coli
What type of patients are most vulnerable to developing cystitis?
- Sexually active women
- Pregnant women
What values on a urinalysis are assessed specifically for the purpose of diagnosing a urinary tract infection?
- Leukocyte esterase
- Nitrites
- WBC
T/F: Nitrites are a normal finding in urine.
False
NitrAtes are a normal finding in urine
Urine specimens must be evaluated within what time frame?
One hour
What should the nurse obtain before beginning antibiotic therapy for a patient with a urinary tract infection?
Urine culture and sensitivity
How long is antibiotic therapy indicated for an uncomplicated urinary tract infection?
1 to 3 days
List medications commonly prescribed for a urinary tract infection.
- Bactrim (trimethoprim/sulfamethoxazole)
- Macrodantin (nitrofurantoin)
How long is antibiotic therapy indicated for an complicated urinary tract infection?
7 to 14 days
What education should the nurse provide to a patient who has been prescribed phenazopyridine?
- Stains urine reddish-orange
- Stop taking medication once pain subsides but continue antibiotic therapy
What education should the nurse provide to a patient who has been prescribed methenamine/phenyl salicylate?
- Stains urine blue or green
- Stop taking medication once pain subsides but continue antibiotic therapy
Urinary analgesics such as phenazopyridine and methenamine/phenly salicylate are use in combination with what other medication(s)?
Antibiotics
The patient asks the nurse why they cannot use urinary analgesics for a prolonged period of time. What is the best response by the nurse?
Long-term use of these medications can cause hemolytic anemia
A patient with cystitis who has been taking antibiotics for 3 days, suddenly develops flank pain and a low grade fever. What is the primary nursing intervention?
Notify HCP!
Acute pyelonephritis most often occurs following what types of procedures or conditions?
- Bacterial contamination
- Invasive procedures
Acute pyelonephritis that goes undiagnosed or untreated can lead to what condition(s)?
- Septic shock
- Death
_____ of people die as a result of unresolved bacteremia involving gram-negative organisms.
15%
List signs and symptoms of acute pyelonephritis.
- CVA tenderness/flank pain
- WBC casts
- Fever
- Chills
- Nausea/Vomiting
- Fatigue
- Tachycardia
- Tachypnea
What do white blood cell (WBC) casts indicate?
Involvement of parenchyma
Signs and symptoms of acute pyelonephritis typically improve within how many hours after beginning drug therapy?
48 to 72 hours
List the signs and symptoms of sepsis or bacteremia.
- Elevated temperature
- Tachycardia
- Hypotension
What are renal calculi? Where is the most frequent site of occurrence?
- Stones that form in the urinary tract
- Most frequent site is kidneys
List dietary substances that put the patient at an increased risk for developing renal calculi.
- Calcium
- Uric acid
- Purine
- Vitamin D
- Protein
- Oxalate
- Alkali
List foods high in purine.
- Red meat
- Seafood
- Alcohol
- Coffee
- Sweetbreads
List education the nurse should provide to the patient in order to help prevent the reoccurrence of renal calculi.
- Adequate hydration
- Decrease caffeine intake
- Avoid foods with purine, calcium, oxalate
List nursing interventions for a patient with renal calculi.
- Administer analgesics
- Strain all urine
- Encourage increased fluid intake
- Monitor I&O’s
- Encourage ambulation
What medication is administered to decreased uric acid levels?
Allopurinol
List nursing interventions for renal and bladder trauma.
- Monitor for shock
- Assess BP and HR
- Monitor I&O’s
- Provide pain relief
- Assess for hematuria
- Assess for myoglobinuria
What is the most prominent risk factor for developing kidney cancer?
Smoking
What is the most common type of kidney cancer?
Renal cell carcinoma
What is a major symptom of benign nephrosclerosis?
Hypertension
A patient with uncontrolled blood pressure who is prescribed aggressive hypertensive therapy should have what diagnostic test done?
Kidney ultrasound
List treatment options for renal cell carcinoma.
- Simple nephrectomy
- Partial nephrectomy
What education should the nurse provide do a patient who is post bladder cancer surgery?
- Drink large volume of water
- Urine will be pink for several days
- Urine should NOT be red or contain clots
What medications are given for Chrons disease, inflammatory bowel disease, and ulcerative colitis?
Anti-inflammatory medications
List examples of anti-inflammatory medications.
- Aminosalicylates
- Sulfasalazine
List the priority nursing intervention for a patient with severe ulcerative colitis?
- NPO
- Bowel rest
The nurse knows to monitor for what in a patient who is having an increased amount of watery bowel movements?
Blood in stool
List environmental factors that may cause an inflammatory bowel disease (IBD) exacerbation?
- Stress
- Smoking
- Diet
A patient is prescribed sulfasalazine. What potential side effects should the nurse inform this patient of?
- Photosensitivity
- Aching joints
- Fever
- Headache
- Vomiting
What types of foods should be avoided during an an inflammatory bowel disease exacerbation?
High-fiber foods
In a patient with Crohn’s disease, where are fistulas most likely to develop?
Between the bowel and the bladder
