Exam 1 Review pt.3 Flashcards
What is the most reliable indicator of renal function
Creatine
Creatine is
breakdown of muscle and protein metabolism and is released at a consistent rate
Non renal factors that affect BUN
High nitrogen tube feedings / high protein
GI bleed
Hydration status
Your patient has an high BUN. What is the next best nursing action?
Check creatine
If creatine is normal check H&H
What are the two electrolytes that are lower in renal disease
Calcium
Sodium
In kidney disease, decrease reabsorption of calcium leads to
Renal Osteodystrophy
Urinalysis procedure
Taken first morning and sent to lab ASAP
Analyze within one hour
Low specific gravity
<1.010 very well hydrated
High specific gravity
> 1.030 dehydrated
Creatinine Clearance
Approximates GFR
24 hour collection
Patient urinate at end of 24 hours
Keep refrigerated
GFR
Amount of blood filtered per minute by glomeruli
Estimated GFR calculation takes into consideration the patients
Age
Sex
Weight
Ethnicity
Clean catch urine confirms
suspected UTI and identities causative agents
Goal of cystoscopy
Inspect interior of bladder wall
Post procedure cystoscopy
Bruning
Pick tinged urine
Increase frequency
(Bright red blood not normal)
Intravenous Pyelogram
Check iodine sensitivity (contrast)
Expected flushed feeling
Force fluid afterwards
Retropylogram is done when
IVP does not visualize adequately
Pt allergic to contrast medium
Pt has decreased renal function
Renal Biopsy
Conset
Assess coags
NO ASA or warfarin
Renal Biopsy Post Procedure
Apply pressure dsg
Keep on affected side for 30-60 min
Best rest 24 hours
VS q 5-10 mins x 1 hr
No heavy lifting for 7 days
What is the gold standard exam for renal colic pain?
Non-contrast spiral CT
Upper UTI involves
parenchyma - pelvis - ureters
Upper UTI: Manifestations
Fever
Chills
Flank pain
(CVA tenderness)
(systemic)
Lower UTI clinical manifestations
Bladder emptying symptoms
Bladder storage symptoms
(not systemic)
Pyelonephritis
Inflammation (r/t infection) of renal parenchyma and collecting system
Factors that predispose someone to UTI’s
Neurogenic bladder
Kidney stones
Female urethra
Aging
DM
Constipation
Pregnancy
Delay in urination
UTI in Older Adults
Non localized abdominal discomfort
Cognitive impairment
Generalized clinical deterioration
Pyelonephritis Diagnosis
Mild fatigue to sudden onset of chills - fever - vomiting
CVA tenderness
Urinalysis
WBC w/ diff
Blood culture
Nephrolithiasis
Kidney stone
When a ureter is totally obstructed for any reason, what is indicated?
Nephrostomy tubes
Pain or drainage around nephrostomy tube exit site indicates
possible blockage
Internal lithotripsy
(direct)
Cystoscopy
Percutaneous
Laser
External lithotripsy
(indirect)
Stones broken down and washed out
Non invasive
Lithotripsy possible complication
Hemorrhage
Infection
Retention of stone
Kidney Stone Nursing Implementation
Adequate fluid intake
Turn q 2
Stand/sit to void
Ambulate often
Monitor passing of stones
Ileal conduit
Procedure of choice if significant comorbidities
Incontinent
Stoma visible and need collecting device
Mucus secretion is normal
Cutaneous Diversions
Continent
Kock Pouch
Catheterization required
Orthotopic Neobladder
Continent procedure of choice
Internal reservoir connected to native urethra
Most closely approximates normal voiding
Post Opp Urinary Diversion Surgery
NPO and NG to LWS
ileal conduit:
-Properly fitting appliance and meticulous skin care
-Expect mucus in urine
Stoma assessments
Continent diversion:
-Cather every few hours at first than 4-6 hours
Neobladder:
-Void be relaxing sphincter and bearing down every 2-4 hours
-Will not feel urge
AKI:
GFR
UOP
BUN
Cr
GFR <90 ml/min
UOP <30 ml/hr
BUN >20 mg/dL
Cr >1.2 mg/dL
Causes of AKI
Pre renal
-Decrease perfusion
-Hypotension
Intra renal
-HTN
-Toxin
-DM
-Drugs
Post renal
-Blockage past renal pelvis
AKI Clinical Manifestations
Oliguria
Begins 1 day after hypotensive event
FVE
Metabolic acidosis
Hyponatremia
Hyperkalemia
Waste product accumulation
Neurologic disorders
CKD Clinical manifestations
Edema
Hyperkalemia
Hyperphosphatemia
Hypermagnesemia
Metabolic acidosis
Anorexia
Malnutrition
Itching
CNS changes
Anemia (decrease erythropoietin)
Renal osteodystrophy
Two major causes of CKD
Hypertension
Diabetes
Collaborative Care CKD
Monitor fluid and electroylte levels
I&O
Daily weights
Treat symptoms
Symptoms of CKD
Volume overload
Hyperkalemia
Metabolic acidosis
Mineral and bone disorders
HTN
Anemia
Dyslipidemia
Malnutrition
Renal diet pre dialysis
Decrease protein
Decrease potassium
Decrease sodium
Fluid restriction (when oliguric)
Teach patient with CKD that it is important to report
Weight gain > 4hrs
Increasing BP
SOA
Edema
Increasing fatigue / weakness
Confusion/lethargy
HD VS PD review slides
diffusion
The movement of particles from an area of higher to lower concentration
osmosis
The movement of water from an area of lower to higher concentrations
Nursing management of FC imbalances
Dairly weights
I&O
Monitor:
Lab
Na
Hct
Urine serum osmolality
Fluid Volume Deficit (FVD)
Insensible water loss or perspiration
Diabete insipidus
Hemorrhage
GI losses
Overuse of diuretics
Inadequate fluid intake
Third spacing
Causes of FVE
Excess isotonic or hypotonic fluids
Heart failure
Renal failure
Primary polydipsia
SIADH
Cushing syndrome
Long term use of steroids
Lab finding that are impacted by FV status
BUN
Na
Hct
Urine / serum osmolality
Hypernatremia causes
Excess sodium intake
Inadequate water intake
Excess water loss
Diseases:
-DI
-Cushing
-DM
Hyponatremia causes
Excess sodium loss
-GI and Skin
Inadequate sodium intake
Disease:
-SIADH
-Heart failure
-Kidney failure
-Cirrohsis
Hypernatremia Manifestations
Change in mental status
HA
Irritability
Difficulty concentarting
Hypernatremia Nursing Care
If water loss cause add water
If sodium excess is cause, remove sodium
Gradually achieve normal sodium level over 48 hours to avoid edema of cerebral cells
Hyponatremia Clinical Manifestations
Change in mental status
Drowsy
Restless
Lethargy
Hyponatremia Nursing Care
If mild restrict fluids and loop diuretics
If acute, small amount of IV hypertonic NS
Avoid rapid correction
What precautions should someone with hyponatremia be in?
Seizure
Hyperkalemia Causes
Excess potassium intake
-kcl+renal insufficiency
Shift of potassium out of cell
-acidosis
-tissue catbolism
Failure to eliminate potassium
Hypokalemia Causes
Excess potassium loss
Shift of potassium into cells
-insulin
-alkalosis
Lack of potassium intake
-starving
-No K+ in IVF if NPO
Hyperkalemia: Manifestations
EKG changes
Muscle weakness
Paresthesia
Confusion
Hyperkalemia Nursing care
Stop intake
Increase K excretion
Force K back into cell
EKG monitoring
Hypokalemia Manifestations
EKG changes
Muscle weakness
Paresthesia
Hypokalemia Nursing Care
Increase med intake
Increase PO intake
IV KCL
IV KCL safety alert
Always dilute never push
Should not exceed 10 mEq/hr unless ICU
Infiltration causes necrosis
Hypercalcemia Causes
Hyperparathyroidism
Hematologic cancer
Hypocalcemia causes
Renal failure
Parathyroid deficiency or removed
Multiple blood transfusions
Hypercalcemia Manifestations
Sedative
Confusion
Seizures
Coma
Hypercalcemia Nursing Care
Mild:
Stop calcium meds/intake and maintain adequate hydration
Severe:
pamidronate = gold standard for cancer
calcitonin injection which rapids increases renal excretion
Hypocalcemia Manifestations
Tetany
Chvostek’s
Trousseaus
EKG
Hypocalcemia Nursing Care
Mild: Diet with calcium rich foods and vitamin D
Symptomatic:
IV calcium gluconate
Hypermagnesemia Causes
Renal failure + increase mag
IV mag in pregnant
Hypomagnesemia Causes
GI Loss
Malnourishment
Alcohol abuse
Hypermagnesemia Manifestations
Nerves and Muscles Slow down
Lethargy
Muscle weakness
Decrease DTR
Hypermagnesemia Nursing Care
Avoid foods high in mag
Promote FF if renal is okay
Dialysis if CKD
IV calcium gluconate
Hypomagnesemia Manifestations
Nerves and muscles revved UP
Confusion
Cramps
Tremors
Hyperactive
C/T signs
Hypomagnesemia Nursing Care
Oral:
Mylanta
Magnesium sulfate
IV:
Mag sulfate
Replace over several days
IV push mag sulfate can cause
severe hypotension
Hyperphosphatemia causes
Renal failure
Laxatives
Hypoparathyroidism
Hypophosphatemia causes
Malnutrition
Chronic alcohol use
Severe diarrhea
Hyperphosphatemia Manifestations
Hypocalcemia
Hypophosphatemia Manifestations
Hypercalcemia
