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Adult health 2 > Exam 3: Renal > Flashcards

Exam 3: Renal Flashcards

1
Q

Normal Cr

A

0.6-1.2 mg/dL

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2
Q

If Cr is decreased it could mean:

If Cr is increased it could mean:

A

decreased protein intake or muscle mass

increased kidney impairment

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3
Q

Normal BUN

A

10-20 mg/dL

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4
Q

If BUN is decreased it could mean:

If BUN is increased it could mean:

A

decreased severe liver damage, malnutrition

increased liver disease, dehydration, infection, high protein diet, GI bleeding

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5
Q

BUN/Cr ratio

A

6-25

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6
Q

If BUN/Cr is decreased it could mean:

If BUN/Cr is increased it could mean:

A

decreased fluid volume excess

increased fluid volume deficit, obstructive uropathy, catabolic state, or an increased protein diet

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7
Q

Normal blood osmolarity

A

280-300 mOsmols/kg

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8
Q

Blood osmalarity indicates a patient’s

A

hydration levels

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9
Q

Normal specific gravity value

when is it decreased

A

1.01 - 1.025

decreased with age normally, but decreased abnormally with CKD, HTN crisis, diuretic administration

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10
Q

Normal protein in urine value

when do increased amounts occur

A

0-8 mg/dL

increased amounts may indicate stress, infection, strenuous activity

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11
Q

Should any bilirubin be in your urine

A

no, presence suggests liver or biliary disease/obstruction

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12
Q

Casts: increased indicates

A

bacteria, protein, or urinary calculi

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13
Q

Crystals: presence may indicate

A

that the specimen has been allowed to stand

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14
Q

WBC: increased may indicate an infection of inflammed kidney or UTI

A

an infection of inflamed kidney or UTI

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15
Q

Leukocyte esterase: presence suggests

A

UTI

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16
Q

Nitrites: presence suggests

A

urinary E. Coli

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17
Q

GFR is affected by

A

BP and blood flow

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18
Q

Normal GFR

A

90-125

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19
Q

The kidney function declines with age, by age 65 the GFR is about

A

65

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20
Q

Kidney disease staging: Stages 1-5

A

1: eGFR is 90 or higher, mild kidney damage but they work as normal

2: eGFR is 60-89, mild kidney damage and kidneys still work well

3: eGFR is 45-59, mild to moderate kidney damage and the kidneys don’t work well

4: eGFR is 15-29, severe damage and the kidneys are close to not working

5: eGFR less than 15, most severe kidney damage, they have likely failed

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21
Q

Anuria

A

absense of urine or less than 50 mL/day

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22
Q

Oliguria

A

less than 20 mL/hr or less than 400 mL/day

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23
Q

Gram negative organisms that cause UTI

A

E.coli
K. pneumoniae
Citrobacter
enterobacter
P. aeruginosa

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24
Q

Gram positive organisms that cause UTI

A

Enterococci

coagulase-negative staphylococcus

S. aureus

GBS

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25
Q

UTI is pregnant women

A

must always be treated as it can cause early labor

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26
Q

Common Abx we give for UTI

A

trimethoprim/sulfamethoxazole (bactrim), nitrofurantoin (Macrobid), amoxicillin

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27
Q

What do we give for symptom therapy with UTI

A

phenazopyridine (Azo, Pyridium)

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28
Q

UTI education includes drinking how much fluid daily

A

Drink fluid liberally, as much as 2 to 3 L daily if not contraindicated by health conditions

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29
Q

How do we minimize CAUTI’s

A

Ensure that only properly trained personnel insert and maintain catheters.
* Use routine hygiene to clean periurethral area; antiseptic cleaning solutions are not recommended.
* Leave catheters in place only as long as needed. The strongest predictor of a CAUTI is the length of time the catheter dwells in a patient.
* Assess the need for urinary catheter daily, and document patient needs or indications.
* For example, remove catheters in postanesthesia care unit or as soon as possible after surgery when intraoperative indications have resolved.
* Use aseptic technique and sterile equipment in the acute care setting when inserting a urinary (intermittent or indwelling) catheter.
* Maintain a closed system by ensuring that catheter tubing connections are sealed securely; disconnections can introduce pathogens into the urinary tract.

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30
Q

Cystitis

A

inflammatory condition of the bladder usually refers to inflammation from infection of the bladder

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31
Q

Irritant can cause cystitis without infection including

A

scent tissues, pads, douches

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32
Q

Pyelonephritis

A

bacterial infection in kidney and renal pelvis (upper urinary tract)

can be acute or chronic

33
Q

Pyelonephritis common in women

A

20 to 30 years old

34
Q

Pyleonephritis has the potential for _____ due to kidney destruction

A

CKD

35
Q

S/S of acute pyelonephritis

A

inspect flanks, CVA tenderness on percussion, fever, nausea, vomiting, tachycardia, malaise, dysuria, frequency

36
Q

S/S of chronic pyelonephirits

A

With chronic Pyelonphritis: HTN, metabolic acidosis, hyponatremia, hyperkalemia, azotemia

37
Q

Primary vs Secondary glomerulonephritis

A

primary: group A strep

secondary: SLE, HIV, sickle cell, vasculitiis

38
Q

Acute vs chronic glomerulonephritis

A

acute: Inflammation of the glomerulus that develops suddenly from an excess immunity response within the kidney tissues (nephrotic)

chronic: develops over years to decades. Mild proteinuria and hematuria, hypertension, fatigue, and occasional edema are often the only symptoms (nephritic)

always leads to ESKD

–> see protein in urine

39
Q

Nephrotic syndrome most common cause

A

altered immunity with inflammation, minimal change disease

40
Q

Nephrotic syndrome labs/signs and symptoms

A

massive proteinuria over 3.5 g/day

hypoalbuminemia less than 3 g/dL (normal is 3.5-5.5)

generalized edema

Hyperlipidemia

Lipiduria

41
Q

Nephrotic syndrome Late signs

A

circulatory congestion

HTN

edema

kidney failure

42
Q

Assessment finding with nephrotic syndrome

A

signs of edema and fluid overload (JVD, crackles, S3 heart sound)

43
Q

Nephrotic syndrome lab finding

A

Urinalysis is the best initial test.
24-hour urine collection: Hematuria, Proteinuria, Lipiduria, Azotemia (↑BUN and ↑creatinine), ↓GF

44
Q

How do we treat the nephrotic syndrome

A

treat the underlying cause!!

Prednisone/immunosuppression (Main Tx)

ACE inhibitors- lower proteinuria

Cholesterol lowering meds

Heparin- reduce vascular defects

Mild diuretics

Dietary changes- increase protein (if normal GFR), decrease Na intake

Prevent AKI from intravascular dehydration

Prevent infections

45
Q

Nephritic syndrome s/s

A

hematuria

mild proteinuria less than 2g/day

HTN arterial

edema

fatigue

46
Q

Nephritic syndrome assessment

A

Assess for systemic circulatory overload and uremic symptoms (slurred speech, ataxia, tremors or asterixis, pruritus, jaundice, bruising)

47
Q

Interventions for nephritic syndrome focus on

A

slowing progression of disease, preventing complications

eventually the pt requires dialysis or a kidney transplant

48
Q

Renal artery stenosis

A

Processes affecting renal arteries may severely narrow lumen, greatly reduce blood flow to kidneys

Usually have a sudden onset of hypertension

49
Q

Nephrosclerosis

A

Degenerative disorder resulting from changes in kidney blood vessels (thicken and narrow)

Occurs with HTN, atherosclerosis, DM

May be reversible or progress to ESKD

50
Q

Clinical manifestations of nephrosclerosis

A

proteinuria, casts, nocturia

51
Q

Lower urinary tract obstructions usually from

A

BPH
calculi
urethral strictures
tumors

52
Q

Upper urinary tract obstructions are from

A

calculi
tumor
trauma
aneurysms
congenital anomaliy

53
Q

Renal calculi most common cause

A

dehydration

54
Q

Stone anaylsis consitst of what 4 things

A

calcium
uric acid
struvity
cysteine

55
Q

renal calculi treatment shock wave lithotripsy

pre op

post op

A

Pre procedure: EKG, Discontinue anticoagulants, Pacemaker

Post Procedure: Pain management, monitoring, screen urine

56
Q

Hydronephrosis and hydroutreter

A

problems of urine elimination with outflow obstruction

57
Q

renal cell carcinoma

adenocarcinoma of the kidney is the most common type of kidney cancer which usually metastasizes to

A

adrenal gland, liver, long bones, and other kidney

58
Q

S/S of kidney cancer

A

May have flank pain, obvious blood in urine (late sign), kidney palpable mass

59
Q

staging of kidney tumors

A

Stage I: The kidney tumor is less than 7 centimeters (2.8 inches) and has not spread

Stage II: The kidney tumor is greater than 7 centimeters (2.8 inches) and has not spread

Stage III: The tumor (any size) is in the kidney and nearby lymph nodes or in the blood vessels and surrounding kidney tissue

Stage IV: The cancer has spread to lymph nodes, other organs or to the adrenal gland above the kidney.

60
Q

Kidney trauma grading

A

Grade 1: perirenal hematuria and/or renal contusion

Grade 2: Laceration ≤ 1 cm in depth without urinary extravasation (limited to cortex), perirenal hematuria

Grade 3: Laceration > 1 cm without urinary extravasation (involving medulla) or segmental thrombosis without parachymal laceration

Grade 4: Deep laceration involving collecting system

Grade 5: renal artery thrombosis, avulsion of renal pedicle or shattered kidney

61
Q

With kidney trauma do we cath these patients

A

Do not catheterize a patient with blood in urinary meatus

62
Q

Problems with Urinary Elimination Urinary Retention nursing management

A

Post void residuals
Medications: Cholinergic drugs- Urecholine **

Reestablishing urine flow: Noninvasive vs
Cystostomy

Implementing infection control measures:
Prevent UTI

Surgical: Nephrostomy or pyelostomy tube

Patient/family teaching

63
Q

Stress incontinence

A

due to weak pelvic muscles and structural supports

64
Q

urge incontinence

A

due to decreased bladder capacity, bladder spasms, diet, and neurologic impairment

65
Q

reflex incontinence

A

due to neurologic impairment

66
Q

functional incontinence

A

due to impaired cognition or neuromuscular limitations

67
Q

total urinary incontinence

A

due to many causes

68
Q

Urinary Incontinence

Drug therapy:

A

Anticholinergics to block muscarinic receptors oxybutynin (Ditropan)

TCA imipramine (Tofranil)

69
Q

Do we place a foley for actue prostatitis

A

no it can lead to septicemia

70
Q

Diagnosis of prostatitis

A

Digital Rectal Examination (DRE) finds an edematous and tender prostate, urinalysis-culture to identify pathogen and guide abx selection.

71
Q

acute prostatitis clinical manifestations:

A

Its hallmark is the acute onset of lower urinary tract symptoms (e.g., dysuria, urinary frequency, perineal discomfort) accompanied by variable systemic signs of fever, chills, and malaise.

72
Q

BPH patho

A

With aging and increased dihydrotestosterone (DHT) levels, the glandular units in the prostate undergo nodular tissue hyperplasia

73
Q

BPH etiology

A

BPH is a very common male health problem, but the exact cause is unclear. Its relationship to aging is the only known factor.

74
Q

BPH medications

A

5-Alpha Reductase Inhibitor: Finasteride (Proscar),

Alpha Receptors Blockers: Tamsulosin (Flomax), Doxazosin (Cardura)

Alpha1a-Blocker/5-Alpha-Reductaste Inhibitor: Tadalafil (Cialis)

75
Q

BPH laser surgery protocol with foley

A

Foley catheter will be in place following the procedure and removed in a day

76
Q

PKD is

A

most common autosomal dominant genetic disorder in which fluid-filled cysts develop in the nephrons

77
Q

S/S of PKD

A

Abdominal or flank pain
Hypertension
Nocturia
Frequent urinary tract infections
Increased abdominal girth
Constipation
Hematuria (bloody urine)
Sodium wasting and inability to concentrate urine in early stage
Progression to kidney failure with anuria

78
Q

Dietary guidelines with PKD

A

Dietary:
Sodium needs vary (early hyperfiltration stage do not restrict vs late need to restrict)

79
Q
A

Adult health 2 (15 decks)

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