Renal/Urinary System

Question 1

What are the important labs associated with urinary and renal function? (5)

Answer 1

1. Blood Urea Nitrogen
2. Creatinine
3. Blood Osmolality
4. Specific Gravity
5. Urine Osmolality

Question 2

Blood Urea Nitrogen (2)

Answer 2

• Measures the amount of waste product
• Measures dehydration
• 10-20mg/dL

Question 3

Creatinine (2)

Answer 3

• End product of protein and muscle metabolism
• Measures renal function
• 0.6-1.2 mg/dL (males)
• 0.5-1.1 mg/dL (females)

Question 4

Blood Osmolality (2)

Answer 4

• measurement of particle in the blood

- indicates hydration status

Question 5

WBC over what indicates a bladder infection and/or UTI?

Answer 5

over 100,000

Question 6

What is the BUN to serum creatinine ratio?

Answer 6

6:25

Question 7

Specific Gravity (3)

Answer 7

• shows how well the kidneys concentrate urine
• increased specific gravity, increases concentration of urine=dehydration
• decreased specific gravity, decreases concentration of urine= fluid overload
• 1.010-1.025

Question 8

Urinalysis

Answer 8

-used for drug testing and detecting ketones and infection

Question 9

When is the best time to take a urine sample?

Answer 9

In the morning

Question 10

Creatinine Clearance

Answer 10

-best indication of overall kidney function (24 hour collection of urine, then a blood test after the urine collection is complete)

Question 11

Urine Osmolality

Answer 11

• collection of the particles in the urine

* 200-800

Question 12

What is the normal urine output for a healthy adult?

Answer 12

1-2 liters

Question 13

What position must the patient be in when performing a KUB and what is the test looking for?

Answer 13

• Patient must be supine

- Looking for kidney stones

Question 14

Cytoscopic Examination (2)

Answer 14

• direct visualization: stones, abnormalities, and blockages

- Dr’s can use this method to remove kidney stone

Question 15

What nursing interventions should be done prior to a patient getting a kidney biopsy? (4)

Answer 15

1. Informed consent
2. Vital signs
3. CBC
4. Coagulation studies

Question 16

What nursing intervention should be done after a patient getting a kidney biopsy? (4)

Answer 16

1. IV site
2. Vitals: BP, HR, respirations
3. Incision site: signs of infection & bruising
4. Urine output
   * *drastic increase in pain can alert to bleeding

Question 17

Urinary Incontinence

Answer 17

• involuntary loss of urine

- pressure in the urethra is greater than the pressure in the bladder

Question 18

What are the 4 types of incontinence?

Answer 18

1. Stress
2. Urge
3. Functional
4. Total

Question 19

Stress Incontinence

Answer 19

-occurs with laughing or coughing

Question 20

Urge Incontinence

Answer 20

-waiting until the last minute to void (common in children)

Question 21

Functional Incontinence (2)

Answer 21

• everything physical works as normal

- cognitive issue

Question 22

Total Incontinence

Answer 22

-nothing is working like it is supposed to

Question 23

What are risk factors for incontinence? (5)

Answer 23

1. Multiple pregnancies
2. Renal disease
3. Cognitive (Parkinson’s)
4. Spinal cord injurt
5. Diuretics

Question 24

What are nursing interventions appropriate for a patient with urinary incontinence?

Answer 24

1. Have pt void q2h
2. Remove barriers
3. Pelvic floor exercises (kegel’s)
4. Avoid use of indwelling catheters

Question 25

Urinary Retention

Answer 25

-inability of the bladder to empt completely

Question 26

What are causes of urinary retention? (5)

Answer 26

- BPH - opiods (suppress the CNS- relaxes the GI tract) - neurological - MS - spinal cord injury

Question 27

Urolithiasis

Answer 27

-kidney stones in the urinary tract

Question 28

Nephrolithiasis

Answer 28

-kidney stones in the kidneys

Question 29

What sex are kidney stones more common in?

Answer 29

Males

Question 30

What are symptoms of a kidney stone?

Answer 30

- N&V - radiating pain - painful urination - increased HR

Question 31

What are nursing interventions for treatment of kidney stones? (4)

Answer 31

- pain management (Toradol in combo w/ morphine or dilaudid) - obstruction: fluids (0.9% NS), increase fluid intake to 3-4L/day - prevent infection - monitor and strain urine

Question 32

Lithotripsy (4)

Answer 32

- shock wave that breaks the stone into small fragments - pt is under conscious sedation - continuous monitoring by electrocardiography - topical anesthetic is applied to skin site of stone

Question 33

Pyelonephritis

Answer 33

-bacterial infection in the kidney and renal pelvis (upper urinary tract)

Question 34

What are risk factors of pyelonephritis? (5)

Answer 34

- women over 65 - spinal cord injury - pregnancy - chronic illness - incomplete bladder emptying

Question 35

What are the lab and diagnostic procedures with pyelonephritis? (4)

Answer 35

- urinalysis - WBC count (w/ differential) - KUB xray - IV pyelogram (dye is inserted to visualize/identify abnormalities/blockages)

Question 36

What are nursing interventions necessary for patient with pyelonephritis?

Answer 36

- monitor: nutritional status, I/O's, F/E balance, pain and vitals - fluid intake - medications for pain - caloric intake needs to be increased

Question 37

What are surgical intervention for pyelonephritis?

Answer 37

- pyelolithotomy (stone in the kidney is removed) - nephrectomy (kidney removed) - ureteroplasty (revising ureters)