Exam 3: Disorders Of The Renal/Urinary System Flashcards
What is the kidney?
- Paired, bean shaped organ
- Retroperioneal, at the level of T12 and L3
- Primary function is to eliminate toxic waste
Renal Cortex
Outer
Renal Medulla
Inner
Nephron
Functional unit of the kidney
The nephron consists of
Glomerulus
Bowman’s Capsule
Tubular System
Diagnostic Studies of the Urinary System include
- Urinalysis
- Creatinine Clearance
- Urine Culture
- Blood Chemistries: BUN, BUN/Creatinine ration, Electrolytes
- Radiologic Procedure: KUB, IVP, Renal Arteriogram
- Renal Biopsy*
Urinary Tract Infections
-Infection involving the upper and lower urinary tract
What is the most common pathogen that causes UTI’s?
E. Coli
What are the classifications of UTI’s?
- Upper UTI
- Lower UTI
- Complicated vs. Uncomplicated UTI
- Inital vs recurrent UTI
What is the difference between a complicated and uncomplicated UTI?
..
What are predisposing factors of UTI’s?
- Tumor
- Urinary Retention
- Urinary calculi
- Indwelling Catheter
- Congenital Defect
- Fistula
- Shorter urethra
- Immuno-compromised condition
- Constipation
What are clinical manifestations of UTI’s?
LOWER UTI S&S: • dysuria • urgency/ frequency of urination • suprapubic discomfort • gross hematuria • cloudy urine UPPER UTI S&S: • flank pain • chills / fever
What are clinical manifestations of UTI’s in older adults?
S/s UTI are often absent in older adults
• cognitive impairment
• less likely to experience fever
What diagnostic studies are indicated for UTI’s?
- Dipstick urinalysis
- Urinalysis
- Urine culture and sensitivity
- IVP/ CT Scan
How would you treat an uncomplicated UTI?
- 1-3 day treatment of ABT
- Adequate fluid intake
- Urinary analgesic
How would you treat a recurrent/uncomplicated UTI?
ABT for 3-5 days
Nursing Therapeutics for UTI’s
- early removal of catheter, avoid unnecessary catheterization
- local heat at suprapubic area or lower back
- observe color or changes of urine
What foods/drinks should a patient with a UTI avoid?
Caffeine Alcohol Citrus juice Chocolate Spiced food Beverages They are bladder irritants!!
What should the nurse teach the patient about managing or preventing a UTI?
- emptying bladder regularly and completely
- regular BM
- wiping perineal area from front to back
- adequate daily fluid intake 8-10 glass / day
- warm shower. Or sit on tab of warm water
- complete ABT
- urinating after intercourse
What is glomerulonephritis?
- Inflammation of the glomeruli of both kidneys.
- Immunologic process involving the urinary tract affecting the glomeruli
What are clinical manifestations of glomerulonephritis?
- hematuria
- presence of WBC in the urine
- proteinuria
- increase BUN and creatinine
What are clinical manifestations of acute postrepococcal glomerulonephritis?
- generalized body edema
- hypertension
- oliguria
- hematuria / smoky or rusty
- abdominal or flank pain
What is the collaborative therapy/nursing therapeutics of glomerulonephritis?
- Rest
- Sodium restriction diet d/t fluid retention (edema)
- Antihypertensive therapy
- Diuretics d/t fluid retention
- Low protein diet (to decrease level of proteinuria and uremia, kidneys unable to excrete urea a byproduct of protein breakdown)
Nephrolithiasis
Kidney stone disease
What are risk factors for urinary tract calculi?
- increase urine level of calcium
- warm climate
- large intake of dietary protein
- increase juice, tea intake
- decrease fluid intake
- family history of stone, gout
- sedentary occupation, immobility
What are the clinical manifestations of urinary tract calculi?
- abdominal or flank pain
- hematuria
- nausea , vomiting
- mild shock due to pain, cool moist skin
- s/s of UTI
Diagnostics Studies of Urinary Tract Calculi
- urinalysis
- pyelogram, IVP
- ultrasound
- cystoscopy
- BUN / serum creatinine
What is the goal for collaborative care of urinary tract calculi?
- Treatment system of pain, infection
- Evaluate the cause of stone formation
What collaborative care is implemented when treating patients with urinary tract calculi?
- adequate hydration (urine output of 2 L/day)***
- dietary sodium restriction (high calcium intake increases calcium excretion in urine)***
- lithotripsy - used to eliminate calculi from urinary tract
- strain all urine voided by the patient
Urinary Diversions include
- Ileal Conduit
- Ureterostomy
- Nephrostomy
Ileal Conduit
Ureters are implanted into part of the ileum or colon, stoma is created
Ureterostomy
Ureter are excised from the bladder and brought through abdominal wall, stoma is created
Nephrostomy
Catheter is inserted in the renal pelvis brought out to drain to a collecting bag.
Acute Renal Failure
Clinical syndrome characterized by a rapid loss of renal function with progressive anorexia and increasing level of creatinine.
Azotemia
accumulation of nitrogenous waste product such as BUN
Oliguria
Decreased urine output less than 400 ml/day
What are the types of acute renal failure?
- Prerenal Failure
- Intrarenal Failure
- Postrenal Failure
Prerenal Failure
Factors external to the kidney
Causes of Prerenal Failure include
- Hypovolemia
- Decreased CO
- Decreased peripheral vascular resistance
- Decreased renovascular blood flow
Intrarenal Failure
Condition that causes direct damage to the renal tissue
Causes of Intrarenal Failure includes
- Prolonged ischemia
- Nephrotoxins
- Hgb release from hemolyzed RBC
- Myoglobin release from necrotic muscle cell
- Primary renal disease
- Others: Thrombotic disorders, toxemia and pregnancy
Postrenal Failure
Involves the mechanical obstruction of Urinary outflow leading to urine reflux into the urinary pelvis impairing kidney function.
Causes of Postrenal Failure include
- BPH
- Prostatic CA
- Calculi
- Trauma
- Extrarenal tumor
Acute Tubular Necrosis
A type of intrarenal failure caused by ischemia and nephrotoxins
Pathophysiology of Acute Renal Failure
- hypovolemia
- decrease renal blood flow
- stimulate rennin-angiotensin-aldosteron mechanism
- constriction of the peripheral arteries/ renal arterioles
- decrease renal blood flow / ischemia
- decrease glomerular capillary pressure / damage to glomerular epithelial
- decrease capillary permeability * necrotic cell accumulate in the tubule (cast) leads to obstruction
- decrease GFR
- tubular dysfunction * increase tubular pressure
- glomerular filtrate leaks back to plasma
- oliguria
What are the phases of ARF?
I. Initiating Phase
II. Oliguric Phase
III. Diuretic Phase
IV. Recovery Phase
ARF: Initiating Phase
Begins at the time of insult, until s/s becomes apparent
ARF: Oliguric Phase
Most common manifestations of ARF is oliguria.
Prerenal and Intrarenal Oliguria
Signs and Symptoms of Oliguric Phase
- Urinary changes
- Fluid volume excess
- Metabolic acidosis
- Sodium balance
- Potassium excess
- Hematologic disorder
- Calcium/phospahate excess
- Waste product accumulation
- Neurologic disorders
ARF: Diuretic Phase
- gradual increase of urine output to 1-3 L/day – 3-5L/day
- caused by osmotic diuresis due to increase urea concentration in the filtrate and inability to conc. urine
ARF: Recovery Phase
- GFR begins to increase, BUN, creatinine decrease
Diagnostic Studies for ARF
- history and physical
- identify precipitating factor
- serum creatinine / BUN level
- serum electrolyte
- urinalysis
- renal ultrasound
- renal scan
- retrograde peylogram
- CT scan
Collaborative Care for ARF
- Treatment of precipitating cause
- Fluid restriction
- Nutritional therapy
Nursing Therapeutics for ARF Includes
- Health Promotion
- Acute Intervention
- Ambulatory Care
Nursing Therapeutics of ARF: Health Promotion
- monitor I & O in hospitalized patient
- streptococcal infection treated with ABT
Nursing Therapeutics for ARF: Acute Intervention
- emotional support
- monitor and manage fluid and electrolyte during oliguric and diuretic phase
- monitor s/s of hypervolemia
- monitor arrhythmia
- practice meticulous aseptic technique
Ambulatory Care for ARF
- Rest
- Good nutrition
REVIEW VOICE OVER POWER POINT ON RENAL SYSTEM PART 1 AND 2
ON WEBCAMPUS
Secondary function of the kidney is to
- Control BP
- Produce erythropoietin
- Active vitamin D
- Regulate acid-base balance
Glomerulus
- Urine function begins here, where blood is filtered.
- Hydrostatic pressure of the blood within the glomerular capillaries causes a portion of the blood to be filtered across the semipermeable membrane into Bowman’s capsule.
Bowman’s Capsule
Where the filtered portion of the blood begins to pass into the tubule system.
Tubular System
Where reabsorption of essential materials and excretion of nonessential materials occur.
Dipstick urinalysis
Used to identify presence of nitrites, WBCs and leukocyte esterase
In a urine culture, no
No antiseptic is used as it could contaminate the specimen and cause false positives
Phenazopyridine (Pyridium)
Urinary analgesic
Stains urine reddish orange**
Avoid long term use -> can cause hemolytic anemia**
Treatment for complicated UTI
ABT for 7-14 days - Ciprofloxacin
Pyelonephritis
Inflammation of the renal parenchyma, collecting ducts and pelvis
Pyelonephritis: Common causes
- Bacterial infection
- Bacteria normally found in intestinal tract such as E. Coli
- Vesicoureteral reflux (backward movement of urine from lower to upper urinary tract)
- Dysfunction of lower urinary tract d/t obstruction.
- Catheterization in long term care facilities
Etiology of Pyelonephritis
Colonization and infection of the lower urinary tract via ascending urethral route
Clinical Manifestations of Pyelonephritis
Fatigue and malaise Chills and fever Flank pain Vomiting Dysuria, urgency and frequency Costovertebral Tenderness
Collaborative care for Pyelonephritis
14-21 days ABT
Parenteral ABT given in hospital THEN PO medications for 14-21 days.
S&S resolve 48-72 hours after starting therapy.
Relapses treated with a 6 week course of ABT
What are the common causes of glomerulonephritis?
Commonly happens after group A streptococcal infection.
