• Questions can include pathophysiology, health assessment (normal and abnormal), and pharmacologic treatment
• Review required readings, course lectures, case study and learning activity. Fluid and electrolyte balance- processes in the kidney
• Hormones controls reabsorption of fluid and e...
NR 545
Final exam
Study Guide
• Questions can include pathophysiology, health assessment (normal and abnormal), and pharmacologic treatment
• Review required readings, course lectures, case study and learning activity.
Fluid and electrolyte balance- processes in the kidney
• Hormones controls reabsorption of fluid and electrolytes
o Antidiuretic hormone
▪ From posterior pituitary; controls reabsorption of water by altering permeability of distal convoluted tubule and collecting duct
o Aldosterone
▪ Secreted by adrenal cortex; controls sodium reabsorption and water by exchanging Na ions for K or hydrogen ions in distal convoluted
tubule
o Atrial natriuretic hormone
rd
▪ From heart; 3 hormone controlling fluid balance by reducing Na and fluid reabsorption in kidneys
Renal circulation process
Laboratory testing- purpose and interpretation ; Age related urinary changes ; Conditions/diagnoses associated with urine color changes
Diagnostic test
• Urinalysis
o Constituents and characteristics of urine may vary w/ dietary intake, drugs, and care w/ which specimen is handled
o Urine is normally: clear, straw colored and has mild color
o Urine pH is 4.5-8.0
o Appearance
▪ Cloudy indicate presence of large amounts of protein, blood cells or bacteria and pus
▪ Dark color indicate hematuria (blood), excessive bilirubin content or highly concentrated urine
▪ Unpleasant or unusual odor indicate infection or result from certain dietary components or medications
o Abnormal constituents (present in significant quantities)
▪ Blood (hematuria)
• small (microscopic) amounts of blood indicates infection, inflammation, or tumors in urinary tract
• large numbers of RBC (gross hematuria) indicates increased glomerular permeability or hemorrhage in tract
▪ protein (proteinuria, albuminuria)
• indicates leakage of albumin or mixed plasma proteins into filtrate d/t inflammation and increased glomerular
permeability
▪ bacteria (bacteriuria) and pus (pyuria)
• indicates infection in urinary tract
▪ urinary casts (microscopic sized molds of tubules, consisting of one or more cells (bacteria, protein, and so on))
• indicates inflammation of kidney tubules
▪ specific gravity
• indicates ability of tubules to concentrate the urine
• very low specific gravity= dilute urine; related to renal failure
▪ glucose and ketones (ketoacids)
• found when DM is not well controlled
• blood test
o elevated serum urea (BUN and Cr)
▪ indicate failure to excrete nitrogen wastes d/t decreased GFR
▪ results from protein metabolism
o metabolic acidosis (decreased pH and Bicarb)
▪ indicate decreased GFR and failure of tubules to control acid-base balance
o anemia (low hgb)
▪ indicated decreased erythropoietin secretion and/or bone marrow depression d/t accumulated wastes
o electrolytes
▪ depend on related fluid balance
▪ retention of fluid= GFR is decreased and may result in dilution effect
o antibody level antistreptolysin O (ASO) or antistreptokinase (ASK)
▪ used for dx of post-streptococcal glomerulonephritis
o renin
▪ indicate cause of HTN
• other test
,BY JEDY
o culture and sensitivity on urine specimens
▪ used to identify the causative organism in urinary infection and select drug tx
o clearance test such as Cr or insulin clearance or radioisotopestudy
▪ used to assess GFR
o radiologic test such as radionuclide imagining, angiography, US, CT, MRI and IV pyelography(IVP)
▪ used to visualize structures and abnormalities in urinary system
o cystoscopy
▪ visualizes lower urinary tract and may be used in performing a biopsy or removing kidney stones
, BY JEDY
o
biopsy
▪ may be used to acquire tissue specimens to allow microscopic examination of suspicious lesions in bladder or kidney
Renal calculi causes- the most common cause ; CVA testing: purpose, organ involvement, interpretation of findings (positive vs negative, associated
diagnoses)
urinary tract obstructions
• older men= urinary tract obstructed by BPH or prostatic cancer
• common causes: tumors, inflammation, scarring, stenosis, congenital defects, renal calculi
• urolithiasis (calculi, or kidney stones)
o kidney stones common and frequently recur if underlying cause not treated
o patho
▪ calculi develop anywhere in urinary tract
▪ stone may be small or very large
• staghorn calculus- very large stone that forms in the renal pelvis and calyces in the shape of a deer’s antlers
▪ form when there are excessive amounts of relatively insoluble salts in filtrate or when insufficient fluid intake creates a highly
concentrated filtrate
▪ once any solid material or debris forms, deposits continue to build up on nidus and form a large mass
• cell debris from infection may also form a nidus
▪ immobility may cause calculi bc of stasis of urine resulting in chemical changes in urine
▪ increasing fluid intake (at least 8 glasses of water/day) can assist in removing small stones
▪ stones one cause manifestations when obstruction in flow of urine in ureter
▪ calculi may lead to infection bc cause stasis of urine in area and irritate tissues
• early indication of calculi
▪ if located in kidney or ureter, calculi may cause development of hydronephrosis
• dilation of calyces and atrophy of renal tissue relate to back pressure of urine behind obstructing stone
o etiology
▪ 75% made up of calcium salts
▪ 25% consisting of uric acid or urate, struvite (magnesium ammonium phosphate) or cystine (rare)
▪ Calculi should be examined and urinalysis completed to determine content of stone and predisposing factors
▪ Calcium stones (phosphate, oxalate or carbonate) for when calcium level in urine are high d/t hypercalcemia, parathyroid tumor
or other metabolic disorders
• Solubility of calcium salts and uric acid varies w/ pH of urine
• Calcium salts form readily when urine is high in alkaline
▪ Inadequate fluid intake is major factor in calculus formation
▪ Calcium oxalate stones develop in ppl following vegetarian diets high in oxalate
• Causing increased level of oxalate in urine
▪ Uric acid stones develop w/ hyperuricemia (d/t gout, high-purine diets, or cancer chemotherapy) and when urine is acidic
o s/s
▪ stone in kidney or bladder frequently asymptomatic unless infections lead to investigation
▪ flank pain bc of distention of renal capsule
▪ obstruction of ureter causes an attack of renal colic
• intense spasms of pain in flank area, radiating into groin that last until stone passes or is removed
• pain is caused by vigorous contractions of ureter in an effort to force stone out
▪ N/V
▪ Cool moist skin
▪ Rapid pulse
o Dx
▪ Radiologic exam confirms locations of calculi
o Tx
▪ Small stones can be passed and urine strained to catch stones for analysis
▪ Fragmentation of larger stones
• Extracorporeal shockwave lithotripsy
o Uses sound waves to break up the stone
• Laser lithotripsy
o Uses a ureteroscope to locate the stone and a scope-mounted laser to destroy it
• Percutaneous nephrolithotomy
▪ Tx of underlying condition
▪ Adjustment of urine pH by ingestion of additional acidic or alkaline substance
▪ Increased fluid intake
Mechanism of action of medications
diuretic drugs
• referred to as “water pills”
• used to remove excess sodium ions and water from body
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