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Copy of The Kidney

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Camille Jackson

on 7 March 2013

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Transcript of Copy of The Kidney

THE KIDNEY What Is It? Kidneys are a small pair of organs, located in the lower back, below the rib-cage. Each kidney hangs on either side of the spine. They appear as a bean-shaped figure, about the size of a fist. Behind the peritoneum or Retroperitoneal Main Function Functions of the kidneys ! Diagram!! Aging Process How does it work? The kidneys main function is to get rid of waste products (like urea) by transferring it from the blood, to the urine. The Kidneys Basic Parts and Their Functions Cortex- Contains parts of the nephrons called renal corpusles and convoluted tubules. Medulla- Is the center of the kidney. This is where the loops of Henle are found and the collecting tubules. The medulla has wedge-shaped pieces called renal pyramids. Renal Vein- Blood vessels that carry purified blood out of the kidney to the inferior vena cava. Renal artery- Carries blood from abdominal aorta to the kidneys. The blood in it contains glucose, oxygen and cellular waste products. Ureter- A long tube at the central portion of the kidney that funnels the urine to the bladder. -Glomerular filtration: B/P forces plasma and dissolved materials and small proteins out of the glomeruli into the Bowman's capsules.

-This fluid is called renal filtrate

- The glomerular filtration rate (GFR) is the amount of renal filtrate formed by the kidneys in 1 minute. Averae of 105=125 mL/min.

- The GFR is directly related to the blood flow changes and consequently the urine output will decrease or increase based on the GFR.

-Acid/Base balance is maintained by the kidney determining the acidity or alkalinity of the blood and secreting hydrogen or bicarbonate as needed to maintain the balance. Normal Urine Amount: 1000-2000 mL in a 24 hour peroid
Color: Straw or Amber
Clarity: Clear
Specific Gravity: 1.002-1.035
if lower than 1.002 the urine is dilute
if greater than 1.028 it is concentrated
pH: 4.6 to 8 with average being 6 Urine is composed of
95% water
5% is waste products
urea; creatinine and
uric acid Renal Mass is Smaller Renal Flow decreased to 50% Bladder capactiy decreases: Bladder Muscles Weaken KIDNEY WITH DISEASE HEALTHY KIDNEY Voiding Reflex is delayed -Form urine which excretes unneeded elements from the body i.e., byproducts of medications, foods etc.

-maintains the acid base balance

-Balance the body's fluids by conserving water or excreting water.

-Release hormones that control blood pressure

-Actives vitamin D and produces erythropoietin that stimulates erythrocyte production in bone marrow. Nephrons are the structural/functional units of the kidneys. Each kidney contains one million or more nephrons. Major portion of the nephron are the renal corpuscle and the renal tubule. Renal Pelvis is formed by the expansion of the
ureter within the kidney at the hilus. Atrophied Kidney Tubular Function Decreases Assessment Health History Pain Burning with Urination Edema; SOB; Weight Gain Fluid Intake Functional Ability Physical Assessment Vital signs
Lung Sounds
Daily weights
Presence of Edema
Intake and Output Laboratory Tests Common Test:
Urine Analysis
Requires 10 mL of urine
Can be voided urine or
catheterized specimen Urine Culture & Sensitivity:
Identifies if Bacteria is present
Needs to be done prior to antibiotics started
Determines what medications
bacteria is susceptible to, aiding in diagnosing and treatment Renal Functions:
Common Blood Tests:
Uric Acid;
Creatinine Clearance Radiological Studies Xray procedures to visualize
ureters, bladder, kidney

IVP: Intravenous Pyelogram

Renal Angiography Endoscopic Procedures Renal Ultrasound Biopsies Urinary Incontinence Stress Incontinence
Involuntary Loss of Urine from abdominal pressure Urge Incontinence
Involuntary Loss of Urine
Abrupt/Strong Desire to Void Functional Incontinence Related to mental or
physical impairment Overflow Incontinence
Involuntary loss due
to overdistention Total Incontinence
Continuous Unpredictable
Loss of Urine Urinary Retention Acute Retention
Local trauma to urinary structures
Medicatioins Chronic
Retention Enlarged Prostate
Strictures What do we do about Retention
Assess: output
Bladder distention
Scan the bladder for volume
Residual of 150-200 mL
requires treatment Residual means
the amount left after
the bladder is supposedly
empty Catheters Indwelling catheters These are placed for justifiable
reasons such as:
Neurogenic bladder WE DO NOT PLACE
CATHETERS FOR INCONTIENCE catheters are highest
incidence of infection Intermittent catheters
Reduce risk of infection
patients can self cath Suprapubic catheters
Inserted through the abdomen
in the lower area into bladder
Long term use Urinary Tract Infections Caused by invasion of bacteria
Women have them more often than men
why ???????
Contributing factors Aging
Men enlarged prostate
Women declining estrogen Predisposing Factors Stasis of urine
contamination from perianal area
reflux of urine
previous UTI's Symptoms of UTI (Patient reports) Dysuria (painful urination)
Cloudy/foul smelling urine Various diagnoses of UTI
Urethritis: inflammation of the urethra
Cystitis: inflammation or irritation of the bladder wall
Pyelonephritis: inflammation of the kidney Data collection by nurse
Dysuria, Flank Pain, Fever, Chills, Malaise
Urine Examined for Cloudiness, Blood, Foul Odor
Predisposing Factors
Urinalysis and Culture Results Nursing Care:
Assess symptoms
Assess I & O
Pain control
Patient Teaching:
Take ALL antibiotics till gone
Ways to prevent infection
cleanliness; no bubble baths
increase fluids
reduce caffeine consumption Obstructions: Obstruction of Urine Flow is Always Significant
Backup of Urine Destroys Kidney Types of Obstructions
Urethral Strictures:
Urethra Lumen Narrowing Due to Scar Tissue
Renal Calculi:
Hard, Generally Small Stones
Kidney Stones Pathophysiology
Urinary Salts Settle Out
Calcium Oxalate Most Common Etiology
Chronic Dehydration
Men Greater than Women Signs and Symptoms
GI Upset
Flank Pain
Renal Colic
Costovertebral Tenderness
Frequency Diagnosis
Kidney-Ureter-Bladder X-Ray
Intravenous Pyelogram (IVP)
Renal Ultrasound
Urinalysis Renal Calculi Therapeutic Interventions Small Stones Passed
IV Fluids
Pain Control
Thiazide Diuretics
Lithotripsy Renal Calculi Surgery Cystoscopy
Nephrostomy Tube Teaching aspects for Renal Calculi Prevention
Exercise Complications
Hydronephrosis Renal Calculi Nursing Care Monitor Symptoms Strain All Urine
Intake and Output Pain Control
Hydration Teaching Nursing Diagnoses Acute Pain
Risk for Infection
Deficient Knowledge
Impaired Urinary Elimination
Risk for Injury
Stress Incontinence
Urge Incontinence
Functional Urinary Incontinence
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