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Hurst Review > Renal > Flashcards

Renal Flashcards

1
Q

Glomerulonephritis Pathophysiology:

a. Inflammatory reaction in the _______________________.
b. Antibodies lodge in the glomerulus; get scarring & _____________ filtering.
c. Main cause:_______________________

A

Pathophysiology:

a. Inflammatory reaction in the glomerulus.
b. Antibodies lodge in the glomerulus; get scarring & decrease filtering.
c. Main cause: strep

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2
Q 
9 S/S: for Glomerulonephritis
9 S/S: for Glomerulonephritis
1.)Sore throat
2)Facial edema
3.)Malaise and headache
4.)BUN&Creatinine_up
5.)Sediment/protein/blood in urine
6.)UO down
7.)Urine specific gravity up
8.). Flankpain(costovertebralangletenderness)
9.). BP_up 
Client going into fluid volume \_\_\_\_\_\_\_\_\_\_\_\_\_\_.
.
A 
9 S/S: for Glomerulonephritis
a. Sore throat
b. Malaise and headache
c. BUN&Creatinine\_\_\_\_\_\_\_
d. Sediment/protein/blood in urine
e. Flankpain(costovertebralangletenderness)
f. BP_up 
g. Facial edema
h. UO down
i. Urine specific gravity up
Client going into fluid volume \_\_\_\_\_\_\_\_\_\_\_\_\_\_.
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3
Q 
Tx:5 treat for Glomerulonephritis
a. Get rid of the strep.
b. Balance activity with rest.
c. I and O and daily weights
d. Monitor blood pressure.
  .
e. 
How is fluid replacement determined?
• Fluid replacement = 24 hour fluid loss + \_\_\_\_\_\_\_\_\_\_.

Dietary needs:
• Protein? ______ Na? __________ Carbs? _______

A

Tx:

a. Get rid of the strep.
b. Balance activity with rest.
c. I & O and daily weights
d. Monitor blood pressure.
e. How is fluid replacement determined?

• Fluid replacement = 24 hour fluid loss + 500 cc (for insensible fluid loss).

f. Dietary needs:

• Protein decrease, Na decrease, Carb increase

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4
Q

Why do these occur

Malaise and headache?

BUN &Creatinine up?

describe the color of Sediment/protein/blood in urine ?. What does the color tell you ?how do they leak through ?

Flank pain (costovertebral angle tenderness?

A

Malaise and headache
Because they are retaining toxins and toxins make you feel funny ( tired)

BUN &; Creatinine up
Because your kidneys aren’t working. You aren’t excreting urea or creatine

Sediment/protein/blood in urine
Urine maybe describe as smoky, Rusty, cola color. This is telling you their is hematorrhea.
There are big holes in the glomerulus so taking leak through.

Flank pain (costovertebral angle tenderness)  
The doctor may wonder how high in the urinary trac the infection is. So they would tap over the flank pain to determine where the complaint of Tenderness is
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5
Q

The client may have to have _______?. Depending on how bad Glomerulonephritis is

____ begins in ___ to ___ weeks after _____?.

___ and _____ may stay in the urine for ______?.
Because it takes a while for the kidneys to be repaired

A

The client may have to have dialysis. Depending on how bad Glomerulonephritis is

Diuresis begins in 1___ to _3__ weeks after onset.

Blood and protein may stay in the urine for months.
Because it takes a while for the kidneys to be repaired

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6
Q

For Glomerulonephritis Teach 5 S/S of_renal failure

Most of these s/s are due to

a lot of this is do to the fact the Client is retaining _______ and _______

A
  1. ) decreased output
  2. ) weight gain
  3. )headache & Malaise
  4. )nausea, vomiting
  5. ))anorexia,

•a lot of this is do to the fact the Client is retaining fluids and toxins

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7
Q

how is nephrotic syndrome different from glomerulonephritis?

A

Nephrotic syndrome-very edematous and losing MASSIVE amounts of protein

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8
Q

What is the Pathophysiology of Nephrotic Syndrome ?

A

It’s an inflammatory response in the glomerulus→ big holes form so protein starts leaking out in the urine
(what do we call this? Proteinuria)→ Now the client is
hypoalbuminemic (low albumin in the blood)→ without albumin you can’t hold on to fluid in the vascular space→ so where does all the fluid in the vascular space go? TISSUES → Now the client is edematous→ since all the fluid is going out into the tissue what has happened to the circulating blood volume?→
Decreases
The kidneys sense this decreased volume and they want to help replace it→ The

renin-angiotensin system kicks in→ aldosterone is produced→ and causes the

retention of SODIUM and WATER but is there any protein (albumin) in the vascular space to hold it?NO→ So where does this fluid go?TISSUES

Total Body Edema = Anasarca

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9
Q

Problems associated with protein loss: Nephrotic Syndrome

Name the 2 problems ?

Why will the blood clot ? What does it put them at risk for ?

Why will they have elevated Cholesterol and triglycerides?

A

Blood clots (thrombosis)

They are losing protein that normally prevents their blood from clotting without these proteins, the blood can clot and put them at risk for thrombosis.

• Cholesterol and triglycerides will be HIGH

The liver compensates by making more albumin causing an increased release of cholesterol and triglycerides.

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10
Q

5 Causes; Idiopathic, but has been related too: Nephrotic Syndrome

A
  1. )Strep
  2. )Bacteria or viral infections
  3. )NSAIDs
  4. )Cancer and_ Genetic predisposition.
  5. )Systemic disease like lupus or diabetes

With Glomerulonephritis strep is usually the cause . Just about every time

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11
Q

4 S/S of Nephrotic Syndrome

A

1) hypoalbuminemia
2) proteinuria (leads to blood clots and high cholesterol too)
3) anasarca (All that 3rd spacing d/t to hypoalbuminemia)
4) hyperlipidemia (caused by hypoalbuminenia, at the liver compensates by making more albumin, which causes increased release of cholesterol and triglycerides)

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12
Q

What is a the 7 TX for Nephrotic Syndrome

A

Tx:

a.
1. )Diuretics

  1. )Ace inhibitors
  2. )Prednisone .
  3. )Lipid lowering .
  4. ) Anticoagulation

6.) Na? Decrease
Protein? Increase
This is the one kidney disease where you have to have protein

7.). Dialysis

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13
Q

Nephrotic Syndrome

Why do we give diuretics?

Why do we give ace inhibitors?

Why do we give prednisone?

Why do we give lipid lowering drugs ?

If thrombosis is suspect what do we give ? How long can it be given ?

Why might dialysis be given ?

A

Tx:

a.
1.)Diuretics
Have to remove the excess fluid

2.)Ace inhibitors to block aldosterone secretion.

3.)Prednisone to decrease inflammation.
Good thing -Shrink holes in the glomerulus→ so Protein can’t get out
Bad thing -It make them Immunosuppressed.

4.)Lipid lowering drugs for hyperlipidemia.

5.)Na? Decrease
Protein? Increase
This is the one kidney disease where you have to have protein

6.) Anticoagulation -If thrombosis is suspected then Anticoagulation therapy for up to 6 months.
•on it for 6 mo.
pt. at risk for blood clots (pt. losing proteins that normally prevents blood from clotting. w/o these proteins, blood can clot and put them at risk for thrombosis)

7.). Dialysis - tthey may also need this to pull off the excess fluid
Rule: Limit protein with kidney problems except with Nephrotic Syndrome

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14
Q

An infusion of what can help this person ?

A

An infusion of lasix and albumin can help this person
Albumin will pull fluid out the tissue and return it to the vascular space
This could create another problem And cause fluid volume excess.
So we give a lasix with the albumin to Enhance the dieresis

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15
Q

Renal failure requires what and why?

A

Requires bilateral failure.

Because you can live with just 1 kidney

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16
Q

Renal failure causes

A

1.) pre, intra and post

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17
Q

Pre renal failure what is it And what are the 4 causes ?

If the heart rate drop below____what are you worried abt?

It take ___mins of poor perfusion to cause tubular necrosis? This means what?

A

Blood can’t get to the kidneys.
1.)Hypotension
If your hypotensive blood can’t get to kidneys
If the BP drop to about 90 we’re worried abt adequate perfusion
It may take only 20 minutes of poor perfusion to cause acute tubular necrosis= (the kidneys are dying )
This means the kidneys are dying and there’s not much time to deal with it .

2.)Hypovolemic =FVD

3.)Low heart rate. (arrhythmia)
Because co is down

3.)

4.)Any form of SHOCK
Shock kills kidney

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18
Q

Intra renal failure what is And what are the 6causes ?

A

damage has occurred INSIDE the kidney.

•
Glomerulonephritis
Nephrotic syndrome
DYES used in test such as heart cath and CT scan
Drugs (Aminoglycosides, Mycins)
Malignant HTN (uncontrolled HTN)
And DM causes severe causes severe kidney/vascular damage.

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19
Q

Post renal failure what is And what are the 5 causes ?

A

FLUID(urine) can’t get out of the kidney
With all of these problem the urine is having trouble getting out of the kidneys
If it can’t get out it’s going to back up and cause renal failure

Enlarged  Prostate
Kidney stone
Tumors 
Ureteral obstruction 
Edematous STOMA  (Ileal conduit)
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20
Q

7S &S of renal failure

A

1:Creatinine and BUN INCREASED
2.Specific gravity
•This is going to depend on the UO
•Initially if only a little urine is coming out it’s going to be very concentrated. So this will make the specific gravity-increased.. then it becomes fixed (check it with the fluid challenge)

3.Anemia
Not making enough of erythropoietin.
erythropoietin (stimluates RBC production)

  1. HTN and HF= Retaining Fluids
  2. Anorexia, nausea, vomiting→ retaining toxins .

6.Itching frost (Uremic frost)
When u have a lot of urea in your blood it’s going to eventually come out through your skin unless you’re being dialyze
Good skin care
Because bad skin care could lead to infection
Could scratch their arm and get a open sore And that could lead to infection . We don’t won’t that

7.Acid- base/fluid and electrolyte imbalances
Potassium could cause lethal arrhythmias.
•( Hyperkalemia K levels - up; may cause lethal arrhythmias)•

•Metabolic acidosis.
Because the kidneys aren’t able to secrete the excess acid and manage the bicarb

•Ppl with renal failure tend to Retain phosphorous→ serum calcium Down calcium pulled from BONE
causing—osteoporosis

21
Q

Specific gravity depends on what?
Initiallyif only a little urine is coming out it’s going to be very _______?. So this will make the specific gravity-_____.. then it becomes _______ (check it with the ______)

Why Anemia ?
erythropoietin stimluates What production?

  1. HTN and HF= ?
  2. Anorexia, nausea, vomiting→ =?.

6.)______When u have a lot of urea in your blood it’s going to eventually come out through your _____ unless you’re being ____???
Why do u need Good skin care ?

7.)Potassium could cause ?

Why do you have Metabolic acidosis. ?

•Ppl with renal failure tend to Retain what?
Then what goes down and result form that ?

A

2.Specific gravity
•This is going to depend on the UO
•Initially if only a little urine is coming out it’s going to be very concentrated. So this will make the specific gravity-increased.. then it becomes fixed (check it with the fluid challenge)

3.Anemia
Not making enough of erythropoietin.
erythropoietin (stimluates RBC production)

  1. HTN and HF= Retaining Fluids
  2. Anorexia, nausea, vomiting→ retaining toxins .

6.Itching frost (Uremic frost)
When u have a lot of urea in your blood it’s going to eventually come out through your skin unless you’re being dialyze
Good skin care
Because bad skin care could lead to infection
Could scratch their arm and get a open sore And that could lead to infection . We don’t won’t that

7.Acid- base/fluid and electrolyte imbalances
Potassium could cause lethal arrhythmias.
•( Hyperkalemia K levels - up; may cause lethal arrhythmias)•

•Metabolic acidosis.
Because the kidneys aren’t able to secrete the excess acid and manage the bicarb

•Ppl with renal failure tend to Retain phosphorous→ serum calcium Down calcium pulled from BONE
causing—osteoporosis

22
Q

Describe Fixed specific gravity

When do they do a fluid challenge ?

A bolus of what is use ?

If the Kidneys are working what will happen?

If the kidneys aren’t working what will happen ?

A

•Fixed specific gravity:
May lose ability to concentrate and dilute urine.

They can do this if they think some1 is abt to go in renal failure
Fluid challenge- bolus with 250 mLs or greater of normal saline

If they kidneys are working their UO should go up and the urine will be more diluted .

If they have renal failure the specific gravity will do nothing and remain the same ( fixed) . It doesn’t matte how much fluid u give or don’t give or hold .

23
Q

Two phases of Acute Renal Failure:

Kidneys have been damaged by one of the causes, this damage leads to the
_____ phase.

A

Oliguric phrase

24
Q

Oliguric phase:

  • What has happened to UO? ________________
  • UO of _______ to _______ mL/ 24 hours.
  • This client is in a fluid volume ____________
  • What do you think will happen to the K+? _____________

Anytime someone UO stops what happens to potassium?

A

Oliguric phase:
What has happened to UO? Decreases
UO of __100_____ to _400______ mL/ 24 hours.
This is where u will c a fix specific gravity
This a good time to do the a fluid challenge
This client is in a fluid volume EXCESS
What do you think will happen to the K+? GOES UP
Anytime someone UO decreases or stop they are not getting rid of potassium they are retaining it

25
Q

Two main thing to focus on in the

A

Two main thing to focus on is FVE and hyperkalemia

26
Q

The Oliguric phrase LAST ____wks Then the _____ phase kicks in

A

LAST 1-3wks Then the Diuretic phase kicks in

27
Q

b. Diuretic phase:

  • ____________ onset
  • What is happening to the UO? _____________
  • This client is in a fluid volume ______________. (Shock)
  • What do you think will happen to the K+? _________
A

SUDDEN onset
What is happening to the UO? Increasing
This client is in a fluid volume FVDeficit. (Shock)
Because they releasing up to 10L a day
What do you think will happen to the K+? Hypokalemia
Decreases because the excreting it

28
Q

Two things to know with follow up care ?

Follow up care

  1. )Complete recovery may take up to ___months
  2. )They need learn to Keep their physican ____, ____, and ___

Why ???

A

Follow up care

1.)Complete recovery may take up to 12 months
2.)They need learn to Keep their physican appointments, monitor blood pressure, and lab values
We don’t want a relapse

29
Q

How many types of Dialysis is there

A

There are 3 types

  1. ) Hemodialysis:
  2. ) CAPD (Continuous Ambulatory Peritoneal Dialysis)
  3. ) CCPD (Continuous Cycle Peritoneal Dialysis
30
Q

Hemodialysis:

a. General Information:

• The machine acts as what ?
How many times a week is this done ?
What do you have to watch out for between Treatments ?

• What med is give during dialysis to prevent blood clots from forming?
Whats that’s meds name ? And - what precautions do you implement _____ hours after ?

How long does herparin stay in the body?so we should avoid what kind of procedure after dialysis?Monitor for any signs of ________

  • Depression → Suicide
  • What 2 things do we watch constantly?
  • Can all clients tolerate hemodialysis?

What type of clients cant tolerate hemodialysis a d why?

A

The machine is the glomerulus. (filter)
Is done 3-4 times per week; so the

client has to watch what they eat and Drink between treatments.

To prevent blood Clots from forming the client is given an anticoagulant during dialysis.

Usually Heparin- implement what? Bleeding precautions-6-8 hrs after

Herpain stay in the body for 4-6 hours so avoid any Invasive procedure
after dialysis. Monitor for any signs of bleeding

Depression → Suicide
Eating no something they should avoid .
Ignoring those diet

Electrolytes and BP are watched constantly.
Can all clients tolerate hemodialysis? NO,
Unstable cardiovascular system can’t tolerate hemodialysis.
Because fluid volume is being removed

31
Q

what meds do you hold before dialysis? ___________.. ?and why

You also hold these two things and why ?

A

blood pressure meds.. dialysis already drops their BP.

hold vitamins and antibiotics bc they will be filtered out

32
Q

What’s the rate of blood being filtered for hemodialysis?

A

What’s the rate of blood being filtered for hemodialysis?300-800 mL/min

33
Q

Abt Is vascular access :

What must Anybody having A Hemodialysis have ? And why?

What is vascular access?why is this important?

A

Vascular Access:

  1. )Anybody having Hemodialysis must have a Vascular access
  2. )They need a permanent way to remove large volumes of blood and return large volumes of blood to the body

What is vascular access?
A site where they have access to a large blood vessel because very rapid blood flow is essential for hemodialysis.

34
Q

1.)where is AVF (arteriovenous fistula) place ?

join With what ?

What does it join ?

A

1.)AVF (arteriovenous fistula) in forearm with an anastomosis( join) between an artery and a vein

35
Q

What is AVG (arteriovenous graft) ?

What does it do ?

A

AVG (arteriovenous graft) a synthetic graft to join the vessels.

36
Q

what AVF and AVG both require ?

How long does it take to be ready repeated venipunctures?

A

Both require surgery,

takes weeks to mature and to be ready for repeated venipunctures

37
Q

During dialysis how many needles are inserted into the vascular access?

What does each needle do ?

What’s the name of end that removes the blood ?

What’s the name of the end that returns the blood ?
.

• For temporary access, the ___ or ___ vein is often used
for catheter placement.

is surgery required for temporary
placement?

Why is a temporary access used

Temporary access is also called?

A

During dialysis two needles are inserted into the vascular access.
One needle will allow blood to be pulled from the circulation
and sent to the hemodialysis machine.
The other is used to return the filtered blood to the client’s circulation.

The Arterial end of the access will remove the blood and the return is through the low pressure VENOUS end.

For temporary access, the internal jugular or femoral vein is often used
for catheter placement.

Surgery is not required for temporary placement.

Used while the access is healing or in a situation where Immediate dialysis is needed.

A Temp acess could be used for short term
Sometimes called
Ash cath or
Vas cath

38
Q

Care of Access:

• Do not use any of the above for IV access (drawing blood,
administering meds, etc.)

• When a client has an alternate vascular access what is the associated
nursing care for that extremity?

No __________________________

    No \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ sticks

No ____________________________

NO_____________________________

A

No ____Bp____________________
No ____needle sticks
No __CONSTRICTION ON ARM
No watch or purse on that arm

39
Q

Assessment of Access:

  • Why? ______________________
  • How?

Thrill-cat purring sensation (palpate)

Bruit-turbulent blood flow (auscultate)

Feel a_________…Hear the _________.

A

Assessment of Access:

•
Why?
to ensure patency
• How?
(palpate) for Thrill-cat purring sensation)
(auscultate) for Bruit-turbulent blood flow

Feel a_THRILL …Hear the BRUIT .

40
Q

Peritoneal Dialysis

What is the filter ?

A

peritoneal membrane

41
Q

Peritoneal Dialysis:
•
What is Dialysate?

What do you do to the dialysate?
How is dialysate given ? Via what kind of catheter?

Describe the dwell time. How much fluid ? How long does it take ?

Describe the exchange.

Why do we warm the fluid?
what does cold fluid cause ?
What should the drainage look like?
\_\_\_\_\_\_\_\_\_\_, straw-colored 
cloudy = \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Should be able to read a newspaper through the drainage/effluent.

What type of client gets peritoneal dialysis? Someone who can’t tolerate ___________ or someone who chooses peritoneal.

What if all the fluid doesn’t come out? ________________

Why do we want the fluid to come out ?

A

the part of a mixture which passes through the membrane in dialysis.

Dialysate is warmed and infused into the peritoneal cavity by gravity via a Tenckhoff catheter.

The fluid (2000-2500 mL) fills the peritoneal cavity (takes about 10 min) remains in peritoneal cavity for a prescribed amount of time. This is called the dwell time.

Then the bag is lowered and the fluid along with the TOXINS, etc., are drained. And that is called the exchange.

Why do we warm the fluid? Cold promotes vasoconstriction→ limits blood flow We want it warm, this promotes vasodilation, and more blood flow.
cold fluids can causes cramping and discomfort

Warm = just want it to be body temperature

What should the drainage look like?
CLEAR or straw-colored cloudy . Should be able to read a newspaper through the drainage/effluent.

if cloudy =infection

What type of client gets peritoneal dialysis? Someone who can’t tolerate hemodialysis or someone who chooses peritoneal.

What if all the fluid doesn’t come out?

Turn from side to side reposition

We want fluids to come because we want toxins to come out

42
Q

Two Types of Peritoneal Dialysis:

A

1) CAPD (Continuous Ambulatory Peritoneal Dialysis):

2. ) CCPD (Continuous Cycle Peritoneal Dialysis):

43
Q

CAPD (Continuous Ambulatory Peritoneal Dialysis):
• Must have a client that have abt 3 things ?
• Done ______ times a day, ___days a week.
At day or night ?
• Could a client with disc disease or arthritis do this? ________
Fluid causes pressure where?.
• Could a client with a colostomy do this? _______ High risk for ________________________

A

CAPD (Continuous Ambulatory Peritoneal Dialysis):
manually
• Must have a client that has the energy and the desire to be active in their treatment and that also has the ability to learn and follow instructions.
• Done __4x a day____ times a day, 7 days a week.
Not at night
• Could a client with disc disease or arthritis do this? _NO-_requires a client that is active and has energy; ability to learn and follow directions_____
Fluid causes pressure on back.
• Could a client with a colostomy do this? _NO______ High risk for INFECTION-Too much pressure on back________________________

44
Q

Describe CCPD (Continuous Cycle Peritoneal Dialysis):

When do they disconnect?

A

CCPD (Continuous Cycle Peritoneal Dialysis):
• Connect their peritoneal dialysis catheter to a cycler at night and their exchange is done automatically while they sleep. Disconnected in the AM; has more freedom.

45
Q

Complications of Peritoneal Dialysis:
• Major complication is ___________________ (Cloudy effluent 1st sign)
6 s/s of peritonitis is

A

Complications of Peritoneal Dialysis:
• Major complication is _ peritonitis(s/s of peritonitis is

•Cloudy effluent 1st sign)

abdominal pain - because it’s a lot of glucose in the Dialysate
Low back pain
May get a hernia
Anorexia- 
Altered body image/sexuality
Constant sweet taste
46
Q

DietaryNeedsofthe PeritonealClient:

• Increase wha 2 things in the in the diet?

A

Fiber→ Have decreased peristalsis due to abdominal fluid.

Protein→ Big holes in peritoneum and lose protein with each exchange.

47
Q

Continuous Renal Replacement Therapy (CRRT):
• what type of setting is this typically done in ? Why is it continuous ?

How much fluid is out of the body at a time and why ?

• CRRT is performed on what time of client?

A

Continuous Renal Replacement Therapy (CRRT):

• Typically done in an ICU setting and is continuous so that the client doesn’t have drastic fluid shifts.

• Never more than 80 mL of blood out of the body at one time being filtered and
therefore does not stress the cardiovascular system as much.

• CRRT is performed on a client with:

A fragile cardiovascular status and acute RENAL failure

48
Q

Kidney Stones (urolithiasis, renal calculi):

  1. 3 S/S:

What can pain cause?
Anytime you suspect a kidney Stoney get a urine sample and check for what ?

If kidney Stoney Are present what will the client get immediately?

A

1.)Pain can cause (nausea/vomiting)
2.)WBCs in increased WBC in the urine
blood in the urine..
3.)Hematuria *
• Anytime you suspect a kidney stone get a urine specimen ASAP and have it
checked fo rRBCS.

• If a kidney stone is present the client will get pain medication immediately.

49
Q

5 Tx: Kidney stones

A
  1. )Ketorolac (Toradol®), Ondansetron (Zofran®), Hydromorphone (Dilaudid®)
  2. )INCREASE fluids. -forever
  3. )Strain urine
  4. )Extracorporeal shock wave lithotripsy (ESWL)-to crush stone
  5. )Maybe surgery

Hurst Review (14 decks)

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