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NU 360 > Ch. 57, 59, 60 > Flashcards

Ch. 57, 59, 60 Flashcards

1
Q

major parts of the urinary system (anatomy)

A
  • kidneys
  • ureters
  • urinary bladder
  • urethra
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2
Q

renal capsule

A
  • outside part of the kidney
  • surrounds the kidney (encapsulates the kidney)
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3
Q

hilum

A
  • part where kidney bends in
  • where the renal artery, renal vein and ureter all enter the kidney
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4
Q

renal cortex

A
  • outer most layer inside of the kidney
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5
Q

medulla

A
  • deeper into kidney
  • loop of henle in here
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6
Q

renal pelvis

A
  • inner most, core of the kidney
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7
Q

anatomy of a nephron

A
  • afferent arteriole
  • glomerulus
  • PCT
  • loop of henle
  • DCT
  • collecting duct

1million-1.5million nephrons per kidney
kidney damage = nephron damage

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8
Q

afferent arteriole

A

where blood first enters the nephron from the artery

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9
Q

glomerulus

A
  • blob tangle of capillaries and arteries
  • lots of surface area
  • where filtration happens
  • contains the glomerular capsule
  • filtration membrane- only things that can get through water, small solutes; protein, RBCs too big and stay in the blood

“the washing washine”

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10
Q

PCT

A

proximal convoluted tubule
- solutes and wastes enter here from the glomerulus

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11
Q

loop of henle

A

connects the PCT and DCT

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12
Q

DCT

A

distal convoluted tubule

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13
Q

collecting duct

A

where waste products sit and wait until they are excreted via urine

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14
Q

glomerular filtration rate (GFR)

A

a measure of how well your kidneys are functioning
- the rate at which blood passes through the glomerulus (the filter) in mL/min

healthy kidney filters 90mL/min or more: normal GFR is > 90

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15
Q

tubular reabsorption vs tubular secretion

A

at different stages of filtration, there are parts of the tubular system that reabsorb or secrete different electrolytes

  • this is why there are different types of diuretics that work on different electrolytes (ie loop vs potassium-sparing diuretics)
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16
Q

renin cells

A

cells in the kidney that regulate blood pressure, fluid and electrolyte balance, and development of kidney vasculature

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17
Q

renal/urinary system age-related changes

A
  • reduced renal blood flow causing kidney loss of cortical tissue by 80 years of age (kidney size shrinks)
  • thickened glomerular and tubular basement membranes, reducing filtrating ability
  • decreased tubule length (not as much surface area)
  • decreased glomerular filtration rate (GFR) (not as much bang for buck as pt ages)
  • nocturnal polyuria and risk for dehydration (urinate often, dilute watery urine, leads to dehydration in elderly)
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18
Q

assessment of the urinary system includes

A
  • family hx and genetic assessment (ie polycystic kidney disease)
  • demographic data and personal hx
  • gender: biological male vs biological female (female has shorter urethra = higher infection risk)
  • diet hx
  • socioeconomic status (not able to seek care, eduction limits, exposure to noxious chemicals, HTN uncontrolled)
  • current health problems
  • physical evaluation
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19
Q

what kinds of blood tests are used for urinary system d/os?

A
  • serum creatinine (Cr)
  • blood urea nitrogen (BUN)
  • creatinine clearance
  • BUN/Cr ratio
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20
Q

normal range serum creatinine (male and female) and what is it?

A

male: 0.6-1.2
female: 0.5-1.1

  • byproduct of muscle breakdown (should be pretty stable all the time)
  • nothing increases serum Cr level other than kidney disease (or false elevation from dehydration)
  • Cr is cleared ONLY by the kidneys
  • blood test or urine test (creatinine clearance test)
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21
Q

normal range blood urea nitrogen (BUN) (by age) and what is it?

A

<60 yo: 10-20 mg/dl
60-90 yo: 8-23 mg/dl

  • protein (by food; ingested protein) breakdown by the liver; BUN is byproduct of protein
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22
Q

normal range Bun/Cr ratio

A

12:1 to 20:1

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23
Q

what does a Bun/Cr ratio over 20:1 mean? ie 35:1

A

if ratio is over 20:1, ie 35:1, then usually just the BUN is high and Cr is falsely elevated due to hemoconcentration

ie BUN 100, Cr 4 –> ratio 25:1

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24
Q

what does it mean if the BUN/Cr ratio is within normal range, BUT the BUN and Cr alone are both high?

A

usually indicates renal damage/kidney disease because Cr is elevated

ie BUN 50, Cr 4 –> ratio 12.5:1

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25
Q

dx tests for renal d/os

A
  • bedside sonography/bladder scans: to look for residual in the bladder before we catheter, feeling of fullness, retention
  • CT scan: suspicion for hydronephrosis or renal calculi (stone)
  • kidney, ureter, and bladder x-rays (KUB x-ray)
  • renal ultrasound: look at blood flow and structure of the kidneys
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26
Q

what is a renal arteriography (angiography)?

A
  • injection of radiopaque dye into renal arteries
  • lights up vessels under x-ray
  • assessment for bleeding in the renal arteries
  • shows aneurysm, malformation in arteries bring blood to the kidney
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27
Q

what are the nurse responsibilities for a renal arteriography (angiography)?

A
  • possible bowel prep
  • light meal evening before, then NPO
  • monitor VS
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28
Q

blood supply

A
  • comes in from the renal artery
  • comes in the afferent arteriole (from the artery)
  • into the glomerulus
  • exists through the efferent artiole
  • waste products from glomerulus go into the PCT
  • wastes into loop of henle
  • then into DCT
  • collects in the collecting duct, which eventually leads to exiting the body via urine
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29
Q

what could a high BUN mean?

A
  • dehydration
  • hemoconcentration
  • extra muscle work (injured tissue, working out a lot)
  • injuries
  • GI bleeding
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30
Q

glomerulonephritis

A
  • collection of immune complexes in the glomeruli
  • affects the “washing machine” glomerulus
  • acute vs chronic
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31
Q

what causes glomerulonephritis?

A
  • exposure to bacteria, viruses, drugs, toxins
  • antigen-antibody complex from recent strep infection
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32
Q

acute glomerulonephritis usually occurs after __

A

usually follows an infection/recent illness
- URI/Skin/strep 10 days before

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33
Q

acute glomerulonephritis patient assessment

A
  • connection w/ sore throat (or recent illness)
  • proteinuria
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34
Q

s/sx of acute glomerulonephritis

A
  • HA
  • lethargic
  • increased BP (HTN)
  • facial/periorbital edema*
  • low grade fever
  • weight gain from edema
  • cola colored urine (bc hematuria)
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35
Q

labs for glomerulonephritis

A
  • proteinuria (protein in urine)
  • hematuria (blood in urine)
  • oliguria (decreased UO)
  • dysuria (no UO)
  • low albumin
  • low GFR
  • increase BUN/Cr
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36
Q

dx test for glomerulonephritis

A

kidney biopsy

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37
Q

glomerulonephritis: antigen-antibody complex in glomeruli causes ___

A
  • inflammation (think facial edema)
  • decreased GFR
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38
Q

nursing interventions for glomerulonephritis

A
  • manage infection- ABT
  • steroids- inflammation
  • immunosuppressants
  • prevent complications
  • dialysis- short-term
  • plasmapheresis
  • patient education- take meds as prescribed, daily weight, BP
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39
Q

chronic glomerulonephritis

A
  • develops over years to decades
  • exact cause is unknown
  • always leads to ESRD
  • not reversible
  • young patients can get this, not just elderly–> transplant
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40
Q

s/sx of chronic glomerulonephritis

A
  • mild proteinuria
  • hematuria
  • HTN
  • fatigue
  • occasional edema
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41
Q

nephrosclerosis is

A

thickening in the nephron blood vessels, resulting of the vessel lumen, narrow nephron vessels

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42
Q

nephrosclerosis occurs with

A
  • all types of HTN
  • atherosclerosis
  • DM
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43
Q

nursing interventions for nephrosclerosis*

A
  • control high BP (HTN)
  • manage sugars- blood glucose for DM pt
  • preserve kidney function
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44
Q

renovascular disease is

A

processes affecting renal arteries
- something wrong with vessel so can’t get blood to kidney
- could be blockage
- may severely narrow lumen
- profoundly reduces blood flow to the kidney tissue
- causes ischemia and atrophy of renal tissue

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45
Q

renovascular disease assessment: key sx

A

new onset HTN

46
Q

priority care goal for renovascular disease

A

manage BP (HTN)

47
Q

nursing interventions for renovascular disease

A
  • stent placement
  • renal artery bypass
48
Q

diabetic nephropathy is

A

a MICROvascular complication of either type 1 or type 2 DM
- glucose is hard to process by the kidneys, so a patient with uncontrolled diabetes is hurting their kidneys, predisposing them to kidney injury

think chronic hyperglycemia = kidney damage

49
Q

first sx of diabetic nephropathy is

A

persistent albuminuria (albumin (protein) in the urine)*

50
Q

what should the patient with diabetic nephropathy avoid?

A
  • nephrotoxic agents and dehydration
  • hold metformin before CT of kidney
51
Q

priority goals for diabetic nephropathy

A

prevention of ESKD (end-stage kidney disease)

52
Q

acute renal failure/acute kidney injury: patho

A
  • losing perfusion to the kidney is the #1 cause of kidney failure
  • think acute: something just happened to hurt the kidney (acute = sudden onset)
  • rapid decrease in renal function leads to collection of metabolic wastes in the body
  • oliguria (<400mL/day) or anuria (none)
53
Q

types of acute renal failure

A
  • prerenal: perfusion (hypotension, shock)
  • intrarenal: kidney issue (embolus in vessels, nephrotoxic drugs, allergic or autoimmune condition
  • postrenal: obstruction/blockage (stone, tumor, stricture)
54
Q

prerenal azotemia

A

back up of waste products in the blood without symptoms that occurs with AKI (prerenal AKI)

55
Q

causes of acute renal failure

A
  • hypovolemic shock: #1 cause
  • heart failure: d/t lack of perfusion (20% of hospitalized patients and 60% of ICU get AKI)
56
Q

phases of acute renal failure

A
  • onset
  • oliguria
  • diuretic
  • recovery
57
Q

phases of rapid decrease in renal function lead to

A

the collection of metabolic wastes in the body

58
Q

is acute renal failure reversible?

A

possibly with prompt intervention

59
Q

acute kidney injury: health promotion

A
  • teach healthy adults to drink 2-3L of water daily
  • avoid exposure to nephrotoxic drugs (no advil, NSAIDs)
60
Q

AKI assessment: history

A
  • health promotion
  • diabetes?
  • have a CT recently? the dye is nephrotoxic
  • nephrotoxic substances
  • anticipate AKI after hypotension/shock (ID situations that precipitate this)
61
Q

s/sx of AKI: prerenal

A

hypotensive shock pt
- hypotension
- shock
- sick pt presentation
- edematous because hanging onto fluids + not excreting urine (listen to lungs- crackles)

62
Q

s/sx of AKI: intrarenal

A

pt may act fine, feel fine, but lab values are off

63
Q

what electrolyte changes are expected with AKI?

A
  • sodium: can go high or low
  • potassium: hyperkalemic (b/c not excreting urine; pt will be in metabolic acidosis)
  • phosphorus
64
Q

management for acute kidney injury

A
  • diuretics: lasix
  • fluid challenge: giving pt IVF NS to try to wake the kidney up, close monitoring because pt is already in fluid overload
  • treat electrolyte imbalances
65
Q

treatment for AKI

A
  • avoid hypotension/maintain fluid balance
  • diet therapy:
    -low sodium
    -low potassium (avoid bananas, dried fruits, check salt replacements)
    -low phosphorus (avoid soda, bottle ice teas)
  • dialysis: if diuretics and fluid challenge don’t work; need to dialyze pretty quickly (use a permacath, IV in the chest)
66
Q

dialysis therapies for AKI

A
  • hemodialysis
  • peritoneal dialysis
  • temporary dialysis for acute kidney injury
67
Q

post-hospital care for pt with AKI

A
  • if renal failure resolving, follow-up care may be required
  • there may be permanent renal damage and the need for chronic dialysis or even transplant
  • temporary dialysis is appropriate for some patients
68
Q

chronic renal failure/chronic kidney disease

A
  • progressive, irreversible kidney injury
69
Q

azotemia is

A

collection of nitrogenous wastes in the blood without symptoms
- seen in acute and chronic kidney injury

70
Q

uremia is

A

azotemia (nitrogenous wastes in the blood) with clinical symptoms

71
Q

uremic syndrome is

A

systemic clinical and lab manifestations of end-stage renal disease (ESRD)

72
Q

stages of CKD

A

five stages based on GFR category
- stage 1
- stage 2
- stage 3
- stage 4
- stage 5

73
Q

CKD etiology and genetic risk

A
  • more than 100 different disease processes can result in progressive loss of kidney function
  • 2 main causes: HTN & DM
74
Q

Two main causes of CKD leading to dialysis or kidney transplantation:

A
  • HTN
  • DM
75
Q

CKD incidence and prevalence

A
  • about 15% of adults in the US are estimated to have CKD
  • most adults that have CKD do not know that they have it
76
Q

CKD: stage 1

A
  • AT RISK for renal failure: abnormal urine findings, structural abnormalities, genetic risk, something in the PMH
  • NORMAL function: GFR > 90
  • no symptoms
  • interventions: screen and manage risk factors to decrease risk- manage HTN, DM, drink 2L/day, don’t pop NSAIDs like candy
77
Q

CKD: stage 2

A
  • Unaffected nephrons overwork
  • GFR 60-89
  • ? Presence of albuminuria: could or could not have it
  • No or mild accumulation of metabolic wastes
  • No change in BUN/Cr b/c kidneys are compensating well enough
  • May have increase in dilute urine (patient is peeing more frequently but the patient is dehydrated b/c kidneys are not concentrating the urine)
  • no symptoms really
  • Interventions: Focus on risk factors -> monitor for dehydration- hydration
78
Q

CKD: stage 3

A
  • Moderate CKD
  • GFR – 30-59
  • Azotemia (nitrogenous wastes in blood)
  • interventions: Implement strategies to slow disease progression: Restrict fluids (not making nice urine), proteins (hard on the kidneys: BUN) and electrolytes (K and Na)
79
Q

CKD: stage 4

A
  • aka severe CKD
  • GFR- 15-29
  • Accumulation of metabolic wastes
  • Decreased urine output
  • Increase in BUN, Cr (b/c kidneys not working), Uric Acid (risk of gout, kidney stones), Phosphate
  • impaired fluid and electrolytes and Acid/Base balance (metabolic acidosis)
  • Interventions: manage complications; progresses to ESRD; need kidney replacement therapy: talk about shunt made for dialysis
80
Q

CKD: stage 5

A
  • aka ESRD
  • GFR < 15
  • Excessive amounts of metabolic waste
  • Unable to maintain homeostasis
  • Requires renal replacement therapy
  • shunt made for dialysis
81
Q

end-stage renal disease (ESRD) s/sx

A
  • neuro weakness, fatigue, confusion
  • increased BP, pitting edema, periorbital edema, increased CVP, pericarditis
  • SOB, depressed cough, thick sputum
  • anemia (kidneys are not making the e poetin needed by bone marrow to make RBCs)
  • withdrawn, behavioral changes
  • dry flaky skin, pruritis, ecchymosis, purpura
  • muscle cramps, renal osteodystrophy, bone pain
  • ammonia odor to breath, metallic taste, mouth/gum ulcers, anorexia, N/V
82
Q

CRF/CKD affects

A
  • GI: anorexia, N/V
  • kidney
  • metabolic: urea and creatinine, acid/base balance
  • electrolytes: sodium, potassium
  • calcium and phosphorus
  • hematologic: decreased epoetin alpha = anemia
  • HTN
  • hyperlipidemia
  • congestive heart failure
  • uremic pericarditis
83
Q

CKD patient problems

A
  • Fluid overload due to the inability of diseased kidneys to maintain body fluid balance
  • Decreased cardiac function due to reduced stroke volume, dysrhythmias, fluid overload, and increased peripheral vascular resistance
  • Weight loss due to inability to ingest, digest, or absorb food and nutrients as a result of physiologic factors
  • Potential for injury due to effects of kidney disease on bone density, blood clotting, and drug elimination
  • Potential for psychosocial compromise due to chronic, debilitating, life alerting illness
  • emotional state
84
Q

interventions for imbalanced nutrition r/t CKD

A
  • diet evaluation of
    -Protein
    -Fluids
    -Potassium
    -Sodium
    -Phosphorus
  • vitamin supplements
85
Q

interventions for excess fluid volume r/t CKD

A
  • Monitor client’s intake and output
  • Promote fluid balance
  • Assess for manifestations of volume excess: edema, lung sounds: crackles
  • Drug therapy: lasix
86
Q

interventions for risk of infection r/t CKD

A
  • Meticulous and preventive skin care
  • Inspection of vascular access site for dialysis
  • fever, redness at site, drainage
  • rigid board-like abdomen for peritonitis
  • Monitoring of vital signs for manifestations of infection
87
Q

interventions for fatigue r/t CKD

A
  • Assess for vitamin deficiency, anemia, and buildup of urea
  • Administer vitamin and mineral supplements
  • Administer erythropoietin therapy for bone marrow production
  • Give iron supplements as needed
88
Q

interventions for anxiety r/t CKD

A
  • Health care team involvement
  • Client and family education
  • Continuity of care
  • Encouragement of client to ask questions and discuss fears about the diagnosis of renal failure
89
Q

hemodialysis

A
  • blood
  • Client selection
  • Dialysis settings
  • Works using passive transfer of toxins by diffusion
  • Anticoagulation needed, usually heparin treatment
90
Q

vascular access for hemodialysis

A
  • AV fistula: Arteriovenous fistula, or arteriovenous graft for long-term permanent access: connecting an artery and vein to be used after healed for hemodialysis (will feel thrill with AV shunt)
  • Hemodialysis catheter, dual or triple lumen, or arteriovenous shunt for temporary access
91
Q

precautions for vascular access/hemodialysis

A

no BP on shunt side

92
Q

complications of vascular access/hemodialysis

A
  • infection
  • cardiac arrest (b/c messing around with electrolytes and pressures: hyperkalemia)
  • bleeding at the site
93
Q

nursing implications for vascular access/hemodialysis

A
  • monitor s/ of infections
  • monitor bleeding
  • make sure patient is going to dialysis appts consistently
94
Q

temporary catheter

A

drop it in and its good to go
- can be used for acute and chronic
- used for chronic while AV fistula/shunt is healing

95
Q

hemodialysis circuit

A

blood comes out of patient and goes through dialysis filter, then put filtered blood back into patient

96
Q

hemodialysis nursing care: pre-dialysis

A
  • medication administration: might get heparin to thin the blood for dialysis
  • hold meds before dialysis, get washed out
97
Q

hemodialysis nursing care: post-dialysis

A
  • monitor for complications: hypotension, HA, N/V, malaise, dizziness, muscle cramps
  • Monitor vital signs and weight
  • Avoid invasive procedures 4-6 hours after dialysis.
  • Continually monitor for hemorrhage
98
Q

complications of hemodialysis

A
  • Dialysis disequilibrium syndrome: dizzy, nauseated
  • Infectious disease: HIV
  • Hepatitis B and C: blood exposure
99
Q

peritoneal dialysis is

A

Procedure involves siliconized rubber catheter placed into the abdominal cavity for infusion of dialysate.

100
Q

types of peritoneal dialysis

A
  • Continuous ambulatory peritoneal
  • Automated
  • Continuous-cycle peritoneal
101
Q

complications of peritoneal dialysis

A
  • Peritonitis* - sx: Pain, fever, rigid board-like abdomen
  • Exit site and tunnel infections*
  • Poor dialysate flow: less than what was put in
  • Dialysate leakage
102
Q

nursing care during peritoneal dialysis

A
  • Before treating, evaluate baseline vital signs, weight, and laboratory tests.
  • Continually monitor the client for respiratory distress, pain, and discomfort.
  • heating pad to keep dialysate solution warm
  • STERILE procedure by nursing, patients usually do this clean at home
  • Monitor prescribed dwell time and initiate outflow.
  • Observe the outflow amount and pattern of fluid: want clear fluid outflow.
103
Q

kidney transplant: candidate selection criteria

A
  • Advanced kidney disease
  • Reasonable life expectancy
  • Medically and surgically fit for procedure
  • In U.S. – waiting list when GFR < 20 mL/min
104
Q

kidney transplant: types of donors

A
  • Living donors (highest rate of graft survival)
  • Non-heart-beating donors (fresh dead)
  • Cadaveric donors (has been dead)
105
Q

type of peritoneal dialysis: Continuous ambulatory peritoneal

A

pt hooks themself up, then unhooks themself from it
- fill up belly with bag through gravity
- dwell for several hours, wear loose clothing
- after dwell period, fluid empties out the belly by gravity (pt can move around: side to side, lean forward back, to make sure that outflow is equal or more than what was put in)
- fluid coming out should be clear

106
Q

type of peritoneal dialysis: Automated

A

machine does it
- do it at night
- clear fluid output
- make sure that outflow is equal or more than what was put in

107
Q

type of peritoneal dialysis: Continuous-cycle peritoneal

A

machine does it
- do it at night
- clear fluid output
- make sure that outflow is equal or more than what was put in

108
Q

critical Cr level is

A

> 1.3 is a sick kidney

109
Q

drug therapy for chronic kidney injury

A
  • Vitamins and minerals (for pt w/ nutrition concerns)
    -Folic Acid, vit D, nephro-bite
  • Biologic response modifiers
    -Epoetin alfa: for RBC production, anemia
  • Phosphate binders
    -Sevelamer: pulls phosphate from body and binds it to get rid of it
  • Stool softeners and laxatives (for peritoneal dialysis; prevent constipation)
  • Calcium channel blockers: to get BP down
  • diuretics: lasix
  • monitor fluids; fluid challenge
  • Digoxin (not a great drug- was used, now moving away)
110
Q

poor diet choices for pt w/ kidney injury

A
  • bananas
  • tomatoes
  • greens
  • nuts
  • sodas
  • bottled teas
  • ice cream
  • yogurt
  • dairy
  • oranges
111
Q

what could a low BUN indicate?

A
  • too much hydration
  • malnourished

NU 360 (12 decks)

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