GU exam 2 Flashcards
acute glomerulonephritis
caused by infection!!
-typically Strep that is untreated
-10 days after infection s/s
-seen in young adult and children
acute glomerulonephritis
edema / fluid retention
hematuria
decrease UO
mild HTN
acute glomerulonephritis labs
urinalysis : protein , blood , WBC
CMP :
-BUN increase
-Creatinine increase
-GFR decreased
-Albumin decreased
CBC : WBC increase
acute glomerulonephritis dx
history
presentation
lab findings
acute glomerulonephritis complications
fluid overload
HTN
acute glomerulonephritis potential complication
acute or chronic kidney disease with no tx
acute glomerulonephritis tx
- abx - penicillin
- diuretics - HTN
- fluid / sodium restrict
- low protein
- steroids
- plasmapheresis
acute glomerulonephritis management
monitor vitals
diet intake
meds
acute glomerulonephritis education
disease
meds : FINISH ALL ABX!!!
dietary restriction
infection prevention
polycystic kidney disease
excessive growth of fluid filled cysts in kidneys
polycystic kidney disease s/s
HTN!!!
hematuria
flank / low back pain
HA
UTI!!!
urinary frequency!!!
urinary calculi
polycystic kidney disease labs
urinalysis : blood and bacteria
CBC : H and H decrease
CMP :
-BUN increase
-Creatinine increase
-potassium increase
-calcium decrease
-phosphorous increase
polycystic kidney disease tests
renal US : shows renal cysts
abd. CT
polycystic kidney disease complications
HTN
hematuria
polycystic kidney disease potential complications
renal calculi / UTIs
heart valve abnormality
aneurysm
liver / GI cysts
RENAL FAILURE
polycystic kidney disease tx
ACE inhibitors / ARBS
non-narcotics - acetaminophen
palliative nephrectomy
UTI abx
RENAL TRANSPLANT
polycystic kidney disease education
immediately report INFECTION
diet
medication adherence
acute kidney injury
rapid loss of renal function that is reversible when treating underlying cause
azotemia
collection of nitrogenous wast products in blood
prerenal AKI
caused by decrease blood flow to kidneys
-ex : hypovolemia!!!
intrarenal AKI
direct damage to renal tissue impairing nephron functioning
-ex : prolonged ischemia , contrast dye , aminoglycoside antibiotics
***acute glomerulonephritis
**acute tubular necrosis
postrenal AKI
caused by obstruction below kidneys
-ex : urinary tract stones , tumors , BPH
**urine is backing up
oliguric phase
urine output < 400 mL / day
-does not respond to fluid challenges or diuretics
diuretic phase
urine output increases rapidly - up to 5L / day
**dehydration common and electrolyte imbalance
AKI s/s
volume overload s/s
-edema
-SOB
-HF
-JVD
-HTN
-chest pain
anorexia / nausea
constipation / diarrhea
confusion
seizure
AKI labs
CBC : H and H decreased
CMP :
-increase potassium
-increase phosphorous
-increase phosphate
-increase BUN
-increase creatinine
-decrease calcium
-decrease sodium
ABG : metabolic ACIDOSIS
AKI complications
HYPERKALEMIA
fluid overload
hyperkalemia EKG
PEAK T WAVES
-worsening = QRS complex is widening and loss of P waves
hyperkalemia protocol
- Calcium Gluconate
- D50 (IV glucose)
- insulin
- albuterol
- bicarb
- kayexalate
AKI tx
eliminate the cause
diuretics
sodium restriction
potassium restriction
dialysis = short term
AKI management
CARDIAC MONITOR
fluid balance
positioning / deep breathing
chronic kidney disease cause
diabetes and hypertension
-IRREVERSIBLE
chronic kidney disease s/s
HTN
yellow / grey skin color
HF
arrhythmia
n/v
HA
fatigue
amenorrhea
chronic anemia
confusion
seizures
chronic kidney disease labs
CBC : H and H decrease
CMP :
-decrease sodium
-increase potassium
-increase phosphate
-decrease calcium
-decrease CO2
-increase creatinine
-increase BUN
ABG : ACIDIC
urinalysis : protein
chronic kidney disease tests
CT and renal US
chronic kidney disease complications
fluid overload
electrolyte imbalance
dysrhythmias
anemia
fragile bones
chronic kidney disease tx
- hyperkalemia protocol
- HTN
- anemia - erythropoietin IV only when active bleed or symptomatic
- dyslipidemia - STATINS
- hypocalcemia - Vit D and calcium supplement
- renal osteodystrophy - phosphate binders (administer with each meal)
renal replacement therapy
hemodialysis
peritoneal dialysis
renal transplant
CKD education
disease process
DO NOT miss dialysis
dietary restriction : protein / phosphorous / sodium / potassium
no nephrotic meds
renal transplant
improve life function NOT A CURE
renal transplant candidate
free of medical problems that increase risk
-cardiac disease
-cancer (metastatic)
-chronic infection
-alcoholism
-chemical dependency
NOT considered
post op renal transplant
- evaluate function : I / O
- immunosuppressive therapy : prevent tissue rejection , increases infection risk
- ASSESS URINE OUTPUT hourly for 48 hours
-abrupt decrease = rejection or acute tubular 4. necrosis - urine color : pink is normal , NOT FRANK RED
- monitor fluid status : NO FLUID OVERLOAD
-weigh daily
acute rejection
1 week - 2 years : mainly 2 weeks
-oliguria or anuria
-temp > 100
-increase BP
-enlarged tender kidney
-lethargy
-elevated creatinine, BUN, potassium
-fluid retention
acute rejection tx
increase immunosuppressant meds
acute tubular necrosis
hypoxic damage when transplant is delayed after kidneys are harvested
-increase risk longer they wait for transplant
thrombosis
sudden decrease in UO can signal this
renal artery stenosis
cause HTN , balloon angioplasty or surgically repaired
renal cancer
occurs in males, AA more common
-smoking
-tobacco
-first degree relative
-obesity
-HTN
renal cancer s/s
TRIAD : flank mass , flank pain , hematuria
weight loss
fatigue
HTN
fever
anemia
renal cancer tests
US
CT scan
MRI
**dx is made from biopsy
renal cancer complications
pain
reduced circulation
ESRD
metastasis
renal cancer chemotherapy…
IS NOT EFFECTIVE
-use immunotherapy and radiation
renal cancer surgery
radical nephrectomy
renal cancer post op
wound / incisions
foley cath
stent
nephrostomy tubes
prostate cancer
higher rate in AA
family hx
diet high in red meat / calcium
high BMI
prostate local disease
weak urinary stream
urinary hesitancy
sensation of incomplete emptying
urgency / frequency
urge incontinence
UTI
prostate invasive disease
hematuria
dysuria
perineal / suprapubic pain
ED
incontinence
s/s of renal failure
hemospermia
rectal pain
prostate cancer labs
PSA
CRITICAL CUT OFF POINT is 4
** >4 ng is a concern
prostate cancer dx
prostate biopsy , screening is controversial
prostate management
radiation
-external beam
-BRACHYTHERAPY
cryotherapy
ablative hormone therapy : testosterone suppression
brachytherapy
radioactive seeds in the prostate , MUST obtain from sex for 2 weeks , USE A CONDOM after 2 week period
**keep partner safe from radiation
prostate cancer surgery
radical prostatectomy : removal of prostate and seminal vesicles
**ALL result in impotence
prostate post op
- aseptic wound care
- manage bladder irrigation
- meds : pain, stool softener , IV abx
prostate cancer education
brachytherapy sex safety
signs of infection
prevention
testicular cancer causes
brother with testicular cancer
cryptorchidism (undescended testes)
down’s syndrome
smoking
testicular cancer s/s
PAINLESS MASS
pain, swelling, hardness in scrotum
testicular cancer labs
alpha-fetoprotein
HCG
^^tumor markers
testicular cancer tests
US: makes sure not infection
CT and x-ray : stage
testicular cancer surgery
ON ALL TESTICULAR CANCER
radical orchiectomy - removal of affected testicle
seminomas
post surgery radiation OR chemo
nonseminomas
chemotherapy after surgery
testicular cancer management
pain
monitor infection
aseptic wound care
testicular cancer teaching
infection s/s
sperm storage : sperm bank before tx
self exams
follow ups
renal replacement therapy
indicated for AKI or ESRD (end stage renal disease)
CRRT (continuous renal replacement therapy)
indicated for acutely ill AKI or severe fluid overload
**HEMODYNAMICALLY UNSTABLE PTS
CRRT access
vascular access - central line
-double or single lumen
CRRT process
uses a filter to move particles and blood is returned to patient
**use anticoagulation to prevent clotting - HEPARIN is used as a bolus
CRRT mechanical complication
vascular access related
-bleeding , hematuria , AV fistula , thrombosis
-infection
circuit complications
-premature filter clotting
-air embolism
CRRT hemodynamic complications
hypothermia
hypotension - less risk than w/ hemodialysis
CRRT metabolic complications
metabolic acidosis / alkalosis
hypernatremia
hypophosphatemia
hypomagnesemia
hypocalcemia
hypokalemia
CRRT nursing assessment
frequent hour vitals
hourly assessment of volume filtrate
hemodialysis
can be performed outpatient, inpatient hospital settings
hemodialysis access
- central venous double lumen: short term
- AV fistula: surgical, cannot use this immediately
- AV graft: do not have to mature , infection prone
AV fistula assessment
auscultate BRUIT
palpable THRILL
**must mature before use
hemodialysis
blood pumped, uses a membrane and dialysate solution
hemodialysis complication
hypotension : rapid removal of fluid
muscle cramp, HA, nausea, dizziness, malaise
bleeding
infection
dialysis associated dementia
dialysis disequalibrium
localized
dialysis associated dementia
progressive complication , r/t aluminum in dialysis
dialysis disequilibrium syndrome
due to rapid changes in extracellular fluid causing shift into brain
**cerebral edema
hemodialysis infections
HIV
hepatitis C / B
cytomegalovirus
hemodialysis assessment
assess vascular access
AV fistulas need THRILL and BRUIT
neuro assessment
peritoneal dialysis
indicated for pts who desire more control or had vascular access problems
**CAN be done at home
PD contraindications
- multiple abd surgeries
- recurrent hernias
- obesity
- pre-existing back problems
- severe COPD
PD access
permanent indwelling PD catheter
Fill phase
room temp steril dialysate instilled
dwell phase
metabolic waste products and excess electrolytes diffuse dialysate remains in abd
drain phase
gravity drains dialysate out of cavity into sterile bag
continuous ambulatory peritoneal dialysis
dialysate infused into abd 4-5 times / day for around 4-6 hours
-pts may be ambulatory , no machines
automated peritoneal dialysis
used overnight exchanges , dialysis free during day
intermittent peritoneal dialysis
30-40 exchanges per week
(30-60 minutes each)
PD complications
peritonitis
catheter infection
hyperglycemia
outflow problems
respiratory compromise
protein loss
peritonitis r/t PD
fever and abd pain
cloud peritoneal effluent
repeated infection = catheter removal
PD catheter infection
site redness, tenderness, drainage
-abscess formation
PD abdominal pain
can be caused by too fast infusion of dialysate
PD hyperglycemia
glucose in dialysate can be absorbed into blood stream
PD nursing assessment
abdominal girth
outflow
complications
