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NSG 211 FINAL TEST Renal & Urologic Disorders
Module Questions With Complete Solutions
oliguria - Low urine output <30mL hour Polyuria - High urine output > or = 2.5 L/day Normal Renal Filtration Rate - 180 L/day Incontinence - The Loss of Voluntary control of the bladder Stress Incontinence - Increased intra abdominal pressure forces urine out sphincter Ex. Coughing, Lifting, Laughing Retention - An inability to empty bladder; May accompany overflow incontinence Anesthesia can lead to ______. Spinal cord injuries at the sacral level blocks the micturition reflex Neurogenic Bladder - Loss of sensation and reflex for bladder emptying Dyssyrnegia - Loss of coordinated neuromuscular function Dyssynergia can be caused by - Spinal Cord Injury Diabetes Mellitus Stroke or Traumatic Brain Injury
Brain Neoplasms CAN LEAD TO AUTONOMIC DYSREFLEXIA Urinalysis - Normally clear, yellow urine; mild odor, ph 4.5- Normally acidic to prevent bacterial growth. NO WBC NO RBC NO PROTEIN NO GLUCOSE hematuria - Blood Protein - proteinuria, albuminuria Bacteria - bacteriuria Purulence - WBC's (pyuria) Urinary Casts - Microscopic- sized "molds" of renal tubules Problem inside the kidney renal tubes. Specific Gravity - High-concentrated; low-dilute Creatine - Sensitive indicator of kidney function (Value: around 1.0) BUN - Blood Urea Nitrogen, Breakdown of protein metabolism If very high termed Azotemia
Functional component of kidney develops backup, backup leads to ischemia Nephrotoxic Drugs: Acute Tubular Necrosis (ATN) Interstitial Inflammation (allergic reaction, infection) Post-Renal AKI - Cause is "after" the glomerular apparatus. Hydronephrosis from: Renal stones, prostatitis, Neurogenic Bladder neurogenic bladder - a urinary problem caused by interference with the normal nerve pathways associated with urination Hydronephrosis - Water on the kidney Renal Failure Symptoms - Increased Creatinine and BUN Metabolic Acidosis Hyperkalemia Oliguria Fluid volume overload Hypertension, Edema. Chronic Kidney Disease (CKD) - progressively declining GFR, it happens slower.
Same pathophysiology as Acute Progression can be slowed but not stopped Causes of CKD - 1. Insufficient Renal Artery Blood flow
- Occlusion/Obstruction leading to.... Tubular ischemia/necrosis. Etiology of CKD - Proteinuria & Angiotensin II Chronic damage --Pyelonephritis -Polycystic Kidney Disease -HTN -Diabetes -Autoimmune (SLE) -Nephrotoxins (Drugs--vancomycin, Toxins) "Dilution is the solution" Complications of CKD - Elevated Creatinine & BUN Metabolic Acidosis Fluid overload Hyperkalemia Death (arrhythmias / fluid overload)
Increased risk of infection Low Output Failure - Oliguria or anuria Azotemia - high BUN Hypocalcemia, Low V&D Hyperphosphatemia - Tetany: Positive Chvostek's/Trousseau's Osteoporotic Fractures Osteomalacia. Chvostek's sign - Cheek, facial spasm when Cheek is tapped associates with hypocalcemia Trousseau's sign - A sign of hypocalcemia. Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes. Urinary Tract Infections (UTI) - Inflammation of Urinary Tract (Can be lower or upper. Lower Urinary Tract - Cystitis (Bladder) urethritis (Often STI) Prostatitis Upper Urinary Track - pyelonephritis Etiology of UTI - Inflammation Infection: Usually perineal E. coli or Staph aureus contamination Women and UTI - Shorter Urethra
Proximity of urethra to anus Irritation of tissue from: Bubble baths, sexual activity tampons Older Men and UTI - Prostatic Hypertrophy Urinary Stasis Increases risk for both upper and lower UTI - Neurogenic Bladder Anatomic Obstructions. Cystitis; Bladder Inflammation/Infection - Inflammation or bacterial infection in lower urinary tract pyelonephritis - ineffective 0rganism attends urinary tract to ureters of the kidney. (Upper respiratory Tract. Patho for Pyelonephritis - Involves one or both kidneys and may be involved Purulent drainage fills renal pelvic and medulla becomes inflamed Tubules tissue sloughs off from forming casts of tubular walls (molds of wall tissue in urine). Signs and Symptoms of Pyelonephritis - Signs of cystitis dysuria, urgency, foul smelling urine. Flank Pain (costovertebral angle tenderness) CVA Tenderness Systemic:
Type III hypersensitivity reaction - Reaction: Antigen-Antibody complexes are formed and lodge in glomerular apparatus of the kidney Inflammatory mediators such as complement, cytokines, IL, T Lymphocytes: Results in increased Capillary permeability, protein and RBC enter filtrate (urine) Cell proliferation and congestion results in decreased GFR, Increased fluid/waste retention. Signs and Symptoms Glomerulonephritis - Urinalysis: Oliguria with Smoky or coffee-colored urine Gross Hematuria Proteinuria (often >3-5 Grams daily) Fluid Retention: HTN Facial & Periorbital, then generalized edema Oliguria Systemic: Malaise Fever Fatigue Headache (HTN) Anorexia Nausea
Diagnostic Tests for Glomerulonephritis - Elevated Creatinine and BUN Decreased GFR (Decreased Renal Filtration) Metabolic Acidosis (Dec Kidney Function) Elevated ASO (immune rxn to strep that caused it)/ASK titers Complications of Glomerulonephritis - Renal Failure (IntraRenal AKI) "Nephrotic Syndrome":>3.5 Grams Proteinuria/day (Type III hypersensitivity) Periorbital edema. nephrotic syndrome - group of clinical signs and symptoms caused by excessive protein loss in urine Urolithiasis - Renal Calculi/Kidney Stones Pathophysiology of Urolithiasis - Stones/Calculi form anywhere in urinary tract: may be smooth or jagged. Deposits continue to build and collect on stone, increasing in mass.
SNS Cool moist skin Tachycardia Complications of Urolithiasis - Dehydration Hydronephrosis Post-Renal Acute Kidney Injury (AKI) Patho of Hydronephrosis - Backflow of urine (dam) increases urine/pressure in kidney leading to dilation of ureters, renal pelvis, & Calyces (major, minor) Etiology of Hydronephrosis - Renal Calculi Tumors Ureter Stenosis Pyelonephritis Postrenal Obstruction; Prostatitis Bladder Urethral Signs and Symptoms of Hydronephrosis - Flank Pain Oliguria Complications of Hydronephrosis - If cause not removed can lead to Post-renal AKI leading to Chronic Renal Failure.
Renal Cell Carcinoma Pathophysiology - Primary tumor arising from the tubule epithelium Most common is near the Renal Cortex (85% of renal cancers). Often Metastasizes to the liver, lungs, bones and CNS before diagnosis. If diagnosed and treated at Stage 1 (encapsulated): 90% 5 year survival rate. Etiology for Renal Cell Carcinoma - 3.7% of newly diagnosed cancers 50-60 years of age cigarette smoking obesity/hypertension Signs and Symptoms of Renal Cell Carcinoma - Hematuria Dull, aching, flank pain Palpable mass Unexplained weight loss Anemia or erythrocytosis (erythropoietin abnormalities) Paraneoplastic syndrome (SIADH) Cushing's syndrome: Excessive adrenal corticosteroids, Excessive fluid retention
dysuria - painful or difficult urination RAAS (renin-angiotensin-aldosterone system) - Renin is released by kidneys in response to decreased blood volume; causes angiotensinogen to split & produce angiotensin I; lungs convert angiotensin I to angiotensin II; angiotensin II stimulates adrenal gland to release aldosterone & causes an increase in peripheral vasoconstriction positive feedback loop - feedback loop that causes a system to change further in the same direction Steps for Hypertension and Renal Damage - 1. Hypertension
- Decreased blood to Nephrons a.Decreased GFR
- Renin-angiotensin-Aldosterone
- Systemic Vasoconstriction
- Sodium and water retention a. Increase in blood volume b. Less space and more fluid for circulating blood
- Increased blood pressure
- Renal Vascular Damage Nephrosclerosis a. HTN, DM, Atherosclerosis.
- Chronic Renal Failure Dialysis - Process of removing waste and excess water from the blood.
Process: Diffusion of solutes across a semipermeable membrane (normally nephron) Diffusion=Movement of fluid or solute from high concentration to low concentration. (downhill) Hemodialysis - Hospital or dialysis center Blood is moved from shunt into a machine, where there is a semipermeable membrane blood on one side, excessive electrolytes (K+ Phos) wastes diffuse out of blood into dialysate Needed electrolytes (HCO3) diffuse from dialysate and into blood. Blood is then returned to the body with less fluid/wastes and better electrolyte balance. Required 3-4 times weekly, for 3-4 hours each day Requires surgical AV Shunt Complications of Hemodialysis - Shunt infection of malfunction Sclerosed vessels around shunt Never use shunt for routine labs Increased risk of HBV, HCV, and HIV
