1. glomerular filtration rate (GFR)
    • amount of renal filtrate formed by kidneys in 1 min
    • range: 105 - 125 mL/min
    • affected by hypo/hypervolemia, affects urine output
  2. normal urine output
    1000ml - 2000 ml
  3. characterisitics of urine
    • specfic gravity: 1.002 - 1.035
    • PH: 4.6 - 8.0
  4. Glomerular filtrate
    • similar to blood plasma; no rbc and little protein
    • blood pressure forces plasma  and dissolved materials out of capillaries
  5. renal filtrate threshold level
    the blood level of a substance is related to the amount shown in the urine

    i.e. if blood glucose is normal, no glucose in urine
  6. What are the other functions of the kidneys
    • renin secretion
    • activationof vitamin D,
    • erythropoietin production
  7. nitrgoneous wastes found in urine
    • uric acid: metabolism of nucleic acids
    • urea: created by liver cells when excess amino acids are deaminated for energy
    • creatinine: metabolism of creatinine phosphate, energy for muscles
  8. how does age affect the urinary system
    • GFR decreases
    • number of nephrons decrease
    • urinary bladder decreases in size, detrusor muscle tone decreases
  9. uremic frost
    • crystals on the skin, late sign of uremia
    • kidneys cant filter waste so it's excreted through the skin
  10. if a pt has renal diseases how should i asses her vitals
    • orthostatic hypotension
    • crackles and wheezing
    • edema
    • weight
    • I&O
  11. When is the best time to collect a urine sample for urinalysis 
    morning; specimens are usually concentrated and are more likely to contain abmormal constituents
  12. when using contrast media which medication is contraindicated
    metformin; 48 hrs before and after 
  13. which medication is given to preven contrast media induced nephropathy
    mucomyst if mild-moderate renal insufficiency is found after a GFR or creatinine level is done
  14. stress incontinence
    • involuntary loss of urine (< 50 ml) related to increased abdominal pressure (sneezing, laughing, etc)
    • kegels help
  15. urge incontinence
    • involuntary loss of urine associated with an abrupt and strong desire to void
    • "unable to make it to the bathroom in time"
    • most common
    • kegels can help
  16. functional incontinence
    • no urincary problems
    • environmental barriers, physical limitations, loss of memory, disorientation prevent use of toilet
  17. overflow incontinence
    • involuntary loss associated with overdistention of bladder
    • associated with spinal cord injuries  or enlarged prostate
  18. total incontinence
    continuous and unpredictable loss of urine
  19. urinary retention
    • inablity to empty the bladder completely
    • bladder usually holds less than 50 ml after urination
    • 150 - 200 ml residual volume indicates need for intervention
  20. what causes acute urinary retention
    anesthesia from surgery or local trauma to the urinary structure
  21. chronic urinary retention is related to 
    enlarged prostate, diabetes, pregnancy, medication, strictures, obstruction of the urinary tract
  22. is urinary incontinence a justification for insertion of a catheter
    • no
    • shock, heart failure and urinary obstruction are
  23. best method to minimize infection from an indwelling catheter
    • normal daily genital hygiene with soap and water
    • dont clamp the tubing
    • encourage fluids unless contraindicated
    • keep it taped or fastened to the pt leg
    • collect specimens and irrigate through the specimen port
  24. Aseptic technique is required when emptyin the drainage bag of an indwelling catheter
    • wash hands
    • wear clean gloves
  25. intermittent catherization
    • best for a pt who is unable to void, post op or with neurologic disorder
    • inserted into bladder every 3 hrs
  26. pyelonephritis
    • inflammation of kidney
    • usually starts with infection of lower urinary tract
  27. cystititis
    • inflammation of bladder
    • symptoms: dysuria, frequency, urgency and cloudy urine
  28. lower urinary tract infection
    urethritis, prostatitis, cystitis
  29. name predisposing factors for UTIs
    • stasis of urine in bladder
    • contamination in the perineal and urethral areas (sex, fecal soiling, infection in the area)
    • instruments in the urinary meatus i.e. catheter
    • previous uti
    • age
    • faulty valves
  30. Signs and symptoms of UTI
    • dysuria, urgency, frequency, incontinence, nocturia, hematuria, back pain, cloudy urine, foul-smelling urine
    • elderly may experience cognitive changes
  31. urethritis
    • inflammation of the urethra
    • commonly associated with bladder or prostatic infections
    • S&S: frequency, urgency and dysuria
  32. pyridium is used to treat dysuria. what is an exepected side effect while a pt is using pyridium?
    orange urine
  33. what's contraindicated for pts with a history of UTIs
    bubble bath and bath salts
  34. medications used to treat  cystitis
    • sulfa meds i.e. bactrim or septra
    • ciprofloxacin (cipro)
  35. signs and symptoms of pyelonephritis
    • fatigue, urgency, dysuria, flank pain, fever, chills
    • costovertebral tenderness
    • cloudy urine, increased wbc, bacteria, casts, RBC, postivie nitrites
    • usually shows signs of systemic disease
  36. what are casts
    • microscopic particles formed in the kidney from abnormal constituents in the urine such as wbc, rbc or pus
    • always indicates a kidney problem
  37. urosepsis
    when septicemia results from a urinary cause 
  38. nursing care for a pt with UTI
    • fluids at 2 - 3 L/day
    • antispasmodics
    • encouraging voiding every 3 hours
    • cranberry juice or capsules
    • apply heat to suprapubic area
    • empty bladder when urge is felt and after sex
    • avoid bubble baths and scented toilet paper
    • avoid cola, coffee, tea and alcohol
  39. urethral stricture
    • lumen of urethra is narrowed by scar tissue
    • acquired from injury or infection
    • pts prone to UTI and have diminshed stream
    • mostly seen in elderly men
    • treated with mechanical dilation, pt needs pain meds
  40. renal calculi
    • kidney stones
    • created from concentrated urinary salts (calcium oxalate, calcium phosphate, magnesium ammonia, uric acid, cystine)
  41. nephrolithiasis
    stones in the kidney
  42. causes of renal calculi
    • family history, chronic dehydration and infection
    •  immobility which causes urinary stasis and increased blood calcium
    • risk peaks between 30 and 50
  43. prevention of renal calculi
    • encourage pt to walk which promotes stone excretion and reduce bone calcium resorption
    • diet modification
  44. complications of renal calculi
    urine flow is obstructed which may cause uti or hydronephrosis
  45. lithotripsy
    • use of sound, laser, dry shock wave energy to break up stones
    • blood in urine is common after treatment
  46. hydronephrosis
    • urine backs up into and distends the kidney
    • caused by stricture, kidney stone, tumor or enlarged prostate
    • pt usually exhibits uti symptoms and flank or back pain
  47. cancer of the bladder
    • most common cancer of the urinary tract
    • common metastasis sites are liver, bones and lungs
    • smokers 2x risk
  48. signs and symptoms of bladder cancer
    • painless hematuria is the most common sign
    • fistula, urine retention, dysuria, changes in bladder habits
  49. bladder cancer treatments
    • chemotherapeutic agents instilled into bladder 
    • bacille calmette-guerin vaccine prevents recurring tumors
    • photodynamic therapy
  50. ileal conduit
    • urinary diversion; 6 - 8 in. section of ileum or colon used to drain urine
    • contains mucus and pt must wear an ostomy bag at all times
  51. 3 classisc symptoms of kidney cancer
    dull pain the flank area, mass in the area, hematuria
  52. polycystic kidney disease
    • multiple cysts form in the kidney and replace normal kidney structures
    • no treatment to stop it
    • hereditary
  53. diabetic nephropathy
    • most common cause of chronic kidney disease
    • complication of diabetes, damages blood vessels in kidneys
  54. risk factors for diabetic nephropathy
    htn, genes, smoking, chronic hyperglycemia
  55. symptoms of diabetic nephropathy
    • microalbuminuria advancing to proteinuria
    • leads to chronic kidney disease
  56. nephrotic syndrome
    • excretion of 3.5g or more of protein in the urine per day
    • low levels of protein cause ascites and widespread edema
    • sodium intake is restricted and pt is on a low to moderate protein diet
  57. nephrosclerosis
    • hypertension damages the kidneys
    • damaged blood vessels cause necrosis
    • treating the htn stops the damage
  58. glomerulonephritis
    • glomerulus is inflammed and proteins, wbc and rbc leak into  urine
    • associated with beta-hemolytic streptoccocal infection of throat or skin
    • edema, oliguria and htn develop
    • usually happens 6 - 10 days after infection
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