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WorksheetsRenal
Total questions: 85
Worksheet time: 3600secs
True or false.
Serum creatinine levels are slightly higher in men than women because men tend to have a larger muscle mass than women do
True
False
What does an elevated creatine level means?
(a)
Bun measures the effective of kidney excretion of
creatine level
urea nitrogen
protein
muscle mass
A serum creatine of (a) or greater place a patient at risk for acute kidney injury from iodinated contrast media and some drugs.
Notify provider of increases in serum creatinine greater than_________baseline and urine ouput values of less than ________for 6 hours or more hours.
(a)
Bun is not always elevated with kidney disease and is not the best indicator of kidney function. What are other reasons for Bun elevations?
dehydration
infection
low cardiac output
cancer treatment
steriod therapy
When elevation of both serum creatinine and BUN levels rises this may suggests (a) that not related to dehydration or poor perfusion
Normal blood osmolarity
350-400
100-120
0-20
280-300
What happens when blood osmolarity is decreased
(a)
What happened when blood osmolarity is increased?
vasopressin causes increase in water reabsorptions in the distal tubules as a result blood osmolarity is decreased
vasopressin causes decrease in water reabsorptions in the distal tubules as a result blood osmolarity is increase
vasopressin causes and equalization in water reabsorptions in the distal tubules as a result blood osmolarity is equalizes
What considered normal for urine?
dark amber
yellow and clear
ammonia smell
cloudy
protein
What is urine ph affected by?
drugs
infection
diet
acid balances disturbances
kidney tubular function
High protein diet produces________urine whereas high intake of citrus fruits produces _______urine
(a)
Best practices: Why never leave urine standing unrefrigerated for more than 1 hour, when bacteria are present or specimen is left uncovered.
causes specimen to become acidic which causes the white blood cell to denigrate
Alkaline urine, increases cell breakdown , thus presence of red blood cells may be missed on analysis
Acidic urine, decreases the ph. of urine, thus making urine more prone to bacteria.
Protein is not normal present in the urine. Microalbumin levels greater than ___________are abnormal
100 mcg /48hr
80mcg/48hr
80mcg/24hr
120mcg/36hr
What causes the glomerular membrane not be intact, causing protein molecules pass through?
infection
diabetes(immunologic problems)
albumin
inflammation
GFR greater than 125
how is microalbuminuria measured?
dip stick for urine greater than 24hrs
specialized assays freshly voided urine
Clean catch
What is the level indicate microalbumin or kidney diseases for fresh voided urine and for 24-hour urine
(a)
What is consider a high level of glucose in the urine
>350
>220
>150
>800
What does Renin do?
lowers blood pressure
raises blood pressure
causes vasodilation
What does erythropoietin do?
(a)
what happens with erythropoietin production when kidney function is poor?
production decrease and anemia results
production increases and polycythemia results
nothing, kidney and erythropoietin are not related
Vitamin D is activated in the kidney. Activated vitamin D is needed to _________________________.
absorb inactivated vitamin D through intestinal tract and regulate calcium balance
absorb calcium in intestinal tract and regulate calcium balance
What vasopressin hormone do?
Makes PCT and loope of henel permeable to water to maxmize excretion and produce diluted urine
Makes PCT and CD permeable to water to eliminated reabsorption and produce a concentrated urine.
Makes DCT and CD permeable to water to maxmize reabsorption and produce a concentrated urine.
Makes glomerus permeable to water to eliminate reabsorption and produce a concentrated urine.
What aldosterone do?
Promotes sodium, water and chloride reabsorption and potassium secretion in DCT and collecting ducts
Promotes potassium reabsorption and sodium, water and chloride secretion in DCT and collecting ducts
Promotes reabsorption and calcium secretion in DCT and collecting ducts
nursing interventions for decreased glomerular filtration rate
monitor hydration status- the ability to regulate water decreases with age
Ensure adequate intake-The kidneys are less able to conserve water when necessary.
Administer potentially nephrotoxic agents or drugs carefully- dehydration reduces kidney blood flood and increases nephrotoxic potential many agents.
what is GRF?(glomerular filtration rate)? normal rate?
indicator of how well heart is working, rate as which heart is pumping per minute
indicator of how well kidney are functioning, rate as which kidney cleaning blood per minute
125ml/min
145 ml/min
65 ml/min
intervention for nocturia
Ensure adequate nighttime lighting and hazard-free environment
Ensure availability of a bedside toilet, bedpan, or urinal
Discourage excessive fluid intake 2-4 hr before the patient goes to bed
Evaluate drug timing
intervention for decrease bladder capacity
Encourage the use of the toilet, bedpan, or urinal at least every 2 hr- emptying bladder or a regular basis may avoid overflow urinary incontinence.
Respond as soon as possible to the patient's indication of the need to void. a quick response may alleviate episodes of urinary stress
intervention for weakened urinary sphincters and shortened urethrae in women
(a)
intervention for tendency to retain urine
observe patient for urinary retention
provide privacy, assistance, and voiding stimulants such as warm water over the perineum as needed
Evaluate drugs for possible contribution to retention
what chronic health problems are at increase risks for development kidney disease?
asthma
hypertension
SIADH
diabetes mellitus
diabetic inspidus
why is it important for nurse to teach patient to drink at least 2l of water a day?
to prevent dehydration
to promote over hydration
to help with fluid overload
to prevent cystitis
What are some thing needed to be assess for to evaluate kidney function
Assess chemical exposure at work(hydocardon, mercury, lead, gases)
Assess use of heroin, cocaine, methamphetamine, ectasy.
Assess pregnant women for protenuria, highblood pressure, gestational diabetes, UTI
Assess for recent trauma or injury to the abdomen or pelvic or genital areas.
Assess exposure to contrast during doing imaging.
Assess SES -lack of insurance to assess health care, lack of transportation, income
Assess Educational level
Assess patient's belief
Assess language
A high protein intake with poor fluid intake may cause
dehydration
calculi(stone)
ingestion
polycythemia
Why nurse want to assess patient for appetite or taste changes?
indicates diabetes as result from elevated sugar
indicates nitrogenous waste build up result from kidney failure
indicates hypernatremia as result from dehydration.
what prescribed drugs affect the kidney
drugs for diabetes, hypertension, cardiac disorder, hormonal, cancer, pyschiatric disorder
morphine
Gentamicin
high doses or longterm NSAIDS AND ACETAMINOPHEN
dietary supplements such as creatine
why is it important for nurse to teach patient to drink at least 2l of water a day?
to prevent dehydration
to promote over hydration
to help with fluid overload
to prevent cystitis
Genetic kidney disorders?
polycystic kidney disease(can occur in either gender)
nephritis(inflammation process)
nephrosis(degenerative process in the kidney)
ESRD
Ureamia
changes in urinary patterns? (means)
a. incontinences
b. urgency
c. nycturia
(a)
Pain severe and spasmodic is associated with
kidney and ureteral irriatation
renal colic
UTI
polycystic
Pain that radiates into the perineal area, groin scrotum or labia is described as
Severe
UTI
Renal colic
spasmodic
Symptoms of renal colic pain
hypertension, fever, nausea
hypotension, diaphoresis, pallor
diaphoresis, edema, tachycardia
fever, tachycardia, hypotension.
Uremia is buildup of nitrogenous waste production in the blood from inadequate elimination as result kidney failure. what are symptoms of uremia?
anorexia, nausea, vomiting
pruritus(itching)
fever
muscle cramps/
fatigue and lethargy
If tumor or aneurysm is suspected, never ? and why
bathe may cause harm the patient
flex the leg, may cause aneurysm to dislodge
palpate may cause harm the patient
Serum creatinine is produced when
muscle and calcium broken down
muscle and protein broken down
muscle and waste broken down
Bun measures
the effectiveness of excretion of urea nitrogen, a by product of protein break down in the liver.
the effectiveness of secretion of urea nitrogen, produce by liver
the effectiveness of secretions of serum creatinine
normal creatine males and female
(a)
what causes an elevation in serum creatine?
heart failure
kidney failure
hypertension
kidney stones
what causes a decrease in serum creatine?
kidney failures
decrease muscle mass
increase muscle mass
renal colic
Serum creatine and Bun is what in older age adult?
(a)
normal BUN?
(a)
An increased in Bun indicates?
liver and kidney disease
dehydration or decreased kidney perfusion
high protein diet
infection/ steriod use/ GI bleed
stress
A decreased BUN level may indicate?
malnutrition
heart failure
fluid volume excess
severe hepatic damage
bun and creatinine ration
10-15
25-40
6-25
8-16
increase bun/creation indicates(hint think about Bun)
(a)
decrease in bun/creatine ration indicates
fluid excess
dehydration
malnutrition
severe hepatic damage
normal range for blood osmolarity
150 to 200
280 to 300
19 to 300
65-1mm
what happens to vasopressin when blood osmolarity is decreased
vasopressin is secreted, causing water to be absorbed in the distal tubules
no effects on vasopressin
vasopressin causes dilation which more water to dilute which raise in blood osmolarity
vasopressin is inhibited, causing water to be excreted in distal tubules causes raise in blood osmolarity
what happens when blood osmolarity is increased?
(a)
what is the normal specific gravity?
(a)
what causes an high specific gravity? (more concentrated)
dehydration
decreased urine blood flow
excess vasopressin with stress, surgery, anesthetic agent(morphine, oral antidiabetic drugs)
SIADH
high fluid intake
what causes low specific gravity?(more diluted)
dehydration
lasix
high fluid intake
diabetes insipidus
SIADH
A decreased BUN level may indicate?
malnutrition
heart failure
fluid volume excess
severe hepatic damage
Normal blood osmolarity
350-400
100-120
0-20
280-300
WHAT AFFECTS URINE PH
DIET
STRESS
DRUGS
KIDNEY TUBULAR FUNCTION
NEPHRON
1. PROTEIN MAKES THE URINE ACIDIC OR ALKALINE
2. CITRUS FRUIT MAKES THE URINE ACIDIC OR ALKALINE
(a)
What happens to a urine specimen if left out for more than an 1hour?
specimen becomes more alkaline thus increasing cell break down
specimen becomes more acidic thus decreasing cell build
its ok to leave specimen out for more than an hour
place the specimen on ice if its out for more than an hour
Glucose greater than 220 in urine indicates
hyperglycemia
CHF
hypoglycemia
renal threshold for glucose occur temporarily in patient with infection or sever stress.
Ketones indicates
strenuous exercise
anorexia nervosa
ketoacidosis
prolonged fasting
A client has protein in the urine. What is the significance of these?
indicate stress
infection
urinary tract infection
recent strenuous exercise
glomerular disorder
bacteria, leukesterace and nitrites in urine indicates
PREGNACY
DIABETES
UTI
KIDNEY DYSFUNCTION
Red blood cells in urine indicates
kidney trauma
UTI
glomerulonephritis
acute tubular necorsis
pyeloephritis
white blood cell indicates
UTI
KIDNEY INFECTION
ACUTE TUBULAR NECROSIS
KETONES
what an increased cast indicates
protein
bacteria
diabetic ketoacidosis
urinary calcui
What parasites indicates
presence Trichomonas vaginalis
presence of urinary tract infection
presence of urinary Escherichia coli
Leukocyte esterase indicates
presence of trichomonas vaginalis
presence urinary tract infection
presence of urinary escherichia coli.
Nitrates indicates
presence of trichomas vaginalis
UTI
Esherichia coli
Ketones
Doctor ordered for urine sample. What nursing intervention and rational
First voided sample in the morning.
RT urine more concentrated in the early morning.
Send specimen to lab asap
RT after urine collected, cellular breakdown results in more alkaline urine
Refrigerate the specimen if a delay is unavoidable
RT bacteria are more likely to multiply in an alkaline environment
Dr. orders a clean check explain procedure with rationales.
Instruct pt to self-clean before voiding
RT is necessary to remove secretion or bacteria from urethral meatus.
Instruct patient to initiate voiding after cleaning. The patient then stops and resumes voiding into the container.
RT midstream removes secretions and bacteria
no part patient anatomy should touch cup. only 1 ounce (30ml is needed) and the rest discarded.
Catharized specimen intervention
1.clamp the drainage tubing, distal to injection port
RT clamping allows urine to collect in the tubing at the location where specimen is obtained
2. clean injection port cap with an antiseptic and allow to dry.
RT surface contamination is prevented
3. attach 5ml syringe and aspirate. RT minimum 5ml is needed for culture and sensitivity
4. Inject sample into sterile container. RT sterile container is used for C&S specimen
24-hr collection urine is necessary to calculate the rate of clearance of a particular substance
inform personnel and family caregivers of test in progress. RT instructional material for pt., signs remind patients and staff to ensure that the total collection is completed
check laboratory or procedure manual on proper technique for maintain the collection(on ice, refrigerator, or with preservative RT to prevent breakdown of elements to be measured.
On initiation of the collection, ask the pt to void, discard the urine and note the time.
collect all urine of the next 24hr
Do not remove urine from the collection container for other specimen RT: urine in the container is not considered a fresh specimen and may be mixed with preservative.
what measures are used to collect urine specimen for culture and sensitivity?
voided urine
24-hour urine
clean catch
catheterized specimen
Creatine clearance measures? what influences the expected excreted creatinine.
(a)
what is the difference in serum creatinine and creatinine clearance?
(a)
