Med Surg: Alterations in renal function Flashcards
What are the hormonal influences?
ADH
Aldosterone
Renin/Angiotension
What is normal Micturation?
Normal bladder capacity at 350-450cc
Urge to urinate when capacity at 200cc
150cc in bladder before able to palpate bladder
What are the signs and symptoms of dysfuntion?
Incontinenece
Retention
Urine volume
- anuria: not producing, less then 100mL/24 hr
- oliguria: small amounts, 100-400 mL/24 hr
- polyuria: larger amount, disease, greater then intake 2,000ml/hr
- diuresis: polyuria medically induced, diuretics
What are the types of urinary incontinence?
Stress incontinence
Urge incontinence
What is stress inconinence?
Interabdominal pressure increase sneeze, cough = dribbling
Interventions:
- diet modification
- pelvic floor exercises
- habit training
What is urge incontinenece?
Interventions include drugs and diet therapy
What are the signs associated with infection?
Dysuria
Burning
Frequency
Urgency
Nocturia
What are laboratory serum tests?
Serum creatinine
BUN
reatio of blood urea nitrogen to serum creatinine
GFR
Protein especially losing in urine, need for wound and metabolic needs
What is in a urinalysis?
Color, odor and turbidity
Specific gravity
pH
glucse
ketones
protein
cells, casts, crystals and bacteria (UTI)
leukycyte esterase
What is keukocyte esterase?
enzyme found in certain white blood cells in urine
can be detected by dipstick
sign of inflammation, signaling a UTI
What are other urine tests?
urine for culture and sensitivity
24 hour studies:
- creatinine clerance: best indication of overall kidness function
What are diagnositc tests?
Computed tomography
Kidney, ureter, and bladder x-rays
IV studies: angiography
Bladder scan
Cystoscopy/ utereroscopy
Renal Biopsy
What is renal dysfunction?
Can lead to multiple pathological situations including:
- fluid and elctrolyte imbalances
- disruption of filtration ability
- abnormalities or urine production
- metabolic alterations: typically, metabolic acidosis
What is cystitis?
Most commonly caused by bacteria that move up the urinary tract from the external urethra to the baldder
Catheter: related infections common during hospital stay
Most common cause in males: chronic bacterial prostatitis
What are the drug therapies for cystitis?
Urinary antiseptics: macrodentin
antimicrobials
bladder analgesics
May need long term low dose antibiotic therapy for chronic, recurring infections
What is nonsurgical management?
provide for urinary elimiation: commode, get up
diet therapy: caloric increase due to increase in metabolism caused by infection, fluids
Other pain relief measures, such as warm sitz baths
Prevention
What is pyelonephritis?
Bacterial infection in the kidney
Key features include:
- fever, chills, tachycardia and tachypnea
- flank or back pain
- abdominal discomfort
- N&V, urgency, frequency and nocturia
General malaise or fatigue
What is acute pyelonephritis?
No signs of complications
may be treated as outpatient
oral antibiotics: 14 days
IF COMPLICATIONS:
- hospitalized
- IV antibiotics
- Parenteral therapy
What is chronic pyelonephritis
suspected in patients with recurrent UTI and acute pyelonephritis
may develop hypertension
can cause chronic renal failure and or ureosepsis
What is urosepsis?
comprises at 25% of all sepsis cases
Secondary to complicated UTI or obstructive uropathy
Patients most likely to develop urosepsis include the elderly, diabetics and immunosuppressed
What are key concepts of urosepsis?
Systemic response to infection
Bacteremia: confirmed by culture
HEmodynamically unstable: supportive therapy
Immediate antimicrobial therapy
Control of complicating factors
What is acute glomerulonephritis?
Involes and allergic or immune response: priteinuria or hematuria
S&S: history sore throat, URI, strep infection in last month, smoky or coffee colored uring
Complications: edema, hypertension
Interventions: prevention infection, fluid restriction, control nausea and anorexia, plasma, no OTC
What is chronic glomerulonephritis?
Develops over a period of 20-30 years or longer
Interventions:
- slowing progression of disease and prevent complication
- diet changes: low protein
- fluid intake
- dialysis, transplantation
What are obstructive disorders?
Tumors
Strictures
Renal calculi
What is prostatic enlargement?
Interferes with urinary flow at the bladder neck
inflammation-prostatis
benign or malignant tumore
Symptoms:
- nocturia
- poor caliber or urinary stream
- overflow incontinence
What are the risk factors and clinical manifestations of urolithiasis
History of urologic stones
Clinical Manifestations:
- pain
- decreased urinary output
Rediographic assessment
Other diagnostic tests
Complications
- urinary obstriction
What are interventions of urolithiasis?
pain control
strain urine
diet teaching
What is drug therapy?
Antibiotics and urinary antiseptics
Pain management drugs:
- opiod analgesics
- NSAID
- spasmolytic drugs
What is lithotripsy?
Extracorporeal shock wave lithortripsy uses sound, laser or dry shock wave energy to break the stone into small fragments
Client undergoes conscious sedation
Topical anesthtic cream to skin site is stone
Continuous monitoring is by electrocardiography
What is surgical management of Lithotripsy?
Stenting
Ureteroscopy
Percutaneous ureterolithotomy and nephrolithotomy
Open surgical procedures
- preoperative care
- operative procedure
What is postoperative care?
Routine postoperative care when procedures for assessment of bleeding, urine and adequate fluid intake
Strained urine
Infection prevention
Prevention of obstruction
What is the potential for renal failure?
Prevention key with high risk groupds
Limit exposure of nephrotoxic substances
Compliance with therapies and regular follow-up
Blood ressure control
Acute vs. Chronic
What are the causes of acute renal failure?
PRerenal: compromise blood flow to kidneys
Intrarenal: damage to kidney tissue
Postrenal: obstucts urine flow after leaving nephron
What are the phases of acute renal failure?
Sudden onset
Oluguric: no response to fluid challenge
Diuretic: unable to concentrate urine
Recovery: go back to normal
Acute syndrome may be reversible with prompt intervention
What are the different drug therapies?
Phosphate biners
Diuretics
Antihypertensives as needed
Erythropoietin
What are the stages of chronic renal failure?
1: at risk
2: mild, some diminshed
3: moderate, diminished renal reserve, 50% decrease RFR, no clinical findings
4: severe, renal insufficiency, 50-80%, accumulate nitrogen waste in blood, increase BUN and creatine
5: End-stage, 80-95%, decrease GFR, >95% decreases later, multisystem failure
What are the clinical manifestations of CRF?
Neurologic: accumulate nitrogen waste
Cardio: dysrhythemia
Respiratory: anemia, destructive RBC
Hematologic
GI
Urinary
SKin
Musculoskeletal
Reproductive
What are the interventions for excess fluid volume?
monitor I&O
promote fluid balance
asess manifestations of volume excess
- crackles in bases of lungs
- edema
- distended neck veins
Drug therapy includes diuretics
What are the interventions of decreased cardiac output?
control HTN with calcium channel blocker, ACE inhibitors
Instruct clinet and family to monitor BP, weight, diet and drug therapy
What are the risks for infection?
Meticulous skin care
Preventive skin care
Inspection of vascular assess site for dialysis
Monitoring of vital signs for manifestations of infection
What are the interventions for risk for injury?
Prevent fall or injury
pathologic fractures
bleeding
toxic effects of prescribed drugs
What are interventions for fatigue
Assess fo vitamin deficiency, anemia and buildup or urea
Administer vitamin and mineral supplements
Administer erythropoietin therapy for bone marrow production
Give iron supplements
What are intervernetions for anxiety?
Health care team involement
Clinet and family educatoin
Continuity of care
Encouragement of client to ask questions and discuss fears about the diagnosis of renal failure
