Module 10 - Start of Final Exam Flashcards

Question

If there is an insult to the nephron, which area is most likely to go and lead to loss of concentrating ability?

Answer 1

the loop of henle

Answer 2

Loop of Henle

Answer 3

Area of the nephron where aldosterone acts to retain sodium and water (passively) This is an area where more fine tuning is done in exchanging of things Acid Base of Electrolyte Balance has its fine tuning done here

Answer 4

blood supply along the loop of Henle

Answer 5

the Renal Vein

Answer 6

part of the nephron where ADH works - posterior pituitary with high blood osmolarity causes ADH release, which waters down the blood. The collecting duct will be worked on to prevent water from leaving the body and the ADH controls the water not the sodium

Answer 7

The Adrenal Glands

Answer 8

In the nephron Filtering part of the nephron Encased in a bowmans capsule Filters fluid, glucose, and tiny things - not large things like plasma proteins and RBC

Answer 9

Inflammation because the glomerulus cells must be inflamed/enlarged and spread out enough to allow outflow

Answer 10

Inflammation in the glomerulus because of a strep infection, which leads to RBC and plasma proteins in the urine that should not be there

Answer 11

Proximal, Distal, and Henle's Loops areas of the kidney Fluid is converted into urine at the tubules --> Urine moves to the Kidney Pelvis --> Urine flows from kidney pelvis to ureter --> Bladder --> Void

Answer 12

fluid , before conversion to urine by the tubules

Answer 13

Renal Corpuscle --> Proximal Tubule -- Loop of Henle --> Distal Tubule --> Collecting Duct

Answer 14

Fluid flows through the proximal tubules which leads to water and solute reabsorption Whatever is not reabsorbed becomes urine and the process of selective reabsorption determines the amount of water and solutes to be secreted each time

Answer 15

Not a renal part, but has an effect on it in males Surrounds the male urethra Has a duct that opens into the prostatic portion of the urethra and secretes the alkaline part of seminal fluid Enlarges with age and can put pressure on the urethra which can cause issues with voiding and thus increased UTI chance

Answer 16

moving something from one place to another but it stays in the body

Answer 17

moving something from one place to another but it leaves the body

Answer 18

keep what we need and void what we dont

Answer 19

Frequent UTI High Na Diet Contact Sports Trauma and Injury History of HTN Family History of Renal Disease Medication Use Associated Medical Conditions like Diabetes

Answer 20

they can cause scarring

Answer 21

the kidneys have to do more fine tuning to get rid of all the salt we do not need

Answer 22

flank area

Answer 23

HTN, CAD, stroke, etc - HTN effects the whole body and since the flow state is important in this system, HTN can be a deterrent to glomerular filtration

Answer 24

Things like chemotherapy drugs can be nephrotoxic

Answer 25

Blood urea Nitrogen (mg/dL) Measures how much nitrogen is coming from urea, and urea is a waste product of the liver when proteins are broken down Decreased solvent in blood will increase BUN (decreases in water) SO THIS IS USED TO MEASURE DEHYDRATION * not a good measure of kidney function on its own

Answer 26

Serum Creatinine is waste products of the muscle (mg/dL) a MUCH better indicator of renal function than BUN Measures the creatinine content in serum (blood) and urine, and creatinine should not be reabsorbed so it SHOULD BE IN THE URINE If there is high blood value, then filtering is not working

Answer 27

This is the amount of blood cleaned of creatinine by the kidneys (mL/min) This value will greatly increase as kidney glomerulus filtration ability decreasesw

Answer 28

Waste product of purine breakdown seen in blood and urine (mg/dL for serum and mg/24 hours for urine) Most uric acid is dissolved and secreted by the kidney, but it can buildup and cause gout, so it should be in urine

Answer 29

over 24 hours to check the urine

Answer 30

Beer Liver Beans Anchovies Peas (So eating more of these can lead to higher uric acid levels)

Answer 31

the main way to test for renal system function and look for renal disease progression/existence ex: Used when suspected UTI

Answer 32

menstruation

Answer 33

Wash the perineal area Use a clean container Obtain 10-15 mL of first morning sample * Refrigerated samples may alter specific gravity * If menstruating, indicate so on lab form

Answer 34

Physical Examination | Chemical Examination

Answer 35

Color Clarity Specific Gravity *water has a sg of 1, dilute urine is 1.002 and higher levels mean more dehydration (range is 1 to 1.030)

Answer 36

``` Urine pH Proteins Glucose Ketones Blood Bilirubin Urobilinogen WBCs Nitrites Leukocyte Esterase ```

Answer 37

slightly acidic (4 to 6) since more alkaline urine increases rate of infection

Answer 38

Inflammation or High Blood Sugar

Answer 39

Byproduct of fat metabolism that builds up in urine Usually abnormal unless they are doing the Atkins Diet which WANTS ketotic urine High ketones could indicate diabetic ketoacidosis

Answer 40

Byproduct of RBC breakdown after 120 days and needs to be conjugated by the liver to be in the urine

Answer 41

Byproduct of conjugation of the bilirubin Half of all of it should be excreted by the kidneys

Answer 42

Indicates bacterial infection since the bacteria may have an enzyme that converts nitrates to nitrites

Answer 43

Enzyme secreted by WBC Is a value that can help detect WBC in urine

Answer 44

A urine test that measures the specific gravity of the urine - which is the weight of urine in comparison to distilled water (1) It evaluates concentrating and excretory abilities of the kidneys and hydration status Essentially, measures amount of solutes in the fluid and a thicker fluid has a higher osmolarity and gravity

Answer 45

Concentrated Urine (Dehydration)

Answer 46

Dilute Urine (Overhydration)

Answer 47

Have too much water (low gravity) due to not enough ADH

Answer 48

Too much ADH pulls more water into the body causing things like bounding pulses and concentrated urine (higher gravity)

Answer 49

Chronic Renal Disease are Assoc. with low specific gravity of urine Knowledge of specific gravity helps in the interpretation of a urinalysis

Answer 50

A urine test that identifies the presence of microorganisms and determines the specific antibiotics that will appropriately treat the existing microorganism

Answer 51

Clean perineal area and urinary meatus with bacteriostatic solution collect a midstream sample in a sterile container Send specimen to lab immediately ID any sources of potential contaminants during collection like hands, skin, clothing, hair, vaginal secretion, rectal secretions

Answer 52

too dilute to provide a positive culture

Answer 53

Vaginal yeast infections and diarrhea since both good and bad bacteria are killed via their cell walls

Answer 54

A blood and timed urine specimen that evaluates kidney function Blood is drawn at the start of the test and the morning of the day the 24 hour specimen collection is completed - compares how much was in the blood versus what was collected

Answer 55

Folly Tubing rather than the bag

Answer 56

The creatinine clearance test (tells us how well the kidney is working!)

Answer 57

aint it nice!

Answer 58

the test is void and must be restarted

Answer 59

Encourage adequate fluids before and during Instruct client as prescribed to avoid TEA, COFFEE, MEDICATIONS during testing If the client is taking ACTH, CORTISONE, or THYROXINE, check with the physician regarding administration of these during testing Maintain the urine specimen on ice or refrigerate and check with the lab in regard to adding a preservative

Answer 60

How much creatinine is filtered through the glomerulus It goes through all the tubules and collecting ducts, and the filtrate moves into urine and it is at that point when none of it can be reclaimed anymore

Answer 61

Vanillylmandelic Acid Test A 24 hour urine collection to diagnose pheochromocytoma, a tumor of the adrenal gland --> this can cause constant fight or flight / NEP and EP release ID's an assay of urinary catecholamines in the urine ()should be 2-7 mg/24 hours in people 15+)

Answer 62

Avoid: Cocoa, Caffeine, Vanilla, Cheese, Gelatin, Licorice and Fruits for 2 days prior to start, during collection, and avoid medications for 2-3 days prior to start Avoid stress Maintain adequate food and fluids during test

Answer 63

a 24 hour urine collection to diagnose gout and kidney disease

Answer 64

can precipitate out into crystals in joint leading to pain (usually in the feet due to the coolness) and inflammation (gout)

Answer 65

encourage fluids and a regular diet during testing place specimen on ice/refrigerate, and check with the lab regarding adding a preservative

Answer 66

invasive needle procedure for when renal cancer is suspected to take some renal tissue Looks for dysplasia and cell development

Answer 67

Kidneys, Ureters, and Bladder Test An x ray film that views the urinary system and adjacent structures Used to detect urinary calculi This exposes people to ionizing radiation, so some people - like pregnant women - cannot do it CT Scan is a better picture but this is still used

Answer 68

There is no specific preparation for this test since it is an x ray

Answer 69

Intravenous Pyelogram Injection of radiopaque dye outlines the renal system Performed to ID abnormalities in the system

Answer 70

Informed consent Asses client for seafood, iodine, radiopaque dye allergies Inform client about possible throat irritation, flushing of face, warmth, salty taste that could be experienced, but is not harmful

Answer 71

An injection of a radiopaque dye through a catheter for examination of the renal arterial supply Looks for renal artery stenosis, which is hard and small lumens of arterial supply leading to increased BP and can damage nephrons

Answer 72

Need to know about allergies to iodine, seafood, and radiopaque dyes Dye may cause burning feelings or feelings of heat along the vessel after injection Need to assess and mark peripheral pulses can cause a lot of bleeding since it is a femoral artery poke with a catheter

Answer 73

An IV injection of a radioisotope for visual imaging of renal blood flow (can see all veins, capillaries, arteries, etc)

Answer 74

Assess for allergies to dye Instruct clients that they will be required to remain motionless Instruct client that imaging may be repeated at various intervals before the test is done Radioactive material will clear in 24 hours

Answer 75

Linens and soiled items must be double bagged since the dye is radioactive

Answer 76

Computed tomography Better than a KUB test to see structure Can visualize kidney tumors

Answer 77

Foley Catheter injects dye into the bladder and the flow of urine is watched to make sure there is no urinary reflux back into the kidney leading to infection or nephron edamage Looks also at how well the bladder empties

Answer 78

Inflammation of the bladder from infection or obstruction of the urethra commonly used as a term with UTI

Answer 79

Inflammation of anywhere from the urethra to the bladder

Answer 80

E Coli Enterobacter Pseudomonas Serratia

Answer 81

Women because of a shorter urethra and location of the urethra near the rectum

Answer 82

Sexually active and pregnant women

Answer 83

Hormonal Changes influencing alterations in vaginal flora Loss of bactericidal properties of prostatic secretions in men Sexual intercourse poor fitting diaphragms Use of spermicides Synthetic underwear and pantyhose Wet bathing suits Allergens or irritants: Soap, sprays, bubble baths, perfumed sanitary napkins Invasive urinary tract procedures Bladder distention urinary stasis calculus

Answer 84

Compensation from medicare will not occur when a catheter UTI occurs

Answer 85

Teach females good perineal care and to wipe front to back Instruct client to avoid bubble baths, tub baths, and vaginal deodorants Instruct voiding every 2 to 3 hours Instruct voiding and drinking a glass of water after intercourse Instruct females to wear cotton pants and avoid wearing pantyhose with slacks, tight clothes, and sitting around in a wet bathing suit teach pregnant women to void every 2 hours Encourage menopausal women to use estrogen vaginal creams to restore pH Instruct women to use water soluble lubricants for coitus, especially after menopause

Answer 86

Gram negative bacteremia originating in the urinary tract The bacteria make toxins that cause illness and are highly resistant/virulent

Answer 87

presence of indwelling catheter or an untreated UTI in a client who is medically compromised

Answer 88

the ability of this bacterium to develop resistant strains

Answer 89

septic shock and a high mortality rate when not treated aggressively

Answer 90

Fever (but it does not diagnose this, it just is an indicator)

Answer 91

Urine C&S IV Antibiotics until client is afebrile for 3-5 days, and then oral antibiotics

Answer 92

An inflammation of the urethra commonly associated with STD, but may also be seen with cystitis (Urethra Inflammation)

Answer 93

gonorrhea and chlamydial infection

Answer 94

feminine hygiene sprays, perfumed toilet paper, sanitary napkins, spermicidal jellies, UTIs, changes in vaginal mucosal lining

Answer 95

UP (move from urethra toward the kidneys up)

Answer 96

``` Burning on urination Frequency Urgency Nocturia Difficulty Voiding Penis Discharge ```

Answer 97

``` Frequency Urgency Nocturia Painful urination Difficulty Voiding Lower Abdominal Discomfort ```

Answer 98

Encourage fluids STI testing Avoiding intercourse until treatment is complete Taking all antibiotics Avoiding bad hygiene supplies

Answer 99

Inflammation of the ureter that is commonly associated with pyelonephritis Chronic pyelonephritis causes the ureter to become fibrotic and narrowed by strictures can cause urinary backup

Answer 100

an inflammation of the renal pelvis and the parenchyma (nephrons), commonly caused by bacterial invasion of E COLI can cause urinary backup

Answer 101

most often after bacterial contamination of the urethra or following an invasive procedure of the urinary tract

Answer 102

most commonly following chronic obstruction with reflux or other chronic disorders

Answer 103

Usually a short course that recurs as a relapse of a previous infection or as a new infection Can progress to bacteremia or chronic pyelonephritis

Answer 104

Fevers and Chills Nausea Flank pain of affected side CVA tenderness headache muscular pain dysuria frequency and urgency cloudy, bloody, or foul smelling urine increased WBC in the urine

Answer 105

A slow progressive disease that is usually associated with recurrent acute attacks Causes contraction of the kidneys and dysfunction of the nephrons, which are replaced by scar tissue particularly troublesome as it leads to loss of balance abilities or possible renal failure

Answer 106

Frequently diagnosed incidentally when a client is being evaluated for HTN Poor urine concentrating ability Pyuria Azotemia Proteinuria Anemia Acuidosis

Answer 107

Higher creatinine/urea nitrogenous wastes

Answer 108

pus in urine

Answer 109

Protein in urine

Answer 110

Erythropoietin cannot be released

Answer 111

Kidneys may not be able to control acid base balance

Answer 112

Kidney Stones in the minor or major calyces of the kidney Lime stone like - causes excruciating pain, obstructs urine flow, and can cause secondary damage to kidney structures

Answer 113

KUB, but its not good for soft tissues IVp CT Scan Renal Ultrasonography (These all can determine stone location)

Answer 114

know what the stones are made of !

Answer 115

the kidneys (ex: in ureter connection to kidney)

Answer 116

pain obstruction tissue trauma with secondary hemorrhaging and infection

Answer 117

Strain the urine and collect the stone for analysis to determine type and assist in determining treatment

Answer 118

urinary stones; ureter

Answer 119

kidney; renal parenchyma

Answer 120

Ureter dilation when a calculus occludes it and blocks urine flow

Answer 121

urinary stasis can result in infection, impairment of renal function on the side of the blockage, and resultant hydro nephrosis and irreversible kidney damage

Answer 122

Family history Diet high in calcium, vitD, milk, protein, oxalate, purines, or alkali high intake of purine rich food obstruction and unrinary stasis dehydration use of diuretics, which can cause volume depletion UTIs and prolonged urinary catheterization immobilization Hypercalcemia and hyperparathyroidism Elevated uric acid levels, like in gout

Answer 123

Renal colic originates in lumbar region and radiates around the side and down toward the testicle in men and the the bladder in women Ureteral colic radiates toward the genitalia and thigh sharp, severe pain of sudden onset Dull aching kidney(s) Nausea and vomiting, pallor, diaphoresis during acute pain Urinary frequency with alternating retention Signs of UTI low grade fever RBC, WBC and bacteria in urinalysis Hematuria

Answer 124

Calcium Oxalate Stones Calcium Phosphate Stones Struvite Stones Uric Acid Stones Cystine Stones

Answer 125

Eat less calcium and phosphate and excess vitD which will absorb calcium Calcium stones are alkaline, so we need to acidify the urine to help

Answer 126

Supersaturation of urine with calcium and oxalate Diet should be acid ash foods since calcium stones are alkaline Decrease intakes of high calcium foods, and avoid oxalate foods

Answer 127

``` Tea Almonds Cashews Chocolate Cocoa Beans Spinach rhubarb ```

Answer 128

"Triple Phosphate" stones composed of magnesium and ammonium phosphate Caused by UREA SPLITTING BACTZERIA form in alkaline urine, so have an acid ash diet Dietary prescription includes limiting high phosphate foods like dairy, red and organ meats, and whole grains to reduce phosphate content in urine

Answer 129

Caused by excess dietary purine OR gout Tend to form in acidic urine so have an alkaline ash diet Decrease purine intake in foods like organ meats, gravies, red wines, and sardines

Answer 130

Medication that may be prescribed to lower uric acid levels

Answer 131

Caused by cystine crystal formation tend to form in acidic urine, therefore alkaline ash diet low intake of methionine, an essential AA that makes cysteine, and avoiding meat/milk/cheese/eggs is prescribed Also, encourage 3L of fluid a day unless contraindicated to help dilute urine and prevent cysteine crystal formation

Answer 132

Struvite Stones | Calcium Stones

Answer 133

Uric Acid Stones | Cysteine Stones

Answer 134

Increases the pH to decrease acidity of urine works against uric acid and cysteine stones Ash means what is left

Answer 135

Milk Fruits, BUT NOT Cranberries Plums and Prunes rhubarb Most vegetables Small amounts of beef, halibut, veal, trout, and salmon are allowed

Answer 136

Decreased the pH to increase acidity of urine Works against struvite and calcium stones

Answer 137

``` Cheese Eggs Meat fish Oysters Poultry Bread Cereal Whole Grains Pastries CPP and Tomatoes Corn and Legumes ```

Answer 138

``` Carbonated Beverages Baking soda or power all vegetables except corn and legumes Olives Pickles Nuts other than peanuts ```

Answer 139

Cranberries Prunes and Plumes Triad of fruits for an acid ash diet, but not alkaline ash

Answer 140

Surgical management method of kidney stones For stones in bladder or lower ureter no incision needed 1/2 ureteral catheters are inserted past the stone and it is manipulated, dislodged, and mechanically moved via the procedure where catheters mechanically guide it downward for removal Catheters are left in place for 24 hours to drain the urine trapped proximal to the stone and to dilate the ureter Continuous chem irrigation may be prescribed to dissolve the stone too

Answer 141

Extracorporeal Shock Wave Lithotriopsy Noninvasive mechanical procedure for breaking up stones in the kidney or upper ureter so they can pass spontaneously or be removed by other methods Fluoroscopy visualizes the stones no incisions or drains ultrasonic waves are delivered through a bath of warm water Stones are passed in urine within a few days

Answer 142

For stones in the bladder, ureter, or kidneys Invasive fluoroscopy guide inserted near the area of the stone, and an ultrasonic wave is then aimed at the stone ti break it up Performed via cystoscopy or nephrostomy No incision needed for cystoscopy, but a small flank incision is needed for nephrostomy

Answer 143

Client may already have an indwelling catheter Nephrostomy tube may be placed to administer chemical irrigations to break up the stone and may remain in place for 1-5 days Encourage client to drink 3000-4000 mL of fluid per day following procedure Monitor for an instruct client to monitor for complications of infection, hemorrhage, and extravasation of fluid into the retroperitoneal cavity NEVER FLUSH THE NEPHROSTOMY TUBE AS PRESSURE CAN HARM THE NEPHRON

Answer 144

Open surgical procedure if the stone is in the ureter and the lithotripsy is not effective Incision into the ureter is made through a lower ab or flank incision to remove the stone Client may have a penrose drain, ureteral stent catheter, and an indwelling bladder catheter

Answer 145

flank incision into the kidney is made to remove stones from the renal pelvis LARGE INCISION in flank area is needed Client will have a penrose drain and an indwelling catheter

Answer 146

Incision into the kidney to remove the stone from the renal calyx LARGE INCISION in flank area is needed client may have a nephrostomy tube and an indwelling catheter

Answer 147

performed if there is extensive kidney damage, renal infection, or severe obstruction - and to prevent stone reoccurrence surgical removal of kidney(s) very extreme