NR 545 Final Exam Study Guide

The final exam includes content from weeks 1-8. The deadline for this exam is Saturday evening at 11:50 pm. Week 8 closes on Saturday not Sunday. Week 7 : renal and urological disorders • Questions can include pathophysiology, health assessment (normal and abnormal), and pharmacologic treatment • Review required readings, course lectures, case study and learning activity. Fluid and electrolyte balance- processes in the kidney  Hormones controls reabsorption of fluid and electrolytes o Antidiuretic hormone  From posterior pituitary; controls reabsorption of water by altering permeability of distal convoluted tubule and collecting duct o Aldosterone  Secreted by adrenal cortex; controls sodium reabsorption and water by exchanging Na ions for K or hydrogen ions in distal convoluted tubule o Atrial natriuretic hormone  From heart; 3rd hormone controlling fluid balance by reducing Na and fluid reabsorption in kidneys Renal circulation process Laboratory testing- purpose and interpretation ; Age related urinary changes ; Conditions/diagnoses associated with urine color changes Diagnostic test  Urinalysis o Constituents and characteristics of urine may vary w/ dietary intake, drugs, and care w/ which specimen is handled o Urine is normally: clear, straw colored and has mild color o Urine pH is 4.5-8.0 o Appearance  Cloudy indicate presence of large amounts of protein, blood cells or bacteria and pus  Dark color indicate hematuria (blood), excessive bilirubin content or highly concentrated urine  Unpleasant or unusual odor indicate infection or result from certain dietary components or medications o Abnormal constituents (present in significant quantities)  Blood (hematuria)  small (microscopic) amounts of blood indicates infection, inflammation, or tumors in urinary tract  large numbers of RBC (gross hematuria) indicates increased glomerular permeability or hemorrhage in tract  protein (proteinuria, albuminuria)  indicates leakage of albumin or mixed plasma proteins into filtrate d/t inflammation and increased glomerular permeability  bacteria (bacteriuria) and pus (pyuria)  indicates infection in urinary tract  urinary casts (microscopic sized molds of tubules, consisting of one or more cells (bacteria, protein, and so on))  indicates inflammation of kidney tubules  specific gravity  indicates ability of tubules to concentrate the urine  very low specific gravity= dilute urine; related to renal failure  glucose and ketones (ketoacids)  found when DM is not well controlled  blood test o elevated serum urea (BUN and Cr)  indicate failure to excrete nitrogen wastes d/t decreased GFR  results from protein metabolism o metabolic acidosis (decreased pH and Bicarb)  indicate decreased GFR and failure of tubules to control acid-base balance o anemia (low hgb)  indicated decreased erythropoietin secretion and/or bone marrow depression d/t accumulated wastes o electrolytes  depend on related fluid balance  retention of fluid= GFR is decreased and may result in dilution effect o antibody level antistreptolysin O (ASO) or antistreptokinase (ASK)  used for dx of post-streptococcal glomerulonephritis o renin  indicate cause of HTN  other test o culture and sensitivity on urine specimens  used to identify the causative organism in urinary infection and select drug tx o clearance test such as Cr or insulin clearance or radioisotopestudy  used to assess GFR o radiologic test such as radionuclide imagining, angiography, US, CT, MRI and IV pyelography(IVP)  used to visualize structures and abnormalities in urinary system o cystoscopy  visualizes lower urinary tract and may be used in performing a biopsy or removing kidney stones