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NUR NUR 545 Final exam study guide
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NR 545 Final exam Study GuideThe final exam includes content from weeks 1-8. The deadline for this exam is Saturday evening at 11:50 pm. Week 8 closes on Saturday not Sunday.
Week 7 : renal and urological disorders
• 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
From heart; 3rd 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
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
, 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
increases excretion of water through kidneys and urinary output
reduces fluid volume in tissues (edema) and blood
prescribed for
o HTN, edema, CHF, liver dz and pulmonary edema
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