Glomerular Filtration Rate (GFR) blood test: Normal GFR in a young adult is______. A decrease in GFR precedes the onset of ________and a _____ _____ GFR is an _____ indication of _____ _____.

120-130 ml/min Kidney failure Persistently reduced GFR is early indicator of Renal failure

Renal - Part 1 Flashcards by Itai Adi

Three main processes of the Kidney’s?

Glomerular filtration
Tubular reabsorption
Tubular secretion

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About ____ of filtrate is reabsorbed back into the blood stream from the ________? What are two things left behind to be excreted via urination?

99%
Promixal convoluted tubule
K and H+

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*Voiding reflex is under ______ control. When bladder fills to a certain volume of urine the _____ muscle contracts to squeeze urine out of the bladder and down the ______. What must be consciously relaxed to open urethra to allow urine to pass through?

Autonomic
Detrusor Muscle
Urethra
External sphincter muscle

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Where is the CVA located? What 3 things need to be inspected for during GU assessment?

Lower portion of 12th rib and spinal column on either side

* Swelling, bruising, redness

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*Auscultate for ______ on either side of the abdomen along the _____ and also the _____?

Bruits
Midclavicular lines
CVAs

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What may bruits indicate in a GU assessment?

*Renal artery stenosis

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Palpate for _____ bladder. Where? What needs to be documented? Bedside nurses do not plapate?

Palpate for full bladder
Above symphasis pubis as far up as umbilicus
Document how high firmness is palpated
Beside nurses dont palpate kidneys

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How does a bladder full of urine sound when percussed?

Dull (palpate towards umbilicus until dullness is no longer heard)

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______ tenderness often occurs with kidney infections

CVA (Costovertebral angle)

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Most accurate and sensitive indicator of kidney function. ? What happens to this with age?

* Declines

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Glomerular Filtration Rate (GFR) blood test:

Normal GFR in a young adult is______.
A decrease in GFR precedes the onset of ________and a _____ _____ GFR is an _____ indication of _____ _____.

120-130 ml/min
Kidney failure
Persistently reduced GFR is early indicator of Renal failure

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• Normal Creatinine = _____
• Creatinine is an end-product of ____ and _____ metabolism that is
filtered out through the kidneys and excreted in urine.
• ______ serum creatinine means kidney dysfunction because the
kidneys aren’t______ the ______out of the body.

0.5 – 1.2
end product of Muscle and protein metabolism
Increased Creat means kidney dysfunction because creat isnt being filtered out of body

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Normal BUN level? What does BUN measure? why is this not always reliable in determining kidney function?

10-20
Nitrogenous waste product from liver and if kidneys are excreting this or not
not always reliable because can also be affected by protein breakdown/dehydration

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When looking at the BUN/Creat ratio, what signifies dehydration and not kidney dysfunction? what does signify kidney dysfunction? What will you never see?

Increased BUN w/ normal creat
Both BUN and Creat increased in kidney dysfunction
Will never see elevated creat w/ normal BUN

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Normal serum osmolarity? How do the kidneys maintain this?

285-295 (the higher, the more concentrated blood is)

* If too concentrated from dehydration, kidneys reabsorb more water and vice versa.

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Normal specific gravity of urine? Normal pH of urine? What four things should not be present in urine?

1.010(Dilute) - 1.030(concentrated)
Ph of 6
Glucose, ketones, protein, red/white blood cells should not be present in urine

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in urine C+S when bacteria count is >/= _______, client is diagnosed w/ what?

> /= 100,000 colonies per ML

* Diagnosed with UTI

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In Composite (Timed) Urine Collections:
When beginning the collection, have the patient void (or empty 
the foley catheter bag),\_\_\_\_\_ urine, and note the time.  
What does this time signify?  What must be done if a specimen is missed or contaminated during the time period?

Discard 1st Urine sample and note time, this time represents the start of the 24 hour time period.
If a sample is missed or contaminated, collection period must start over.

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Normal urine osmolarity is_______. The higher the number,

the________ the urine is.

300 – 900 mOsm/L

* The higher the number, the more concentrated the urine is.

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Provides information about soft tissue abnormalities such as tumors, cysts,
abscesses, etc., What may client receive?

CT scan

* Contrast dye

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Plain ____ of the abdomen focusing on the kidneys, ureters and bladder.
• Shows gross anatomic features such as kidney___, ____or _____.

X-ray

* Size, Stones, Strictures

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Client is injected intravenously with a radiopaque dye. As the dye travels
through the kidneys, ureters, and bladder, a series of regular x-rays are
taken that provide an outline of the above structures.

Intravenous Pyelogram (IVP):

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All dyes for any diagnostic test are ________ and can cause
_______! So, all dyes must be ______ from the system and
______must be closely monitored!

Nephrotoxic
Renal failure
Flushed (large amounts of IV fluids/diuretics)
Monitor Kidney function (BUN/CREAT)

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This test is done in the interventional radiology department to assess
arterial blood supply to the kidneys and to detect bleeding from trauma.

Renal Arteriogram

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Test done by nuclear medicine gives us information about renal blood flow and glomerular filtration rate. What is placed in client's IV?

* Renography | * small amount of radioactive isotope

Dye is instilled into the bladder via a urinary catheter. | X-rays are taken.

*Cystography

Done using local anesthetic. The physician inserts a needle through the skin into the kidney to obtain tissue samples. What should be checked before hand?

* Renal biopsy | * Coagulation studies, H+H

gives us a picture of the soft tissues of the genitourinary | (GU) tract (kidneys, ureters, bladder) without using nephrotoxic dyes. What does this test usually require?

* Renal/Bladder ultrasound | * Full bladder

a study that assesses how the bladder and urethra are performing their job of storing and releasing urine.

*Urodynamic testing

type of urinary tract infection where one or both kidneys become infected.

Pyelonephritis

UTIs are more common in _____ and a common site fo _______.

* Women | * Hospital acquired infections

Most common UTI comes from _____ called _____.. This infection can ascend to the _______. Once there, can spread to the bloodstream. This is known as ______.

* Bacteria - Ecoli * Ascend to Kidney's * Once in kidneys, can spread to bloodstream - UROSEPSIS

6 Risk factors for UTI?

* Female sex organs * Sexual activity * Renal Caculi * Diabetes * Catheterization * Inability to empty bladder

Lower Vs. Upper urinary tract infections

* Lower - Prostate, bladder, urethra (Cystitis) | * Upper - Kidneys (Pyelonephritis)

Complicated Vs Uncomplicated Urinary tract infections

* Uncomplicated - general community acquired w/o complications * Complicated - Hospitalized, Septic, Pregnancy, Immunosuppresed

6 Common Assessment findings of UTI

* Frequency,urgency,hesitancy to urinate * Dysuria (painful urination)/Hemautria * Nocturia * Pyuria (cloudy foul smelling urine) * Bladder spasms * Incontinence

Common subjective finding in UTI in older adults? Common and very important objective finding in UTI in older adults.

* Reports of fatigue * Sudden change in cognitive function (Note: Anorexia, new incontinence, hyperventilation, Low grade fever)

4 Signs indicating UTI in urinalysis.

1. Positive leukocyte estrace 2. Positive Nitrite 3. Presence of WBC/RBC 4. Presence of >or= 100,000 colonies of bacteria per ml

2 reasons urine culture is taken? How long do results take?

* Identify organism * Identify antibiotic sensitivity * results take 48 hours

This test is a good | indicator of overall kidney function because it estimates actual glomerular filtration rate.

*Creatinine clearance test (Done over 24 hours)

backward flow of urine from the urethra into the bladder

Urethrovesical Reflux

backward flow of urine from the bladder into one or both ureters

Ureterovesical reflux

How does Diabetes contribute to UTI?

*Glucose in the urine creates infection prone environment in urinary tract

Anticholinergic. | Has antispasmotic effects on the detrusor muscle. Used in UTI treatment.

*Hyoscamine

Teaching for UTI Emphasize need to take _____ of antibiotics. Void every_____ or try not to delay voiding. Drink at least ______of fluid a day (unless contraindicated). Avoid ___ ____ ____, and other fluids that are urinary irritants.

* Take full course of antibiotics * Void every 2-3 hours * Drink 2-3 Liters of fluid per day * Avoid coffee, tea, alcohol

Characterized by loss of small amounts of urine during coughing, sneezing, changing position, jogging or lifting. Kind? Caused by? Which women tend to experience this? Men?

* Stress incontinence * weakness in external sphincter and pelvic floor * Women who have had vaginal deliveries * Men who have had radical prostatectomy

6 interventions for stress incontinence

* Diary * Kegal exercises * Estrogen therapy * DO NOT stop diuretics because of incontinence * Weight reduction * Surgery

Strong urge to void that cannot be suppressed. Also known as overactive bladder. What is the cause of this?

* Urge incontinence* | * Cause unknown

In urge incontinence______ _____are perceived as the urge to urinate. Persons with urge incontinence can’t suppress the normal contractions of the ____ _______in time to get to the toilet.

* Bladder Contractions | * Detrusor muscle

4 interventions for Urge incontinence

* Drug therapy * Avoid food/drink with stimulating effect - e.g. coffee alcohol * Limit fluids after dinner * Bladder and habit training

Drugs to relax the bladder smooth muscle: 1- anticholenergic 2 anticholinergic/antispasmodic

* propantheline - anticholenergic | * Oxybutinin and tolterodine - anticholenergic/antispasmodic

4 side effects of anticholenergic : 1. Increased _____ pressure 2. Extreme Dry _____ 3. Gi? 4. Bladder?

* Increased intraocular pressure * Extreme dry mouth * Constipation * Urinary Retention

When the detrusor muscle fails to contract, the bladder becomes overdistended as it fills with urine. What is this? whats another name for this? Why does the bladder leak?

* Overflow/reflex incontinence * Hypotonic (Neurogenic) bladder * To avoid rupture

a method when the person applies nonforceful, smooth, even pressure from the umbilicus toward the lowest part of the abdomen. The pressure is applied only downward toward the bladder. The person can repeat this process several times to empty the bladder.

Crede maneuver

3 interventions for overflow incontinence

* Drug therapy * Bladder compressions (Valsalva, Crede) * Intermittent catheterization using clean technique.

Drug that Increases bladder pressure to stimulate the bladder to empty. What is this used for?

* Bethanechol | * Overflow incontinence

______ is where The patient is incontinent due to factors that have nothing to do with the bladder or urethra. Most common cause?

* Functional incontinence | * Cognitive impairment e.g dementia

2 interventions for functional incontinence? What must you never do?

* Frequent toileting * Pads/depends (Meticulous skin care) * NEVER use a Foley catheter just because a client is incontinent (only for short term use for skin healing and hospice)

for prostatic obstruction in men when catheterization attempts are unsuccessful.

Suprapubic catheter

Stones (calculi) are often ______ until they pass into the ________ where they can cause excruciating pain.

* Asymptomatic | * Lower urinary tract

75% of all calculi are made up of what two things? What are 3 other composites?

* CALCIUM OXALATE and CALCIUM PHOSPHATE9 | * Uric acid, cystine, struvite

Number 1 symptom of calculi? What does flank pain signify? What does pain that radiates to the abdomen, scrotum, testes or vulva signify?

* Renal Colic * stone in kidney or upper ureter * Stone in ureter or bladder

Renal colic begins _____and is _____. May be accompanied by what four things? Patient may ______from the pain. _______may be present.

* Suddenly and is unbearable * N/V, pallor, diaphoresis * go into shock from pain * Hematuria may be present

The formation of various types of kidney stones is strongly influenced by ________. An _____ __favors the crystallization of calcium and phosphate-containing stones, whereas an_________promotes uric acid or cystine stones.

* Urinary pH * Alkaline pH = calcium/phosphate stones * Acidic pH= Uric acid/cystine stones

6 Nursing considerations for Calculi?

* Check urine pH DAILY * Strain urine for passage of calculi * Send any stone to lab to determine make up * Client should walk as often as possible to promote passage of stones * Client should drink at least 3 L of fluid a day (unless contraindicated) * Teach s/s of UTI

Most stones expel on their own, especially if they are less than _____ in diameter?

*6 mm

Pain from stones is the worst when? What is given for mild pain? Severe pain?

* first 24-36 hours * ibuprofen, acetaminophen, naproxen * Morphine/narcotics

Ureteroscope is passed through urethra and bladder into the ureter. Once stone is visualized, it can be grasped and removed or lithotripsy can be done.

Retrograde Ureteroscopy

Small tube placed in ureter by ureteroscopy. | Stent dilates the ureter to enlarge passageway for stones.

Stenting

Lithotripsy Also known as _________ Uses ________ to break the stone into small fragments to be passed. Client receives conscious sedation and has an____. The lithotriptor is aimed at the stone which is visualized with______. Pain medication is given and the lithotripter delivers _______shocks over 30 – 45 minutes. _____ for stones afterward. _______ may occur on the flank of the affected side. It is normal to have ______ for several days.

* extracorporeal shock wave lithotripsy. * Sound waves * EKG * flouroscopy * 500-1500 shocks over 30-45 minutes * Strain urine for stones afterwards * Extensive bruising * Blood in urine

For Calcium oxalate stones avoid oxelate sources such as?

*Spinach, balck tea and rhubarb

For Calcium phosphate stones, how should the diet be adjusted?

*Limit foods high in animal proteins (Decreases acidity of urine)

Diet adjustments for Struvite stones?

Limit high-phosphate foods - Dairy products, red and organ meats, and whole grains

Diet adjustment for uric acid stones?

Limit intake of purines - Organ meats, poultry, fish, red wines and sardines

Diet adjustment for Cystine stones?

Limit animal protein intake