Urinary System Function - Assessment Notes

URINARY BYSTEM ASSESSMENT STRUCTURE FUNCTION 1. regulate volume H₂O ADH Aldosterone 2. control bisou pressure renin alwobkrone system 3. erythropoietin (kiency foliore anemic] 4. cothrate vit D 5. regulare acla- bare balance 4 maintain BOF PH: 7.35-7.46 bicarbonate reabsorbed; hydrogen lans: scortard MICROSTRUCTURE nephron functional unit LABS creatinine & BUN normal glomerular filtration rate Core) 125ml/min Distal Tubule regulation of Nat nyperxesernia kidney failorz BLADDER: STRUCTURE FUNCTION reservoir for urine normal adult urine outpor 1500mLiday 200-250m mila diskunion 4bb-born moderac distention. 400-1000mL capacity GERONTOLOGIC CONSIDERATIONS Changes *1056 of 50% of glomeruli ↓ size of renal kidneys GFR RENIN-ANGIOTENSIN ALDOSTERONE SYSTEM regulation of BP renin secreted to: (Nat) [Na] & renal perfusiση ↓arterial BP angiotensin 11: + vasoconstriction188 Na water retention BP inhibits renin release "aldosterone retains H2O + Nat ASSESSMENT FINDINGS "chine, cognitive changes Facial periorbital edema CVA Tenderness dysuria Flank pain DIAGNOSTIC STUDIES radiologic studies bowel prep to onnance visualization magnesiom citrate & fleet enema do not use volviany fallure altered hormones & ability to concentrare urine. urethra •female stress incontinence: "Haking" males enlarged prostate NEPROTOXIC Аббить contrast dye Clodine) lodine -based contrast maintain hydration NPO DO NOT USE antibacterial vancomycin (trough: 10-20; peak: Inr] ithium •illegal drugs cephalosporins gentamicin antifungals: amphotericin 8 antivirals: acyclovir administer N-acetylcyskine to reduce CIN magnesium containing laxatires nypermagnesemia phosphate containing laxatives nyperphosphatemia mineral oil aspiration risk. fruittax contains k = hyperkal. CLEAN CATCH TECHNIQUE NO1 Sterile Femals spread labia wipe front to back. Male xolpe glans pents no antiseptic DIAGNOSTIC STUDIES 1. urinalysis 1st morning vaid check win thr PHI 4.4-8 color: light yellow-amber 561-005-1-030 Bogin to vola 1-2 seconds: stop stream collect in sterile cup minimal to no protin no WBCs or nitrites no glucose, ketones refrigerate Immediately. URINE COLLECTIONS CATHETER 1. tramp tubing: walt 16-30mins 2. scrub hub olaicone 30secs 3. sterile syringe to withdraw 10-20mL 4. transfer to storile cop 5. unclamp tubing POST VOID RESIDUAL LOVE) checks how much urine is in braader pt retaining urine or no 3. Blood Chemistry 'Sodium 136-145 potassium 3.0-5.0 'bicarb: 22-२७ calcium, toral: 9-10.5 UROLOGY DIAGNOSTIC STUDIES KUB: abdominal xray 2. creatinine cicarance moon accurate 24hr collection approximates R discard 1st voi to Sh Save for ay tirs refrigerate/keep on ke phosphorus: 3.0-4-6 creatinine: 0.5-1.2 BUN: 10-20 shows site, shape position of kidneys CT shows stones, Obstruction, intection, trauma CYSTOSCOPY vis valizes interior of bladder used insert catheters, remore stones, obtain biopsies local anesthesia conscious sedation. PRIDE force Fluid INS Informed consent AFTER: expect pink-tinged urine burning, frequency brighe to buwaingiferer, severe paint RETROGRADE PYELOGRAM same postop as cystoscope inserted into ureters contrast media: xrays painful conscious sedation take 15-30mins CYSTOGRAM radioactive solution takes pictures Indications dysfunctional voiding neurs genic bladder UTIS Stones, tumor RENAL ARTERIOGRAM visualizes renal blood vessels. neca bowel prep cam Inserted imo femoral a. "Contrast diye postop! same as cardiac cath INTRAVENOUS PYELOGRAM CIVP) shows urinary tract W contort do not do il renal failure need bowel preρ fore fivias RENAL BIOPSY pre procedure obtain consern, assess coagulation status, STOP NSAIDS. ASA warfarin *contra: busding disorder, single kidney, & uncontrolled HTN "post procedure: pressure dressing keep on affected side 30-60ming ood rest frequent vs watch for bueding no heavy lifting: 5-7 days