Test 2 Renal Flashcards

1
Q

Anatomy of kidneys

A

Attached to the abdominal wall at the level of the last thoracic and first three lumbar vertebrae
Enclosed in the renal capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cortex

A

Outer layer of the renal capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Medulla

A

Surrounded by the cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Functions of kidneys

A

Maintain homeostasis of the blood
Excrete end products of metabolism
Control fluid and electrolyte balance
Excrete bacterial toxins, water-soluble drugs and drug metabolites
Secrete renin and eryhropoietin
Play a role in the function of the parathyroid hormones and vitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Nephron

A

Functional renal unit
Composed of glomerulus and tubules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Glomerulus

A

Encased in Bowman’s capsule
Filters the fluid out of the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tubules

A

Fluid is converted to urine in tubules and urine then moves to pelvis of kidneys
Urine flows from the pelvic of kidney through the ureter and empties into the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What the tubules include

A

Proximal distal and Henle’s loop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Urine production

A

As fluid flows through the proximal tubules water and solutes are reabsorbed
Water and solutes not reabsorbed become urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Selective reabsorption

A

Determines the amount of water and solutes to be secreted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Prostate gland

A

Surrounds male urethra
Contains a duct that opens into the prostatic portion of the urethra and secretes the alkaline portion of the seminal fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk factors associated with renal disorders

A

Frequent UTIs
High sodium diet
Contact sports
Trauma and injury
History of hypertension
Family history of renal disease
Medication use
Associated conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Normal BUN (blood urea nitrogen)

A

5-20 mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Normal Serum creatinine

A

0.6-1.3 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Normal Creatinine clearance

A

100-120 mL/minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Normal acid serum

A

2.5-8.0 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Normal Uric Acid Urine

A

250-750 mg/24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Urinalysis

A

A urine test for evaluation of the renal system and for determining renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Implementation of Urinalysis

A

Wash perineal area
Use a clean container
Obtain 10-15 mL of the first morning sample

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Lookout for in urinalysis

A

Refrigerated samples may alter the specific gravity
If client is menstruating, indicate in lab requisition form

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Physical exam of urinalysis

A

Color
Clarity
Specific gravity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Chemical exam of urinalysis

A

Urine pH
Protein
Glucose
Ketones
Blood
Bilirubin
Urobilinogen
WBCs
Nitrites
Leukocyte esterase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Specific gravity

A

Urine test that measures the specific gravity of the urine
Evaluates concentrating and excretory ability of the kidneys and hydration status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Results of specific gravity

A

High indicates concentrated urine - dehydration
Low indicates dilute urine - overhydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Application of specific gravity test
Chronic renal diseases are associated with low specific gravity Knowledge of specific gravity helps in the interpretation of a urinalysis
26
Urine culture and sensitivity
Urine test that identifies the presence of microorganisms and determines the specific antibiotics that will appropriately treat the existing microorganisms
27
Implementation of urine culture and sensitivity
Clean perineal are and urinary meats with bacteriostatic solution Collect midstream sample in a sterile container Send to laboratory immediately
28
Lookout of urine culture and sensitivity
Urine from clients who forced fluids mat be too dilute to provide a positive culture Identity any sources of potential contaminants during the collection of the specimen such as the hands, skin, clothing, hair and vaginal or rectal secretions
29
Creatinine Clearance Test
Blood and timed urine specimen that evaluates kidney function Blood is drawn at the start of the test and the morning of the day that the 24-hour urine specimen collection is complete
30
Implementation of Creatinine Clearance Test
Encourage adequate fluids before and during the test Maintain the urine specimen on ice or refrigerate and check with the laboratory regarding the addition of a preservative to the specimen during collection
31
Lookouts for Creatinine Clearance Test
Avoid tea, coffee and medications during testing If taking ACTH, cortisone or thyroxine, check with physician regarding admin during testing
32
VMA (Vanillylmandelic Acid) Test
24-hour collection to diagnose pheochromocytoma Test identifies as assay of urinary catecholamines in the urine
33
Pheochromocytoma
Tumor of the adrenal gland
34
Implementation and lookouts of VMA test
Avoid foods such as caffeine, cockamamie vanilla, cheeses gelatin, licorice and fruit for at least 2 days prior to beginning the urine collection and during Avoid taking meds for 2-3 days prior to beginning as prescribed Avoid stress and maintain adequate food and fluids during the tests
35
Uric Acid test
24-hour urine collection to diagnose gout and kidney disease
36
Implementation and lookouts of Uric Acid Test
Encourage fluids and a regular diet during testing Place specimen on ice or refrigerate and check with lab regarding the addition of a preservative
37
KUB (kidneys, ureters and bladder)
An x-ray film that views the urinary system and adjacent structures Used to detect urinary calculi
38
Intravenous Pyelogram (IVP)
Injection of a radiopaque dye that outlines the renal system Preformed to identify abnormalities in the system
39
Education of Intravenous Pyelogram (IVP)
Obtain informed consent Assess the client for allergies to iodine, seafoods and radiopaque dyes Inform the client about possible throat irritation, flushing of the face, warmth, or a salty taste that may be experienced during the test
40
Renal Angiography
The injection of a radiopaque dye through a catheter for examination of the renal arterial supply
41
Implementation of Renal Angiography
Need to know about allergies to iodine, seafood and radiopaque dyes Dye may cause a burning feeling or a feeling of heat along the vessel after the dye is injected Need to assess and mark the peripheral pulses
42
Renal Scan
IV injection of a radioisotope for visual imaging of a renal blood flow
43
Implementation of Renal Scan
Assess for allergies Instruction clients that they will be required to remain motionless Instruct clients that imaging may be repeated at various intervals before the test is complete Radioactive material will clear within 24 hours
44
Voiding Cystourethrogram
The contract medium is injected through the catheter
45
Cystitis
UTI Inflammation of the bladder from injection or obstruction of the urethra More common in women because they have a shorter urethra and is close to the rectum Sexually active and pregnant women are most vulnerable to cystitis
46
Most common causative organisms of Cystitis
Escherichia coli Enterobacter Pseudomonas Serratia
47
Causes of Cystitis
Hormonal changes influencing alterations in vaginal flora Loss of bactericidal properties of prostatic secretions in men Sexual intercourse Poor fitting diaphragms Use of spermicides Synthetic underwear and pantyhose Wet bathing suits Allergens or irritants Invasive urinary tract procedures In dwelling urethral catheters Bladder distention Urinary stasis Calculus
48
Urosepsis
Gram neg bacteremia originating in the urinary tract Major problem is the ability for it to develop resistant strains Can lead to septic shock if not treated aggressively
49
Most common causes of Urosepsis
Organism: Escherichia coli Most common cause is the presence of an indwelling catheter or an untreated UTO in a client who is medically compromised
50
Management of Urosepsis
Includes urine C&S, IV antibiotics until the client has been afebrile for 3 to 5 days and then oral antibiotics
51
Urethritis
Inflammation of the urethra commonly associated either sexually transmitted diseases (STDs) Also may be seen with cystitis
52
Urethritis in Men
It is most often caused by gonorrhea and chlamydial infection
53
Urethritis in women
Most often caused by feminine hygiene sprays, perfumed toilet paper and sanitary napkins, spermicidal jellies, UTIs and changes in the vaginal mucosal lining
54
Signs and symptoms of Urethritis in Men
Burning on urination Frequency Urgency Nocturia Difficulty voiding Discharging from the penis
55
Signs and symptoms of urethritis in women
Frequency Urgency Nocturia Painful urination Difficulty voiding Lower abdominal discomfort
56
Ureteritis
Inflammation of the ureter that is commonly associated with pyelonephritis Chronic pyelonephritis causes the ureter to become fibrotic and narrowed by strictures
57
Pyelonephritis
Inflammation of the renal pelvis and the parenchyma Commonly caused by bacterial invasion
58
Acute pyelonephritis causes
Often occurs after bacterial contamination of the urethra or following as invasive procedure of the urinary tract
59
Chronic pyelonephritis causes
Most commonly occurs following chronic obstruction with reflux or chronic disorders Escherichia coli is the most common bacterial causative organism
60
Acute pyelonephritis description
Usually a short course that recurs as a relapse of the previous infection or as a new infection Can progress to bacteremia or chronic pyelonephritis
61
S/s of acute pyelonephritis
Fever and chills Nausea Flank pain on the affected side Costovertebral tenderness Headache Muscular pain Dysuria Frequency and urgency Cloudy, bloody or foul smelling urine Increased WBC in the urine
62
Chronic pyelonephritis description
A slow progressive disease that is usually associated with recurrent acute attacks Causes contraction of the kidneys and dysfunction of the nephrons, which are replaced by scare
63
S/s of chronic pyelonephritis
Frequently diagnosed incidentally when a client is being evaluated for hypertension Poor urine concentrating ability Pyuria Azotemia Proteinuria Anemia Acidosis
64
Urolithiasis and Nephrolithiasis
Calculi or stones can form anywhere in the urinary tract however, most frequently in the kidneys The problems that can occur as a result are pain, obstruction and tissue trauma with secondary hemorrhages and infection
65
Urolithiasis and Nephrolithiasis testing
KUB film, IVP, CT scan and renal ultrasonography will determine location Stone analysis will be done after to determine the type and treatment
66
Urolithiasis
Refers to the formation of urinary stones Urinary calculi are formed in the ureter
67
Nephrolithiasis
Referees to the formation of kidney stones Kidney stones are formed in the parenchyma
68
Hydroureter
When a calculus occludes the ureter and blocks the flow of urine, the ureter dilates If the obstruction is not removed, urinary stasis results in infection, impairment of renal function on the side of the blockage and resultant hydronephrosis and irreversible kidney damage
69
Causes of Urolithiasis and Nephrolithiasis
Family history Diet high in calcium, vitamin D, milk, protein, oxalate, purines or alkali Obstruction and urinary stasis Dehydration Use of diuretics which cause volume depletion UTIs and prolonged catheterization Immobilization Hypercalcemia and hyperparathyroidism Elevated Uric acid levels (gout)
70
S/s of Urolithiasis and Nephrolithiasis
Renal colic originates in the lumbar region and radiates around the side and down towards the testicle. In men and to the bladder in women Ureteral colic radiates towards the genitalia and thigh Sharp sever pain of sudden onset Dull, aching kidney(s) N&V, pallor, diaphoresis during a true pain Urinary frequency with alternating retention Signs of UTI Low grade fever RBCs, WBCs and bacteria in urinalysis Hematuria
71
Calcium Oxalate Stones
Caused by supersaturation of urine with calcium and oxalate Diet includes acid ash foods, because calcium stones have alkaline chemistry
72
Dietary prescription for calcium oxalate stones
Decreasing intake of foods high in calcium Avoiding oxalate doos sources to reduce oxalate content and formation of
73
Oxalate rich foods
Tea, almonds, cashews, chocolate, cocoa, beans, spinach and rhubarb
74
Struvite stones
Also called triple phosphate stones Composed of magnesium and ammonium phosphate Caused by urea splitting bacteria Tend to form in alkaline urine Diet included acid ash foods
75
Dietary prescription for struvite stones
Limiting high-phosphate foods
76
High phosphate foods
Dairy product, red and organ meat, whole grains
77
Uric acid stones
Caused by excess dietary purine or gout Tend to form in acidic urine
78
Dietary prescription for Uric acid stones
Alkaline ash foods and decreased intake of purine sources Allopurinol (zyloprim) may be prescribed to lower Uric acid levels
79
Purine sources
Organ meats, gravies, red wines, and sardines to reduce urinary purine content
80
Cystine stones
Caused by cystine crystal formation Tend to form in acidic urine Diet includes alkaline ash foods
81
Dietary prescription for cystine stones
Low intake of methionine, an essential AA that does cystine Also focus on encouraging fluids up to 3 L a day, unless contraindicated to help dilute the urine and prevent cystine crystals from forming
82
Alkaline Ash Diet
Increases the pH Reduces the acidity of the urine Includes: Milk Fruits, except cranberries, plums and prunes Rhubarb Most veggies Small amounts of beef, halibut, veal, trout and salmon allowed
83
Acid ash diet
Decreases pH, makes urine more acidic Includes: Cheese, eggs Meat, fish, oysters, poultry Bread, cereal, whole grains Pastries Cranberries, prunes, plums, tomatoes Corn and legumes
84
Foods to avoid in acid ash diet
Carbonated beverages Baking soda or powder All veggies except corn and legumes Olives, pickles Nuts other than peanuts
85
Cystoscopy
May be done for stones located in the bladder or lower ureter No incision One or two ureteral catheters are inserted past stone, may mechanically guide stones downward May be manicured or dislodges by the procedure Catheters left for 24 hrs to drain urine Continuous chemical irrigation
86
Extracorporeal shock wave lithotripsy (ESWL)
Noninvasive no incisions or drains Breaks up stones that are located in the kidney or upper ureter Fluoroscopy is utilized to to visualize the stone Ultrasonic waves are delivered through a bath of warm warm water to the area of the stone Stones are passed in three urine within a few days
87
Percutaneous Lithotripsy
Performed for stones in the bladder, ureter or kidneys An invasive procedure in which a guide is inserted under fluoroscopy near the area of the stone Ultrasonic wave is aimed at the stone to break it into fragments May be cystoscopy (no incision) or nephroscopy (small flank) Possibly indwelling catheter Nephrostony tube to administer chemical irrigation
88
Steps after a percutaneous lithotripsy
Encourage client to drink 3000 to 4000 mL of fluid per day following the procedure Monitor for and instruct client to monitor for complications of infection, hemorrhage and extravasation of fluid into the retoperitoneal cavity
89
Ureterolithotomy
Open surgical procedure, preformed if lithotripsy is not effective Performed if the location is in the ureter Incision into ureter is made through lower abdominal or flank incision to remove the stone Client may have a Penrose drain, ureteral stent catheter and an indwelling bladder catheter
90
Pyelolithotomy
A flank incision into the kidney is made to remove stones from the renal pelvis Large flank incision required Client will have a Penrose drain and indwelling catheter
91
Nephrolithotomy
Incision into the kidney is made to remove the stone Large flank required Client may have a nephrostomy tube and an indwelling catheter
92
Partial or total nephrectomy
Performed if there is extensive kidney damage, renal infection or severe obstruction and to prevent stone recurrence