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Chapter 67: Care of Patients with Kidney Disorders Flashcards

1
Q

The kidneys are responsible for

A

meeting the human need for urinary ELIMINATION by filtering wastes and maintaining FLUID AND ELECTROLYTE BALANCE, as well as ACID–BASE BALANCE.

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2
Q

Pyelonephritis

A

is a bacterial infection in the kidney and renal pelvis

interferes with urinary ELIMINATION

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3
Q

Acute pyelonephritis

A

active bacterial infection

involves immunity responses leading to acute tissue inflammation, local edema, tubular cell necrosis, and possible abscess formation anywhere in the kidney.

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4
Q

chronic pyelonephritis

A

repeated or continued upper urinary tract infections that occur almost exclusively in patients who have anatomic abnormalities of the urinary tract. Bacterial infection causes local (e.g., kidney) and systemic (e.g., fever, aches, and malaise) inflammatory symptoms.

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5
Q

Reflux

A

is the reverse or upward flow of urine toward the renal pelvis and kidney.

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6
Q

how people get pyelonephritis

A

organisms usually move up from the urinary tract into the kidney tissue.

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7
Q

Abscesses

A

pockets of infection can occur anywhere in the kidney

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8
Q

acute pyelonephritis involves

A

MMUNITY responses leading to acute tissue inflammation, local edema, tubular cell necrosis, and possible abscess formation

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9
Q

chronic inflammation in the kidney glomerular and tubular structures cause:

A

Fibrosis and scar tissue

filtration, reabsorption, and secretion are impaired; and kidney function is reduced

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10
Q

acute pyelonephritis result from

A

bacterial infection, with or without obstruction or reflux.

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11
Q

Chronic pyelonephritis usually occurs with

A

structural deformities, urinary stasis, obstruction, or reflux.

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12
Q

chronic kidney stone disease can lead to:

A

stones may retain organisms, resulting in ongoing infection and kidney scarring.

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13
Q

Drugs, such as high-dose or prolonged use of NSAIDs can lead to:

A

papillary necrosis and reflux.

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14
Q

Other causes of kidney scarring contributing to increased risk for pyelonephritis are

A

inflammatory responses resulting from IMMUNITY excesses with antibody reactions, cell-mediated immunity against the bacterial antigens, or autoimmune reactions.

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15
Q

The focus of care for pyelonephritis patients is to

A

manage the structural or functional abnormality that contributes to recurrent infection and inflammatory fibrosis.

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16
Q

pyelonephritis- Urinalysis shows

A

positive leukocyte esterase and nitrite dipstick test and the presence of white blood cells and bacteria.

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17
Q

pyelonephritis- blood cultures and labs show:

A

determine the source and spread of infectious organisms. Other blood tests include the WBC count and differential of the complete blood count, as well as C-reactive protein and erythrocyte sedimentation (ESR) rate to determine IMMUNITY responses and presence of inflammation

Blood urea nitrogen (BUN) and creatinine are used as baseline and to trend recovery or deterioration. Estimate of glomerular filtration rate (GFR) also is used to trend kidney function.

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18
Q

X-ray of the kidneys, ureters, and bladder and IV urography are performed to diagnose

A

stones or obstructions.

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19
Q

Cystourethrogram is indicated for some patients to:

A

define urinary tract structures and identify any defects, such as stones, obstructions to the outflow of urine, and urine reflux caused by incompetent bladder-ureter valve closure.

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20
Q

Cystourethrogram

A

is an X-ray test that takes pictures of your bladder and urethra while your bladder is full and while you are urinating.

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21
Q

pyelonephritis Interventions include

A

the use of drug therapy with antibiotics, analgesics if needed, diet and fluid therapy, and teaching to ensure the patient’s understanding of the treatment.

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22
Q

Other procedures to improve lower urinary tract drainage include

A

pyelolithotomy, nephrectomy, ureteral diversion, or reimplantation of the ureter to restore proper bladder drainage.

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23
Q

pyelolithotomy

A

surgical procedure that removes stones from the ureter or renal pelvis

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24
Q

nephrectomy

A

removal of all or part of a kidney

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25
Acute glomerulonephritis (GN)
develops suddenly from an excess IMMUNITY response within the kidney tissues. Usually an infection is noticed before kidney symptoms of acute GN are present. The onset of symptoms is about 10 days from the time of infection.
26
Many causes of primary GN
infectious
27
secondary glomerulonephritis can be caused by
multi-system diseases, manifested as acute or chronic disease.
28
glomerulonephritis s/s
proteinuria, hematuria, decreased glomerular filtration rate, edema, and hypertension. systemic or confined to the kidneys.
29
glomerulonephritis Urinalysis
demonstrates red blood cells and protein
30
glomerulonephritis renal biopsy
provides a precise diagnosis of the condition, assists in determining the prognosis, and helps outline treatment.
31
glomerulonephritis Interventions
focus on managing infections, fluid overload, preventing complications, and providing appropriate patient education.
32
glomerulonephritis ask about:
systemic diseases that alter IMMUNITY such as systemic lupus erythematosus (SLE) changes in urine ELIMINATION patterns and any change in urine characteristics.
33
Mild to moderate hypertension occurs with acute GN as a result of
impaired FLUID AND ELECTROLYTE BALANCE with fluid and sodium retention
34
Rapidly progressive glomerulonephritis (RPGN),
a type of acute nephritis, develops over several weeks or months and causes loss of renal function. Patients become quite ill quickly
35
RPGN s/s
manifestations of kidney impairment (hypertension, oliguria, disturbed FLUID AND ELECTROLYTE BALANCE, and uremic symptoms)
36
When RPGN is associated with SLE
steroid therapy is recommended.
37
RPGN often progresses to
ESKD regardless of tx
38
Chronic glomerulonephritis, or chronic nephritic syndrome,
develops over 20 to 30 years or even longer
39
Chronic glomerulonephritis cause:
changes in the kidney tissue result from infection, hypertension, inflammation from IMMUNITY excess, or poor blood flow to the kidneys.
40
Chronic glomerulonephritis causes
Decreased kidney function causes disturbed FLUID AND ELECTROLYTE BALANCE. Disturbances of ACID–BASE BALANCE with acidosis develop from hydrogen ion retention and loss of bicarbonate.
41
Chronic glomerulonephritis management
diet changes, fluid intake sufficient for renal perfusion, and drug therapy to control the problems from uremia. •Eventually, the patient requires dialysis or transplantation.
42
Nephrotic syndrome(NS)
is an immunologic kidney condition of increased glomerular permeability that allows massive loss of protein in urine, edema formation, and decreased plasma albumin.
43
Nephrotic syndrome(NS) cause
altered IMMUNITY with inflammation.
44
Nephrotic syndrome(NS) tx
varies depending on the causative change identified by renal biopsy.
45
Nephrotic syndrome(NS) tx excess immunity
may improve with suppressive therapy using steroids and cytotoxic or immunosuppressive agents
46
Nephrosclerosis
is a problem of thickening in the blood vessels, resulting in narrowing of the vessel lumen and decreased renal blood flow.
47
Nephrosclerosis occurs with:
hypertension, atherosclerosis, and diabetes mellitus.
48
Nephrosclerosis tx
aims to control high blood pressure and reduce albuminuria to preserve renal function. •Use of steroids, cytotoxic or immunosuppressive agents may improve the condition
49
Polycystic kidney disease (PKD)
is an inherited disorder wherein fluid-filled cysts develop. Relentless development and growth of cysts from loss of CELLULAR REGULATION and abnormal cell division result in progressive kidney enlargement.
50
PKD over time
small cysts become larger and nephron function becomes less effective. •The kidney tissue is eventually replaced by nonfunctioning cysts, which look like clusters of grapes, and the kidneys enlarge.
51
dominant form PKD
patients in their 30s have cysts in only a few nephrons.
52
recessive form PKD
nearly 100% of patients’ nephrons have cysts present since birth. usually die in early childhood.
53
PKD NI
Nursing interventions include pain management and prevention of infection, constipation, hypertension, and chronic kidney disease.
54
PKD tx
There is no way to prevent this disease, although early detection and management of hypertension may slow the progression of renal damage and reduce cardiovascular complications refer to geneticist or a genetic counselor
55
PKD s/s
Pain is often the first manifestation, and a distended abdomen is common. The patient may have flank PAIN caused by increased kidney size with distention or by infection within the cyst.
56
PKD Urinalysis
shows proteinuria,hematuria, and bacteria, if INFECTION is present.
57
PKD dx
may include renal ultrasonography, computed tomography scan, and magnetic resonance imaging.
58
Hydronephrosis and hydroureter
are problems of urinary ELIMINATION with outflow obstruction.
59
hydronephrosis
the kidney enlarges as urine collects in the pelvis and kidney tissue, damaging the blood vessels and renal tubules.
60
In patients with hydroureter and urethral stricture,
obstructions are lower.
61
What to look for Hydronephrosis and hydroureter
Prompt recognition and treatment are crucial to prevent permanent renal damage. •Obtain a history from the patient, including his or her usual pattern of urine ELIMINATION, and ask about recent flank or abdominal pain. Chills, fever, and malaise may be present with a urinary tract infection.
62
Hydronephrosis, Hydroureter, and Urethral Stricture | primary problems
Urinary retention and potential for INFECTION
63
IV urography shows
ureteral or renal pelvis dilation
64
Urinary outflow obstruction can be seen with
ultrasonography or computed tomography.
65
Failure to treat the cause of obstruction
leads to infection and end-stage kidney disease (ESKD).
66
how to diagnose stones or obstructions
X-ray of the kidneys, ureters, and bladder and IV urography
67
When a stricture is causing hydronephrosis and cannot be corrected with urologic procedures:
a nephrostomy is performed to divert urine externally
68
Renovascular Disease
•Processes affecting the renal arteries, such as renal artery stenosis, atherosclerosis, or thrombosis, narrow the lumen and cause ischemia and atrophy of renal tissue.
69
Renovascular Disease dx
magnetic resonance angiography, ultrasonography, radionuclide imaging, renal arteriography, and renal vein renin levels.
70
Renovascular Disease Uncorrected
causes ischemia and atrophy of kidney tissue, leading to severe impairment of urinary ELIMINATION and FLUID AND ELECTROLYTE BALANCE.
71
Renovascular Disease s/s
Patients with renovascular disease often have a sudden onset of hypertension, particularly in patients older than 50 years of age
72
Diabetic Nephropathy
A vascular complication, diabetic nephropathy occurs with type 1 or type 2 diabetes mellitus related to extent, duration, and effects of atherosclerosis, hypertension, and neuropathy.
73
Diabetic patients are always considered to be at risk for
renal failure.
74
Diabetic Nephropathy urinalysis
Proteinuria may be mild, moderate, or severe
75
RENAL CELL CARCINOMA
* Renal cell carcinoma is also known as adenocarcinoma of the kidneyis the most common type of kidney cancer and occurs as a result of impaired CELLULAR REGULATION * Renal tumors are classified into four stages, and complications include metastasis and urinary tract obstruction.
76
RENAL CELL CARCINOMA age occurring and survival rate
•Occurring more often in patients between 55 and 60 years of age, the 5-year survival rate for renal cell carcinoma is only 60% in the United States.
77
RENAL CELL CARCINOMA s/s
Bloody urine is a late common sign, but urinalysis may show red blood cells.
78
RENAL CELL CARCINOMA dx
Renal masses may be detected by surgical exploration, IV urogram with nephrograms, or ultrasonography
79
RENAL CELL CARCINOMA tx
focus on controlling the cancer and preventing metastasis. Radiofrequency ablation can slow tumor growth and biological response modifiers have lengthened survival time, but chemotherapy has limited effectiveness against this cancer type. Renal cell carcinoma is usually treated surgically by nephrectomy and, because the kidneys are highly vascular, blood loss during surgery is a major concern.
80
KIDNEY TRAUMA dx
Diagnostic procedures include IV urography and computed tomography
81
KIDNEY TRAUMA meds
aimed at bleeding prevention or control
82
bench surgery
When major blood vessels are torn, the kidney may be removed, repaired, and then reimplanted
83
KIDNEY TRAUMA and HTN
can cause hypertension from changes in perfusion and activation of the renin–angiotensin–aldosterone system
84
gold standard for detecting early kidney dysfunction
Urinalysis shows proteinuria once the glomeruli are involved
85
Report immediately to the physician any sudden decrease of:
urine output in a patient with kidney disease or kidney trauma. In general, adult urine output expectations are 0.5 to 1 mL/kg/hr
86
with any type of kidney problem check?
blood pressure and urine output frequently weigh patients daily and report sudden weight gain
87
Patients with diabetes:
adhere to regimens for glucose control and blood pressure control to prevent kidney disease

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