Urinary Disorder - Part 2 Flashcards
ANATOMY AND PHYSIOLOGY OF THE URINARY SYSTEM
,
As proteins break down, nitrogenous waste-urea, ammonia, and creatinine (a nitrogenous compound produced by metabolic processes in the body) is produced. The primary function of the kidneys is excretion of these waste products. The kidneys also assist in regulating the body’s water, electrolytes, and acid-base balance
A)true
B)false
A
__________(a nitrogenous compound produced by metabolic processes in the body)
Creatine
The primary function of the kidneys is excretion of uremia,ammonia and creatine
A)true
B)false
A
The kidneys assist in regulating the body’s water, electrolytes, and acid-base balance.
A)true
B) false
A
the three phases of urine formation and location of the processes are as follows:
Filtration,reabsorption and secretion
- Filtration of water and blood products occurs in the glomerulus of Bowman’s capsule.
A)true
B)false
True
- Reabsorption of water, glucose, and necessary ions back into the blood occurs primarily in the proximal convoluted tubules, Henle’s loop, and the distal convoluted tubules. This process reclaims important substances needed by the body.
A)true
B)false
A
Reabsorption phase is of water, glucose, and necessary ions back into the blood occurs primarily in the proximal convoluted tubules, Henle’s loop, and the distal convoluted tubules.
A) true
B)false
A
When the body has suffered increased fluid loss through hemorrhage, diaphoresis, vomiting, diarrhea, or other means, the blood pressure drops.
A)true
B)false
A
the body suffer increased fluid loss through hemorrhage, diaphoresis, vomiting, diarrhea, or other means.
A)true
B)false
A
The body suffers increase fluid loss by hemorrhage,diarrhea,vomiting and diaphoresis that causes the BP to
Drop
Major Functions of the Kidneys
,
Urine formation: Glomerular filtration, tubular reabsorption, and secretion; 1000 to 2000 ml of urine formed each day
A)true
B)false
A
Fluid and electrolyte control: Maintain correct balance of fluid and electrolytes within a normal range by excretion, secretion, and reabsorption
A)true
B)false
A
Kidneys maintain fluid and electrolyte balance by excretion, secretion and reabsorption.
A)true
B)false
A
Acid-base balance: Maintain pH of blood (7 .35 to 7 .45) at normal range by directly excreting hydrogen ions and forming bicarbonate for buffering
A)true
B)false
A
Excretion of waste products: Direct removal of metabolic waste products contained in the glomerular filtrate
A)true
B)false
A
Blood pressure regulation: Regulation of blood pressure by controlling the circulating volume and renin secretion
A)true
b)false
A
Kidney also controls blood pressure by circulating the blood and renin secretion
A)true
B)false
A
Red blood cell (RBC) production: Secretion of erythropoietin, which stimulates bone marrow to produce RBCs
A)true
B)false
A
The kidney stimulates a hormone that tells the bone marrow to produce red blood cells is called
Erythropoietin
Regulation of calcium-phosphate metabolism: Regulation of vitamin D activation
A)true
B)false
A
URINE COMPOSITION AND CHARACTERISTICS
,
The word urine comes from one of its components, uric acid.
A)true
B)false
A
amount of urine is influenced by several factors, including mental and physical health, oral intake, and blood pressure.
A)true
B)false
A
Urine is 95% water; the remainder is nitrogenous wastes and salts.
A)true
B)false
A
Normal urine is yellow because of urochrome, a pigment resulting from the body’s destruction of hemoglobin.
A)true
B)false
A
URINE ABNORMALITIES
,
A___________, which studies the physical, chemical, and microscopic properties of urine, can give important diagnostic information
urinalysis
•_________ in the urine indicates possible renal disease, increased blood pressure, or toxicity of the kidney cells from heavy metals.
Albumin
• __________ in the urine (glycosuria) most often indicates a high blood glucose level. The blood glucose level rises above the renal threshold (the point at which the renal tubules can no longer reabsorb), and the glucose spills into the urine.
Glucose (sugar)
•_________ in the urine (hematuria) may indi- cate infection, tumors, or renal disease. Occasionally an individual may have a renal calculus (kidney stone), and irritation produces hematuria.
Erythrocytes
•_________ in the urine is called ketoaciduria (or ketonuria). It occurs when too many fatty acids are oxidized. This condition is seen with diabetes mellitus, starvation, or any other metabolic condition in which fats are rapidly catabolized.
Ketone bodies
•_________ (white blood cells [WBCs]) are found in urine when there is an infection in the urinary tract.
Leukocytes
URINARY BLADDER
,
bladder can hold 750 to 1000 mL of urine.
A)true
B)false
A
When the bladder contains approximately 250 mL of urine, the individual has a conscious desire to urinate.
A)true
B)false
A
Person has consciousness to void when the bladder has 250 ml full
A
NORMAL AGING OF THE URINARY SYSTEM
,
In the aging woman the bladder loses tone and the perineal muscles may relax, resulting in stress incontinence.
A)true
B)false
A
Women are more affected by stress incontence, because of weak pelvic floor muscle do to loos of muscle tone in the external shinpter
A)true
B)false
A
In the aging man the prostate gland may become enlarged, leading to constriction of the urethra.
A)true
B)false
A
Common in older male adults is prostate enlargement, which causes constriction on the urethra.
A)true
B)false
True
Incomplete emptying of the bladder in both men and women increases the possibility of urinary tract infection (UTI)
A)true
B)false
A
Incomplete emptying of the bladder can lead to UTI
True
Urinary frequency, urgency, nocturia, retention, and incontinence are common with ______
aging
Urinary incontinence is a leading reason for institutional placement of older adults.
A)true
B)false
A
Urinary incontinence can lead to a loss of self-esteem and result in decreased participation in social activities.
A)true
B)false
A
Older women are at risk for stress incontinence because of hormonal changes and weakened pelvic musculature.
A)true
B)false
A
Older women are at risk of stress incontincnce due to weaken pelvic floor muscles and hormonal changes
A)true
B)false
A
Urinary tract infections in older adults are often associated with invasive procedures such as catheterization, diabetes mellitus, and neurologic disorders.
A)true
B)false
A
UTI in older adults are associated with neurological disorders, diabetes mellitus and chaterization
A)true
B)false
A
Inadequate fluid intake, immobility, and conditions that lead to urinary stasis increase the risk of infection in the older adult.
A)true
B)false
A
Inadequate fluid and immobility can lead to ______ in older adults
Infection
Common substances measured to monitor kidney function include total urine protein, creatinine, urea, uric acid levels, and catecholamines.
A)true
B)false
True
Common substances measured to monitor kidney function include total urine protein, creatinine, urea, uric acid levels, and catecholamines.
A)true
B)false
A
URINALYSIS
,
SPECIFIC GRAVITY
,
Specific gravity measures hydration status and gives information about the kidneys’ ability to concentrate urine.
A) true
B)false
True
Specific gravity is decreased by high fluid intake, reduced renal concentrating ability, diabetes insipidus, and diuretic use.
A)true
B)false
True
It is increased in dehydration due to fever, diaphoresis, vomiting, diarrhea, and medical conditions such as diabetes mellitus (diabetic ketoacidosis or hyperglycemic h yperosmolar nonketotic coma) and inappropriate secretion of ADH.
Specific gravity
BLOOD (SERUM) UREA NITROGEN
,
Blood urea nitrogen (BUN) is a laboratory test used to determine the kidney’s ability to rid the blood of non- protein nitrogen (NPN) waste and urea, which result from protein breakdown (catabolism).
A)true
B)false
True
Normal BUN is 10 to 20 mg / dL.
A)true
B)false
True
For a more accurate test result of BUN TEST, the patient should receive (NPO) for 8 hours before blood sampling.
A)true
B)false
A
If the BUN is elevated, institute preventive nursing measures to protect the patient from possible ___________or________
disorientation or seizures.
BLOOD (SERUM) CREATININE
,
creatinine, depends on muscle mass, which fluctuates little.
A)true
B)false
A
Only renal disorders (such as glomerulonephritis, pyelonephritis, acute tubular necrosis, and urinary obstruction) cause an abnormal elevation in creatinine.
A)true
B)false
A
The serum creatinine test, as with BUN, is used to diagnose impaired kidney function.l
A)true
B)false
A
Blood creatinine level is affected little by dehydration, malnutrition, or hepatic function.
A)true
B)false
True
Blood creatine is affected little by dehydration, hepatic function and malnutrition
A)true
B)false
A
The acceptable serum creatinine range is 0.5 to 1.1 mg/ dL (female) and 0.6 to 1.2 mg/ dL (male)
A)true
B)false
A
Normal creatine for female, 0.5-1.1 and 0.6-1.2 for male
A)true
B)false
A
CREATININE CLEARANCE
,
Creatinine, an NPN substance, is present in blood and urine. Levels are directly related to muscle mass and are usually measured for a 24-hour period
A)true
B)false
A
Creatinine is generated during muscle contraction and then excreted by glomerular filtration.
A)true
B)false
A
During the testing period, the patient avoids_________ physical activity.
excessive
Normal ranges are serum, 0.5 to 1.1 mg/ dL (female), 0.6 to 1.2 mg / dL (male);
A)true
B)false
A
Normal range for urine creatinine is , 87 to 107 mL/ min (female), 107 to 139 mL/min (male)
A)true
B) false
A
PROSTATE-SPECIFIC ANTIGEN
,
Prostate-specific antigen (PSA) is an organ-specific glycoprotein produced by normal prostatic tissue.
A)true
B)false
True
Test results rise with tissue manipulation; therefore obtain a blood sample before physical examination.
A)true
B)false
A
Obtain an blood sample before PSA because the physical examination can rise the leve
A)true
B)false
A
Normal range is less than 4 ng/ mL.
A)PSA
B)false 10
A
Elevated PSA levels result from prostate cancer, benign prostatic hypertrophy (BPH), and prostatitis.
A)true
B)false
A
OSMOLALITY
,
Assessment of urine osmolality (the weight of the solute compared with its own weight) may be preferred over specific gravity.
A)true
B) false
A
Assessment of urine osmolality may be preferred over specific gravity.
A)true
B)false
A
When pituitary disorders are suspected plasma osmolality may be done in conjunction with the urine sampling.
A)true
B)false
A
KIDNEY-URETER- BLADDER RADIOGRAPHY
,
A kidney-ureter-bladder (KUB) radiograph assesses the general status of the abdomen and the size, structure, and position of the urinary tract structures.
A)true
B)false
A
Abnormal findings related to the urinary system may indicate tumors, calculi, glomerulonephritis, cysts, and other conditions.
A)true
B)false
A
INTRAVENOUS PYELOGRAM OR INTRAVENOUS UROGRAPHY
,
Intravenous pyelogram (IVP) or intravenous urography (IVU) evaluates structures of the urinary tract, filling of the renal pelvis with urine, and transport of urine via the ureters to the bladder. A)true B)false
A
It is vital to determine whether the patient has an allergy to iodine (or iodine-containing foods such as iodized salt, saltwater fish, seaweed products, vegetables grown in iodine rich soils) because it is the base of the radiopaque dye that is injected into a vein for this and other radiologic examinations.
A)true
B) false
True
Beware of iodine-containing foods such as iodized salt, saltwater fish, seaweed products, vegetables grown in iodine rich soils)
A)true
B)false
A
If the patient has had an allergic reaction to iodine, the physician may order administration of a corticosteroid or an antihistamine before testing or, alternatively, may order ultrasonography.
A)true
B)false
A
Preparation usually includes eating a light supper, taking a non-gas- forming laxative, and remaining NPO 8 hours before testing.
IPV , IUV
When the dye is injected, the patient experiences a warm, flushing sensation and a metallic taste.
A)true
B)false
A
RETROGRADE PYELOGRAPHY
.
Retrograde pyelography involves examination of the lower urinary tract with a cystoscope under aseptic conditions.
A)true
B)false
A
Retrograde cystography: Radiopaque dye is injected through an indwelling catheter into the urinary bladder to evaluate its structure or to determine the cause of recurrent infections.
A)true
B)false
A
Retrograde urethrography: A catheter is inserted and dye injected as with the cystography to assess the status of the urethral structure.
A)true
B)false
A
VOIDING CYSTOURETHROGRAPHY
,
Preparation includes an enema before testing.
VOIDING CYSTOURETHROGRAPHY
An indwelling catheter is inserted into the urinary bladder, and dye is injected to outline the lower urinary tract. Radiographs are taken, and the catheter is then removed.The patient is asked to void while radiographs are being taken.
A)true
B)false
True. BVOIDING CYSTOURETHROGRAPHY
ENDOSCOPIC PROCEDURES
,
Endoscopic procedures are visual examinations of hol- low organs using an instrument with a scope and light source
A)true
B)false
A
informed consent is necessarY,
A)endoscopic procedure
B)none
A
Cystoscopy is a visual examination to inspect, treat, or diagnose disorders of the urinary bladder and proximal structures. The patient is placed in a litho tomy position for the procedure, which may produce embarrassment and anxiety.
A)true
B) false
A
The patient experiences a feeling of pressure as the scope is passed. Continuous fluid irrigation of the bladder is necessary to facilitate visualization . Care after the procedure includes hydration to dilute the urine. Monitor the first voiding after the procedure, assessing time, amount, color, and any dysuria (painful or difficult urination). The first voiding is occasionally blood tinged due to the trauma of the procedure.
A)true
B)false
A
Nephroscopy (renal endos- copy) is done using the percutaneous (through the skin) route and provides direct visualization of the upper urinary structures. The urologist can obtain biopsy or urine specimens or remove calculi.
A)true
B)false
A
RENAL ANGIOGRAPHY
,
Renal angiography aids in evaluating blood supply to the kidneys, evaluates masses, and detects possible complications after kidney transplantation.
A)true
B)false
True
when the procedure is completed, have the patient lie flat in bed for several hours to minimize the risk of bleeding. Assess the puncture site for bleeding or hematoma, and maintain the pressure dressing at the site. Assess circulatory status of the involved extremity every 15 minutes for 1 hour, then every 2 hours for 24 hours.
Renal angiogram
Life Span Considerations
Older Adults Urinary Disorder
,
RENAL VENOGRAM
,
renal venogram provides information about the kidney’s venous drainage
A)true
B) false
A
COMPUTED TOMOGRAPHY
,
A computed tomography (CT) scan differentiates masses of the kidney. Images are obtained by a computer-controlled scanner. A radiopaque dye may be injected to enhance the image. A serum urea and creatinine level are obtained before use of radi- opaque dye.
A)true
B)false
A
MAGNETIC RESONANCE IMAGING
L
Magnetic resonance imaging (MRI) uses nuclear magnetic resonance as its source of energy to obtain a visual assessment of body tissues.
A)true
B)false
A
Patients with metal prostheses (such as heart valves, orthopedic screws, or cardiac pacemakers) cannot undergo MRI.
A) true
B)false
A
Patient will hear a pounding sound during MRI THAT IS NORMAL
A)true
B)false
A
RENAL SCAN
,
The scan provides data related to functional parenchyma (the essential parts of an organ that are concerned with its function). No special preparation is needed
A)true
B)false
A
Pregnant nurses should refrain from caring for this patient during this time.
Renal scam
ULTRASONOGRAPHY
,
Ultrasonography is a diagnostic tool that uses the reflection of sound waves to produce images of deep body structures. Inform the patient that a conducting jelly will be applied on the skin over the area to be studied; this improves the transmission of sound waves.
A)true
B)false
A
Deviations from normal findings may indicate tumor, congenital anomalies, cysts, or obstructions. No special preparations are necessary.
Ultrasonography
TRANSRECTAL ULTRASOUND
,
Transrectal ultrasound instrumentation of the prostate gland provides clear images of prostatic tumors that otherwise might go undiagnosed.
A)true
B)false
A
RENAL BIOPSY
,
The kidney can be biopsied by an open procedure similar to other surgical procedures on the kidney or by the less invasive method of needle biopsy, also called a percutaneous biopsy.
A)true
N)false
True
Bed rest is instituted for 24 hours after the procedure. Mobility is restricted to bathroom privileges for the next 24 hours, and gradual resumption of activities is allowed after 48 to 72 hours.
Renal biopsy
holding the breath.during the renal biopsy procedure
A)true
B)false
A
URODYNAMIC STUDIES
,
Urodynarnic studies are indicated when neurologic disease is suspected of being an underlying cause of incontinence.
A)true
B)false
True
The studies evaluate detrusor reflex.
Urodynamic
During cystometrogram a catheter is inserted into the bladder, then connected to a cystometer, which measures bladder capacity and pressure
Urodynamic studies
The examiner asks the patient about sensations of heat, cold, and urge to void and instructs the patient at times to void and change position during a
Cystogramometer of urodynamic studies
Cholinergic and anticholinergic medications may be administered during urodynamic studies to determine their effects on bladder function
A)true
B) false
A
Cholinergic and anticholinergic are medications administered during urodynamic studies to determine their effects on bladder function
A)true
B)false
True
(A cholinergic drug, such as bethanechol [Urecholine], stimulates the atonic bladder;
A)true
B)false
A
an anticholinergic drug, such as atropine, brings an overactive bladder to a more n ormal level or function.
A)true
B)false
A
MEDICATION CONSIDERATIONS
,
The kidneys’ effectiveness of removing medications from the blood may be affected by various conditions, such as renal disease, changes in the pH of urine, and age.
A)true
B)false
A
Changes in ph, renal disease and age can affect the kidneys on removing medications in the blood
A)true
B)false
A
DIURETICS TO ENHANCE URINARY OUTPUT
,
Diuretics are administered to enhance urinary output.
A)true
B)false
A
Diuretics increase urinary output.
A) true
B)false
A
_________They achieve this by increasing the kidney’s filtration of sodium, chloride, and water at different sites in the kidney.
Diuretics
Diuretics, Are achieve by increasing filtration of sodium, chloride, and water at different sites in the kidney.
A)true
B)false
A
Diuretics are used to mange hypertension and heart failure.
A)true
B) false
A
Thiazide Diuretics
,
________impair sodium and chloride reabsorption, leading to excretion of electrolytes and water.
Thiazides
The thiazide diuretic chlorothiazide (Diuril) affects electrolytes to cause hypokalemia, hyponatremia, and/ or hypercalcemia.
A)true
B)false
A
Hypochloremic alkalosis occurs from a deficiency of chloride
A)true
B)false
A
The main uses of________ diuretics is management of systemic edema and control of mild to moderate hypertension, although it may take a month to achieve the full antihypertensive effect.
Thiazides
Chlorothiazide is contraindicated in anuria.
A)true
B)false
A
Thiazides diuretics main use is for edema and mild to moderate hypertension
A)true
B) false
A
Loop (or High-Ceiling) Diuretics
,
Loop (or High-Ceiling) Diuretics inhibit sodium and chloride tubular reabsorption.
A)true
B)false
A
___________ This group of diuretics is the most potent of all diure tics and may lead to significant electrolyte depletion
Loop (or High-Ceiling) Diuretics
These diuretics are effective for use in patients with impaired kidney function .
Loop Diuretics
The loop diuretic furosemide (Lasix) affects electrolytes to cause hypokalemia, hypochloremia, hyponatremia, hypocalcemia, and /or hypomagnesemia.
A)true
B)false
A
Furosemide is used in nephrotic syndrome, heart failure, and pulmonary edema.
A)true
B)false
A
Furosemide is a loop diuretic used in nephrotic syndrome, heart failure, and pulmonary edema.
A)true
B)false
A
Potassium-Sparing Diuretics
,
_______Diuretics act on distal con. tubule to inhibit sodium reabsorption and potassium secretion.
Potassium-Sparing Diuretics
diuretics decrease the sodium-potassium exchange
Potassium sparing diuretics
Potassium-sparing diuretics are contraindicated in patients who experience______________, since further retention of potassium could cause a fatal cardiac dysrhythmia
hyperkalemia
Retention of extra potassium can cause fatal dysrythymia of the heart
A)true
B)false
A
There are two types of potassi um-sparing diuretics: aldosterone antagonists and nonaldosterone antagonists.
A)true
B)false
A
Corticosteroid hormone that stimulates absorption of sodium, to regulate water and salt balance.
Aldosterone
The aldosterone antagonist spironolactone (Aldactone) blocks aldosterone in the distal tubule to promote potassium uptake in exchange for sodium secretion.
A)true
B)false
A
The aldosterone antagonist spironolactone (Aldactone) blocks aldosterone to promote potassium uptake in exchange for sodium secretion.
A)true
B)false
A
The aldosterone antagonist spironolactone (Aldactone). Although it can be used in combination with other diuretics, primarily in the treatment of hypertension and edema.
A)true
B)false
A
The nonaldosterone antagonist triamterene (Dyrenium). Triamterene is instead used to help limit the potassium-wasting effect of other diuretics.
A) true
B) false
A
Osmotic Diuretics
,
_________increase plasma osmotic pressure, causing redistribution of fluid toward the circulatory vessels.
Osmotic diuretics
