Kidney and Urinary Tract Function Flashcards
kidney transplant
list based on severity
new kidneys last 10-15 yrs
serum Cr lvl
Renal function effectiveness measurement. Creatinine is a result of protein energy metabolism and is monitored and excreted by the kidneys. [0.6-1.2 mg/dL]
BUN
(BUN) Urea is the nitrogenous end product of protein metabolism. Can be altered by protein intake, tissue breakdown, and fluid volume fluctuations. [7-18 mg/dL, >65 yo 8-20 mg/dL]
bun to cr ratio
evaluates hydration status. Increased ratio indicates hypovolemia. [10:1]
specific gravity urine osmolality
degree urine conc
norm- 1.005- 1.030
GFR
L plasma being filtered
dec w/ renal damage
24 h urine collection
every single void
conc can vary w/ stress lvl (cortisol)
AKI requirement
Rapid loss of renal function defined as a 50% increase in Serum Creatinine from damage down to the kidney.
AKI- complications
Potentially lethal metabolic complications including fluid/electrolyte imbalances, metabolic acidosis (manage pH)
AKI trtmnt
fix underlying cause and return kidney function
AKI- causes
Prerenal - impaired blood flow to kidney (dehyd, trauma, dec bp)
Intrarenal- Parenchymal damage to glomeruli or kidney tubule (agent in blood, contrast dye, antib)
Postrenal-obstruction distal to the kidney (kidney stone or enlarged prostate)
oliguria, anuria, hematuria, polyuria, diuresis, pyuria
o- dec urine production (50% dec) a- no urine h- blood poly- inc production d- fluid from vascular system pyuria- WBC in urine
RIFLE- AKI
classification R isk- GFR > 25% dec, UO <0.5ml/hr I njury GFR > 50%, < 0.5ml/hr F ailure GFR dec >75%, scr > 4mg/dl, uo < 0.3 ml/hr L oss complete loss function > 4 wks E nd stage renal disease > 3mon
UTI cause
pathogenic microo
UTI- cystitis
(bacterial) inflammation of the urinary bladder, considered a lower UTI- ecoli
UTI- upper
less common but include Pyelonephritis, interstitial nephritis, and renal abscesses.
UTI- fungal
accompanied by immunosupp meds (rare)
UTI risk factors
Foley catheters Lack of hygiene (front to back) Obstruction Diabetes (bac loves sugar) Urinary Retention Neurological Disorders (spinal injury) Gender (females shorter urethra)
UTI-patho
A microorganism (usually bacteria) is introduced into the urinary tract, adheres, and colonizes to the epithelium. Inflammatory process begins
UTI- clincal manif
Burning Urgency Frequency Foul odor Cloudy Urine
Fever
UTI- elderly consid
inc confusion
antib can cause super infection (cdiff)
UTI- nursing considerations
UA push Fluids Blood work (WBC, lactic acid) Hygiene x2 daily Toxic renal medications or treatment (metformin) Void habits Discontinuing Foley Safety (fall risk, confusion) Antibiotics, antifungals Yeast (super infection)
ex. antib- azo, oxybutinin, pyrimadine
foley cath- indications
Assist with urinary outlet obstruction
Urologic surgeries (bladder tumor, prostate removal)
Achieve exact output measurement in critically ill patients
Neurogenic bladder, retention concerns
Stage III & Stage IV Pressure ulcers (avoid skin irritation)
CAUTI
Catheter Associated Urinary Tract Infections
goal- remove cath 3-4 days
cauti prevention
Sterile technique with insertion
Using smallest tube size for insertion (prevent abrasion)
Diligent perineal care and foley care at least q 8 hours
Securement of tube
Monitoring of color, clarity, odor, and consistency
REMOVE AS SOON AS APPROPRIATE
pyelonephritis- def
inflamm of renal pelvis (UTI of kidneys)
pyelonephritis- s/s
Nausea/Vomiting Chills and fever Flank pain (costovertebral) Hematuria Elevated WBC
pyelonephritis-complications
bacteremia, sepsis, perm kidney damage
CKD chronic kidney disease- requirements and complications
requir- dec GFR lasting 3 or more months
complications - (stage 4/5) not trtd= end stage renal dis and dialysis
CKD- stage 1
90% norm fun
cr lvl show damage
CKD- stage 2
60-89% norm fun
no specific s/s
CKD- stage 3
30-59% norm fun
no specific s/s
CKD- stage 4
15-29% norm fun
need trtment for survival
CKD- stage 5
<15% norm fun
need trtment
risks for CKD
Cardiovascular disease
Diabetes
Hypertension
Obesity
renal failure- kidney deficiet characteristics
cant filter waste, excrete extra fluid, or manage electrolytes (K, Na, Mg)
K (3.5-5 necessary for cardiovasc)
renal failure- require
gain 10lbs water weight in 3 days
renal replacement trtmnt- hemodialysis
AV fistual in arm
peritoneal (infuses dialysate at night at home, inc risk peritonitis)
renal replacement trtmnt- AV fistual and Dialysis cath
av- arteriovenous
no bp or labs on that arm
dialysis cath- in chest or neck
sterile procedure by physician (sutured in)
purple color
dialysis- considerations
Fluid Volume
Shifts
Electrolyte
Disturbances
Itching (not getts rid of wastes effectively)
Quality of Life (cant work, vacation, very sick, exhausted, muscles cramps, pts delicate)
3-4h 3-4x week (MWF)
dialysis- nursing interventions
montior- K, ph, mg, na and fluid volume
watch for s/s- muscle spasms, itching, hypovol, fvo, hyperkalemia
urolithiasis- def
kidney stone or calculi in UTI or kidneys
formed frm ca oxalate, ca ph, or uric acid
urolithiasis- s/s
cause is unknown
can pass naturally
Infection: chills, fever, urinary frequency
Obstruction with stones causes buildup of urine in the kidney can cause flank pain (intermittent)
Stones traveling in the ureter can get stuck and result in
severe, intermittent, radiating pain
Stones stuck in the bladder cause UTI symptoms and Hematuria (stone scrape urethra)
Nausea / Vomiting
urolithiasis- diagnosis
X rays of Kidney, ureters, and bladder Ultrasound Retrograde pyelography 24 hour Urine cytoscopy
urolithiasis- trtment
IV fluids (help pass stone) Pain management: NSAIDS (Tordol) & Opioids Nausea management Ureteroscopy Electrohydraulic lithotripter Ultrasound device Ureter Stent placement Extracorporeal shock wave lithotripsy (ESWL) (brks stone w/o breaking vessels)
incont- def and types
The involuntary leakage of urine Types: -Stress -Urgency -Overflow (prostate blocks urethra, bladder overflows and squeezes off urine)
incont- female
50%
d/t age, preg, obesity, parity or high impact exercise
common= stress incont
wmn menopause and UTI
inc risk bc dec estrogen/ loss good bac
incont- male
Age is common factor
- Urge urinary incontinence
- Bladder Outlet Obstruction
- Stress incontinence
- Overflow Incontinence
incont- nursing considerations
Skin integrity Urinary tract infections Anxiety Toileting Schedule (q1-2) Behavioral Therapy Medications (flomax for enlarged prostate) Surgical interventions Pelvic Floor Exercises (Kegels)
intventions for no urine w/in last 36h and on antib
blader scan, straight cath, post void residual, UA, fluids, contact provider
