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Medsurg Exam 2 > Renal > Flashcards

Renal Flashcards

1
Q

What is the primary function of the renal and urinary system?

A

homeostasis

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2
Q

kidney’s specific role in homeostasis

A

regulating fluid and electrolytes, removing wastes, and providing hormones that are involved in red blood cell (RBC) production, bone metabolism, and blood pressure.

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3
Q

each kidney has how many nephrons

A

1 million

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4
Q

purpose of nephrons

A

filters blood

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5
Q

purpose of the glomerulus

A

filtration of waste

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6
Q

what can alter filtration

A

Increases in the glomerular capillary hydrostatic pressure cause increases in net filtration pressure and GFR
increases in Bowman space hydrostatic pressure causes decreases in filtration pressure and GFR

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7
Q

a substance moves from the filtrate back into the peritubular capillaries or vasa recta

A

tubular reabsorption

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8
Q

a substance moves from the peritubular capillaries or vasa recta into tubular filtrate

A

tubular secretions

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9
Q

What are some substances that should not be found in urine and why?

A

no protein = damage happens quickly to kidneys
no glucose in urine = diabetes
blood = internal bleeding

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10
Q

measuring the ratio of the amount of solutes (milliosmoles) to water using liters

A

osmolarity

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11
Q

calculates the ratio of the amount of solutes (milliosmoles) to water using weight or kilograms

A

osmolality

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12
Q

percentage of K filtered through the kidneys

A

90%

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13
Q

how is water regulated by kidneys

A

ADH/vasopressin

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14
Q

volume of electrolytes excreted each day by the kidneys

A

excretion is equal to intake per day

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15
Q

regulation of acid base balance by the kidneys

A

filtering bicarbonate and phosphate
results in metabolic acidosis

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16
Q

vessels constantly monitor blood pressure as blood begins its passage into the kidney

A

vasa recta

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17
Q

specialized juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole secrete the hormone:

A

renin

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18
Q

Why is (MAP- Mean arterial pressure) important?

A

MAP of 65 maintains renal perfusion

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19
Q

how do kidneys regulate RBCs

A

releasing erythropoietin - which stimulates bone marrow to produce RBCs

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20
Q

purpose fo regulation of Vit D

A

production of calcium from active form of Vit D

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21
Q

purpose of prostaglandins

A

vasodilatory effects and important in maintaining renal blood flow

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22
Q

kidneys function of regulating waste

A

kidney is main excretory organ, eliminating body’s metabolic waste product

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23
Q

assessment involved for renal/urinary tract

A

Health History
Social History
Recognize cues (subjective data)
Costovertebral angle

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24
Q

labs for renal/urinary tract

A

Urinalysis and Urine Culture
Renal clearance
Creatinine clearance
Creatinine level (0.6- 1.2)
BUN (7-20)
GFR 120- 130mL/min

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25
Q

diagnostics for renal

A

Imagining
Ultrasounds
Urologic Endoscopic
Bladder Scan

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26
Q

what is post void residual

A

amount of urine left in bladder after urinating

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27
Q

what do we want a PVR to be

A

less than 50
less than 350

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28
Q

progressive loss of kidney (nephron) function

A

kidney disease 1

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29
Q

percentage of those with CKD that do not know

A

70%

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30
Q

nephron level classification for kidney disease

A

nephron functioning less than 20%

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31
Q

risk factors for kidney disease

A

diabetes and HTN
proteinuria
greater than 60 YO
family history

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32
Q

GFR indication for end stage renal disease

A

less than 15

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33
Q

clinical manifestations of CKD

A

hypertension
heart failure
hyperkalemia
metabolic acidosis
pulmonary edema
edema
uremia
GI and neuro symptoms
anemia
skeletal buffering
hypocalcemia
hyperphosphatemia
hyperparathyroidism
osteodystrophies

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34
Q

diagnostic testing for CKD

A

Lab work/ Urine Studies
K+ - hyperkalemia
Creatinine clearence – excreted in urine
Creatine level – 0.6-1.2
Hgb
BUN (7-20)
Magnesium
GFR – 120-130
Renal Ultrasound
Renal Biopsy –risk for bleeding
CT scan

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35
Q

medicatoins for CKD treatment

A

Sodium Polystyrene (Kayexalate) - Patiromoer (Veltassa) – decrease K
ACE Inhibitors and ARBs –lower BP
Svelamer carbonate (Renvela) - Calcium Acetate (PhosLo) – lowers phosphate
Calcium and Vit D – supplementation
Cinacalcet (Sensipar)
Exogenous Erythropoietin - Epogen, Procrit
Iron – reproduce RBC
Statins (Atorvastatin-Lipitor)
Gemfibrozil (Lopid) -cholesterol – build up – stops blockages

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36
Q

medications for CKD to decrease potassium

A

Sodium Polystyrene (Kayexalate)
Patiromoer (Veltassa)

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37
Q

medications for CKD to lower BP

A

ACE inhibitors
ARBs

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38
Q

medications for CKD to lower phsophate

A

Svelamer carbonate (Renvela)
Calcium Acetate (PhosLo)

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39
Q

medications for CKD to supplement

A

calcium
Vit D

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40
Q

medications for CKD to treat hyperparathyroidism

A

Cinacalcet (Sensipar)

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41
Q

medications for CKD to reproduce RBCs

A

Exogenous Erythropoietin
Epogen
Procrit
Iron

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42
Q

medications for CKD to lower cholesterol building and stop blockages

A

Statins (Atorvastatin-Lipitor)
Gemfibrozil (Lopid)

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43
Q

nutrition restrictions for CKD

A

protein restriction
fluid restriction
sodium restriction
potassium restriction
phosphate restriction

44
Q

why do we restrict protein for patients with kidney disease and how do we monitor

A

causing damage and increases toxins

monitor lab work

45
Q

why do we restrict fluid for patients with kidney disease and how do we monitor

A

avoid fluid overload

based on urine output

46
Q

why do we restrict sodium for patients with kidney disease and how do we monitor

A

hurt kidneys cannot filter and control with ADH

2-4 grams/day

47
Q

why do we restrict potassium for patients with kidney disease and how do we monitor

A

kidneys responsible for filter of 90% of potassium

2000-3000mg
monitor lab work

48
Q

why do we restrict phosphate for patients with kidney disease and how do we monitor

A

hyperphosphatemia

1g/day
limit meat and dairy products

49
Q

purpose of renal replacement therapy

A

diffusion, osmosis, ultrafiltration
remove waste
filters blood

50
Q

vascular access for hemodialysis

A

Temporary Vascular Access
Arteriovenous fistula (AVF) – A
Arteriovenous graft (AVGs) – B – IV drug users – scar tissue

51
Q

how to assess fistula

A

feel thrill
listen to bruit

52
Q

assessment of vascular assess sites

A

Assess for maintenance
Assess for infection
Assess for possible obstruction

53
Q

frequency and length of hemodialysis

A

Completed on average 3 times per week for 3-4 hours

54
Q

what medications the nurse should hold before dialysis

A

cardiac glycosides
antibiotic agents
antiarrythmic medications
antihypertensive agents
blood products
blood thinners

55
Q

complications of hemodialysis and what causes thme

A

dysrhythmias - too much potassium and fluid
chest pain - potassium - fluid shift - hemoglobin
hypotension - fluid/blood loss
muscle cramps - hyperkalemia
hepatitis - sterility

56
Q

process of PD

A

infuse 2 L of fluid
allows both diffusion and osmosis to occur
drainage portion of the exchange begins
The solution drains from the peritoneal cavity by gravity through a closed, sterile system. Usually drainage is completed in 10 to 30 minutes.

57
Q

peritoneal dialysis access

A

Tenckhoff Catheter
Inserted through abdominal wall.
Takes 2 weeks to heal.
Can be used immediately with low volume of fluid.
Monitor for signs of infection

58
Q

complications for PD

A

exit site infection
peritonitis
hernias and lower back problems
bleeding
pulmonary complications
protein loss

59
Q

assessment for PD access

A

H&P
Complete history of any existing kidney disease, family history
Long-term health problems
Drugs and herbal preparations
Dietary habits
Support systems
Output
Skin – itching and edema
Chest pain or palpitations

60
Q

nursing diagnoses for kidney disease

A

Excess fluid volume
Risk for electrolyte imbalance
Risk for injury
Anemia
Imbalanced nutrition: less than body requirements

61
Q

overall planning goals for kidney disease

A

Demonstrate knowledge and ability to comply with therapeutic regimen
Participate in decision making
Maintain normal fluid volume status
Preserve kidney function
Minimize complications

62
Q

health promotion fro kidney disease

A

Identify individuals at risk for CKD
Diabetes mellitus
Hypertension
History or family history of kidney disease
Repeated urinary tract infection
Regular checkups and changes in urinary appearance, frequency, and volume should be reported

63
Q

acute care for CKD

A

Most care for CKD occurs on an outpatient basis
In-hospital care required for management of complications and for kidney transplantation

64
Q

ambulatory care for CKD

A

Patient can complete evaluation for kidney transplant
Explain what is involved in PD or HD, home dialysis modalities, transplantation, palliative care
Teach patient and caregiver about
Diet
Drugs
Common side effects
Pill organizer
Avoid over-the-counter drugs
Take daily BP
Identify signs of fluid overload, electrolyte imbalances

65
Q

evaluation for CKD

A

The patient with CKD will maintain:

Fluid and electrolyte levels within normal ranges
Absence of complications
An acceptable weight with no more than a 10% weight loss
Adherence to treatment plan

66
Q

possible complications for upper urinary tract infections

A

sepsis
UTI

67
Q

normal defense to prevent UTIs

A

urinating
acidic PH
high urea concentration
glycoproteins

68
Q

classification of UTIs

A

Upper tract infection
Lower tract infection
Complicated vs. Uncomplicated

69
Q

causes and risk factors of UTI

A

Bacteria: E. Coli (70%-95% of cases that are uncomplicated), Staphylococcus, gram (+) bacteria
Indwelling Catheter- CAUTIs/HAI: gram (-) bacteria such as Klebsiella and Pseudomonas
Chronic antibiotic use
Diabetes
Sexual intercourse
Women/ Pregnancy
Compromised immune system
Aging
Immobility
BPH in men.

70
Q

infection of urethra and cause

A

urethritis
sexual intercourse or viral infection

71
Q

infection of bladder and cause

A

cystitis
causes puss and mucosa becomes hyperemic

72
Q

Occurs in the renal parenchyma and collecting system (upper tract) caused by a bacterial infection usually beginning in the lower tract.

A

pyelonephritis

73
Q

risk for chronic pyelonephritis

A

Reoccurring upper urinary tract infections

74
Q

clinical manifestations of pyelonephritis

A

Lower UTI symptoms
Fever/chills
N/V
Malasie
Flank pain
CVA tenderness

75
Q

risk factors for pyelonephritis

A

Failure to empty bladder
Obstruction
Immunosuppression
DM
Pregnancy
Neurologic disorders
Gout
AMS

76
Q

clinical manifestations of upper and lower tract infections

A

Dysuria
Hesitancy
Intermittency
Post-void dribbling
Hematuria
Pyuria – puss
Incontinence
Nocturia
Urgency
Frequency

77
Q

Upper and Lower Tract: Diagnostic Testing

A

Urinalysis
Clean Catch Urine or Straight Cath
+ nitrates, WBCs, leukocyte esterase, blood, cloudy urine
Pyelonephritis
Blood Studies
Elevated WBCs
Urine Cultures (antibiotic sensitivities)
Blood Cultures
Ultrasounds
CT scan
Kidney biopsy
Renal function panel

78
Q

medical treatment for uncomplicated UTI 3 days

A

Fluoroquinolones (Levofloxacin, Cipro)
Nitrofurantoin (Macrodantin)

79
Q

medical treatment complicated UTI

A

Ampicillin
Amoxicillin
Cephalosporins

80
Q

medical treatment for fungus related to UTI

A

Fluconazole (Diflucan)

81
Q

treatment of UTI symptoms

A

Urinary analgesic (phenazopyridine) - Relieve discomfort caused by dysuria.

82
Q

medication education for management of UTIs

A

Medication compliance.
Side effects of antibiotics.
Clean perineal area.
Sexual health.
Void regularly
Fluid intake
Educate women.
Signs and symptoms of UTI/ infection.
Follow up care.

83
Q

fluid management for UTIs

A

generous intake of fluid, 15ml per pound of body weight is minimumq

84
Q

maintainence of acidic urine for UTIs

A

cranberry juice
vit C

85
Q

bladder irritants to avoid with UTI

A

caffeine
alcohol
citrus juices

86
Q

fever treatment for UTIs

A

NSAIDs and antipyretics

87
Q

Care of a patient with Urinary Incontinence

A

Involuntary urinary leakage.
Bladder pressure is greater than urethral closure pressure.
OAB (overactive bladder)

88
Q

causes of urinary incontinence

A

DIAPPERS stand for:
Delirium
Infection
Atrophic vaginitis
Psychological
Pharmacologic
Excess urine output
Restricted mobility
Stool impaction

89
Q

risk factors for urinary incontinence

A

Neurogenic disorders
Spinal Cord dysfunction
Surgery
Medications
Stress

90
Q

types of incontinence

A

functional
after trauma/surgery
overflow
reflex
stress
urge
iatrogenic

91
Q

unable to get to bathroom in time

A

functional incontinence

92
Q

PP, accidents, catheter, prostate, hysterectomy

A

incontinence after trauma or surgery

93
Q

bladder doesn’t empty, pressure, obstruction, leakage

A

overflow incontinence

94
Q

CNS – sphrincter relaxation

A

reflex incontinence

95
Q

coughing, sneezing incontinence

A

stress incontinence

96
Q

continuous need to pee

A

urge incontinence

97
Q

medication side effects causes what incontinence

A

iatrogenic

98
Q

inability to empty bladder

A

urinary retention

99
Q

causes of urinary retention

A

Enlarged prostate
Tumor
Obstruction
Neurologic disorders
Diabetes
Medications

100
Q

diagnostics of urinary retention

A

Bladder Log
Post Void residual – leftover urine after voiding
Urinalysis

101
Q

treatment for urinary retention

A

Treat the cause
Kegel Exercises
Medication Therapy
Botox
Surgical Intervention/ Bladder sling
Schedule toileting
Double voiding
Straight Cath

102
Q

uses for indwelling catheters

A

Urinary Retention
Inability to void
Obstruction
Bladder decompression
Accurate measurement of output
Prevent contamination

103
Q

uses for straight cath

A

Relieve retention
Sterile sample
Measure postvoid residual
Neurogenic bladder
Bladder outlet obstruction in men
Every 3 to 5 hours

104
Q

role of nurse in management of cathiterization

A

Peri care, infection prevention, monitor output, empty bag, placement

105
Q

types of indwelling catherters

A

Ureteral Catheter
Suprapubic Catheter
Nephrostomy tubes

Medsurg Exam 2 (6 decks)

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