Understanding Medical Surgical Nursing Ch 34
Terms
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- The urinary system consists of two 1_____, two 2_____, the 3_____ 3_____, and the 4_____.
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1 kidneys
2 ureters
3 urinary bladder
4 urethra - In addition to removing waste products from the blood, the kidneys also regulate:
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1 blood volume
2 electrolyte balance
3 acid-base balance
4 tissue fluid - What are the two major parts of a nephron?
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The renal corpuscle
The renal tubule - filtration
- the process by which blood pressure forces plasma & dissolved materials out of capillaries
- The formation of urine involves three major processes:
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1 glomerular filtration
2 tubular reabsorption
3 tubular secretion - glomerular filtration rate (GFR)
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amount of renal filtrate formed by the kidneys in one minute
averages 100 to 125 mL - tubular reabsorption
- recovery of useful materials from renal filtrate & their return to the blood in the peritubular capillaries
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What percentage of renal filtrate is retained in the body due to tubular reabsorption?
a. 75%
b. 89%
c. 90%
d. 99% -
d. 99%
Approximately 99 percent of the renal filtrate formed is reabsorbed . . .
p 575 - renal filtrate
-
end product of blood pressure forcing plasma, dissolved substances, & small proteins out of glomeruli & into Bowman's capsules
similar to blood plasma except far less protein & no blood cells present -
Normal urinary output for a 24 hour period is:
a. 500 to 750 mL
b. 750 to 1500 mL
c. 1000 to 2000 mL
d. 2000 to 2500 mL -
c. 1000 to 2000 mL
. . . and normal urinary output is 1000 to 2000 mL per 24 hours.
p 575 - tubular secretion
- substances actively secreted from blood in peritubular capillaries into filtrate in renal tubules
- erythropoietin
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hormone secreted by kidneys during states of hypoxia
stimulates red bone marrow to increase rate of RBC production which then increase oxygen-carrying capacity of blood - Each ureter extends from the 1_____ of a kidney to the lower, posterior side of the 2_____ 2_____.
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1 hilus
2 urinary bladder - What are the two functions of the urinary bladder?
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1 storage of urine
2 elimination of urine - What is the function of the urethra?
- The urethra carries urine from the bladder to the exterior.
- The usual range of specific gravity of urine is 1_____ to 2_____; this is a measure of the 3_____ 3_____in urine. The 4_____ the specific gravity, the more that is present.
-
1 1.010
2 1.025
3 dissolved materials
4 higher -
The pH range of urine is ___ to ___, with an average of ___.
a. 4.6 to 8.0; average of 6.0
b. 4.6 to 8.0; average of 6.5
c. 5.6 to 8.5; average of 6.0
d. 5.6 to 8.0; average of 6.0 - a. 4.6 to 8.0; average of 6.0
- Urine is approximately 1_____% water, which is the solvent for 2_____ 2_____ and 3____.
-
1 95%
2 waste products
3 salts - uremia
- waste products building up in blood
- uremic frost
-
crystals on the skin indicating waste products building up in blood
waste products are not filtered by kidneys so are coming out through skin - An 1_____ in blood pressure is commonly seen with renal disease. A 2_____ in blood pressure accompanied by a 3_____ in pulse rate as the patient rises to sitting or standing positions is called 4_____ or 5_____ hypotension and may indicate fluid deficit.
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1 increase
2 drop
3 rise
4 orthostatic
5 postural - How do you locate your kidneys?
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-> put your hands on your hips w/thumbs pointing back & upward
-> thumbs are now pointing to bottom of kidneys
-> known as the flank area & is location of flank pain - hematuria
- blood in urine
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What are some S/S of illness detected in urine?
(four listed) -
1 hematuria
2 cloudiness
3 foul odor
4 dark-amber color - urinalysis
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gives information regarding kidney function & various body functions
commonly performed diagnostic test for renal system - What is the minimum amount of urine necessary to perform a urinalysis?
- minimum of 10 mL
- urine culture
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determines number of bacteria present in urine & identifies organism causing infection in urine
urine should be collected before antibiotic treatment is begun
midstream clean-catch system used to obtain specimen -
Generally, a bacterial count of _____ or more per milliliter of urine indicates a urinary tract infection.
a. 750,000
b. 500,000
c. 300,000
d. 100,000 - d. 100,000 per milliliter
- What is a method for quickly approximating kidney function?
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-> equate the creatinine clearance result to % of renal function
-> ex: creatinine clearance of 100 mL/min = 100% renal function
-> ex: 30 mL/min = 30% renal function
-> ex: 5 mL/min = 5% renal function - serum creatinine test
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measures waste product (present in blood) from muscle metabolism
normal: 0.6 to 1.5 mg/dL
higher creatinine level = greater kidney impairment - blood urea nitrogen (BUN) test
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measures waste product of protein metabolism
normal: 8 to 25 mg/dL
numerous factors can affect results (kidneys, dehydration, high-protein diet, steroid use, and gastrointestinal bleeding) - uric acid test
-
measures end product of purine metabolism & breakdown of body proteins
normal: 2 to 7 mg/dL
can be affected by several factors (kidenys, gout, malnutrition, leukemia, thiazide diuretics) - creatinine clearance test
-
measures amount of creatinine cleared from blood in a specified period by comparing amount of creatinine in blood w/amount of creatinine in urine
test performed utilizing urine collected for 24 hours
results expressed in volume of blood cleared of creatinine in 1 min.
normal: 85 to 125 mL (min of 10 mL needed to survive w/o dialysis) - kidney-ureter-bladder (KUB)
- x-ray exam of named structures
- intravenous pyelogram (IVP)
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radiopaque dye is injected into large vein and outlines renal structures for visualization
pt preps w/laxatives day prior to test & NPO after midnight - renal angiography
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test to visualize renal arteries
femoral artery is pierced w/needle & catheter threaded through body to renal artery
contrast agent is injected to make renal areterial supply visible on x-ray
assists w/visualizing blood flow to kidneys
pt is NPO for 4-8 hours before & on bedrest for 12 hrs following w/head of bed not raised more than 45 degrees - cystoscopy and pyelogram (C& P)
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minor surgical procedure involving fiberoptic instrument (cystoscope) inserted into bladder via urethra
pyelogram involves injecting dye into pelvis of kidney & radiographs are taken - What are four therapeutic interventions that can be done during a C&P?
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1 removal of small bladder tumors
2 removal of stones from bladder
3 removal of stones from ureters
4 dilation of ureters - dysuria
- difficult/painful urination
- percutaneous
- done with a needle through the skin
- renal biopsy
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most are percutaneous
pt is NPO 6 to 8 hrs before
mild sedative given & local anesthetic used
pressure dressing applied to prevent bleeding
pt on bedrest for 24 hrs after - urinary incontinence
- involuntary passing of urine
- stress incontinence
- involuntary loss of urine associated w/increasing abdominal pressure during coughing, sneezing, laughing, or other physical activities
- urge incontinence
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involuntary loss of urine associated w/abrupt & strong desire to void
pt often "unable" to make it to bathroom - functional incontinence
- caused by chronic impairment of physical function or ability to think, leaving pt unable to get to toilet in time to maintain continence
- total incontinence
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continuous & unpredictable loss of urine
often pt is neurologically impaired
nurse's priority is keeping pt clean & dry - Normally the bladder contains less than 1_____ mL after urination. A residual volume of 2_____ to 2_____ mL of urine indicates the need for treatment for urinary retention.
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1 50
2 150 to 200 - What are two ways bacteria can enter the bladder of a pt w/an indwelling catheter?
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1 through outlet at end of drainage bag
2 around catheter up the urethra & into bladder