GU Assessments Flashcards
Kidney Function
Regulate the volume and composition of extracellular fluid (ECF)
Excrete waste products from the body
Control BP
Erythropoietin production
Vitamin D activation
Acid-Base balance regulation
How many nephrons are in one kidney?
1 million
What gender gets more UTIs? Why?
female
the urethra is shorter and closer to the rectum where E. coli is
Where are the kidneys and what do they look like?
bean shaped behind the peritoneum
right is slightly lower than left
adrenal gland on top of each
Why is the right kidney lower than the left?
liver placement on the right
Where is the entrance of the renal artery and nerves + exit of the renal vein?
Hilus -medial side of kidney
What is the parenchyma?
tissue of the kidney
outer = cortex
inner = medulla
What is a nephron?
the functional unit of the kidney
Each nephron contains what
glomerulus
Bowman’s capsule
tubular system
What is located in the cortex of the kidney?
loop of Henle
collecting tubules
About how many mL/min of blood flow to the kidneys?
1200
Blood flow to the kidneys accounts for what percentage of cardiac output?
20-25
How does blood filter through the kidneys?
Renal artery
glomerulus
capillaries
venous system
Urine formation
Glomerular filtration
Tubular reabsorption
Tubular secretion
Urine concentration
Glomerular filtration
blood being filtered by hypostatic pressure through the glomerulus
Through Bowman’s capsule to tubule
Glomerular filtration Rate normal value
125 mL/min
How many gallons of water a day in filtered by healthy kidneys?
47.6
Tubular reabsorption
Where the necessary fluids and nutrients are reabsorbed into the body
Where does water absorption occur in the kidney process?
renal medulla
Nephron function can contain small amounts of waste products that are okay in the blood but large amounts
are harmful and renal failure
bc of toxin build up
PVT means
Proximal convoluted tubule
Where does most of the reabsorption occur in the tubular reabsorption (amino acids, Na, Cl, and others)?
PCT
What is the order of tubular reabsorption?
PCT (reabsorbs essential nutrients)
Loop of Henle
Descending (hypertonic)
Ascending
DCT
Collecting tubule or Bloodstream
What analogy does Mrs.Moreno use when discussing tubular reabsorption?
Coffee filter
What is the entire pathology of the healthy kidney?
Renal artery
Glomerulus
Bowman’s capsule
Tubular secretion
secreted bad stuff out of the bloodstream and to be excreted
Urine concentration
water, urea, Na, k, Cl, Creatinine, and more
A damaged kidney has what type of pores? Allowing for?
large; allow larger molecules to exit (protein)
ADH
water balance
regulated by the posterior pituitary gland
Aldosterone
reabsorption of Na and water
released from the adrenal cortex through the RAAS system
What hormones maintain homeostasis with each other?
ADH and Aldosterone
Ureters
carry urine from the renal pelvis to the bladder
lumens narrow
ease for occlusion and kidney stones
Bladder
reservoir for urine
detrusor muscle
urination, micturition, voiding
Bladder Capacity
600-1000 mL
Urethra lengths for females and males
Fem: 1-2 inches
Male: 8-10 inches
Continence
voluntary control of the ureterovesical unit
Bladder distention stimulates
stretch receptors = damage
impulses to the brain
What conditions could affect the continence of the bladder?
DM
MS
Paralysis
What would you use to strengthen the bladder detrusor muscle?
Kegel Exercises
Who is more susceptible to infection?
old
females
postpartum females (hormone changes with natural flora)
homeless
occupation (nurses)
Hx Collection for GU assessment
gender
age
socioeco
occupation
dietary
surgeries
health hx
What should you ask a pt about GU?
Probiotics, bathtub, douching, perfumes in peri-area
Meds, immobility
Hx kidney stones, UTIs, CA, Cath use
Medication Use for GU
Rx, OTC, illegal, antibiotics
Vitamins supplements
Potential nephrotoxic agents
Anuria
– inability to urinate
Oliguria
– small amounts
Polyuria
frequent or large
Hematuria
blood in urine
What are some nephrotoxic antibiotics?
Vancomycin
Gentamycin
Amphotericin
- illegal drugs, chemotherapy
Smoking causes what
vasoconstriction
What health perception question would you ask a GU pt?
visual changes
smoked
energy level
What nutrition question would you ask a GU pt?
weight chnage
supplements
caffeine
spice
What elimination question would you ask a GU pt?
blood in urine
awaken at night
color
smell
constipation or diarrhea
controlling bowels
What activity question would you ask a GU pt?
ADLs
worsening
stopping
awaken at night
daytime sleepiness
urge
sex pleasure
Objective assessment of GU
Inspect
Listen
Palpate
Percuassion in costal vertebral space if able
Blood Studies for UA
Creatinine
BUN
Ration
GFR
24 Hour
HIGH K
Normal BUN
7-21
Normal Creatinine
0.7-1.4
If BUN is elevated by Creatinine is not what does it mean
dehydrated
If BUN and Creatinine are both high what does that mean?
renal or kidney damage
UA
FIRST morning void (concentrated)
within 1 hour to lab
Culture and sensitivity is used for
bacteria identification and medicine needed
Creatinine Clearance
24 hour
closely approximates GFR
discard 1st urine and collect EVERY void for 24 Hours and at the end go one last time
ON ICE
Creatinine is the
waste product of protein
Radiographic Exam for GU
KUB (stones and foreign X-RAY exams)
IVP (contrast not for kidney failure)
CT (good for not contrast)
Cystography
Ultrasound (masses)
IVP is contraindicated because
the dye is nephrotoxic
- no kidney disease
elevated BUN, Creatinine and GFR
If IVP is used then
assess for allergies
notify of warm and flushed feelings
increase fluid intake to flush out dye
Dx Studies of GU
Renal Bx (renal tissue for exam by needle)
Cystoscopy
Arteriogram(visual blood vessels)
Renal Bx Post Op
lay on the biopsy site for maximum pressure (stop bleeding)
affected side for 30-60 mins
bed rest for 24 hours
avoid lifting 5-7 days and don’t take anticoagulant until Physician orders
How often are VS done on a Renal Bx pt?
5-10 mins 1st hours
then every 15 etc
What are you looking for during VS of renal Bx pt?
low BP, HR
Fever, chills
urine frequency
dysuria
hematuria
massive pain
means infection or bleeding
Renal Bx Contraindications
bleeding disorders
single kidney
uncontrolled HTN
suspected renal infection
hydronephrosis
vascular lesions
Renal Bx Pre-Op
Type and Cross for transfusion
consent
coagulation
Hx
CBC and H&H
Blood thinner held not aspirin or warfarin
Arteriogram Renal Before
enema, antibiotic
assess for iodine sensitivity for contrast
warm feeling
After arteriogram renal
Pressure dressing over femoral artery
observe for bleeding and inflammation
bed rest with affected leg straight
Peripheral pulses 30-60 mins to detect occlusion
If they start to bleed from the femoral artery what do you do
put your fist there to stop the bleeding
What are the labs of a gerontologic pt?
low creatinine clearance
HIGH BUN AND CREATININE slightly
less muscle mass
