Implementation-renal failure - ANSWER Monitor fluid balance - Administer medications-
Monitor lab values - Mouth care- Skin care - Impact on individual, family and community
Hemodialysis - ANSWER Uses a dialyzing membrane unit
•Selective reabsorption maintains acid-base and electrolyte balance
Tubular Secretion - ANS •The third process in the formation of urine.
• Collecting system in the tubules is where concentration and secretion of urine takes
place. (1000-1500 mL per day)
•Daily minimum 500 mL u/o is required to excrete enough solute load to keep waste
products down in the blood.
•Urine flows from renal pelvis into the ureters and with smooth muscle peristalsis,
,moves into the bladder (holds 300-500mL) for storage.
Urine Storage - ANSWER Bladder: a muscular sac with stretch receptors; anatomic
capacity 1500-2000 mL, functional capacity 350 mL
Sympathetic and parasympathetic innervation and reflexes
Detrusor muscle contraction results in micturation; once completed, pressure drops
and efflux of urine resumes to replace urine in bladder. Residual urine volume 50 mL.
Urethra is outlet that carries urine to external meatus.
Bladder filling pressure must be low so that urine may easily exit the renal pelvis.
Which of the following best describes the glomerulus? - ANSWER The cluster of
capillaries where filtration takes place.
Osmolarity (L) and Osmolality (kg) - ANSWER •Concentration ratio of solute-substances
to water
•One litre liquid is equal to one kilogram, same examinations
•Isotonic, Hypertonic and Hypotonic are used for osmolarity.
•Control salt and water to maintain osmolarity.
•Very narrow range: with just a modest rise in solutes, the sensation of thirst is triggered
along with a urine excretion that minimizes water loss from the kidneys.
•Impaired cognition results in an inability to rehydrate which results in dehydration.
Which of the following is true or false?
A hypotonic solution would contain fewer molecules and more water than blood. -
ANSWER •True
Rationale: A hypotonic solution has fewer molecules and more water in the solution, less
, than 275 mOsm/L compared to the normal osmolality of the blood, which is between 275
to 295 mOsm/kg of body weight.
Assessment of the Patient
with Urinary Tract Dysfunction - ANSWER •Health History: Risk factors
•Chief complaints:
-Fatigue, short of breath
-Pain
-Changes in Voiding
-GI symptoms, mimics GI disorders
•Family and Social History
Physical Examination- Head-to-Toe
•Kidney palpation
•Abdominal inspection, auscultation, palpation, and percussion
•Bladder palpation and percussion
•Palpation of the prostate and inguinal area (males)
•Inspection and palpation of the female genitalia
•Assessment for edema and body weight
•Assessment of lower extremities
how to palpate kidneys - ANSWER under the 12th rib and costovertebral angle
Gerontologic Considerations - ANSWER •Structural and functional changes in upper and
lower urinary tract
•Steady decrease in GFR and renal reserve
•Prone to acute and chronic renal failure
•Increased risk for adverse drug reactions
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