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NUSC 2P14 > Week 8: Renal and Genitourinary Disorders > Flashcards

Week 8: Renal and Genitourinary Disorders Flashcards

1
Q

The Kidney Primary Function

A

-Remove waste products from blood
-Maintain water and electrolyte balance
-Maintain acid-base balance

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1
Q

The Kidney Primary Function

A

-Remove waste products from blood
-Maintain water and electrolyte balance
-Maintain acid-base balance

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2
Q

Inside the Kidney

A

Medulla
-Medullary pyramids
-Papillae
Minor Calyces
-Small collection tubules
Major Calyces
-Large collection tubules
Renal Pelvis
-Drains into ureter

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3
Q

Kidney- Blood & Nerve Supply

A

Aorta -> renal artery
-Delivers blood to nephron units at the capillary level (glomerulus)
Renal vein -> inferior vena cava
Renal nerves travel with the renal blood vessels to the kidney
Primary sympathetic nerves
-Control blood flow
-Regulates release of BP enzyme

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4
Q

The Nephron

A

-Functional unit of the kidney
-Each kidney = 1 million nephrons
-Filters blood and forms urine
-Each nephron has 2 parts
1.) tubular structure - renal tubules
2.) vascular structure - blood vessels

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5
Q

Nephron Unit- Tubular Structure

A

Four Tubules
1.)Bowman’s capsule
2.)Proximal convoluted tubule
3.)Distal convoluted tubule
*many nephrons connect to collecting duct

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6
Q

Nephron Unit- Vascular Structure

A

-Afferent arterioles from the aorta branch into a cluster of capillaries (glomerulus)
-Efferent arterioles leave the glomerulus to form a secondary capillary network
-Capillaries then form into venules leading to the renal vein and inferior vena cava

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7
Q

Urine Formation

A

-The basic function of nephrons is to cleanse or clear blood plasma of unnecessary substances
-After the glomerulus has filtered the blood, the tubules separate the portions of tubular fluid that are useful to the body from those that are
not
-The necessary portions are returned to the blood, and the unnecessary portions pass into urine as waste

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8
Q

Urine Formation 1.) Glomerular Filtration

A

Glomerulus: selective filtration of water & solutes from the blood
-Contains ~ 50 capillaries
-Hydrostatic pressure
-Blood (water & solutes) is filtered across the membrane into Bowman’s capsule
-Semi permeable membrane
-Large molecules are not filtered (RBCs, platelets, large plasma proteins)
-Unfiltered blood goes on to the peritubular capillaries
-Glomerular filtration rate (GFR) = 125ml/min
-Results in ~1 ml urine/min

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9
Q

Urine Formation- 2.) Tubular Reabsorption

A

Returns filtrate from the tubules to the blood of
peritubular capillaries
Proximal Tubule
~80% of the electrolytes are reabsorbed
Loop of Henle
-Important in conserving water
-Concentrates the filtrate
Distal Convoluted Tubule
-Final regulation of water balance
-Acid-base balance
Collecting Tubule
-Reabsorption of water if necessary

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10
Q

Urine Formation- 2.) Tubular Secretion

A

Secretes very small amounts of select substances from the peritubular capillaries into the tubules
Potassium
Hydrogen
Ammonia

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11
Q

Urine Formation

A

What is reabsorbed from the urine & returned to the blood?
-Water (most)
-Glucose & other nutrients
-Sodium & other salts
What is secreted from the blood into the urine & voided from the body?
-Hydrogen & potassium ions
-Some drugs

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12
Q

Aldosterone

A

-Acts on the distal tubule
“salt-retaining” hormone
Stimulates
-reabsorption of Na+ & H2O
-Expands blood volume & BP
-K+ excretion
-Deficiency: drop blood volume, drop BP, shock

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13
Q

Antidiuretic Hormone (ADH)

A

-Released by posterior pituitary in response to low blood volume or high Na+ concentration in blood
-H2O moves out of collecting duct into tissue spaces and then into peritubular capillaries

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14
Q

The Kidney- Secondary Functions

A

Blood Pressure
-Renin regulates BP and is released from the nephron
-In response to drop arterial BP, renal ischemia, ECF depletion, increased norepinephrine,
increased urinary Na+ concentration
Bone Density
-Vitamin D is activated in the kidneys
Erythropoiesis
- Erythropoietin stimulates the production of RBCs in the bone marrow in response to hypoxia & decreased renal blood flow

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15
Q

Ureters

A

-0-12” long
-Smooth muscle
-Peristalsis – one-way flow
-Renal pelvis to bladder

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16
Q

Bladder

A

-Sac-like hollow organ
-Reservoir for urine (300-400ml)
-Voluntary contraction of external sphincter can prevent urination until bladder filled to capacity

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17
Q

Urethra

A

-Tube allowing passage of urine from bladder neck to outside of the body (voiding, micturition, peeing)
-Shorter in women (UTIs)

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18
Q

Characteristics of Urine

A

Volume
-Average 1500 mL/24h
-Oliguria < 400 ml/24h
-Polyuria > 1500 ml/25h

Colour
-Amber or straw-colored
-Deep yellow in dehydration
-Pale yellow with overhydration

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19
Q

Age Related Considerations

A

-drop in size and weight of kidney from 30 to 90 years of age
-decreased blood flow to and within the kidneys
-Physiological changes to kidney, bladder, and urethra
-Decreased elasticity, weakening of GU system
-Decreased bladder capacity
-Increased incidence of UTI
-Prostatic enlargement
-Decreased estrogen = decreased elasticity of the female urethra & bladder

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20
Q

Assessment- Subjective Data

A

-Painful urination
-Changes in urine, colour (blood, cloudy)
-Changes in urination (diminished, excessive)
-Past health history- illness, hospitalization
-Cigarette smoking
-Medications: OTC/prescribed
-Surgery or other treatments
-Family history

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21
Q

Assessment- Objective Data

A

Inspect
Skin: pallor, yellow-grey cast, excoriations, changes in turgor, bruises, texture
Mouth: stomatitis, ammonia breath
Extremities: edema
Abdomen: distension, masses
General State of health: fatigue, lethargy, and diminished alertness

Palpate
Kidneys: not usually palpable
Abdomen: for bladders distension, masses, tenderness

Auscultate:
-over both CVAs and in the upper abdominal quadrants
-renal arteries for bruits (an abnormal murmur), which indicates impaired blood flow to the kidneys

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22
Q

Assessment- Signs & Symptoms

A

-Anorexia
-Blurred vision
-Chills
-Change in body weight
-Change in mentation
-Excess thirst
-Fatigue
-Headaches
-Hypertension
-Itching: advanced kidney disease
-N & V

23
Q

Diagnostics

A

Urine- urinalysis, culture & sensitivity (C&S)
-Voided midstream clean-catch urine sample
Blood tests- blood urea nitrogen, creatinine
Radiological Procedures
-CT scan, MRI
-Ultrasound- bladder scan
-Cystography – voiding cystourethrogram
-Intravenous pyelography (IVP)
-Renal angiography
Renal biopsy
-Cystoscopy

24
Q

Bladder Scan

A

-Noninvasive, portable ultrasound device that provides:
~a virtual 3D image of the bladder
~the volume of urine retained within the bladder
-Safe, painless, reliable
**Contraindicated if the patient has wounds in suprapubic area or is pregnant

25
Q

Urinary Tract Infection (UTI)

A

-Inflammation of the urinary tract may be attributable to a variety of disorders, but bacterial infection is by far the most common, particularly among females
-The urinary tract above the urethra is normally sterile
-The organisms that usually cause UTIs are introduced via the ascending route
from the urethra
(E. coli is the most common pathogen leading to a UTI)
-An important source of UTIs is health care–acquired infection
-Urological instrumentation, particularly with an in-dwelling urinary catheter, is the most common predisposing factor
-CAUTI: catheter-associated UTI

26
Q

UTI Signs and Symptoms

A

-Dysuria
-Frequency of urination (>q2h)
-Urgency
-Suprapubic discomfort or pressure
-Hematuria
-May contain sediment- cloudy appearance
-Flank pain
-Chills
-Fever: indicating pyelonephritis

27
Q

UTI Diagnostics

A

Dipstick Urinalysis
-Provides chemical analysis of urine, along with a microscopic interpretation
Urine Culture & Sensitivity (C&S)
-To confirm suspected urinary tract infection & identify causative organisms
IVP
-The presence, position, size, and shape of the kidneys, the ureters, and the bladder can be evaluated
Abdominal CT

28
Q

UTI Classification

A

Urethritis (lower tract)
Cystitis (lower tract)
Pyelonephritis (upper tract)

29
Q

UTI Collaborative Care & Drugs

A

Antibiotics
-trimethoprim–sulfamethoxazole (TMP-SMX) (Bactrim)
-nitrofurantoin (Macrodantin)
-Increase fluid intake
-Avoidance of unnecessary catheterization
-Early removal of indwelling catheters

30
Q

Urethritis- Presentation

A

Inflammation of the urethra, most commonly from a sexually transmitted bacterial or viral infection
-Dysuria & frequency
-Feeling the frequent or urgent need to urinate
-Difficulty starting urination
-Discharge from urethral opening
Tx: identify & treat the cause & provide symptomatic relief
Trichomonas & monilial infection: esp females
Chlamydia
Gonorrhea: esp males

31
Q

Interstitial Cystitis (IC)

A

Interstitial cystitis (IC) is a chronic, painful inflammatory disease of the bladder
-The bladder wall becomes inflamed or irritated
-Can cause scarring, stiffening, and bleeding
IC should not be confused with common cystitis, a bacterial infection of the bladder
-IC is not caused by bacteria, nor does it respond to antibiotics
S & S: pain, frequency, urgency
Care: to alleviate symptoms
-Dietary and lifestyle changes (low acid diet)
-Some meds

32
Q

Pyelonephritis

A

-Inflammation of the renal parenchyma & collecting system (incl. renal pelvis)
-Most common cause is bacterial infection that begins in the lower urinary tract
-Commonly starts in the renal medulla & spreads to cortex
-Usually a pre-existing factor resulting in
backward flow of urine from lower to upper
tract

33
Q

Pyelonephritis Signs and Symptoms

A

-Mild fatigue, malaise
-Sudden onset of chills
-Fever
-Vomiting
-Flank pain
-Frequency
-Urgency

34
Q

Pyelonephritis Care

A

-Antibiotics 14-21 days
-F/U urine culture
-Increase fluid intake (8 glasses/d)

35
Q

Glomerulonephritis (Nephritis)

A

-Immune- related inflammation of the glomeruli characterized by:
* proteinuria, hematuria (smoky), oliguria & edema
-Fluid retention occurs as a result of decreased glomerular filtration
-Periorbital edema initially, then spreads
-Hypertension related to increased ECF volume

Adjust protein intake
Sodium & fluid restriction
Rest
Drugs
Diuretics
Antihypertensives

36
Q

Polycystic Kidney Disease (PKD)

A

-One of the most common genetic diseases in Canada
-The cortex and the medulla are filled with thin-walled cysts
-The cysts enlarge and destroy surrounding tissue by compression
-Filled with fluid and may contain blood or pus

37
Q

Polycystic Kidney Disease (PKD)

A

-Symptoms appear when the cysts begin to enlarge
-Common early symptom is abdominal or flank pain: steady or abrupt in onset as well as episodic and colicky
-This pain is often caused by bleeding into the cysts
-On physical examination, palpable bilateral enlarged kidneys are often found
-Other clinical manifestations include hematuria (from rupture of cysts), UTI, and hypertension
-Usually progress to end- stage renal failure
Tx: nothing specific
Goal: prevent or treat infections of the urinary tract

38
Q

Urinary Incontinence

A

Uncontrolled loss of urine that is of sufficient magnitude to be a problem
-The prevalence is higher among older women and older men, but it is not a natural consequence of aging

39
Q

Urinary Retention

A

Inability to empty the bladder despite micturition or the accumulation of urine in the bladder because of the inability to urinate
-obstruction leads to urinary retention when the blockage (i.e. enlarged prostate) prevents bladder evacuation
MEDICAL EMERGENCY

40
Q

Urinary Catheters

A

-Tube inserted into bladder to drain urine
-Promoting comfort when unable to use other means (weakness, disabilities, dying)
-Specimen collection
-Measuring exact urine output
-Before, during, and after surgery
-LAST resort for incontinence

41
Q

Catheter & Drainage

A

Closed system for indwelling catheters
Sterile environment
Tubing + drainage bag

42
Q

Subrapubic Catheter

A

-Surgically inserted through abdomen into bladder
Indicators for use:
-Gynecological surgeries
-Long-term catheterization
-Urethral injury or obstruction

43
Q

Different Types of Catheters

A

Simple: “in & out”
Indwelling: foley
Indwelling: 3 way (for bladder irrigation)

44
Q

Continuous Bladder Irrigation (CBI)

A

-Indicated to maintain catheter patency and prevent blockages in patients with significant hematuria
-Fluid (0.9% saline) is continuously administered into the bladder via 3-way catheter and allowed to drain

45
Q

Urinary Diversion

A

Surgically created route to allow urine passage after cystectomy
INCONTINENT:
-diversion to the skin, requiring an appliance
CONTINENT:
-intra-abdominal urinary reservoir that is catheterizable or has an outlet controlled by the anal sphincter
Contributing Factors
-Cystectomy for cancer treatment
-Cystectomy following injury

46
Q

Incontinent Urinary Diversion

A

Ureterostomy
-Ureter(s) brought directly to abdominal surface
-One stoma for each ureter
-Simplest

Ileal Conduit
-Section of intestine links ureters to abdominal surface
-Construction of an artificial bladder

47
Q

Continent Urinary Diversion

A

-Internal pouch created from the ileum, ileocecal segment, or colon
-Pt must self-catheterize q4-6h
-No need for external appliance
-Does not leak involuntarily

48
Q

Acute Kidney Injury (AKI)

A

Previously known as acute renal failure
-sudden onset after severely decreased blood flow to the kidneys
-usually affects people with other life-threatening conditions
Can Be Caused By:
-Severe bleeding
-Heart attack
-CHF
-Burns
-Infections
-Severe allergic reactions

49
Q

Acute Renal Failure- Phases

A

Phase 1:
-oliguria (urine output <400ml in 24h)
-lasts few days to 2 weeks
Phase 2:
-diuresis (output 1000-5000 ml in 24h)
Recovery increase kidney function improves and returns to normal:
-Can take 1 month - 1 year
-Some don’t recover: chronic renal failure

50
Q

Acute Renal Failure- Presentation

A

-Decreased urine output
-Edema: legs, ankles, feet
-shortness of breath
-Confusion
-Nausea
-Flank pain
-Fatigue, weakness

51
Q

Acute Renal Failure- Treatment

A

Dialysis
Treatment of underlying issue
Medications
Two Possible Outcomes
-Kidney function returns to normal without permanent damage
-Chronic renal disease develops

52
Q

Dialysis

A

Technique in which substances move from the blood through a semipermeable membrane (dialyzer) and into a dialysis solution (dialysate)
-to correct fluid and electrolyte imbalances
-to remove waste products in renal failure
PERITONEAL DIALYSIS
HEMODIALYSIS

53
Q

Principles of Dialysis

A

Diffusion
-movement of solutes from an area of greater concentration to an area of lesser concentration
Osmosis
-movement of fluid from an area of lesser to an area of greater concentration of solutes
Ultrafiltration
-water & fluid removal results when there is an osmotic gradient or pressure gradient across the membrane

54
Q

Peritoneal Dialysis

A

Thin tube into the peritoneal cavity
-Peritoneal catheter
-Space between abdominal wall and bowel
Fills peritoneal cavity with solution
-Absorbs waste and excess fluids
-Wastes move from high to low concentration
Solution + waste drains from the body
Daily (minimum): 30-40 mins each time

55
Q

Hemodialysis

A

Blood removed from body
-Access port in the arm
Filtered by machine (artificial kidney)
Returned to body
3 times/week: 4 h each time

NUSC 2P14 (7 decks)

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