NR 545 Final Exam Study Guide 2020

NR 545 Final exam Study Guide
The 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