renal Flashcards
concentration and dilution
Water, Sodium and Chloride Urea Catecholamines Renal Hormones Antidiuretic Hormone Natriuretic Peptides Vitamin D Erythropoietin Renin- Angiotensin Aldosterone
male assessment (subjective)
Frequency, urgency and nocturia Dysuria Hesitancy and straining Urine colour Past GU history Penis: pain, lesion, discharge Scrotum, self-care behaviors, lump Sexual activity and contraceptive use STI Contact
female assessment (subjective)
Menstrual History Obstetrical History Menopause Self-Care Behaviors Urinary symptoms Vaginal discharge Past history Sexual activity Contraceptive use STI Contact and Risk reduction
renal assessment objective
Inspect and report any abnormal findings to the physician
Urine
Continent or Incontinent
Fluid Balance
24 hour fluid balance and how much they are voiding within your shift
Lab Values(Which Lab Values are most Pertinent to Renal?)
Electrolytes
Creatinine and BUN
sodium
potassium
obstruction
There is an interference with flow of urine any where along the urinary tract
May be anatomical of functional
Flow is impeded dilation of the urinary system increase risk for infection compromises the renal system
upper urinary tract obstruction etiology
Stricture
Congenital compression of a calyx, ureteropelvic or ureterovesical junction
Compression from an aberrant vessel, tumor or abdominal inflammation and scarring
Ureteral blockage form stones
Malignancy of the renal pelvis or ureter
upper urinary tract obstruction pathophysiology
Obstruction causes dilation of the ureter, renal pelvis, calyces and renal parenchyma proximal to the site of the blockage.
Dilation is an early response to the obstruction
Increased pressure decreases filtration
response to relief of upper urinary tract obstruction
Diuresis (called post-obstructive diuresis)
Restoration of fluid and electrolyte imbalance
May be further complicated by severe post obstructive diuresis
upper urinary tract obstruction kidney stones
Calculi or urinary stones are masses of crystals, protein or other substances
Most common stone type is calcium oxalate or phosphate, struvite and uric acid
kidney stone pathophysiology
Stone formation requires:
Super-saturation of one or more salts in urine
Precipitation of salts from liquid to a solid state
Growth through crystallization or agglomeration
Presence of absence of stone inhibitors
stone formation is influenced by
Age, gender, race Geographic location seasonal factors Fluid intake Diet Occupation Genetic predisposition Previous UTI HTN Obesity
clinical manifestations of kidney stones
Moderate to severe pain
located in the flank and radiating to the groin
lateral flank or lower abdomen pain
Urinary urgency, frequency and urge incontinency
Nausea and vomiting
Gross or microscopic hematuria
kidney stones evaluation and diagnosis
Presenting Symptoms Patient history Assessment Imaging studies Functional study of renal pelvic and ureteral pressures Urinalysis (including pH) Diagnostic Tests X-Rays, CT scan or ultrasound
lower urinary tract obstructions
Related to how urine is stored in the bladder or how urine is emptied from the bladder
etiology of lower urinary tract obstruction
Neurogenic
Anatomic alterations
Or Both Neurogenic and Anatomic
Primary symptom is incontinence*
lower urinary tract obstruction neurogenic bladder
Bladder dysfunction caused by neurological disorders
Lesion above C2 or above the pontine micturition center result in detrusor hyperreflexia
Loss of coordinated neuromuscular contraction and overactive or hyperreflexive bladder function
Likely a lesion located in the upper motor neurons of the brain and spinal cord between C2 and S1 results in detrusor hyperreflexia with vesicosphincter dyssynergia
Loss of bladder muscle contraction and overactive bladder
Lesions can also occur in the sacral area of the spinal cord or peripheral nerves below S1 results in detrusor areflexia
Results in an underactive, hypotonic or flaccid bladder function with loss of sensation
