renal

Question 1

kidney filters how many gallons of blood daily? how many full blood filters is that?

Answer 1

45 gallons of blood; filters all of blood 30x per day

Question 2

how many nephrons are in each kidney

Answer 2

~1 million

Question 3

functions of the kidney

Answer 3

filtration + detoxification; BP regulation; erythropoietin release; acid/base balance; regulating vit. D and Ca+ formation (impacts multiple systems)

Question 4

values used to measure kidney function

Answer 4

serum creatinine and blood urea nitrogen (BUN)

Question 5

normal serum creatinine

Answer 5

men: 0.9-1.3
women: 0.6-1.1

Question 6

normal BUN

Answer 6

8-20

Question 7

acute kidney injury (AKI)

Answer 7

sudden, short term loss of renal function caused by obstruction, poor circulation or kidney disease; usually reversible with proper treatment (can take up to a year for full recovery); 3 types

Question 8

types of acute kidney injury (AKI)

Answer 8

prerenal, intrarenal, postrenal

Question 9

prerenal AKI

Answer 9

AKI due to reduction in blood flow to kidney (hypoperfusion); could be caused by hypovolemia, hypotension, vasoconstriction, inadequate CO, or a clot; treatment: restore hydration and perfusion

Question 10

intrarenal AKI

Answer 10

also called acute tubular necrosis(ATN); AKI due to damage to the filtering structures of the kidney; more serious than prerenal; caused by infections, autoimmune disease, or nephrotoxic medications; diagnosis: creatinine >1.3; remove underlying cause

Question 11

nephrotoxic medications

Answer 11

NSAIDS, CT contrast dye (make sure to stay hydrated); antibiotics (ending in -mysin)

Question 12

postrenal AKI

Answer 12

bilateral obstruction of urine outflow; caused by prostatic hyperplasia, renal calculi (stones), strictures(narrowing ureter/urethra), or tumors; look for obstructions through x-ray, ultra sound, and CT w/o dye

Question 13

clinical manifestations of AKI

Answer 13

dec. urine output, edema, nausea, fatigue, SOB, hyperkalemia (can cause arrhythmias, MI, cardiac arrest)

Question 14

AKI nursing care

Answer 14

IV fluids, take input+outputs; review labs, avoid nephrotoxic meds, monitor for dysrhythmias, weigh daily, assess urine flow

Question 15

factors leading to AKI

Answer 15

nephrotoxic meds, chronic NSAID use; opioid abuse, older age, procedures requiring fasting or bowel prep

Question 16

chronic kidney disease risk factors

Answer 16

acute kidney injury, diabetes (infection risk + inc. protein excretion), nephrotoxic meds, HTN, recurrent infections (like UTIs), smoking (dec. perfusion), obesity, high cholesterol

Question 17

symptoms of chronic kidney disease

Answer 17

hypervolemia (dec. fluid excretion), peripheral edema, hyperphosphatemia, hyperkalemia, hypocalcemia, metabolic acidosis, anemia (low erythropoietin), peripheral neuropathy (waste product build up)

Question 18

chronic kidney disease

Answer 18

progressive, irreversible kidney disease; 5 stages

Question 19

chronic kidney disease stage 1

Answer 19

at risk pt., kidney function normal; educate and screen for risk factors

Question 20

chronic kidney disease stage 2

Answer 20

mild chronic kidney disease; renal function begins to be impaired; testing indicates kidney disease

Question 21

chronic kidney disease stage 3

Answer 21

moderate chronic kidney disease; renal function impaired; interventions to slow development of disease (manage causes of disease)

Question 22

chronic kidney disease stage 4

Answer 22

severe chronic kidney disease, renal function severely impaired; manage complications, educate ab options

Question 23

chronic kidney disease stage 5

Answer 23

end stage kidney disease (ESKD); can’t maintain homeostasis, waste elimination severely impaired; educate pt. on options (dialysis, transplant, etc.)

Question 24

chronic kidney disease treatment

Answer 24

meds to manage symptoms: diuretics, vit. C, Ca+ reducer, erythropoietin; dialysis in stage 4+5; kidney transplant

Question 25

benign prostatic hyperplasia (BPH)

Answer 25

enlarged prostate gland; puts pressure on urethra, impeding urine flow; can be partial or complete; most common benign tumor in men

Question 26

benign prostatic hyperplasia pathophysiology

Answer 26

prostate cells inc. in # and form large nodules narrowing urethra; enzyme 5 a reductase converts testosterone to dihydrotestosterone (DHT), which induces growth factors that inc. prostate growth

Question 27

benign prostatic hyperplasia symptoms

Answer 27

nocturia, dribbling at end of stream, incontinence, urine urgency, painful urination(dysuria), hematuria, straining, incomplete bladder emptying, slow or delayed stream

Question 28

BPH treatment

Answer 28

alpha1 adrenergic blocker, 5 alpha reductase inhibitors; usually combo of both

Question 29

alpha1 adrenergic blocking agents

Answer 29

tamsulosin (flowmax); treat BPH; blocks alpha receptors in prostate-> smooth muscle relaxation in bladder and prostate

Question 30

tamsulosin (flowmax)

Answer 30

alpha1 adrenergic blocking agents; smooth muscle relaxation in bladder and prostate; may cause sleepiness, weakness, back pain, diarrhea; monitor BP (fluids), priapism; start low and word up; take 30 mins after the same meal everyday

Question 31

5-alpha reductase inhibitors

Answer 31

block conversion of testosterone to DHT to stop prostate hyperplasia

Question 32

finasteride

Answer 32

5-alpha reductase inhibitor; treat benign prostatic hyperplasia; may cause impotence, decreased libito, abd. upset, gynecomastia(breast tissue); wear gloves when giving

Question 33

transurethral resection of the prostate (TURP)

Answer 33

go through the urethra and debulk prostate; may only be a temporary fix

Question 34

renal calculi predisposing factors

Answer 34

dehydration, infection, obesity, exercise, prolonged diuretic therapy, immobility, urinary rentention

Question 35

renal calculi symptoms

Answer 35

flank pain, NV, hematuria, dysuria, urinary frequency

Question 36

most common kidney stone type

Answer 36

caldium oxalate

Question 37

renal calculi treatment

Answer 37

vigorous fluids to pass stone; diuretics (lower Ca+), analgesics

Question 38

urinary tract infection (UTI)

Answer 38

can occur anywhere in the urinary tract; most are acute, but can be chronic (can cause kidney damage); diabetes inc. risk (sugar feeds bacteria); pt. w/ catheter; women 4x as likely; e. coli is most common cause

Question 39

UTI symptoms

Answer 39

frequent, painful urination; red, dark, milky or cloudy urine; foul smelling urine; kidney pain (back); pelvic pressure; fever, fatigue, altered mental status; confusion in older adults

Question 40

sulfamethoxazole/trimethoprim (bactrim)

Answer 40

antibacterial used to treat UTIs; may cause NV, anorexia; watch for superinfection; hydrate to prevent renal calculi; take on full stomach

Question 41

nitrofurantoin (macrobid)

Answer 41

antibacterial used to treat UTIs; may interfere w/ bacterial cell wall formation of bacterial enzyme systems; monitor for pulmonary sensitivity; may cause asthma attack; may cause dark yellow or brown urine

Question 42

ciprofloxacin (cipro)

Answer 42

antibacterial used to treat UTIs; more aggressive antibiotic; may cause ND; monitor I&O; do not take with milk

Question 43

phenazopyridine (pyridium)

Answer 43

analgesic to relieve UTI pain; stops spasm; can turn urine orange or red (normal); only take for <2 days; take after meal; still need an antibiotic