renal-urinary system Haile

physical exam

inspect, auscultate, palpate, percuss vitals/ weight mental status: ( old man confused is indicator of UTI) lungs: indicative of body fluid status

control of the internal urethral sphincter is

involuntary

enuresis

involuntary loss of urine

nocturnal enuresis

involuntary loss of urine while asleep

auscultation

listen for bruit over the abd aorta and each renal artery. indicates altered blood flow to the kidneys

Decreased creatinine indicates

loss of muscle mass certain medications- some classes of antibiotics and lithium

enuresis abnormal finding

lower urinary tract disorder

urgency abnormal findings

medications, pelvic organ prolapse, cystitis, UTI

how to take a clean catch sample

mid stream

can you palpate the left kidney?

no

in a 24 hr urine can you miss a void?

no you have to start all over

retention abnormal findings

normal finding briefly after child birth, pelvic surgery, and removal of indwelling catheter prolonged/ abnormal related to neurogenic bladder, obstruction or stricture of the urethra

renal calculi (kidney stones) or tumors obstruct ___

normal flow of urine

when inspecting, assess for the presence of the following abnormal changes

skin: poor skin turgor, rough texture, pillow, yellow-gray color, flank bruising mouth: ammonia breath odor, stomatitis abdomen: uneven contour, unilateral lower abd mass, striae extremities: edema urethral meatus: bloody or purulent discharge, skin lesions or rashes, obvious tissue trauma

more water in ADH is _____

suppressed

the GFR is dependent of several factors

systemic blood pressure blood flow volume

Glomerular Filtration Rate (GFR)

the amount of blood filtered by the glomeruli in a set amount of time

Frequency

the need to urinate in short intervals, small amounts

renal capsule

the outer layer of the kidney

proteinuria

the presence of protein in the urine

micturition

to start the stream of urine; to urinate; release urine from the bladder

efferent arterioles

transport blood away from the glomeruli and into the peritubular capillaries

Prostaglandins

trigger vasodilation increasing blood flow to the kidneys and increased sodium and water excretion

female are more likely to get UTIs than males? T or F

true

renal colic abnormal findings

ureter spasm during passage of calculi, ureter obstruction

hesitancy abnormal findings

urethral obstruction, enlargement of prostate gland (benign of malignant)

anuria

urine output is less than 100ml in 24hrs

water volume in =

volume of water out

control of the external urethral sphincter is

voluntary

adrenal glad is located

on top of the kidney

urine flows ___

one way

what are the 3 layers too the bladder

outer lining middle smooth muscle- detrusor inner epithelium- urothelium

renal colic

pain radiating to the perineal or groin area

the urethra goes through what in males

prostate

less than 30 ml of urine per 2 hours is

red flag, something is wrong

creatinine is the most ____

reliable indicator of kidney function

Increased BUN indicates

renal dysfunction liver disease dehydration infection high-protein diet GI bleeding steroid use trauma

Decreased BUN indicates

severe liver damage malnutrition low-protein diet fluid volume excess

oliguria abnormal findings

shock, ESRD, acute kidney injury, severe dehydration, blood transfusion reaction

dysuria abnormal finding

UTI, cystitis(bladder infection)

bradykinin

increases the permeability of the capillary membrane and dilates the afferent arteriole

computed tomography (CT)

indirect, 3D images, used to further investigate after X-ray/ultrasound, npo,

x-ray studies

indirect, KUB, taken while supine, can reveal masses, obstruction and calculi, no prep or discomfort

IV urography/ pyelography

indirect, dye administered through IV, supine, X-rays performed at certain intervals and then after pt voids, bowel prep and npo, no discomfort

renal ultrasound

indirect, identify masses, cysts, obstructions in the kidneys, no prep, noninvasive

magnetic resonance imaging (MRI)

indirect, magnetic forces rather than radiation, contrast between tissues, NO METAL, assess for implanted devices (pacemakers)

renal biopsy

indirect, removal of a piece of kidney to rule out malignant abnormalities, npo 4-6hrs before, bedrest 24 hrs, at risk for internal bleeding

calcium

8.2-10.2 mg/dL

creatinine range

0.5-1.2mg/mL

what are the 6 main functions of the kidneys?

1. excretion of wastes 2. regulation of fluid and electrolyte balance 3. regulation of acid-base balance 4. regulation of blood pressure 5. secretion of erythropoietin for RBC production 6. activation of Vitamin D

Each ureter is approximately _________ long.

10-12 in

BUN/Creatinine Ratio

10:1 to 20:1

sodium

135-145 mEq/L

Phosphorus

2.5-4.5 mEq/dL

bicarbonate HCO3

22-26mEq/L

uric acid

3.5- 8mg/dL

potassium

3.5-5.0 mEq/L

the kidneys produce how much urine per hour

50-60 mL

BUN level

8-21 mg/dL

the nurse is assessing a patient for a routine physical exam. which of the following are normal findings when assessing the renal and urinary systems? (select all) a. inability to palpate the kidneys b. CVA tenderness upon percussion c. absence of a renal artery bruit d. purulent drainage from the urinary meatus e. tympanic sounds over an empty bladder upon percussion

A & C

end-stage renal disease (ESRD)

A chronic rise in serum creatinine levels associated with loss of kidney function that must be treated with dialysis or transplantation. Also known as chronic renal failure (CRF)

oliguria

Urine output of less than 400 mL in 24 hours.

when can you send a UA to the lab

ASAP no longer than 1hour

increased creatinine indicates

Acute & Chronic Renal Failure Cancer Shock Diet high protein CHF Diabetic nephropathy

acute renal failure (ARF)

An acute rise in the serum creatinine level of 25% or more. May be caused by inadequate blood flow to the kidney, injury to the kidney glomeruli or tubules, or obstruction of kidney outflow.

renal and urinary assessment

Appearance: color and clarity - changes due to meds, hydration status and presence of blood Odor: slightly of ammonia - changes due to meds, hydration status and presence of organisms Pattern of Urination: frequency, flow and amount - average of 5-6x's per day Ability to control voiding

nurse prep for imaging studies

complete bowel prep. this eliminates feces and flatus I the bowel so that the view of the urinary tract is not obstructed by a distended colon

hydration is a big indicator of ___

BUN

hematuria

Blood in the urine. May be due to trauma, kidney stones, infection, or menstruation.

common bacteria in urine tests C&S

Echoli and Klebsiella

acidosis

H+ excreted + HCO3 reabsorbed = increased serum pH

alkalosis

H+ reabsorbed + HCO3 excreted = decreased serum pH

dysuria

Painful or difficult urination.

pyuria

Pus in the urine; sign of urinary tract infection (UTI).

erythropoietin stimulates the the bone marrow to produce __

RBC

nephrotoxic

Substance that damages kidney tissue. Some antibiotics (gentamicin, tobramycin, & amikacin), non-steroidal anti-inflammatory drugs, lead, & contrast media have the potential to be nephrotoxic.

afferent arteriole

a series of smaller arteries that supply blood to the nephron. direct blood flow to the glomeruli

urgency

a sudden, almost uncontrollable need to urinate

the nurse expects to observe which of the following altered laboratory values in a patient diagnosed with renal failure? A. decreased calcium b. increased calcium c. decreased phosphorus d. increased hct

a. decreased calcium

vitamin D

activation finishes in kidneys, required for calcium to be absorbed in the GI tract

pessary

an incontinence device that is inserted into the vagina to reduce organ prolapse or pressure on the bladder

sensitivity identifies

antibiotic in urine

culture identifies

bacteria in urine

incontinence abnormal findings

bladder infections, trauma to the external sphincter, neurogenic bladder, trauma to the nerve innervating the urinary tract structures

frequency abnormal findings

bladder inflammation, excessive fluid intake, urinary retention

bedside sonography

bladder scanner, noninvasive to measure amount of urine in bladder

hematuria abnormal findings

cystitis or other inflammation in the urinary tract, calculi, cancers of the urinary tract, renal disease, bleeding disorders, meds such as anticoagulants

the nurse is caring for an older adult with intermittent urinary incontinence. the nurse recognizes that the incontinence is a result of which structure failing to contract to keep urine in the bladder until micturition? a. the detrusor muscle b. the external urethral sphincter c. the urethra d. the internal urethral sphincter

d. the internal urethral sphincter

increased sodium causes

decreased urination

less water in triggers ADH _________ serum osmolality

decreases

hesitancy

difficulty starting the flow of urine

nephropathy

disease of the kidney

anuria abnormal findings

end stage renal disease, acute renal failure, urinary tract obstruction

polyuria abnormal findings

excessive fluid intake, diabetes inspidus, diabetes mellitus, diuretic meds, dieresis phase of chronic renal failure

hypertrophy

excessive growth of the prostate gland, especially in older men, interfere with the flow of urine from the bladder into the urethra

polyuria

excessive urination, greater than 2,000ml per 24hr

Erythropoietin

exclusively produced by the kidneys when decreased renal blood flow and hypoxia occur

nocturia

frequent urination at night

UA is most precise when results are obtained when

from the first void of the day

nephron

functional unit of the kidney

nocturia abnormal findings

heart failure, renal disease, bladder obstruction, consumption of excessive fluids late at night

renin

helps regulate blood pressure

retention

inability to completely empty the bladder

incontinence

inability to voluntarily control micturition

decreased electrolyte level=

increased reabsorption of electrolyte

increased electrolyte level =

increased secretion of electrolyte

caffeine and alcohol lead to

increased urination