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semester 3 > medsurg test 3 > Flashcards

medsurg test 3 Flashcards

1
Q

Structures of the Urinary System

A

Kidneys, ureters, bladder, and urethra

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2
Q

Why can we survive with only one kidney?

A

We have so many fucking nephrons

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3
Q

When do we begin to consider kidney transplants?

A

Less than 20% function left of kidneys is when we look to dialysis and kidney replacement

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4
Q

What makes older adults more susceptible to kidney injury?

A

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)

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5
Q

Changes in creatinine levels indicates a

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.

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6
Q

Changes in BUN Indicates a

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

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7
Q

Changes in GFR looks for

A

how well the kidneys are filtering the blood

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8
Q

possible causes of pale to colorless urine

A

Dilute urine, could be from diuretics, alcohol consumption, diabetes insipidus, glycosuria, excess fluid intake, chronic kidney disease

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9
Q

possible causes of yellow to milky white urine

A

pyuria, infection, vaginal cream

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10
Q

possible causes of bright yellow urine

A

the patient might be taking multivitamins

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11
Q

possible causes for pink to red urine

A

hemoglobin breakdown, red blood cells, gross blood, menses, bladder or prostate surgery, medications (phenytoin, rifampin, thioridazine, cascara sagrada, senna products), beets and blackberries

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12
Q

possible causes of blue to blue/green urine

A

blue dye, certain bacteria, and medications (amitriptyline HCI, triamterene)

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13
Q

possible causes of orange to amber urine

A

dehydration, fever, bile, excess bilirubin or carotene, or medications (phenazopyridine hydrochloride, nitrofurantoin)

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14
Q

possible causes of brown to black urine

A

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)

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15
Q

what should you educate patients about post op for endoscopic kidney procedures?

A

there may be hematuria after

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16
Q

what is retrograde pyelography

A

a KUB with contrast! (kidneys, ureters and bladder x-ray)

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17
Q

what is cystography

A

a bladder x-ray that is done after a catheter is placed and contrast is inserted directly into the bladder

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18
Q

Renal angiography

A

looks at the vasculature structure of the renal system

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19
Q

Renal angiography

A

looks at the vasculature structure of the renal system

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20
Q

Specific gravity normal range

A

1.005-1.025

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21
Q

Blood creatinine normal range

A

female: 0.4-1.0
male: 0.6-1.2

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22
Q

BUN normal range

A

8-20 mg/dL

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23
Q

BUN to creatinine ratio

A

10:1

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24
Q

Most accurate indicator of fluid loss or gain

A

daily weight

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25
Q

What is AKI?

A

Acute kidney injury, When the function of the kidneys goes down drastically after an injury to the organ

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26
Q

Changes in creatinine with AKI?

A

50% increase above baseline creatinine

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27
Q

How does hypovolemia, hypotension, reduced cardiac output and heart failure affect the kidneys?

A

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

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28
Q

Causes of AKI

A

hypovolemia, hypotension, reduced cardiac output, heart failure, obstruction of the kidneys, lower urinary tract, renal arties or renal veins could all cause AKI

29
Q

categories of AKI

A

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

30
Q

phases of AKI

A

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.

31
Q

chronic kidney disease causes

A

Diabetes mellitus, hypertension, chronic glomerulonephritis, pyelonephritis or other infections, obstruction of urinary tract, hereditary lesions, vascular disorders, medications or toxic agents

32
Q

Nephrosclerosis

A

Hardening or renal arteries (expected with aging). Major cause of chronic kidney disease
treat underlying hypertension
Increased risk in African Americans and diabetic nephropathy

33
Q

Acute nephritic syndrome

A
34
Q

Glomerulonephritis

A
35
Q

Acute Nephritic Syndrome

A

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

36
Q

Acute Nephritic Syndrome Manifestations

A

hematuria, edema, azotemia, proteinuria, and hypertension

37
Q

Azotemia

A

abnormal increase of nitrogenous waste in the blood. Leads to increased BUN. Urine will look like cola

38
Q

Nursing management of acute nephrotic syndrome

A

assessment, education, follow up
Maintain fluid balance, fluid and dietary restrictions (low salt, low protein, high carbohydrates. Possible fluid restrictions)

39
Q

Chronic Glomerulonephritis

A

Repeated acute glomerular nephritis, hypertensive nephrosclerosis, hyperlipidemia, and other causes of glomerular damage

40
Q

Glomerulonephritis symptoms and lab changes

A

can be asymptomatic for years
urine with fixed specific gravity, casts, proteinuria, electrolyte imbalances, and hypoalbuminemia

41
Q

Nursing management for chronic glomerulonephritis

A

Potential fluid and electrolyte imbalances, cardiac status, neurologic status (can have neuropathy and possibly diminished deep tendon reflexes)

42
Q

Nephrotic Syndrome

A

Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins. Leads to hypoalbuminemia and edema

43
Q

Causes of Nephrotic Syndrome

A

chronic glomerulonephritis, diabetes mellitus with intercapillary glomerulosclerosis, amyloidosis, lupus erythematosus, multiple myeloma, and renal vein thrombosis

44
Q

Polycystic Kidney Disease

A

Genetic disorder—most common inherited cause of kidney failure. cysts may also be in other organs
Autosomal dominant and autosomal recessive

45
Q

Polycystic kidney disease treatment

A

No cure, supportive treatment. Patients will need dialysis or kidney transplants

46
Q

risk factors for renal cancer

A

Tobacco use, increased BMI, African American descent

47
Q

symptoms of renal cancer

A

May be asymptomatic with only painless hematuria with dull back pain

48
Q

Chronic renal disease (ESRD)

A

a progressive, irreversible deterioration of renal function that results in azotemia (build up of BUN and creatinine)

49
Q

assessment for chronic renal disease

A

Fluid and nutritional status, patient knowledge, activity tolerance, self-esteem, potential complications

50
Q

complimentary problems to kidney disease and injury

A

Pericarditis, pericardial effusion, pericardial tamponade
Hypertension, anemia, bone disease and metastatic calcifications
Hyperkalemia, improper calcium balance, can lead to changes in vitamin D

51
Q

assessment for patient on hemodialysis

A

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

52
Q

interventions for patient on hemodialysis

A

monitor medications and dosages, address pain, infection control measures, moisturize their skin bc they’re gonna get very dry

53
Q

diet for dialysis patients

A

low sodium, potassium, protein restrictions, fluid restrictions, individual nutritional needs

54
Q

Anuria

A

is less then 50 mL in 24 hours

55
Q

Oliguria

A

urine output less than 400 mL in 24 hours

56
Q

Lower UTI

A

cystitis, prostatitis, urethritis

57
Q

Upper UTI

A

pyelonephritis, interstitial nephritis, renal abscess, perirenal nephritis

58
Q

nursing intervention for UTI

A

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

59
Q

causes of urinary retention

A

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)

60
Q

Lithiasis

A

stones. Usually calcium of some sort or uric acid

61
Q

Genitourinary tract injury management

A

control hemorrhage, pain and infection; monitor for oliguria, shock, s/s acute peritonitis

62
Q

ilieal conduit surgery patient education

A

pus and mucous in the urine may be seen in the urine depending on the type of tissue used to create the stoma

63
Q

what does 24 hour urine measure

A

creatinine, urea nitrogen, sodium, chloride, calcium, catecholamines, and proteins

64
Q

creatinine

A

results form protein and muscle breakdown. kidney function must be 50% lost for a difference to be apparent

65
Q

BUN

A

blood urea nitrogen breakdown of protein in the liver, creating the biproduct BUN which is excreted by the kidneys

66
Q

hemodialysis vs peritoneal dialysis

A

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

67
Q

old person respiratory changes

A

Alveoli can lose their shape and become baggy. The diaphragm can, over time, become weaker, decreasing the ability to inhale and exhale

68
Q

old person respiratory changes

A

Alveoli can lose their shape and become baggy. The diaphragm can, over time, become weaker, decreasing the ability to inhale and exhale

semester 3 (9 decks)

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