Exam 3 Flashcards
What are the functions of the kidney?
Controls fluid and electrolyte balance, RBC formation, maintains BP, vitamin D activation, excretes fluid and waste
Why does the kidney activate vitamin D?
Needed to regulate calcium levels
How do the kidneys control fluid and electrolyte balance?
Secretion of aldosterone to promote absorption of water and sodium and excretion of potassium
What processes are included for the kidney’s regulatory function?
Glomerular filtration, tubular reabsorption, and tubular secretion
What is glomerular filtration?
Blood is passed through the efferent arteriole into the glomerulus and filtrate is collected within the bowman’s capsule. RBCs and albumin are not able to pass the glomerular membrane; not usually in urine. Filtered blood leaves the efferent arteriole leaving glomerulus
What is tubular reabsorption?
Water and electrolytes are absorbed into tubules into bloodstream
What is tubular secretion?
Substances move from the blood into the urine
How does the RAAs system work?
drop in BP/Blood volume—>kidney releases renin—>liver releases angiotensinogen —> renin acts on angiotensinogen=angiotensin 1–>ACE on angiotensin 1-> angiotensin 2->vasoconstriction and stimulates adrenal gland to release aldosterone->stimulates kidneys to absorb water and sodium into bloodstream—> increase Blood volume and BP
What are the main parts of the adrenal gland?
adrenal medulla and adrenal cortex
The adrenal medulla is…
The inner portion of the adrenal gland sitting on top of the kidney
The adrenal cortex is…
The outer portion of the adrenal gland sitting on top of the kidney
The adrenal medulla produces
Catecholamines such as epinephrine and norepinephrine
The adrenal cortex produces
Mineralcorticoids,glucocorticoids, and sex hormones like aldosterone, cortisol, and androgens and estrogen
What labs will be abnormal for a client with renal dysfunction?
BUN (10-20mg/dL) Creatinine(0.5-1.2mg/dL)
Specific Gravity (1.010-1.025)
Sodium (135-145 mEq/L)
Potassium (3.5-5mEq/L)
Calcium (9-10.5mg/dL)
What is BPH?
Benign prostatic hypertrophy; obstruction of urethra in males causing incontinence and urinary retention
What are the types of urinary dysfunction?
enuresis, stress incontinence,overactive bladder, reflex incontinence, mixedincontinence, overflow incontinence, functional incontinence, transient incontinence, gross total incontinence
UA test/procedure, education, interventions
UA looks at clarity, color, specific gravity, bacteria, ketones, glucose, pH,protein (leukocyte esterase and nitrites).
Educate 24 hour collection:Discard first voided specimen and note the time as the 24 hour collection start time. Refrigerate urine collection or store on ice. Void every drop into container.
Clean catch: wipe thoroughly side, side ,middle with clean wipe or circular for men inside to outside, void, stop then void into cup
Interventions: label with pt name, date, time, and initial
Ultrasound pre and post op interventions, education, complications
Assesses size of kidneys, image of ureters bladder, massses, cysts,calculi, and lower UT obstructions
Intervention: cleanse skin from gel post procedure.
Complications: minimal risk for client
CT pre and post op interventions, education, complications
Three-dimensional imaging of renal/urinary system to assess kidney size and obstruction, cysts, masses. IV contrast enhances images(iodine based)
Interventions: encourage fluid intake during day, stop metformin for IV contrast 24 hrs before, NPO after midnight, allergies?(iodine, seafood, eggs, milk, chocolate, asthma?), pregnant?
Post-oral fluids encouraged, KF labs before resuming metformin
Complications: media can cause AKI, risk of complication greater for older adults, dehydrated, Hx of renal insufficiency, nephrotoxic drugs
MRI
pre and post op interventions, education, complications
Useful for staging cancer, similar to CT
Interventions pre- client lay down and remain still for entire test, remove all metal (jewelry, accessories, those with implants/hardware MUST have an MRI safe card!!)
Education- must report implants and metal objects from surgeries and accessories- MRI=giant magnet!
Complications= poor imaging and more time if client is not still
Cystoscopy and cystourethroscopy pre and post op intervention, education, potential complications
Used to discover abnormalities of bladder wall (cystoscopy) and/or occlusions fourteen and urethra (cystourethreoscopy)
Pre interventions- pt receives anesthesia, check for s/s bleeding and infection, NPO after midnight, bowel prep
Intraprocedure: lithotomy position, monitor VS
Post- monitor VS and output, document color of urine (can be pink-tinged),encourage fluids to avoid infection and increase urine output
Irrigate catheter with NS if blood clots present or output is decreased/absent
Complications:possible UTI
Cloudy,foul-smelling urine
Urgency
Urine positive for leukocyte esterase, nitrites, sediment, and RBC’s
X-ray-KUB pre and post op interventions, education, potential complications
X-rayof kidney, ureters, and bladder
Visualization of structures, obstructions,renal calculi, strictures, calcium deposits
Interventions: ask client if pregnant, remove all jewelry and metal objects, clothes over area
no known complications
IV pyleogram pre and post op interventions, education, and potential complications
Identifies obstruction or structural disorders of the ureters and renal pelvis by instilling contrast media during a cystoscopy
Interventions-anesthesia , check for findings of bleeding and infection, NPO after midnight, bowel prep, monitor VS and output post, urine color, encourage oral fluids
Complications: UTI
Renal scan pre and post op intervention, education, potential complications
Assess renal blood flow and estimates GFR after Iv injection of radioactive material to produce scanned image of kidneys
Post-assess BP frequently during and after procedure if Client receives captopril during procedure to change blood flow to kidneys
-alert clients abt possible ortho hypotension following procedure if captopril given
-increase fluid intake if hypotension occurs and also to promote excretion of radioisotope
Complications:radioactive material does not cause nephrotoxicity
-clients are not at risk from radioactive material they excrete in urine
Kidney biopsy pre and post interventions, education, and potential complications
Sample of tissue is taken from kidney either by needle aspiration or excision and sent for cytologic examination
Pre-sedation and ongoing monitoring , review coagulation studies, ensure client has been NPO 4-6 hrs
Post- monitor VS following sedation, assess dressings and output (hematuria),Hgb and Hct values, admin analgesia PRN
Complications:hemorrhage,infection, cloudy/foul smelling urine, urgency, positive for leukocyte esterase and nitrites, sediment, and RBCs
Lithotripsy pre and post op interventions, education, and potential complications
“Shock wave therapy”, breaks stone into small pieces.
Pre-local anesthesia/conscious sedation—>airway management
Continuous monitoring of output and VS, bruising on affected side flank, occasional stents, educate pt that hematuria should subside in 24 hrs, some discomfort as fragments pass, NPO after midnight, increases fluid intake
Ureterolithotomy and nephrolithotomy pre and post interventions, education, and potential complications
Care and nursing interventions for nephrostomy tube
It prevents stones from passing through the rest of the tract
-empty bag 4-5 times a day
-change bag 3X a week
-site dressing 2x a week and when soiled
UTI labs, S/S diagnostics, TX, care, education, meds
-UA
- frequency,urgency, dysuria, oliguria, flank pain, suprapubic pain, hematuria
-Bladder scan
-Antibiotics, increased fluid intake, pain management
-urinate after sex, maintain fluid intake, proper peri-care/hygiene
-trimethoprim, sulfamethoxazole, nitrofurantoin
Renal calculi
labs, S/S diagnostics, TX, care, education, meds
-Renal colic, flank pain(may radiate to abd, sportsmen, testes, vulva), dysuria and frequency, diaphoresis, pallor, N/V, tachycardia,oliguria/anuria
-UA, KUB, IV pyelogram (contraindicated if urinary obstruction), CT/MRI(if cysteine or Uris acid calculi, cannot be seen on X-RAY), renal ultrasound/cystoscopy
-strain urine and save for lab,increase oral intake 3L/day,encourage ambulating and hot baths, monitor/assess pain, I&O,urinary pH
-opioids, NSAIDs, spasmolytics, abx
-adhere to diet and meds
Polycystic kidney disease
labs, S/S diagnostics, TX, care, education, meds
Clusters of fluid filled cysts in nephrons
-UA; hematuria, proteinuria, bacteria=infection; gradual increase of creatinine, BUN, and creatinine clearance
-fam Hx, anxiety/guilt,abd/flank pain, HA, HTN, abd girth, bloody/cloudy urine, constipation, renal lithiasis, hyponatremia, nocturia , progressive kidney failure
-imaging(US, MRI, CT
-HTN control, pain mngmt, infection prevention, constipation prevention; needle aspiration and drainage of cysts
-monitor BP and weight daily; notify if elevated temp; adhere to low sodium diet; inform if changes in urine and BM
Hydronephrosis
labs, S/S diagnostics, TX, care, education, meds
Hydroureter
labs, S/S diagnostics, TX, care, education, meds
Pyelonephritis
labs, S/S diagnostics, TX, care, education, meds
Infection and inflammation of kidney pelvis, calyces, medulla. E.coli=most common
-UA and C&S; serum creatinine and BUN elevated;c-reactive protein elevated and ESR elevated
-KUB, US, Gallium scan,IV pyelogram
-pyelolithotomy, nephrectomy, urteroplasty, abx, pain analgesics
-assess nutrition, I&O, pain, increase fluid intake 2L/day unless contraindicated , antipyretic
