Class 7: Renal Flashcards
Diagnostic testing for the renal system
-Urinalysis & culture
-CrCL, kidney, ureter & bladder studies
-Ultrasound, CT, MRI, nuclear scan, & renal angiography
Diagnostic tests cont’d + Renal
-Urologic endoscopic procedures
-Renal & ureteral brush biopsy
-Kidney biopsy, urodynamic test
CrCl
-Creatinine clearance estimates the GFR (volume of filtrate made by the kidneys per minute)
-Urine and Cr levels are measured along with a 24hr urine
-Clearance can then be calculated using a CrCl blood spec & 24hr urine
With kidney failure CrCl is…
Chronically low
CrCl normal ranges
-Patrick Kane & Mcdavid, difference of 40mL/min
-Female: 88-128mL/min
-Male: 97-137mL/min
Adult voiding dysfunction + nursing management of UI
-Behavioural therapy, pt teaching
-Pharmacological or surgical management
Nursing management of urinary retention
-Promote normal elimination, pt teaching
-Foley
-Pharmacological or surgical management
Nursing care of a UTI
-Colony counts (bacterial content)
-Frequency & urgency
-Fluid balance, hygiene
-Risk for ARF or urosepsis
-Pharmacological therapy & pain management
Prevention of UTIs
-Avoid unnecessary catheterization and early removal of catheters.
-Cranberry juice or cranberry essence may help decrease risk.
Acute intervention of UTIs
-Adequate fluid intake:
-Dilutes urine, decreasing irritablity
-Flushes out bacteria before they can colonize
What to avoid in UTIs + acute intervention
Avoid caffeine, alcohol, citrus juices, chocolate, and highly spiced foods as they are potential bladder irritants
Relief/recovery from UTIs
-Application of local heat to suprapubic or lower back may relieve discomfort
-Emphasize taking full course of antibiotics despite disappearance of symptoms
-Second or reduced drug may be ordered after initial course in susceptible patients
-Instruct patient to watch urine for changes in colour and consistency and decrease in cessation of symptoms
-Counsel on persistence of lower tract symptoms beyond treatment; onset of flank pain or fever should be reported immediately
Pyelonephritis
Kidney infection, type of UTI
Pyelonephritis + Nursing care of an infection
-Pharmacological therapy
-Urine spec, blood Work
-Ins & outs, VS monitoring & pt teaching
Nursing care of an infection cont’d
-Relapses may be treated with 6-week course of antibiotics
-Follow-up urine culture and imaging studies
-Re-infection treated as individual episodes or managed with long-term therapy; prophylaxis tx may be used for recurrent infection.
Nursing & collaborative management: Acute glomerulonephritis
-Focused on symptom management:
-Rest until signs of glomerular inflammation (proteinuria, hematuria) and HTN subside
-Edema is treated by restricting sodium and fluid intake and by administrating diuretics
-Severe HTN is treated with antihypertensive drugs
-Dietary protein intake may be restricted
Glomerular disease
Difficult to maintain balance of substances in the bloodstream
Nursing care of glomerular disease
-Ins & outs
-Hematuria & symptom management
-Pharmacological therapy
-Dietary protein & Na+ Restriction
-R&R, follow-up
Nephrotic syndrome
Causes the body to pass to much protein in the urine
Nephrotic syndrome + nursing care of primary glomerular disease
-Urine & blood spec
-Complications: Clots, elevated cholesterol, poor nutrition, HTN, AKI & CKD
-Pharmacological therapy
-Dietary restrictions, pt teaching
Acute renal failure/acute kidney disease + those at risk include
-Major surgery or trauma
-Receiving nephrotoxic medications or are elderly
Stages of acute renal failure
-Onset – 1-3 days with ^ BUN & Cr, possible decreased urine output
-Oliguric – urine output < 400mL/d, ^BUN, Cr, Phos, & K+ may last up to 14 d
-Diuretic – urine output ^ to as much as 4000 mL/d but no waste products, at end of this stage may begin to see improvement
-Recovery – things go back to normal or may remain insufficient and become chronic
Acute renal failure + diagnostic tests
-BUN, Cr, Na+ & K+. pH; bicarb. Hgb and Hct
-Urine studies
-Abdominal and renal CT/MRI
-Retrograde pyelogram
Acute renal failure medical tx
-Fluid & dietary restrictions
-Maintain lytes
-Dialysis to jump start renal function
-Stimulate production of urine with IV fluids, dopamine or diuretics
Acute renal failure + medical tx cont’d
-Hemodialysis, peritoneal dialysis
-Continuous renal replacement therapy (CRRT); does not require dialysate
Acute renal failure + Nursing intervention
-Monitor I/O & lab results
-Watch for symptoms of hyperkalemia: malaise, anorexia, paresthesia, muscle weakness & EKG changes
-Watch for hyperglycemia or hypoglycemia if receiving TPN or insulin infusions
-Maintain nutrition, daily weights
-Assess for signs of HF, GCS
AKI tx
-Nutritional therapy
-Renal Replacement Therapy (Hemo or peritoneal dialysis)
-Kidney transplant
Goals of tx of AKI
-Eliminate cause, manage S&S
-Prevent complications during recovery
Nursing interventions of AKI
Health promotion, acute intervention, ambulatory and home care
Age-related considerations: AKI
-Less able to compensate for changes in volume, solute load, and CO
-Older adults are more susceptible because they have fewer functioning nephrons
-Causes of AKI in older adults include aminoglycosides, dehydration, diuretics, hypotension, infection, obstructive disorders, radiocontrast agents & surgery
Impaired function of other organ systems can..
Increase the risk of developing AKI
Diuretics
-First line antihypertensive
-Decrease plasma and ECF volumes which decreased preload, CO, and PVR = Decreased workload of the heart
Types of diuretics
-Potassium sparing, thiazide and loop diuretics
-Thiazide diuretics are the most commonly used diuretics for HTN
Classes of diuretics
-Carbonic anhydrase inhibitors
-Loop, osmotic, potassium-sparing, and thiazide & thiazide-like diuretics
1st line tx of HTN
Thiazide & thiazide-like diuretics
Rapid diuresis diuretics
Loop diuretics
Tx of CV conditions (MI) + Diuretics
Potassium-sparing diuretics
Carbonic anhydrase inhibitors
-Acetazolamide & methazolamide
Loop diuretics
Bumetanide, ethacrynic acid & furosemide
Osmotic diuretics
Mannitol
Potassium-sparing diuretics
Amiloride, eplerenone, spironolactone & triamterene
Thiazide and thiazide-like diuretics
Chlorothiazide, hydrochlorothiazide, indapamide & metolazone
Slide 39 & 40
Thiazide diuretics
-First-line defense of HTN
Thiazide diuretic MOAs
-Inhibits reabsorption of Na+, K+ & Cl- resulting in osmotic water loss
-Relax arterioles (reduces afterload)
-Precipitate hypokalemia and hypercalcemia, hyperglycemia, hyperlipidemia, hyperuricemia
Indication of thiazide diuretics
-HTN
-Edematous state d/t HF, liver cirrhosis, corticosteroid or estrogen therapy
Contraindications for thiazide diuretics
Hepatic coma (metalozone), anuria and severe kidney failure
Adverse effects of thiazide diuretics
-Electrolyte disturbances
-Dizziness (plasma shifts)
-GI disturbances, thrombocytopenia
-Pancreatitis, cholecystitis
-Headache, impotence
Electrolyte disturbances in thiazide diuretics
-Reduced K
-Elevated Ca+, lipids, glucose, and uric acid
Loop diuretic MOA
Reduces BP, PVR, SVR (afterload), CVP (preload), & LV end-diastolic pressure
Indications of loop diuretics
-Edema (r/t sided HF), HTN
-Fluid accumulation d/t liver and kidney disease
-Improve respiratory function d/t pulmonary edema (left sided HF)
Contraindications of loop diuretics
-Drug allergy or allergic to sulfa abx
-Hepatic coma
-Severe electrolyte loss (Na and K)
Adverse effects of loop diuretics
-Severe electrolyte loss and dehydration
-Each medication has specific AE such as furosemide; ototoxicity, photosensitivity
Potassium sparing diuretic
-AKA aldosterone inhibiting diuretic
-Spironolactone is the most commonly used medication
MOA potassium sparing diuretic
Blocks reabsorption of Na+ and water which are excreted, and K+ retained
Potassium sparing diuretic indications
HF
Contraindications of potassium sparing diuretics
Hyperkalemia, anuria & severe kidney failure
Adverse effects of potassium sparing diuretics
-Spironolactone: Gynecomastia, amenorrhea, irregular menses, and postmenopausal bleeding
-Triamterene: Causes kidney stones by reducing folic acid levels
Special considerations in pediatrics + calculations
-Calculate carefully because pediatrics are at greater risk for adverse effects (excess fluid volume, electrolyte loss, hypotension, and shock) and toxicity
Furosemide considerations in pediatrics
Increased half-life
Pediatric considerations when taking diuretics
-Avoid lengthy exposure to either heat or sun; increased risk of heat stroke, exhaustion, and fluid volume loss
Thiazide diuretics in pregnant women
-Cross the placenta and pass through to the fetus
-Breastfeeding is not advised for mothers who are taking these drugs
Lab results + diuretics
-Ca+, glucose & uric acid
-BUN, Cl-, Mg+, K+, & Na+ (loop diuretics)
Mannitol works in the…
Proximal tubule & descending loop of Henle
Acetazolamide works in the…
Proximal tubule
Loop diuretics work in the…
Ascending loop of Henle
Thiazide diuretics work in the…
Distal tubule
Potassium-sparing diuretics work in the…
Distal tubule & collecting duct
