urinary assessment chap 45

Question 1

which med taken by a renal pt is concerning to a nurse?

Answer 1

ibuprofen (NSAIDS) is processed by the kidneys.

Question 2

if nurse cannot palpate kidney is that bad?

Answer 2

No- kidneys should not be felt upon palpation

Question 3

what should nurse expect to see in a pt after cystoscopy?

Answer 3

blood tinged urine

Question 4

Rifampin

phenazopyridine

Answer 4

turns urine bright red

turns urine dark orange

Question 5

where is kidney located?

Answer 5

retro- perineal in the back. Right one should be felt in a very skinny person, but not the left one.

Question 6

kidneys

Answer 6

run on a lot of hemodynamic control. 
about size of the person's fist 
located retro peritoneally
adrenal gland on top of each 
cushioned by fat and connective tissue
Hilus is on he medial side

Question 7

nephron

Answer 7

functional unit of kidney

Question 8

Loop of Henley

Answer 8

where Lasix (furosemide) takes effect

Question 9

Blood supply of kidneys

Answer 9

Renal artery arises from aorta

-

Question 10

GFR glomerular filtration rate (in adult)

Answer 10

Normal is 125mL/min
measured by 24 hour urine collection have pt void then start collecting all urine for 24 hours and store it on ice until 24 hours is up. to compare to creatinine clearance from labs

Question 11

BUN

Answer 11

blood, urea, nitrogen= wastes that kidneys are filtering off helps us determine the function of the kidneys
elevated BUN= kidneys not doing a good job of condensing

Question 12

other functions of kidney?

Answer 12

creation of erythropoietin

Question 13

Ace inhibitors

Answer 13

work by preventing angiotensin 1 from changing to angiotensin 2

Question 14

ureters

Answer 14

drain from kidneys to the bladder

Question 15

bladder

Answer 15

reservoir for urine. can hold 600mL to 1 L at a time -

-detrusor muscle contracts bladder and stops and starts urination

Question 16

Trigone muscle

Answer 16

controls ability of urine to pass through the bladder

Question 17

aging and kidneys

Answer 17

between age 30 and 90- size and function decrease by 20-30%

by 7th decade loss of 30-50% of glomerular function,

Question 18

atherosclerosis

Answer 18

accelerates the decrease of kidneys

Question 19

aging changes of bladder?

Answer 19

prostate enlargements

loss of elasticity and muscle support

Question 20

Assessment of Urinary system

Answer 20

subjective- 
past hx?
Meds? 
surgery or other treatments? 
functional health patterns? 
nutritional/metabolic pattern?
elimination pattern? 
exercise pattern? 
sleep/rest?

Question 21

Assessment of US- physical exam

Answer 21

Inspection of skin, mouth , face, extremeties abdomen.
weight - general health

Palpation -
left kidney rarely palpable
right kidney
bladder (full bladder- not empty)
Percussion: kidney punch to see if pain aka costrovertebral
bladder (or use a bladder scanner which is easier!)
Auscultation- listen for bruit

Question 22

anasarca

Answer 22

generalized edema?

Question 23

US exams

Answer 23

Urinalysis-
first morning void
examine urine within 1 hr

Question 24

Urinary System exams

Answer 24

Urinalysis-
first morning void
examine urine within 1 hr

Question 25

creatinine clearance

Answer 25

collect 24 hour urine specimen
creatinine clearance closely approximates GFR
(should be close to equal to GFR)

Question 26

urodynamics

Answer 26

not done often- place hoses into ureters or urethra

Question 27

contrast test (IVP)

Answer 27

be sure kidneys are healthy enough to handle the dye- serum level should be 1.6 or lower and pt cannot be allergic to shellfish or iodine

Question 28

cystogram

Answer 28

like and endoscope= can go in bladder and look for damage, tumors, foreign objects

Question 29

cystoscopy = assessment finding requires IMMEDIATE

attention by the nurse

Answer 29

back pain =

Question 30

UTI risk

Answer 30

Female 
diminished host defenses 
Urinary tract abnormality 
blockage of urinary tract 
urinary retention 
suppressed immune system 
catheterization and other procedures  (over 48 hrs increases chance of UTI)

Question 31

catheter can be used for

Answer 31

strict I and O required
palliative care for terminally ill
if has skin issue that would be affected by incontinence

Question 32

upper UTI

Answer 32

pyelonephritis (fever, chills, flank pain) kidney infection can cross from urine into the blood = Urosepsis

Question 33

lower UTI

Answer 33

cystitis

urethritis

Question 34

urosepsis

Answer 34

pathogen has become blood borne can cause death in the elderly

Question 35

HAI

Answer 35

hospital acquired infection - cause is usually due to use of antibiotics, instrumentation and catheterization

Question 36

CAUTI

Answer 36

catheter associated UTI

bacteria biofilms develop on inner surface of catheter

Question 37

UTI labs

Answer 37

CBC elevated WBC- neutrophils (basically signs of infection and inflammation)

Question 38

Urinalysis - microscopic UA

Answer 38

tells urine specific gravity, pH, urine culture and sensitivity

Question 39

drugs for UTI antispasmodic

Answer 39

oxybutynin, tolteridine (Detrol)

Question 40

UTI analgesics

Answer 40

phenazopyridine == turns urine bright orange

Urised (methenamine/phenyl salicylate

Question 41

bladder irritants

Answer 41

smoking (increases risk of bladder cancer)