Study Guide Ch 89 Flashcards
Explain how the urinary system influences homeostasis.
The urinary system maintains blood homeostasis by filtering out excess fluid and other substances from the bloodstream and secreting waste. It produces, stores, and eliminates urine and waste which influences balancing homeostasis. Maintenance of homeostasis consists of controlling water and blood volume, maintaining blood pressure, regulating electrolyte pressure, reabsorbing electrolytes and maintaining pH balance.
Describe the functions of the two hormones secreted by the kidneys.
● Erythropoietin- a hormone secreted by the kidneys that stimulates the production of red blood cells.
- too little = risk for anemia
- Too much = may trigger polycythemia (high RBC Count). May result in high blood viscosity, high BP
● Renin- important in blood pressure regulation. Part of the RAA mechanism.
Explain how the kidney, ANP, and the RAA system impact red blood cells, blood pressure, water and electrolyte balance, acid–base balance, and vitamin D synthesis.
a. Control of blood pressure by the renin-angiotensin - aldosterone system. Renin combines with the plasma protein angiotensinogen to form angiotensin 1; angiotensin-converting enzyme in the lung converts angiotensin 1 to angiotensin 2; and angiotensin 2 produces vasoconstriction and increase salt and water retention through direct action on the kidney and through increased aldosterone section by the adrenal cortex.
b. Vitamin D is another substance that must be supplied in active form to the client with ESRD, because these kidneys cannot synthesize it. Vitamin D from diet and sunlight is in an inactive form and cannot be directly absorbed. For it to become metabolically active, conversion must first occur in the liver and then in the kidneys. If the body cannot synthesize vitamin D, bone demineralization will occur, because calcium cannot be absorbed from the GI tract.
Describe blood supply to, within, and from the kidneys.
a. Blood from the aorta is transported to the renal artery and afferent arterioles which supply the glomeruli. From the glomeruli, the efferent arterioles carry the blood to the peritubular capillaries which empty into the renal vein, supplying the kidneys with oxygenated blood. From the renal vein, the deoxygenated blood empties back into the heart through the inferior vena cava.
Illustrate the pathway of waste products from the blood to the external environment
Illustrate the pathway of waste products from the blood to the external environment.
During filtration, blood enters the afferent arteriole and flows into the glomerulus where filterable blood components such as water and nitrogenous waste will move towards the inside of the glomerulus, and nonfilterable components such as cells will exit via the efferent arteriole. These filterable components accumulate in the glomerulus to form the glomerular filtrate.
Describe chemical differences between plasma, glomerular filtrate, and urine.
Plasma is composed of 90% water and 10% plasma protein. Glomerular filtrate resembles plasma, but contains no blood cells and almost no protein. It is made up of water, glucose, urea, creatinine, and numerous electrolytes. Urine - the composition of normal urine is about 95% water( solvent) and 5% solutes. It may be composed of nitrogenous waste products from breakdown of proteins: urea, úrico acid, & creatinine. Excess minerals from one’s diet such as sodium, potassium, chloride, calcium, sulfur, magnesium, ammonium, & phosphate.
Compare and contrast normal micturition and incontinence.
Normal Micturition is normally a yellowish color and has a ph of 4.5-8 and a specific gravity of 1.010-1.025 and should be slightly cloudy and clear. They should test negative for glucose, protein, bilirubin,urobilirubin, blood, ketone, nitrate, leukocyte, and acid. Incontinence is the leakage of urine there are 4 types urge stress overflow and functional. Both involve urination occurring however incontinence is a urinary system malfunction where urine is released without control.
List characteristics and usual components of normal urine.
Normal Urine should have specific gravity of 1.010-1.025 and a pH of 4.6-8. No glucose, ketones, bacteria, albumin, or bilirubin should appear. And when microscopically examined, urine should have very little or no RBC OR WBC or else it’ll indicate hemorrhage.
Describe effects of aging on the urinary system and related nursing implications.
Effects of aging on the urinary system can be urinary incontinence and urine retention. Both often occur due to old age. Urinary incontinence is having no control over when urine decides to leak out and empty the bladder. This often happens due to weakening of bladder and pelvic floor muscles. Some nursing interventions for incontinence are kegel exercises, having a pessary put in place and the Crede maneuver. Urine retention , also be normal apart of aging is due to pressure on the urethra not allowing urine to pass through. If this occurs some nursing interventions would be to schedule a routine to void, monitor Is & Os, and potentially catheterize patient if ordered by physician.
Identify the components of a normal urinalysis.
- PH: 4.6 - 8
- Specific gravity: 1.010 – 1.025
- No glucose, ketones or bacteria or bacteria or albumin or bilirubin should appear
- Little to no RBCs and WBCs
- UA also checks for urine color, appearance, odor and foam content
Discuss the rationale for using the following tests of renal function: BUN, serum creatinine, creatinine clearance, and uric acid.
The BUN (blood) test determines how efficiently the glomeruli remove the nitrogenous waste (urea) that result from protein metabolism. An elevated BUN level most commonly indicates kidney disease, but may also be caused by high dietary protein intake, diabetes, improper protein metabolism, malignancy, and fluid loss as manifested by dehydration. Serum creatinine, also a blood test, is a product of protein metabolism and is excreted by the kidneys. Creatinine is the major nitrogenous waste of protein muscle metabolism. An elevated serum creatinine level indicates a serious kidney disorder such as impaired kidney function or obstruction. Creatinine clearance test uses a collected urine specimen to indicate glomerular filtration rate and renal insufficiency. It is collected in a 12 or 24 increment and the start and end time of collection is noted for accuracy. It is typically ordered together with serum creatinine. The creatinine clearance test is used to identify early kidney disease as well as monitoring renal function for clients with known kidney disease. Uric acid tests can be collected by urine or serum (blood) and serve a purpose in diagnosing gout (pain and inflammation occur when too much uric acid crystallizes and deposits in the joints) in clients with gouty arthritis or kidney disease.
Describe the role that the following imaging studies play in diagnosis of urinary disorders: KUB, IVP, radioactive renogram, cystogram, voiding cystogram, retrograde pyelogram, and renal arteriogram.
- KUB: Kidney, ureter, and bladder x-ray.
- IVP (Intravenous pyelogram): A series of x-ray films taken after a radiopaque dye has been injected IV. The films outline the kidney, ureter, and bladder.
**N/C: Allergy to iodine? NPO for 8-10 hours & laxative is given night before to get rid of any possible obstruction that can block urinary structures. - Radioactive renogram (renal scan): Tests the kidneys by means of radioactive substances. It shows blood vessels, obstructions, and each kidney . Tumors may also be detected.
- Cystogram: an X-ray study of the bladder and urethra made possible by instillation of dye directly into the bladder through a catheter. Using fluoroscopy, the x-ray cystogram will show the bladder’s outline and the ureters (if reflux is present). It is used to evaluate the degree of vesicoureteral reflux (backflow of urine into the ureters) and the presence of bladder injury.
- VCUG (voiding cystourethrogram): Same as cystogram but when the client feels the urge to void the cath is then removed while x ray films are taken, because reflux often occurs when the client voids.
- Retrograde pyelogram: is used to show the kidneys and ureters. After the bladder is outlined on X-ray film by installation of dye by catheter, smaller catheters are introduced into the ureters and then passed into the kidney pelvis, where dye is injected into them. X-ray films are then taken that show the kidneys and ureters. This procedure is combined with cystoscopy. Preparation includes giving the client a low-residue diet the day before and a laxative or enema in the evening and immediately before the test. Observation following the test is the same as that required for any other test using dye.
- Renal arteriogram: is obtained by injecting a contrast dye through a catheter into the aorta at the level of the renal blood vessels. The kidneys are thereby visualized to determine the presence of a pathologic condition (like tumors).
Identify the nursing considerations related to pre- and postprocedure cystoscopy care.
Post procedure
- reporting blood-tinged urine for more than 24 hours or darkening urine
- Encourage drinking of fluids to flush remaining dye
- Help client with sitz bath to ease voiding
- Remind client to report signs and symptoms of UTI or increasing urine blood
- Mild analgesic may be prescribed because voiding may be uncomfortable for 1-2 days
- Urine has a reddish tinged color after cystoscope is normal but anything darker is abnormal
Pre procedure
- Make sure client is not allergic to lidocaine, procaine, bupivacaine
- Obtain urinalysis and urine culture before to determine if kidney infection is present
Describe the role of urodynamic tests in diagnosing urinary disorders.
- Determines the function of the detrusor muscle of the bladder, the external sphincter muscle and the pelvic muscles.
- It also evaluates the ability of these muscles to work in sequence
