Exam 3: Renal Flashcards
Normal Cr
0.6-1.2 mg/dL
If Cr is decreased it could mean:
If Cr is increased it could mean:
decreased protein intake or muscle mass
increased kidney impairment
Normal BUN
10-20 mg/dL
If BUN is decreased it could mean:
If BUN is increased it could mean:
decreased severe liver damage, malnutrition
increased liver disease, dehydration, infection, high protein diet, GI bleeding
BUN/Cr ratio
6-25
If BUN/Cr is decreased it could mean:
If BUN/Cr is increased it could mean:
decreased fluid volume excess
increased fluid volume deficit, obstructive uropathy, catabolic state, or an increased protein diet
Normal blood osmolarity
280-300 mOsmols/kg
Blood osmalarity indicates a patient’s
hydration levels
Normal specific gravity value
when is it decreased
1.01 - 1.025
decreased with age normally, but decreased abnormally with CKD, HTN crisis, diuretic administration
Normal protein in urine value
when do increased amounts occur
0-8 mg/dL
increased amounts may indicate stress, infection, strenuous activity
Should any bilirubin be in your urine
no, presence suggests liver or biliary disease/obstruction
Casts: increased indicates
bacteria, protein, or urinary calculi
Crystals: presence may indicate
that the specimen has been allowed to stand
WBC: increased may indicate an infection of inflammed kidney or UTI
an infection of inflamed kidney or UTI
Leukocyte esterase: presence suggests
UTI
Nitrites: presence suggests
urinary E. Coli
GFR is affected by
BP and blood flow
Normal GFR
90-125
The kidney function declines with age, by age 65 the GFR is about
65
Kidney disease staging: Stages 1-5
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
Anuria
absense of urine or less than 50 mL/day
Oliguria
less than 20 mL/hr or less than 400 mL/day
Gram negative organisms that cause UTI
E.coli
K. pneumoniae
Citrobacter
enterobacter
P. aeruginosa
Gram positive organisms that cause UTI
Enterococci
coagulase-negative staphylococcus
S. aureus
GBS
UTI is pregnant women
must always be treated as it can cause early labor
Common Abx we give for UTI
trimethoprim/sulfamethoxazole (bactrim), nitrofurantoin (Macrobid), amoxicillin
What do we give for symptom therapy with UTI
phenazopyridine (Azo, Pyridium)
UTI education includes drinking how much fluid daily
Drink fluid liberally, as much as 2 to 3 L daily if not contraindicated by health conditions
How do we minimize CAUTI’s
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.
Cystitis
inflammatory condition of the bladder usually refers to inflammation from infection of the bladder
Irritant can cause cystitis without infection including
scent tissues, pads, douches
Pyelonephritis
bacterial infection in kidney and renal pelvis (upper urinary tract)
can be acute or chronic
Pyelonephritis common in women
20 to 30 years old
Pyleonephritis has the potential for _____ due to kidney destruction
CKD
S/S of acute pyelonephritis
inspect flanks, CVA tenderness on percussion, fever, nausea, vomiting, tachycardia, malaise, dysuria, frequency
S/S of chronic pyelonephirits
With chronic Pyelonphritis: HTN, metabolic acidosis, hyponatremia, hyperkalemia, azotemia
Primary vs Secondary glomerulonephritis
primary: group A strep
secondary: SLE, HIV, sickle cell, vasculitiis
Acute vs chronic glomerulonephritis
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
Nephrotic syndrome most common cause
altered immunity with inflammation, minimal change disease
Nephrotic syndrome labs/signs and symptoms
massive proteinuria over 3.5 g/day
hypoalbuminemia less than 3 g/dL (normal is 3.5-5.5)
generalized edema
Hyperlipidemia
Lipiduria
Nephrotic syndrome Late signs
circulatory congestion
HTN
edema
kidney failure
Assessment finding with nephrotic syndrome
signs of edema and fluid overload (JVD, crackles, S3 heart sound)
Nephrotic syndrome lab finding
Urinalysis is the best initial test.
24-hour urine collection: Hematuria, Proteinuria, Lipiduria, Azotemia (↑BUN and ↑creatinine), ↓GF
How do we treat the nephrotic syndrome
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
Nephritic syndrome s/s
hematuria
mild proteinuria less than 2g/day
HTN arterial
edema
fatigue
Nephritic syndrome assessment
Assess for systemic circulatory overload and uremic symptoms (slurred speech, ataxia, tremors or asterixis, pruritus, jaundice, bruising)
Interventions for nephritic syndrome focus on
slowing progression of disease, preventing complications
eventually the pt requires dialysis or a kidney transplant
Renal artery stenosis
Processes affecting renal arteries may severely narrow lumen, greatly reduce blood flow to kidneys
Usually have a sudden onset of hypertension
Nephrosclerosis
Degenerative disorder resulting from changes in kidney blood vessels (thicken and narrow)
Occurs with HTN, atherosclerosis, DM
May be reversible or progress to ESKD
Clinical manifestations of nephrosclerosis
proteinuria, casts, nocturia
Lower urinary tract obstructions usually from
BPH
calculi
urethral strictures
tumors
Upper urinary tract obstructions are from
calculi
tumor
trauma
aneurysms
congenital anomaliy
Renal calculi most common cause
dehydration
Stone anaylsis consitst of what 4 things
calcium
uric acid
struvity
cysteine
renal calculi treatment shock wave lithotripsy
pre op
post op
Pre procedure: EKG, Discontinue anticoagulants, Pacemaker
Post Procedure: Pain management, monitoring, screen urine
Hydronephrosis and hydroutreter
problems of urine elimination with outflow obstruction
renal cell carcinoma
adenocarcinoma of the kidney is the most common type of kidney cancer which usually metastasizes to
adrenal gland, liver, long bones, and other kidney
S/S of kidney cancer
May have flank pain, obvious blood in urine (late sign), kidney palpable mass
staging of kidney tumors
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.
Kidney trauma grading
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
With kidney trauma do we cath these patients
Do not catheterize a patient with blood in urinary meatus
Problems with Urinary Elimination Urinary Retention nursing management
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
Stress incontinence
due to weak pelvic muscles and structural supports
urge incontinence
due to decreased bladder capacity, bladder spasms, diet, and neurologic impairment
reflex incontinence
due to neurologic impairment
functional incontinence
due to impaired cognition or neuromuscular limitations
total urinary incontinence
due to many causes
Urinary Incontinence
Drug therapy:
Anticholinergics to block muscarinic receptors oxybutynin (Ditropan)
TCA imipramine (Tofranil)
Do we place a foley for actue prostatitis
no it can lead to septicemia
Diagnosis of prostatitis
Digital Rectal Examination (DRE) finds an edematous and tender prostate, urinalysis-culture to identify pathogen and guide abx selection.
acute prostatitis clinical manifestations:
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.
BPH patho
With aging and increased dihydrotestosterone (DHT) levels, the glandular units in the prostate undergo nodular tissue hyperplasia
BPH etiology
BPH is a very common male health problem, but the exact cause is unclear. Its relationship to aging is the only known factor.
BPH medications
5-Alpha Reductase Inhibitor: Finasteride (Proscar),
Alpha Receptors Blockers: Tamsulosin (Flomax), Doxazosin (Cardura)
Alpha1a-Blocker/5-Alpha-Reductaste Inhibitor: Tadalafil (Cialis)
BPH laser surgery protocol with foley
Foley catheter will be in place following the procedure and removed in a day
PKD is
most common autosomal dominant genetic disorder in which fluid-filled cysts develop in the nephrons
S/S of PKD
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
Dietary guidelines with PKD
Dietary:
Sodium needs vary (early hyperfiltration stage do not restrict vs late need to restrict)
