Nursing 107 Exam #4 Flashcards
What are normal components of urine?
Water, sodium, chloride, potassium, calcium, bicarbonate, urea, creatinine
What components should not be in urine?
Glucose, protein, blood
What does very pale yellow urine represent?
Diluted urine
What does dark amber urine represent?
Concentrated urine
What does Dark red/brown urine represent?
Blood in urine
What does tea brown colored urine represent?
Bilirubin in urine
What does green colored urine represent?
Gentimycin (antibiotic)
What does orange colored urine represent?
pyridium
What does red urine represent?
rifampin & myoglobin
What does smokey colored urine represent?
Red blood cells
What does cloudy turbidity of urine mean?
infection, high levels of urinary protein
What is the normal urine specific gravity?
1.005-1.030
What causes a specific gravity of less than 1.005 (diluted urine) mean?
Diuretics, fluid overload, diabetes insipidus
What causes a specific gravity of more than 1.030 (concentrated urine)
Dehydration, SIADH, decreased renal perfusion
What is the average and normal pH of urine?
Average = 6 Normal range (4.6-8)
Why do changes occur in the pH of urine?
Diet, medications, acid base imbalance, altered renal function
What does the positive finding of protein in urine mean?
Renal disease, stress, infection, and strenuous exercise
What does glucose in urine mean?
Reflects hyperglycemia in the blood
What happens when the blood sugar >180?
The renal threshold for what kidneys can save has been exceeded
What does urine that is positive for ketones mean?
Incomplete metabolism of fatty acids
What causes ketones in urine?
DKA, prolonged fasting, anorexia nervosa, adkins diet (high protein that causes the body to breakdown fats for fuel)
What causes the urine to test positive for nitrites?
Presence of nitrite-forming bacteria including E. coli, Citrobacter, Enterobacter, Klebsiella, Proteus, Pseudomonas, Salmonella & some species of staphylococcus
What is the normal reading of RBC in urine?
0-2 per high power field
What causes a increased reading of RBC in urine?
catheterization, menses, abnormal tumors, stones, trauma, glomerular disorders, cystitis, or bleeding disorders
What is the normal reading of WBC in urine?
0-3 in males
0-5 in females
What causes increased numbers of WBC in the Urine
Infection or inflammation anywhere in the renal/urinary tract, renal transplant rejection, fever, or exercise
What is the normal reading of Casts in urine?
few or none
What causes an increase in Casts in urine?
renal disease, infections, transplant rejection
What is the normal reading of crystals in the urine?
none
What are crystals?
Crystals are salts that precipitate in the urine.
Large number of crystals are common in what patients?
urolithiasis (kidney stone), gout, high dietary intake of foods rich in purines, or receiving chemotherapy
What is the normal count of bacteria found in the urine?
Normal is less than 1000 colonies/ml
What is the normal reading of parasites in the urine?
none
What does the presence of Trichomonas vaginalis indicate?
infection, usually of the urethera, prostate or vagina
Considered STI
What is the most common organism in community acquired infection from fecal organism?
E. Coli
What organisms cause infection in hospitalized patients?
Staph, Klebsiella, Proteus, Enterobacter
What are the risk factors in UTI development?
Age, altered immunity, DM, obstruction of urine flow, (BPH, kidney stone) sexual activity (diaphragm use), pregnancy, urinary stasis, catheterization
What are the s/s for a UTI?
Frequency, urgency, dysuria
What are the nonspecific s/s for UTI in the elderly?
Lethargy, altered sensorium (LOC), low grade fever, anorexia, new onset of incontinence
What are some common drug treatments for UTI?
Antibiotics, Urinary Antiseptics, and Bladder Analgesics
What is are two lower UTI’s names?
Cystitis and Urethritis
Describe Cystitis
Bladder inflammation
Acute or chronic
Urgency, frequency, pain, spasms
Describe s/s of Urethritis
Painful urination
Discharge
Neisseria gonorrhea
Describe an upper UTI?
Inflammation of renal pelvis and kidney
Usually results from bacterial infection ascended from bladder
Sudden onset of fever & chills, dull flank pain
What are some complications of Pyelonephritis (Upper UTI)?
Chronic renal failure
Inflamed pelvis
Dilated ureter
Scar tissue
What is Glomerulonephritis?
Acute nephritic syndrome
How is Glomerulonephritis contracted?
Usually follows upper respiratory infection caused by Streptococci
What are the s/s of Glomerulonephritis?
Hematuria, proteinuria, red cell casts, oliguria, edema, pruritus, nausea, constipation, hypertension, increasing BUN & Creatinine.
What is BUN?
Blood Urea Nitrogen
Urea=nitrogen compound formed in the liver from ammonia as an end product of protein metabolism.
What does BUN tell us?
Reflects both protein intake and renal excretion function.
What are the normal levels of BUN?
Newborn: 5-17 mgdL
Youth: 7-17 mg/dL
14 yo - adult: 8-21 mg/dL
Adult >90 yo: 10-31 mg/dL
What are some reasons for abnormal high BUN?
Acute renal failure, chronic glomerulonephritis, HF, decreased renal perfusion, excess protein intake, GI bleeding, muscle wasting from starvation, dehydration.
What are some reasons for abnormal low BUN?
Inadequate dietary protein intake, malabsorption syndrome, pregnancy, overhydration, severe liver disease
What is Serum (blood) Creatinine?
End product of creatine metabolism
What are normal levels of Serum (blood) creatinine?
1-5 yo: 0.3-0.5 mg/dL
6-10 yo: 0.5-0.8 mg/dL
Adult male: 0.6-1.2 mg/dL
Adult female: 0.5-1.1 mg/dL
What are some reasons for high creatinine levels?
Increased muscle mass, decreased renal blood flow (HF, shock), decreased renal excretion, released from damaged muscle
What are some reasons for low creatinine levels?
Decreased muscle mass (increasing age, muscular dystrophy, small stature, inadequate protein intake), increased GFR (Hyperthyroidism)
What is Creatinine Clearance?
Ideal substance for determining renal clearance
Measures a blood sample with urine sample to determine rate at which the kidneys are clearing creatinine from the blood.
What is Glomerular Filtration Rate (GFR)?
Best indication of overall kidney function based on 24hr urine collection. Shows how well the renal system clears creatinine
What is the normal BUN/Creatinine ratio?
10:1 and 20:1
A ratio > than 20:1 indicates what in BUN/Creatinine ratio?
decreased renal perfusion
A ration < than 10:1 indicates what in BUN/Creatinine ratio?
diminished protein intake or liver dysfunction
Ratio of BUN/Creatinine can remain normal with intra-renal failure? T or F
True
Which is drawn up first in a Peak & Trough level test?
Trough is drawn 1st, then Peak 2nd
What drugs require peak/trough testing?
Aminoglycosides, Amphotericin B, Antibiotics, Systemic antifungals, ACE inhibitors, NSAIDS, Radiographic contrast agents
A quantitative analysis of a composite urine sample for levels of creatinine, urea nitrogen, sodium, chloride, calcium or catecholamine is called?
24 hour urine test
X-ray of the kidneys, ureters, and bladder to screen for presence of 2 kidneys, measure kidney size, and to detect gross obstruction is called what?
KUB
Uses sound waves to identify the size of the kidneys, obstruction, tumor, or cysts. Minimal risk to the client. This is called?
Ultrasound
This procedure has a radiopaque dye the is injected intravenously. The dye circulates into the kidney blood vessels and excreted in the urine. A series of x-rays are taken at various times after injection. Helps evaluate kidney function, renal calculi, and trauma is called?
IVP
Blood test that provides information about renal impairment is?
BUN, CR
This is performed under general anesthesia or local anesthesia with sedation. Scope goes through the urethra and into the bladder to examine for trauma, obstruction, tumor, or enlarged prostate gland?
Cystoscopy
The catheter is inserted into the femoral artery and threaded into the renal arteries. Radiopaque dye is injected into vessel and x-rays taken to determine areas of narrowing or obstruction. Bleeding from the insertion site is the most common complication.
Renal angiogram
This provides information on components present in urine sample. Abnormal results include blood, protein, glucose, white blood cells.
UA
This analyzes presence of bacteria and determines which drugs are effective at killing or stopping growth of the bacteria?
C & S
A decrease in this occurs with increased fluid intake, diuretic administration, and diabetes inspidus. An increase occurs with dehydration, ADH, and decreased renal perfusion.
Specific gravity
Provides 3-dimentional information about the kidneys, ureters, bladder, and surrounding tissues. May be performed with contrast medium.
CT Scan