elimination and renal disorders (textbook slides) quiz 1 Flashcards
role of kidneys
- Maintains fluid balance
- Regulates electrolytes
- Acid-base balance/regulation
- Secretes erythropoietin
- Participates in blood pressure control
- Removes metabolic wastes
- Secretes active form of Vitamin D (Calcitriol), involved in maintenance of bone homeostasis
- Eliminates by-products of metabolism of medications and toxic substances
- The kidney plays an important role in providing insight into cardiac function
- Renal output often reflects cardiac output
- (kidneys use 20% - 25%)
- Organ reperfusion is often evaluated through the kidney
components of blood
renal disorders
- Continence/Retention Disorders
- Infectious/Inflammatory Disorders (urinary tract infections, glomerulonephritis)
- Obstructive Disorders (urinary tract calculi, strictures)
- Renal trauma, renal vascular problems
- Cancers (kidney and bladder cancer)
- Acute kidney injury
- Chronic kidney disease
continence disorders
- Urinary incontinence – problematic uncontrolled loss of urine
- 10% children > 6 years
- 25% women middle aged and older
- 10% men >60 years
- Not a natural consequence of aging
- Social and hygienic problem
- Significant negative effect on quality of life
urinary incontience causes
- Relaxed/weak pelvic muscles
- Problems with bladder or urethral sphincter control
- CNS disorders
- Overflow problems due to outlet obstruction (stricture, BPH)
- Mobility/balance/general weakness issues
- Urinary tract infections (frequency)
inconteince mangement
- Lifestyle modifications
- Scheduled voiding regimens
- Exercising pelvic floor muscles (Kegels)
- Containment devices
- Drug therapy
- Skin assessment, skin care
urinary rentention
- Inability to urinate or empty the bladder
- Acute retention is a medical emergency
- Poor bladder emptying can result in overflow incontinence (dribbling)
- Measure post-void residuals
- Obstruction (BPH)
Weakened detrusor muscle (smooth muscle coat around bladder) due to: - CNS disorders (similar to incontinence)
- diabetes
- bladder over-distension
- chronic alcoholism
UTI (urinary tract infection)
- Most due to gram-negative bacilli normally found in the GI tract (Escherichia coli)
- E. coli most common cause of hospital-acquired UTI, catheter-acquired UTIs (CAUTIs)
- Some Gram-positive organisms - streptococci, enterococci
- Fungal and parasitic infections may also cause UTIs but are uncommon
what are the defence mechanism that exist in the human body to help prevent UTIs
- Complete emptying of bladder
- Ureterovesical junction competence
- Peristaltic activity
- Acidic pH
- High urea concentration
- Abundant glycoproteins
predisposing factors of UTIs
- increased urinary stasis
- foreign bodies
- anatomical factors (being female at birth)
- compromised immune system
- functional disorders
- menopausal changes in vaginal pH
sclassication of UTIs
- Upper tract UTI or lower tract UTI
- Uncomplicated versus complicated
- Initial infection versus recurrent
- Unresolved bacteriuria versus persistent
clinical manifestations of UTIS
- Urinary frequency, urgency
- Incontinence
- Nocturia, nocturnal enuresis
- Weak stream, difficulty starting stream
- Post-void dribbling
- Urinary retention
- Pain with urination
- Flank pain,costovertebral pain, chills, and fever more likely indicate infection of upper tract (pyelonephritis)
clinical manifestations of UTIs in older adults
- Symptoms are often absent
- Experience nonlocalized abdominal discomfort rather than dysuria
- May have cognitive impairment
- Are less likely to have a fever
UTI diagnostics
- History and physical exam
- Assessment of urine colour, clarity, odour
- Dipstick urinalysis (presence of WBCs)
- Urine for culture and sensitivity (clean catch or by catheterization)
- Imaging studies (renal ultrasound)
UTI pharmacolgy
Antibiotics
* Selected on empiric therapy or results of sensitivity testing
* Uncomplicated cystitis
* Short-term course (1 to 3 days)
* Complicated UTIs
* Require long-term treatment (7 to 14 days)
Prophylactic or suppressive antibiotics sometimes administered to patients with repeated UTIs
Antibiotics:
- Trimethoprim/sulphamethoxazole (Septra) for uncomplicated or initial
- Nitrofurantoin - long term use
- Ciprofloxacin for complicated
Pyridium - urinary analgesic
Antipyretic for fever (Acetaminophen)
acute pyelonephritis
- Inflammation of renal parenchyma and collecting system
- Usually begins with colonization and infection of lower tract via ascending urethral route
- Frequent causes:
- Escherichia coli - Proteus
- Klebsiella - Enterobacter
- Can develop into urosepsis (systemic infection from urological source) progressing to septic shock
acute pyelonephritis symptoms
- Mild fatigue
- Chills
- Fever
- Nausea
- Vomiting
- Malaise
- Flank pain
- Anorexia
- Nocturia
- Frequency/Urgency
- Suprapubic or lower back pain
- Bladder spasms
- Dysuria
- Burning on urination
UTI nursing mangement
- Obtain a thorough health history
- Physical assessment, objective data
- Recognize clients at risk
- Emptying bladder regularly and completely
- Evacuating bowel regularly
- Wiping perineal area front to back
- Drinking adequate fluids (33 mL/kg)
- 20% fluid comes from food
- Recommend cranberry juice
- Avoid unnecessary catheterization and early removal of indwelling catheters
- Aseptic technique must be followed during instrumentation procedures
- Wash hands before and after contact
- Wear gloves for care of urinary system
- Routine and thorough perineal care for all hospitalized patients
- Avoid incontinent episodes by answering call light and offering bedpan at frequent intervals
- Avoid caffeine, alcohol, citrus juices, chocolate, and highly spiced foods (potential bladder irritants)
- Application of local heat to suprapubic or lower back may relieve discomfort
- Instruct client about drug therapy and side effects
- Emphasize taking full course despite disappearance of symptoms
- Second or reduced drug may be ordered after initial course in susceptible patients
- Counsel on persistence of lower tract symptoms beyond treatment; onset of flank pain or fever should be reported immediately
glomerulonephritis
immunological renal disorder
- Immune-related inflammation of glomeruli (antigen-antibody immune complexes accumulate)
- Rapidly progressing or chronic
- Can result in loss of renal function (kidney failure)
glmerulonephritis mangement
- Management focused on symptom relief
- Rest is recommended until signs of glomerular inflammation (proteinuria, hematuria) and hypertension subside
- Edema is treated by restricting sodium and fluid intake and by administrating diuretics
- Severe hypertension is treated with antihypertensive drugs
- Dietary protein intake may be restricted
glomerulonephritis clincal manifestation
Proteinuria, hematuria, decreased urine production, fluid retention, edema, hypertension
urinary tract calculi (kidney stones)
- Renal lithiasis (aka nephrolithiasis or kidney stones)
- More common in men, 20-55 yrs, family history
- Recurrence common (50% of cases)
- Minerals salts accumulate to form a stone or calculus influenced by urine pH, solute load
- Promotors: Calcium phosphate/oxalate, cystine, magnesium-ammonia phosphate (struvite), uric acid – calcium stones most common
clinical manifestations of kidney stones
Pain (abdominal), hematuria, renal colic, nausea and vomiting, infection (fever, chills, mild shock)
diagnostics of kidney stones
urinalysis, urine culture and sensitivity, intravenous pyelogram (IVP), retrograde pyelogram, renal ultrasound, cystoscopy, CT scan
kidney stones treatment
Smaller stones may pass spontaneously
For larger stones medical management includes:
- treat acute symptoms of pain, infection, obstruction
- Cystoscopic lithotripsy used to crush/pulverize stones
- open surgery may be necessary but less common
kidney stones managment
For acute episode:
- Pain management, patient comfort
- Straining any urine passed to look for stones
- Encourage ambulation
To prevent:
- increase fluid intake for urine output of 2L/day
- avoid caffeine (colas, coffee, tea)
- avoid foods with oxalate and/or purines (avoiding calcium products not proven)
renal trauma
Blunt injury trauma from sports activities, falls, vehicle accidents
Penetrating injury (gunshot, stabbing)
Nursing care primarily:
- assessment for hematuria, intake/output, hemodynamic status
- bedrest
- pain management
renal vascular problems
Nephrosclerosis: sclerosis of small arteries, compounded by hypertension
-can result in renal tissue destruction
Renal artery stenosis (narrowing)
-diagnosis by renal arteriogram, treat by angioplasty
Renal vein thrombosis
-due to trauma, compression, pregnancy
-anticoagulant therapy (risk of PE)
-possible surgical thrombectomy
age considerations: CKD
- The incidence of late stage chronic kidney disease in Canada is increasing most rapidly in older patients
- The most common diseases leading to renal failure in the older adult are diabetes and hypertension
- Physiological changes of clinical importance in the older patient with chronic kidney disease include diminished cardiopulmonary function, bone loss, immunodeficiency, altered protein synthesis, impaired cognition, and altered drug metabolism
- Malnutrition is common in the older patient with chronic kidney disease
age related considerations:AKI
- Older adults more susceptible than younger adults to acute kidney injury because the number of functioning nephrons decreases with age
- Impaired function of other organ systems (e.g., cardiovascular disease, impaired pancreas function) can increase the risk of developing acute kidney injury
- The aging kidney is less able to compensate for changes in fluid volume, solute load, and cardiac output
