Week 10 - GU Flashcards
What is the primary function of the renal system?
Maintains homeostasis by regulating fluid and electrolytes, regulating acid–base balance, removing waste, producing RBC production hormone, bone metabolism, and controlling blood pressure.
What does RAAS stand for?
Renin-Angiotensin-Aldosterone System.
What is the daily blood filtration volume by the kidneys?
Approximately 180L of blood.
What percentage of filtered blood volume is excreted as urine?
About 1%.
What is the nephron responsible for?
Formation of urine through glomerular filtration, tubular reabsorption, and tubular secretion.
What substances are filtered by the kidneys?
- Hydrogen ions (H+)
- Urea
- Creatinine
What does aldosterone do in the renal system?
Increases sodium and water reabsorption and decreases urine volume
What stimulates the secretion of Antidiuretic Hormone (ADH)?
Increase in osmotic pressure of ECF and decrease in volume of ECF.
What is pyelonephritis?
A bacterial kidney infection that typically begins as a urinary tract infection (UTI).
- can be acute or chronic
- r/t the ascent of bacteria from the bladder to the kidneys
- mostly affects children and older adults
What are common symptoms of urinary tract infections (UTIs)?
- Pain on urination
- Foul-smelling, cloudy urine
- Frequent urge to urinate
What are the types of urinary tract calculi?
- Calcium
- Struvite
- Uric acid
- Cystine
What is the most common type of renal stone?
Calcium.
What are the age-related considerations for the renal system?
- Decrease in size and weight of kidneys
- Decrease in filtration capacity
- Increased urinary incontinence
Fill in the blank: The kidneys filter out ________ and produce urine.
[waste products]
True or False: The bladder’s walls stretch to store urine.
True.
What is the role of the ureters?
Carry urine from the kidneys to the bladder.
What is the significance of measuring BUN and creatinine?
Helps evaluate renal function.
What does urinalysis help detect?
- Color
- Clarity and odor
- Presence of protein, glucose, ketones
What is nephrolithiasis?
The presence of calculi in the kidneys.
What are some risk factors for urinary tract calculi?
- Dehydration
- High sodium intake
- Obesity
What is the function of urine culture in diagnostics?
Determines the presence of bacteria and the strain of pathogen.
What is the primary metabolite derived from dietary protein?
Urea.
What is the main purpose of lithotripsy?
To break down kidney stones using sound or shock waves to crush stones
- stent may be inserted into affected urter after procedure to maintain patancy after lithotripsy procedures
What are common clinical manifestations of pyelonephritis?
- Flank pain
- Fever
- Chills
- Vomiting
Fill in the blank: The glomerulus allows ________ and waste products to pass through.
[fluid]
What can cause urinary obstructions?
Intrinsic and extrinsic factors, such as tumors or neurological issues.
What is the function of the renal pelvis?
Collects urine from the kidneys before it enters the ureters.
True or False: Healthy kidneys filter creatinine and other waste products from the blood.
True.
What is the typical treatment for small kidney stones?
Watchful waiting and increased fluid intake.
What is the first step in the empirical treatment of a urinary tract infection (UTI)?
Broad spectrum antibiotic with aminoglycosides
Followed by treatment according to sensitivity from culture and sensitivity (C&S) results.
What are common antibiotics used for UTIs after initial empirical treatment?
- Trimethoprim
- Sulphamethoxazole
- Fluoroquinolones
These antibiotics are chosen based on the sensitivity results from urine culture.
What are the nursing diagnoses for chronic pyelonephritis?
- Impaired urinary elimination
- Pain
These diagnoses guide the nursing care plan for patients with chronic pyelonephritis.
What are the goals for planning care in chronic pyelonephritis?
- Pain relief
- Normal body temperature
- Normal renal function
- No relapse
These goals help in evaluating the effectiveness of the nursing interventions.
What educational interventions are important for managing chronic pyelonephritis?
- Education on bladder emptying
- Perineal wiping
- Avoiding perineal irritants
- Avoid unnecessary urinary instrumentation and catheterization
- Education on sexual activity and urination
These interventions aim to reduce the risk of infection and promote bladder health.
What is the most common pathogen responsible for UTIs?
E. coli
E. coli is a common bacterium that can cause urinary tract infections.
How are UTIs classified?
- Uncomplicated
- Complicated
Complicated UTIs are related to obstruction, stones, instrumentation, catheters, or existing disease.
What are the clinical manifestations of a UTI?
- Nausea
- Vomiting
- Anorexia
- Chills
- Malaise
- Urinary frequency
- Hesitancy
- Nocturia
- Suprapubic/flank pain
- Pressure in the bladder
- Costovertebral tenderness
- Bladder spasms
- Dysuria
- Burning
These symptoms can vary and may indicate the presence of a UTI.
What are some risk factors for developing UTIs?
- Urological instrumentation
- Sexual intercourse
- Bacteria from vagina/perineum
- Spinal cord injuries or nerve damage
- Obstruction (calculi, enlarged prostate)
- Diabetes or immune system issues
These factors increase the likelihood of developing a urinary tract infection.
What older adult considerations are important regarding UTIs?
- Higher incidence of chronic illness
- Frequent antibiotic use
- Acute confusion or delirium
- Possible cognitive impairment
- Immobility
- Decrease in bladder tone
- Incontinence
- Nonspecific symptoms (altered sensorium, lethargy, anorexia, low-grade fever, N/V, falls)
Older adults may present differently when experiencing a UTI, making clinical judgment critical.
What diagnostic tests are used for UTIs?
- Urinalysis (dipstick)
- Clean catch urine sample
- Nitrates (indicator of bacteriuria)
- WBCs
- Leucocyte esterase
- Urine C&S
- CBC/electrolytes
- IVP/CT (if obstruction is considered)
These tests help confirm the diagnosis and assess for complications.
What are the pharmacological treatments for UTIs?
- Cephalosporins
- Penicillins
- Bactrim/Septra
- Ciprofloxacin
- Levofloxacin
- Analgesics
- Anti-inflammatories
These medications are commonly prescribed for treating urinary tract infections.
What non-pharmacological management strategies can help with UTIs?
- Cranberry supplements or juice
Cranberry products may help prevent UTIs by preventing bacterial adhesion to the urinary tract.
What are the goals for planning care in UTI management?
- Pain relief
- Normal body temperature
- Normal renal function
- No recurrent infection
Education on completing the full course of antibiotics is crucial to prevent recurrence.
What interventions should be included in the care plan for UTI management?
- Education on bladder emptying every 2-4 hours
- Perineal wiping
- Avoiding perineal irritants
- Avoid unnecessary urinary instrumentation and catheterization
- Education on sexual activity and urination
- Education on hydration
These interventions are aimed at reducing the risk of infection and promoting health.
What are common reasons for reduced renal function?
- Dialysis
Reduced renal function can lead to increased risks for various complications, including UTIs.
What systems in the urinary tract help prevent infection?
- One-way valves at ureter-bladder junction
- Urination washes microbes out of the body
These mechanisms are crucial for maintaining urinary tract health.
What is the primary reproductive organ in the male reproductive system
Testes
1. production and transportation of sperm
2. Deposit of sperm in the female reproductive tract
3. Secretion of hormones
What are the primary reproductive organ in the female system
Ovaries
1. Production of ovaries (eggs)
2. Protection and facilitation of fetus during gestation
3. Secretion of hormones
Ejaculatory path of sperm (SEVEn UP)
Seminiferous tubules
Epididymis
Vas deferents
Ejaculatory ducts
N
Urethra
Penis
Hormonal regulation in males
- regulated by hormones such as testosterone, luteinizing Hormone (LH) , follicle stimulating hormones (FSH)
Benign Prostatic Hyperplasia
- type of benign obstructive uropathy
- enlarged prostate can partially obstruct the urethra causing urinary changes (nocturnal is the most common symptom)
-1/2 of all men 50+ years have some signs of BPM - risk factors are smoking, aging, obesity, sedentary lifestyle, diabetes, family hx
Dutasteride (avodart) (5a reductase inhibitor)
- reduces the size of the prostate gland
-5a reductase (ase= an enzyme) normally converts testosterone to dihydroxytestosterone (DHT) which is the main androgen r/t prostate growth - S/E: decreased libido, decreased volume of ejaculate, erectile dysfunction
Tamsulosin (Flo max) [a1-adrenergic receptor antagonist “alpha blocker”]
- relaxes the smooth muscles in the prostate
- block alpha 1 recpetors (SNS) which are located in the smooth muscle of the blood vessels, bladder and prostate
- alpha blockers are also used to treat HTN
- S/E: postural hypotension, dizziness, fatigue, nasal congestion
Function of female reproductive organs
- primary function of female reproductive organs include ovulation, fertilization and childbirth
- uterus provides an environment for embryo implantation and development throughout pregnancy
Hormonal regulation in females
- involves the hypothalamus, pituitary gland, and ovaries
-produces hormones like estrogen, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH)
-estrogens are a group of hormones (estradiol, estrone, and estriol) that are primarily produced in fertile years, menopause and pregnancy respectively
Common disorders affecting FRS
- PCOS
- endometriosis
- uterine fibroids
- breast health and menopause are prioritized
Female changes —> largely r/t estrogen reduction
Breast changes
- decreased subcutaneous fat and skin turgor, increased fibrous tissue (r/t less glandular tissue)
Vulvar changes
- decreased skin turgor
Vaginal changes
- atrophy of tissue, decreased muscle tone, alkaline ph (normally the PH of the vagina is acidic)
Urethral changes
- decreased muscle tone
Uterine changes
- decreased thickness of myometrium
Ovarian changes
- atrophy, with decreased ovarian function
Male changes —> largely r/t testosterone reduction
Penile changes
- decreased subcutaneous fat and skin turgor
Testicular changes
- muscle atrophy
- loss of firmness
Prostate changes
- benign prostatic hyperplasia (BPH)
Breast changes
- enlargement of tissue (gynecomstia is abnormal enlargement)
- enlargement of this sue
Common serum (blood) studies (GU)
- serum human chorionic gonadtropin (HCG)
- serum testosterone
- serum prolactin
- serum prostate-specific antigen (PSA_ indicating pathology of the prostate (not necessarily prostate cancer)
- serum progesterone
- serum estradiol
- serum follicular stimulating hormone
- venereal diseases (STI)
- C&S (vaginal, urethral, cervical, and sperm)
- C&S (vaginal, urethralm cervical, or sperm)
Common urine studies
- urine human chorionic gonadotropin (hCG)
- urine testosterone (24 hour urine collection)
- urine follicular stimulating hormone (FSH) (24 hour collection)
Common reproductive imaging
mammography (x-ray of breast tissue)
- women aged 50-69 screened Q2 years
Ultrasound (includes abdominal, trans vaginal, transrectal)
-CT
-MRI
Estrogen reduction in s&s in menopause
- vasomotor (hot flashes, night waves)
- GU (incontinence, atrophic vaginitis, vaginal dryness leading to painful sex)
- MSK (increased risk of fractures and osteoporosis)
- CVS (decreased HDLs and increased LDLs, increased CAD risk)
-Integ (breast tissue changes, decreased collagen content of the skin, redistribution of fat around abdomen) - Psych (sleep changes, decreased REM sleep, emotional lability)
Low risk menopausal hormone therapy
- recent menopause
- normal weight
- normal blood pressure
- physically active
- 10 year ASCVD
- low risk for breast cancer
Intermediate risk of menopausal Hormone therapy
- diabetes
-smoking - HTN
- obesity
- sedentary/limited movement
- autoimmune disease
- hyperlipidemia
- metabolic syndrome
- 10 years ASCVD risk
- greater than or equal to 5-10% risk
- high risk for breast cancer
High risk menopausal hormone therapy
- congenital heart diseases
- ASCVD/CAD/PAD
- venous thrombosis or pulmonary embolism
- stroke/ TIA or MI
- breast cancer
- 10 years ASCVD risk greater than or equal to 10%
A wet bed: A
Acid base balance
- ph homeostasis by regulating ph of the blood plasma
-Reabsorb bicarbonate from urine
- excrete hydrogen ions into the urine
A wet bed: W
Water removal
- maintains the body’s fluid balance
- controls how much is leaving the body against the amount entering
A wet bed: E
Erthropoesis
- hormone erythropoietin is produced
- carried to bone marrow where it stimulates production of RBC
A wet bed: T
Toxin removal
- remove waste and excess water collected by, carried in, the blood
- automatically removed the right amount of sodium/minerals from the blood
A wet bed: B
BP control
- makes renin and angiotensin
- these regulate how much sodium and fluid and body keeps
- how well the blood vessels contract/expand
- this regulates the water and width of the arteries
A wet bed: E
Electrolyte imbalance
help control electrolyte concentrations by:
- filtering some electrolytes to blood and excreting excess
A wet bed: D
Vitamin D activation
- keep bones strong by producing the hormone calcitrol
- this hormone maintain the right levels of calcium and phosphate in the blood
Aldosterone
- produced by the adrenal cortex
- increased aldosterone secretion decreases urine volume by stimulating kidney tubules to reabosrb
—> sodium (primary), water (secondary) - also helps control the secretion of potassium by the distal tubules
Antidiuretic hormone (ADH)
produced in the hypothalamus and secreted by the posterior pituitary gland into the blood stimulated by
- increase in the osmotic pressure of ECF (increased plasma concentration)
- decrease in the volume of ECF (hypervolemia)
-ADH causes water to be reabsrbed back onto the blood
- causes decreased urine volume
Kidney Filtration
3 things the kidney needs to filter
1. Hydrogen ions (H+)
- H+ balance = pH balance or acid-base balance
2. Urea Nitrogen
- liver produces ammonia, which contains nitrogen, combines with other waste to create urea
3. Creatinine
- a waste product produced by muscle metabolism and to a smaller extent by eating meat
Urgency
A sudden, compelling and often difficult to deter desire to urinate
Polyuria
- excessive urination
- greater than 2.5 or 3L in over 24 hours
Pyuria
- the presence of white blood cells in urine
Protienuria
- the presence of excessive protein in the urine, which often indicates kidney damage
Oliguria
Decreased urine output, usually defines as less than 400mL per day or less than 20mL per hour
- often a sign of kidney disfunction
Incontinence
The involuntary leakage of urine, not directly caused by the kidneys but kidney function can play a role in overall health of urinary system
Nocturia
- the need to wake up at night to urinate
- can be a sign of kidney disease
Hesitancy
Difficulty starting or maintaining a urine stream
Hematuria
The presence of blood in the urine
- can be a sign of kidney issues
Frequency
The frequency of urination, specifically increased or abnormally frequent urination
Nocturnal Enuresis
- bed wetting at night
- can be associated with with kidneys, particularly in cases where the kidneys are producing too much urine at night
Dysuria
Painful urination
- most commonly associated with infections or inflammation of the urinary tract
Anuria
A condition where the kidneys stop producing urine, resulting in a urine output of less than 100mL in 24 hours
* severe medical emergency
BUN (Blood urea nitrogen)
- helps evaluate renal function or the presence of dehydration
Creatinine
Helps evaluate renal function
- increase possible renal insufficiency or possible decrease nephron function
BUN: creatinine ratio
- used together to measure kidney function
- useful in differential diagnosis of acute or chronic renal disease
BUN
A waste product formed after your body uses the protein it needs to
- normal: 7-20mg/dL
Serum creatinine
A waste product in the blood created by the metabolism of muscle cells
Normal: 1.2mg/dL for women, 1.4mg/dL men
Creatinine clearance
A measure of how much of the waste product creatinine is in your blood
Normal: greater than 90ml/min
Glomerular filtration rate (GFR)
Measure of how well the kidneys are processing waste
- normal: 90ml/min. Less than 15 indicates kidney failure
Micro-albumin urine test
A measure of microscopic amounts of protein in the urine, may be an early sign of kidney disease
Normal: less than 30mg/L
- 30mg/L - 300 is called microalbiminuria
- greater than 300ml/L is called macroalbimuria
Urine protein test
A measure of protein in the urine
- normal: negative
Diagnostic evaluation for renal function
- X-ray, MRI, CT KUB
- U/S
- nuclear scans
- urography
-retrograde pyelography - cystography
- renal angiography
- urologic endoscopic procedures
- biopsy
- urodynamic tests
- uroflowmetryt
Urinary obstructions
- anything that blocks or impedes the flow of urine
may be congenital or acquired - intrinsic (within the urinary tract)
—> anomalies, tumours, benign growths - Extrinsic (outside) the urinary tract
- functional
—> neurological/psychigenic - spinal cord injuries
calcium stones (calcium oxalate, calcium phosphate)
- associated with high concentrations of calcium in blood or urine
- genetic link
- most common
Uric acid stones
- associated with high concentrations of Uric acid in urine
- genetic link
- more common in males
- associated with gout
Sturvite stones
- associated with uti caused by bacteria proteus
- stones are very large
Stag horn stones
- in renal pelvis and calyces
Cystine stones
- associated with genetic defect
- least common
Risk factors for urinary tract calculi
Metabolic
- increased urine levels of calcium, oxaluric, Uric, citric acid
Climate
- warm climates, increased fluid loss, low urine, increase sodium in urine
Diet
- large intake protein, low fluid intake, excessive tea/fruit juice
Genetic
- family hx of gout, renal acidosis , cystinuria
Lifestyle
- send in tray lifestyle, immobility
Diagnostics for urinary tract calculi
- urinalysis
- urine culture
- urine pH
- blood BUN, creatinine
- IVP
- retrograde pyelogram
- U/S
- cystoscopy
- retrieval and analysis of stone
S&S of pylenophritis
- lower urinary tract symptoms, flank pain, costovertebral tenderness , fatigue, chills, fever, committing
Risk factors for Pyelonephritis
- bacterial UTI
- HTN
- vesicouteral reflex
- urinary tract obstruction
- immunospression
Diuretic action: Spironolactone, triamterene
- late distal convoluted tubule
- collecting duct (distal nephron)
Diuretic action: thiazides
- early distal convoluted tubule
Diuretic action: furosemide
Thick segment - ascending limb of henles loop
Diuretic action: mannitol
- proximal convoluted tubule
