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NUR5002 > Renal > Flashcards

Renal Flashcards

1
Q

Roles of the kidneys:

A
  1. Maintaining homeostasis
  2. Excretion
  3. Acid-base balance (reabsorbing H+/HCO3-
  4. Water balance
  5. Electrolyte balance
  6. Removing toxins and waste (urea, creatinine, uric acid, bilirubin)
  7. Controlling BP
  8. Hormone secretion (eg. Renin)
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2
Q

What waste product is used as an indicator of GFR and why?

A

Creatinine as it is not reabsorbed or secreted during filtration

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3
Q

Hormones that increase water reabsorption:

A
  • Aldosterone: acts on distal tubule to increase H2O absorption
  • Vasopressin (ADH): released from posterior pituitary and acts on collecting ducts to increase H2O absorption
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4
Q

UTI risk factors (for females)

A
  • short, straight urethra
  • pregnancy
  • use of diaphragm and spermicidal compounds for birth control
  • proximity of urinary meatus to vagina and anus
  • sexual intercourse
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5
Q

Urinary risk factors (for males)

A
  • prostatic hypertrophy
  • uncircumcised
  • anal intercourse
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6
Q

UTI risk factors (general)

A
  • ageing
  • catheterisation
  • genetic factors
  • urinary tract obstruction
  • Neurogenic bladder dysfunction
  • vesicoureteral reflux
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7
Q

Cystitis

A

Inflammation of the bladder (most common)

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8
Q

Pyelonephritis

A

Inflammation of renal pelvis and parenchyma (ascending to the kidneys)

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9
Q

Common bacterial agents causing UTI

A
  • E. Coli (most common)
  • proteus mirabilis
  • enterbacter
  • klebsiella spp.
  • enterococcus spp.
  • pseudomonas aeruginosa
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10
Q

Clinical manifestations of UTI

A
  • frequency/urgency
  • dysuria
  • cloudy/smelly
  • unilateral flank pain or groin pain
  • fever/chills
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11
Q

Diagnosis of renal calculi (kidney stones)

A

UA
cystoscopy
Renal stone analysis
X-ray
Serum: calcium, oxalate, uric acid

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12
Q

Kidney stones risk factors:

A
  • infection
  • genetic predisposition
  • urinary stasis
  • immobility
  • hypercalcaemia
  • increased uric acid
  • increased urinary oxalate level
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13
Q

UTI treatment

A
  • antibiotics
  • agents that sterilise the urinary tract
  • drugs:
  • block spasms of the urinary tract muscles
  • decrease urinary tract pain
  • protect the cells of the bladder from irritation
  • treat enlargement of the prostate gland in men
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14
Q

Prerenal causes of acute kidney injury:

A
  • hypovolaemia (dehydration, haemorrhage, excessive diuretics)
  • decreased CO (arrhythmias, HF, MI)
  • decreased PVR (anaphylaxis, neurological injury, septic shock)
  • decreased renovascular blood flow (renal vein/artery thrombosis, embolism)
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15
Q

Intrarenal causes of acute kidney injury:

A
  • nephrotoxic injury (medications, contrast media, crush injury, chemical exposure, haemolytic blood transfusion reaction)
  • interstitial nephritis (allergies, infections)
  • thrombotic disorders
  • malignant hypertension
  • SLE
  • prolonged prerenal ischarmoa
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16
Q

Post-renal causes of acute kidney injury

A
  • benign prostatic hyperplasia
  • bladder cancer
  • calculi formation
  • prostate cancer
  • spinal cord disease
  • strictures
  • trauma (back, pelvis, perineum)
17
Q

Functional and structural characteristics of acute renal failure

A

Functional:
- decreased GFR
- decreased urine output
- increased nitrogenous waste in blood (urea and creatinine)
Structural:
- cell death (apoptosis and necrosis)
- loss of adhesion in intrinsic renal cells (obstruction)

18
Q

Dialysis

A
  • movement of fluid and molecules across semipermeable membrane from one compartment to another
  • haemodialysis or peritoneal dialysis
19
Q

Indications for diuretics:

A
  • oedema associated with CHF
  • acute pulmonary oedema
  • liver disease
  • renal disease
  • hypertension
  • conditions that cause hyperkalaemia
20
Q

Phases of acute kidney injury

A
  1. Onset phase: kidney injury occurs
  2. Oliguric phase: urine output decreases from renal tubule damage
  3. Diuretic phase: kidneys try to heal and urine output increases, but tubule scarring and damage occur
  4. Recovery phase: tubular oedema resolves and renal function improves
21
Q

Clinical manifestations of acute kidney injury

A
  • decreased urine output
  • fluid retention and peripheral oedema
  • SOB
  • fatigue
  • confusion
  • nausea
  • weakness
  • irregular heartbeat
22
Q

Clinical signs in the oliguric phase of acute kidney injury

A
  • urine output <400ml/day
  • increases in blood urea nitrogen and creatinine levels
  • electrolyte disturbances - hyperkalaemia, hyperphosphataemia
  • acidosis
  • fluid overload
  • distended neck veins
  • hypertension
  • pulmonary oedema
23
Q

Important nursing assessments for acute kidney injury

A
  • monitor urine output, assess fluid balance
  • monitor vital signs (particularly BP and HR), auscultate heart sounds
  • assess urine (dipstick), assess for blood, infection or pain
24
Q

Indications for haemodialysis in acute kidney injury:

A
  • volume expansion that cannot be managed with diuretics
  • hyperkalaemia refractory to medical therapy
  • correction of severe acid-base disturbances that are refractory to medical therapy
  • severe azotemia (BUN>80-100)
  • uraemia
25
Q

Ongoing care for a temporary shunt

A
  • wash with soap and water every day
  • don’t scratch the area
  • check daily for signs of infection
  • check that there is blood flow in the access - thrill
  • rotate needle sites of the access
  • avoid trauma (measuring BP, tight clothing)
26
Q

UTI risk factors (toddler vs 80 year old)

A

Toddler:
- infrequent voiding
- not circumcised
- structural deformity
- vesicoureteral reflux
- bubble baths
- wiping from back to front
- poor hygiene
- nappies
- tight-fitting clothes
80 year old:
- female
- weakened immune system
- catheters
- reduced oestrogen in females
- history of prior UTI
- sexual activity
- urinary retention
- exposure to nosocomial pathogens

27
Q

UTI aetiology (toddler vs 80 year old)

A

Toddler:
- urinary reflux
- shorter urethra
80 year old:
- urine retention allows bacteria colonisation
- catheters
- menopause

28
Q

Diagnostics in UTI

A
  • urinalysis (infection)
  • kidney ultrasound
  • urine culture and sensitivity
  • renal scan
29
Q

Clinical manifestations of UTI (toddler vs 80 year old)

A

Toddler:
- irritability
- tiredness
- poor feeding
- failure to put on weight

80 year old:
- burning
- frequency/urgency
- fever
- back and lower flank pain
- cloudy/smelly urine
- dysuria
- confusion and disorientation

30
Q

Nursing interventions for UTI (toddler vs 80 year old)

A

Toddler:
- cotton underwear
- frequent toileting/nappy changes
- hydration
- antibiotics
- parent education
- hygiene
80 year old:
- pain management
- antibiotics
- hydration
- hygiene
- cotton underwear

31
Q

What is the most common causative agent of UTIs

A

Escherichia coli

32
Q

required urine output

A

0.5-1.0mL/kg/hr
Eg. 60kg person should produced 30-60mL/hr

NUR5002 (10 decks)

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