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Questions and Answers

What does a protein level greater than 0.15g/day in urine indicate?

  • Impaired filtration (correct)
  • Kidney infection
  • Dehydration
  • Normal filtration

Which of the following conditions is indicated by the presence of glucose in urine?

  • Hyperglycemia (correct)
  • Dehydration
  • High protein intake
  • Kidney stones

What is the normal range for Creatinine levels in blood?

  • 60 – 150 mcmol/L
  • 45 – 90 mcmol/L
  • 90 – 120 mcmol/L
  • 53 – 103 mcmol/L (correct)

What role do stretch receptors in the bladder play during the micturition reflex?

<p>Signal the need to void (D)</p> Signup and view all the answers

Which electrolyte is often the first to become abnormal in kidney function tests?

<p>Potassium (B)</p> Signup and view all the answers

What is the normal range for the Glomerular Filtration Rate (GFR)?

<p>Greater than 90 mL/min/1.73 m² (C)</p> Signup and view all the answers

What happens to the internal sphincter during the micturition reflex?

<p>It relaxes (D)</p> Signup and view all the answers

What is the significance of finding leukocytes in urine analysis?

<p>Indicator of infection (A)</p> Signup and view all the answers

What is a primary consequence of acute kidney injury (AKI)?

<p>Rapid decline in the glomerular filtration rate (GFR) (D)</p> Signup and view all the answers

What is oliguria defined as in acute kidney failure?

<p>Less than 500 ml of urine per day (B)</p> Signup and view all the answers

Which of the following is NOT a common cause of acute kidney injury?

<p>Best diet adherence (A)</p> Signup and view all the answers

What dietary intervention is recommended for patients with acute kidney injury?

<p>Low potassium diet (B)</p> Signup and view all the answers

What condition can result from prolonged urinary blockage?

<p>Hydronephrosis (A)</p> Signup and view all the answers

What is the most common component of kidney stones?

<p>Calcium (B)</p> Signup and view all the answers

Which clinical sign is commonly associated with the presence of kidney stones?

<p>Severe flank pain (C)</p> Signup and view all the answers

Which of the following is a non-surgical treatment for kidney stones?

<p>Pain management (D)</p> Signup and view all the answers

What should be monitored closely after lithotripsy procedures?

<p>Intake and output (A)</p> Signup and view all the answers

What dietary factor increases the risk of developing kidney stones?

<p>High oxalate diet (D)</p> Signup and view all the answers

What triggers the release of urine?

<p>Voluntary relaxation of the external sphincter (D)</p> Signup and view all the answers

Which type of glomerulonephritis develops gradually over time?

<p>Chronic glomerulonephritis (B)</p> Signup and view all the answers

How does urinary stasis in the bladder affect health?

<p>Promotes bacterial growth and infection (B)</p> Signup and view all the answers

What is a significant result of decreased renal perfusion?

<p>Tissue ischemia and insufficient filtration (B)</p> Signup and view all the answers

Which condition is associated with injuries to neurons in the spinal cord?

<p>Urinary incontinence or retention (B)</p> Signup and view all the answers

What impact does increased fluid intake have on urine production?

<p>Enhances the rate of urine production (A)</p> Signup and view all the answers

What measurement serves as an indicator of decreased renal function?

<p>Elevated blood urea nitrogen (BUN) levels (D)</p> Signup and view all the answers

Which factor does NOT impact urinary motility?

<p>Exercise levels (D)</p> Signup and view all the answers

What is the primary function of the renal system?

<p>Management of body fluids and blood pressure (D)</p> Signup and view all the answers

Which substances are typically filtered in the glomerulus?

<p>Water, ions, glucose, and small proteins (C)</p> Signup and view all the answers

In which part of the nephron does most reabsorption of sodium occur?

<p>Proximal convoluted tubule (B)</p> Signup and view all the answers

How does active transport in the nephron differ from passive transport?

<p>Active transport requires energy to move substances against a concentration gradient. (C)</p> Signup and view all the answers

What role does aldosterone play in the urinary system?

<p>It influences sodium reabsorption. (C)</p> Signup and view all the answers

Which process allows water to pass through cell membranes based on concentration gradients?

<p>Osmosis (B)</p> Signup and view all the answers

What is the end product of the filtration and reabsorption processes in the nephron?

<p>Urine (A)</p> Signup and view all the answers

What influences water reabsorption in the collecting duct?

<p>Antidiuretic hormone (ADH) (B)</p> Signup and view all the answers

What is the primary component of macroscopic urine analysis?

<p>Color and clarity (A)</p> Signup and view all the answers

Which of these mechanisms describes the movement of particles from an area of high concentration to an area of low concentration?

<p>Diffusion (B)</p> Signup and view all the answers

Flashcards

Urinary Sphincter Relaxation

Voluntary relaxation of the external sphincter muscle allows urine to flow out of the bladder.

Glomerulonephritis

Inflammation of the tiny filters in the kidneys (glomeruli) causing damage and potentially leading to kidney failure.

Altered Urinary Neuromuscular Function

Damage to nerves controlling bladder function can cause problems with urinary retention or incontinence.

Urine Stasis

Slow movement of urine through the nephrons or in the bladder, allowing bacteria to grow and increasing the risk of infection.

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Kidney Perfusion

Blood flow reaching the kidneys, essential for proper filtration and waste removal.

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Decreased Renal Function

Reduced kidney function due to inadequate blood flow and oxygenation leading to impaired filtration and toxin buildup.

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BUN and Creatinine

Blood tests measuring levels of urea nitrogen and creatinine, indicators of kidney function.

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Kidney Failure

Complete or severe loss of kidney function, requiring dialysis or transplantation.

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Urine Analysis: Protein

The presence of more than 0.15g/day of protein in urine indicates impaired filtration in the kidneys.

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Urine Analysis: Glucose

Glucose in urine is a sign of hyperglycemia which can be due to diabetes or infection.

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Urine Analysis: Ketones

Ketones in urine indicate an acid/base imbalance and may point towards Diabetic Ketone Acidosis (DKA).

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Urine Analysis: Leukocytes

Elevated leukocytes (white blood cells) in urine suggest an infection within the urinary tract.

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Urine Analysis: Nitrites

Nitrites in urine are a good indicator of a bacterial infection.

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BUN (Blood Urea Nitrogen)

BUN is a waste product of protein metabolism and reflects kidney function. Normal range: 3.6 – 7.1 mmol/L.

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Creatinine

Creatinine is a waste product of muscle and protein metabolism. Normal range: 53 – 103 mcmol/L. It is a more reliable indicator of kidney function than BUN.

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Potassium

Kidneys excrete most of the potassium in the body. Normal range: 3.5 – 5 mmol/L. It is often the first electrolyte affected in kidney dysfunction.

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Renal System Function

The renal system plays a vital role in regulating body fluid volume and composition, managing blood pressure, eliminating metabolic waste, and synthesizing crucial substances like erythropoietin, renin, and vitamin D.

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Nephron's Role

The nephron, the functional unit of the kidney, is responsible for filtering water-soluble substances from the blood, reabsorbing filtered nutrients, water, and electrolytes, and secreting metabolic waste products.

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Filtration Process

Blood enters the glomerular capillaries (Glomerulus) under pressure, creating filtrate which consists of water, ions, glucose, and small proteins.

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Proximal Tubule

The proximal tubule is the primary site of reabsorption for important substances like sodium, glucose, potassium, amino acids, bicarbonate, phosphate, urea, and water.

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Loop of Henle

The Loop of Henle plays a crucial role in further reabsorbing both water and sodium, concentrating the filtrate.

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Distal Tubule

The distal tubule is responsible for secreting ions, acids, medications, and toxins into the filtrate, while also reabsorbing some ions and water.

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Diffusion in Nephron

Diffusion is the movement of particles from an area of high concentration to an area of low concentration, facilitating the reabsorption of substances within the nephron.

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Osmosis in Nephron

Osmosis is the passive movement of water from a region of high water concentration to an area of low water concentration, also contributing to reabsorption within the nephron.

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Facilitated Transport

Facilitated transport involves the movement of substances across the cell membrane with the help of transport proteins, enhancing the efficiency of reabsorption.

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Active Transport

Active transport requires energy to move particles across the cell membranes, enabling the reabsorption of substances against their concentration gradients.

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Acute Kidney Injury (AKI)

A sudden decrease in the kidney's ability to filter waste, leading to a buildup of creatinine and urea nitrogen in the blood.

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Prerenal AKI

Kidney injury caused by factors outside the kidneys, such as dehydration or low blood pressure, that reduce blood flow to the kidneys.

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What is the most common cause of kidney stones?

Calcium oxalate and phosphate are the most common components of kidney stones.

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What are the clinical signs of kidney stones?

Kidney stones often cause severe flank pain, blood in the urine (hematuria), nausea, vomiting, and urinary urgency.

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What is the term for a blocked urine flow in the urinary tract?

Alteration of urinary patency refers to any blockage or obstruction in the urinary tract that prevents urine from flowing freely.

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What is the condition of a kidney with blocked flow of urine and swelling?

Hydronephrosis is the swelling of the kidney due to the buildup of urine caused by a blockage in the urinary tract.

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What are the potential complications of urinary tract blockage?

Prolonged or severe pressure from a blockage can damage nephrons and lead to infection.

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What are the main treatment goals for kidney stones?

Kidney stone treatments aim to relieve pain, manage complications, and remove the stone. This might include pain medications, fluids, antispasmodics, and surgical interventions like lithotripsy.

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What are the common dietary recommendations for preventing kidney stones?

Maintaining proper hydration, reducing intake of oxalate-rich foods, and limiting caffeine consumption are key dietary recommendations for lowering the risk of kidney stones.

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What does ESWL stand for?

Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive procedure using shock waves to break down kidney stones.

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Study Notes

Altered Elimination Module 1

  • Elimination processes are vital for maintaining homeostasis by removing waste products from the body.
  • This module reviews the impact of altered urinary and gastrointestinal processes.
  • A YouTube video link is provided for further information: https://www.youtube.com/watch?v=QV1Y
  • The renal system is crucial for managing body fluid balance, blood pressure, and eliminating metabolic waste.
  • The renal system produces erythropoietin for red blood cell production, renin for fluid and blood pressure balance, and vitamin D for calcium absorption.
  • A YouTube video link is provided for further renal system information; https://www.youtube.com/watch?v=H2VkW9L5QSU (6.)

Renal System

  • The nephron is the functional unit of the kidneys.
  • It filters water-soluble substances, reabsorbs nutrients and water, and secretes wastes.
  • A YouTube video link is provided: https://www.youtube.com/watch?v=SZ3BZ_
  • Blood enters the kidneys through the renal artery, which branches into smaller arterioles.
  • Blood then flows into the glomerular capillaries (glomerulus) where pressure forces a filtrate into the Bowman's capsule.
  • The filtrate contains water, ions, glucose, and small proteins.
  • The proximal tubule absorbs sodium and other ions back into the bloodstream.
  • Filtrate passes through the loop of Henle, where further water and sodium are absorbed.
  • The distal tubule further adjusts the electrolyte composition of the filtrate, secreting ions and wastes.

Urine Production

  • Water, ions, glucose, and small proteins are filtered from the blood in the glomerulus.
  • The proximal tubule absorbs valuable substances.
  • The loop of Henle absorbs more water and sodium.
  • The distal tubule, controlled by hormones like aldosterone and ADH, adjusts ion concentration and excretes waste.
  • The filtrate is collected in the collecting ducts and finally becomes urine expelled from the body.

Filtration

  • Filtrate composition includes water, ions (sodium, potassium, chloride), glucose, and small proteins.
  • Substances are reabsorbed or secreted in different parts of the nephron, including the proximal tubule, loop of Henle and distal tubule.
  • A diagram depicts the process of filtration.

Urine Production Overview

  • The process involves the Bowman's capsule, glomerulus, proximal tubule, loop of Henle, distal tubule, and collecting duct.
  • Water and solutes are reabsorbed or secreted depending on the specific location in the nephron.
  • Various substances are reabsorbed or secreted along the process.
  • ADH plays a significant role in controlling water reabsorption.
  • Specialized blood vessels called the vasa recta facilitate efficient transport of water and substances.

Filtrate Absorption

  • Diffusion, osmosis, facilitated transport, and active transport are the mechanisms used by the nephrons to reabsorb substances.
  • Diffusion moves particles from an area of high concentration to one of low concentration.
  • Osmosis moves water from high to low concentration.
  • Facilitated transport utilizes specialized proteins to facilitate the movement of substances across cell membranes..
  • Active transport requires energy to move particles across cell membranes.

Urine Production

  • The majority of sodium is absorbed in the proximal convoluted loop.
  • Glucose, potassium, amino acids, bicarbonate, phosphate, urea, and water are also reabsorbed (in the proximal convoluted loop)
  • Water is reabsorbed, and sodium actively reabsorbed.
  • In the distal tube, ions, acids, medications, and toxins (such as K+, urea, and ammonia) are secreted. Some ion and water absorption occurs.

Urine Production (Distal Convoluted Loop)

  • Aldosterone regulates sodium reabsorption.
  • Potassium, urea, hydrogen ions, and ammonia are secreted into the filtrate.
  • Antidiuretic hormone (ADH) controls water reabsorption.
  • The final product is urine.

Urine Production (Macroscopic Analysis)

  • Urine is typically light yellow in color.
  • The pH ranges from 4.6-8.0.
  • Specific gravity is 1.005-1.030.
  • Proteins are less than 0.15g/day.
  • Red blood cells (RBCs) and white blood cells (WBCs) are typically 0-4 and 0-5/hpf respectively.
  • Occasionally, casts (formed from proteins and cells) may be present.

Urine Analysis: Abnormal Findings

  • Elevated protein levels (>0.15g/day) may indicate impaired filtration.
  • Glucose presence suggests hyperglycemia or infection.
  • Elevated ketones may indicate an acid-base imbalance or diabetes.
  • Leukocytes presence may indicate an infection.
  • Nitrites presence suggests an infection.

Lab and Kidney Function

  • Blood urea nitrogen (BUN) is a measure of urea from protein metabolism. Normal range is 3.6 to 7.1 mmol/L.
  • Creatinine is a waste product from muscle metabolism. Normal range is 53 to 103 μmol/L.
  • Potassium is an electrolyte mostly excreted by the kidneys. Normal range is 3.5 to 5 mmol/L.
  • Glomerular filtration rate (GFR) is the rate at which blood is filtered by the glomeruli; normal values are >90 mL/min/1.73 m².

Urine Removal

  • Urine from the kidneys travels through the ureters to the bladder.
  • Peristalsis propels urine through the ureters.
  • The trigone, located in the bladder, is sensitive to stretch, triggering the need to urinate.
  • Messages are sent to the brain, signaling urination.

Micturition Reflex

  • Stimulation of stretch receptors in the bladder sends impulses to the sacral spinal cord.
  • Impulses travel to the pons and to the spinal detrusor muscles.
  • Internal sphincter relaxation and external sphincter relaxation lead to urine release.

Incontinence and Retention

  • Loss of voluntary bladder control = incontinence.
  • Increased intra-abdominal pressure causes stress incontinence (laughing, coughing).
  • Spinal cord injury or brain damage can disrupt the micturition reflex, causing retention or incontinence.
  • Catheters can be used to drain urine.

Categorization of Urinary Track Problems

  • Pre-renal, intra-renal, and post-renal problems are categorized.
  • Kidney failure can be a result of these conditions.

Glomerulonephritis

  • Glomerulonephritis is inflammation of the glomeruli.
  • It can be acute or chronic, and it can be associated with other diseases (lupus, diabetes).
  • Inflammation in the glomeruli can damage the kidneys.

Altered Urinary Neuromuscular Function

  • Altered function can lead to urinary retention or incontinence.
  • Spinal cord injuries may affect neural impulses that control urination.
  • The level of the injury influences the impact and urinary function.

Alteration in Urinary Motility

  • Fluid intake impacts urine output.
  • Urine stasis can lead to infection.
  • Stasis occurs with slow nephron movement or bladder retention of the filtrate.

Alteration in Urinary Perfusion

  • The kidneys filter 1 liter of blood per minute.
  • Decreased blood flow negatively impacts kidney function resulting in reduced filtration and toxicity.
  • Elevated levels of blood urea nitrogen (BUN) and creatinine indicate reduced kidney function.
  • High blood pressure is a significant cause of kidney damage.

Acute Kidney Failure

  • Acute kidney failure is the inability of the kidneys to remove waste effectively.
  • Characterized by rapid accumulation of waste products (azotemia) and reduced urine output (oliguria <500mL/24hrs.).
  • Causes include hemorrhage, trauma, infection (such as pyelonephritis or glomerulonephritis)

Acute Kidney Failure Nursing Interventions

  • Initially, fluid restriction to 1L/day is implemented.
  • Intake and output are closely monitored, and daily weights are recorded.
  • Low potassium diets are prescribed.
  • Closely monitoring electrolytes, BUN, creatinine, and GFR are important. -Rehydration may be provided once GFR improves. -The role of youtube videos is mentioned.

Alteration of Urinary Patency

  • Blockage or obstructions in the urinary tract disrupt urine flow, potentially damaging nephrons.
  • Blockages may be caused by substances (stones) or external sources (tumors).
  • Urine backing up into the kidneys creates a condition known as hydronephrosis.
  • Urine stasis can lead to infection.

Urolithiasis (Kidney Stones)

  • Urolithiasis is the presence of kidney stones.
  • Calculi are solid masses, often composed of salts, or organic acids precipitating from the filtrate.
  • Calcium, oxalate, and phosphate constitute most kidney stones.
  • Kidney stones can form due to elevated calcium levels combining with oxalate or phosphate, creating stones, that are slowly increase in size.
  • Sudden flank pain and microscopic blood in the urine indicate possible stones.

Urolithiasis (Kidney Stones) Risk Factors

  • Genetic predisposition plays a significant role in kidney stone formation.
  • Urinary tract infections increase susceptibility to kidney stones.
  • Diabetes, obesity, and hyperparathyroidism are additional factors.
  • High oxalate intake, high animal protein, and high sodium intake contribute to kidney stone development (while low fluid intake hinders stone dissolution).

Urolithiasis (Kidney Stones) Non Surgical Treatment

  • Pain management techniques, fluids (non-caffeinated beverages), and antispasmodic medications are employed.
  • Urine straining helps identify stones.
  • Dietary modifications (reducing stone risk factors) and increased hydration are advocated.
  • Decreasing caffeine and foods with oxalates aids in reducing the risks of stones.

Urolithiasis (Kidney Stones) Surgical Treatment

  • Extracorporeal shockwave lithotripsy (ESWL) uses shock waves to break stones into smaller pieces.
  • Ureteroscopes are used to retrieve or fragment stones in the ureters.
  • Placement of a stent may be necessary after procedures.
  • The importance of post-procedural nursing care is highlighted, including vital signs monitoring, IV fluids, intake and output management, pain management.

Learning Objectives

  • Understanding kidney structure and functions, nephron structure and function (proximal tubule, loop of Henle, distal tubule)
  • Defining filtrate and its components.
  • Understanding bladder structure and function.
  • Understanding the micturition reflex.
  • Recognizing normal and abnormal urine content. Describing the processes of acute kidney failure, urolithiasis, and altered urinary motility, along with relevant nursing interventions.

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