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NSG219 > Renal part 1 > Flashcards

Renal part 1 Flashcards

1
Q

What is the basic anatomy of the kidney

A

several layers of tissue surrond the kidney, providing protection and support

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2
Q

what is the rich blood supply in the kidneys

A

renal artery

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3
Q

what is the basic functions of the kidney

A

urine formation, regulatory function, hormonal function

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4
Q

how does glomerular filtration work in the kidneys

A

Begins as blood is filtered across the membrane of the glomerulus.
Filters particles by size.

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5
Q

what is hydrostatic pressure work in glomerular filtrate in the kidneys

A

Forces electrolytes, water, and particles such as nitrogen, creatinine, and glucose from the blood across the glomerular membrane and into the Bowman’s capsule.

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6
Q

what is glomerular filtration rate

A

Amount of blood filtered by the glomeruli in a set amount of time.

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7
Q

what is normal GFR

A

125mL/min

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8
Q

what is glomerular filtration dependent on

A

Blood Pressure
Blood Flow
Blood Volume

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9
Q

Pressures at or below 70 mmHg systolic, result in what GFR

A

decreased it cannot usually compensate

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10
Q

Dilation and Constriction of afferent and efferent arterioles can change what in the kidneys

A

the pressure

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11
Q

can GFR be compensatory

A

yes but it does have limits

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12
Q

what is the tubular reabsorption in the kidenys

A

-Second phase of urine production
-Movement of water and solutes from tubular filtrate back into blood
Selective on what substances are removed during this phase

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13
Q

what controls the permeability of the membrane with tubular reabsorption

A

Antidiuretic hormone (ADH) and aldosterone

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14
Q

when dose urine concentration need to happen

A

prior to be excreted if it cannot then the body will dehydrate

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15
Q

what does the loop of henle do for urine

A

reabsorbs additional water that is required to concentrate the urine

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16
Q

what maintains water balance

A

kidney

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17
Q

what is the last mechanism to activate in the kidneys

A

renal regulation of pH

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18
Q

what organ has the only capability to fully excrete H+ from the body

A

the kidneys

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19
Q

what does the hormone renin regulate

A

blood pressure regulation

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20
Q

the hormone erythropoietin is found only where

A

kidney

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21
Q

when would erythropoietin be released

A
  • Produced in response to decreased renal blood flow and hypoxia
  • Stimulated the bone marrow to produce RBCs.
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22
Q

what happens when there is renal impairment and erythropoietin is released

A

In renal impairment or failure, becomes produced in insufficient amounts, resulting in anemia.

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23
Q

how is vit D obtained

A

die and exposure to UV radiation

must be activated to be useful

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24
Q

how is vit D changed in the body

A

Transported from liver as calcidiol, then converted into calcitriol.
Activated form of Vitamin D required for calcium to be absorbed into the GI tract.

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25
Q

Renal impairment results in what deficiency

A

deficiencies of Vitamin D, decreased serum calcium levels -> thus serum phosphate increased.

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26
Q

what does the hormone prostanglandins do

A
  • These prostaglandins trigger vasodilation, resulting in increased blood flow and water excretion.
  • They also play a role in lowering systemic blood pressure as a result of decreasing vascular resistance.
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27
Q

how does diminshed functional kidney tissue effect prostanglandins

A

Diminished functional kidney tissue = deficient production of these prostaglandins

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28
Q

when would the hormone bradykinin be released

A

Released in response to the presence of PGs, ADH, and angiotensin II

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29
Q

what does the hormone bradykinin do

A

Increases the permeability of the capillary membrane to certain solutes and dilates the afferent arteriole to ensure adequate reabsorption of solutes and blood flow to the kidneys.

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30
Q

Narrowing portion of ureter known as the

A

ureteropelvic junction

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31
Q

Narrowing of ureter into the bladder known as the

A

uterovesical junction

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32
Q

how is urine moved in the bladder

A

Contraction of smooth muscle in the ureter moves urine from the kidney to the bladder.

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33
Q

the act of releasing urine from the body

A

Micturition

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34
Q

Total capacity of the bladder varies

A

600 – 1000 mL of urine

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35
Q

what does the detrusor of the bladder do

A

Detrusor consists of smooth muscle that distends as bladder fills, contract to empty bladder.

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36
Q

what is included for the assessment: Demographics and Personal Data

A 
Age
Gender
Race
Socioeconomic Status
Occupational History
Dietary and Personal Habits
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37
Q

what is included for personal health assessment

A 
Overall health status
Alterations in functioning of renal and urinary systems
Fatigue
Changes in weight
Excessive thirst
Fluid retention symptoms
Neurological deficits
Frequent UTIs
Trauma
Kidney disease
Sexual and Reproductive History
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38
Q

what is included for medication assessment

A
  • Collect a thorough history of current prescriptions and Over-the-Counter medications.
  • Duration of medication use
  • Dosage of medication
  • This includes Herbal supplements and vitamins.
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39
Q

what is included in a urine assessment

A

Appearance of urine
Odor
Pattern of urination
Ability to voluntarily control voiding

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40
Q

what will you assess for when percussing

A

Costovertebral Angle

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41
Q

what will you assess during inspection

A 
Skin
Mouth
Abdomen
Extremities
Urethral meatus
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42
Q

what will you assess when auscultation

A

Abdominal aorta & each renal artery

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43
Q

what labs will you assess for the kidneys

A 
Creatinine
Blood Urea Nitrogen (BUN)
BUN/Creatinine Ratio
Uric Acid
Bicarbonate
Electrolytes
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44
Q

what are some urine tests you could perform

A 
Bedside Urine Dipsticks
Urinalysis
Culture and Sensitivity 
Composite Urine Collection
Creatinine Clearance
Urine Cytology
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45
Q

what can be tested for during an urianlysis

A 
Color, Turbidity, Odor
Specific Gravity
Osmolality
pH
Protein
Glucose
Ketones
Bilirubin
Red Blood Cells
White Blood Cells
Bacteria
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46
Q

what are some imaging studies that can be performed for the kidneys

A 
Bedside Sonography
X-ray
Intravenous Urography
Renal Ultrasound
CT Scan
MRI
Cystography and Urethrography
Arteriography
Renography (Kidney Scan)
Renal Biopsy
Cystoscopy
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47
Q

what does a bedside sonography do

A
  • Sonogram of kidneys
  • Can be performed at bedside
  • Measures amount of urine in bladder
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48
Q

what is an x-ray used for the kidneys

A
  • Kidneys, ureters, bladder (KUB)
  • Reveals the size and anatomy of the renal and urinary system structures
  • Can identify obstructions, masses, and calculi within the kidneys
  • No discomfort to the client
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49
Q

how does an intravenous urography work

A
  • AKA IV Pyelography
  • Contrast injected through IV line
  • Following dye injection, x-rays are taken at specific times
  • Final x-ray is taken after the patient voids to measure the volume of any residual urine in bladder.
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50
Q

what is the pre op for intravenous urography

A
  • bowel prep evening before then NPO
    • 30-45 min
    • IV contrast before initiation
  • informed consent
  • baseline serum creatine before
  • allergies
  • metformin consideration
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51
Q

what is the during and post-op for intravenous urography

A
  • increase fluid intake to flush the contrast

- monitor for changes in output, IV site, and delayed signs of contrast reaction

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52
Q

what can a renal ultrasound be used to test for

A
  • Identifies masses, cysts, and obstructions
  • Determines kidney size
  • Differentiate between renal cysts and renal tumors
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53
Q

what is the pre-op for renal ultrasound

A

May be ordered to drink up to 24 oz of fluid 1 hour prior to procedure, instructed not to void

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54
Q

how does cystography and urethrography work

A
  • Dye is injected into bladder via a urinary catheter
  • Cystoscope inserted into urethra and slowly advanced into bladder.
  • Assesses the bladder for abnormalities or trauma.
  • Voiding cystourethrogram (VCUG) can also be performed to determine abnormalities.
  • Client voids after contrast is inserted into bladder
  • X-rays are taken as client voids
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55
Q

what does an arteriography test for

A

Visualizing the renal vasculature to assess for strictures, bleeding, renovascular hypertension, and other vascular abnormalities.

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56
Q

what is used during an arteriography

A
  • Requires catheter placement into the femoral artery.

- Advanced to the level of the renal arteries and IV contrast is injected

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57
Q

what is the pre-op for arteriography

A
  • Educate indication of study and bowel prep
  • NPO PMN
  • Informed Consent on chart
  • Allergies
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58
Q

what is the post op for arteriography

A
  • When complete: Apply pressure to femoral site following removal of catheter until bleeding is stopped.
  • Pressure dressing should be placed and monitored FREQUENTLY
  • VS frequently
  • Neurovascular status of extremity
  • Lie with affected leg straight for 8-12 hours
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59
Q

how does a renal biopsy work

A
  • Removing a tissue sample via small percutaneous site
  • Ultrasound or CT guided
  • Local anesthesia
  • Used to rule out malignant processes
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60
Q

what meds should be stopped before a renal biopsy

A

Aspirin, warfarin (Coumadin), and other agents that affect clotting stopped

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61
Q

what is the pre-op of a renal biopsy

A
  • Educate patient regarding procedure
  • Informed Consent signed and on chart
  • NPO 4-6 hours prior
  • Type and screen ordered and collected
  • Coagulation labs
  • -Platelet, Prothrombin Time, and aPTT
  • Vitals
  • -Baseline
  • -Frequent monitoring during the biopsy
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62
Q

What is the post-care after renal biopsy

A
  • Apply manual pressure until bleeding stopped.
  • Pressure dressing in place
  • Monitor dressing frequently
  • Hematocrit and Hemoglobin levels post-procedure
  • -Internal bleeding can occur
  • Bedrest up to 24 hours
  • Some local discomfort
  • Increase fluids
  • Will have hematuria 48 – 72 hours after procedure
  • Avoid heavy lifting for 1 week
  • Do not resume anticoagulant medications until told by provider.
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63
Q

what are the s/s of internal bleeding

A

Flank pain, decreased UO, decreased BP, other signs of hypovolemia

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64
Q

what is a cystoscopy used for

A

-Surgical procedure to diagnose and/or treat bladder problems
-Assesses for bladder trauma, urethral trauma, or urinary tract obstructions
-Can be used to remove an enlarged prostate gland, bladder tumors, or renal calculi.
-

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65
Q

how is a cystoscopy performed

A

Inserted through urethra while patient is sedated

66
Q

what is the post care after a cystoscopy

A

Educate about normal findings post procedure

  • -Hematuria
  • -Mild analgesics and topical measures may be used
  • -S/S infection
67
Q

what is the post care after a cystoscopy

A

Educate about normal findings post procedure

  • -Hematuria
  • -Mild analgesics and topical measures may be used
  • -S/S infection
68
Q

what are some age related changes to the kidney

A
  • kidneys decrease on size so they are less palpable
  • # of nephrons decrease as well as their function
  • increase bun and creatine
  • blood flow decreases
  • change of loop of henle so decrease concentration of urine, urinary frequency and risk for dehydration
  • loss of muscle tone and elasticity so incontinence
  • decreased bladder size
    enlargement of prostate gland
69
Q

anuria

A

less the 100ml in 24 hr

70
Q

dysuria

A

difficulty or pain with urine

71
Q

enuresis

A

involuntary urination at night

72
Q

hematuria

A

blood in the urine

73
Q

hesitancy

A

difficulty starting the flow of urine

74
Q

incontinence

A

inability to voluntary control peeing

75
Q

nocturia

A

frequent peeing at night

76
Q

oliguria

A

decreased urine output less then 400ml in 24 hours

77
Q

polyuria

A

increase urine output more then 2000 ml in 24 hours

78
Q

renal colic

A

pain radiating to groin area

79
Q

retention

A

inability to completely empty the bladder of urine

80
Q

urgency

A

sudden onset of the urge to void immediately

81
Q

what is normal creatine

A

0.5-1.2

82
Q

what would increase creatine mean

A

kidney impairment

83
Q

what would decrease creatine mean

A

decreased muscle mass

84
Q

what is normal BUN

A

10-20

85
Q

what would an increase in BUN mean

A

liver or kidney disease, dehydration, decreased kidney perfusion, high-protein diet, infection, stress, steroid use, GI bleeding.

86
Q

what would decrease in BUN mean

A

malnutrition, fluid volume excess, or severe hepatic damage.

87
Q

what is normal bun/creatine ration (bun divided by creatine)

A

6-25

88
Q

what would increase bun/creatine ratio mean

A

fluid volume deficit, obstructive uropathy, catabolic state, or high-protein diet.

89
Q

what would decrease bun/creatine ratio mean

A

fluid volume excess

90
Q

what is normal uric acid

A

3.5-8

91
Q

what does above 12 uric acid mean

A

critical and warrant immediate intervention

92
Q

what does increase in uric acid mean

A

renal failure, can result s/t alcoholism

93
Q

what does decrease uric acid mean

A

folic acid anemia, pregnancy, can be s/t medications

94
Q

what is normal bicarbonate

A

22-26

95
Q

what does a decrease in bicarbonate mean

A

renal failure. Can occur s/t DKA, severe diarrhea, malnutrition, burns

96
Q

what does a decrease in bicarbonate mean

A

renal failure. Can occur s/t DKA, severe diarrhea, malnutrition, burns

97
Q

what is normal specific gravity of urine

A

1.005-1.030

98
Q

what is normal pH of urine

A

4.5-8

99
Q

what is normal protein in urine

A

2-8

100
Q

what is normal RBC in urine

A

0-4

101
Q

what is normal WBC in urine

A

0-5

102
Q

what is normal bacteria in urine

A

less then 1,000

103
Q

Injuries above S2– S4 result in

A

hyperreflexic bladder.

104
Q

what are the causes and risk factors of stress incontinence

A
  • women
  • child birth
  • post menopausal women
  • smoking obesity
105
Q

what are the causes and risk factors of stress incontinence

A
  • women
  • child birth
  • post menopausal women
  • smoking obesity
106
Q

what are the causes and risk factors for urge incontinence

A

exposure to bladder irritants such as caffeine, artifical sweetners, or nicotine

107
Q

what are the causes and risk factors for overflow incontinence

A

enlarged bladder due to obstrucion, spinal cord injury, stroke, diabetes, neurological diseases

108
Q

what are the causes and risk factors for functional incontinence

A

inability to get to the toliet or communicate the need to do so

109
Q

what are the ss of stress incontinence

A

urine leakage occurs when abdominal pressure increases like laughing, coughing, lifting ect

110
Q

what are the ss of stress incontinence

A

urine leakage occurs when and

111
Q

what are the ss of urge incontinence

A

strong urge to pee followed by uncontrolled leakage

112
Q

what are the ss of overflow incontinence

A

frequent urination

113
Q

what are the ss of reflex incontinence

A

bladder muscle contracts on its own, urethral sphincters exhibit varying control

114
Q

what are the ss of reflex incontinence

A

bladder muscle contracts on its own, urethral sphincters exhibit varying control

115
Q

how would you diagnose urinary incontinence

A

-Diagnosed with a thorough history
(Include questions about medical, urological, voiding, neurological, and reproductive history.)
-Assess how the client has been managing their incontinence (Identify routines and patterns)
-Labs (C or UA) to r/o infection and/or illness
-Ultrasound
-Diagnostic Tests

116
Q

what is the treatment for urinary incontinence

A
  • Goal is to prevent or stop urinary leakage
  • If not possible, skin care and odor control becomes goal
  • Prevention or reduction of damage to upper tracts or the kidneys.
  • Medications, nonsurgical measures, or surgical measures can be used for management.
117
Q

what is the purpose of Anticholinergics ( Oxybutynin (Ditropan); tolterodine (Detrol); darifenacin (Enablex); trospium (Sanctura); salifenacin (Vesicare). )

A

Used to calm an overactive bladder. Anticholinergics block nervous stimulation from the parasympathetic nervous system to help relax and control bladder muscle contractions.

118
Q

what is the purpose of Topical estrogen

A

Used in stress incontinence in peri and postmenopausal women to help restore tone in urethra and vaginal areas.

119
Q

what is the purpose of Tricyclic antidepressant ( Imipramine (Tofranil). )

A

Used to treat mixed-urge and stress incontinence; decreases bladder contractility and has an antispasmodic effect on the bladder

120
Q

what is the purpose of Beta-3 adrenergic agonist

Mirabegron (Myrbetrig)

A

Used to treat frequent and/or urgent uncontrolled urination; relaxes bladder muscles.

121
Q

what is the purpose of Beta-3 adrenergic agonist

Mirabegron (Myrbetrig)

A

Used to treat frequent and/or urgent uncontrolled urination; relaxes bladder muscles.

122
Q

what are kegel exercises

A
  • Strengthen pelvic floor muscles

- Specific for strengthening external urinary sphincter

123
Q

what is intermitten catheterization

A
  • Involves the intermittent placement of a catheter through the urethra into the bladder.
  • Done to completely empty the bladder to prevent UTIs or kidney damage s/t urinary retention
124
Q

what assessment will be involved to diagnose urinary incontinence

A 
Vital Signs
What causes incontinence
Urinalysis
Urine Culture
Voiding Diary
125
Q

what are the ss of UTI

A 
Dysuria
Urinary frequency
Urgency 
Urinating in small volumes
Gross hematuria
Suprapubic pain
Fever
N/V
Flank pain
126
Q

how are UTI diagnosed

A

Urinalysis
Culture & Sensitivity
Appearance of urine

127
Q

what antimicrobials are used to treat UTI

A
  • Trimethoprim/sulfamethoxazole (Bactrim DS)

- Ciprofloxacin (Cipro)

128
Q

what bladder analgesics are used to treat UTI

A

Phenazopyridine (Pyridium)

129
Q

what is a bladder prolapse

A

Wall between the bladder and vagina are weakened, allowing the bladder to descend into the vagina.

130
Q

what can a benign prostatic hyperplasia cause

A

means a large prostate gland so it can cause urinary retention, which increases the risk for urinary tract infection

131
Q

what nursing interventions are used for UTIs

A
  • Report elevated temperature, flank pain, nausea, and vomiting
  • Increase fluid intake
  • Signs and symptoms of UTI
  • UTI prevention
  • med education
132
Q

what is UTI prevention

A 
3L fluid daily
Good hygiene
Empty bladder every 3-4 hours
Urinate before and after intercourse
Drink cranberry juice to minimize infections
133
Q

what is urolithiasis

A
  • Calcifications in the urinary system
  • Commonly referred to as kidney stones
  • Can occur in the kidneys, ureter, or bladder
  • Renal stones are the most common
134
Q

what gender and race is urolithiasis more common in

A

white males

135
Q

what are the ss of urolithiasis

A
  • Severe pain (When stone lodges into ureter)
  • N/V if pain severe enough
  • Location of stone influence’s location of pain
  • Gross hematuria with any stone location and occurs in 95% of patients
136
Q

what diagnostic tests are used to diagnosis urolithiasis

A
  • Noncontrast CT scan (Can assess for hydronephrosis s/t obstruction)
  • KUB (Does not reflect uric acid stones)
  • Ultrasound (Recommended in children and pregnant females )
137
Q

what is the treatment for urolithiasis

A
  • Narcotics
  • Nonsteroidal anti-inflammatory medication
  • Alpha-adrenergic blockers
  • If stone doesn’t pass, surgical management is required
138
Q

what alpha-adrenergic blockers

A

tamsulosin (Flomax)

139
Q

what alpha-adrenergic blockers

A

tamsulosin (Flomax)

140
Q

what surgical management is used for urolithiasis

A
  • Stenting
  • Ureteroscopy
  • Percutaneous nephrolithotomy
  • Extracorporeal shock wave lithotripsy
141
Q

what is a ureteroscopy used for and what kind of anesthesia

A

Used for mid/distal ureteral stones

General anesthesia

142
Q

why would a stent be placed during a ureterocopy

A

The placement of small tubes in the ureter during a ureteroscopy to dilate the ureter and allow passage of a calculus. An indwelling urinary catheter can be used to facilitate the passage of the calculus.

143
Q

what is a Percutaneous ureterolithotomy/nephrolithotomy used for

A
  • Used for stones larger than 2cm
  • Stones located in the renal pelvis and branching into the calyces
  • General anesthesia
  • Access is gained to the kidney percutaneously to remove stone
144
Q

what is the pre-op for urolithiasis

A
  • Explain the procedure
  • Maintain NPO status
  • Ensure bowel prep if needed
145
Q

what is the post-op for urolithiasis

A
  • Monitor for bleeding
  • Maintain adequate fluids
  • Initiate infection control measures
  • Monitor for passage of stone fragments
146
Q

what analgesics are used for urolithiasis

A 
hydromorphone (Dilaudid)
morphine sulfate (Morphine)
147
Q

what alpha blockers are used for urolithiasis

A

tamsulosin (Flomax)

148
Q

what meds are used for urolithiasis

A
  • Administer analgesics
  • Administer antiemetics
  • Administer alpha blockers as ordered
149
Q

what teaching and assessment is onvolved for urolithiasis

A
  • Educate client on kidney stone prevention
  • Hydration
  • Encourage urine output of 2L a day
  • Monitor urine color
  • Low-sodium diet
  • Increase dietary intake of citrate
  • Decrease dietary oxalate
150
Q

what are the ss of benign prostatic hyperplasia

A
  • Difficulty starting the flow of urine
  • Weak stream of urine
  • Multiple interruptions during urination
  • Dribbling once urination starts
  • Incontinence may result
  • Bed-wetting
151
Q

what are the complications of benign prostatic hyperplasia

A

acute urinary retention, UTI, bladder stones, bladder damage, kidney damage

152
Q

what is the treatment of benign prostatic hyperplasia

A
  • watchful waiting
  • used in patients w/ minimal symptoms
  • yearly provider exams using DRE
153
Q

what 5-alpha reductase inhibitors are used for benign prostatic hyperplasia

A

finasteride (proscar)

154
Q

what alpha adrenergic bloackers are used for benign prostatic hyperplase and what do they do

A
  • tamsulosin (flomax)
  • act on alpha receptors in prostate, cause relaxation of smooth muscles
  • 2-4 weeks to notice improvement
155
Q

what does Androgen inhibitor do

A

Androgens are the group of male sex hormones (Testosterone) that mediate the normal development and maintenance of the primary and secondary male sex characteristics.

first line for benign prostate hyperplasia

156
Q

what is a Coude

A

speciality catheter used to treat benign prostatic hyperplasia

157
Q

what kind of surgical treatment is used for benign prostatic hyperplasia

A
  • Transurethral Resection of the Prostate (TURP) (Used to treat BPH, but must be a smaller prostate)
  • Lighted resectoscope is passed into the urethra.
  • Small cutting tool is used to remove the entire inner prostate, leaving the outer layer.
  • Symptoms are usually relieved quickly, resulting in a stronger flow of urine.
  • Risk of bleeding and infection post-procedure.
158
Q

what is the most common risk factor for bladder cancer

A

smoking

159
Q

what is the diagnosis of bladder cancer

A
  • Thorough history and physical (Special attention to risk factors)
  • Urine cytology (40% accuracy)
  • Blood and Urine test (Identify tumor markers)
  • Urine cultures
  • Cystoscopy (Definitive diagnosis)
160
Q

what is the treatment for bladder cancer

A
  • Chemotherapy
  • Targeted drug therapy
  • Surgical management
  • -Surgical excision
  • -Radical cystoprostatectomy

NSG219 (11 decks)

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