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Topics Discussed Here Are: 1. Anatomy and Physiology of the Renal System 2. Functions of the Kidney 3. Assessment of the Renal System 4. Diagnostic Procedures
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Urethra If in the Event Function: For the passageway of urine to the outside Female Urethras are more shorter, a. Male: (Size and Function) then they are more at risk for UTI / Ascending infections 1. Excretion of urine 2. Reproduction (Passage of semen) b. Female: (Size differs from male) 1. Excretion of urine ONLY Nursing Consideration Correct technique of perineal care (UP DOWN) Urethritis Males have a much larger emotional IMPACT
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Saturday woke up at 8:30 AM, DISCARD and not part of the 24 Hour urine collection But when urinated at 9:00 AM, already a part of the collection
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Regulation of Electrolytes Sodium (Na) [135 145 mEq/L) If in the Event Most ABUNDANT electrolyte in the ECF! There is more INTAKE of Na Normal Intake: 6 8 grams Then there would be OVERHYDRATION! Function: Where Na goes, H2O goes Potassium (K) [3.5 5.5 mEq/L] Most ABUNDANT electrolyte in the ICF Normal Intake: 6 8 grams o The amount of Na and K passed out is affected by Aldosterone o Dietary Intake: K Diet = Hyperkalemia K Diet = Hypokalemia GREATEST PROBLEM IS WHEN K CANNOT BE EXCRETED ( Contraction of HEART)
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Regulates Acid-Base Balance Two Functions of the kidneys for regulating acid-base balance i. REABSORPTION of BICARBONATE Tubular Reabsorption Brings back the HCO3 to the circulation ii. EXCRETION of URIC ACID Tubular Excretion Control of H2O Balance Controlled through URINE OUTPUT Amount of fluid intake should be equal to the output
If in the Event Fluid intake (DILUTED URINE) Fluid intake (CONCENTRATED URINE)
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Control of Blood Pressure Vasa Recta Special type of blood vessel Responsible for recognizing pressure on the blood vessel Renal Clearance Ability of the kidney to CLEAR solutes from the plasma To perform: Use the 24 Hour Urine Collection Production of erythropoietin or regulation of RBC production Erythropoietin Bone Marrow Erythropoiesis
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Synthesis of Vitamin D to its active FORM Functions of Vitamin D o To maintain the normal balance of Ca in the body o Sun is a good source for Vitamin D (Infants are exposed under the sun for 10 15 minutes) o 1,25 dihydroxycholecalciferol
10. Production of PROSTAGLANDIN Produces VASODILATION To maintain the normal renal blood flow~ Functions of the Kidney~ (Gsto ko lang isa-isahin ulit ) Urine Formation 6. Control of Blood Pressure Excretion of waste products 7. Renal Clearance Regulation of Electrolytes 8. Production of erythropoietin or regulation of Regulates Acid-Base Balance RBC production Control of H2O Balance 9. Synthesis of Vitamin D to its active FORM 10. Production of PROSTAGLANDIN
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Physical Assessment
1. 2. 3. 4. Inspection Palpation Auscultation Percussion
INSPECTION
Only modality USED o Is there presence of edema? o Bloating? o Periorbital edema? o Clubbed fingers? o Ascites? o Peripheral edema (Lower Extremities)
PALPATION
Can also be done: Patient is lying down Right hand / left hand under the patient depending upon the side Palpate and ask patient to inhale and exhale
AUSCULTATION
Assess for presence of renal stenosis o Shock, CO Blood flow to the kidneys Narrowing of renal arteries o Bruit Sound Indication of difficulty of blood getting through a narrowed vessel (Renal Artery Stenosis)
PERCUSSION
Percussion of the Urinary Bladder is important! Percussion CANNOT BE DONE not until the urinary bladder is distended
Diagnostic Procedures
1. Urinalysis Supposed to get the 1st VOIDED urine (Mid-stream catch) Most basic urine test for kidneys and excretory Expect to See Color: o Normal (Amber) o Dehydration (Dark Yellow) Highly Concentrated o Overhydrated (Light Yellow) Highly Diluted o Bleeding (Tea-colored) o Drug Induced (Blue / Green Colored) Clarity o Transparent (Clear) o Turbid (Cloudy) INFECTION!! Positive (+) Pus / WBC o Supposed to be (NEGATIVE) [-] o If cloudy / turbid and (+) for pus/WBC then it is INFECTION Look for level of RBC, should be (-) o Tea colored and (+) RBC o BLEEDING due to STONE FORMATION
After collection of urine, it should be brought to the lab within 30 mins! If in the event that it cannot be brought to the lab immediately, it should be refrigerated! NOT SUPPOSED TO ALLOW IT TO STAY! o Because if it remains in room temperature, it may come in contact with microorganisms within the environment and it can become CONTAMINATED !
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Urine Culture and Sensitivity Test a. Can be taken anytime of the day b. Supposed to be sterile urine specimen c. Ideally speaking, client should be catheterized d. Client must clean perineal area and mid-stream catch e. Should not have taken any antibiotics for 2 3 days CULTURE Identification of microorganism SENSITIVITY What drug the microorganism responds to 2. Renal Function Test Used to determine the ability of the kidney to excrete waste products of metabolism Creatinine Urea BUN Determines the Urine Specific Gravity (N: 1.000 1.03) Urine Specific Gravity means the ability of the kidney to CONCENTRATE solutes within the urine Determines the Urine Osmolality (N: 300 900 mOsm/kg/24 hours) Urine Osmolality is the ability of the kidney to DILUTE / CONCENTRATE the urine Creatinine: 1. Urine (24 hour urine collection) 2. Assess the level of Serum Creatinine (Through the BLOOD) Imaging Procedures a. KUB (Kidney Ureter Bladder) Is the X-RAY of the abdomen to visualize the KIDNEY, URETER and BLADDER It can determine: IMPORTANT in CARE of Gen. Utz 1. Number of functioning kidneys FULL BLADDER before performing 2. Size (Small, large, abnormal) procedure 3. Ureters (Patency, strictures, mass) Cannot proceed if bladder is EMPTY!! b. General Ultrasonography (Utz) General Abdominal Ultrasonography It differs from KUB because General Utz uses the principle of SOUND with a transducer b. c. CAT Scan d. MRI e. Intravenous Urography It is visualization of the Kidney, Ureters and Bladder, but uses a CONTRAST MEDIA per IV IMPORTANT: Assess clients history of allergic reaction to SEA FOODS!! Do SKIN TESTING f. Retrograde Pyelography Visualization of Kidney, Bladder and Ureters BUT! Contrast media is NOT GIVEN per IV, but directly to the URETHRA up to the URINARY BLADDER, URETERS and KIDNEYS Uses a CYSTOSCOPE to insert a catheter to introduce a radiopaque dye followed by a series of X-rays g. Cystography SPECIFIC FOR THE URAINARY BLADDER ONLY! Used to assess if the bladder is traumatized (Due to accidents such as; falls, vehicular accidents, stab wounds) Uses contrast media
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h. Renal Angiography Visualization of RENAL ARTERIES by use of a radiopaque dye To assess if blood flow to the kidney is enough or patent IMPORTANT: Get CONSENT NPO (6 8 hours prior to procedure) Produce a CLEAR COLON To have a BETTER visualization of renal arteries 1. Laxatives 2. Enemas ENDOSCOPIC EXAMINATION Cystoscopy (Visualization of the urinary bladder) 4. Biopsy To get a piece of tissue, not merely brushing! a. Urethral Brushing Kind of like a Pap Smear Uses a brush to wipe mass and into a slide b. Renal Biopsy Through the use of a LAPAROSCOPE, a lighted instrument Makes an incision on flank area Pinch like a stapler and get a piece of TISSUE And put on a slide to check if its malignant or not Important Nursing Care in BIOPSY Before: o Doctor should first KNOW the CLOTTING TIME OF THE CLIENT! o Place the patient on NPO After: (Situation) o Biopsy: Right kidney had just gone biopsy o Position: Place the client on a PRONE position Place a pillow on the right side to promote PRESSURE and prevent possibility of BLEEDING Assess if patient is BLEEDING! WOF: Urine OUTPUT!
8:00 AM
12:00 PM
3:00 PM
Lighter in color
Lighter in color
REMEMBER! FIRST 24 48 HOURS BLEEDING IS NORMAL But if about 4 days and more, the BLEEDING IS ABNORMAL!!
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