kidneys (extra slides) quiz 1 Flashcards
Chronic kidney disease definition
-Involves progressive, irreversible loss of kidney function
Defined as presence of:
Kidney damage
- Pathological abnormalities
- Markers of damage
- Blood, urine, imaging tests
-Glomerular filtration rate (GFR) <60 mL/minute/1.73m2 for 3 months or longer (normal 125ml/min)
clinical manifestation of chronic kidney disease
Result of retained substances
- Urea
- Creatinine
- Phenols
- Hormones
- Electrolytes
- Water
- Other substances
- Uremia (Syndrome that incorporates all signs and symptoms seen in various systems throughout the body )
clinical manifestations of chronic kidney disease: urinary system
Polyuria
- results from inability of - - kidneys to concentrate urine.
- occurs most often at night (nocturia).
- specific gravity fixed around 1.010.
Oliguria (low urine output)
- occurs as CKD worsens.
Anuria
- Urine output <40 mL per 24 hours
clinical manifestations of CKD: metabolic disturbances
Waste product accumulation
- As GFR decreases, BUN increases and serum creatinine levels increases
BUN increases
- not only by kidney failure but by protein intake, fever, corticosteroids, and catabolism.
- N/V, lethargy, fatigue, impaired thought processes, and headache may occur.
Altered carbohydrate metabolism
- Caused by impaired
glucose use
- From cellular insensitivity to the normal action of insulin
Defective carbohydrate metabolism
- Clients with diabetes who become uremic may require less insulin than before onset of CKD.
- Insulin dependent on kidneys for excretion
Elevated triglycerides
- Hyperinsulinemia stimulates hepatic production of triglycerides.
- Altered lipid metabolism
- Decrease levels of enzyme lipoprotein lipase
-Important in breakdown of lipoproteins
clinical manifestations CKD: elctrolye/ acid-base imbalances
Hyperkalemia
- Most serious electrolyte disorder in kidney disease
- Fatal dysrhythmias
Sodium
- May be normal or low
-Because of impaired excretion, sodium is retained.
Water is retained.
causes: Edema, Hypertension, CHF
Calcium and phosphate alterations
Magnesium alterations
Metabolic acidosis
Results from:
- Inability of kidneys to excrete acid load (primary ammonia)
- Defective reabsorption/regeneration of bicarbonate
clinical manifestations CKD: Hematological system
Anemia
- Due to decreased production of erythropoietin
(From decrease in functioning renal tubular cells)
Bleeding tendencies
- Defect in platelet function
Infection
- Changes in leukocyte function
- Altered immune response and function
- Diminished inflammatory response
clinical manifestation CKD: cardiovascular system
Hypertension
Heart failure
Left ventricular hypertrophy
Peripheral edema
Dysrhythmias
Uremic pericarditis
clinical manifestation CKD: resp system
Kussmaul’s respirations
Dyspnea
Pulmonary edema
Uremic pleuritis
Uremic pneumonitis (uremic lung)
Pleural effusion
Predisposition to respiratory infection
clinicla manifestations CKD: GI system
Every part of GI is affected due to excessive urea
- Stomatitis with exudates and ulcerations
- Uremic fetor (urinous odour of breath)
- GI bleeding
clinical manfestations CKD: neuro
Expected as renal failure progresses
Attributed to
- Increased nitrogenous waste products
- Electrolyte imbalance
-Metabolic acidosis
- Axonal atrophy
- Demyelination of nerve fibres
Restless legs syndrome
Muscle twitching
Fatigue, irritability
Apathy
Decreased ability to concentrate
Peripheral neuropathy
clinical manifestatioins CKD: musco-skeletal system
CKD mineral and bone disorder
- Systemic disorder of mineral and bone metabolism
- Results in skeletal complications (renal osteodystrophy) and extraskeletal (vascular and soft tissue complications) calcifications
clinical manifestations CKD: Integumentary system
Pruritus
Uremic frost
Clinical manifestations CKD: reproductive system
Infertility
- Experienced by both sexes
Decreased libido
Low sperm counts
Sexual dysfunction
clinical manifestations CKD: psycological
Personality and behavioural changes
Emotional lability
Withdrawal
Depression
how to diagnos CKD
History and physical examination
Dipstick evaluation
Albumin–creatinine ratio (first morning void)
GFR\Renal ultrasound
Renal scan
CT scan
Renal biopsy
non-pharm therapy for CKD
Correction of extracellular fluid volume overload or deficit
Nutritional therapy
Erythropoietin therapy
Calcium supplementation, phosphate binders
Antihypertensive therapy
Measures to lower potassium
Adjustment of drug dosages to degree of renal function
nursing assessment for CKD
Complete history of any existing renal disease, family history
Long-term health problems
Dietary habits
overall goals with CKD
Overall goals
Demonstrate knowledge and ability to comply with therapeutic regimen.
Participate in decision making.
Demonstrate effective coping strategies.
Continue with activities of daily living within physiological limitations.
nursings implementation with CKD
Health promotion
Identify individuals at risk for CKD.
- History of renal disease
- Hypertension
- Diabetes mellitus
- Repeated urinary tract infection
Regular checkups and changes in urinary appearance, frequency, and volume should be reported.
Care considerations for chronic kidney disease in stages 4–5
- Daily weight, BP
- Identify signs and symptoms of fluid overload, hyperkalemia and electrolyte imbalances
- Strict dietary adherence
-Medication education
- Motivate clients in management of their disease.
Ambulatory and home care
- When conservative therapy is no longer effective, HD, PD, and transplantation are treatment options.
- Client/family need clear explanation of dialysis and transplantation.
CKD nursing evaulation
Maintenance of ideal body weight
Acceptance of chronic disease
No infection
No edema
Hematocrit, hemoglobin, and serum albumin levels in acceptable range
Complicated UTI
include those that occur
concurrently with obstruction, stones, or catheters; those that occur in
patients with existing diabetes or neurological diseases; and recurrent
infections
uncomplicated UTI
those that occur in an otherwise normal
urinary tract
risk factors of UTIs
Factors Increasing Urinary Stasis
* Extrinsic obstruction (tumour, fibrosis compressing urinary tract)
* Intrinsic obstruction (stone, tumour of urinary tract)
* Urinary retention (including neurogenic bladder and low bladder-wall compliance)
Foreign Bodies
* In-dwelling catheter
* Ureteral stent (proximity of urethral and anal orifices)
* Urinary calculi
Anatomical Factors
* Congenital defects leading to obstruction or urinary stasis
* Fistula (abnormal opening) exposing urinary stream to skin, vagina, or fecal stream
* Shorter female urethra (proximity of urethral and anal orifices)
Factors Compromising Immune Response
* Diabetes mellitus
* Human immunodeficiency virus infection
Functional Disorders
* Constipation
* Voiding dysfunction with detrusor sphincter dyssynergia
lower UTI symtpoms
Emptying Symptoms
* Dysuria—difficulty voiding
* Hesitancy—difficulty starting the urine stream, resulting in a delay between initiation of urination by relaxation
of the urethral sphincter and the actual start of the urine stream
* Intermiency—interruption of the urinary stream while voiding
* Pain on urination
* Postvoid dribbling—urine loss after completion of voiding
* Urinary retention or incomplete emptying—inability to empty urine from the bladder, which can be caused by
atonic bladder or obstruction of the urethra; can be acute or chronic
* Weak urinary stream
Storage Symptoms
* Incontinence—involuntary or unwanted loss or leakage of urine
* Nocturia—waking up two or more times at night because of the need or the urge to void
* Nocturnal enuresis—complaint of loss of urine during sleep; called bedweing in children
* Urgency—a sudden, strong or intense desire to void immediately, usually accompanied by frequency
* Urinary frequency—an abnormally frequent (usually eight times in a 24-hr period) desire to void, often of only
small quantities (e.g., <200 mL)
diagnostics for UTIs
- History and physical examination
- Imaging studies of urinary tract (e.g., IVP, cystoscopy) (if indicated)
- Urinalysis
- Urine for culture and sensitivity (if indicated)
Care for UTIs
uncomplicated UTI
* Adequate fluid intake
* Antibiotic: 1- to 3-day treatment regimen
* Nitrofurantoin (MacroBid)
* Trimethoprim–sulphamethoxazole (Septra)
* Counselling about risk for recurrence and reduction of risk factors
Recurrent, Uncomplicated UTI
* Repeated urinalysis and consideration of need for urine culture and sensitivity testing
* Antibiotic: 3- to 5-day treatment regimen
* Nitrofurantoin (MacroBid)
* Sensitivity-guided antibiotic (ampicillin, amoxicillin, first-generation cephalosporin, fluoroquinolone)
* Trimethoprim–sulphamethoxazole (Septra)
* Consideration of 3- to 6-mo trial of suppressive antibiotics
* Adequate fluid intake
* Counselling about risk for recurrence and reduction of risk factors
* Imaging study of urinary tract in select cases
Nursing assessment for UTIs
Subjective Data
Important Health Information
Past health history: Previous UTIs; urinary calculi, stasis, reflux, strictures, or retention; neurogenic bladder;
pregnancy; prostatic hyperplasia; sexually transmied infection; bladder cancer
Medications: Use of antibiotics, anticholinergics, antispasmodics
Surgery or other treatments: Recent urological instrumentation (catheterization, cystoscopy, surgery)
Symptoms
* Lassitude, malaise
* Nausea, vomiting, and anorexia; chills
* Suprapubic or low back pain, pressure in bladder area, costovertebral tenderness; bladder spasms, dysuria,
burning on urination, sense of incomplete emptying
* Urinary frequency, urgency, hesitancy; nocturia
Objective Data
General
Fever
Urinary
Hematuria; cloudy, foul-smelling urine; tender, enlarged kidney
Possible Findings
Leukocytosis; urinalysis positive for bacteria, pyuria, RBCs, and WBCs; positive urine culture; IVP, CT scan,
ultrasound, voiding cysto-urethrogram and cystoscopy demonstrating abnormalities of urinary tract
nursing diagnoses for UTI
- Impaired urinary elimination related to multiple
causality (effects of UTI) - Readiness for enhanced health management as
evidenced by expressed desire to enhance management of
risk factors
UTI nursing implementation
- The patient must take all antibiotics as prescribed. Symptoms may improve after 1 to 2 days of therapy, but
organisms may still be present. - The patient must be instructed about appropriate hygiene, including the following:
a. Careful cleansing of perineal region
b. Wiping from front to back after urinating
c. Cleansing with soap and water after each bowel movement - The patient should be taught about the importance of emptying the bladder before and after intercourse, which
may help flush out bacteria introduced during intercourse. The patient should wash the genital area with warm
water before having sex. - The patient should be advised to urinate regularly, approximately q2–4 hr during the day.
- The patient should be advised about how to maintain adequate fluid intake (33 mL [1 oz] per kilogram of body
weight per day). - The patient should understand why harsh soaps, bubble baths, powders, and sprays should not be applied in
the perineal area. - The patient should be advised to report symptoms or signs of recurrent UTI (e.g., cloudy urine, pain on
urination, urgency, frequency).
kidney stones
calculi formation in the urinary tract
risk factors for kidney stones
Metabolic
* Abnormalities that result in increased urine levels of calcium, oxaluric acid, uric acid, or citric acid
Climate
* Warm climates that cause increased fluid loss, low urine volume, and increased solute concentration in urine
Diet
* Excessive amounts of tea or fruit juices that elevate urinary oxalate level
* Large intake of calcium* and oxalate
* Large intake of dietary proteins that increase uric acid excretion
* Low fluid intake that increases urinary concentration
Genetic
* Family history of stone formation, cystinuria, gout, or renal acidosis
Lifestyle
* Sedentary occupation, immobility
diagnosic studies of kidney stones
urinalysis, urine culture, IVP, retrograde pyelogram,
ultrasound, and cystoscopy. A plain film of the abdomen and renal
ultrasound will identify larger, radiopaque stones.
An IVP or retrograde
pyelogram is used to localize the degree and the site of obstruction or to
confirm the presence of a radiolucent stone, such as a uric acid or cystine
calculus
Ultrasonography can be used to identify a
radiopaque or radiolucent calculus in the renal pelvis, the calyx, or the
proximal ureter.
care for an acute kidney stone attack
treating the symptoms of pain, infection,
or obstruction as indicated for the individual patient. Opioids are typically
required at frequent intervals for relief of renal colic pain. Many stones
pass spontaneousl
urinary inconitence
is an uncontrolled loss of urine that is of
sufficient magnitude to be a problem
