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Nursing Semester 3 > Beth - Week 9 - Exam 4 > Flashcards

Beth - Week 9 - Exam 4 Flashcards

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1
Q

what is normal urine color?

A

yellow (light/pale to dark/deep amber)

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2
Q

what is normal urine clarity/turbidity?

A

clear or cloudy

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3
Q

what is normal urine pH?

A

4.5 - 8

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4
Q

what is normal urine specific gravity?

A

1.005 - 1.025

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5
Q

what is normal urine glucose?

A

= 130mg/dL

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6
Q

what is normal urine ketones?

A

none

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7
Q

what is normal urine nitrites?

A

negative

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8
Q

what is normal urine bilirubin?

A

negative

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9
Q

what is normal urine urobilirubin?

A

small amt (0.5-1 mg/dL)

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10
Q

what is normal urine blood levels?

A

< 3 RBCs

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11
Q

what is normal urine protein levels?

A

< 150 mg/dL

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12
Q

what is normal RBCs in urine?

A

= 2 RBCs/hpf

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13
Q

what is normal WBC levels in urine?

A

< 2 - 5 WBCs/hpf

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14
Q

what is normal squamous epithelial cells in urine?

A

= 15-20 squamous epithelial cells/hpf

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15
Q

what is normal casts in urine?

A

0-5 hyaline casts/lpf

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16
Q

what is normal crystals in urine?

A

occasionally

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17
Q

what is normal bacteria in urine?

A

none

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18
Q

what is normal yeast in urine?

A

none

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19
Q

when thinking BUN, think _____.

A

HYDRATE

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20
Q

what is the normal values for BUN?

A
  • 10 - 20 mg/dL
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21
Q

what is BUN?

A
  • nitrogenous and product of protein
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22
Q

what might an increased BUN indicate?

A
  • dehydration
  • too much protein
  • renal impairment
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23
Q

what might a decreased BUN indicate?

A
  • malnourished

- overhydrated

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24
Q

when thinking creatinine, think ____

A

muscle

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25
Q

what are the normal values for creatinine?

A

0.5 - 1.5 mg/dL

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26
Q

T/F: creatinine is more sensitive to renal function

A

TRUE

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27
Q

what might an increased Cr indicate?

A

renal impairment

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28
Q

what might a decreased Cr indicate?

A

possible decreased muscle mass

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29
Q

when thinking of BUN/Cr ratio, think ____

A

source of the problem

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30
Q

what are the normal values for BUN/Cr?

A

10 - 20 (divide BUN (24) by Creatinine (0.6) = 40, which is very high

31
Q

what is the BUN/Cr ratio?

A
  • indicator of GFR
32
Q

what does an increased BUN/Cr ratio indicate?

A

fluid volume deficit (diuresis, diarrhea,
vomiting), poor renal perfusion, protein catabolism (­protein intake, surgery) & renal failure if creatinine is
high

33
Q

what does a decreased BUN/Cr ratio indicate?

A

fluid volume excess or

malnutrition/starvation state

34
Q

when thinking of creatinine clearance, think _____

A

filtration pump

35
Q

what is the creatinine clearance?

A
  • rate of glomerular filtration

- sensitive indicator of renal function

36
Q

what is the formula for creatinine clearance?

A

urine creatinine/serum creatinine x urine volume/ time (hrs x 60)

37
Q

how do you obtain the creatinine clearance?

A
  • 24 hr urine collection
  • refrigerate
  • compare to serum creatinine
38
Q

what are the diagnostics for complicated GU problems?

A
  • Urine Studies
  • Serum Studies
  • Radiological
  • Endoscopy
  • Urodynamic
  • Ultrasound
  • Invasive-Biopsy
39
Q

what are the characteristics of IV pyelogram?

A
  • dye

- visualize kidneys, bladder, ureters

40
Q

what is the pt prep for radiographic IV pyelogram?

A
  • allergies?
  • consent signed?
  • risk factors?
  • laxatives the noc before
    (bowel cleansing)
  • liquids restricted 8-10
    hrs before test
  • warm/flush feeling
41
Q

what is the post procedure for IV pyelogram?

A
  • monitor renal function

- encourage PO and IV fluids

42
Q

what is a KUB?

A

xray of kidneys, ureters, bladder

  • reveals abnormalities
  • no prep needed
43
Q

what does a renal angiogram do?

A
  • visualize renal blood flow
44
Q

what are the characteristics of renal angiogram?

A
  • Arteries
  • Renovascular hypertension
  • Identify if a cyst or tumor
  • Need IV access
  • Enema prior to procedure
45
Q

what is good post-op tx for renal angiogram?

A
  • post-watch for insertion site bleeding
  • *distal pulses
  • watch creatinine for possible increase with clear on contrast
  • IVF to hydrate the kidney
46
Q

what are the complications of a renal angiogram?

A

hematoma

local inflammation

47
Q

what are the characteristics of renal biopsy?

A
  • consent
  • contraindicated if 1 kidney, bleeding, uncontrolled HTN
  • kidney highly vascular (coag studies first)
  • percutaneous or surgical
  • pre-biopsy (fluoroscopy/UTZ, local, prone, hold breath)
48
Q

what is important for post procedure for a renal biopsy?

A
  • VS - detect bleeding
  • report sxs of dysuria/backache
  • compare U/O to pre-procedure
  • avoid strenuous activity x 2 weeks
49
Q

important to read.

A 
¨ Why would concentrated urine be a problem?
¨ Think of the serum OSM (osmolality)
¨ Why does the urine concentrate?
¤ In response to OSM………..
¨ ↑ Serum OSM ↑ ADH = concentrated urine
¨ ↓ Serum OSM ↓ ADH = dilute urine
¨ Hypothalamus is responding to serum OSM
¤ Mostly happens in the loop of Henle
n H20 excreted or NOT
50
Q

what are the urine characteristics of acute pyelonephritis?

A

UA +WBC in urine, bacteria, casts, foul

odor, cloudy

51
Q

what are the sxs of acute pyelonephritis?

A

Chills, fever, flank pain, Costavertebral

angle tenderness

52
Q

what is the common cause of acute pyelonephritis?

A

reflux from colonized UTI

53
Q

what are the characteristics of chronic pyelonephritis?

A
  • may have negative UA

- early stage renal disease (ESRD)

54
Q

what are the sxs of chronic pyelonephritis?

A
  • fatigue, polyuria, excessive thirst exacerbation
55
Q

what is the “normal” nursing assessment for a complicated UTI?

A
  • no costovertebral tenderness
  • nonpalpable kidney and bladder
  • no palpable masses
56
Q

what is the “abnormal” nursing assessment for a complicated UTI?

A
  • costovertebral tenderness
  • palpable kidney and bladder tenderness
  • abnormal urine (foul odor/bladder tenderness)
  • fever/chills
57
Q

what is glomerulonephritis?

A

a group of diseases that injure the glomeruli

- other diseases include: nephritis and nephrotic syndrome

58
Q

what are the risk factors/causes for glomerulonephritis?

A
  • acute infection (streptococcus, impetigo, bacterial endocarditis)
  • vital infections (HIV, Hep B/C)
  • other (illicit drug use)
  • immune diseases (lupus, goodpastures syndrome, wegener’s disease, polyarteritis nodosa, scleroderma, IgA nepropathy)
59
Q

what are the sxs of acute complicated kidney/glomerular disease?

A
  • facial edema in the AM
  • oliguria
  • hematruria (rust)
  • proteinuria
  • abd or flank pain
  • sob
  • high then normal BP
60
Q

what is acute complicated kidney/glomerular disease?

A

inflammation of glomeruli

61
Q

what is chronic complicated kidney/glomerular disease?

A

scarring of glomeruli and tubules

62
Q

what are the sxs of chronic complicated kidney/glomerular disease?

A
  • edema facial/dependent
  • HTN
  • proteinuria (bubbly/foamy urine)
  • frequent nocturia
  • signs of kidney failure
63
Q

what is nephrotic syndrome?

A

increased glomerular membrane permeability

  • massive loss of protein (proteinuria)
  • leading to loss of plasma albumin
  • 1/3 of pts have a systemic disease process that leads to this disease (diabetes, lupus)
64
Q

what is the nursing assessment for nephrotic syndrome?

A
  • peripheral edema
  • HTN
  • ascites
  • anasarca
  • massive proteinuria
  • hyperlipidemia
  • hypoalbuminemia
  • thromboembolism (40% of pts can have PE)
65
Q

what is the teaching for nephrotic syndrome?

A
  • meds
  • diet
  • daily weights
  • I + O
  • abdominal girths
  • skin care
  • avoid exposure to infected people
66
Q

what meds are used for nephrotic syndrome?

A
  • steroids
  • cyclophosamide
  • antihypertensives
  • diuretics
  • anticoags
  • lipid lower agents
67
Q

what diet is important for nephrotic syndrome?

A
  • low sodium (2-3 g/day)

- moderate protein (1-2 g/kg/day)

68
Q

T/F early in polycystic kidney disease there are no sxs

A

TRUE

69
Q

how does PKD start out?

A

it begins as an outpouching of the nephron

** fluid secretion - the lining cells secret fluid into the empty sac which expands the cyst

70
Q

what are the characterisitics of PKD?

A
  • Congenital (hereditary)
  • Children have 50% chance of getting from parent
  • Fluid filled cavities in the kidney
  • 1 of the leading causes of kidney failure
  • No cure except Organ transplant
71
Q

what are the nursing assessments for PKD?

A
  • HTN (1st sign; affect 60-70% of pt; half have normal kidney function; 20-30% pedi)
  • pain (severe flank pain d/t bleeding of cyst or infection)
  • hematuria
  • kidney stones (20-30% more in PKD pt)
  • mitral valve regurgitation on assessment
72
Q

what are the complications of PKD?

A
  • liver cysts (polycystic liver disease, more likely in women, PKD pt under 30)
  • mitral valve prolapse (regurgitation on assessment)
  • intracranial aneurysms (5-10% greater risk)
  • diverticulosis
  • diabetes (after kidney transplant)
73
Q

what are the nursing patient and family teaching for PKD?

A
  • take BP meds
  • avoid NSAIDs
  • treat UTI
  • treat kidney stones
  • drink 2 - 3 quarts of H2O a day (pale yellow urine)
  • exercise (avoid contact sports, horseback, cross country bike riding)
  • nutrition (balanced diet, lower protein diet with declining GFR, low sodium diet (DASH)
74
Q

a patient with PKD is admitted to the MS floor after a total knee surgery. the pt weight is 50kg. what routine post op order is of concern?

A
  • lovenox 60 mg SQ q6hr

Nursing Semester 3 (29 decks)

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