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