Fluid/electrolytes, Acid/Base and Elimination Flashcards
What is GFR?
refers to the amount of blood filtered by the glomerulus
what is the function of the kidneys
- makes urine
- regulates volume and the composition of extracellular fluids
- filter waste products
- Assist in control of blood pressure
- Produce erythropoietin r/t RBC
- Activates vitamin D
- produces and secretes renin –> affects acid and base
what are the functional units of kidneys?
- nephrons
can a person live with 1 functioning kidney
Yes
What happened to enlarge prostates?
it presses into the urethra so less urine is able to leave the bladder
what type of symptoms will person with enlarged BP have?
- mostly GU symptoms
- trouble emptying bladder
- Frequency which can lead to infection etc.
What to assess
Monitor trends **`
- I &O fluid balance
- Serum BUN and Cr, serum K
- Edema, auscultate breathing sounds
- Acid and base balance
- Urine output (u/o)
- Pain
- Signs of infection
How do we monitor I and O fluid balance
- 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
How/ Why is Serum BUN & Cr, Serum K important to assess?
- Important for kidney functions
- If we see an increase it means that the kidney function is decreasing
- might have to do 24h Cr clearance
What is BUN
End product of protein metabolism
What is creatinine
End product of muscle metabolism
What does it mean when Serum k is increase? Why is it important to check?
- Maybe kidney might not be functioning?
- it impact cardiac rhythm
What does edema and crackles in the lungs tells us ?
- Protein level is low ( albumin)
- Sign that body holds onto water
- maybe sign of fluid overload
overall kidney might not be working well
When kidney starts to fail how does it affect Acid/Base balance?
- Patient goes to metabolic acidosis
- Bicarb decreases because body is using it up and buffering H+ ions
What is the normal urine output
- 30ml/ hr even with one kidney
- if theres no 30mL we have to wonder why
What do we do if patient have pain?
- assess for the location ( lower abd –> bladder, Flank –> kidneys)
- pain could indicate an infection, distended bladder or obstruction from kidney stone
what are things we can do to check for infection?
- urine culture
- urine analysis ( looks at WBC and protein in the urine)
what are the possible problems in the GU (5)
- Infection
- Blockage/ Obstruction
- Kidney failing ( diabetes, lupus, medication)
- Trauma/ injury to kidney ( stabbing, fall, etc)
- Cancer
what are the 3 different types of infection ? which is the most serious?
- Urethra (urethritis) - lower tract infection
- bladder ( cystitis) - lower tract infection
- 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.
what are the 3 different type of Blockage/ Obstruction
- Stricture (narrowing) - narrowing of urethra or ureter
- Calculi (stones) - creates backup, results in stagnant urine –> infection
- 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.
what is the 3 causes of kidney failure
- diabetes
- medication
- lupus
What are the examples of Trauma/ injury to kidney
- Stabbing
- fall
- etc…
What are the 3 types of cancer
- bladder
- Prostate
- Kidney
what is the two surgical approach for renal and ureteral surgery?
Laparoscopic and open surgery
what are the most common indications for nephrectomy?
4
- renal tumour
- severely bleeding or infected kidneys
- massive traumatic injury to the kidneys
- removal of kidneys from the donor
post operative needs of patient who went for surgery are related to what 3 things?
- urinary output
- respiratory status
- abdominal distention
how often should urine get checked postoperatively?
every 1 - 2 hours
How should you record drainage in post op?
drainage from different tubings should be recorded separately
what should you not do post op for urine output?
should not clamp catheter or tube and should not irrigate without order
what else should we do to assess urine output for post op patients?
- weigh the patients everyday
2. assess for urine colour and consistency of urine
why do we need to assess RESP status?
renal surgery is often performed through a flank incision just below the diaphragm and often involves removal of the twelfth rib.
patient are often reluctant to turning and DB and C due to pain which can increase respiratory problem, what should we do?
- Give patient analgesics to ensure patient’s comfort and ability to perform coughing and deep-breathing exercises
what else would help post op patient regarding respiratory status
- spirometry
2. early and frequent ambulation
why does stomach gets distended after post op surgery or ureter or kidneys?
it is most commonly result of paralytic ileus caused by manipulation and compression of the bowel during surgery.
When is oral intake resumes after post op?
oral intake is resumed until bowel sounds comes back ( usually 24 - 48hrs after surgery)
what are the diagnostic tests for kidneys and ureters
- KUB X-ray
- Cystoscopy
- IVP
- Retrograde pyelogram
what do you need to do before KUB X ray?
Bowel prep
what is KUB X-ray ( Kidney Ureter Bladder)
- Shows abdomen and pelvis
- shows size, shape, and position of the kidneys
- Bowel prep is needed before Xray
What do you need to do before cystoscopy?
Need consent from the patient before the procedure because its invasive
What is cystoscopy?
- Doctor use light scope which goes through urethra to see the bladder wall and it can also take biopsy.
In Cystoscopy why is it irritating? what are the patients expected symptoms?
- it is irritating because it goes through the urethra
- symptoms that patient might feel is burning, pink tinged urination and urinary frequency
what do we do to alleviate some of the symptoms of cystoscopy?
give sitz bath and tylenol
what is cystoscopy good for?
Good test for looking at bladder problems and possibly cancer
What do we have to ask before IVP ( Intravenous pyelogram)
- Ask patient about allergies!
- if patient is allergic to shellfish or iodine then contrast dye will not be inserted through their IV
what do we have to consider before doing IVP
- consider patients kidney function because the dye is hard on the kidneys
- Take BUN and Cr
what is IVP?
- 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
what is an important teaching after IVP?
tell patient to drink lots of fluids PO or IV so that it can help flush out dye from kidneys.
What is retrograde pyelogram?
- 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
what does retrograde pyelogram shows?
lets us see if theres any obstructions narrowing a tumour or a stone, or even a blood clot.
what would patient feel after retrograde pyelogram?
Patient may have pain because of distention of the pelvis and discomfort of the scope.
what is the difference between IVP and Retrograde pyeologram?
both use dye but in IVP it is inserted in the vein as for retro it is inserted through urethra.
what are some medications we use?
- NSAIDS
- Antibiotics
- Kidney function/ increase urine output
- Treatments for bladder symptoms
- Alter the prostate
what are NSAIDS and narcotics for? give examples
- ## use for pain, narcotics are use for large kidney stones, cancer, post op
what are the 2 antibiotics used.
- TMP-SMX (Septra, bactrim)
2. Ciprofloxacin
TMP-SMX (Septra, bactrim)
- used for 1-3 days for uncomplicated UTI
- 3-5 days for recurrent UTI
Ciprofloxacin
Used for complicated UTI with other issues involve or when patient has indwelling catheter that we cannot remove
What medication do we use for kidney function/ increase urine output
Lasix ( loop diuretics)
what medications are used to treat bladder symptoms
- Pyridium ( urinary analgesics)
- Ditropan ( reduce of muscle spasms of bladder and urinary tract)
- Belladonna & opium suppository ( moderate to severe pain from spasms of urinary tract)
meds for altering the prostate
- proscar - decrease prostate size
2. Flomax - promotes smooth muscle relaxation in the prostate
