medsurge 2

Renal Cortex:
- Forms the outer region of the kidney.
Renal Medulla:
- Forms the inner region of the kidney.
Renal Columns:
- Extensions from the renal cortex that divide the interior region into cone-shaped sections.
Renal Pyramids:
- Cone-shaped sections consisting of tubules that transport urine away from the cortex.
- The base faces outward toward the cortex, and the renal papilla, located at the point, faces the hilum.
Major Calyx:
- Formed by joining two or three minor calyces that collect urine leaving the renal papilla.
Renal Pelvis:
- Convergence of major calyces which receives urine before it channels into the ureter, leading to the urinary bladder.

Function: Basic unit of kidney function involved in filtration and urine formation.
Structure:
1. Afferent Arterioles: Supply blood to each nephron.
2. Glomerulus: A cluster of capillaries where filtration occurs, enclosed by Bowman's capsule.
3. Efferent Arteriole: Exits the glomerulus and leads to peritubular capillaries.
4. Peritubular Capillaries: Surround the renal tubules, allowing for reabsorption of water and solutes.
Blood Flow: From afferent arterioles to glomerulus, then through efferent arterioles to peritubular capillaries, eventually returning to the renal vein.

Formation of Urine:
Excretion of Water:
Electrolyte Balance:
Acid–Base Balance:
Activation of Vitamin D:
Production of Erythropoietin: Hormones that stimulate red blood cell production.
Production of Renin: Enzyme that regulates blood pressure.

Renal Corpuscle Components:
- Bowman's Capsule
- Visceral Layer: Innermost layer enveloping glomerulus.
- Parietal Layer: Outer layer of Bowman's capsule.
- Capsular Space: Contains ultrafiltrate from blood filtration.
- Filtration Membrane: Separates blood in glomerulus from capsular space.

Ureters:
- Carry urine from kidney to bladder.
Bladder:
- Temporary storage for urine.
- Facilitates elimination through the urethra.

Amount: 1,000 to 2,000 milliliters per 24 hours.
Color: Pale yellow to amber.
Appearance: Clear.
Specific Gravity: 1.005 to 1.030.
- Lower values indicate dilute urine; higher values indicate concentrated urine.
pH: Ranges from 4.5 to 8.0.
Constituents:
- 95% water, waste products include urea, creatinine, uric acid.

Health History:
- Pain in flank area, dysuria, new onset edema, shortness of breath, weight gain, functional ability.

Vital Signs: High blood pressure may indicate kidney disease.
Lung Sounds: Crackles may indicate fluid overload.
Edema: Indicates fluid overload.
Daily Weights: Best indicator of fluid balance; critical for monitoring intake and output and medication orders.
Skin Assessment: Check for yellow or gray cast, signs of uremic frost.

24-hour Urine Collection:
- Proper collection is critical for accuracy; discarded urine at start, final collection at end of 24 hours.
Urine Culture:
- Identifies pathogens and requires collection before initiating antibiotics.
Sensitivity Testing: Identifies appropriate antibiotic for treatment.
Blood Tests:
- Blood Urea Nitrogen (BUN): Normal range is 7-20 mg/dL; elevated with kidney dysfunction.
- Serum Creatinine (Cr): Normal range is <1.2 mg/dL for females and <1.4 mg/dL for males; indicates muscle metabolite clearance.
- Glomerular Filtration Rate (GFR): Normal is ≥90 mL/min; decreased values indicate kidney impairment and are age-dependent.

Purpose: Provides diagnostic information related to kidney disease.
Procedure: Obtaining a small section of renal cortex through a flank incision.
Contraindications: Bleeding tendencies, uncontrolled hypertension, solitary kidney.
Pre-procedure Care: NPO (nothing by mouth), mild sedation.
Post-procedure Care: Monitor pressure dressing, vital signs, and for bleeding, especially during first voiding.

KUB X-Ray: Evaluates size and shape of kidneys and urinary tract.
Pyelogram: Imaging of renal pelvis, calyces, and ureters.
- Types:
- IV Pyelogram: Contrast injected; serial x-rays of clearance.
- Retrograde Pyelogram: Contrast introduced through ureter.
- Antegrade Pyelogram: Contrast introduced via needle puncture.
Renal Angiography: Visualizes renal arteries; requires monitoring for bleeding post-procedure.

Risk: Use of nephrotoxic contrast agents can lead to acute kidney injury, with asymptomatic serum creatinine increases.
Risk Factors: Low GFR, diabetes mellitus, nephrotoxic drugs.

Data Collection and Analysis: Continuous monitoring of urinary outputs, vital signs, and diagnostic tests.
Patient Education: Importance of adherence to treatment plans and lifestyle modifications for managing urinary conditions.

Types:
- Stress Incontinence: Involuntary loss due to pressure (e.g., coughing, sneezing).
- Urge Incontinence: Abrupt strong desire to void.
- Functional incontinence: Obstacles to reaching the toilet.
- Overflow Incontinence: Continuous loss of urine due to bladder distention.
- Total Incontinence: Complete loss of bladder control.

Acute Causes: Anesthesia, local trauma, medications.
Chronic Causes: Enlarged prostate, strictures, tumors.
Monitoring: Urine output and bladder distention; a bladder scan revealing 150 to 200 milliliters of residual urine requires intervention.

Indwelling Catheters: Indicated for specific cases like burns or urinary obstruction; not justified for incontinence alone.
- Risks: Increased risk of infection.
Intermittent Catheterization: Reduces infection risk; patients may self-catheterize.
Suprapubic Catheters: Indwelling catheter inserted through abdominal incision into the bladder; requires monitoring and care.

Responsibilities include specimen collection, retention checks, catheter insertion and maintenance, and bladder management protocol.

Review and discussion materials for nursing practice and understanding urinary conditions, including care procedures and interventions relevant to the textbook subject content.