Renal and Urological Systems Flashcards
Kidneys are located
outside peritoneal cavity in post upper abdomen on each side of vertebral column at level T12 to L2
The renal pelvis is what
a wide, funnel shaped structure at the upper end of the urethra that drains the kidney into the lower urinary tract (bladder and urethra)
Bladder is
membranous sac that collects urine
located behind symphysis pubis
Ureter extends from
renal pelvis to bladder and moves urine via peristaltic action
Urethra extends from
bladder to an external orifice for elimination of urine from the body
Function of kidneys
Regulate composition and pH of body fluids Controls mineral and water balance Eliminates metabolic waste Assists in BP regulation Contributes to bone metabolic function Controls production of RBCs
Glomerular filtration rate (GFR) is what
the amount of filtrate that is formed each minute as blood moves through the glomeruli and serves as an important gauge of renal function
Glomerular filtration rate is regulated by
arterial blood pressure and renal blood flow
Glomerular filtration rate is measured clinically by
obtaining creatinine levels in blood and urine samples
Normal creatinine is
115-125
Blood urea nitrogen (BUN) is what
urea produced in the liver as a by-product of protein metabolism that is eliminated by the kidneys
BUN levels are elevated with
increase protein intake, GI bleeding, dehydration
Normal values for urinanalysis
Yellow amber color
pH 4.6-8 (should be acid)
0-8 protein
0 sugar
Urinary regulation of fluids and electrolytes - homeostasis is regulated through
thirst mechanisms and renal function via circulating antidiuretic hormone (ADH)
Urinary regulation of fluids and electrolytes - fluid imbalances - causes for edema
inc capillary pressure
dec colloidal osmotic pressure
inc capillary permeability
obstruction of lymphatic flow
Urinary regulation of fluids and electrolytes - Potassium - normal serum level
3.5-5.5
Urinary regulation of fluids and electrolytes - K - Hypo causes
deficient K or excessive loss due to diarrhea, vomit
metabolic acidosis
renal tubular disease
alkalosis
Urinary regulation of fluids and electrolytes - K - hypo observe for
mm weakness, aches, fatigue, cardiac arrythmias, abdominal distention, n/v
Urinary regulation of fluids and electrolytes - K - hyper causes
inadequate secretion with acute renal failure kidney disease metabolic acidodis diabetic ketoacidosis sickle cell anemia
Urinary regulation of fluids and electrolytes - Na - Hypo causes
water intoxication associated with excess intake or excess ADH
Urinary regulation of fluids and electrolytes - Na - Hypo - observe for
confusion dec mental alertness signs of inc intracerebral pressure poor motor coordination sleepy anorexia
Urinary regulation of fluids and electrolytes - Na - hyper causes
water deficits (NOT SALT EXCESS) dehydration insufficient water intake
Urinary regulation of fluids and electrolytes - Na - hyper - observe for
circulatory congestion pulmonary edema with dyspnea hyeprtension tachycardia agitation restless convulsions
Urinary regulation of fluids and electrolytes - Ca - normal
8.4-10.4
Urinary regulation of fluids and electrolytes - Ca - hypo causes
reduced albumin levels hyperphosphatemia hypoparathyroidism malabsorption of Ca and vit D alkalosis acute pancreatitis Vit D deficiency
Urinary regulation of fluids and electrolytes - Ca - hypo = observe for
mm cramps tetany spasms convulsions paresthesias anxiety, irritability arrythmias hypotension
Urinary regulation of fluids and electrolytes - Ca - hyper - causes
hyperparathyroidism
tumors
hyperthyroidism
vit a intoxication
Urinary regulation of fluids and electrolytes - Ca - hyper - observe for
fatigue, depression, mental confusion
n/v, inc urination
occasional arrythmias
Urinary regulation of fluids and electrolytes - Mg - norm
1.8 to 2.4
Urinary regulation of fluids and electrolytes - Mg - hypo - causes
hemodialysis blood transfusions chronic renal disease hepatic cirrhosis chronic pancreatitis hypoparathyroidism excess loss of body fluiids
Urinary regulation of fluids and electrolytes - Mg - hypo - observe for
hyperirritability
confusion
leg and foot cramps
Urinary regulation of fluids and electrolytes - Mg - hyper - causes
renal failure diabetic acidosis hypothyroidism addisons dehydration and use of antacids
Urinary regulation of fluids and electrolytes - Mg - hyper - observe for
hyporeflexia, mm weakness, drowsy
lethargy, confusion, bradycardia, hypotension
Acid base balance
Balance of acids and bases in the body (normally a ratio of 20 base to 1 acid)
normal serum pH is 7.35-7.45
Metabolic acidosis is what
a depletion of bases or an accumulation of acids
blood pH below 7.35
Metabolic acidosis causes
diabetes
renal insufficiency
diarrhea
Metabolic acidosis observe for
hyperventilation deep respirations weakness mm twitch malaise n/v, diarrhea, HA, dry skin and mucus can lead to stupor and come/death
Metabolic alkalosis is what
an increase in bases or a reduction of acids
pH rises above 7.45
Metabolic alkalosis causes
excess vomit excess diuretics hypokalemia peptic ulcer excessive intake of antacids
Metabolic alkalosis observe for
hypoventilation depressed respirations dysrhythmias prolonged vomit, diarrhea weakness mm twitch irritability agitation convulsions coma/death
Respiratory acidosis is what
CO2 retention, imapired alveolar ventilation
Respiratory acidosis causes
hypoventilation
drugs/over sedation
chronic pulmonary disease
hypermetablism (sepsis, burns)
Respiratory acidosis observe for
dyspnea hyperventilation cyanosis resltessness HA May lead to stupor, coma/death
Respiratory alkalosis is what
diminished CO2
alveolar hyperventilation
Respiratory alkalosis - causes
anxiety attack with hyperventilation hypoxia impaired lung expansion CHF PE diffuse liver or CNS disease salicylate poisoning extremem stress
Respiratory alkalosis - observe for
tachypnea, dizziness, anxiety, difficulty concentrating
numb/ting
blurred vision
diaphoresis, mm cramps
twitching, tetany, weakness, arrhythmias, convulsions
Renal and Urological Disorders - UTI is what
infection of urinary tract with microorganisms
Renal and Urological Disorders - UTI - lower UTI
cysitis (inflammation and infection of the bladder)
or urethritis (inflammation and infection of the urethra)
Usually secondary to ascending urinary tract infections - may invovle kidneys and ureters
Symptoms of urinary frequency, burning with urination, pain
Renal and Urological Disorders - UTI - upper UTI
pyelonephritis (inflammation and infection of one or both kidneys)
Symptoms of systemic involvement - back pain, pain over costovertebral angle (murphy’s sign) burning urination
Renal and Urological Disorders - UTI - increased risk in those with
autoimmunity, urinary obstruction and reflus, neurogenic bladder and catheterization, diabetes, kidney transplant
older adults and women at inc risk
Renal and Urological Disorders - Renal cystic disease - renal cysts are what
fluid filled cavities that form along the nephron and can lead to renal degeneration or obstruction
Renal and Urological Disorders - Renal cystic disease - types
polycystic
medullary sponge
Acquired
Simple renal cysts
Renal and Urological Disorders - Renal cystic disease - symptoms
Pain Hematuria Hypertension Maybe fever if infection Cysts can rupture and produce hematuria
Renal and Urological Disorders - Obstructive disorders are what
developmental defects, renal calculi, prostatic hyperplasia or cancer, scar tisue from inlammation, tumors and infection
Renal and Urological Disorders - Obstructive disorders - Renal Calculi (kidney stones) are what
crystalline structures formed from normal components of urine
Renal and Urological Disorders - Obstructive disorders - Renal Calculi (kidney stones) - etiologic influences
concentration of stone components in urine and a urinary environemnt conductive to stone formation
Renal and Urological Disorders - Obstructive disorders - Renal Calculi (kidney stones) - s/s
Renal colic pain
Pain might radiate to lower abdominal quadrant, bladder area
N/v common with clamy skin
Renal and Urological Disorders - Obstructive disorders - Renal Calculi (kidney stones) - how are stones broken up
extracorporeal shock wave lithotripsy (ESWL) breaks up stones into fragments to allow for easy passage
Renal and Urological Disorders - Renal failure - Acute
Acute renal failure - sudden loss of kidney function with resulting elevation in serum urea and creatnine
Renal and Urological Disorders - Acute renal failure - etiology
can be due to circulatory disruption to kidneys, toxic substances, bacterial toxins, acute obstruction, or trauma
Renal and Urological Disorders - chronic renal failure
progressive loss of kidney function leading to end stage failure
Renal and Urological Disorders - chronic renal failure - etiology
may result from prolonged acute UT obstruction and infection, diabetes, SLE, uncontrolled hypertension
Renal and Urological Disorders - chronic renal falure - uremia
an end stage toxic condition resulting from renal insufficiency and retention of nitrogenous wastes in blood - symptoms can include anorexia, nausea, mental confusion
Renal and Urological Disorders - Renal failure - RED FLAGS
May lead to multisystem abnormalities and failure
Renal and Urological Disorders - Renal failure - dialysis
process of diffusing blood across a semipermeable membrane for the purposes of removal of toxic substances; maintains fluid, electrolyte and acid-base balance in presence of renal failure
Renal and Urological Disorders - Renal failure - Dialysis disequilibrium
symptoms of nausea, vomit, drowsy, HA, seizures
result of rapid changes after beginnin dialyssi
Renal and Urological Disorders - renal failure - dialysis dimentia
signs of cerebral dysfunction - result of long standing years of dialysis treatment
Renal and Urological Disorders - renal failure - locate dialysis shunt - why?
taking BP at the site of shunt is CONTRAINDICATED!
Renal and Urological Disorders - Urinary incontinence is what
Inability to retain urine
REsult of loss of sphincter control
may be acute or persistent
Renal and Urological Disorders - Urinary incontinence- Types - stress incontinence
Sudden release of urine due to
inc in abdominal pressure
weakness and laxity of pelvic floor mm, sphincter weakness
Renal and Urological Disorders - Urinary incontinence- types - urge incontinence
bladder begins contracting and urine is leaked after sensation of bladder fullness is perceived, an inability to delay voiding to reach toilet due to
detrusor mm instability or hyperreflexia
sensory instability - hypersensitive bladder
Renal and Urological Disorders - Urinary incontinence- types - Overflow incontinence
bladder continuously leaks secondary to urinary retention due to
anatomical obstruction
acontractile bladder
neurogenic bladder
Renal and Urological Disorders - Urinary incontinence - types - functional incontinence
leakage associated with inability or unwillingness to toilet due to
impaired cognition
impaired physical functioning
environmental barriers
Renal and Urological Disorders - Urinary incontinence - management
dietary
medications
surgery
Bladder training
Renal and Urological Disorders - Urinary incontinence - PT
Teach pelvic floor mm exercises Provide behavioral training Functional mobility training as needed Environmental mod Maintain good skin condition Emotional support
