Renal Assessment and Diagnostics Flashcards
Function of the Kidneys
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
How do kidneys regulate BP
they vasoconstrict by secreting Renin and in response to low BP, secrete aldosterone
How do kidneys regulate RBC production
kidneys produce erythropoietin
how do kidneys synthesize vitamin D
kidney produces calcitrol
Dysuria
painful urination
Hematuria
blood in urine
Nocturia
night urination
Polyuria
excessive urination
Oliguria
less than normal urination
Proteinuria
protein in the urine
Normal sodium
135-145
Normal potassium
3.5-5.1
Magnesium
1.3-2
Phosphorous
3-4.5
Bicarb
23-30
BUN
7-18
Creatinine
F- 0.5-1.1, M- 0.6-1.2
GFR
125 ml/min (>60 ml/min), decreases 10% every decade
Normal urine output
800-2000ml/day, 30ml/hr minimum
Normal SG
1.010-1.025
Low SG
hypovolemia
High SG
hypervolemia
Urinalysis
1st void in morning is best, cleansing of perineal area, non sterile specimen
24 hr urine
creatine clearance, quant protein (discard 1st morning void, include all urine for exactly 24 hours)
Urine culture
clean catch in a sterile container, confirms suspected UTI, 72 hrs, identifies specific organism, >10k colony count= infection
KUB
kidneys, ureter, bladder x ray- delineates size, shape, position of kidneys, laxative or bowel prep may be needed
KUS, BUS
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
Renal scan
evaluates blood flow to kidneys and GFR (nuclear) can detect masses and organ injury, requires isotope (increase fluids)
Use of IV contrast
can be nephrotoxic, can be prevented by Mucomyst and IV hydration
Renal angiography
catheter threaded through femoral artery, evaluates blood flow and visualizes renal vessels (use of IV contrast required)
Nursing interventions for renal angiography
laxative/ enema may be given, assess for iodine allergy, shave groin, monitor NV status and bleeding
IV Pyelogram
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
Kidney Biopsy
evaluates extent of kidney disease and transplant rejection
Contraindications- bleeding tendencies, uncontrolled HTN, sepsis, morbid obesity, solitary kidney
Kidney biopsy pre test
npo 6-8 hrs before, peripheral IV catheter, obtain coag studies and CBC, no anticoag use
Kidney biopsy post test
monitor VS for 24h, signs of bleeding, pain, signs of infection; IV fluids to decrease clot formation, bedrest 24h, pressure dressing
Cystoscopy
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
Cystoscopy pre test
administer IV fluids, encourage oral fluids
Cystoscopy post test
pink tinged urine and burning are expected, observe for bright red bleeding, monitor for OHT
