Genitourinary Flashcards
Urethra
cm? female and male
Urethra
* Females: 3-4 cm
* Males: 20 cm
functional capacity for bladder to empty the urine
functional capacity 400-500ml
- Oliguria:
- Anuria
- Normal
Oliguria: daily urine volume of less than 400 mL
* Anuria urine output of less than 100 mL/day
* Normal urine production is 0.5mL/kg/hr
GFR - glomerular filtration rate
GFR - glomerular filtration rate
* < 90 mL/min/1.73 m2 considered chronic kidney damage
< 60 mL/min/1.73 m2 considered irreversible kidney damag
Acute kidney injury Vs Chronic Kidney Failure
Acute kidney injury is a reversible syndrome that results in
decreased glomerular filtration rate and oliguria
- Chronic renal failure (ESRD) is a progressive, irreversible
deterioration of renal function that results in azotemia
Acute kidney injury cause
Prerenal
Intra-renal
Post-renal
Prerenal
*Hypoperfusion of kidney
* Hypovolemia
* Reduced cardiac output
* Vasodilation
Intrarenal
* Prolonged renal ischemia
* Nephrotoxic agents
* Infectious processes
Postrenal
* Urinary tract obstruction
Four Phases of Acute Kidney Injury
- Initiation
- Begins with the initial insult
Oliguria
* Increase in serum urea, creatinine, uric acid, organic acids, K+,
mag
Diuresis
* Increase in urine output
Recovery
* Renal function continues to improve
Urinalysis and urine culture:
Renal function tests:
Ultrasonography:
Urinalysis and urine culture
* Specific gravity, CYU, pH, protein,
glucose, ketones
Renal function tests
* GFR
Ultrasonography
* Bladder should be ful
What is the difference between Prerenal and
Intrarenal failure?
- Prerenal acute renal failure is characterized by diminished renal
blood flow (60 to 70 percent of cases). - In intrinsic acute renal failure, there is damage to the renal
parenchyma (25 to 40 percent of cases). - Postrenal acute renal failure occurs because of urinary tract
obstruction (5 to 10 percent of cases)
Acute Kidney Injury: clinical manifestations in oliguric phase
( Hint more like right-side heart failure symptoms)
- Peripheral edema, pulmonary edema, JVD, HTN
- Fatigue
- N/V
- SOB
- Confusion
- Seizures or coma
- Chest pain
Azotemia
abnormally high levels of nitroge
Initial diagnostic test for Acute kidney injury
Ultrasound
then CBC -
* Hemoglobin
Acute Kidney Injury: Tx medications for hyperkalemia especially
K+ is the most life-threatening in AKI
Hyperkalemia
- Sodium polystyrene sulfonate (PO, PR)
- Sorbitol
- IV insulin/D50
- IV bicarbonate
- Dialysis
Monitor nephrotoxic medications
example?
Contrast, biguanides, etc
Collaborative Problems and Complications
Hyperkalemia
* Pericarditis
* Pericardial effusion
* Pericardial tamponade (extra fluid builds up in the space around the
heart)
* Hypertension
* Anemia - lower production of erythropoietin production of RBCs
* Bone disease and metastatic calcifications (calcium salts in normal
tissue)
Stages of Chronic Kidney Disease
stage 1-5
Stages of Chronic Kidney Disease
* Stage 1
* Kidney damage with normal or increased GFR
* Stage 2
* Mild decrease in GFR
* Stage 3
* Moderate decrease in GFR
* Stage 4
* Severe decrease in GFR
* Stage 5
* End-stage kidney disease or chronic kidney disease
End Stage Kidney Disease: Diagnostics
- GFR decreases
- Increased creatinine & BUN
- Na & H2O balance
- Potassium balance
- Metabolic Acidosis
- Calcium decreases
- Phosphorous increases
- Anemia
Kidney Disease Diet Considerations
- 4 to 5 small meals
- Read food labels (no salt added, low sodium)
- Low in sodium and potassium (lemon, spices)
- Avoid salt substitutes
- Avoid foods high in phosphorus (dairy, lentils, beans)
- High-quality protein (lean meat, poultry, fish, eggs)
- Monitor fluids carefully (anything liquid at room temp counts)
Kidney Transplant:
Donor contraindications:
Sucess rate:
- Treatment of choice for patients with ESRD
- Elective surgery with many requirements
Donor contraindications
* HTN
* DM
Success rate
* Living-donor 97% after one year; 86% after five years
* Cadaver-donor 96% after one year; 79% after five years
* Second kidney transplant if the first fail
Hemodialysis:
Hemodialysis: used when patient is acutely ill until kidneys resume
function and for long-term replacement therapy in CKD and ESKD
- Objective is to extract toxic nitrogenous substances from the blood
and to remove excess fluid: - Diffusion, osmosis, and ultrafiltration
Vascular access
* Arteriovenous fistula
* Arteriovenous graft
Peritoneal Dialysis:
Complications:
Goals are to remove toxic substances and metabolic wastes and to
reestablish normal fluid and electrolyte balance
* Peritoneal membrane serves as semipermeable membrane
* Ultrafiltration
* Peritoneal catheter
* Acute intermittent, continuous ambulatory, continuous cyclic
Complications:
peritonitis, leakage, bleeding
* bowel or bladder perforation
* Peritonitis
* Loss of protein
* Hyperglycemia
* Effluent assessment
* Color
* Clarity
Recipient Contraindications to surgery for kidney transplant
- Recent cancer
- Chronic or active infection (HIV, hepatitis B, and C)
- Cardiac disease, chronic lung disease, severe peripheral vascular disease
- Class II obesity (body mass index greater than 35 kg/m2)
- Current substance abuse
- Inability to give informed consent
- History of nonadherence to treatment regimen
Pre-operative Nursing Management
- Both donors and recipients should be in the best possible health and
have the ability to remain so. - Both patients must be free of infection
- Recipient anti-rejection medications suppress the immune response
- Psychosocial evaluation
- Motivation
- Psychiatric illness
Postoperative Nursing Management
and intervention
- Assessment: include all body systems, pain, fluid and electrolyte
status, and patency and adequacy of urinary drainage system - Complications: bleeding , pneumonia, infection, and DV
Pain relief measures, analgesic medications
* Promote airway clearance and effective breathing pattern, turn,
cough, deep breathe, incentive spirometry, positioning
* Monitor UOP and maintain patency of urinary drainage systems
* Use strict asepsis with catheter
* Monitor for signs and symptoms of bleeding
* Encourage leg exercises, early ambulation, and monitor for signs of
DVT
