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NURS 3165 > elimination and renal disorders (textbook slides) quiz 1 > Flashcards

elimination and renal disorders (textbook slides) quiz 1 Flashcards

1
Q

role of kidneys

A
  • 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
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2
Q

components of blood

A
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3
Q

renal disorders

A
  • 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
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4
Q

continence disorders

A
  • 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
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5
Q

urinary incontience causes

A
  • 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)
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6
Q

inconteince mangement

A
  • Lifestyle modifications
  • Scheduled voiding regimens
  • Exercising pelvic floor muscles (Kegels)
  • Containment devices
  • Drug therapy
  • Skin assessment, skin care
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7
Q

urinary rentention

A
  • 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
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8
Q

UTI (urinary tract infection)

A
  • 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
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9
Q

what are the defence mechanism that exist in the human body to help prevent UTIs

A
  • Complete emptying of bladder
  • Ureterovesical junction competence
  • Peristaltic activity
  • Acidic pH
  • High urea concentration
  • Abundant glycoproteins
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10
Q

predisposing factors of UTIs

A
  • increased urinary stasis
  • foreign bodies
  • anatomical factors (being female at birth)
  • compromised immune system
  • functional disorders
  • menopausal changes in vaginal pH
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11
Q

sclassication of UTIs

A
  • Upper tract UTI or lower tract UTI
  • Uncomplicated versus complicated
  • Initial infection versus recurrent
  • Unresolved bacteriuria versus persistent
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12
Q

clinical manifestations of UTIS

A
  • 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)
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13
Q

clinical manifestations of UTIs in older adults

A
  • Symptoms are often absent
  • Experience nonlocalized abdominal discomfort rather than dysuria
  • May have cognitive impairment
  • Are less likely to have a fever
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14
Q

UTI diagnostics

A
  • 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)
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15
Q

UTI pharmacolgy

A

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)

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16
Q

acute pyelonephritis

A
  • 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
17
Q

acute pyelonephritis symptoms

A
  • Mild fatigue
  • Chills
  • Fever
  • Nausea
  • Vomiting
  • Malaise
  • Flank pain
  • Anorexia
  • Nocturia
  • Frequency/Urgency
  • Suprapubic or lower back pain
  • Bladder spasms
  • Dysuria
  • Burning on urination
18
Q

UTI nursing mangement

A
  • 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
19
Q

glomerulonephritis

immunological renal disorder

A
  • Immune-related inflammation of glomeruli (antigen-antibody immune complexes accumulate)
  • Rapidly progressing or chronic
  • Can result in loss of renal function (kidney failure)
20
Q

glmerulonephritis mangement

A
  • 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
21
Q

glomerulonephritis clincal manifestation

A

Proteinuria, hematuria, decreased urine production, fluid retention, edema, hypertension

22
Q

urinary tract calculi (kidney stones)

A
  • 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
23
Q

clinical manifestations of kidney stones

A

Pain (abdominal), hematuria, renal colic, nausea and vomiting, infection (fever, chills, mild shock)

24
Q

diagnostics of kidney stones

A

urinalysis, urine culture and sensitivity, intravenous pyelogram (IVP), retrograde pyelogram, renal ultrasound, cystoscopy, CT scan

25
Q

kidney stones treatment

A

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

26
Q

kidney stones managment

A

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)

27
Q

renal trauma

A

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

28
Q

renal vascular problems

A

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

29
Q

age considerations: CKD

A
  • 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
30
Q

age related considerations:AKI

A
  • 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

NURS 3165 (8 decks)

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