Week 3 GU System Flashcards
Kidneys function by
Filter blood
Urine formation
Regulates osmolarity and osmolarity
Regulates water excretion by ADH
Regulates electrolyte excretion mainly Na by action of aldosterone
Regulate Acid Base Balance at glomerlous and synthesis of new bicarb by renal tubular
Removal of Wastes - Urea, creatinine, phosphates, sulfates, and uric acid and drug metabolites
Release erthropetin- hormone that stimulates bone marrow to produce more RBCs
Release of Renin - Stimulates vasoconstriction to regulate BP RAAS- Vas Recta Identifies
Activates Vitamin D
Secretion of Prostaglandins
Regulates CA and Phosphate
Kidneys and Urinary Systems
Regulates fluid and electrolytes, removing wastes and providing hormones involved in RBC production, bone metabolism, and BP control.
Where are kidneys located?
Retroperitoneal and important to flank area during assessment
What does tenderness indicate?
UTI, pyelonephritis, and nephrolithiasis.
Where are nephrons located?
Renal cortex
Responsible urine formation.
Where are juxtamedullary nephrons located?
Renal Medulla. Responsible for concentration of urine .
Renal Medulla also contains loop of Henle and vas recta and collecting ducts of nephrons.
Main difference between juxta and cortical?
Loop henle much longer in Juxta which gives ability to concentrate Urine
Renal Arteries
Coming from AA and deliver 20- 25 percent of CO.
Then divide to smaller arteries. Then progress through glomelrus and then vessels to loop of henle
GFR
Glomerular Filtration Rate - Filtration rate of kidneys.
Where does most reabsorption occur?
PCT
Aldosterone and ADH affect what tubule?
Distal Tubule responsible for concentration of urine.
What apparatus is a major structural component of the RASS?
Juxtaglomerular
Also one of the most important regulator of renal salt and H20
Between afferent arteriole and DCT.
What cells secrete Renin?
Macula Densa
Sense change in serum osmolarity and secrete renin when needed
Loop of Henle works with?
Vas Recta.Work in opposite directions. Vas Recta is highly permeable to water. Solutes enter but water does not. They are intertwined
Osmolality
Amount of SOLUTES dissolved in water
Osmolarity
The RATE of solutes to water
ADH
Anti Direutic Hormone. Also known as vasopressor.
Synthesized by hypothalamus and store in PPG. PPg secrets ADH to response to increase solutes.
Causes DCT and collecting ducts to reabsorb more.
Too much water? Less ADH
Vasopressin shunts blood from?
Mesenteric system to core circulation
Assists in bleeding complications associated with GI tract used in TX of DI.
Dehydration?
ADH secreted to keep more nutrients
Overhydrated?
ADH not secreted and decrease absorption.
Osmotic Pressure
Min. pressure needed to be applied to a solution to prevent inward flow
What does ADH help control?
Body’s amount of water
Body can control amount of solutes through…. Aldosterone
Aldosterone
Mineralocorticoid steroid hormone secreted under Angiotensin II. Made from the adrenal cortex.
What does Aldosterone reabsorb?
Na
Excretes what? K
Helps expand intravascular fluid volume for proper BP and proper GFR.
When does RAAS get activated?
Renal arteriole pressure falls below normal.
When is Aldosterone released?
HyperK
HypoNA
Increased levels of ACTH
RAAS System
Decrased BP= Vas Recta
Denta cells secrete Renin
Renin released by kidneys with low pressure
Converts Angio to AngioI
ACE released by from pulmonary and Renal endothelium converts AngioI to AngioII
Angio II stimulates vasoconstriction and reabsorbs sodium and water and excretes K.
Adrenal glands secrete Aldosterone for more reabsorption and release ADH for more water reabsorption
BP regular= Denta Cells stop renin release
After the Nephron…
Urine is formed
No longer concentration gradient
Within Renal Pyramid- Urine is transported from collecting duct through renal papilla to minor calyx
Renal Pelvis
Hilium- Concave portion
Ureter
Peristaltic contractions of smooth muscle
Efflux or Antegrade- DOWNward movement of urine.
What prevents absorption?
Urothelium
Area that meets renal pelvis and the ureter?
Ureteropelvic Junction
Ureterovesical Junction
Area ureters meet the bladder. Central and hollow portion
What prevents reflux of urine?
Angle of Ureterovesical junction
Urethrovesical Junction
Area where bladder opens into urethra
When is the bladder completely empty?
Last second of micturition due to continual efflux
Urinalysis
Test for electrolytes, proteins, sugars, and hyaline casts.
Urine Culture
Determines type of microbe
Ultrasound
Noninvasive technique no med required
Renal Function Test
Blood sample and creatinine clearance.
Ct Scan
May or may not use dye
MRI
May or may not use dye
used for soft tissue abnormalities, trauma, chronic, and renal infections
Nuclear Scan
Radioisotopes injected into blood stream. Use camera. Determine GFR used for acute and chronic renal failure.
Iv Urography
Contrast Dye injected and x-rays taken upper and lower part
Cytoscopy
Occur via urethra or percutaneously
Retrograde Pyelography
Use of catheter to advance through ureters and into renal pelvis via cytoscopy
Cystography
Catheter inserted through urethra to bladder and contrast dye instilled to determine leakage from potential injury
Voiding Cystourethrography
Use of fluoroscopy and contrast dye placed via catheter into the bladder
Renal Angiography
Catheter fed into the femoral artery up to aorta to renal arteries- dye injected to determine renal blood flow
Biopsies
Test for acute renal failure , proteinuria, hematuria, transplant rejection.
Assess coags prior
Contras in obesity, uncontrolled HTN, and bleeding tendencies
Renal Clearance
Ability to clear solutes from plasma
What is Creatinine?
Normal waste product of skeletal muscle. Good indicator for kidney function in ability to filter
Amino acid in muscles and brain tissue
How is creatinine clearance measured?
Serum Creatinine halfway through 24 hour urine collection.
CKD
Stage 1 90 or higher - Stage 5 Less than 15
Disease worse, number DOWN
Nursing Considerations for Diagnostic Studies
Contrast Dye
Educate not to take METFORMIN after 48 hrs after contrast administration
Allergies
NPO
Consent
Educate what to expect after
May premedicate before
Pay attention to GFR and Creatinine.
When does GFR decrease?
35-40
Yearly decline 1ml/ min thereafter
What does renal tubule dysfunction lead to?
Acid- Base Imbalance
Renal Reserves are diminished
Gerontological Considerations
Decreased thirst
Increased risk of HyperNa
Structural and functional changes
Myogenic causes
Over distention of bladder wall
Neurogenic Causes
Stroke, Parkinson’s, spinal cord injuries, ED, CNS tumor, surgeries of spine
BPH
Benign Prostate Enlargement
Estrogen level decreases leads to what?
Thinning of urogenital tissues causing increased vaginal irritation and urinary incontinence.
Deficient Knowledge
Acute Pain
Fear
Anxiety
Readiness for Enhanced Knowledge
Impaired Urinary Elimination
Situational Low Self Esteem
Nursing Dx
Adrenal Glands Cortex
Synthesizes
Androgens- Sex hormones
Glucocorticoids- Cortisol
Mineralocorticoids- Aldosterone
What does Medulla synthesize?
Epi
Norepi
Both hormones and neurotransmitters
Vasocontrictors
ACTH secreted by
Anterior Pituitary Gland
Adrenal Sex Hormones
Steroid hormones
Produces sex hormones
ACTH controls secretion of adrenal androgens
too much= Women- masculinity
Men- Feminization
Children- Premature sexual development
Adrenal Cortex Feedback
Cortisol from Adrenal Glands
decreases CRH and ACTH at hypothalamus and Pituitary Gland
Cortisol
Glucocorticoid
Regulates metabolism and helps with memory. Also inflammation
Elevated Cortisol
Increased blood sugar
Increased sodium and water retention
Decreased CRH and ACTH
Corticosteroids
Decrease inflammation and suppress allergic reactions
Used in organ transplant
Sudden discontinuation- Addison’s = Adrenal Insufficiency, why? body becoming dependent on exogenous corticoid steroid
Dosages must be TAPERED
Addison’s Disease
Addison’s Disease ( Adrenal insufficiency)
Lethargy
Weakness
Fever
Anorexia
Nausea and Vomiting
Weight Loss
HypoNa
HyperK
Hypogly
Cushings Syndrome
Adrenal Excess
Buffalo Hump
Heavy Trunk
Thin Extremities
Fragile Skin
Impaired Wound Healing
Bruising
Women may have more masculine traits? why? Androgens excess
