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Year One: Semester Two > Term 3: Fluid Regulation > Flashcards

Term 3: Fluid Regulation Flashcards

1
Q

What is micturition or voiding?

A

Urination

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2
Q

What are some common signs of urinary problems?

A
  • Discomfort or burning during urination
  • Blood in urine
  • Change in frequency
  • Quality and quantity of urine
  • Increased voiding during nocte
  • Foam in urine
  • Pain
  • Ankle swelling
  • Lethargy
  • SOB
  • High bp
  • Nausea and vomiting
  • Pins and needles in fingers and toes
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3
Q

What could foam in the urine suggest?

A

This could indicate protein in urine.

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4
Q

What does the urinary system consist of?

A
  • 2 kidneys
  • 2 ureters
  • Urinary bladder
  • Urethra
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5
Q

What and where is a nephron and what does it do?

A

There are about 1 million nephrons in a kidney. Their role is to remove waste products from the kidney such as urea, uric acid, creatinine and ammonia.

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6
Q

Briefly, what does the urinary system do?

A

Kidneys remove waste from the blood to form urine.

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7
Q

What is peristalsis?

A

A contraction and relaxation of muscles that works in a wave down a tube. Eg. urine moving from the kidneys through the ureters.

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8
Q

There is a membrane that folds over the bladder and ureters, what is it for?

A

To prevent urine from back tracking in to the kidneys.

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9
Q

How much of the cardio vascular blood supply do the kidneys require?

A

20%

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10
Q

How does the blood supply get to and from the kidneys?

A

The abdominal aorta directs blood to the kidneys via the renal artery. The blood supply then returns via the renal vein to the inferior vena cava.

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11
Q

What are five significant functions of the kidney?

A
  • Homeostatic function (this involves regulation of electrolytes, acid base balance and blood pressure)
  • Filtering of the blood
  • Removal and excretion of water soluble wastes
  • Release of hormones (erythropotein, calcitrol and renin enzyme)
  • Reabsorption of water, glucose and amino acids.
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12
Q

How big are kidneys and where are they located?

A

Your kidney is the size of a fist. They are found just above the waist between the parietal peritoneum and the posterior wall of the abdomen. They are partially protected by the 11th and 12th pairs of ribs.

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13
Q

What are the kidney’s three layers called and what is their function?

A
  1. The renal capsule. It is a smooth fibrous membrane. Protects against trauma and infection.
  2. The adipose capsule. A mass of fatty tissue protecting the kidney from trauma and holds it firmly in place.
  3. The renal facia. A layer of fibrous tissue holding the kidney in place.
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14
Q

What are the functional units of the kidney?

A

Nephron

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15
Q

What is the glomerulus?

A

They are a network of capillaries fed by afferent and drained by the efferent arteriole. The glomerus is encapsulated in a globe called the Bowmans capsule.

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16
Q

What three parts is the renal tubule divided in to?

A
  1. Proximal tubule
  2. Nephron loop or loop of henle
  3. Distal tubule
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17
Q

What are the two types of nephrons?

A
  • cortical nephron

- juxtamedullary nephron

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18
Q

What are the four steps of urine production?

A

Glomerular filtration - this is where 20% of the fluid volume passes through a glomerular capsule (Bowmans capsule) that acts like a sieve.

Tubular reabsorption - movement of useful substances from the tubular fluid back in to blood.

Tubular secretions - fluid moves from the peritubular capillaries and undesirable substances are disposed of

Urine concentration - water reabsorption occurs in the collecting duct. This occurs via osmosis and urine is concentrated to avoid dehydration.

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19
Q

What are the three layers of the ureters?

A
  • Mucosa (inner layer)
  • Muscularis (smooth muscle middle layer)
  • Advenentita (outer layer)
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20
Q

What are the three layers of the bladder?

A
  • Mucosal (inner)
  • Muscular (middle)
  • Adventita (outer)
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21
Q

What is the muscular wall of the bladder called?

A

Detrusor muscle.

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22
Q

What are the names of the two sphincters in the urethra and which one is not under voluntary control?

A
  • Internal urethral sphincter (not under voluntary control)

- external urethral sphincter (conscious control)

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23
Q

About how much volume can the bladder hold before the brain becomes aware of it?

A

300ml

24
Q

Generally, how much urine does an adult pass in one day?

A

About 1500ml per day.

Micturation will occur about 4 to 5 times a day.

25
Q

Assessment of a person with altered urinary elimination processes: what is it important to consider?

A
  • health history
  • usual voiding pattern
  • number of pregnancies
  • prostate health
  • smoker or non smoker
  • fluid intake
  • pain, location of pain
  • incontinence
  • any other symptoms (shortness of breath, weight gain)
  • self care (are they able to get trousers off in time?)
  • assesing urine (colour, clarity, odur) urinalysis.
26
Q

What are some potential factors that impact urine output?

A
  • change to renal function
  • change to bladder function
  • illness and frailty
  • cognitive ability
  • anxiety and stress
  • medication/surgical procedures
27
Q

What is nocturnal enuresis?

A

Loss of urine while sleeping - bed wetting, common in children

28
Q

At what age does an infant begin to gain voluntary urine control?

A

18 months to 2 years.

29
Q

What are the four common types of incontinence?

A
  • urge incontinence: involuntary leakage, unable to prevent void.
  • stress incontinence: involuntary leakage on exertion, coughing, sneezing, laughing.
  • functional urinary incontinence: impaired cognition, mobility, getting there quick enough
  • nocturnal enuresis: loss of urine while sleeping
30
Q

What does a urinalysis test (multi stix 5) show?

A
  • Leukocytes: may be present with/without bacterial infection.
  • Nitrates: associated with bacteria, most likely indicator of infection
  • Protein: may be present with infection, may indicate diabetes
  • Glucose: presence of glucose
  • Blood: if not associated with menses the presence of blood requires further investigation
31
Q

What are some common continence aids?

A
  • indwelling catheter or IDC (this enters bladder through urethra)
  • suprapubic catheter (enters bladder through lower abdomen)
  • sheath/urodome (similar to condom)
  • pads and protective devides
  • urinals
32
Q

What is the difference between an indwelling catheter (IDC) and a suprapubic catheter?

A

An IDC enters the bladder via urethra, can be intermittent or continuous.

A suprapubic catheter enters the bladder via lower abdomen, this is good for long term draining.

33
Q

What is glomerular filtration?

A

The first step of unrine formation. Urine formation begins with movement of water and small solutes from blood/plasma via the glomerulus in to the Bowman capsule.

34
Q

What is ADH hormone?

A

Anti-diurectic hormone is produced in the posterior piturity gland. It’s function is to regulate the balance of water in the body and prevent dehydration by accelerating reabsorption of water in the kidney tubules.

35
Q

What is aldosterone hormone?

A
  • Secreted by the adrenal cortex
  • Similar to and cooperates with ADH to promote the reabsorption of water back into the vascular compartment
  • Does this by actively moving Na+ ions from the tubules into the peri-tubular blood supply.
36
Q

What is atrial natriuretic hormone?

A
  • It is released by the heart when bp is high.

- Works to oppose aldosterone and ADH by lowering blood pressure and ensuring more water is excreted in urine.

37
Q

What is the functional unit of the kidneys?

A

Nephrons

38
Q

What is the function of ADH (antidiuretic hormone)?

A

Produced in posterior pituitary gland to regulate the balance of water in the body by accelerating reabsorption of water in the kidney tubules. ADH responds to changes in the plasma osmolality of sodium and it works on a feedback loop to maintain a stable blood volume.

39
Q

What hormones does the posterior pituitary gland produce?

A

Anti diuretic hormone and oxytocin. The pituitary gland is an extension of the hypothalamus.

40
Q

Describe the process of aldosterone?

A
  • Process starts with an enzyme called renin, which is released in response to changes in blood pressure.
  • Response starts at the juxtaglomerular complex, strategically situated between the afferent artery and distal convoluted tubule.
  • Sets off a mechanism resulting in the release of aldosterone from the adrenal cortex
41
Q

What is the role of juxtaglomerular apparatus?

A

Secretes an enzyme into the blood called renin.

42
Q

Describe the steps in the Renin- Angiotension Aldosterone System? (Four steps).

A
  1. Juxtaglomerular apparatus secretes an enzyme into the blood called renin.
  2. Renin converts to angiotension I.
  3. Angiotension I is converted into Angiotension II (AT II) through angiotension converting enzyme (ACE).
  4. AT II responds by increasing blood pressure by increasing peripheral resistance and blood volume by:
    - vasoconstrictor increasing peripheral resistance.
    - stimulating aldosterone and ADH
    - stimulating thirst
43
Q

In a urinalysis, what is the most likely indication of infection?

A

Nitrates

44
Q

What might protein in a urinalysis suggest?

A

Infection or diabetes

45
Q

What is functional incontinence?

A

Impaired cognition, impaired mobility

46
Q

What is the difference between nocturia and nocturnal enuresis?

A

Nocturia is excessive urination at night due to inability to concentrate urine.

Nocturnal enuresis is involuntary urination during the night.

47
Q

What is ANH?

A

Atrial Natriuretic Hormone.

48
Q

What are the functions of ANH (Atrial natriuretic hormone)

A

> A hormone that singularly opposes the ADH, aldosterone and angiotension II to lower blood pressure.
Promotes Na+ to secrete into the tubules of the nephron from the interstitial space and from plasma.
Creates an osmotic imbalance, reducing the reabsorption of water so that more water is excreted in urine

49
Q

What is the role of the hypothalamus?

A

Regulates thirst mechanism.

50
Q

What are two important electrolytes within the urinary system?

A

Sodium and potassium. Sodium determines the body water content which determines blood pressure. Potassium: maintains normal cardiac function and is regulated by the kidneys. When potassium plasma rises , the plasma moves into the interstitial fluid and into the renal tubular cells. Then released for excretion as urine.

51
Q

What is a buffer?

A

This is any substance that acts to restrain the change of pH following the addition of either acid or base.

52
Q

Where is Vitamin D activated?

A

Kidneys.

53
Q

What is the role Vitamin D?

A

Calcium absorption and regulation of the deposition of Ca+ in bone. An inactive form of Vitamin D is produced in the liver where it is then converted into an active form in the renal cortex.

54
Q

Why is erythropoietin important?

A

Promotes the production of RBCs in the bone marrow (it is produced in response to a decrease in oxygen levels in the renal cells. It circulates to the bone marrow where it stimulates the hemocytoblasts to develop red blood cells).

55
Q

Where is erythropoietin produced?

A

Kidneys (majority) and a small amount in the spleen.

Year One: Semester Two (8 decks)

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