Exam NR 545 Final exam Study Guide The final exam includes content from weeks 1-8.

• 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