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2. Ureters
1. Each kidney has one and each about 12 inches long
2. Peristalsis propels urine from renal pelvis to bladder
blood pressure, and (2) Nervous and Endocrine system which must detect a loss of
homeostasis and adjust accordingly
3. Endocrine secretions
a. Renin--a hormone stored in the JGA sensitive to volume flow through kidney;
secreted in response to low perfusion through kidney and causes
vasoconstriction, stimulates secretion of aldosterone from adrenal gland
which causes retention of Na and water and thus an increase in BP.
b. Erythropoietin
2. Physical Assessment
a. Inspection
b. Auscultation for bruits over aorta and renal arteries [mid clav. line] (+ = narrowing)
c. Palpation of kidneys
d. Determination of pain
e. Integumentary status--color (yellow, gray or pale with renal disease), dry skin with
CRF and fluid volume depletion; crystal deposits with CRF (uremic frost)
f. Fluid status--I and O, wt gain/loss, mucus membranes, edema (peripheral, periorbital,
sacral)
g. Neurologic status
h. Musculoskeletal status--tone, ability to handle urinary elimination needs,
i. CV status--BP specific to urinary tract
j. Resp. Status--Acid-Base balance, ketoacidosis, uremic fetor
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2. pH--4.5 - 8
b. RBCs
2. Culture
a. in voided spec., UTI if bacteria > 100,000/ml;
b. in sterile cath spec., UTI if bacteria > 10,000/ ml
d. Sodium
e. Glucose
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f. Ketones
g. Protein
c. Blood tests
1. BUN --Normal 7 – 20 (definitely less than 30)
d. Bladder scan—to determine urine left in bladder after voiding (normal < 50 mL)
e. Renal Ultrasound
f. Radiologic Tests
1. KUB
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2 IVP
3. Retrograde Pyelogram
4. Renal Angiography
5. Renal Scan
6. MRI
7. CT
g. Surgical Procedures
1. Cystoscopy (Cysto
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2. Renal Biopsy
a. DM
c. HTN
d. Shock or hypotension
2. Infections
a. UTI
1. DX
2. Types
a. Lower UTI
1. Urethritis
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2. Cystitis
b. Upper UTI
1. Pyelonephritis
a. Acute Pyelonephritis
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b. Chronic Pyelonephritis
d. Causes
e. Symptoms
f. DX of chronic glomerulonephritis
g. TX of chronic glomerulonephritis
3. Treatment of UTI
a. Antibiotics (Yeast vaginitis frequently occurs secondary to
antibiotics, and is more difficult and more costly to
treat than the original UTI.); Must finish prescribed
course
Amoxacillin
Ampicillin
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Bactrim
Cipro
Flagyl
Garamycin
Levaquin
Macrodantin
b. Analgesics
Pyridium (urinary analgesic—urine orange) available OTC
c. Antispasmodics
(B& O suppository)
Ditropan
3. Urethral Syndrome
a. Causes
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b. Risk factors
c. Symptoms
4. Interstitial Cystitis
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5. Glomerulonephritis
a. Acute Glomerulonephritis
b. Chronic Glomerulonephritis
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On GU pts., monitor T q 4 hrs. Check 1 hr after Antipyretics--you may find pt dripping wet and
in need of drying. Also, may need to call MD and get order for something else.
Normal fluid intake is 1500 - 2000 cc per day. Increased means 2500 - 3000 cc per day.
Typical Renal Diet: 20-40 Gm Protein, 500mg Na, 40 meq K, 600-1000cc
of fluid plus urine output for last 24 hrs. Insensible fluid loss is normally about 900cc per
day; This increases with exercise and fever.
Acid-Ash Diet: cranberry, plum, prune juice--inhibit bacterial growth, but acidic urine can
interfere with antibiotics.
Be sure to teach pt. to take all of antibiotics prescribed. Many will stop once they feel better--to
save some for next time--then develop a resistant strain of bacteria.
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Follow up exams, UA, etc, very important also.--Many won't return because they feel
better and don't see any reason to come back, then they develop a resistant strain and
become sicker than before. Provide verbal and written instruction to pts and families.