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MedSurg > Lecture 5.2 - Renal > Flashcards

Lecture 5.2 - Renal Flashcards

1
Q

What are some predisposing factors to a UTI?

A

–> Renal scarring
–> Compression during pregnancy
–> Urinary retention
–> Caliculi (stones)
–> Diabetes

Concerning in older population.

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2
Q

What populations are UTIs most common in?

A

Older men d/t enlarged prostate
Also common in nurses

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3
Q

What are some S/S of UTI?

A

–> Dysuria (painful)
–> Frequency (<2h)
–> Urgency
–> Suprapubic discomfort or pressure

–> Chills/fever and lower back pain might indicate upper UTI.

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4
Q

What might the urine of someone with a UTI look like?

A

Urine
–> Sediment
–> Hematuria
–> Cloudiness

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5
Q

How do UTI presentations differ in older adults?

A

More generalized
–> ABD discomfort instead of dysuria
–> Sudden onset delirium

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6
Q

How to test for UTI?

A

Dipstick analysis for
–> Nitrates
–> bacteremia
–> Elevated WBC
–> Leukocyte extrase

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7
Q

What is leukocyte extrase?

A

An enzyme found in WBCs that might indicate infection (Used in UTI dipstick)

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8
Q

After a positive UTI dipstick, what might a physician also want to perform?

A

Microscope analysis for bacteria in urine + midstream urine analysis

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9
Q

How are UTIs treated?

A

–> Sulfonamide antibiotics (most common)
–> Older adults respond to nitrofurantoin
–> Ciprofloxacin for chronic infections

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10
Q

What is pyelonephritis?

A

Inflammation of the renal parenchyma
–> Usually bacterial, not always

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11
Q

Where does acute pyelonephritis usually start?

A

Renal medulla and spreads to cortex.

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12
Q

What are the possible complications of recurrent pyelonephritis?

A

Scar tissue development which effects kidney function

Possible development of chronic pyelonephritis

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13
Q

What are the S/S of pyelonephritis?

A

–> Fatigue
–> Sudden onset fever
–> Flank pain
–> Cystitis

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14
Q

What is a KUB?

A

A kidney, ureter, and bladder ultrasound

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15
Q

What is cystitis?

A

Inflammation of the bladder

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16
Q

How long are antibiotics given for pyelonephritis?

A

14-21 days

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17
Q

What antibiotics are used for acute pyelonephritis?

A

Ampicillins, vancomycin, cipros, septra

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18
Q

What is septra?

A

Combination of sulfamethoxazole and trimethoprim
–> Used to treat pyelonephritis

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19
Q

Which demographics are most affected by kidney stones?

A

More common in men and those aged 20-55. More common in the summer months - likely due to dehydration

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20
Q

Which diagnostic tests are done when a person is suspected to have kidney stones?

A

Urinalysis
Urine culture
Pyelogram/KUB
X-ray

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21
Q

What is the main priority when treating someone with kidney stones?

A

Main priority is pain control
–> opiates (10-15 mg)
–> Toradol/Ketorolac is very helpful IM for this kind of pain (NSAIDS)

Combination therapy can be used too

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22
Q
A
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23
Q

What precaution should be taken in those with kidney stones while they urinate?

A

Ensure to strain urine to detect is stone has been passed spontaneously.

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24
Q

What is Lithotripsy?

A

Blasting of kidney stones with high energy shock waves

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25
Q

What dietary changes should be made for those with kidney stones?

A

At least 3L fluid a day
–> Dehydration contributes to caliculi formations, UTI

Large intakes of dairy or other high protein high calcium foods can contribute to the formation

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26
Q

What size of kidney stone is unlikely to pass spantaneously?

A

Larger than 4 mm are unlikely to pass through ureter

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27
Q

What percentage of people with have another kidney stone after the first incidence?

A

About half

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28
Q

What age group is most affected by kidney cancers?

A

50-70 years old

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29
Q

What is the most common cause of kidney and bladder cancer?

A

Cigarette smoking is most common cause

Others include:
–> Obesity
–> Exposure to asbestos

30
Q

What are early and late symptoms of kidney and bladder cancer?

A

No early symptoms, but later symptoms include:
Hematuria, flank pain

We also see common cancer symptoms:
Weightless, weakness, anemia

31
Q

Where do kidney and bladder cancer usually metastasize?

A

Liver, lungs, long bones

32
Q

What diagnostic tests are used for kidney and bladder cancer?

A

Pyelogram primary examination where most masses are detected.

KUB ultrasound to differentiate tumour vs cyst.

CT scans

33
Q

What should we focus on during an assessment of urinary retention or incontinence?

A

Focus on Hx and physical assessment
–> Voiding record/nutritional log when possible
–> urinalysis for UTI detection or DM
–> Residual bladder volume measurement

Be on alert for sudden onset retention or incontinence

34
Q

What lifestyle recommendations should be made for a person experiencing urinary retention or incontinence?

A

Promote adequate fluid intake and reduce irritants such as coffee and alcohol.
Frequent and routine urination (2-3 hours while awake)
Quit smoking to reduce stress incontinence

35
Q

Acute urinary retention is a ____ that should be managed with _____

A

Medical emergency
–> Insert 3-way catheter (as prescribed) unless otherwise directed

36
Q

What is a nephrostomy tube and when are they used?

A

Temporarily inserted into pelvis of kidney when a complete obstruction of the ureter is present.

37
Q

What is the frequency of incidence of benign prostatic hypertrophy?

A

50% of men over 50
80% men over 80

and 25% of men require some treatment by the age of 80

38
Q

What diagnostic tests and exams are used to diagnose BPH?

A

Hx and physical
–> Size, symmetry, and consistency of prostate with digital examination

Urinalysis and culture
PSA - Prostate specific antigen might be considered to rule out cancer (but causes false positives)

39
Q

What is a TURP?

A

Trans-Urethral Resection of the Prostate

Removal of prostate tissue with retro scope through urethra
–> No external incision made

40
Q

What are the two most common procedures for a radical prostatectomy?

A

Retropubic
–> Mid-line abd incision

Perineal
–> incision between scrotum and rectum (preserves lymph nodes)

41
Q

What is the most common complication of a radical prostatectomy?

A

Incontinence
–> nearly all men in first few months following surgery

Over time bladder adjusts and control is regained

42
Q

What is a uretosigmoidostomy?

A

Ureters detached from bladder (bladder is typically removed) and attached to sigmoid colon.

43
Q

ileal loop/Conduit?

A

Urostomy
–> Ureters are attached to portion of ileum and ostomy is brought through abdominal wall

44
Q

What is a cutaneous ureterostomy?

A

A procedure than bring the ureters through the abdominal wall to create 1 or 2 stomas.

45
Q

What are the three causes of AKI (Major)?

A

Prerenal
Intrarenal
Postrenal

46
Q

What are some common causes of prerenal AKI?

A

Hypovolemia, GI loss, burns, decreased cardiac output

47
Q

What are some common causes of intrarenal AKI?

A

Prolonged ischemia, gentamycin + Amphotericin B

48
Q

What are some common causes of postrenal AKI?

A

BPH, cancers, caliculi formation

49
Q

What is the most common cause of AKI and CKD?

A

AKI: Acute tubular necrosis
CKD: Diabetic nephropathy

50
Q

Can AKI be reversible?

A

Unlike CKD, the damage from AKI can potentially be reversed.

51
Q

How does the mortality rate change between AKI and CKD?

A

AKI: 60%
CKD: 19-24%

52
Q

What is the diagnostic difference between AKI and CKD?

A

AKI: Acute reduction of output and/or elevation of serum creat

CKD: GFR less than 60 and/or progressive kidney damage for over 3 months.

53
Q

What are some S/S of AKI?

A

–> Urinary output decrease
–> Fluid + waste retention (Neuro disorders)
–> Metabolic acidosis

–> Excess phosphate, Na, and K
–> Deficit in Ca

54
Q

What are the three phases of AKI? What occurs during each?

A

Initiation
–> Increase in serum Creat & BUN & decreased output

Maintenance (days-weeks)
–> Oliguria or none at all (less than 400 ml in 24h)
–> Dilute urine without filtering wastes

Recovery
–> Return of BUN and Creat to normal filtration level
–> Pts may experience diuretic phase that can cause lyte imbalances (can lead to 4-5L or more per day –> Hypovolemia)
–> Hypo K + Na, dehyration

55
Q

The longer the oliguric phase of an AKI lasts…

A

Longer less chance for recovery and increased chance for permanent damage.

56
Q

What is considered oliguria?

A

Less than 400 mls in 24 hours

57
Q

functioning kidneys are required to activate which vitamin?

A

Vit D

58
Q

How long can it take renal function to stabilize following AKI?

A

12 months

59
Q

What lifestyle changes are necessary for someone with AKI?

A

Fluid restriction (600mls + previous 24 hours losses)

K + Na restrictions

Calcium supplementation

Phosphate binding supplements

Dialysis

60
Q

Why are older adults for susceptible and sensitive to kidney damage?

A

Not able to compensate for fluid overload or loss

More susceptible to AKI d/t decreasing nephrons with age

61
Q

What is uremia?

A

Constellation of symptoms associated with buildup of wastes usually excreted by the kidneys
–> Elevated Creat + BUN, abnormal lytes
–> Acidosis
–> Anemia
–> Fluid Volume Excess
–> N/V, Anorexia
–> Fatigue
–> Itchiness
–> Neuropathy

62
Q

Which hormone should we examine in a pt with CKD?

A

Parathyroid for calcium

63
Q

What restriction would we put on someone with CKD?

A

Protein, Na, K, Phosphate

64
Q

How many cycles of peritoneal dialysis should be performed in 24 hours?

A

4/day

65
Q

How long does a person have to come to the hospital for hemodialysis?

A

4-8 hours

66
Q

What is disequilibrium syndrome?

A

Complication of hemodialysis
–> High osmotic pressure results in cerebral edema

67
Q

What is a major complication of kidney transplant?

A

Rejection

68
Q

What is aseptic necrosis of joints and what causes it?

A

Caused by corticosteroids
–> Calcium and phosphate supplementation + weightbearing exercises to prevent this

69
Q

Should phosphate binders be taken with or without food?

A

They should be taken with a meal as most phosphate absorption occurs within an hour of eating.

70
Q

What weight gain should a client with kidney complications report?

A

2kg

MedSurg (13 decks)

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