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ADN002 MED SURG > Week 3 GU System > Flashcards

Week 3 GU System Flashcards

1
Q

Kidneys function by

A

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

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2
Q

Kidneys and Urinary Systems

A

Regulates fluid and electrolytes, removing wastes and providing hormones involved in RBC production, bone metabolism, and BP control.

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3
Q

Where are kidneys located?

A

Retroperitoneal and important to flank area during assessment

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4
Q

What does tenderness indicate?

A

UTI, pyelonephritis, and nephrolithiasis.

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5
Q

Where are nephrons located?

A

Renal cortex

Responsible urine formation.

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6
Q

Where are juxtamedullary nephrons located?

A

Renal Medulla. Responsible for concentration of urine .

Renal Medulla also contains loop of Henle and vas recta and collecting ducts of nephrons.

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7
Q

Main difference between juxta and cortical?

A

Loop henle much longer in Juxta which gives ability to concentrate Urine

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8
Q

Renal Arteries

A

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

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9
Q

GFR

A

Glomerular Filtration Rate - Filtration rate of kidneys.

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10
Q

Where does most reabsorption occur?

A

PCT

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11
Q

Aldosterone and ADH affect what tubule?

A

Distal Tubule responsible for concentration of urine.

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12
Q

What apparatus is a major structural component of the RASS?

A

Juxtaglomerular

Also one of the most important regulator of renal salt and H20

Between afferent arteriole and DCT.

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13
Q

What cells secrete Renin?

A

Macula Densa

Sense change in serum osmolarity and secrete renin when needed

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14
Q

Loop of Henle works with?

A

Vas Recta.Work in opposite directions. Vas Recta is highly permeable to water. Solutes enter but water does not. They are intertwined

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15
Q

Osmolality

A

Amount of SOLUTES dissolved in water

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16
Q

Osmolarity

A

The RATE of solutes to water

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17
Q

ADH

A

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

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18
Q

Vasopressin shunts blood from?

A

Mesenteric system to core circulation

Assists in bleeding complications associated with GI tract used in TX of DI.

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19
Q

Dehydration?

A

ADH secreted to keep more nutrients

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20
Q

Overhydrated?

A

ADH not secreted and decrease absorption.

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21
Q

Osmotic Pressure

A

Min. pressure needed to be applied to a solution to prevent inward flow

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22
Q

What does ADH help control?

A

Body’s amount of water

Body can control amount of solutes through…. Aldosterone

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23
Q

Aldosterone

A

Mineralocorticoid steroid hormone secreted under Angiotensin II. Made from the adrenal cortex.

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24
Q

What does Aldosterone reabsorb?

A

Na

Excretes what? K

Helps expand intravascular fluid volume for proper BP and proper GFR.

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25
Q

When does RAAS get activated?

A

Renal arteriole pressure falls below normal.

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26
Q

When is Aldosterone released?

A

HyperK
HypoNA
Increased levels of ACTH

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27
Q

RAAS System

A

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

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28
Q

After the Nephron…

A

Urine is formed
No longer concentration gradient

Within Renal Pyramid- Urine is transported from collecting duct through renal papilla to minor calyx

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29
Q

Renal Pelvis

A

Hilium- Concave portion

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30
Q

Ureter

A

Peristaltic contractions of smooth muscle

Efflux or Antegrade- DOWNward movement of urine.

31
Q

What prevents absorption?

A

Urothelium

32
Q

Area that meets renal pelvis and the ureter?

A

Ureteropelvic Junction

33
Q

Ureterovesical Junction

A

Area ureters meet the bladder. Central and hollow portion

34
Q

What prevents reflux of urine?

A

Angle of Ureterovesical junction

35
Q

Urethrovesical Junction

A

Area where bladder opens into urethra

36
Q

When is the bladder completely empty?

A

Last second of micturition due to continual efflux

37
Q

Urinalysis

A

Test for electrolytes, proteins, sugars, and hyaline casts.

38
Q

Urine Culture

A

Determines type of microbe

39
Q

Ultrasound

A

Noninvasive technique no med required

40
Q

Renal Function Test

A

Blood sample and creatinine clearance.

41
Q

Ct Scan

A

May or may not use dye

42
Q

MRI

A

May or may not use dye

used for soft tissue abnormalities, trauma, chronic, and renal infections

43
Q

Nuclear Scan

A

Radioisotopes injected into blood stream. Use camera. Determine GFR used for acute and chronic renal failure.

44
Q

Iv Urography

A

Contrast Dye injected and x-rays taken upper and lower part

45
Q

Cytoscopy

A

Occur via urethra or percutaneously

46
Q

Retrograde Pyelography

A

Use of catheter to advance through ureters and into renal pelvis via cytoscopy

47
Q

Cystography

A

Catheter inserted through urethra to bladder and contrast dye instilled to determine leakage from potential injury

48
Q

Voiding Cystourethrography

A

Use of fluoroscopy and contrast dye placed via catheter into the bladder

49
Q

Renal Angiography

A

Catheter fed into the femoral artery up to aorta to renal arteries- dye injected to determine renal blood flow

50
Q

Biopsies

A

Test for acute renal failure , proteinuria, hematuria, transplant rejection.

Assess coags prior

Contras in obesity, uncontrolled HTN, and bleeding tendencies

51
Q

Renal Clearance

A

Ability to clear solutes from plasma

52
Q

What is Creatinine?

A

Normal waste product of skeletal muscle. Good indicator for kidney function in ability to filter
Amino acid in muscles and brain tissue

53
Q

How is creatinine clearance measured?

A

Serum Creatinine halfway through 24 hour urine collection.

54
Q

CKD

A

Stage 1 90 or higher - Stage 5 Less than 15

Disease worse, number DOWN

55
Q

Nursing Considerations for Diagnostic Studies

A

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.

56
Q

When does GFR decrease?

A

35-40

Yearly decline 1ml/ min thereafter

57
Q

What does renal tubule dysfunction lead to?

A

Acid- Base Imbalance

Renal Reserves are diminished

58
Q

Gerontological Considerations

A

Decreased thirst
Increased risk of HyperNa
Structural and functional changes

59
Q

Myogenic causes

A

Over distention of bladder wall

60
Q

Neurogenic Causes

A

Stroke, Parkinson’s, spinal cord injuries, ED, CNS tumor, surgeries of spine

61
Q

BPH

A

Benign Prostate Enlargement

62
Q

Estrogen level decreases leads to what?

A

Thinning of urogenital tissues causing increased vaginal irritation and urinary incontinence.

63
Q

Deficient Knowledge
Acute Pain
Fear
Anxiety
Readiness for Enhanced Knowledge
Impaired Urinary Elimination
Situational Low Self Esteem

A

Nursing Dx

64
Q

Adrenal Glands Cortex

A

Synthesizes
Androgens- Sex hormones
Glucocorticoids- Cortisol
Mineralocorticoids- Aldosterone

65
Q

What does Medulla synthesize?

A

Epi
Norepi

Both hormones and neurotransmitters
Vasocontrictors

66
Q

ACTH secreted by

A

Anterior Pituitary Gland

67
Q

Adrenal Sex Hormones

A

Steroid hormones
Produces sex hormones

ACTH controls secretion of adrenal androgens

too much= Women- masculinity
Men- Feminization
Children- Premature sexual development

68
Q

Adrenal Cortex Feedback

A

Cortisol from Adrenal Glands
decreases CRH and ACTH at hypothalamus and Pituitary Gland

69
Q

Cortisol

A

Glucocorticoid
Regulates metabolism and helps with memory. Also inflammation

70
Q

Elevated Cortisol

A

Increased blood sugar
Increased sodium and water retention
Decreased CRH and ACTH

71
Q

Corticosteroids

A

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

72
Q

Addison’s Disease

A

Addison’s Disease ( Adrenal insufficiency)
Lethargy
Weakness
Fever
Anorexia
Nausea and Vomiting
Weight Loss
HypoNa
HyperK
Hypogly

73
Q

Cushings Syndrome

A

Adrenal Excess
Buffalo Hump
Heavy Trunk
Thin Extremities
Fragile Skin
Impaired Wound Healing
Bruising
Women may have more masculine traits? why? Androgens excess

ADN002 MED SURG (18 decks)

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