Renal Assessment and Diagnostics

Question 1

Function of the Kidneys

Answer 1

Excretion of water, urea, creatinine, phosphates, uric acid, electrolytes glucose, bicarbonate, most medications; regulation of acid base balance, BP, RBC production, synthesis of vitamin D

Question 2

How do kidneys regulate BP

Answer 2

they vasoconstrict by secreting Renin and in response to low BP, secrete aldosterone

Question 3

How do kidneys regulate RBC production

Answer 3

kidneys produce erythropoietin

Question 4

how do kidneys synthesize vitamin D

Answer 4

kidney produces calcitrol

Question 5

Dysuria

Answer 5

painful urination

Question 6

Hematuria

Answer 6

blood in urine

Question 7

Nocturia

Answer 7

night urination

Question 8

Polyuria

Answer 8

excessive urination

Question 9

Oliguria

Answer 9

less than normal urination

Question 10

Proteinuria

Answer 10

protein in the urine

Question 11

Normal sodium

Answer 11

135-145

Question 12

Normal potassium

Answer 12

3.5-5.1

Question 13

Magnesium

Answer 13

1.3-2

Question 14

Phosphorous

Answer 14

3-4.5

Question 15

Bicarb

Answer 15

23-30

Question 16

BUN

Answer 16

7-18

Question 17

Creatinine

Answer 17

F- 0.5-1.1, M- 0.6-1.2

Question 18

GFR

Answer 18

125 ml/min (>60 ml/min), decreases 10% every decade

Question 19

Normal urine output

Answer 19

800-2000ml/day, 30ml/hr minimum

Question 20

Normal SG

Answer 20

1.010-1.025

Question 21

Low SG

Answer 21

hypovolemia

Question 22

High SG

Answer 22

hypervolemia

Question 23

Urinalysis

Answer 23

1st void in morning is best, cleansing of perineal area, non sterile specimen

Question 24

24 hr urine

Answer 24

creatine clearance, quant protein (discard 1st morning void, include all urine for exactly 24 hours)

Question 25

Urine culture

Answer 25

clean catch in a sterile container, confirms suspected UTI, 72 hrs, identifies specific organism, >10k colony count= infection

Question 26

KUB

Answer 26

kidneys, ureter, bladder x ray- delineates size, shape, position of kidneys, laxative or bowel prep may be needed

Question 27

KUS, BUS

Answer 27

kidney ultrasound delineates organ size, detects fluid accumulation, cysts, masses, malformations, obstruction, usually requires full bladder to perform

Bladder ultrasound measures urine volume and post void residual

Question 28

Renal scan

Answer 28

evaluates blood flow to kidneys and GFR (nuclear) can detect masses and organ injury, requires isotope (increase fluids)

Question 29

Use of IV contrast

Answer 29

can be nephrotoxic, can be prevented by Mucomyst and IV hydration

Question 30

Renal angiography

Answer 30

catheter threaded through femoral artery, evaluates blood flow and visualizes renal vessels (use of IV contrast required)

Question 31

Nursing interventions for renal angiography

Answer 31

laxative/ enema may be given, assess for iodine allergy, shave groin, monitor NV status and bleeding

Question 32

IV Pyelogram

Answer 32

visualizes urinary tract (size, shape, position of kidneys, ureters, bladder) uses IV contrast

Laxative or enema evening before test, NPO after midnight, assess for iodine allergy, encourage oral fluids after test

Question 33

Kidney Biopsy

Answer 33

evaluates extent of kidney disease and transplant rejection

Contraindications- bleeding tendencies, uncontrolled HTN, sepsis, morbid obesity, solitary kidney

Question 34

Kidney biopsy pre test

Answer 34

npo 6-8 hrs before, peripheral IV catheter, obtain coag studies and CBC, no anticoag use

Question 35

Kidney biopsy post test

Answer 35

monitor VS for 24h, signs of bleeding, pain, signs of infection; IV fluids to decrease clot formation, bedrest 24h, pressure dressing

Question 36

Cystoscopy

Answer 36

inspects inside of bladder with lighted scope, can be used to remove calculi, obtain biopsy, insert ureteral stents, treat bleeding lesions, uses local or regional anesthesia (lithotomy)

complications include urinary tract hemorrhage, bladder infection and perforation

Question 37

Cystoscopy pre test

Answer 37

administer IV fluids, encourage oral fluids

Question 38

Cystoscopy post test

Answer 38

pink tinged urine and burning are expected, observe for bright red bleeding, monitor for OHT