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Med Surg Test 6: Renal/GI > Med Surg: Alterations in renal function > Flashcards

Med Surg: Alterations in renal function Flashcards

1
Q

What are the hormonal influences?

A

ADH

Aldosterone

Renin/Angiotension

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2
Q

What is normal Micturation?

A

Normal bladder capacity at 350-450cc

Urge to urinate when capacity at 200cc

150cc in bladder before able to palpate bladder

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3
Q

What are the signs and symptoms of dysfuntion?

A

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
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4
Q

What are the types of urinary incontinence?

A

Stress incontinence

Urge incontinence

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5
Q

What is stress inconinence?

A

Interabdominal pressure increase sneeze, cough = dribbling

Interventions:

  • diet modification
  • pelvic floor exercises
  • habit training
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6
Q

What is urge incontinenece?

A

Interventions include drugs and diet therapy

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7
Q

What are the signs associated with infection?

A

Dysuria

Burning

Frequency

Urgency

Nocturia

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8
Q

What are laboratory serum tests?

A

Serum creatinine

BUN

reatio of blood urea nitrogen to serum creatinine

GFR

Protein especially losing in urine, need for wound and metabolic needs

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9
Q

What is in a urinalysis?

A

Color, odor and turbidity

Specific gravity

pH

glucse

ketones

protein

cells, casts, crystals and bacteria (UTI)

leukycyte esterase

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10
Q

What is keukocyte esterase?

A

enzyme found in certain white blood cells in urine

can be detected by dipstick

sign of inflammation, signaling a UTI

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11
Q

What are other urine tests?

A

urine for culture and sensitivity

24 hour studies:

  • creatinine clerance: best indication of overall kidness function
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12
Q

What are diagnositc tests?

A

Computed tomography

Kidney, ureter, and bladder x-rays

IV studies: angiography

Bladder scan

Cystoscopy/ utereroscopy

Renal Biopsy

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13
Q

What is renal dysfunction?

A

Can lead to multiple pathological situations including:

  • fluid and elctrolyte imbalances
  • disruption of filtration ability
  • abnormalities or urine production
  • metabolic alterations: typically, metabolic acidosis
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14
Q

What is cystitis?

A

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

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15
Q

What are the drug therapies for cystitis?

A

Urinary antiseptics: macrodentin

antimicrobials

bladder analgesics

May need long term low dose antibiotic therapy for chronic, recurring infections

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16
Q

What is nonsurgical management?

A

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

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17
Q

What is pyelonephritis?

A

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

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18
Q

What is acute pyelonephritis?

A

No signs of complications

may be treated as outpatient

oral antibiotics: 14 days

IF COMPLICATIONS:

  • hospitalized
  • IV antibiotics
  • Parenteral therapy
19
Q

What is chronic pyelonephritis

A

suspected in patients with recurrent UTI and acute pyelonephritis

may develop hypertension

can cause chronic renal failure and or ureosepsis

20
Q

What is urosepsis?

A

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

21
Q

What are key concepts of urosepsis?

A

Systemic response to infection

Bacteremia: confirmed by culture

HEmodynamically unstable: supportive therapy

Immediate antimicrobial therapy

Control of complicating factors

22
Q

What is acute glomerulonephritis?

A

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

23
Q

What is chronic glomerulonephritis?

A

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
24
Q

What are obstructive disorders?

A

Tumors

Strictures

Renal calculi

25
Q

What is prostatic enlargement?

A

Interferes with urinary flow at the bladder neck

inflammation-prostatis

benign or malignant tumore

Symptoms:

  • nocturia
  • poor caliber or urinary stream
  • overflow incontinence
26
Q

What are the risk factors and clinical manifestations of urolithiasis

A

History of urologic stones

Clinical Manifestations:

  • pain
  • decreased urinary output

Rediographic assessment

Other diagnostic tests

Complications

  • urinary obstriction
27
Q

What are interventions of urolithiasis?

A

pain control

strain urine

diet teaching

28
Q

What is drug therapy?

A

Antibiotics and urinary antiseptics

Pain management drugs:

  • opiod analgesics
  • NSAID
  • spasmolytic drugs
29
Q

What is lithotripsy?

A

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

30
Q

What is surgical management of Lithotripsy?

A

Stenting

Ureteroscopy

Percutaneous ureterolithotomy and nephrolithotomy

Open surgical procedures

  • preoperative care
  • operative procedure
31
Q

What is postoperative care?

A

Routine postoperative care when procedures for assessment of bleeding, urine and adequate fluid intake

Strained urine

Infection prevention

Prevention of obstruction

32
Q

What is the potential for renal failure?

A

Prevention key with high risk groupds

Limit exposure of nephrotoxic substances

Compliance with therapies and regular follow-up

Blood ressure control

Acute vs. Chronic

33
Q

What are the causes of acute renal failure?

A

PRerenal: compromise blood flow to kidneys

Intrarenal: damage to kidney tissue

Postrenal: obstucts urine flow after leaving nephron

34
Q

What are the phases of acute renal failure?

A

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

35
Q

What are the different drug therapies?

A

Phosphate biners

Diuretics

Antihypertensives as needed

Erythropoietin

36
Q

What are the stages of chronic renal failure?

A

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

37
Q

What are the clinical manifestations of CRF?

A

Neurologic: accumulate nitrogen waste

Cardio: dysrhythemia

Respiratory: anemia, destructive RBC

Hematologic

GI

Urinary

SKin

Musculoskeletal

Reproductive

38
Q

What are the interventions for excess fluid volume?

A

monitor I&O

promote fluid balance

asess manifestations of volume excess

  • crackles in bases of lungs
  • edema
  • distended neck veins

Drug therapy includes diuretics

39
Q

What are the interventions of decreased cardiac output?

A

control HTN with calcium channel blocker, ACE inhibitors

Instruct clinet and family to monitor BP, weight, diet and drug therapy

40
Q

What are the risks for infection?

A

Meticulous skin care

Preventive skin care

Inspection of vascular assess site for dialysis

Monitoring of vital signs for manifestations of infection

41
Q

What are the interventions for risk for injury?

A

Prevent fall or injury

pathologic fractures

bleeding

toxic effects of prescribed drugs

42
Q

What are interventions for fatigue

A

Assess fo vitamin deficiency, anemia and buildup or urea

Administer vitamin and mineral supplements

Administer erythropoietin therapy for bone marrow production

Give iron supplements

43
Q

What are intervernetions for anxiety?

A

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

44
Q
A

Med Surg Test 6: Renal/GI (6 decks)

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