Module 3 and Module 4 Flashcards
major role of the urinary system
MAINTAIN HOMEOSTASIS BY MAINTAINING FLUID COMPOSITION AND VOLUME
components of the urinary system (KUUU)
○ Kidneys
○ Ureters
○ Urinary bladder
○ Urethra
Functions of kidneys
○ Maintaining overall fluid balance
○ Regulating and filtering minerals from the blood
○ Filtering food and waste materials and toxic substances
○ Creation of hormones that helps in the production of red blood cells
○ Promote bone health
○ Regulate blood pressure
functional units of kidneys
nephrons
what nephrons do in the kidneys
Nephrons aid in the formation of urine
Amount of blood flows in the kidneys and its percentage in the cardiac output
About 1200 ml of blood flows to the kidney per minute, which is 20-25% of the cardiac output
Through the formation of urine, what kidneys do?
Through the formation of urine, the kidneys remove waste products from the blood, regulate fluid volume, maintain electrolyte concentration, blood pressure, and pH within the body
Paired muscular docks with narrow lumina which carry the urine from the kidneys to the bladder
URETERS
Measurement of two small tubes in the ureters
Two small tubes about 25 cm long
Enumerate the three layers in the ureters
○ Outer layer (Fibrous coat)
○ Middle layer (Muscular coat)
○ Inner layer (Mucosa)
supporting layer of fibrous connective
tissue
Outer layer (Fibrous coat)
inner circular and outer longitudinal smooth
muscle
Middle layer (Muscular coat)
Define Inner layer (Mucosa)
made up transitional epithelium that is continuous
with the lining of the renal pelvis and
urinary bladder
Main function of the middle layer (muscular coat)
Main function is peristalsis which
helps in propelling in the release
of the urine
Purpose of mucus that secretes in the inner layer (mucosa)
This layer secretes mucus which
coats and protects the surface
the cells
Transport the urine from the _____ to the urinary
bladder
pelvis
this structure prevents the reflux of urine as the
bladder contracts
ureters
Serves as temporary storage reservoir for urine
THE URINARY BLADDER
Location of the urinary bladder
Located in the pelvic cavity
Size of urinary bladder
Its size varies with the amount of urine it contains
and with the pressure it receives from the
surrounding organ
Amount of urine that urinary bladder can hold
Can hold up to 1000 ml of urine
Tube that drains the urine from the bladder out of
the body
THE URETHRA
The passageway of the urine into the external
environment
THE URETHRA
Size of the urethra
● Female: 1 ½ ( cm long) to 2 ½ inches, ending at
the vulva or the external female genital organ
● Male: 5 ½ to 6 ½ inches up to 8 inches (20 cm) in
length , ending at the tip of the penis
three steps of urine formation by the kidneys
GTT
Glomerular filtration
Tubular reabsorption
Tubular secretion
Glomerular filtration process
The water or solute go to the
glomerular capsule and
becomes glomerular filtrate
Tubular reabsorption process
The glomerular filtrate goes into the kidney tubules, then into peritubular capillaries where 1% stays in the tubules and becomes urine
Tubular secretion process
- Substances from the blood are transported into the renal tubules
- There is an elimination of potassium ion, hydrogen, ammonia and uric acid
- Usually only few substances are secreted and typically these are waste products
- Urine is the substance left over inthe collecting dock, following
secretion and reabsorption
DIAGNOSTIC TESTS OF GENITOURINARY DISORDERS
ROUTINE URINALYSIS
CREATININE CLEARANCE AND BLOOD STUDIES
SERUM ELECTROLYTES
CYSTOSCOPY
KUB X ray
EXCRETORY UROGRAM/INTRAVENOUS
PYELOGRAPHY
RETROGRADE PYELOGRAM (RPG)
VOIDING CYSTOURETHROGRAM
CYSTOMETROGRAM
RENAL ARTERIOGRAM
UTZ OF KIDNEYS, URETERS, AND BLADDER
RENAL BIOPSY
Also known as routine analysis
ROUTINE URINALYSIS
What is the simple test that looks at the simple sample of the urine?
URINE ANALYSIS
It can help find problems that need treatment
including infection or kidney problems
URINE ANALYSIS
ROUTINE URINALYSIS helps find serious diseases in early stages like ___________
kidney disease, diabetes or liver disease
ROUTINE URINALYSIS is often used prior to surgery as?
as a pre-emptive screening during a pregnancy check up and as part of routine medical or physical examination
ROUTINE URINALYSIS NORMAL FINDINGS IN URINE COLOR
Amber Yellow/Straw
ROUTINE URINALYSIS NORMAL FINDINGS IN pH level
4.5 to 8.00 (Average is 6, slightly
acidic)
ROUTINE URINALYSIS NORMAL FINDINGS IN specific gravity
1.010-1.025
TRUE OR FALSE
Normal urine has protein positive (+)
False. Protein negative (-), if positive, it means that thempatient is consuming too much protein rich foods or there already an entry in the kidney tissues that may cause leakage of protein that thereby mixes in the urine of the patient
Normal range of RBC and WBC in urinalysis
(0-5/hpf) hpf- high power
field
Indication of exceeding levels in RBC and WBC in urinalysis
urinary tract infection
TRUE OR FALSE
Normal urine has absence of pus
TRUE. Pus should be absent, if positive, it can be a sign of bacterial urinary tract infection. Usually happens in people with sepsis or older people with pneumonia
TRUE OR FALSE
Normal urine has absence of glucose and ketones
TRUE
■ If positive in glucose, there can
be diabetes mellitus
■ If positive in ketones, may
indicate diabetic ketoacidosis
best indicator of glomerular function
Creatinine
Indication of decrease creatinine levels
renal function impairment
Normal range of creatinine
74.3 to 107 micromoles per liter
(But vary from lab to lab between men
and women and by age)
ENUMERATE BLOOD STUDIES AND THEIR NORMAL VALUES
BUN (blood urea nitrogen) - 10-20 mg/dl
Serum uric acid – 2.5-8mg/dl
Albumin – 3.2-5.5 mg/dl
RBC (red blood cells) – 4.5-5
million/cubic.mm of blood volume
Hct (Hematocrit Measurement) - 41-50% (Male); 36-48% (Female)
What happens if there is a high BUN level?
it may indicate that kidneys are not working well, urinary tract obstruction, congestive heart failure or recent heart attack, GI bleeding, dehydration which resulted from shock, severe burns, not drinking enough fluid, certain medications such as antibiotics and high-protein diet
What happens if there is a high uric acid?
kidneys don’t eliminate uric acid efficiently
Causes of a slow down in the removal of uric acid
overweight, having diabetes, taking certain diuretics (water pills), too much alcohol
Other less common causes are diet high in purine containing items or your body is producing too much uric acid
a protein found in the blood
Albumin
TRUE OR FALSE
A healthy kidney doesn’t let albumin pass from the blood in the urine
TRUE
_, _, _ commonly accompanying illness which means
it’s not a disease itself but a clinical manifestation
of another underlying condition.
Fluid, electrolyte, and acid-base imbalances
TRUE OR FALSE
A damage kidney let some albumin pass into the urine
TRUE
TRUE OR FALSE
The more albumin in the urine, the better
FALSE; more-less
What is the purpose of measuring albumin in the urine?
Measuring the albumin in the
urine is a toll for diagnosing
kidney disease as well as in
monitoring progression of a
kidney disease
A genitourinary disorders that covers a lot of problems that can result eventually to kidney failure. It usually happens when the kidney does not get enough blood to filter; happens also perked by disease, like high blood sugar, high blood pressure glomerulonephritis, and polycystic kidney disease. It also happens when kidney is blocked by a kidney stone or scar tissue.
RENAL FAILURE
What would the nurse should do if the high count of RBC were detected and the patient is a female?
If a high count of red blood cells
were detected and the patient
is a female, it is important to ask
them if they are having
menstruation. The nurse must
also assess the genitalia for
possible trauma due to bladder
catheterization
Indication of high presence of RBC? KIT
infection, tumors or kidney stones
Renal failure is perked by what diseases?
High blood sugar, high blood pressure, glomerulonephritis, and polycystic kidney disease
What does it mean if RBC is seen under microscopy and look distorted?
they suggest kidney is the possible
source and may arise to kidney
inflammation
(glomerulonephritis)
2 Types of Renal Failure
Acute Renal Failure and Chronic Renal Failure
Without water, we cannot promote
______ and it will be
hard for our body to _______________.
cellular chemical function, maintain normal
body temperature
It can help in the promotion of neuromuscular
irritability.
Electrolytes
It can also help our body to distribute body water
fluid compartments.
Electrolytes
TRUE OR FALSE
Small amounts in the urine is
sometimes seen in young people
and usually not indicative of any
disease
TRUE
Refers to the percentage of red
blood cells in your blood
Hct (Hematocrit Measurement)
It is essential in maintaining blood volume
or plasma.
water
Identify which type of renal failure:
1) It happens due to sudden loss of renal function
2) Gradual progressive loss of renal function
Answer Key
1) Acute Renal Failure
2) Chronic Renal Failure
It is helpful in the transportation of gases,nutrients, and other substances to the cells.
water
Identify which type of renal failure:
1) Irreversible
2) Potentially reversible
Answer Key
1) Chronic Kidney Failure
2) Acute Kidney Failure
water is considered a way of ___________________.
eliminating waste products from our cells.
Identify which type of renal failure:
Glomeruli is totally damaged
Chronic Renal Failure
Electrolytes can also help our body to distribute _________________________.
body water fluid compartments.
Identify which type of renal failure:
Renal tubules are damaged, however, the glomeruli remain intact
Acute Renal Failure
Three Stages of Acute Renal Failure
ODR
Oliguric Phase
Diuretic Phase
Recovery Phase
Electrolytes can help in the regulation of ________________.
acid-base
balance.
Oliguric Phase
Decreased Urine Output
Increased BUN, serum creatinine
Edema
Hypertension
Hyperkalemia
Hypermagnesemia
Hyperphosphatemia
Hyponatremia
Metabolic Acidosis (last 1-3 weeks)
Without electrolytes, these essential functions will
not be possible and our ___________ will be compromised.
homeostasis
Diuretic Phase
Kidneys starting to regain function
Increase urine output (3-5 L per day)
Excessive potassium loss
Recovery Phase
Takes 3-12 months for kidney to recover
Pt should avoid nephrotoxic drugs
4 Stages of Chronic Renal Failure
Renal Impairment
Renal Insufficiency
Renal Failure
ESRD (End Stage Renal Disease)
What are the 2 BODY FLUID COMPARTMENTS?
ICF (intracellular fluid), ECF (extracellular fluid)
Which stage of chronic renal failure has a 40-50% remaining GFR?
Renal Impairment
fluid inside the cells
ICF (intracellular fluid)
Which stage of chronic renal failure has a 10-20% remaining GFR?
Renal Failure
fluid found outside the
cells
ECF (extracellular fluid)
Which stage of chronic renal failure has a 20-40% remaining GFR?
Renal Insufficiency
ICF (intracellular fluid) comprises _______ of the body fluid
2/3 or 70%
Which stage of chronic renal failure has a less than 10% remaining GFR and has a presence of uremia?
ESRD
What does uremia mean?
Having urine in the blood
ECF (extracellular fluid) comprises _______ of the body fluid
1/3 or 30%
Clinical Manifestations of Chronic Renal Failure
1) Inability of the kidney to excrete metabolic waste products through urine formation
2) Inability of the kidney to secrete erythropoietin
3) Inability of the kidney to maintain fluid-electrolyte acid-base balance
4) Inability of the kidney to metabolize Vitamin D
5) Altered biochemical environment
What does oliguria mean?
Having a less than 400 ml of urine output per day
WHAT ARE THE CONSTITUENTS OF EXTRACELLULAR FLUIDS?
Interstitial fluid (ISF), Intravascular fluid (plasma), Transcellular water (TSW)
An increased BUN and serum creatinine is a condition we call as
Azotemia
spaces between cells
Interstitial fluid (ISF)
Interstitial fluid (ISF) comprising ___ of total body fluid
15%
4% of the total body fluid
Intravascular fluid (plasma)
1-2% of total body fluids
Transcellular water (TSW)
How does urineferous odor of breath happen?
It happens when elevated concentration of UREA IN BLOOD is associated with FLUID ELECTROLYTE, HORMONE IMBALANCES, AND METABOLIC ABNORMALITIES
specifically it’s 75 mL/kg of body weight
Intravascular fluid (plasma)
It is due to conversion of urea back to ammonia, which irritates mucous membranes, including that of GI tract
Stomatitis and GI bleeding
no electrical charge
Nonelectrolytes
have an electrical charge
Electrolytes
(+) charged electrolytes
Cations
(-) charged electrolytes
Anions
Examples of Cations
sodium, potassium, calcium, magnesium, and hydrogen ions
Based on the premise that a reduced RBC lifespan in renal disease is primarily caused by the
Toxic Uremic Milleu
Examples of Anions
chloride, bicarbonate, phosphate, and sulfate
major cation in the ECF
Sodium
major cation in the ICF
Potassium
A reduced RBC lifespan continues to contribute to
Renal anemia
Electrolytes combine in solutions based on the
__________ they are producing
electrical charge
Measurement of solute concentration in body
fluid is based on the fluid’s __________.
osmotic pressure
pressure exerted by a solution necessary to
prevent osmosis; minimum pressure required to
prevent the inward flow of a solution’s pure
solvent through a semipermeable membrane
osmotic pressure
It occurs in patients with CKF and it happens when the brain tissue is damaged due to HIGH UREA AND NITROGEN
Renal encephalopathy
It is due to the accumulation of HIGH URATES IN THE SKIN, causing severe pruritus and skin dryness
Uremic frost
the number of osmoles per kilogram of solution
Osmolality
Solution that have the same solute concentration as another solution
Isotonic Solution
the number of osmoles per liter of solution
Osmolarity
Solution that have a lower solute concentration than another solution
Hypotonic Solution
Solution that have a higher solute concentration than another solution
Hypertonic Solution
Hypertonic Solution: Cell Shrinking
_______________: Cell Swelling
Isotonic Solution: ______________
Hypotonic Solution : Cell Swelling
Isotonic Solution: No Particular Effect on cell
What are the other clinical manifestations of CRF in worst cases?
Decreased libido, impotence and infertility
What are the sources of fluid intake?
Water in food, Water from oxidation, Water taken as liquid
Water in ____ - 1000 mL
food
Water from ______ - 300 mL
oxidation
Water taken as _____ - 1200 mL
liquid
Water in food - ____ mL
1000 mL
Water from oxidation -_____ mL
300 mL
Water taken as liquid -________ mL
1200 mL
The inability of the kidneys to secrete erythropoietin results in
Severe anemia and reducing RBC production by bone marrow
What are the sources of fluid output?
Skin, Lungs, Feces, Kidneys
Skin - ___ mL
500mL
Inability of the kidney to maintain fluid-electrolyte, acid-base balance causes the manifestation of:
Edema
Hyperkalemia
Hypermagnesemia
Hypo/Hypernatremia
Metabolic Acidosis
Lungs - ___ mL
300 mL
Feces- ___ mL
150 mL
Kidneys- _____ mL
1500 mL
It is due to CRF and due to inability of the kidneys to BUFFER HYDROGEN IONS that regenerate HCO3 (bicarbonate), and their failure to excrete waste products, which are mostly ACIDIC in nature.
Metabolic Acidosis
Inability of the kidneys to metabolize Vitamin D due to decrease calcium absorption
Hypocalcemia
Inability of the kidneys to metabolize Vitamin D due to decrease serum calcium levels
Hyperphosphatemia
Inability of the kidneys to metabolize Vitamin D due to lack of calcemia and in this case, the bone become weak and brittle
Renal osteodystrophy
the major control of actual fluid intake
THIRST
Inability of the kidneys to metabolize Vitamin D due to calcemia that triggers the parathyroid glands to increase secretion of parathyroid hormone
Hyperparathyroidism
Normal values of K in serum electrolyte
3.5 to 5.5 mEq/L
Normal values of Na in serum electrolyte
135-145 mEq/L
It is the feeling of needing to
drink something.
THIRST
Thirst occurs whenever the body is ______ for
any reason.
dehydrated
What are the collaborative management for clients with RENAL FAILURE? (2 Conservative Management)
Fluid control and Electrolyte control
Normal values of Ca in serum electrolyte
4.5-5.5 mEq/L
Thirst is the major control of ________.
actual fluid intake
Normal values of Mg in serum electrolyte
1.5-2.5 mEq/L
Respiratory Acidosis is also known as
Carbonic Acid Excess
Normal values of Phosphorus in serum electrolyte
2.5-4.5 mg/dl
Normal values of chloride in serum electrolyte
98-108 mEq/L
Any condition that can result in a _________ can lead to thirst or excessive thirst.
loss of body water
Caused by the failure of the respiratory system to
remove CO2 from the body fluid
Respiratory Acidosis
Thirst can be a characteristic symptom of certain medical conditions most notably __________.
diabetes mellitus
major organs controlling output
KIDNEYS
Kidneys helps the body in eliminating fluid waste such as
____.
urine
Blood ph in renal failure
metabolic acidosis
Fill in the blanks: (In respiratory acidosis)
________ can also occur because of this
problem and usually this visual disturbances is
accompanied by _________.
Visual Disturbances, Headaches
Kidneys are also helpful in performing many crucial functions such as maintaining the __________.
overall fluid balance
What is the meaning of ADH?
antidiuretic hormone
What structures are being visualized using cystoscopy?
urethra, bladder wall,
trigone, urethral opening
What is cystocope?
a hollow tube equipped with the
lens which is inserted into your urethra and then
slowly advance into the bladder
What is the meaning of RAAS?
Renin-Angiotensin-Aldosterone System
retains water in the renal tubules
ADH (antidiuretic hormone)
Where cystoscopy is being done and their respective anesthesia given?
-testing room using a local anesthetic jelly that numbs the urethra
-outpatient procedure using sedation
-in the hospital during general anesthesia
ADH (antidiuretic hormone) prevents diuresis or urination so its tendency is to _________.
retain water instead of releasing through urination
Electrolyte Control in Renal Failure:
Hyperkalemia
Ensure that Pt is:
- In LOW POTASSIUM DIET
- Given with GLUCOSE 10% with INSULIN administered INTRAVENEOUSLY
- Given with RESIN KAYEXALATE
What is the meaning of the acronym ESRD?
End Stage Renal Disease
Why doctors recommending cystoscopy?
-to investigate causes of signs and symptoms
manifested by the patient such as having blood
in the urine, having urinary incontinence,
overactive bladder, and painful urination
-to diagnose bladder diseases and condition such
as bladder cancer and cystitis
-to treat bladder diseases and condition so special tools can be passed through cystoscope to treat certain condition
○ For example a very small bladder tumor
might be removed
-To diagnose an enlarged prostate, this can
reveal a narrowing the urethra where it passes
through the prostate gland
_______ retains sodium and water
Aldosterone
It happens when the angiotensinogen which is secreted by the liver is converted by ____, a hormone produced by kidneys into Angiotensin I.
renin
Give the nursing interventions before cystoscopy
- Secure informed written consent
● It is the duty of the nurse to secure that the written consent will be signed by the patient or the legal representative of the patient - Done under local/general anesthesia
- Force fluids (if under local anesthesia) to prevent ascending UTI
● If the patient is administered with local anesthesia, the proper nursing action is to force fluid or to hydrate the patient.This is done to prevent the occurence of ascending UTI - NPO if under GA
● If the patient was given general anesthesia, the nurse must do a nothing per orem status or NPO to prevent episode of aspiration pneumonia - Inform client that the desire to void is felt as cystoscope is inserted
● They must be informed to gain better control while the procedure is being done - Place client in lithotomy position during the procedure
● This position is commonly used for a variety of open and endoscopic neurologic procedures
The presence of ______________ will lead to the conversion of Angiotensin I into Angiotensin II.
Angiotensin-converting enzyme (ACE)
This Angiotensin II can lead to the
secretion of two substances: (1) ____________ (2) _________
(1)antidiuretic hormone (2) release of
aldosterone.
Electrolyte Control in Renal Failure:
Hypocalcemia
Ensure that CALCIUM SALTS and VITAMIN D supplements are administered
If the Angiotensin II will trigger the
release of antidiuretic hormone, then
there will be an _______________.
increase in the water reabsorption
if the Angiotensin II will release aldosterone, our body will experience ______ and if there is constriction of blood vessels, chances are there will be _________.
vasoconstriction, high blood pressure
What are the clinical manifestations of respiratory acidosis? HVHVK
> Hyperpnea/Hyperventilation
Visual Disturbances
Headaches
Ventricular Fibrillation
K+ Excess
Electrolyte Control in Renal Failure:
Hyperphosphatemia
AMPHOGEL is given
Diet is: HIGH CALORIE, HIGH CARBOHYDRATES, LOW PROTEIN, LOW POTASSIUM, LOW SODIUM
Potassium regulation is relevant to ______ because
aldosterone retains ___ and excretes _______.
aldosterone, ion, potassium
relevant to aldosterone because aldosterone retains ion and excretes potassium.
Give the nursing interventions after cystoscopy
- Bed rest until V/S are stable
● Done to prevent orthostatic hypotension - Pink-tinged urine is normal 24-48 hrs after the
procedure
● Happens due to irritation of mucous
membrane upon insertion of the cystoscope - Expect Dysuria (difficulty in urination), urine
frequency, hematuria (blood in the urine) due to
irritation and these signs and symptoms must be
informed the patient to prevent anxiety - Observe for urine retention, signs of infection,
and excessive hematuria
● Notify the physician if these are
manifested - Monitor intake, output and V/S
- Hot sitz bath to relieve pelvic discomfort
- Advice warm, moist soak in the pt.’s legs to
promote relief and comfort due to prolonged
lithotomy position - Force fluids to prevent ascending UTI
True or False
Weeping Edema is characterized by swelling of feet, ankle, and sacrum part of the body
False
Dependent Edema instead Weeping
Increased aldosterone
hypokalemia
What is common between KUB (kidney, ureters, bladders) Xray and excretory urogram?
Both of them performed X-ray visualization of the kidney, ureters, bladder
Decrease aldosterone
hyperkalemia
A painless procedure that performed to assess the abdominal area for causes of abdominal pain or to assess the organ and structures of the urinary or gastrointestinal system.
KUB (kidney, ureters, bladders) Xray
low potassium levels in the blood
hypokalemia
high levels of potassium in the blood
hyperkalemia
True or False
Abdominal Effusion is the accumulation of fluid in the abdomen
False
Ascites instead Abdominal Effusion
Collaborative Management for Clients with Renal Failure - for Metabolic Acidosis
Give NaHCO3 (Sodium Bicarbonate)
increases K+ excretion that results to
hypokalemia
Alkalosis
Collaborative Management for Clients with Renal Failure - for Anemia
Administer hormonal drugs, such as EPOGEN, PROCRIT/EPOIETIN ALFA
decreases K+ excretion that results to
hyperkalemia
Acidosis
It helps the doctor determine the size and
position of your bladder, kidneys, as well as ureters
KUB (kidney, ureters, bladders) Xray
Who could be the candidate for KUB (kidney, ureters, bladders) Xray?
People who have symptoms of gallstones or kidney
stones
conditions that can be diagnosed through KUB (kidney, ureters, bladders) Xray?
intestinal blockage, foreign objects in the stomach, certain tumors and kidney stones and other
types of gallstones.
Potassium is the major cation found in the
intracellular fluid and this is very important because it
helps in the conduction of ________ as well as the
promotion of skeletal and cardiac activity.
nerve impulses
Give the bowel preparation in KUB (kidney, ureters, bladders) Xray
Bowel preparation: laxative in the evening and enema
in the morning as ordered
-This is done to prevent gas or feces from
interference during visualizations of the organs that are
being examined.
What is the meaning of PTH?
Parathormone
These three regulate calcium levels
Parathormone (PTH), thyrocalcitonin, and Vitamin D