medsurg test 3 Flashcards
Structures of the Urinary System
Kidneys, ureters, bladder, and urethra
Why can we survive with only one kidney?
We have so many fucking nephrons
When do we begin to consider kidney transplants?
Less than 20% function left of kidneys is when we look to dialysis and kidney replacement
What makes older adults more susceptible to kidney injury?
Sclerosis of the glomerulus and renal vasculature
Decreased blood flow
Decreased GFR
Decreased renal reserve
Altered tubal function and acid–base balance
Incomplete urine clearance
Inefficient med clearance (increases change of drug-drug interactions)
Changes in creatinine levels indicates a
chronic problem with the kidneys. It is a waste product that is filtered out by the kidneys, so it takes some time to build up once the kidneys start fucking up.
Changes in BUN Indicates a
a more recent problem with kidneys. Blood urea nitrogen is often one of the first indicators of kidney disease as it usually is increased before symptoms appear
Changes in GFR looks for
how well the kidneys are filtering the blood
possible causes of pale to colorless urine
Dilute urine, could be from diuretics, alcohol consumption, diabetes insipidus, glycosuria, excess fluid intake, chronic kidney disease
possible causes of yellow to milky white urine
pyuria, infection, vaginal cream
possible causes of bright yellow urine
the patient might be taking multivitamins
possible causes for pink to red urine
hemoglobin breakdown, red blood cells, gross blood, menses, bladder or prostate surgery, medications (phenytoin, rifampin, thioridazine, cascara sagrada, senna products), beets and blackberries
possible causes of blue to blue/green urine
blue dye, certain bacteria, and medications (amitriptyline HCI, triamterene)
possible causes of orange to amber urine
dehydration, fever, bile, excess bilirubin or carotene, or medications (phenazopyridine hydrochloride, nitrofurantoin)
possible causes of brown to black urine
old red blood cells, urobilinogen, bilirubin, melanin, porphyrin, extremely concentrated urine due to dehydration, medications (cascara sagrada, metronidazole, iron preparations, quinine sulfate, senna products, methyldopa, nitrofurantoin)
what should you educate patients about post op for endoscopic kidney procedures?
there may be hematuria after
what is retrograde pyelography
a KUB with contrast! (kidneys, ureters and bladder x-ray)
what is cystography
a bladder x-ray that is done after a catheter is placed and contrast is inserted directly into the bladder
Renal angiography
looks at the vasculature structure of the renal system
Renal angiography
looks at the vasculature structure of the renal system
Specific gravity normal range
1.005-1.025
Blood creatinine normal range
female: 0.4-1.0
male: 0.6-1.2
BUN normal range
8-20 mg/dL
BUN to creatinine ratio
10:1
Most accurate indicator of fluid loss or gain
daily weight
What is AKI?
Acute kidney injury, When the function of the kidneys goes down drastically after an injury to the organ
Changes in creatinine with AKI?
50% increase above baseline creatinine
How does hypovolemia, hypotension, reduced cardiac output and heart failure affect the kidneys?
Blood flow is needed for the kidneys to work properly. Hypovolemia and hypotension could cause less fluid to get to the kidneys, which fucks them up
Causes of AKI
hypovolemia, hypotension, reduced cardiac output, heart failure, obstruction of the kidneys, lower urinary tract, renal arties or renal veins could all cause AKI
categories of AKI
prerenal - when damage occurs before the kidneys (such as poor perfusion to the nephrons)
intrarenal - when damage occurs to the kidneys
postrenal - obstruction distal to the kidneys
phases of AKI
Initiation - the injury
Oliguria - decreased urine output (less than 30 mLs) increased BUN and potassium
Diuresis - gradual increase of urine output. Monitor for dehydration, especially in older patients.
recovery - improvement in renal function. Can take up to several months. This is not a super fast process.
chronic kidney disease causes
Diabetes mellitus, hypertension, chronic glomerulonephritis, pyelonephritis or other infections, obstruction of urinary tract, hereditary lesions, vascular disorders, medications or toxic agents
Nephrosclerosis
Hardening or renal arteries (expected with aging). Major cause of chronic kidney disease
treat underlying hypertension
Increased risk in African Americans and diabetic nephropathy
Acute nephritic syndrome
Glomerulonephritis
Acute Nephritic Syndrome
Postinfectious glomerulonephritis, rapidly progressive glomerulonephritis, and membranous glomerulonephritis whatever that means
most common cause is strep throat
Usual treatment is antibiotics, corticosteroids and sometimes immunosuppresants
Acute Nephritic Syndrome Manifestations
hematuria, edema, azotemia, proteinuria, and hypertension
Azotemia
abnormal increase of nitrogenous waste in the blood. Leads to increased BUN. Urine will look like cola
Nursing management of acute nephrotic syndrome
assessment, education, follow up
Maintain fluid balance, fluid and dietary restrictions (low salt, low protein, high carbohydrates. Possible fluid restrictions)
Chronic Glomerulonephritis
Repeated acute glomerular nephritis, hypertensive nephrosclerosis, hyperlipidemia, and other causes of glomerular damage
Glomerulonephritis symptoms and lab changes
can be asymptomatic for years
urine with fixed specific gravity, casts, proteinuria, electrolyte imbalances, and hypoalbuminemia
Nursing management for chronic glomerulonephritis
Potential fluid and electrolyte imbalances, cardiac status, neurologic status (can have neuropathy and possibly diminished deep tendon reflexes)
Nephrotic Syndrome
Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins. Leads to hypoalbuminemia and edema
Causes of Nephrotic Syndrome
chronic glomerulonephritis, diabetes mellitus with intercapillary glomerulosclerosis, amyloidosis, lupus erythematosus, multiple myeloma, and renal vein thrombosis
Polycystic Kidney Disease
Genetic disorder—most common inherited cause of kidney failure. cysts may also be in other organs
Autosomal dominant and autosomal recessive
Polycystic kidney disease treatment
No cure, supportive treatment. Patients will need dialysis or kidney transplants
risk factors for renal cancer
Tobacco use, increased BMI, African American descent
symptoms of renal cancer
May be asymptomatic with only painless hematuria with dull back pain
Chronic renal disease (ESRD)
a progressive, irreversible deterioration of renal function that results in azotemia (build up of BUN and creatinine)
assessment for chronic renal disease
Fluid and nutritional status, patient knowledge, activity tolerance, self-esteem, potential complications
complimentary problems to kidney disease and injury
Pericarditis, pericardial effusion, pericardial tamponade
Hypertension, anemia, bone disease and metastatic calcifications
Hyperkalemia, improper calcium balance, can lead to changes in vitamin D
assessment for patient on hemodialysis
protect vascular access for dialysis (keep it clean, no BP no blood draw)
closely watch and maintain fluid balance, monitor cardiac and respiratory systems closely (hold cardiac medications before dialysis)
watch for s/s of uremia and electrolyte imbalance, regularly check lab data
interventions for patient on hemodialysis
monitor medications and dosages, address pain, infection control measures, moisturize their skin bc they’re gonna get very dry
diet for dialysis patients
low sodium, potassium, protein restrictions, fluid restrictions, individual nutritional needs
Anuria
is less then 50 mL in 24 hours
Oliguria
urine output less than 400 mL in 24 hours
Lower UTI
cystitis, prostatitis, urethritis
Upper UTI
pyelonephritis, interstitial nephritis, renal abscess, perirenal nephritis
nursing intervention for UTI
Medications as prescribed: antibiotics, analgesics, and antispasmodics.
Application of heat to the perineum to relieve pain and spasm
Increased fluid intake
Avoidance of urinary tract irritants such as coffee, tea, citrus, spices, cola, and alcohol
Frequent voiding
Patient education
causes of urinary retention
Adults 60 years and older may have 50 to 100 mL of residual urine remaining in the bladder after voiding
Postoperative spasms
Diabetes, prostatic enlargement, urethral pathology, trauma, pregnancy, neurologic disorder
medications (anesthesia among others)
Lithiasis
stones. Usually calcium of some sort or uric acid
Genitourinary tract injury management
control hemorrhage, pain and infection; monitor for oliguria, shock, s/s acute peritonitis
ilieal conduit surgery patient education
pus and mucous in the urine may be seen in the urine depending on the type of tissue used to create the stoma
what does 24 hour urine measure
creatinine, urea nitrogen, sodium, chloride, calcium, catecholamines, and proteins
creatinine
results form protein and muscle breakdown. kidney function must be 50% lost for a difference to be apparent
BUN
blood urea nitrogen breakdown of protein in the liver, creating the biproduct BUN which is excreted by the kidneys
hemodialysis vs peritoneal dialysis
hemodialysis is blood running through a dialyzer and back into circulation. peritoneal dialysis is when hypertonic dialysate solution is inserted in the peritoneal cavity and then drained at the time it needs to be
old person respiratory changes
Alveoli can lose their shape and become baggy. The diaphragm can, over time, become weaker, decreasing the ability to inhale and exhale
old person respiratory changes
Alveoli can lose their shape and become baggy. The diaphragm can, over time, become weaker, decreasing the ability to inhale and exhale
