Urinary Elimination Flashcards
these organs help maintain body fluid volume and composition, filter waste products for elimination, regulate blood pressure/acid-base balance, produce erythropoietin for RBC synthesis, and convert vitamin D to an active form.
kidneys
the blood supply to each kidney comes from the _________.
renal artery
__________ promotes the reabsorption of sodium in the DCT.
aldosterone
______ increases tubular permeability to water, allowing water to leave the tube and be reabsorbed into the capillaries. acts within the DCT and CD; released from posterior pituitary
ADH; vasopressin (arteriole constriction)
The kidneys produce..
renin, prostglandins, bradykinin, erythropoietin, activated vitamin D
released when there is a decrease in blood flow, blood volume, or blood pressure through the arterioles or when too little sodium is present in kidney blood.
renin
what releases angiotensinogin II?
renin
increases systemic blood pressure through powerful blood vessel constricting effects and triggers the release of aldosterone from the adrenal glands
angiotensinogin II
produced when protein or muscle breaks down. filtered by kidneys and excreted in urine. Good indicator of kidney function.
creatinine
the by-product of protein breakdown in the liver
urea
increasing BUN more than creatinine BUN:creatinine ratio
deficient blood volume or low cardiac output
elevated BUN:creatinine ratio
kidney dysfunction that is not related to dehydration or poor perfusion
a measure of the overall concentration of particles in the blood and is a good indicator of hydration status
blood osmolarity
the rate of glomerular filtration (GFR) in the kidneys is altered by what
blood flow the kidneys
Which lab value most accurately reflects possible renal dysfunction? a. Urine specific gravity of 1.020 b. BUN/creatinine ration of 10:1 c. BUN of 15 mg/dl d. Creatinine of 5.0 mg/dl
d. Creatinine of 5.0 mg/dl
The rate of glomerular filtration (GFR) in the kidneys is alter by what?
blood flow to the kidneys
Antidiuretic hormone (ADH) acts within the _______ to promote reabsorption of _______.
distal tubules; water (via sodium)
the presence of calculi (stones) in the urinary tract. Stones often do not cause symptoms until they pass into the urinary tract.
Urolithiasis
the formation of stones in the kidney
Nephrolithiasis
formation of stones in the ureter
Uterolithiasis
With which type of urinary diversion will male clients need to learn to sit to urinate?
Diversion into sigmoid colon
Symptoms of prerenal azotemia
hypotension tachycardia decreased CO decreased central venous pressure (taken by Swann Gan) decreased urine output lethargy
kidney injury caused by poor blood flow to the kidneys
prerenal azotemia
administering normal saline 500 to 1000ml infused over one hour
fluid challenge
indications for dialysis in the client with acute renal failure
presence of uremia, persistent high potassium levels, metabolic acidosis, continued fluid overload, uremic pericarditis, and encephalopathy
used for patients who have fluid volume overload, are resistant to diuretics, and have unstable blood pressures and cardiac output can regulate rate (less hemofluctuation)
continuous arteriovenous hemodialysis and filtration (CAVH)
risk associated with use of a pump in continuous arteriovenous hemodialysys and filtration (CAVH)
air embolism, bleeding caused by anticoagulants used to prevent membrane clotting
most accurate ways to monitor kidney function
urine output, BUN:creatinine ratio (both elevated =problem)
decreased serum creatinine level
decreased muscle mass
Normal BUN range
~10-20
increased BUN
hepatic or renal disease, dehydration or decreased kidney perfusion, high protein diet, infection, stress, GI bleeding
if liver and kidney dysfunction are present, urea nitrogen levels are ______ because liver failure limits urea production
decreased
the density of urine compared with water (1.00)
specific gravity
divert urine directly to the skin surface through a ureteral skin opening (stoma). Pt will wear a pouch.
ureterostomies
collect urine in a portion of the intestine which is then opened onto the skin surface as a stoma. Pt will wear a pouch.
conduit
divert urine to the large intestine. no stoma is required. The patient excretes urine with bowel movements, and bowel incontinence may result.
-sigmoidostomies
divert urine into a surgically created pouch, or pocket, that functions as a bladder. The stoma is continent, and the patient removes urine by regular self-catheterization.
ileal reservoir (Kock’s pouch)
Pt presenting symptoms of: Confusion, Decreased alertness, Decreased or no urine production, Dry mouth, Fast pulse, Fatigue, Pale skin color, Swelling, Thirst
Prerenal azotemia
increased level of BUN & creatine wastes in the blood
Caused by: burns, hemmoraging blood, long term N&V, decreased blood volume (dehydration)
:hypotension, tachycardia, Decreased CO, decreased CVP, decreased urine output
Azotemia
The appearance of a patient with prerenal azotemia is similar to that of a patient with what?
Heart failure or dehydration
usually occurs with damage to the glomeruli, interstitial tissue, or tubules of kidney
Intrarenal (intrinsic) AKI
A client in uremia will have all of the following except which of the following?
a. uremic halitosis or stomatitis
b. hiccups and anorexia
c. spider hemangiomas
d. nausea and vomiting
c. spider hemangiomas
this type of kidney disease is irreversible, you treat with dialysis, usually anemia, 5 stages
chronic kidney disease
advantages of using peritoneal dialysis instead of hemodialysis
- easy to learn
- ban be done at home
- ambulatory - no machine needed
a decrease in specific gravity occurs with:
increased fluid intake, diuretic drugs, and diabetes
increased specific gravity occurs with:
- dehydrartion
- decreased kidney blood flow
- the presence of ADH
- damaged kidneys absorb less water
**urine is more concentrated
normal range for glucose in urinalysis
<0.5 g/day
presence reflects hyperglycemia or a decrease in the renal threshold for glucose
normal range of pH in urine analysis
4-6.8 (less than 7 is acidic)
can be changed by diet, drugs, infection, freshness of specimen, acid-base imbalance, and altered renal functions
normal range for ketones in urinalysis
none; presencre reflects incomplete metabolism of fatty acids, as in diabetic ketoacidosis, prolonged fasting, anorexia nervosa
normal range for protein in urinalysis
0.8mg/dL; increased amounts may indicate stress, infection, recent strenous exercise, or glomerular disorders