1
Q
Kidneys: Location, Protection, Operation
A
- Location: behind/outside peritoneal cavity (retroperitoneal)
- Protected by: ribs (externally), fatty tissue (internally)
- Independent functions, blood supply, innervations
2
Q
Kidneys: Renal Parenchyma
A
Medulla:
• loops of Henle, vasa recta, collecting ducts, juxtamedullary nephrons
Cortex:
• cortical nephrons
3
Q
Kidneys: Blood Supply
A
- 20-25% cardiac output
- Supplied via renal artery
- Artery–> atrioles–> glomerulus (glomerular filtration)
4
Q
Kidneys: Nephrons
A
- 1 million per kidney
- Most are in cortex (80-85%)
- Initial formation of urine
- 2 parts: glomerulus and tubule
- Filters fluids–> changes in composition according to body’s needs–> end product filtrate excreted as urine
5
Q
Kidneys: Urine Formation
A
- In nephron via glomerular filtration, tubular reabsorption, tubular secretion
- Sodium, chloride, urea, creatinine, bicarbonate, glucose, uric acid
- 1 - 1.5 L of urine produced daily
6
Q
Kidneys: Ureters, Bladder, Urethra
A
- Urine flows from kidneys to ureters
- Ureters empty into bladder
- Urethra at base of bladder drains urine
7
Q
Renal and Urinary System Functions
A
(RbcPVdWHFeBpAb) • RBC production via synthesis of erythropoietin • Prostaglandins • Vitamin D synthesis • Waste removal • Homeostasis • Fluid and electrolyte balance • Blood pressure control via renin • Acid-base balance
8
Q
Factors Affecting Urinary Elimination: Food and Fluid
A
• Dehydration= ↓ in urine, more concentrated
9
Q
Factors Affecting Urinary Elimination: Psychological
A
- Individual, family, socio-cultural
* Daily schedule, privacy, time to void
10
Q
Factors Affecting Urinary Elimination: Activity Level and Muscle Tone ↑↓
A
- Exercise promotes urinary elimination
* Immobility= ↓ muscle, bladder, sphincter tone
11
Q
Factors Affecting Urinary Elimination: Developmental
A
Elderly:
• loss of ability to concentrate urine
• ↑ urge/frequency to void
12
Q
Factors Affecting Urinary Elimination: Pathological
A
- Can affect quality and quantity or urine
* Hypertension, renal disease, diabetes mellitus, gout
13
Q
Factors Affecting Urinary Elimination: Medication
A
- Nephrotoxic= renal damage
* Can affect amount/color of urine
14
Q
Assessment: Health History: Subjective Data
A
- Onset
- Pain
- Voiding problems
- Infection/Obstruction history
- Fluid/Dietary intake
- Pattern
- Medications
- Drug use
- Childbirth
- Family history of kidney disease
- Recent change in weight
- Other urinary/renal problems
- Other health problems
15
Q
Renal/Urinary Problems and Urinary Pain
A
- Pain= distension
- Distention caused by obstructed urine flow or inflammation
- Pain location, quality, duration depends on where distention is
16
Q
Location of Renal/Urinary Problem is Consistent with Site of Urinary Pain
A
- Kidneys/ureter= CVAT; abdominal pain
- Bladder= suprapubic and voiding pain
- Urethral= voiding pain
- Prostate= perineal and rectal pain
17
Q
Assessment: Physical Exam
A
- Kidneys should NOT be palpable
- Palpate for CVA
- Inspect abdomen for ascites
- Palpate/percuss bladder for distension
- Palpate inguinal area for enlarged lymph nodes and inguinal/femoral hernia
- Genitalia
- Edema/changes in body weight leading to fluid retention
18
Q
Urine Color and Clarity
A
- Food, medications, hydration can affect
- Normal urine= straw/yellow
- Severe infection= milky green/yellow
- Cloudy/sediment/tissue shreds= infection
19
Q
Urine Colors
A
- Pale yellow= normal
- Dark yellow= concentrated
- Amber= dehydration
- Orange= medications, liver/bile duct, food dye
- Green= pseudomonas infection, bacteria, meds, genetic disease, food dye
- Red= blood, food
- Brown/cola= concentrated, liver disease
- Fizzy= excess protein, kidney problem
20
Q
Urine Clarity
A
- Clear= transparent
- Hazy= few particles
- Cloudy= many particles
- Milky
21
Q
Urine Odor
A
- Can be affected by foods, infections, medications, concentration
- Foul odor= infection, concentrated from dehydration
22
Q
Urine Frequency
A
- Adults 4-5 times/day
- Day= no greater than every 2 hours
- Night= 1-2 times
23
Q
Urine Volume
A
- Adults 40-80 ml/hour (1500-2000/24 hour)
* MINIMUM 30 ml/hour
24
Q
Diagnostic Urine Tests: Urinalysis
A
• hematuria, proteinuria, glucosuria
25
Diagnostic Urine Tests: Routine Urinalysis
•
26
Diagnostic Urine Tests: Clean Catch/Midstream Specimen
1. Self-clean
2. Void
3. Stop void
4. Continue void into sterile specimen cup
5. Cover without contaminating
27
Diagnostic Urine Tests: Sterile/Catheterized Specimen
• Non-indwelling (straight) catheter
1. Indwelling (foley) catheter clamped distal to injection port
2. Clean with alcohol
3. Aspirate amount of urine with sterile 5 mL syringe
4. Unclamp and resume drainage
28
Diagnostic Urine Tests: 24 Urine Specimen
1. Inform all family/personnel of test
2. Start of test: patient void, discard, and record time
3. Collect all urine after start
4. At 24 hour mark: have patient void and add to collection
5. Send to lab
29
Diagnostic Urine Tests: Urine Culture
* Identifies bacteria (strain/concentration)
| * > 100,000 CFU= Urinary Tract Infection
30
Diagnostic Urine Tests: Post Void Residual Volume (PVR)
* Measures urine in bladder after voiding
| * Bladder scanner or catheter
31
Renal/Urinary Diagnostic Studies: Bladder Scanner
* Bladder volume, PVR, need for catheter
| * No patient preparation, no discomfort, non-invasive
32
Renal/Urinary Diagnostic Studies: Blood Urea Nitrogen (BUN)
* Urea formed in liver from ammonia, diffuses freely, excreted by kidneys
* BUN levels reflect the balance between production and excretion of urea
33
How is BUN Used
* Kidney function, kidney disease, acute/chronic kidney dysfunction/failure
* General health status as BMP/CMP
34
When is BUN Ordered
* Non-specific complaints
* Routine test
* Checking kidney function before starting drug therapies
* Acutely ill patient
* During hospital stay
35
Normal BUN Lab Values
14-adult: 8-21 mg/dL
| Adult over 90: 10-31 mg/dL
36
BUN Indications
* Nutritional
* Hydration
* Hemodialysis
* Lymphoma after chemotherapy
* Liver function
* Renal function
* Nephrotoxic/Hepatotoxic drugs
37
BUN Levels
• Increased: impaired kidney function (kidney disease/damage/failure, CHF, shock, sever burns, myocardial infarction, obstruction of urine flow, dehydration)
• Decreased: liver disease, malnutrition, over hydration
*Increased and Decreased levels seen in normal pregnancy
38
BUN/Creatinine Ratio
* Between 10:1 and 20:1
* Increased: decreased blood to kidneys (CHF, dehydration), increased protein (GI bleed, diet)
* Decreased: liver disease (lack of formation urea), malnutrition
39
Creatinine, Blood
• Amount generated is proportional to mass of skeletal muscle unless muscle damage/disease
• Decreases with age
*DETERMINES RENAL CLEARANCE
40
How is Creatinine Blood Used
* Assess kidney function
* Monitor progress of kidney dysfunction/effectiveness of treatments in patient's with abnormal levels/diseases affecting kidneys (diabetes)
* Prior to procedures (CT) that use drugs that affect kidneys
41
How is Creatinine Blood Used: Creatinine Clearance
* Measures how effectively kidneys are filtering small molecules out of blood
* 24-hr urine creatinine levels
42
How is Creatinine Blood Used: Correction Factor
* UP/CR, A/CR
* Evaluates kidney function
* Detects other urinary tract disease
43
How is Creatinine Blood Used: Serum Creatinine
* Calculates estimated glomerular filtration rate (eGFR)
| * Evidence of kidney damage
44
Normal Creatinine Lab Values
* Male: 0.6-1.2 mg/dL
| * Female: 0.5-1.1 mg/dL
45
Creatinine Indications
* Disorder involving muscles
| * Impairment of renal function
46
Creatinine Levels
Increased: impaired kidney function
• damage to blood vessels in kidney (infection, auto-immune disease)
• Urinary tract obstruction (prostate disease, kidney stones)
• Death of cells in kidney (drugs, toxins)
• Bacterial Infection in kidney
• Reduced blood flow to kidney (shock, dehydration, CHF, atherosclerosis, diabetes)
• Muscle injury
Decreased
• Pregnancy
• Decreased muscle mass
N110 Exam #3
flashcards
Decks in class (6)
# Cards
