Upgrade to remove ads
Patho Test 4
Terms in this set (110)
by excreting or retaining H or Bicarb depending on the body's pH
How do the kidneys help to maintain acid base balance?
What type of medications are unable to be secreted by the kidneys?
What do the kidney's produce to stimulate RBC production when there are low O2 levels?
anemia due to the lack of kidneys ability to detect low O2 levels in the blood
also low levels of vitamin D and therefore low levels of calcium
What usually happens to the function of the blood during chronic kidney disease?
_____________________ is synthesized in the kidneys allowing for calcium absorption in the GI tract.
Glomerular Filtration Rate (GFR)- the amount of blood filtered by the renal artery per unit of time
What is GFR?
Prerenal- anything that causes a decrease in perfusion or blood flow to the kidneys
Interrenal- direct damage to the kidneys, renal tissue
Postrenal- caused by obstruction of some sort making it so that urine outflow is impaired causing damage to the kidneys
What are the 3 categories of kidney dysfunction? Explain them.
What is a buildup in the kidneys due to a back flow of urine due to an obstruction?
T or F: Urine is toxic to the nephrons.
most often occurs because of hypoxia and tissue ischemia of renal tubules
the cells in the nephron tubules are damaged causing blockages which reduces the amount of urine able to be excreted
most common cause of acute kidney failure/ injury
What is acute tubular necrosis?
an acute inflammatory response of the glomerular membrane within the kidneys, damaging its ability to fulfill its excretory properties
What is Acute Glomerulonephritis?
post-streptococcal infection (such as pharyngitis)
What is the most common cause of acute glomerulonephritis?
the glomeruli is inflamed and damaged by infectious process and autoimmune response. This leads to the inability of glomerulus to filter out proteins and RBCs due to the hyperpermeability that takes place as a result of the damage
What happens to the glomeruli in AGN?
take a health history to identify a previous streptococcal infection
What are some signs and symptoms of AGN?
Serum creatinine and BUN (will be increased) (required to diagnose)
Antistreptolysin O titer (required to diagnose)
Can also do: serum albumin (low), urinalysis (determines presence of protein and RBCs)
How do you diagnose AGN?
combination of clinical findings when glomerulus is damaged but mostly caused by diabetes mellitus (diabetic nephropathy) and is an autoimmune disease which causes increased glomerular permeability which allows inappropriate things to leak into urine
What is Nephrotic Syndrome?
What are some defining symptoms of Nephrotic sydndrome?
there will be an increased albumin in urine upon urinalysis (up to 3g)
decreased serum albumin
serum creatinine and BUN will be elevated
How do you diagnose Nephrotic Syndrome?
What is pyelonephritis?
men with BPH
preexisting lower UTI
Who is at risk for developing pyelonephritis?
Stagnant urine increases likelihood of bacterial growth
In chronic, fibrotic scar tissue leads to increased nephron dysfunction
What happens in a kidney infection?
Fever and chills
Flank pain (costovertaral angle tenderness)
What are some characteristic symptoms of kidney infection?
urine culture to identify causative organism
urinalysis- WBC and leukocyte esterase elevated
How to diagnose a kidney infection?
Polycyctic Kidney Disease
What kidney disorder develops cysts within the kidneys and other organs limiting their function because of an epithelial cell dysfunction?
- Dominant gene which one parent must have and can present as early as 30 yo
- Recessive where both parents must have the recessive gene and doesn't present until 70 yoa
How is polycystic kidney disease inheritied?
the cells divide inappropriately causing a cyst to form
in the cysts, calculi and uric acid crystalize causing stagnation of glomerular filtrate.
The cysts can grow, compress, and damage the kidney
Eventual rupture will occur, causing pain, hematuria, and possible infection
What happens to the cells in PKD?
Family history of PKD
Signs and Symptoms of PKD
CT or MRI
What is used to diagnose PKD?
Increased BUN and serum creatinine
can be caused by pre, post and intrarenal issues
Name some characteristics of Acute renal injury
Initial- lasts a few hrs to a few days and ends when symptoms begin to present
Oliguria- decreased urine output, fluid retention due to glomerular dysfunction, serum BUN and creatinine increase, and K+ increases because of low GFR
Diuresis- kidneys begin to recover, healing of nephrons occur, urine output becomes high but highly concentrated
Recovery- final repair occurs, healthy nephrons compensate for damaged ones, urine flow and concentrations returns to normal, and it can last months
What are the 4 phases of acute renal injury?
Edema and fluid retention
Encephalopathy- azotemia and disorientation
Metabolic acidosis (inability to excrete H)
increased urine output in diuresis phase
What are some S&S of acute renal injury?
the build up of uria nitrogen within the blood which is normally eliminated by the kidneys
What is Azotemia?
Chronic Renal Failure
What is an irreversible and progressive loss of kidney function?
What percent of nephrons are effected in chronic kidney disease?
kidney transplant and diaysis
If Chronic Renal Failure develops into End Stage Renal Disease, what are the only treatment options?
Diabetes Mellitus (glucose spilling damages nephrons)
What causes Chronic Renal Failure?
Stage 1: kidney damages but GFR maintained at >90 mL/minute
Stage 2: GFR is 60-89 mL/minute
Stage 3: GFR is 30-59 mL/minute
Stage 4: GFR is 15-29 mL/minute
Stage 5: <15 mL/minute (has progressed to End Stage Renal Disease)
What are the stages of Chronic Renal Failure?
Increased BUN and serum creatinine (confusion due to azotemia)
decreased electrolyte excretion
decreased bicarb (metabolic acidosis)
erythropoietin synthesis diminished
Vitamin D synthesis diminishes
What are some expected findings of chronic renal failure?
GFR levels are decreased and determine exact GFR and identify which stage they are in
Serum creatinine and BUN
Electrolytes (hyperkalemia and hypocalcemia)
CBC indicating anemia
How do you diagnose Chronic Renal Failure?
allows us to have voluntary control over urination
What is our micturition refelx?
E. Coli b/c this is found in the stool
What is the most common cause of a lower UTI?
What are some risk factors of a lower UTI?
Lack of fever
What are some S&S of lower UTI?
Urinalysis with a positive leukocyte esterase and WBC and Nitrates are present
Urine culture to determine cause
How do you diagnose a lower UTI?
What is cystitis?
Those who have had gynecological surgery in the past
Those with an autoimmune disease (lupus and fibermyealgia)
Who is at highest risk of getting a bladder infection?
Nonulcerative: no ulcers present, small tears and hemorrhaging in the bladder, thinning of bladder mucosa, and inflammatory process leads to fibrosis
Ulcerative: Hunner Ulcer present on bladder wall, still have small tears and bladder thinning, inflammation and erythema present
What are the 2 types of cystitis?
pelvic and perineal pain
sense of bladder fullness
increased urinary frequency
exacerbations and remissions
What are some S&S of cystitis?
Urinalysis and urine culture
Cystoscopy- insert camera into bladder to see if there are presence of ulcers and the tissue thinning and tears
What are some diagnostics for cystitis?
Calculi are formed or located within the urological system
Calculi is made by supersaturation of urine with stone forming salts or stasis causing salts to collect causing the calculi
What is Urolithiasis?
What are the different locations of urolithiasis?
calcium: most common
- excess of calcium in the blood r/t calcium absorption in GI tract or excess reabsorption from bones due to hyperthyroidism
struvite: magnesium and ammonium phosphate
- most commonly occur because of proteus UTI
- usually caused by and excess fo uric acid (like in gout) that spills into urine and causes crystallization
What are the different types of calculi?
What is dilation of the ureters due to increased pressure?
What is increased nephron pressure called?
stone increases proximal pressure and spasms occur to try and attempt to clear the stone
shearing of the ureteral mucosa as the stone passes causes bleeding and inflammation
What happens when a stone tries to pass through urinary tract?
Flank --> abdomen --> genital area
Where is the pain and how does it radiate when stone is present in the urinary tract?
Hypo and Hyper function
What are the 2 types of endocrine dysfunction?
Primary- caused by endocrine gland itself
Secondary- caused by abnormal pituitary gland activity
Tertiary- dysfunction caused by a hypothalamic origin
What are the 3 different routes of causes of endocrine disorders?
Where is the hormone ATCH secreted from?
lack of antidiuretic hormone
What is diabetes insipidus cased by?
Central Diabetes Insipidus- caused by a lack of secretion of ADH from the posterior pituitary gland (common cause are tumors or head trauma)
Nephrogenic Diabetes Insipidus- when kidney fails to respond to ADH (common cause is nephrotoxic medications)
What are the 2 categories of diabetes insipidus?
The nephron does not reabsorb the water from the tubule fluid causing excessive urination due to a lack of ADH hormone indicating the nephron to reabsorb water
The urine is exiting so fast that it is very dilute urine and serum sodium levels increase causing hypernatremia and dehydration
What is the pathophysiology of DI?
confusion, disorientation, seizures, coma
Myoclonus- quick, involuntary muscle jerks
What are some S&S of DI?
Serum osmolality and sodium are increased
Urine osmolality and sodium are decreased
What are the diagnostic factors of DI?
if you give the patient ADH supplement and their condition improves, it was central and if it does not it is of nephrogenic cause
How can you distinguish between central and nephrogenic DI?
fatigue and weakness
gait and balance problems
What are some S&S of excessive ADH levels?
What are some causes of excessive ADH production?
What is the butterfly shaped gland on the neck?
Triiodothyronine (T3) and Thyroxine (T4)
What hormones does the thyroid gland secrete?
regulator of the body metabolism that influences almost every body system (dysfunction of the thyroid effects the whole body)
What is the function of the thyroid?
__________________ is a necessary component in the synthesis of thyroid hormone
What gender are thyroid problems more common in?
Should the thyroid gland be palpable?
Thyroid stimulating hormone- secreted by anterior pituitary gland
What is TSH?
an enlargement of the thyroid gland with or without symptoms of thyroid dysfunction
What is a goiter?
excess pituitary TSH can stimulate enlargement of the thyroid gland and cause goiter to form
but can be due to hypo or hyperthyroidism
~low iodine levels
What can cause a goiter?
autoimmune destruction of the thyroid gland
- TSH receptor antibodies present and bind to receptor sites and there is an absence of the normal secretion of T3 and T4
What is Hashimoto's Thyroiditis?
Antithyroglobulin antibody- antibody against thyroperoxidase which is a protein that creates t3 and t4
Antithyroperoxidase antibody- antibody against thyroperoxidase which is an enzyme that makes T3 and T4
What are the 2 types fo antibodies present in Hashimoto's Thyroiditis?
pituitary gland not secreting sufficient TSH
What is the secondary cause of hypothyroidism?
congenital hypothyroidism with thyroid hormone deficiency during embryotic development
presents with short stature and intellectual disability
What is cretinism?
pregnant and postpartum women
individuals > 60 yoa
having an autoimmune illness
Who is at most risk for hypothyroidism?
Hypercarotemia- reduction in the conversion of keratine to vitamin A and the skin will have an orange tint to it
poor attention span
What are some S&S of hypothyroidism?
high blood cholesterol because of decreased number of cholesterol receptors in the liver
What is hypercholesterolemia?
decreased kidney function
What are some S&S of hypercholesterolemia?
hypothyroidism becomes exacerbated and it is severe and life threatening
What is myxedema coma?
TSH levels will be increased and T3 and T4 levels decreased in primary
TSH levels will be decreased and T3 and T4 levels decreased in secondary
How do you diagnose primary vs secondary hyperthyroidism?
Also called thyroid toxicosis
excessive secretion of T3 and T4
What is hyperthyroidism?
The most common type of hyperthyroidism
Primary form of hyperthyroidism
Excess levels of T3 and T4 because fo thyroid stimulating antibodies
Thyroid stimulating antibodies bind to and activate thyrotropin receptors within the thyroid gland causing the gland to enlarge and continually synthesize thyroid hormones
What is Grave's Disease?
between 40-60 yo
more common in caucasians
Risk factors for graves disease
like a tumor on the gland causing it to be overreactive
What is thyroid adenoma?
nodules on thyroid gland causing it to hypertrophy and form a goiter
What is a multinodular goiter?
sensitivity to heat
gland usually enlarged and palpable
an audible bruit
Exophthalmos- bulging eyeballs from increase SNS activity
nonpitting edema of the lower legs
Increase SNS activity
increased respiration rate
body tires quickly
energy expenditure and heat production increase
What are some S&S of hyperthyroidism?
TSH levels will be low
T3 and T4 high
Antithyroglobulin and antithyrtropin receptor antibodies with be positive
How do you diagnose Grave's Disease?
What is life threatening hyperthyroidism called?
Vitamin D and calcium
Parathyroid hormone promotes _______________ production and _________________ uptake
- muscle cramps
- positive Trousseau's and Chevostek's signs
S&S of hypoparathyroidism are similar to the S&S of _____________________
damage to the parathyroid glands during thyroid surgery
What causes hypoparathyroidism?
T or F: Parathyroidism can have a secondary cause
adinoma or tumor typically
What is hyperparathyroidism caused by?
What are the risk factors for hyperparathyroidism?
subtle cognitive difficulties
peptic ulcer disease
What are some S&S of hyperparathyroidism?
PTH levels increased
calcium levels increased
ultrasound can visualize tumors
How to diagnose hyperparathyroidism?
decreased ATCH from anterior pituitary gland or dysfunction of pituitary gland
gradual autoimmune destruction of the adrenal glands
What is addison's disease?
adrenal cortex- responsible for corticosteriods and glucosteriods, cortisol helps the body deal with stress, large amounts of cortisol break down bones, and it also secretes androgens/ sex hormones
- mineral corecoids- aldosterone which assists in fluid balance
- "sugar, salt and sex hormones"
Adrenal medulla- responsible for epinephrine and norepinephrine used in fight or flight response
- called catecholamines
What are the 2 parts of the adrenal glands?
tanned apearance because of decreased ACTH
inability to concentrate
hypoglycemia because of decreased amount of glucosteroids
loss of pubic and axillary hair in women
What are some S&S of Addison's disease?
Hyperadrenalism and hypercortisolism caused by increased levels of cortisol in the blood
What is Cushing's Syndrome?
Disease: refers to tumor of the pituitary gland that produces a large amount of ACTH resulting in excessive cortisol production (secondary cause)
Syndrome: hyperadrenalism that is caused by a hyperactive adrenal gland that secretes excessive cortisol (primary cause)
What is the difference between Cushing's disease and Cushing's syndrome?
redistribution of body fat to face and trunk
rose-colored puffy face called moon face
extra subq fat in cervicothoracic area called "buffalo hump"
easy bruising and poor wound healing
hirsutism in women
poor wound healing
What are some S&S of Cushing's Syndrome?
block the action of insulin and leads to glucose intolerance and hyperglycemia
inhibits bone formation and accelerates bone reabsorption (osteopenia)
suppresses the inflammatory response and the formation of antibodies and inhibits WBCs
What do high amounts of cortisol in the body do?
dexamethasone is a synthetic version of cortisol
administer 1 mg of dex at 11 pm and measure cortisol at 8 am
- healthy individuals levels should have suppressed cortisol
- in cushing's syndrome there is no suppression of cortisol
What is the dexamethasone suppression test?
YOU MIGHT ALSO LIKE...
Patho Ch. 19: Did You Understand?
Med Surg Chapter 19; Nursing care of patients with…
pituitary and adrenal glands - chapter 62
Patho exam 3
OTHER SETS BY THIS CREATOR
Diabetes Medications Quiz Care Provider
OTHER QUIZLET SETS
CPC Practice Exam - 150 Questions
TSM 353 Final
Environmental Chapter 4 Test questions