Renal Exam Topics
When the urologist wants to directly visualize the bladder, urethra, and ureteral orifices, what diagnostic test would he use? - laparoscopy - cystoscopy
Cystoscopy Explanation: Cystoscopy provides a means for direct visualization of the urethra, bladder, and ureteral orifices. It relies on the use of a cystoscope, an instrument with a lighted lens
The nurse is caring for a client with recurring urinary tract infections (UTIs). The client asks, "Other than taking antibiotics, what else can I do?" Which response by the nurse is most accurate? page 871
Drink lots of fluids to help relieve the signs/symptoms of UTIs.
An older adult with urge incontinence and overactive bladder begins medication treatment with oxybutynin. Which side effects would the nurse include in the education? page 911
Dry mouth and constipation are common.
What is the usual cause of acute pyelonephritis? page 884
Infection
The edema that develops in persons with glomerulonephritis and nephrotic syndrome reflects which physiologic principle? page 876
Salt and water tubular reabsorption
ADH
- causes kidneys to save water NOT electrolytes - decrease output
Intrarenal
- acute tubular necrosis is the most common cause of intrarenal failure - postischemic ( low BP, post OP) - nephrotoxic ( kidneys have been damaged by toxins ) - Oliguria ( GFR is low)
What types of substances should never be in the urine
- blood - protein - glucose
A client has been given the diagnosis of diffuse glomerulonephritis. The client asks the nurse what diffuse means. The nurse responds: page 882
"All glomeruli and all parts of the glomeruli are involved."
Urinary tract infections (UTIs) in children do not generally present as they do in adults. What are the signs and symptoms of a UTI in a toddler? page 874-875
- abdominal pain - poor growth - diarrhea
hydroureter
- accumulation of urine in the ureter - Cant drain into bladder properly
A nurse is teaching a client scheduled for a cystoscopy about the procedure. Which statement made by the client verifies that the teaching has been successful?
- "The doctor will insert a lighted tube through my urethra into my bladder in order to inspect the inside of the bladder." Explanation: Cystoscopy provides a means for direct visualization of the urethra, bladder, and ureteral orifices. It relies on the use of a cystoscope, an instrument with a lighted lens. The cystoscope is inserted through the urethra into the bladder. Biopsy specimens, lesions, small stones, and foreign bodies can be removed from the bladder
A client who developed acute pyelonephritis asks the nurse what caused the infection. What should be included in the nurse's response? page 869
- Acute pyelonephritis is caused by bacterial infection. - Escherichia coli is the causative agent in about 80% of cases. - Outflow obstruction, catheterization, and urinary instrumentation
Intrarenal Definition and Causes
- Acute tubular necrosis is the most common cause of intrarenal renal failure - Cause o Postischemic (low BP, post OP) o Nephrotoxic (kidneys have been damaged by toxins) o Oliguria (GFR is low)
Chronic Kidney Disease CKD
- Affects all organs - Progressive loss of renal function - Associated with: o HTN o Diabetes o Primary kidney disease
endocrine functions of the kidney
- Assisting with BP regulation through the RAA mechanism - Regulation of RBC production through the synthesis of erythropoietin - Assisting with calcium homeostasis by activating Vitamin D
Aging and renal function
- Decrease in renal blood flow and GFR ( Altered sodium and water balance) - Number of nephrons decrease due to renal vascular and perfusion changes -Response to acid-base changes delayed - Increased risk for drug toxicity - Alterations in thirst and water intake ( hypernatremia: no water intake) ( water is hard b/c they have to walk to bathroom etc) ( water is important for joints)
Pediatric renal function
- Decreased ability to remove excess water and solutes - Decreased concentrating ability - Narrow margin for fluid and electrolyte balance - Increased risk of drug toxicity
Proteinuria and Uremia
- Due to glomerular hyperfiltration - Uremia not being excreted - Not saving protein (kidney) - Damages interstitial tissue of kidney via inflammation
AKI maintenance phase
- Established by kidney injury and dysfunction - Urine output is lowest during this phase - Serum creatinine and blood urea nitrogen both increase ( BUM : values that we watch to see how kidney injury is evolving)
Signs and sypmtoms of chronic renal failure
- Frost: salt crystals on skin - Red Eye - Anorexia - Nausea - Vomiting - Dyspnea - Nail changes - Bone (losing calcium) - Edema - Peripheral neuropathy - Myophtaly weakness (muscle weakness) - Fertility problems (amenorrhea) - Bruising - Itching (pruritic) - Sallow pigmentation - Anemia (pallor - Epitaxies - Hypocalcemia - Osteoporosis in bones and pathologic fracture - Hypertension - Hyperkalemia
Creatinine and Urea clearance
- GFR falls - Plasma creatinine increases o Creatinine views how kidney has been functioning overall for several weeks o Long term picture of the way kidneys has been function o BUN: short term; how kidneys are doing right now ( Can be high b/c of dehydrated or low BP; not having enough fluid moving through . creatinine doesn't go up unless kidney failure )
The nurse will monitor the client with chronic kidney disease (CKD) for which possible cardiovascular changes? page 900
- Heart failure - Hypertension - Pericarditis
The client with chronic kidney disease asks the nurse why he must take active vitamin D (calcitriol) as a medication. What is the most appropriate response by the nurse?
- In renal disease, Vitamin D is unable to be transformed to its active form
nephortic syndrome
- Increasing kidney failure ( not complete ) - 24-hour urine they have above certain level of protein - The protein excretion is caused by glomerular injury - Excretion of 3.5 g or more of protein in the urine per day - Findings o Hypoalbuminemia - Albumin: holds water in blood vessels leads to edema - Will lead to being dehydrated. o Edema - Not enough albumin to keep osmotic pressure fluid in the blood vessels o Hyperlipidemia and lipuduria o Vitamin deficiency
glomerulonephritis
- Inflammation of the glomerulus o Immunologic abnormalities (most common ) o Drugs or toxins o Vascular disorders o Systemic diseases (secondary) o Viral causes
AKI recovery phase
- Injury repaired and normal renal function reestablished - Diuresis common ( So blood can be cleaned up quick) - Decline in serum creatinine and urea - Increase in creatinine clearance
AKI initiation phase
- Kidney injury is evolving - Post Op - Prevention of long-term injury if possible - Improving Bp and fluid
Fluid and electrolyte balance/ Anemia
- Kidneys stop making erythropoietin - Lethargy - dizziness - low hematocrit are common
Nuerogenic Bladder
- Lower Urinary tract obstruction - detrusor hyperflexia: overactive: makes you need to go pee pee all the tine - detrusor areflexia: underactive: cannot empty bladder all the way - predispose patients to infections
Manifestations of Acute cystitis
- Manifestations o Frequency, dysuria, urgency o Suprapubic pain: pubic region o Lower abdominal paino Low back pain
Prerenal
- Most common cause of ARF - Surgical patient. - Caused by impaired renal blood flow - Low blood pressure - GFR declines become of the decrease in filtration pressure - Can turn into permanent injury
Stages of Chronic Kidney Disease
- Normal (GFR> 90 mL/min) - Mild (GFR 60-89) - Moderate (GFR 30-59) - Severe (GFR 15-29) - End Stage (GFR less than 15) High GFR- plenty of fluid flow anything greater than 90 Is good.
Postrenal
- Occurs with urinary tract obstructions that affect the kidneys bilaterally ( both) - Happens in bladder or urethra - Problems with bladder emptying - Bladder infection - Problem with urethra - DAMAGE TO THE URETERS - Benign PH
A pediatric unit is admitting an 8-day-old infant with a suspected congenital renal disorder. Which are possible causes of the renal abnormality?
- One of the infant's kidneys may have failed to develop normally. - The kidneys may be misshapen and have cysts present. - The upper or lower poles of the two kidneys may be fused. - Urine-filled dilation of renal pelvis associated with atrophy of the kidney is occurring.
Select the manifestations of renal cell carcinoma. Select all that apply. Page 887 - Palpable flank mass - Hematuria - Often silent in the early stages
- Palpable flank mass - Hematuria - Often silent in the early stages
A nurse suspects a female patient who suffered a CVA is not able to empty her bladder completely when she urinates what test can be used? - cytometry - Uroflowmetry - video urodymanics - postvoid residual urine
- Postvoid residual volume - empty bladder as best as they can and then do cauterization and measure how much is left after urinating ( residual_ - voiding another word for urinating - if ANS isn't functioning well after CVA she might be retaining urine and might develop info infections
Renal Blood Flow/ Hormone regulation
- RAAS - Natriuretic Peptides
Acute Kidney injury AKI
- Renal insufficiency - Renal failure - End stage renal failure
Fluid and electrolyte balance / Sodium and Potassium
- Sodium and water balance o Sodium excretion increases with water excretion leading to sodium deficit and volume loss o Hyponatremia and hypovolemia o Concentration and dilution ( filtration of kidneys) ability diminishes Cannot save sodium as once did - Potassium balance o Oliguria: cannot excrete potassium o Tubular secretion increases early o Once oliguria sets in, potassium is retained
A client with end-stage kidney disease has developed anemia. The nurse teach this client that the reason anemia has developed is:
- The damaged kidney is unable to produce erythropeitin
glomerular filtration rate
- The filtration of the plasma per unit of time - based on ethnicity - not as much blood moving through the kidneys per minute - kidney failure
A client suffering from chronic hypertension is beginning to show the symptoms of glomerular disease. This client's kidney damage is due to what phenomenon? page 876
- The higher pressures force protein and cells through the glomerular membrane, resulting in glomerular inflammation.
bladder tumors
- Transitional cell carcinoma (most common) - Gross, painless hematuria - Most common in males older than 60 years and smokers
Kidney stone formation
- classified according to the minerals that make up the stone - supersaturation of one or more salts (Presence of a salt in a higher concentration that the volume to dissolve the salt) - If you don't have enough fluid/pressure to push fluid through tubules then the salt cannot be dissolved to be eliminated or go back to blood stream SO it sits int tubule and gets bigger - Hypernatremia, hypercalcemia - Precipitation of salt from liquid to solid state ( Temperature and pH) ( If you have enough blood flow it doesn't have chance to precipitate) - Grows into a stone via crystallization or aggregation - Other factors affecting stone formation ( Crystal growth inhibiting substances ) ( Medications can be given to help kidneys filter out, or keep salts in fluid form ) - Stones - Calcium oxalate or calcium phosphate- - Uric acids tones ( How liver turns waste into protein metabolism ( urea) . blood urea nitrogen is about- test level of urea )
Ureters
- connect the kidneys with the bladder - Long, intertwining smooth muscle bundles - Peristaltic activity - Micturition (urination) compresses the lower end of the ureter to avoid urine reflux - empty bladder
What is the most sensitive test to monitor fluid?
- daily weights
Ureterohydronephrosis
- dilation of the ureter and kidney - blockage in ureter for the urine to drain into bladder
The kidney functions
- elimination of water, waste products, excess electrolytes and unwanted substances from the blood ` - Regulate the composition and pH of body fluids through the reabsorption and elimination or conservation of water and substances ( NA, K, H, CL) - regulate the osmolality of the ECF though the action of ADH - Play a role in BP regulation through the RAA and ANP mechanisms on NA and water elimination - Eliminate urea, Uric Acid, Drugs - stimulates the production of erythropoietin
A client has just been diagnosed with a neurogenic disorder of the bladder. The nurse caring for him understands that this means that this client could demonstrate which of the following? page 914
- failure to store urine - failure to empty urine
Autoregulation
- feedback b/w kidney and arterial blood and glomerulus - ANS control - negative feedback
Function of Nephrons
- filter plasma - reabsorbs and secretes in the tubules - Forms a filtrate of protein free fluid -regulates the filtrate to maintain fluid volume, electrolytes and pH
kidney stone risk factors
- fluid intake - diet causes toxicity that kidneys have to eliminate - block up kidneys - has to do with calcium
overactive Bladder syndrome OBS
- frequency, urgency, nocturia - Lower urinary tract obstruction - bladder prolapse ( women after birth) nerves and muscles in pelvis are damaged
Nephron
- glomerulus - Bowman capsule - 1 to 2 million nephrons per kidney
Erythropoietin
- in response to hypoxia. makes new RBC - released when decreased oxygen to the kidney - COPD, chronic lung disease, polycythemia b/c they need more RBC to keep more oxygen.
The nurse is planning care for a client with a urinary tract obstruction. The nurse includes assessment for which possible complication?
- increased blood pressure page 868
The nurse is reviewing the laboratory work of several medical clients. Which laboratory result is most suggestive of abnormalities in kidney function?
- increased creatinine and blood urea nitrogen ( BUN ) levels Explanation: Increased creatinine and BUN is associated with abnormalities in renal function, as is the presence of glucose in a urine sample. Urine samples normally lack protein and have a specific gravity of 1.030 to 1.040. An elevated BUN coupled with normal creatinine is likely not attributable to impaired kidney function. PAGE 856
Urinary Tract Infection UTI
- inflammation of the urinary epithelium caused by bacteria - acute cystitis - painful bladder syndrome/ interstitial cystitis - climbs up to the ureter and gets into the kidneys ( pyelonephritis, infection is in the kidney itself ) - acute and chronic pyelonephritis ( accumulate in kidneys, no room for swelling ) - Most common pathogens Escherichia Coli (have in colon) - Virulence of uropahtogens - Host defense mechanisms ( First sign with developing immune deficiency( ( Frequent infection)
Urinary Tract obstruction
- interference with the flow of urine at any site along the urinary tract CAUSES - anatomic ( birth defect that shows up when its time to be potty trained,) - Functional ( something isn't working good, sympathetic nervous system too much epinephrine in adrenal muddle and causing BP problems )
causes of urinary tract obstruction
- kidney stones - prostate enlargement - tumor - infection - enlarged uterus - blood clots
Urinary Tract Obstruction Severity basers
- location - urethra problems - completness - involvement of ureters/ kidneys - duration - cause
Diuretics
- medications that reduce fluid volume in the body - Drugs that elevate the rate of bodily urine excretion - make you PEE. MORE
Prenal
- most common cause of Acute renal failure - surgical patient - caused by impaired renal blood flow - low blood pressure - GFR declines become of the decrease in filtration pressure - Can turn into permanent injury
Panful Bladder syndrome/ Interstitial Cystitis
- nonbacterial infectious cystitis noninfectious
bening prostatic hyperplasia Definition and Causes
- noncancerous: enlarged prostate: squeezing urethra: bladder cant empty completely - Happens from as man ages - result in change of hormone balance - Pituitary gland - not making all the hormones needed
Postrenal
- occurs with urinary tract obstructions that affect the kidney bilaterally - happens in BLADDER AND URETHRA - problems with bladder emptying - bladder infection - problem with urethra - damage to the urethers - bening PH
What substances should not be in the urine?
- protein - RBC - WBC - glucose - amino acids
An older adult client has been hospitalized for the treatment of acute pyelonephritis. Which characteristic of the client is most likely implicated in the etiology of this current health problem?
- recently had a urinary tract infection page 884 chapter 33
The nurse is reviewing glomerular disorders with a group of nursing students. Which lab/diagnostic results will the nurse likely talk about? Select all that apply page 865
- red cells in the urine - protein in the urine
Renal tumors
- renal adenomas - renal cell carcinoma ( hard to treat, kidney ( one) have to be removed sometimes )
Kidney stones
- renal calculi or urinary stones - masses of crystals, protein, or other substances that form within and may obtruct the urinary tract
renin-angiotensin-aldosterone system
- saves sodium - saves water - decrease output - renin functions via angiotenin II to produce constriction of the efferent arteriole as a means of preventing a serious decrease in glomerular filtration pressure
Natriuretic peptides
- secreted by atrial myocardium of the heart in response to high blood pressure - increases urine output b/c of dieresis - gets rid of excess fluid
The nurse caring for clients who have bladder cancer identifies which treatments to be acceptable for this cancer?
- surgical removal - radiation therapy - chemo
obstruction of Lower urinary tract
- urethral stricture - prostate enlargement - pelvic organ prolapse - partial obstruction of bladder outlet or urethra - lower bladder wall compliance ( bladder isnt able to squeeze out the urine)
A client is admitted with lower urinary tract obstruction and stasis. Which action is the primary intervention? page 914
- urinary catherization
treatment for kidney stones
-high fluid intake - decreasing dietary intake of stone-forming substances -stone removal: endoscopy; laser lithotripsy
cytometry
-measure the catheror and the pressure - fill the bladder and measure pressure as you push fluid out of the catheror ( urodynamic test)
how much is the normal renal blood flow
1000-2000 mL of blood per minute
How long is the urethra in males?
18-20 cm
how long is the urethra in females
3 to 4 cm
urine is ___ % water, and __ % dissolved solids
95 , 5
Which statement about the use of angiotensin-converting enzyme (ACE) inhibitors and autosomal recessive polycystic kidney disease (ARPKD) is accurate? page 882
ACE inhibitors may interrupt the renin-angiotensin-aldosterone system to reduce renal vasoconstriction
A 34-year-old woman presents with an abrupt onset of shaking chills, moderate to high fever, and a constant ache in her lower back. She is also experiencing dysuria, urinary frequency, and a feeling of urgency. Her partner states that she has been very tired the last few days and that she looked like she may have the flu. What is the most likely diagnosis? - acute pyelonophritis - chronic pyelonophirtis - nephrotic syndrome - kidney stones - UTIS
Acute pyelonephritis page 871
Renin
An enzyme secreted by the juxtaglomerular cells when blood pressure decreases. Renin converts angiotensinogen to angiotensin I.
a patient is experiencing dieresis which statement is an accurate explanation ? - renin - aldosterone - ADH -ANP
Atrial Natriuretic Peptide - dieresis ( making extra pee) ANP: has excess urine output b/c of diaresis
The form of polycystic kidney disease (PKD) that first manifests in the early infant period is most commonly characterized as: page 865
Autosomal recessive
The nurse suspects that a newborn infant who presents with bilateral flank masses, impaired lung development, and oliguria may be suffering from which disorder?
Autosomal recessive polycystic kidney disease (ARPKD) page 865
Lower Urinary Tract Obstruction
Bladder -Neurogenic bladder - OBS -Urethra -Urethral stricture -Prostate enlargement -Pelvic organ prolapse -Obstruction of urethra
A client with a history of chronic kidney disease (CKD) is experiencing increasing fatigue, lethargy, and activity intolerance. The care team has established that the client's glomerular filtration rate (GFR) remains at a low, but stable, level. Which laboratory assessments will most likely be prescirbed to help determine the cause of these new symptoms? page 897
Blood work for hemoglobin, red blood cells, and hematocrit
Select the body systems most commonly affected by chronic kidney disease in older adults. Select all that apply - Cardiovascular system - Gastrointestinal system - Skeletal system - cerebrovascular system - respiratory system
Cardiovascular system Cerebrovascular system Skeletal system
oliguria
Decreased urine output
An older male comes to the clinic with the chief report of having difficulty voiding. The physician diagnoses him with a lower urinary tract obstruction and stasis. What should the nurse suspect to be the most frequent cause of this client's problem? page 918
Enlargement of prostate gland
Most common pathogen of UTI's
Escherichia coli
Which procedure is a nonsurgical method of treatment for renal calculi (kidney stones)?
Extracorporeal shock wave lithotripsy (ESWL) page 868
Nephrons
Functional units of the kidneys
The health care provider is reviewing laboratory results of a client. Select the diagnostic test that is considered the best measurement of overall kidney function.
GFR
Each nephron has __
Glomerulus that filters the blood and a system of tubular structures that selectively reabsorb needed substances back into the blood and secrete unneeded substances into the tubular filtrate that will become urine
Which signs and symptoms would you expect to see in a client diagnosed with acute nephritic syndrome? page 878
Hematuria and proteinuria
A client is diagnosed with renal calcium stone formation. Which endocrine imbalances could contribute to this condition? page 869
Hyperparathyroidism
Signs of nephrotic syndrome include proteinuria, edema, hyperlipidemia, and: page 879
Hypoalbuminemia
WHICH OF THE FOLLOWING IS A SYMPTOM OF CHRONIC RENAL FAILURE? o Hypocalcemia o Osteoporosis in bones and pathologic fracture o Hypertension o Hyperkalemia o Hyponatremia
Hypocalcemia
uremia
If your kidneys stop working completely, your body fills with extra water and waste products.
evaluation of kidney stones
Imaging studies 24-hour urinalysis
A client reports urinary incontinence, specifically not feeling the urge to urinate until the bladder voids uncontrollably. Client history shows type 1 diabetes of 40+ years and compliance with medication and diet. What is the most likely diagnosis page 914
Incontinence related to neuropathy causing overactive bladder
Where is renin stored in our kidneys?
Juxtaglomerular cells
An older adult presents to the primary health care provider's office with a report of bladder leakage. Which assessment correlates with a diagnosis of stress incontinence? page 917
Loss of small amounts of urine when laughing or sneezing
If a client is in the early phases of nephrotic syndrome, which area of the body will likely have the initial presence of edema?
Lower extremities page 879
A nurse is explaining the clinical manifestations of diabetic nephropathy (diabetic glomerulosclerosis) to a client. Which statement would be the most important information for the nurse to provide? page 885
Microalbuminuria is a predictor of future nephropathies.
Following a health promotion class, which statement by a participant demonstrates an accurate understanding of the risk factors for bladder cancer
More than ever, I guess it would be worthwhile for me to quit smoking."
Can the kidneys regenerate nephrons?
NO, with aging there is a decreased in functioning nephrons
A PATIENT PRESENTS WITH FLANK (lumbar region of the back) PAIN AND ANURIA FOLLOWED BY POLYURIA AFTER UNDERGOING CATHERIZATION OF THE URETERS. WHAT IS THE MOST LIKELY CAUSE OF THIS CONDITION? - Acute tubular necrosis - Prerenal Acute Renal Failure - Post Renal acute renal failure - intrarenal acute renal failure
Post Renal Acute Renal failure b/c of damage to the ureters
The nurse reviews the lab results for a client who has advanced autosomal dominant polycystic kidney disease (ADPKD). The client 's hemoglobin is 8.8 g/dL (88 g/L). The nurse suspects this lab value is related to which cause? page 864
Reduced production of erythropoietin
A woman has sought care because of recurrent urinary tract infections that have been increasing in both frequency and severity. Which factor is likely to contribute to recurrent UTIs? page 871
Reflux flow of urine
The nurse is teaching a group of nursing students about the major functions of the kidney. What should the nurse include in the discussion? Select all that apply. - Removal of excess electrolytes - Removal of waste products - Elimination of water
Removal of excess electrolytes Removal of waste products Elimination of water
The nursing students have learned in class that causes of urinary obstruction and urinary incontinence include which of the following? Select all that apply. page 913
Structural changes in the bladder Structural changes in the urethra Impairment of neurologic control of bladder function
Which medication may be responsible for a client developing increased uric acid levels by decreasing ECF volume?
Thiazide diuretics and Loop diuretics
A client tells the nurse that he is experiencing involuntary loss of urine associated with a strong desire to void (urgency). The nurse would recognize this as: page 917
Urge incontinence
The nurse understands that medications, although very beneficial to clients, can have harmful effects. When working with older adult clients the nurse should recognize that which outcome is a common result of potent, fast-acting diuretics? page 919
Urge incontinence
One of the most damaging effects of urinary obstruction on kidney structures is which effect? page 874
Urinary stasis
Which is the most important factor in reducing hospital-acquired (nosocomial) urinary tract infections? page 872
Using urinary catheters only when necessary and their prompt removal when no longer needed
urinary catheter
a tube inserted into the bladder through the urethra to drain urine from the bladder
urinary tract infection (UTI)
infection of one or more organs of the urinary tract
cysitis
inflammation of the bladder
urinary retention
abnormal accumulation of urine in the bladder because of an inability to urinate
anuria
absence of urine
Aldosteron
acts on distal tubule to increase sodium reabsorption and exerts a longer term affect on the maintenance of blood pressure - increases blood osmality and BP
Renal Failure
acute or chronic failure of the kidneys to effectively eliminate fluids or wastes from the body - waste builds up and electrolytes are not balanced so its toxic to all organs - organs shut down - no pain of comatose
What kind of tissue protects the kidneys
adipose tissue
fiberoctivescope
all the way to the kidney can be caused by inflammation, stones or blockage
renal colic
an acute pain in the kidney area that is caused by blockage during the passing of a kidney stone
Why is a person with end stage kidney disease often anemic?
because of the inability of the kidneys to produce erythropoietin
Pre renal
before the kidney
glomerulonephritis
inflammation of the glomeruli of the kidney
nephritis
inflammation of the kidney
The client has just been diagnosed with bladder cancer and asks the nurse what causes it. What would be the nurse's best response to the client? page 920
cause is unknown
A client asks, "Why did my provider order a glomerular filtration rate (GFR) to my usual blood work?" The nurse's best response is based on the fact that GFR can estimate serum levels of which substance?
creatinine
A 65-year-old female who smokes presents with increased urinary frequency, dysuria, and sporadic, painless hematuria. The client's follow-up will likely include: page 921
cystoscopy.
pyelonephritis
inflammation of the renal pelvis and the kidney
A client asks the nurse what the most common sign/symptom of bladder cancer is. Which is the best response by the nurse? page 920
painless hematuria
Urodynamic test
determines actual function of the detrusor muscle of the bladder which pushes the urine out the external sphincter muscle and the pelvic muscles.
Bladder
detrusor muscle ( helps squeeze bladder down to urethra to get out) Trigone ( sensory area of receptors that tell nervous system when bladder is full)
hesistancy
difficulty starting urination
hydronephrosis
enlargement of renal pelvis and calyces b/c of a blockage
polyuria
excessive urination
nocturia
excessive urination at night
Bladder is __ and has ___ muscle__ and is under what type of control?
flat, smooth, autonomic nervous system
The nurse is caring for a client with cystitis. Which sign/symptom is most characteristic of the urine associated with cystitis? page 872-873
foul smell
What is the test to tell us how the kidneys are functioning?
glomerular filtration rate
A client informs the nurse that she is afraid of developing bladder cancer because her mother had it. She asks the nurse what signs and symptoms are present with this cancer. What does the nurse tell the client is the most common sign of bladder cancer? page 920
gross hematuria
While taking a history from an adult client newly diagnosed with renal cell cancer, the nurse can associate which high-risk factor with the development of this cancer? page 887
heavy smoking
What does a bladder detrusor muscle do?
helps squeeze bladder down to urethra to get out
Virulence of Uropathogens of UTI
host defense mechanism
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display?
hypertension
A nurse is assessing a client for early manifestations of chronic kidney disease (CKD). Which would the nurse expect the client to display? page 895
hypertension
Post renal
in the ureter/ bladder/ urethra
incontinence
inability to control bladder and/or bowels
Unilateral obstruction of the urinary tract may result in renin secretion, thereby leading to which manifestation?
increased blood pressure page 868
diuresis
increased formation and secretion of urine
What does Vitamin D do?
increases calcium absorption from the GI and regulates calcium deposition in the bone. - necessary for the absorption of calcium and phosphate - we made this vitamin by UV/sunlight exposure
What is an internal urethra sphincter?
internal opens when you open external sphincters
renal
kidney
Urolift
kidney stone
Renal stones
most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor - KIDNEY STONES - NEPHROLITH
Both type 1 and type 2 diabetes mellitus can cause damage to the glomeruli of the kidneys. Which renal disease is diabetic nephropathy associated with?
nephrotic syndrome page 879-880
benign prostatic hypertrophy
noncancerous enlargement of the prostate gland
pyelonephritis ( Acute)
o Acute infection of the ureter, renal pelvis interstitial o E coli, proteins, pseudomoments ( all gram negative ) o Steral cauterization to get the urine sample to grow out in a culture
Treatment of Acute Cystitis
o Antimicrobial therapy o Increased fluid intake o Avoidance of bladder irritants o Urinary analgesics ( Reduce bladder spasms ) (Turn urine orange.)
Manifestations of Painful bladder syndrome/ Interstitial Cystitis
o Most common in women 20-39 years old o Bladder fullness, frequency, small urine volume, chronic pelvic pain
Treatment of Painful Bladder syndrome/ Interstitial cystitis
o No single treatment effective o Symptom relief o Antibiotics can cause yeast infection ** o Probiotic foods
Fluid and electrolyte balance : Acid Base Balance
o Organic acids building up in blood once GFR gets down down to 30-40% o Become acidotic o Metabolism acidosis will be present hen GFR 30%- 40 %
Pyelonephritis ( Chronic )
o Persistent or recurring episodes of acute pyelonephritis that leads to scarring o Risk increases when people have frequent renal infections and some types of obstructive pathologic conditions (kidney stones, ureter is twisted and goes into bladder *obstructive *
Fluid and Electrolyte balance/ Disordered protein, carbohydrate and fat metabolism
o Problem in cardiovascular system o hypertension
Fluid and electrolyte balance/ Calcium , phosphate, bone deuteration
o Reduced renal phosphate excretion, decreased renal synthesis of vitamin D3, and hypocalcemia o Fracture,osteoporosis.
Manifestations of glomerulonephritis
o Two major symptoms if severe - Hematuria - Proteinuria Excessing 3-5 g/day with albumin (macroalbuminuria) as the major protein Protein and blood/ glucose should NEVER be in urine High glucose - insulin resistant , kidneys help by releasing glucose through the urine. o Oliguria ( saving fluid) o Hypertension o Edema ( goes into interstitial space )
A client with stage 5 chronic kidney disease (CKD) is presenting with fever and chest pain, especially when taking a deep breath. The nurse detects a pericardial friction rub on auscultation. Which condition does the nurse suspect is common with this stage of kidney disease? page 900
pericarditis
Bladder is outside __
peritoneum
A client in renal failure has marked decrease in renal blood flow caused by hypovolemia, the result of gastrointestinal bleeding. The nurse is aware that this form of renal failure can be reversed if the bleeding is under control. Which form of acute renal injury does this client have? - prerenal - post renal - intrarenal
prerenal
An 86-year-old client is being treated for dehydration and hyponatremia after curtailing fluid intake to prevent urinary incontinence. Given these findings, the nurse recognizes that this client is likely in what phase of acute kidney injury? - prerenal - post renal - intrarenal
prerenal
Signs of kidney failure in the urine
presence of proteins
Where is erythorpoitein produced? and function, and response to?
produced by fibroblast regulates the production of red blood cells in the bone marrow in response to hypoxia
The nurse would be most concerned when the glomerular filtrate contains: - sodium - potassium - water - protein
protein
WHAT ARE THE KIDNEYS **MAIN FUNCTIONS
regulate fluid and electrolyte balance
What is the most common cancer of the kidney? page 887
renal cell carcinoma
Manifestations of kidney stones
renal colic (come and go of great pain in lower back or sides) - Peristalsis of the ureter - Ureters have peristalsis and when you have a kidney stone the peristalsis tries to push stone through ureter. This causes Pain . in the back through abdomen to groin
An infant has been diagnosed with autosomal recessive polycystic kidney disease (ARPKD). Which treatment goal would be considered the priority in the care of this child? page 863
respiratory support
What is renin in response to?
response to low blood pressure - converts angiotensinogen to angiotensin I
bulbourethral glands
secretes mucus to help sperm be able to move out of the body through urethra
what does bladder trigone area do
sensory area of receptors that tell nervous system when bladder is full
The GFR is considered to be the best measure of renal function. What is used to estimate the GFR? page 896
serum creatinine
glomerulus
small network of capillaries encased in the upper end of a nephron; where the filtration of blood takes place
Drug-related nephropathies involve functional and/or structural changes to the kidney after exposure to a drug. What does the tolerance to drugs depend on? page 882
state of hydration.
lith
stone
A nurse is caring for a client who has been diagnosed with kidney colic but has yet passed the stone. Which interventions would the nurse emphasize when planning the care for this client? page 870
strain the urine
Renal Blood flow/ Neural regulation
sympathetic fibers regulate size of afferent and efferent arterioles, thus renal blood flow - no significant parasympathetic regulation
postvoid residual (PVR)
the amount of urine remaining in the bladder immediately after voiding ( urodynamic test)
stress incontinence
the inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing
Urethra
tube that carries urine from the bladder to the outside of the body
What is an external urethra sphincter?
under autonomic nervous system controlled - opens at a time and place when you are ready to urinate
azotemia
urea in the blood (a toxic condition resulting from disease of the kidney in which waste products are in the blood that are normally excreted by the kidney); (also called uremia)
What is high counts of Uremia indicate?
uremia is blood in the urea its a sign of kidney failure
An obese client with a history of gout and a sedentary lifestyle has been advised by the primary health care provider to avoid organ meats, certain fish, and other foods that are high in purines. The care provider is demonstrating an awareness of the client's susceptibility to which type of kidney stones? page 869
uric acid stones
uremia
urine in the blood
ureteroscopy
visual examination of the ureter
cytoscopy
visual examination of the urinary bladder ( direct visualization tests)
Prior to undergoing diagnostic testing with contrast, it is recommended that older adult clients have their creatinine level checked. The rationale for this is to ensure the client: page 885
will not undergo an acute kidney injury by decreasing renal blood flow.