chapter 36 for cathey exam 1

Removal of toxic waste. Regulation of blood volume, pressure, and composition Regulation of the acid-base balance of the blood Regulation of Electrolyte Balance Production of erythropoietin Activation of vitamin D 2

Carry Urine from Kidneys to Bladder – Narrow point where each ureter joins the renal pelvis is the uretropelvic junction (UPJ) – Point where each ureter inserts in the side of the bladder base is the ureterovesical junction (UVJ)

Carry urine from bladder to outside of body • Controls voiding via internal and external sphincters Length • Female: 1-2 inches • Male: 8-10 inches

blood k level rises--aldosterone released from adrenal cortex---aldosterone targets kidneys--k release falls---blood na/K levels normalize

Urinary bladder-----Eliminates waste products from the body

Congenital malformation of male urethra • Hypospadias- urethral meatus is abnormally positioned somewhere on the ventral (underside) surface of penis • Epispadias- urethral meatus is positioned on dorsal surface/top of penis

On the dorsal surface of the penis

125mL/minute and egfr is 60ml/min1.73 m2

potassium, hydrogen ions (H+), ammonia

1.005 to 1.030

blood cells, platelets, protein

Void into a sterile cup immediately after initial voiding..........Urinalysis – Common Test – Voided or Sterile Catheter Specimen – Clean Catch Specimen – clean urethral area, void small amount in toilet, then void in sterile cup

• Water • Sodium • Chloride • Calcium • Bicarb (HCO3)

color-• Pale yellow • Dark Amber • Brown/green • Orange • Red/pink • Smoky Clarity • Clear • Cloudy Specific Gravity • 1.005 to 1.03..... pH 4.5 to 8.0 ..........Protein0-8 mg/dL • 24 hour: 30-150 mg/dL......... Glucose None ........Ketones None .........Bilirubin None ........Nitrites None ........Leukocytes None......... Red Blood Cells less than 5.....White Blood Cells less than 5.......... Casts None to rare

1.005 to 1.03

Identifies – number of bacteria or yeast in urine – Causative organism of urinary tract infection – Most effective medication use • Normal Value – Negative: None. – Positive: 100,000 or more/mL of urine................must collect before antibiotics

Renal Function Tests – Serum Creatinine- 0.6-1.2 – Blood Urea Nitrogen (BUN)- 10-20 – Creatinine Clearance Test- 85-135 (24-hour urine) – Estimated Glomerular Filtration Rate (eGFR)- >60

Caused by IV or oral contrast dye for CT or MRI Nephrotoxic Causes contrast-induced nephropathy Decline in renal function as shown by a rise in serum creatinine Risk Factors: • azotemia, • diabetes mellitus associated renal impairment

Intravenous Contrast Media Injected – Contrast Media Outlines Renal Structures – Check Allergies – Monitor creatinine level – Hydration Before and After

Incontinence – Diapers • Potty training – Ineffective control • Hygiene – Improper wiping • Irritants- bubble bath, baby powder, etc.

Kidneys-Ureter-Bladder (KUB) XR • Will show: – Tumors – Swollen Kidneys – Kidney Stones

Cystoscopy – Endoscopy through urethra to visualize bladder and/or collect specimens • Renal US • Renal biopsy – Pre/Post-op care same as any minor procedure

Urge incontinence-----Involuntary Urine Loss with Abrupt/Strong Desire to Void – Most common in older adults – Can’t make it to the bathroom in time------------------------------------------------------Stress Incontinence – Involuntary Urine Loss from Increasing Abdominal Pressure – Occurs after sneezing, laughing, coughing – Most common in women after childbirth

Functional incontinence------From Impairment of Physical/Mental Function

Overflow incontinence------------Involuntary Loss of Urine Associated with Bladder Overdistention • Usually associated with urinary retention r/t SCI or enlarged prostate • “Dribbling

Total incontinence---------Continuous, Unpredictable Loss of Urine

Suprapubic tenderness

oliguria and anuria

palpable over suprapubic firm

normal residual volume is 50mL, residual volume of 150 to 200mL urine indicates need for further treatment

treatment is generally urinary catheterization that can be temporary or long term------------------------------------------------URINARY CATHETER S • Indwelling (Foley) – Needs justification for insertion and removal as soon as medically able – CAUTI protocol to prevent UTI – Sterile insertion – if not done correctly bacteria is introduced and will cause UTI in patient – Incontinence is NOT a reason for an indwelling catheter

Guidelines for Care of the patient with an indwelling urinary catheter – Maintain a closed system – Secure the catheter with tape or fastener – Encourage fluid consumption – Use aseptic technique when emptying collection bag – Wash perineum with soap and water daily and after BM – Keep tubing coiled on the bed and positioned for free flow of urine – Do not clamp catheters – Remove indwelling catheters as soon as possible

Every 3 hours

Intermittent catheterization – Best for pt who is unable to void r/t retention (BPH) or neurological condition (SCI) – Usually performed every 3 hours – Pts can be taught to self-catheterize at home

uprapubic catheter – Inserted ONLY by physician – If pulled out, short time frame for MD to reinsert 37