renal A+P, diagnostic testing, and assessment Flashcards
describe blood flow the kidney gets
- total blood supply circulates through the kidneys 12x/hr
- receives a ton a blood/minute (25% of CO)
what are the kidneys protected by
fat, renal capsule, muscle, SQ tissue, and skin
what are the three parts the kidney is divided into
- cortex
- medulla
- pelvis
describe bloodflow coming to and leaving the kidneys
- afferent arteriole supplies the glomerulus with blood
- efferent arteriole drains blood from glomerulus
what is a nephron
- the functional unit of the kindey
- each kidney is composed of 1 million nephrons
describe the glomerulus
- specialized capillary loops at the beginning of the nephron
- site of filtration, first process in urine formation
- rate of blood flow determined by BP
what is GFR
- volume of plasma filtered from the glomerular capillaries into bowmans capsule each minute, expressed in ml/min
- normal 125ml/min
what are some functions of the kidneys
- urine formations
- excretion of wastes
- fluid and electrolyte regulation
- acid base balance
- regulation of blood pressure
- stimulation of RBC production
- synthesis of vit D to active form
what does the RAAS do
regulates blood flow to kidneys, BP, and GFR
what are some functions of aldosterone
- hold onto Na+
- H2O follows Na+
- releases K+
- increases BP
where does furosemide work in the kidney?
tubules
what can affect GFR? choose all that apply
1) chronic HTN
2) diabetes type 1
3) advanced age
4) hpotension
all of em
what does aldosterone do to the body?
1) vasodilation
2) release Na, retain K
3) fight or flight
4) retain Na, release K
retain Na, release K
whats included in the urinary system
- ureters
- bladder
- urethra
whats the capacity of the bladder
400-500ml
whats an acceptable bladder post residual
less than 100ml
when does decline in renal function begin
35-40 years
describe the progressive loss of renal function
- glomerular sclerosis
- decreased blood flow
- decreased GFR
- altered tubular function
- acid-base imbalance
whats a person at risk for with age related changes in the renal system
- adverse drug effects
- hypernatremia
- fluid volume imbalance
- UTIs
what health history is included in renal assessment
- chief complaint
- pain
- changes in voiding
- GI symptoms
- unexplained anemia
- past health, family, and social history
whats included in physical assessment of renal assessment
- subjective like asking about what the piss looks like
- objective data like I+O, weight, lab values, meds
what diagnostic tests are used for the renal assessment
- UA/C&S
- BUN
- creatinine
- GFR
- 24 hour creatinine clearance
- hemoglobin and hematocrit
- electrolytes
whats used to test function of kidneys
BUN and Cr
describe BUN
- normal is 10-20
- measures nitrogen in blood
- can be falsey elevated with increased protein intake
describe creatinine
- normal is 0.7-1.4
- waste product from everyday living
what does GFR test
filtration
whats included in urinalysis results
- color
- clarity
- odor
- pH
- specific gravity
- protein
- glucose
- ketones
- RBC
- WBC
- bacteria
- leukocyte esterase
what can tell the concentration of urine
- color
- clarity
- odor
- pH
- specific gravity
increase speicifc gravity can mean…
super concentrated urine
what does protein in the urine mean
tells if theres damage to glomerulus
what does glucose in the urine mean
blood sugar is super high
what do ketones in the urine mean
then the body starts to break itself down bc its not getting proper nutrition
can be seen in DKA
what does RBC in the urine indicate
UTI or kidney damage
what does WBC in the urine indicate
infection
what does leukocyte esterase indicate
show inflammation in kidneys/urinary tract
what does renal angiography do
looks at bloodflow of the kidneys, can tell if there is a clot
what are some pre test interventions for renal angiography
- need good kidney function -> check labs
- be hydrated to dilute dye
what are some post procedure interventions for renal angiography
check for bleeding
what are some complications of renal angiography
hematoma, damage from dye, blood clots
whats some patient education shit to include for renal angiography
- hydrate
- explain what will happen with test
- explain what to expect after
- explain when to call the doc
what is a renal biopsy
- can diagnose cancer or failure
- big ass needle, numb spot
what are some pre test nursing interventions for renal biopsy
look at clotting times, no blood thinners
what are some post procedure interventions for renal biopsy
- vitals, watch for low BP and high hr
what are some complications with renal biopsy
- bleeding
- urination issues
- can have a little blood in the urine and thats okay
whats some stuff to include in patient education for renal biopsy
- know when to call doc, if theres still bleeding after three days
- explain what the test is and what to expect after
describe cystoscopy
- scope up the urethra
- can take samples
- see urethra, bladder
- uncomfy procedure
what are some pre test interventions for cystoscopy
do UA beforehand
what are some post procedure interventions for cystoscopy
burning and painful urination after
what are some complications of cystoscopy
blood tinged urine, urinary retention
what does intravenous pyelography show
shows shape and size of kidney
what are some pre test interventions for intravenous pyelography
need working IV and be hydrated
what are some post procedure interventions for intravenous pyelography
hydrate to flush the dye out
whats some patient education for intravenous pyelography
- ecourage fluid
- call if not urinating
describe KUB
kinda like intravenous pyelography but with no dye
better for patients with bad kidney function
can see kidney stones
what does an ultrasound show
shape of kidney, massess, tumors, and size
