48 Questions
What is pyuria?
The presence of an abnormal amount of white blood cells in the urine
Which of the following promotes proper renal and urinary function?
Adequate flow of blood to and from the kidney
What is the purpose of intravenous urography?
To take an x-ray image of the KUB
What is the normal range of serum creatinine levels in men?
53-106 mcmol/L
What is the purpose of cystography?
To evaluate reflux and injury
What is blood urea nitrogen (BUN)?
A byproduct of protein breakdown in the diet
What is the purpose of cystoscopy?
To remove stones from the urethra or kidney
What is urinary retention?
The inability of the patient to empty their bladder
What is the term for the inflammation of the bladder?
Cystitis
Which type of incontinence is characterized by the loss of urine resulting from an uninhibited detrusor contraction?
Urge incontinence
What is the most common lower UTI in men?
Prostatitis
What is the term for the uncontrolled loss of urine that is sufficient in magnitude to be a problem?
Urinary incontinence
What is the term for the upper UTI?
Pyelonephritis
What is the main factor that contributes to the development of transient incontinence?
All of the above
What type of incontinence is characterized by the loss of urine resulting from the lack of sensation?
Reflex incontinence
What is the term for the loss of urine when the lower urinary tract is intact but other factors cause the loss?
Functional incontinence
What is the primary function of the renal system in maintaining fluid and electrolyte balance?
Maintaining fluid and electrolyte homeostasis
What is the hormone responsible for stimulating the production of red blood cells?
Erythropoietin
What is the term for the absence of urine?
Anuria
What is the normal pH range of urine?
4.5-5.5
What is the term for painful urination?
Dysuria
What is the term for the presence of blood in the urine?
Hematuria
How much filtrate is produced by the kidneys per day?
180 liters
What is the term for the inability to control urination or defecation?
Incontinence
What is the primary goal of chemotherapy in the treatment of urinary cancer?
To reduce microextension of tumor
What is the purpose of a 15- to 20-minute sitz bath two to three times a day?
To promote muscle relaxation and reduce the risk of urinary retention
What is the purpose of a suprapubic catheter?
To test the client's ability to void once the obstruction is resolved
What is the purpose of a nephrostomy tube?
To drain urine from the kidney to the outside of the abdomen/flank
What is the purpose of an ileoconduit?
To implant the ureter into a 12-cm loop of ileum to the abdominal surface with an attached urostomy bag
What is glomerulonephritis characterized by?
Proteinuria, hematuria, decreased urine production, and edema
What can glomerulonephritis be classified by?
The extent of damage, the initial cause of the disorder, and the extent of changes
What is affected in glomerulonephritis?
The glomeruli, tubular, interstitial, and vascular changes
What is the primary cause of the rapid accumulation of toxic wastes in Acute Renal Failure?
Protein breakdown
Which of the following is a characteristic of the Maintenance phase of Acute Renal Failure?
Reduced blood flow to the kidney
What is the significance of serum creatinine levels in Acute Renal Failure?
It is a good indicator of kidney function
What is the primary goal of treatment in Acute Renal Failure?
To correct the underlying cause and prevent permanent damage
What is the typical duration of the Recovery phase in Acute Renal Failure?
3-12 months
What is the consequence of Acute Renal Failure if left untreated?
Permanent damage to the kidneys
What is the first priority intervention when a client is admitted to the PACU?
Assess for airway patency and quality of respirations and obtain vital signs.
What is the primary goal of the nurse's initial assessment in the PACU?
To identify potential complications
A client is admitted to the PACU after major abdominal surgery and reports feeling nauseous. What is the priority nursing intervention?
Administer antiemetic medication as ordered.
What is the purpose of reviewing intraoperative laboratory values and medications received in the PACU?
To monitor the client's response to medications
What is the primary focus of the nurse's initial assessment in the PACU?
The client's vital signs and respiratory status
What is the priority when a client is admitted to the PACU after major abdominal surgery?
Establish a patent airway
What is the primary reason for assessing the client's vital signs in the PACU?
To identify potential complications
What is the nurse's role in the PACU?
To identify and manage potential complications
What is the purpose of assessing the client's airway patency in the PACU?
To identify potential respiratory complications
What is the primary goal of the nurse's initial assessment in the PACU?
To identify potential complications
Study Notes
Renal System Function
- Maintains fluid and electrolyte homeostasis
- Excretes urine
- Acts as a buffering system to control pH
- Critical for the production of: • Vitamin D to maintain blood calcium balance • Erythropoietin to stimulate red blood cell production • Renin to regulate blood pressure • Growth hormone activation • Prostaglandins secretion
Fun Facts
- Kidneys filter 1.2 liters of blood per minute, creating 180 liters of filtrate per day
- Each kidney has approximately 800,000 - 1 million nephrons
- 99% of the filtrate is reabsorbed back into the venous system
- Only 1000-2000 ml of urine is produced per day under normal conditions
- Urine pH is 4.5
- The bladder holds 400-500 ml and loses its natural shape and elasticity when overstretched
- The body senses the urge to void when the bladder contains approximately 200 ml of urine
- Micturition occurs approximately 8 times per day
Renal Terminology
- Anuria: absence of urine
- Diuresis: increased urine volume
- Dysuria: painful urination
- Enuresis: involuntary nocturnal urination
- Frequency: voiding more frequently than usual
- Nephritis: inflammation of the kidney
- Hematuria: blood in the urine
- Hesitancy: difficulty initiating urination
- Incontinence: inability to control urination or defecation
- Lithiasis: presence or formation of stones
- Nocturia: excessive urination at night
- Oliguria: decreased urine formation or passing
- Polyuria: abnormally large urine production
- Proteinuria: abnormal protein in the urine
- Pyuria: abnormal white blood cells in the urine
- Urinary retention: inability to empty the bladder
- Urgency: intense desire to urinate immediately
Factors Promoting Proper Renal and Urinary Function
- Adequate blood flow to and from the kidney
- Good blood pressure and sufficient fluid intake
- Functioning filtering system (nephrons, afferent and efferent arterioles)
- Patent ducts from kidney (ureter) and bladder
- Intact bladder (no holes, tears)
- Proper nerve innervation and hormone relay
- Functioning pelvic floor muscles and sphincter function
- Proper pH
Diagnostic Tests
- Urinalysis and urine culture
- Renal function tests (SG, osmolality, 24-hr urine, etc.)
- Ultrasonography
- CT and MRI
- Intravenous urography
- Retrograde pyelography
- Cystography
- Renal angiography
- Cystoscopy
- Urodynamic studies
- Lab tests (Serum Creatinine, Blood Urea Nitrogen, etc.)
Urinary Incontinence
- Uncontrolled loss of urine affecting 15-50% of the elderly
- Causes of Transient Incontinence: delirium, infection, pharmacologic, psychological, excessive urine production, restricted activity, and stool impaction
- Types of incontinence: • Stress incontinence: loss of urine due to increased pressure on the bladder • Urge incontinence: loss of urine due to uninhibited detrusor contraction • Overflow incontinence: loss of urine due to lack of sensation • Reflex incontinence: loss of urine due to neurological dysfunction • Functional incontinence: loss of urine due to cognitive impairment • Iatrogenic incontinence: loss of urine due to medical factors
Urinary Diversion Devices
- Urinary catheter: keeping the drainage bag lower than the bladder, choosing the right size, lubricant, and avoiding manipulation
- Suprapubic catheter: testing client ability to void once obstruction is resolved
- Nephrostomy tube: tube from kidney to abdomen/flank
- Ileoconduit: implanting ureter into a 12-cm loop of ileum to abdominal surface with an attached urostomy bag
Glomerulonephritis
- Immune-related inflammation of the glomeruli, characterized by proteinuria, hematuria, decreased urine production, and edema
- Affects both kidneys equally
- Divided into classifications based on extent of damage, initial cause, and changes
Acute Renal Failure
- Complex disorder with many etiological factors and variant clinical manifestations
- Develops as a consequence of prerenal, intrarenal, or postrenal disorders
- Rapid accumulation of toxic wastes occurs, leading to azotemia
- Serum urea (BUN) and creatinine (CR) levels rise
- Progresses through four phases: initiation, maintenance, diuresis, and recovery
- Prevention is key
Surgical Suffixes
- -ectomy: Excision/removal (e.g., Appendectomy)
- -oscopy: Looking into (e.g., Gastroscopy)
- -ostomy: Creation of opening into (e.g., Colostomy)
- -otomy: Cutting into/incision (e.g., Tracheotomy)
- -plasty: Repair/reconstruction (e.g., Mammoplasty)
Types of Surgery
- Emergency Surgery: Urgent and immediate (e.g., Trauma, Appendectomy)
- Elective Surgery: Carefully planned and thought out (e.g., Knee replacement)
- Ambulatory Surgery: Same-day surgery, discharged home same day (e.g., Endoscopy)
Phases of Surgery
- Preoperative phase: From decision for surgery to transfer to operating room
- Intraoperative phase: From transfer to operating room to admission to post-anesthesia care unit (PACU/recovery room)
- Postoperative phase: From admission to PACU to follow-up evaluation in clinical setting or at home
Preoperative Care
- Preoperative preparation: Assessment, laboratory/diagnostics, teaching/education, informed consent, physical preparation, pre-op medications, and pre-op checklist
- Assessment: Physical (full review of systems) and psychological status
- Laboratory and diagnostics: Obtaining lab tests, EKG, and CXR based on patient's history to determine surgical and anesthetic risk
Psychological Condition
- Explore the meaning of surgery with the patient to understand their perception and anxiety level
- Encourage clients to express feelings and fears about receiving anesthetic and having surgery
- Observe client for nonverbal clues indicative of anxiety
- Reduce client anxiety by explaining the surgical experience
Intraoperative Care
- Nursing management: Positioning the patient, proper patient positioning, and anesthesia
- OR set up: Maintaining a sterile environment, adhering to aseptic technique, and monitoring for breaks in aseptic technique
Postoperative Care
- Nursing management: Managing potential complications, such as gastrointestinal, urinary, and alterations in skin/surgical wounds
- Gastrointestinal: Managing abdominal distension, paralytic ileus, and nausea/vomiting
- Urinary: Monitoring urinary output, maintaining catheter, and monitoring for UTI symptoms
- Alterations in skin/surgical wounds: Assessing wound, managing surgical site infections, and monitoring for signs of infection
Test your knowledge on the renal system and its functions, including fluid and electrolyte homeostasis, excretion, buffering, and hormone production. Review the purpose and fun facts about the renal system.
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