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NURS 3512 > Fluid/electrolytes, Acid/Base and Elimination > Flashcards

Fluid/electrolytes, Acid/Base and Elimination Flashcards

1
Q

What is GFR?

A

refers to the amount of blood filtered by the glomerulus

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2
Q

what is the function of the kidneys

A
  1. makes urine
  2. regulates volume and the composition of extracellular fluids
  3. filter waste products
  4. Assist in control of blood pressure
  5. Produce erythropoietin r/t RBC
  6. Activates vitamin D
  7. produces and secretes renin –> affects acid and base
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3
Q

what are the functional units of kidneys?

A
  • nephrons
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4
Q

can a person live with 1 functioning kidney

A

Yes

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5
Q

What happened to enlarge prostates?

A

it presses into the urethra so less urine is able to leave the bladder

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6
Q

what type of symptoms will person with enlarged BP have?

A
  • mostly GU symptoms
  1. trouble emptying bladder
  2. Frequency which can lead to infection etc.
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7
Q

What to assess

A

Monitor trends **`

  1. I &O fluid balance
  2. Serum BUN and Cr, serum K
  3. Edema, auscultate breathing sounds
  4. Acid and base balance
  5. Urine output (u/o)
  6. Pain
  7. Signs of infection
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8
Q

How do we monitor I and O fluid balance

A
  • Look for trends
  • Intake ( IV, po, u/o, diarrhea, NG suction, etc..)
  • weight patient daily ( look for daily trends) –> is the patient gaining weight? if they are that means theyre retaining water and kidney might not be working
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9
Q

How/ Why is Serum BUN & Cr, Serum K important to assess?

A
  • Important for kidney functions
  • If we see an increase it means that the kidney function is decreasing
  • might have to do 24h Cr clearance
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10
Q

What is BUN

A

End product of protein metabolism

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11
Q

What is creatinine

A

End product of muscle metabolism

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12
Q

What does it mean when Serum k is increase? Why is it important to check?

A
  • Maybe kidney might not be functioning?

- it impact cardiac rhythm

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13
Q

What does edema and crackles in the lungs tells us ?

A
  • Protein level is low ( albumin)
  • Sign that body holds onto water
  • maybe sign of fluid overload

overall kidney might not be working well

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14
Q

When kidney starts to fail how does it affect Acid/Base balance?

A
  • Patient goes to metabolic acidosis

- Bicarb decreases because body is using it up and buffering H+ ions

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15
Q

What is the normal urine output

A
  • 30ml/ hr even with one kidney

- if theres no 30mL we have to wonder why

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16
Q

What do we do if patient have pain?

A
  • assess for the location ( lower abd –> bladder, Flank –> kidneys)
  • pain could indicate an infection, distended bladder or obstruction from kidney stone
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17
Q

what are things we can do to check for infection?

A
  • urine culture

- urine analysis ( looks at WBC and protein in the urine)

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18
Q

what are the possible problems in the GU (5)

A
  1. Infection
  2. Blockage/ Obstruction
  3. Kidney failing ( diabetes, lupus, medication)
  4. Trauma/ injury to kidney ( stabbing, fall, etc)
  5. Cancer
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19
Q

what are the 3 different types of infection ? which is the most serious?

A
  1. Urethra (urethritis) - lower tract infection
  2. bladder ( cystitis) - lower tract infection
  3. Kidney (pyelonephritis) - upper tract infection
  • Kidney (pyelonephritis) is the most serious because it is affecting the kidney itself.
  • We worry about kidney functioning and if its not caught early and treated we could then have a kidney failure.
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20
Q

what are the 3 different type of Blockage/ Obstruction

A
  1. Stricture (narrowing) - narrowing of urethra or ureter
  2. Calculi (stones) - creates backup, results in stagnant urine –> infection
  3. Benign prostatic hyperplasia (BPH) - prostate is enlarged and it can block urine from coming out. Very uncomfortable and creates urinary retention and high risk of urinary infection.
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21
Q

what is the 3 causes of kidney failure

A
  1. diabetes
  2. medication
  3. lupus
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22
Q

What are the examples of Trauma/ injury to kidney

A
  1. Stabbing
  2. fall
  3. etc…
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23
Q

What are the 3 types of cancer

A
  1. bladder
  2. Prostate
  3. Kidney
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24
Q

what is the two surgical approach for renal and ureteral surgery?

A

Laparoscopic and open surgery

25
Q

what are the most common indications for nephrectomy?

4

A
  1. renal tumour
  2. severely bleeding or infected kidneys
  3. massive traumatic injury to the kidneys
  4. removal of kidneys from the donor
26
Q

post operative needs of patient who went for surgery are related to what 3 things?

A
  1. urinary output
  2. respiratory status
  3. abdominal distention
27
Q

how often should urine get checked postoperatively?

A

every 1 - 2 hours

28
Q

How should you record drainage in post op?

A

drainage from different tubings should be recorded separately

29
Q

what should you not do post op for urine output?

A

should not clamp catheter or tube and should not irrigate without order

30
Q

what else should we do to assess urine output for post op patients?

A
  1. weigh the patients everyday

2. assess for urine colour and consistency of urine

31
Q

why do we need to assess RESP status?

A

renal surgery is often performed through a flank incision just below the diaphragm and often involves removal of the twelfth rib.

32
Q

patient are often reluctant to turning and DB and C due to pain which can increase respiratory problem, what should we do?

A
  • Give patient analgesics to ensure patient’s comfort and ability to perform coughing and deep-breathing exercises
33
Q

what else would help post op patient regarding respiratory status

A
  1. spirometry

2. early and frequent ambulation

34
Q

why does stomach gets distended after post op surgery or ureter or kidneys?

A

it is most commonly result of paralytic ileus caused by manipulation and compression of the bowel during surgery.

35
Q

When is oral intake resumes after post op?

A

oral intake is resumed until bowel sounds comes back ( usually 24 - 48hrs after surgery)

36
Q

what are the diagnostic tests for kidneys and ureters

A
  1. KUB X-ray
  2. Cystoscopy
  3. IVP
  4. Retrograde pyelogram
37
Q

what do you need to do before KUB X ray?

A

Bowel prep

38
Q

what is KUB X-ray ( Kidney Ureter Bladder)

A
  • Shows abdomen and pelvis
  • shows size, shape, and position of the kidneys
  • Bowel prep is needed before Xray
39
Q

What do you need to do before cystoscopy?

A

Need consent from the patient before the procedure because its invasive

40
Q

What is cystoscopy?

A
  • Doctor use light scope which goes through urethra to see the bladder wall and it can also take biopsy.
41
Q

In Cystoscopy why is it irritating? what are the patients expected symptoms?

A
  • it is irritating because it goes through the urethra

- symptoms that patient might feel is burning, pink tinged urination and urinary frequency

42
Q

what do we do to alleviate some of the symptoms of cystoscopy?

A

give sitz bath and tylenol

43
Q

what is cystoscopy good for?

A

Good test for looking at bladder problems and possibly cancer

44
Q

What do we have to ask before IVP ( Intravenous pyelogram)

A
  • Ask patient about allergies!

- if patient is allergic to shellfish or iodine then contrast dye will not be inserted through their IV

45
Q

what do we have to consider before doing IVP

A
  • consider patients kidney function because the dye is hard on the kidneys
  • Take BUN and Cr
46
Q

what is IVP?

A
  • it is used to visualize urinary tract ( mostly for stones and strictures)
  • Patient is given a dye through their vein and they take an X-ray
  • Physician can then visualize urinary tract to see if theres kidney stones or narrow strictures in the ureter
47
Q

what is an important teaching after IVP?

A

tell patient to drink lots of fluids PO or IV so that it can help flush out dye from kidneys.

48
Q

What is retrograde pyelogram?

A
  • Dye is inserted through urethra by a catheter and this outlines the bladder, ureter and the renal pelvis
  • uses Xray to look at bladder, ureters and kidneys
  • Performed under anesthesia or conscious sedation
49
Q

what does retrograde pyelogram shows?

A

lets us see if theres any obstructions narrowing a tumour or a stone, or even a blood clot.

50
Q

what would patient feel after retrograde pyelogram?

A

Patient may have pain because of distention of the pelvis and discomfort of the scope.

51
Q

what is the difference between IVP and Retrograde pyeologram?

A

both use dye but in IVP it is inserted in the vein as for retro it is inserted through urethra.

52
Q

what are some medications we use?

A
  1. NSAIDS
  2. Antibiotics
  3. Kidney function/ increase urine output
  4. Treatments for bladder symptoms
  5. Alter the prostate
53
Q

what are NSAIDS and narcotics for? give examples

A
  • ## use for pain, narcotics are use for large kidney stones, cancer, post op
54
Q

what are the 2 antibiotics used.

A
  1. TMP-SMX (Septra, bactrim)

2. Ciprofloxacin

55
Q

TMP-SMX (Septra, bactrim)

A
  • used for 1-3 days for uncomplicated UTI

- 3-5 days for recurrent UTI

56
Q

Ciprofloxacin

A

Used for complicated UTI with other issues involve or when patient has indwelling catheter that we cannot remove

57
Q

What medication do we use for kidney function/ increase urine output

A

Lasix ( loop diuretics)

58
Q

what medications are used to treat bladder symptoms

A
  1. Pyridium ( urinary analgesics)
  2. Ditropan ( reduce of muscle spasms of bladder and urinary tract)
  3. Belladonna & opium suppository ( moderate to severe pain from spasms of urinary tract)
59
Q

meds for altering the prostate

A
  1. proscar - decrease prostate size

2. Flomax - promotes smooth muscle relaxation in the prostate

NURS 3512 (10 decks)

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