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NURS 3525 - Urinary System Exam With Complete Solutions
What are the 6 primary functions of the kidneys?
- Regulate ECF volume + composition
- Excrete waste products
- PB Regulation
- Erythropoietin Production
- Vit. D Activation
- Acid-Base Regulation What is the four step process of urine formation?
- Glomeruler function
- Tubular reabsorption
- Tubular secretion
- Water reabsorption H2O and solutes move from blood into nephron Glomeruler filtration Use substances move from filtrate into blood Tubular reabsorption Waste & excess substances move from blood into filtrate
Tubular secretion H2O moves from filtrate into blood Water reabsorption Tissue of the kidney Parenchyma What are influential hormones for urine formation Antidiuretic hormone (ADH) Aldosterone Acid/Base regulation Natriuretic peptide Parathyroid hormone (PTH) Promotes retention of water by kidneys Antidiuretic hormone (ADH) Hormone that stimulates the kidney to retain sodium ions and water Aldosterone Protein produced by the heart that increases the excretion of sodium by the kidney Natriuretic peptide A hormone of the parathyroid gland that regulates the metabolism of calcium and phosphorus in the body.
What are 4 major defense mechanisms to prevent UTIs?
- Voiding + complete bladder emptying
- Ureterovesical junction competence
- Ureteral peristaltic activity
- Urine composition What are risk factors for UTIs? Urine stasis, Urologic Instrumentation, Compromised Immune Response What are causes of urine stasis? Obstruction, Retention, Delaying urination T/F? GI is a bacterial source for UTIs GI bacterial source What does the lower urinary tract consist of? Urethra, bladder What is the upper urinary tract composed of? Kidney, ureter What is included in LUTS? Pain, Dysuria, frequency, urgency, Suprapubic pressure, Incontinence, Hesitancy What is included in upper urinary tract symptoms? Fever, chills, pain
What diagnostic tests are available for UTIs? History & Physical, Urinalysis (UAs), Urine Culture with sensitivity, Ultrasound, CT Scan What UA findings may indicate a UTI? Presence of bacteria, WBC > 10, positive nitrates, presence of RBC, ๐ณ pH, presence of leukocyte esterase What are the interventions for UTIs? Hydrate Medications What medications are used for UTI treatment? Antibiotics: Bactrim, Macrobid, Phenazopyridine (AZOS) What do we need to monitor for with bactrium antibiotics? Kidney function tests What do we teach a pt about antibiotics? Finish full prescription, SE, food effects (take w/wo, avoid?) What do we teach a pt to avoid to prevent bladder irritation? Alcohol, caffeine, avoid bubble baths What can a pt do to reduce UTI symptoms?
IV contrast dye, NSAIDS, "mycin" What are cues for glomerulonephritis? Generalized edema (due to โ GFR), HTN, oliguria, hematuria, & proteinuria What is normal urine output/hour? 30ml/hr What does a urine output < 400ml/24 hour indicate? Oliguria What does no urine output in a 24 hour span indicate? Anuria What diagnostic tests are done for glomerulonephritis? History & Physical, urinalysis, streptozyme tests, renal biopsy, BUN, creatinine What is the treatment for glomerulonephritis? REST, Restrict sodium & protein intake, diuretics, antihypertensives, antibiotics
Blood and protein in the urine indicates: Glomerular inflammation Glomerulus excessively permeable to protein Nephrotic Syndrome What are cues for nephrotic syndrome? Peripheral edema, anasarca, massive proteinuria, hyperlipidemia, hypoalbuminemia, & foamy urine Severe generalized edema Anasarca What is the treatment for nephrotic syndrome? Corticosteroids, ACE Inhibitors, Diuretics, diet education (โ Na+, read food labels) Complications of nephrotic syndrome Rsk for infections, hypercoagulability Crystals present in urine can precipitate together and form a stone (calculus) Urinary Tract Calculi (Nephrolithialsis) Risk factors for urinary tract calculi
What is the nutrition management for urinary tract calculi? Avoid dehydration & overhydrating during episode, Encourage fluids after episode, Dietary choices (based on stone type) What types of urinary incontinence are there? Overflow, urge, functional, stress Loss of the ability to control urination Urinary incontinence (UI) Loss of urine associated with overdistention and overflow of the bladder Overflow incontinence Involuntary passage of urine that occurs soon after a strong sense of urgency to void Urge incontinence The person has bladder control but cannot get to the toilet in time Functional incontinence Incontinence related to physical such as running, sneezing, laughing or coughing Stress incontinence Interventions for UI Kegel exercises, Education, Bladder training, Environmental, Lifestyle modifications, Behavioural therapies, Pharmacological interventions (anticholinergics)
Inability to empty the bladder completely Urinary retention Causes of urinary retention Neurologic impairment, Bladder Outlet Obstruction, Deficient detrusor contraction strength Interventions for Urinary Retention Double Voiding, Behavioural Therapies, Catheterization Prostate gland enlarges and obstructs the flow of urine from the bladder through the urethra Benign Prostatic Hyperplasia (BPH) Irritative symptoms of BPH? Nocturia, Frequency, Urgency, Dysuria, Bladder pain, Incontinence Obstructive symptoms of BPH? Decrease in force of urine stream, Difficulty initiating stream, Intermittency, Dribbling at end of urination Complications of BPH? Acute Urinary Retention, UTI, Pyelonephritis, Sepsis, Bladder Calculi, Renal Failure What are the goals of care for BPH?
- Restore bladder drainage
What are the complications of TURP? Bleeding, bladder spasms, UI, and infection Progressive, irreversible loss of kidney function CKD What are the risk factors of CKD? DM, HTN, Age >60, Ethnicity, Family Hx T/F? 1 out of every 9 Americans have CKD True What GFR reflects kidney damage? GFR < 60 mL/min > 3 months Susan GFR that suggests ESRD GFR < 15 mL/min
Name at least 5 symptoms of CKD? Altered Urinary Output, Waste product accumulation, Electrolyte Imbalances, Metabolic Acidosis, Anemia, Impaired platelet aggregation, Impaired release of factor III, Infection, HTN, Dyspnea, Metallic taste, Uremic fetor, CKD mineral and bone disorder (CKD-MBD), Itchy skin, Uremic Frost, Psychologic changes T/F? All body systems are affected in CKD True What are the 4 goals of CKD care?
- Preserve existing kidney function
- Reduce risks for CVD
- Prevent complications
- Provide for patient's comfort Movement of molecules Diffusion Movement of water and solutes across and semi-permeable membrane Osmosis Water and fluid removal Results when there is an osmotic gradient or pressure gradient across membrane Excess fluid moves into dialysate Ultrafiltration The diffusion of small solutes through a selectively permeable membrane
Expected outcomes of HD? โ weight, BP, work of breathing, crackles, dyspnea
