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adult 2 exam 2 > Renal > Flashcards

Renal Flashcards

1
Q

Normal kidney function CAREER

A

Controls BP
Activates vitamin D
Regulates volume comp and ECP
Excretes waste
EPO production
Regulates acid base balance

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2
Q

how to prevent CAUTIs

A
  • 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.
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3
Q

where is the kidney located

A

RP space
you have to palpate and percuss for the CVA pain

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4
Q

urine flow

A

kidney
ureters which have UVJ valves to prevent backflow
bladder
urethra

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5
Q

patho of pyelo

A

inflammation of renal parenchyma and collecting tubes

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6
Q

Pyelo Risk Factors

A

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

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7
Q

what can chronic pyelo can do

A

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

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8
Q

how to get UA

A

clean catch stream!
midstream with soap and water NO antibio wipes
and you have one hour or refrigerate it.

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9
Q

pyelo expected findings

A

flank pain
fever
chills
malaise
N
V

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10
Q

pyelo lab tests

A

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

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11
Q

pyelo meds

A

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

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12
Q

Nursing Interventions for pyelo

A
  1. Assess vitals
  2. Monitor I and O’s
    1. we want to see 30 ml/hr, 1500 output
    2. remember patient can hold 600 to 1000ml
    3. 250 DISTENDED
    4. 400 UNCOMFY
  3. monitor fluid and electrolyte
  4. pain management
  5. encourage fluid 2-3 L to flush out bacteria
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13
Q

NANDAs

A

acute pain

impaired urinary elimination

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14
Q

renal stone patho

A

masses of crystals, PROTEINS, that can cause obstruction by sticking to each other. no single reason for stone formation

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15
Q

what are the most common types of stones

A
  1. calcium phosphate
  2. calcium oxalate
  3. struvite
  4. uric acid
  5. cysteine stones
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16
Q

renal stone risk factors

A

runs in family.

young white men who live in the south and live sedentary lifestyles.

in the summer

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17
Q

CIPP

A

calcium/citric acid/uric acid

immobility

protein

poor hydration: you drink tea

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18
Q

high urine pH and less soluble

A

calcium and phosphate

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19
Q

lower ph and less soluble

A

uric acid and cysteine

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20
Q

calcium oxalate

A

occurs: MEN
treatment: berries, tea, chocolate, peanuts, meat, REDUCE sodium and calcium

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21
Q

struvite stone

gender

what should we do

A

struvite: WOMEN

acidify urine and cranberry juice

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22
Q

uric acid

gender

treatment

diet

A

MEN

decrease purines: organ meats, mussels, shellfish, mushrooms, asapargus

ALKALIZE URINE.

TREATMENT: allopurinol

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23
Q

cystine

A

increase hydration and ALKALIZE URINE.

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24
Q

renal stone expected findings

A

-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

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25
Q

renal stone dx

A
  • 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!!
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26
Q

interprofessional care

A
  1. Pain management
    1. relieve obstruction with tamsulosin and terzosin
  2. STRAIN URINE to assess and prevent future stones
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27
Q

how does tamusolosin and terzosin relieve obstruction

A

relaxes smooth muscles of the ureters to allow passage

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28
Q

how can doctors remove stones

A
  • 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
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29
Q

lithotripsy

A

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.

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30
Q

nutrition for renal stones

A

DO NOT FORCE FLUIDS BC PAIN MIGHT BE WORSE
1. MANAGE PAIN

  1. REDUCE TEA AND COLA
  2. LOW SODIUM FOR CALCIUM FORMING
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31
Q

nursing management for renal stones

A

ambulate

pain management with meds

positions

strain all urine

ADEQUATE FLUID INTAKE

DIETARY INTAKE

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32
Q

what are allergy responses to IVP

A

itching

hypotension

respiratory distress

tachy

33
Q

AKI patho

A

kidney loss of function because of some infection and there is the reduction of UO and azotemia

34
Q

how can AKI kill you

A

hypotension

hypovolemic shock

nephrotoxic drugs

hyperkalemia

IT CAN GO UNNOTICED AND UNTREATED

35
Q

prerenal

A

MOST COMMON

decreased perfusion from trauma, HF, and dehyration

36
Q

intrarenal

A

prerenal

ATN because of the nephrotoxic drugs or sepsis

blood transfusion reaction

37
Q

postrenal

A

hydronephrosis

BPH

prostate cancer

trauma

38
Q

level of UO in each phase

A

prerenal: oliguria
interenal: polyuria or oliguria
postrenal: oliguria eventually

39
Q

Phases of AKI

A

Oliguria

Diuresis

Recovery

40
Q

tell me about oliguric phase

A

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

41
Q

oliguric phase extra

A

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

42
Q

direutic phase

A

UO 1-3 L

lasts 1-3 weeks

kidneys cannot conc urine

Hyponatremia

Hypokalemia

Dehydration

43
Q

AKI DX

A

history and physical: what type?

serum creatinine

UA

renal scan

CT scan

renal biospy

44
Q

Prerenal Treatment

A

FORCE FLUIDS and DIURETICS because of the intravascular volume and cardiac output

45
Q

How can we treat oliguric phase

A
  1. fluid restriction: 600ml plus UO from the day before
  2. Lower potassium with calcium carbonate, kayexlate, dialysis, sodium bicarb, insulin but make sure you give glucose because of hypoglycemia
46
Q

what is kayexlate contraindicated with

A

loose stools

paralytic ileus

so assses their bowels to prevent necrosis

47
Q

AKI nutrition

A

limit protein bc its harder to metabolize

no sodium

increase fat

48
Q

nursing assess

A
  • 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
    *
49
Q

Specific gravity

A

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

50
Q

Osmolality

A

Osmolality is the most accurate measurement of the kidney’s ability to dilute and concentrate urine.

51
Q

NUMBER ONE DX FOR AKI

A

FLUID OVERLOAD

52
Q

CKD ICD how?

A

GFR is less than 60

longer than 3 months

or

kidney damage

longer than 3 months

53
Q

CKD leading causes

A

DM damaged vessels so waste cannot be filtered

HTN damages and weakens vessels

54
Q

CKD urinary

A

polyuria because of DM

eventually

fluid retention

anuria

55
Q

CKD metabolic

A

waste

elevated tri because hepatic stimulation

altered carb metabolism

56
Q

CKD electrolyte imbalances

A

hyperkalemia

hypermagnesia

hyperphosphatemia

hypocalcemia

metabolic acidosis

57
Q

CKD hematologic

A

anemia

infection

bleeding easily because of altered platelet function

GI bleeds because of ASA

58
Q

CKD Cardiovascular

A

Hypertension

Calcium deposits

HF

PVD

59
Q

CKD Respiratory

A

Kussumals

SOB

pulmonary edema

uremic pleuritis

pneumonia and other infections because immune sys is trash

60
Q

CKD GI

A

Stomatitis (stomach ulcers)

Uremic fector

because urea is converted to ammonia

metallic taste

DM Gastroparesis

GI bleed

Constipation

61
Q

CKD Neuro

A

Lethargic

apathy

fatigue

peripheral neuropathy

RLS

62
Q

CKD MSK

A

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.

63
Q

CKD skin

A

uremic frost

itching

64
Q

CKD reproductive

A

infertility

libido

low sperm count

65
Q

CKD DX

A

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

66
Q

CKD Conservative Therapy

A
  • 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
    *
67
Q

phosphate binders names

A
  • calcium acetate
  • calcium carbonate
  • renagel
68
Q

give phosphate binders with

A

meals

69
Q

renagel can lower what

A

cholesterol

70
Q

phosphate binder side effect

A

constipation

71
Q

no foil for ckd means

A

avoid aluminum prep

72
Q

Vitamin D supplements

A

Calcitriol

Cincalcet

73
Q

Anemia meds

A

EPO

IV or SQ

74
Q

when should we see increase in H and H

A

2 or 3 weeks

75
Q

what can the anemia drugs cause

A

Thromboembolism and HTN

76
Q

What drugs can cause drug toxicity

A

Digoxin

Diabetic agents

Antibiotics

Opiods

77
Q

Protein intake based on dialysis?

A

H: normal

P: increase

78
Q

oliguria diet

A

NO POTASSIUM NO PHOSPHORUS

NO COFFEE

HIGH CARB

79
Q

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?

A

signed consent

allergies

BUN and Creatinine

1 hours

yes NPO midnight also no caffiene

visualizes renal pelvis and tubules to see any obstruction

adult 2 exam 2 (3 decks)

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