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FON, Renal & Urinary System

FON, Renal & Urinary System

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Published by Raf Luis
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Published by: Raf Luis on Nov 21, 2010
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Functions of kidneys:Urine formation, drug excretion, acid base balance, secretion of renin, activationof vitamin D, production of erythropoitenFormation of urine:Glomerular filtrationTubular reabsorptionTubular secretionDescribe urination reflexDestention of the bladder muscle sends sensory impulses to spinal cord whichactivate the parasympathetic motor system to contract detrusor muscles & dialatethe internal urethral sphincter allowing it to relax (voluntarly) resulting in urinationWhat is the point of incontinance in theurination reflex?The point where the external urethral sphincter relaxesWhen is the micturitionreflex activated?It is initiated when 300 to 400 mL of urine form in the bladder, stimulating stretchreceptors within the wall.NocturiaUrination during the nightOliguriadecreased urination (less than 400mL/24hrs)EnuresisBedwettingPolyuriaExcessive urination (more than 2000mL/24 hrs)Anuriaabsence of urinationNursing assessment of UrinaryEliminationCollection of data about the patient's voiding patterns, habits, and difficulties anda history of current or past urinary problemsPhysical Assessment Nursing of UrinaryEliminationPalpation of bladder,skin color & texture, vitals, lung sounds, edema, orthostatichypotension (<BP/>HR)What is the normal daily Urine Output1000 - 2000 mL every 24hrsCharacteristics of Urine; Color A freshly voided specimen is pale yellow, straw-colored, or amber, depending onits concentration.Characteristics of Urine; odor Odor Normal urine smell is aromatic. As urine stands, it often develops anammonia odor because of bacterial action.Characteristics of Urine: TurbidityFresh urine should be clear or translucent; as urine stands and cools, it becomescloudy.Characteristics of Urine: pHThe normal pH is about 6.0, with a range of 4.6 to 8. (Urine alkalinity or aciditymay be promoted through diet to inhibit bacterial growth or urinary stonedevelopment or to facilitate the therapeutic activity of certain medications.) Urinebecomes alkaline on standing when carbon dioxide diffuses into the air.Characteristics of Urine: Specific gravityThis is a measure of the concentration of dissolved solids in the urine. Thenormal range is 1.015 to 1.025.
 
a high specific gravity usually indicates dehydration and a low specific gravityindicates overhydration.Renal function tests: Serum CreatintineMeasuring serum creatinine is a useful and inexpensive method of evaluatingrenal dysfunction. Creatinine is a non-protein waste product of creatinephosphate metabolism by skeletal muscle tissue. Creatinine production iscontinuous and is proportional to muscle massRenal function tests: BUNBlood urea nitrogen (BUN) measures the amount of urea nitrogen, a wasteproduct of protein metabolism, in the blood. Urea is formed by the liver andcarried by the blood to the kidneys for excretion.Adult: 7-20 mg/100 mlRenal function tests: Uric AcidUric acid is the end product of purine metabolism. Purines are obtained from bothdietary sources and from the breakdown of body proteins. Organ meats such asliver, kidneys, and sweetbreads, sardines, anchovies, lentils, mushrooms,spinach, and asparagus are all rich sources of purines. The kidneys excrete uricacid as a waste product.Renal function tests: CreatinineclearanceA creatinine clearance test measures the rate at which the kidneys clear creatinine from the blood. A creatinine clearance test compares the serumcreatinine with the amount of creatinine excreted in a volume of urine for aspecified time. A 24-hour time frame is most common. At the beginning of thetest, the patient empties his bladder and the urine is discarded. Then, all urinevoided during the specific time period is collectedNursing Diagnoses associated withRenal Function TestsPotential Fluid Volume DeficitPotential fluid volume deficitPotential alterations in nutritional requirements for specific nutrients - potassium,sodium, and proteinCystoscopyCystoscopy is the direct visual examination of the bladder, ureteral orifices, andurethra with a cystoscope. It is used to view, diagnose, and treat disorders of thelower urinary tract, interior bladder, urethra, male prostatic urethra, and ureteralorificesIntravenous Pyelogram (ExcretoryUrography)Intravenous pyelogram is the radiographic examination of the kidney and ureter after a contrast material is injected intravenously. It is used to diagnose kidneyand ureter disease and impaired renal function.
 
Retrograde PyelogramRetrograde pyelogram is the radiographic and endoscopic examination of the kidneysand ureters after a contrast material is injected into the renal pelvis through the ureter.Renal UltrasoundA renal ultrasound is a noninvasive procedure that involves the use of ultrasound tovisualize the renal parenchyma and renal blood vessels. It is used to characterize renalmasses and infections, visualize large calculi; detect malformed kidneys; provideguidance during other procedures, such as biopsy; and monitor the status of renaltransplants and kidney development in children with congenital processesRenal BiopsyIt is an invasive procedure that involves obtaining a small piece of renal tissue for microscopic examination. Tissue sample may be obtained by needle and syringethrough a skin puncture or small incision, during an open surgical procedure duringwhich a wedge of tissue is removed, or through a cystoscope during which a brush isused to obtain a tissue fragment.Total incontinenceContinuous and unpredictable loss of urine, resulting form surgery, trauma, or physicalmalformation.Nursing Interventions: Keep skin clean & dry, condom cathStress incontinenceInvoluntary loss of less than 50mL of urine. r/t increase in intra-abdominal pressure.Occurs during coughing, sneezing, laughing, or other physical activities. Childbirth,menopause, obesity, or straining from chronic constipation can also result in urine lossOverflow incontinenceInvoluntary loss of urine is associated with overdistention and overflow of the bladder.The signal to empty the bladder may be underactive or absent, the bladder fills, anddribbling occurs. It may be due to a secondary effect of some prostatic or neurologicconditionsFunctional incontinenceis urine loss caused by the inability to reach the toilet because of environmentalbarriers, physical limitations, loss of memory, or disorientation.Common cause in elderly; instituionalizedWhat are the causes of disordersof the urinary tract?Infection, obstructions, cancer, heriditary diseases, chronic disease, traumaticdiseases & metabolic diseasesFactors of UTI'sstasis, past history, contamination, female, reflux, instruments, agingSigns & symptoms of UTI'sDysuria, urgency, frequency, incontinence, hematuria, cloudy, foul smelling urine andconfusion in the elderlyNANDA diagnoses of UTI'sImpaired urinary elimination; frequencyPain/DiscomfortHealth maintenance, alteredUrethral StricturesNarrowing of urethral lumen by scar tissueRenal CalculiNephrolithiasis is the formation of crystal aggregates in the urinary tract results in

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