Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

632 Advanced Anesthesia Health Assessment > Renal Assessment > Flashcards

Renal Assessment Flashcards

1
Q

Where do you elicit for kidney tenderness?

A
  • Costovertebral angle

- formed by the lower border of the 12th rib & the transverse processes of the upper lumbar vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is contained within the Pelvic cavity

A
  • Terminal ureters
  • Bladder
  • Pelvic genital organs
  • At times small & large intestine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What type of muscle is the bladder composed of ?

A
  • Strong smooth muscle chiefly detrusor muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How much urine can the bladder hold

A

400 - 500 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does bladder expansion stimulate?l

A
  • Parasympathetic innervation at relatively low pressures = detrusor contraction & inhibition (relaxation) internal urethral sphincter
  • Also requires relaxation of the external urethral sphincter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Relaxation of the external urethral sphincter is controlled via:

A
  • Voluntary control as it is composed of striated muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When can you palpate the bladder?

A
  • A distended bladder may be palpable above the symphysis pubis
    = nearly full ~400 - 500 mL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In infants how is the bladder emptied?

A
  • By reflex mechanisms in the sacral spinal cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does one have voluntary control of the bladder?

A
  • Voluntary control of the bladder depends on HIGHER centers in the brain & the reflex arcs of the SACRAL spinal cord
  • When voiding is inconvenient - the brains higher centers can inhibit the detrusor contractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can the integrity of the sacral nerves be tested?

A
  • By assessing perirectal & perineal sensation in the

S2, S3, & S4 dermatomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

5 Common or concerning urinary symptoms

A
  1. Suprapubic pain
  2. Dysuria, urgency or frequency
  3. Nocturnal & polyuria
  4. Incontinence
  5. Hematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dysuria

A
  • Pain on urination, usually felt as a burning sensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Burning can be a common complaint of Dysuria, but for women you really want to distinguish the pain between what other diagnosis?

A
  • For women distinguish from burning of inflamed labia (vulvovaginitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Men typically feel a burning sensation proximal to the glans penis in what condition?

A
  • Infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Men typically feel a burning sensation in the perineum and occasionally in the rectum in what condition?

A
  • Prostatic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Painful urination accompanies what 6 other conditions?

A
  1. Cystitis
  2. Urethritis
  3. UTI
  4. Bladder stones
  5. Tumors
  6. In men - Acute Prostatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Urinary Urgency

A
  • An unusually intense & immediate desire to void

- sometimes w/ urge incontinence & frequency (abnormally frequent voiding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Urinary Frequency

A
  • Can be either High volume (polyuria) or low volume (oliguria)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If your patient is having urinary urgency what might it suggest?

A
  • UTI or irritation from possible urinary calculi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If your patient is having urinary frequency what might it suggest?

A
  • Suggest UTI & bladder neck obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If your patient is having urinary urgency or frequency with flank or back pain what might it suggest?

A
  • Pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Polyuria

A
  • A significant increase in 24-hr urine volume

- roughly defined as exceeding 3 L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Nocturia

A
  • Urinary frequency at night (awakening the patient more than once) w/ small or large volumes
  • need to clarify the daily total fluid intake & how much they are consuming in the evening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are 4 causes of Polyuria ?

A
  1. High fluid intake of psychogenic polydipsia
  2. Poorly controlled diabetes
  3. Decreased secretion of antidiuretic hormone (ADH) of central diabetes insipidus
  4. Decreased renal sensitivity to ADH of Nephrogenic diabetes insipidus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why is incontinence a big concern in older adults?

A
  • Socially restricting
  • Increase risk of infection
  • Increase risk of falls
26
Q

Central or peripheral nerve lesions affecting where can affect normal voiding ?

A
  • S2, S3, & S4 = Sacral spinal reflex
27
Q

What are the 5 types of incontinence?

A
  1. Stress incontinence
  2. Urge incontinence
  3. Overflow incontinence
  4. Functional incontinence
  5. Incontinence secondary to medications
28
Q

Stress incontinence

A
  • Urethral sphincter is weakened so that transient increases in intraabdominal pressure raises the bladder pressure to levels that exceed urethral resistance
29
Q

Causes of stress incontinence in women

A
  • Pelvic floor weakness & inadequate muscular & ligamentous support
    • Childbirth
    • Surgery
    • Postmenopausal atrophy of the mucosa
    • Urethral infection
30
Q

Causes of stress incontinence in men

A
  • Prostate surgery
31
Q

What are symptoms of stress incontinence

A
  • Momentary leakage of small amounts of urine with coughing, laughing, & sneezing while the person is in an upright position
  • Urine loss is unrelated to a conscious urge to urinate
32
Q

What are signs of stress incontinence

A
  • May be demonstrable, especially if bladder is full
  • Atrophic vaginitis may be present
  • Bladder distention is absent
33
Q

Urge incontinence

A
  • Detrusor contractions are stronger than normal & overcome the normal urethral resistance
  • Several causes
34
Q

Decreased cortical inhibition of the detrusor contractions causing urge incontinence may be caused from ?

A
  • Stroke
  • Brain tumor
  • Dementia
  • Lesions of the spinal cord above the sacral level
  • Symptoms: involuntary urine loss preceded by an urge to void - moderate volume
  • Signs: small bladder
35
Q

Hyper-excitability of sensory pathways causing urge incontinence can be caused from what? What might you see clinically?

A
  • Bladder infections
  • Tumors
  • Fecal impactions
  • Symptoms: urgency, frequency, & nocturia with small- moderate volumes
  • Signs: possible mental deficits or motor signs of central nervous system disease
36
Q

Deconditioning of voiding reflexes that cause urge incontinence can be caused by what? What might you see clinically?

A
  • Frequent voluntary voiding at low bladder volumes
  • Symptoms: poss. “Pseudo-stress incontinence” = voiding 10 -20 sec after stresses such as a change of position, going up-or- down stairs, coughing, laughing, or sneezing
  • Signs: local pelvic problems or a fecal impact ion may be present
37
Q

Overflow incontinence

A
  • Detrusor contractions are insufficient to overcome urethral resistance, causing urinary retention
38
Q

Mechanisms of overflow incontinence

A
  1. Obstruction of the bladder outlet = BPH or tumor
  2. Weakness of the detrusor muscle with peripheral nerve disease at S2-S4 level
  3. Impaired bladder sensation that interrupts the reflex arc = diabetic neuropathy
39
Q

What symptoms might you see clinically with overflow incontinence ?

A
  • Continuous dripping or dribbling incontinence
  • Decreased force of the urinary stream
  • Prior symptoms of partial urinary obstruction
40
Q

What signs might you see clinically with overflow incontinence ?

A
  • Examination often reveals an enlarged, sometimes tender bladder
  • Prostatic enlargement
  • Motor signs of peripheral nerve disease
  • A decrease sensation (including perineal sensation)
  • Diminished to absent reflexes
41
Q

Functional incontinence

A
  • The patient is functionally unable to reach the toilet in time because of impaired health or environmental conditions
42
Q

What are some mechanisms behind functional incontinence?

A
  • Problems in mobility: weakness, arthritis, poor vision

- Environmental factors: unfamiliar setting, distant bathroom, bed rails, or physical restraint

43
Q

What are the symptoms of functional incontinence you might see clinically ?

A
  • Incontinence on the way to the toilet or only in the early morning
44
Q

What are signs of functional incontinence you might see clinically ?

A
  • Bladder is not detectable on exam (look for physical or environmental clues)
45
Q

Incontinence secondary to medications

A
  • Drugs may contribute to any type of incontinence
    • Sedatives
    • Antipsychotics
    • Anticholinergics
    • Sympathetic blockers
    • Potent diuretics
46
Q

What is major cause of concern in a renal assessment

A
  • Hematuria
    • gross Hematuria = visible to the naked eye
    • microscopic = detected only during urinalysis
47
Q

Where is flank/ kidney pain usually located?

A
  • At or below the posterior costal margin near the CVA (costovertebral angle) & may radiate anteriorly toward the umbilicus
48
Q

What is the mechanism behind flank/ kidney pain? And how is it described?

A
  • Visceral pain produced by distention of the renal capsule

- Typically dull, aching & steady

49
Q

Where would you assess for urethral colic?

A
  • Pain radiating around the trunk into the lower abdomen & groin or possibly into the upper thigh, testicle or labium
50
Q

What is the mechanism behind ureteral colic?

A
  • Sudden distention/ obstruction of the ureter & renal pelvis
51
Q

What is the quality of pain described as with ureteral colic?

A
  • Severe colicky pain (comes & goes)
52
Q

Your patient presents with flank pain, fever, & chills this would signal what ?

A
  • Acute pyelonephritis
53
Q

How do you assess the kidneys during a general exam?

A
  • 1st check for CVA tenderness using percussion

- the kidneys are usually not palpable unless markedly enlarged

54
Q

Which patients might present with CVA tenderness?

A
  • Renal colic or Pyelonephritis

- due to inflammation of the renal capsule

55
Q

How do you assess the urinary bladder during a general exam?

A
  • Percuss the urinary bladder (distention, tenderness)
    • not palpable unless distended above the pubic symphysis
    • bladder vol. must be ~ 400 - 600 mL before dullness appears
56
Q

3 abnormal findings during the general renal exam?

A
  1. CVA pain (costovertebral angle)
  2. Bladder distention: outlet obstruction, meds, neurological (stroke, MS)
  3. Suprapubic tenderness: bladder infection
57
Q

Your patient is experiencing dull/ pressure like pain in the lower abdomen, what do you expect to find?

A
  • A bladder infection
58
Q

Your patient is experiencing agonizing pain, accompanied by acute urinary retention, what do you expect to find?

A
  • Sudden over distention of the bladder - this can be emergent
  • This can be due to regional anesthesia & not able to void yet d/t sacral block
59
Q

Your male patient is experiencing agonizing pain, accompanied by acute urinary retention, plus painful urination. He does not have frequency or urgency, what do you suspect?

A
  • Urethritis
60
Q

Your patient has chronic bladder distention listed in their medical history you understand the sensation to be…

A
  • Painless

632 Advanced Anesthesia Health Assessment (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions