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Patho > Test 2 Renal > Flashcards

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

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2
Q

Cortex

A

Outer layer of the renal capsule

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3
Q

Medulla

A

Surrounded by the cortex

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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

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5
Q

Nephron

A

Functional renal unit
Composed of glomerulus and tubules

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6
Q

Glomerulus

A

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

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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

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8
Q

What the tubules include

A

Proximal distal and Henle’s loop

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9
Q

Urine production

A

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

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10
Q

Selective reabsorption

A

Determines the amount of water and solutes to be secreted

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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

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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

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13
Q

Normal BUN (blood urea nitrogen)

A

5-20 mg/L

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14
Q

Normal Serum creatinine

A

0.6-1.3 mg/dL

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15
Q

Normal Creatinine clearance

A

100-120 mL/minute

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16
Q

Normal acid serum

A

2.5-8.0 mg/dL

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17
Q

Normal Uric Acid Urine

A

250-750 mg/24 hours

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18
Q

Urinalysis

A

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

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19
Q

Implementation of Urinalysis

A

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

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20
Q

Lookout for in urinalysis

A

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

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21
Q

Physical exam of urinalysis

A

Color
Clarity
Specific gravity

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22
Q

Chemical exam of urinalysis

A

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

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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

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24
Q

Results of specific gravity

A

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

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25
Q

Application of specific gravity test

A

Chronic renal diseases are associated with low specific gravity
Knowledge of specific gravity helps in the interpretation of a urinalysis

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26
Q

Urine culture and sensitivity

A

Urine test that identifies the presence of microorganisms and determines the specific antibiotics that will appropriately treat the existing microorganisms

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27
Q

Implementation of urine culture and sensitivity

A

Clean perineal are and urinary meats with bacteriostatic solution
Collect midstream sample in a sterile container
Send to laboratory immediately

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28
Q

Lookout of urine culture and sensitivity

A

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

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29
Q

Creatinine Clearance Test

A

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

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30
Q

Implementation of Creatinine Clearance Test

A

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

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31
Q

Lookouts for Creatinine Clearance Test

A

Avoid tea, coffee and medications during testing
If taking ACTH, cortisone or thyroxine, check with physician regarding admin during testing

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32
Q

VMA (Vanillylmandelic Acid) Test

A

24-hour collection to diagnose pheochromocytoma
Test identifies as assay of urinary catecholamines in the urine

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33
Q

Pheochromocytoma

A

Tumor of the adrenal gland

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34
Q

Implementation and lookouts of VMA test

A

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

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35
Q

Uric Acid test

A

24-hour urine collection to diagnose gout and kidney disease

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36
Q

Implementation and lookouts of Uric Acid Test

A

Encourage fluids and a regular diet during testing
Place specimen on ice or refrigerate and check with lab regarding the addition of a preservative

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37
Q

KUB (kidneys, ureters and bladder)

A

An x-ray film that views the urinary system and adjacent structures
Used to detect urinary calculi

38
Q

Intravenous Pyelogram (IVP)

A

Injection of a radiopaque dye that outlines the renal system
Preformed to identify abnormalities in the system

39
Q

Education of Intravenous Pyelogram (IVP)

A

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
Q

Renal Angiography

A

The injection of a radiopaque dye through a catheter for examination of the renal arterial supply

41
Q

Implementation of Renal Angiography

A

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
Q

Renal Scan

A

IV injection of a radioisotope for visual imaging of a renal blood flow

43
Q

Implementation of Renal Scan

A

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
Q

Voiding Cystourethrogram

A

The contract medium is injected through the catheter

45
Q

Cystitis

A

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
Q

Most common causative organisms of Cystitis

A

Escherichia coli
Enterobacter
Pseudomonas
Serratia

47
Q

Causes of Cystitis

A

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
Q

Urosepsis

A

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
Q

Most common causes of Urosepsis

A

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
Q

Management of Urosepsis

A

Includes urine C&S, IV antibiotics until the client has been afebrile for 3 to 5 days and then oral antibiotics

51
Q

Urethritis

A

Inflammation of the urethra commonly associated either sexually transmitted diseases (STDs)
Also may be seen with cystitis

52
Q

Urethritis in Men

A

It is most often caused by gonorrhea and chlamydial infection

53
Q

Urethritis in women

A

Most often caused by feminine hygiene sprays, perfumed toilet paper and sanitary napkins, spermicidal jellies, UTIs and changes in the vaginal mucosal lining

54
Q

Signs and symptoms of Urethritis in Men

A

Burning on urination
Frequency
Urgency
Nocturia
Difficulty voiding
Discharging from the penis

55
Q

Signs and symptoms of urethritis in women

A

Frequency
Urgency
Nocturia
Painful urination
Difficulty voiding
Lower abdominal discomfort

56
Q

Ureteritis

A

Inflammation of the ureter that is commonly associated with pyelonephritis
Chronic pyelonephritis causes the ureter to become fibrotic and narrowed by strictures

57
Q

Pyelonephritis

A

Inflammation of the renal pelvis and the parenchyma
Commonly caused by bacterial invasion

58
Q

Acute pyelonephritis causes

A

Often occurs after bacterial contamination of the urethra or following as invasive procedure of the urinary tract

59
Q

Chronic pyelonephritis causes

A

Most commonly occurs following chronic obstruction with reflux or chronic disorders
Escherichia coli is the most common bacterial causative organism

60
Q

Acute pyelonephritis description

A

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
Q

S/s of acute pyelonephritis

A

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
Q

Chronic pyelonephritis description

A

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
Q

S/s of chronic pyelonephritis

A

Frequently diagnosed incidentally when a client is being evaluated for hypertension
Poor urine concentrating ability
Pyuria
Azotemia
Proteinuria
Anemia
Acidosis

64
Q

Urolithiasis and Nephrolithiasis

A

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
Q

Urolithiasis and Nephrolithiasis testing

A

KUB film, IVP, CT scan and renal ultrasonography will determine location
Stone analysis will be done after to determine the type and treatment

66
Q

Urolithiasis

A

Refers to the formation of urinary stones
Urinary calculi are formed in the ureter

67
Q

Nephrolithiasis

A

Referees to the formation of kidney stones
Kidney stones are formed in the parenchyma

68
Q

Hydroureter

A

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
Q

Causes of Urolithiasis and Nephrolithiasis

A

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
Q

S/s of Urolithiasis and Nephrolithiasis

A

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
Q

Calcium Oxalate Stones

A

Caused by supersaturation of urine with calcium and oxalate
Diet includes acid ash foods, because calcium stones have alkaline chemistry

72
Q

Dietary prescription for calcium oxalate stones

A

Decreasing intake of foods high in calcium
Avoiding oxalate doos sources to reduce oxalate content and formation of

73
Q

Oxalate rich foods

A

Tea, almonds, cashews, chocolate, cocoa, beans, spinach and rhubarb

74
Q

Struvite stones

A

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
Q

Dietary prescription for struvite stones

A

Limiting high-phosphate foods

76
Q

High phosphate foods

A

Dairy product, red and organ meat, whole grains

77
Q

Uric acid stones

A

Caused by excess dietary purine or gout
Tend to form in acidic urine

78
Q

Dietary prescription for Uric acid stones

A

Alkaline ash foods and decreased intake of purine sources
Allopurinol (zyloprim) may be prescribed to lower Uric acid levels

79
Q

Purine sources

A

Organ meats, gravies, red wines, and sardines to reduce urinary purine content

80
Q

Cystine stones

A

Caused by cystine crystal formation
Tend to form in acidic urine
Diet includes alkaline ash foods

81
Q

Dietary prescription for cystine stones

A

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
Q

Alkaline Ash Diet

A

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
Q

Acid ash diet

A

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
Q

Foods to avoid in acid ash diet

A

Carbonated beverages
Baking soda or powder
All veggies except corn and legumes
Olives, pickles
Nuts other than peanuts

85
Q

Cystoscopy

A

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
Q

Extracorporeal shock wave lithotripsy (ESWL)

A

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
Q

Percutaneous Lithotripsy

A

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
Q

Steps after a percutaneous lithotripsy

A

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
Q

Ureterolithotomy

A

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
Q

Pyelolithotomy

A

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
Q

Nephrolithotomy

A

Incision into the kidney is made to remove the stone
Large flank required
Client may have a nephrostomy tube and an indwelling catheter

92
Q

Partial or total nephrectomy

A

Performed if there is extensive kidney damage, renal infection or severe obstruction and to prevent stone recurrence

Patho (6 decks)

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