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MedSurg 1 > Kidney and Urinary Tract Function > Flashcards

Kidney and Urinary Tract Function Flashcards

1
Q

kidney transplant

A

list based on severity

new kidneys last 10-15 yrs

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2
Q

serum Cr lvl

A

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]

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3
Q

BUN

A

(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]

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4
Q

bun to cr ratio

A

evaluates hydration status. Increased ratio indicates hypovolemia. [10:1]

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5
Q

specific gravity urine osmolality

A

degree urine conc

norm- 1.005- 1.030

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6
Q

GFR

A

L plasma being filtered

dec w/ renal damage

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7
Q

24 h urine collection

A

every single void

conc can vary w/ stress lvl (cortisol)

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8
Q

AKI requirement

A

Rapid loss of renal function defined as a 50% increase in Serum Creatinine from damage down to the kidney.

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9
Q

AKI- complications

A

Potentially lethal metabolic complications including fluid/electrolyte imbalances, metabolic acidosis (manage pH)

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10
Q

AKI trtmnt

A

fix underlying cause and return kidney function

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11
Q

AKI- causes

A

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)

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12
Q

oliguria, anuria, hematuria, polyuria, diuresis, pyuria

A 
o- dec urine production (50% dec)
a- no urine
h- blood 
poly- inc production
d- fluid from vascular system
pyuria- WBC in urine
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13
Q

RIFLE- AKI

A 
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
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14
Q

UTI cause

A

pathogenic microo

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15
Q

UTI- cystitis

A

(bacterial) inflammation of the urinary bladder, considered a lower UTI- ecoli

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16
Q

UTI- upper

A

less common but include Pyelonephritis, interstitial nephritis, and renal abscesses.

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17
Q

UTI- fungal

A

accompanied by immunosupp meds (rare)

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18
Q

UTI risk factors

A 
Foley catheters
Lack of hygiene (front to back)
Obstruction
Diabetes (bac loves sugar)
Urinary Retention
Neurological Disorders (spinal injury)
Gender (females shorter urethra)
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19
Q

UTI-patho

A

A microorganism (usually bacteria) is introduced into the urinary tract, adheres, and colonizes to the epithelium. Inflammatory process begins

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20
Q

UTI- clincal manif

A 
Burning
Urgency
Frequency
Foul odor
Cloudy Urine

Fever

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21
Q

UTI- elderly consid

A

inc confusion

antib can cause super infection (cdiff)

22
Q

UTI- nursing considerations

A 
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

23
Q

foley cath- indications

A

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)

24
Q

CAUTI

A

Catheter Associated Urinary Tract Infections

goal- remove cath 3-4 days

25
Q

cauti prevention

A

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

26
Q

pyelonephritis- def

A

inflamm of renal pelvis (UTI of kidneys)

27
Q

pyelonephritis- s/s

A 
Nausea/Vomiting
Chills and fever
Flank pain (costovertebral)
Hematuria
Elevated WBC
28
Q

pyelonephritis-complications

A

bacteremia, sepsis, perm kidney damage

29
Q

CKD chronic kidney disease- requirements and complications

A

requir- dec GFR lasting 3 or more months

complications - (stage 4/5) not trtd= end stage renal dis and dialysis

30
Q

CKD- stage 1

A

90% norm fun

cr lvl show damage

31
Q

CKD- stage 2

A

60-89% norm fun

no specific s/s

32
Q

CKD- stage 3

A

30-59% norm fun

no specific s/s

33
Q

CKD- stage 4

A

15-29% norm fun

need trtment for survival

34
Q

CKD- stage 5

A

<15% norm fun

need trtment

35
Q

risks for CKD

A

Cardiovascular disease
Diabetes
Hypertension
Obesity

36
Q

renal failure- kidney deficiet characteristics

A

cant filter waste, excrete extra fluid, or manage electrolytes (K, Na, Mg)
K (3.5-5 necessary for cardiovasc)

37
Q

renal failure- require

A

gain 10lbs water weight in 3 days

38
Q

renal replacement trtmnt- hemodialysis

A

AV fistual in arm

peritoneal (infuses dialysate at night at home, inc risk peritonitis)

39
Q

renal replacement trtmnt- AV fistual and Dialysis cath

A

av- arteriovenous
no bp or labs on that arm

dialysis cath- in chest or neck
sterile procedure by physician (sutured in)
purple color

40
Q

dialysis- considerations

A

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)

41
Q

dialysis- nursing interventions

A

montior- K, ph, mg, na and fluid volume

watch for s/s- muscle spasms, itching, hypovol, fvo, hyperkalemia

42
Q

urolithiasis- def

A

kidney stone or calculi in UTI or kidneys

formed frm ca oxalate, ca ph, or uric acid

43
Q

urolithiasis- s/s

A

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

44
Q

urolithiasis- diagnosis

A 
X rays of Kidney, ureters, and bladder
Ultrasound
Retrograde pyelography
24 hour Urine
cytoscopy
45
Q

urolithiasis- trtment

A 
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)
46
Q

incont- def and types

A 
The involuntary leakage of urine
Types:
	-Stress
	-Urgency
	-Overflow (prostate blocks urethra, bladder overflows and squeezes off urine)
47
Q

incont- female

A

50%
d/t age, preg, obesity, parity or high impact exercise
common= stress incont

48
Q

wmn menopause and UTI

A

inc risk bc dec estrogen/ loss good bac

49
Q

incont- male

A

Age is common factor

  • Urge urinary incontinence
  • Bladder Outlet Obstruction
  • Stress incontinence
  • Overflow Incontinence
50
Q

incont- nursing considerations

A 
Skin integrity
Urinary tract infections
Anxiety
Toileting Schedule (q1-2)
Behavioral Therapy
Medications (flomax for enlarged prostate)
Surgical interventions 
Pelvic Floor Exercises (Kegels)
51
Q

intventions for no urine w/in last 36h and on antib

A

blader scan, straight cath, post void residual, UA, fluids, contact provider

MedSurg 1 (9 decks)

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