Renal Flashcards
Normal kidney function CAREER
Controls BP
Activates vitamin D
Regulates volume comp and ECP
Excretes waste
EPO production
Regulates acid base balance
how to prevent CAUTIs
- secure catheter tubing dont let it dangle on the side of bed
- make sure tubing is free of kinks
- collection bag should be below bladder
- perineal care WITH soap and water once a shift
- don’t disconnect catheter from tubing because there is a separate port.
where is the kidney located
RP space
you have to palpate and percuss for the CVA pain
urine flow
kidney
ureters which have UVJ valves to prevent backflow
bladder
urethra
patho of pyelo
inflammation of renal parenchyma and collecting tubes
Pyelo Risk Factors
Vesi Reflux( the backflow of urine from the bladder to the ureters to the kidneys)
hydronephrosis: SWELLING of kidney because of the backflow of urine
BPH, Strictures, Stones
CAUTI
what can chronic pyelo can do
kidney damage so it can lead to ESRD which is why we might need a biopsy to see if there is any fibrosis or atrophy FROM the inflammation
how to get UA
clean catch stream!
midstream with soap and water NO antibio wipes
and you have one hour or refrigerate it.
pyelo expected findings
flank pain
fever
chills
malaise
N
V
pyelo lab tests
UA to see RBC, WBC, and bacteria
Urine for C/S this takes a while!!
CBC with WBC differential
Blood culture
Ultrasound: abnormal, hydronephrosis, masses, stones
CT urogram: infections
pyelo meds
BROAD spectrum antibiotics because C/S doesnt come back that fast. Switch to Bactrim or Cipro after the results come back
NSAIDs for PAIN and FEVER
Nursing Interventions for pyelo
- Assess vitals
- Monitor I and O’s
- we want to see 30 ml/hr, 1500 output
- remember patient can hold 600 to 1000ml
- 250 DISTENDED
- 400 UNCOMFY
- monitor fluid and electrolyte
- pain management
- encourage fluid 2-3 L to flush out bacteria
NANDAs
acute pain
impaired urinary elimination
renal stone patho
masses of crystals, PROTEINS, that can cause obstruction by sticking to each other. no single reason for stone formation
what are the most common types of stones
- calcium phosphate
- calcium oxalate
- struvite
- uric acid
- cysteine stones
renal stone risk factors
runs in family.
young white men who live in the south and live sedentary lifestyles.
in the summer
CIPP
calcium/citric acid/uric acid
immobility
protein
poor hydration: you drink tea
high urine pH and less soluble
calcium and phosphate
lower ph and less soluble
uric acid and cysteine
calcium oxalate
occurs: MEN
treatment: berries, tea, chocolate, peanuts, meat, REDUCE sodium and calcium
struvite stone
gender
what should we do
struvite: WOMEN
acidify urine and cranberry juice
uric acid
gender
treatment
diet
MEN
decrease purines: organ meats, mussels, shellfish, mushrooms, asapargus
ALKALIZE URINE.
TREATMENT: allopurinol
cystine
increase hydration and ALKALIZE URINE.
renal stone expected findings
-FIRST SYMPTOM RENAL Colic(sharp severe pain in the flank, back, lower abdomen. they are constantly moving around because of the pain.
Common sites of obstructions:
-UPJ: flank pain (renal colic)
UVJ: groin pain that radiates to labia and testes
severe pain: N/V
renal stone dx
- Noncontrast CT scan: tells us if its a stone or tumor
- Ultrasound: to see masses
- IVP to see renal pelvis and tubules becuase of UPJ and UVJ
- UA to see sepsis because bacteria, RBC, WBC, crystaluria, and we want to see if we should acidify or alkaline urine
- Lab Electrolytes to see if turned into AKI
- 24 hours urine collection: creatinine!!
interprofessional care
- Pain management
- relieve obstruction with tamsulosin and terzosin
- STRAIN URINE to assess and prevent future stones
how does tamusolosin and terzosin relieve obstruction
relaxes smooth muscles of the ureters to allow passage
how can doctors remove stones
- cystoscopy: basically a doctor will put a telescope through your urethra if there is an obstruction in bladder or urethra.
- pain: morphine and NSAIDs
- lithotripsy
lithotripsy
monitor the urine output because we have to catch that stone and make sure the broken stone pieces don’t obstruct the urine. educate patient that bruising and pain is normal at the site.
nutrition for renal stones
DO NOT FORCE FLUIDS BC PAIN MIGHT BE WORSE
1. MANAGE PAIN
- REDUCE TEA AND COLA
- LOW SODIUM FOR CALCIUM FORMING
nursing management for renal stones
ambulate
pain management with meds
positions
strain all urine
ADEQUATE FLUID INTAKE
DIETARY INTAKE
what are allergy responses to IVP
itching
hypotension
respiratory distress
tachy
AKI patho
kidney loss of function because of some infection and there is the reduction of UO and azotemia
how can AKI kill you
hypotension
hypovolemic shock
nephrotoxic drugs
hyperkalemia
IT CAN GO UNNOTICED AND UNTREATED
prerenal
MOST COMMON
decreased perfusion from trauma, HF, and dehyration
intrarenal
prerenal
ATN because of the nephrotoxic drugs or sepsis
blood transfusion reaction
postrenal
hydronephrosis
BPH
prostate cancer
trauma
level of UO in each phase
prerenal: oliguria
interenal: polyuria or oliguria
postrenal: oliguria eventually
Phases of AKI
Oliguria
Diuresis
Recovery
tell me about oliguric phase
UO is less than 400ml/day
occurs for a week after injury
lasts for two weeks
UA will show cast from the mucoprotein necrosis, RBC, WBC because the infection(leukocytosis)
metabolic acidosis: because of waste buildup
volume overload: fluid being backed up can affect cardiac and lung
potassium excess
no EPO (anemia)
Neuro issues: confusion, stupor, seizures,coma!!
waste buildup
oliguric phase extra
hypovolemia
JVD
bounding pulses
edema
hypertension
HF
PE/PE
Kussmaul respirations from the metabolic acidosis
Hyponatremia because the blood is diluted >cerebral edema
Hyperkalemia: ECG! TELEMETRY
direutic phase
UO 1-3 L
lasts 1-3 weeks
kidneys cannot conc urine
Hyponatremia
Hypokalemia
Dehydration
AKI DX
history and physical: what type?
serum creatinine
UA
renal scan
CT scan
renal biospy
Prerenal Treatment
FORCE FLUIDS and DIURETICS because of the intravascular volume and cardiac output
How can we treat oliguric phase
- fluid restriction: 600ml plus UO from the day before
- Lower potassium with calcium carbonate, kayexlate, dialysis, sodium bicarb, insulin but make sure you give glucose because of hypoglycemia
what is kayexlate contraindicated with
loose stools
paralytic ileus
so assses their bowels to prevent necrosis
AKI nutrition
limit protein bc its harder to metabolize
no sodium
increase fat
nursing assess
- assess UO and color
- assess crackles and rhonchi and diminished breath sounds
- monitor F and E
- I and O
- monitor of infection
- AMBULATEEEEEE
- NO PROTEIN AND NO K
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Specific gravity
Specific gravity is an expression of the degree of concentration of the urine that measures the density of a solution compared to the density of water, which is 1.000.
CONCENTRATION OF SOLUTES
Osmolality
Osmolality is the most accurate measurement of the kidney’s ability to dilute and concentrate urine.
NUMBER ONE DX FOR AKI
FLUID OVERLOAD
CKD ICD how?
GFR is less than 60
longer than 3 months
or
kidney damage
longer than 3 months
CKD leading causes
DM damaged vessels so waste cannot be filtered
HTN damages and weakens vessels
CKD urinary
polyuria because of DM
eventually
fluid retention
anuria
CKD metabolic
waste
elevated tri because hepatic stimulation
altered carb metabolism
CKD electrolyte imbalances
hyperkalemia
hypermagnesia
hyperphosphatemia
hypocalcemia
metabolic acidosis
CKD hematologic
anemia
infection
bleeding easily because of altered platelet function
GI bleeds because of ASA
CKD Cardiovascular
Hypertension
Calcium deposits
HF
PVD
CKD Respiratory
Kussumals
SOB
pulmonary edema
uremic pleuritis
pneumonia and other infections because immune sys is trash
CKD GI
Stomatitis (stomach ulcers)
Uremic fector
because urea is converted to ammonia
metallic taste
DM Gastroparesis
GI bleed
Constipation
CKD Neuro
Lethargic
apathy
fatigue
peripheral neuropathy
RLS
CKD MSK
Vitamin D and calcium
osteomalacia
osteo fibrosa
vascular calcifications
hyperparathyroidism: bone demineralization. body thinks that we have a lot of phosphate and not enough calcium so PTH will be broken.
CKD skin
uremic frost
itching
CKD reproductive
infertility
libido
low sperm count
CKD DX
H and P
Dipstick to see PROTEIN in Urine
UA
Renal Biopsy
Renal ultrasound
CT scan
first morning void because urine is most conc so we can get albumin and creatinine ratio
GOLD STANDARRD: GFR
CKD Conservative Therapy
- correction of fluid volume overload with diuretics and fluid restriction
- nutrition: low sodium, potassium and protein
- EPO: give epogen
- calcium and phosphate binders
- Anti HTN: weight loss, diet, sodium and fluid restriction
*
phosphate binders names
- calcium acetate
- calcium carbonate
- renagel
give phosphate binders with
meals
renagel can lower what
cholesterol
phosphate binder side effect
constipation
no foil for ckd means
avoid aluminum prep
Vitamin D supplements
Calcitriol
Cincalcet
Anemia meds
EPO
IV or SQ
when should we see increase in H and H
2 or 3 weeks
what can the anemia drugs cause
Thromboembolism and HTN
What drugs can cause drug toxicity
Digoxin
Diabetic agents
Antibiotics
Opiods
Protein intake based on dialysis?
H: normal
P: increase
oliguria diet
NO POTASSIUM NO PHOSPHORUS
NO COFFEE
HIGH CARB
IVP
what should the patient give before the procedure?
ask the patient what?
assess for?
how long will this procedure take?
is there an NPO status?
what can you see on an IVP?
signed consent
allergies
BUN and Creatinine
1 hours
yes NPO midnight also no caffiene
visualizes renal pelvis and tubules to see any obstruction
