Renal - Part 1 Flashcards
Three main processes of the Kidney’s?
- Glomerular filtration
- Tubular reabsorption
- Tubular secretion
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+
*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
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
*Auscultate for ______ on either side of the abdomen along the _____ and also the _____?
- Bruits
- Midclavicular lines
- CVAs
What may bruits indicate in a GU assessment?
*Renal artery stenosis
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
How does a bladder full of urine sound when percussed?
Dull (palpate towards umbilicus until dullness is no longer heard)
______ tenderness often occurs with kidney infections
CVA (Costovertebral angle)
Most accurate and sensitive indicator of kidney function. ? What happens to this with age?
- GFR
* Declines
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
• 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
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
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
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.
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
in urine C+S when bacteria count is >/= _______, client is diagnosed w/ what?
- > /= 100,000 colonies per ML
* Diagnosed with UTI
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.
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.
Provides information about soft tissue abnormalities such as tumors, cysts,
abscesses, etc., What may client receive?
- CT scan
* Contrast dye
Plain ____ of the abdomen focusing on the kidneys, ureters and bladder.
• Shows gross anatomic features such as kidney___, ____or _____.
- X-ray
* Size, Stones, Strictures
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):
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)
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
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
