Renal Flashcards
1
Q
What are the main functions for the kidneys?
A
Fluid and electrolyte balance
Elimination of waste
Maintenance of fluid volume
Acid-Base balance
2
Q
Kidney characteristics
A
Highly vascular
Perfusion is important
Filter 1/2 to 1 liter of blood every minute
3
Q
What is the functional unit of the kidney?
A
Nephron
4
Q
Renal Functions
A
Create renin-BP control
Erythropoetin
Activation of vitamin D
Prostaglandins
5
Q
Kidney/Urinary System Changes Associated with Aging
A
Reduced blood flow to kidneys Risk for dehydration Decreased GFR Higher risk for urosepsis Older adults have atypical symptoms(confusion, cognitive impairment)
6
Q
Are males or females more likely to get a UTI and why?
A
Females; urethra is shorter
7
Q
What medications are we assessing for nephrotoxicity?
A
NSAIDS
Vancomycin
Sulfas
Acyclovir
8
Q
What race has a higher risk of developing kidney disease?
A
African Americans
9
Q
Serum Creatinine
A
Muscles or proteins are broken down
DOES NOT ELEVATE UNLESS PROBLEM HAS REACHED THE KIDNEYS
10
Q
Serum Creatinine normal range
A
0.5-1.1
11
Q
BUN
A
Blood Urea Nitrogen
Proteins broken down in the liver
IF ELEVATED, COULD BE KIDNEYS OR POSSIBLY SOMETHING ELSE
12
Q
BUN normal range
A
7-20
13
Q
Glucose, ketone bodies, and protein should all be what in urine?
A
absent
14
Q
Leukoesterase, nitrites, cells, casts, crystals and bacteria in urine indicate
A
infection
15
Q
Clean catch urine sample
A
wipe front to back
catch midstream
16
Q
Urine culture
A
grow stuff to see what bacteria is there
17
Q
Creatinine clearance
A
Best indication of overall kidney function
Estimate GFR
18
Q
Kidney biopsy
A
Tissue sample
Needle through the skin into kidney
19
Q
Whats the highest risk for a kidney biopsy?
A
bleeding bc kidneys are very vascular
20
Q
Contrast medium
A
NEPHROTOXIC and can cause acute kidney injury
21
Q
Before giving contrast, assess and ask what?
A
Large IV(20g)- AC or higher
Ask about allergy to shellfish or iodine
make sure they are hydrated
22
Q
Why can’t a patient take metformin on contrast?
A
Could have a reaction to contrast that leads to lactic acidosis
stop 24hrs before procedure, once done can resume
23
Q
A patient with a history of kidney disease is admitted with acute shoulder pain. Which order should the nurse question?
A
Ibuprofen 800 mg by mouth every 4 hours as needed for pain
24
Q
Cystitis
A
Inflammation of bladder
Caused by bacteria moving UP urinary tract
25
What is cystitis usually caused by?
E.Coli
26
Other things that lead to cystitis
Kidney stones
| Intercourse
27
Cystitis S/S
Frequency urinating
Dysuria
Urgency
28
Cystitis Treatment
Antibiotics
Antispasmodics
Antifungals
Pain relief
29
Cystitis Education
```
wipe front to back
use bathroom before and after sex
hydrate and use bathroom regularly
don’t hold urine
take all of antibiotic dose
```
30
Catheter Associate UTI’s (CAUTIs)
If a patient develops a UTI while in the hospital the cost is on the nurse $$$$$$
31
When inserting a catheter, what should be made sure of?
STRICT SEPTIC TECHNIQUE
32
CAUTIs treatment
Prevention is key!!!
Limit the duration
GU bag always below the bladder
Frequent catheter care
33
Urethritis
Inflammation of urethra causing symptoms similar to urinary tract infection
34
Urethritis is most common in
young women and men and often linked to STIs
35
Urethritis S/S
Pain, burning with urination
Frequency
Mucopurulent drainage
Abdominal discomfort
36
Urethral Strictures
(think stasis)
| Narrowed areas of urethra
37
Urethral Strictures most common symptom is
obstruction of urine flow
38
Urethral Strictures treatment
Surgical treatment by urethroplasty has the best chance of long term use
short-term: stent
39
Incontinence
inability to control urine
controlled by sphincter tone
40
Types of Incontinence
Stress
Urge
Overflow
Functional
41
Stress
pressure or weight overcoming the tone of the bladder (pregnancy, sneezes)
42
Urge
problem with translation from the brain to the bladder about when they need to go(aka hyperactive bladder)
43
Overflow
bladder is at max capacity
44
Functional
not a problem with the anatomy, just can’t get to the bathroom, ex. Bed bound
45
Stress Incontinence treatment
```
Pelvic floor (kegel) exercises
estrogen cream: increase blood flow
```
46
Urge Incontinence treatment
Drugs: Anticholinergics, antihistamines
Diet therapy: Avoid caffeine and alcohol
Behavioral interventions: Exercises, bladder training, habit training, electrical stimulation
47
Overflow Incontinence treatment
Surgery to relieve obstruction
Intermittent catheterization
Bladder compression: pressure on the bladder to fully urinate
48
Functional Incontinence
Urinary habit training: permanent, put on schedule (if incontinence not reversible)
Applied devices: diaper
Catheter: if needed
49
Urolithiasis
Presence of calculi (stones) in urinary tract
50
Urolithiasis S/S
high pain scale
Nausea
Hematuria
51
Urolithiasis treatment
pain management is priority
Extra fluids IV
Depending on where the stone is will tell us what to do
Strain urine for stones
Surgery
52
Lithotripsy
Uses sound, laser, or dry shock wave energy to break stones into small fragments
conscious sedation
continuous monitoring
53
Urothelial Cancer
Malignant tumors of urothelium
54
Urothelial Cancer treatment
Surgical removal of tumor
Intravesical chemo or immunotherapy: avoid splashing urine, avoid having sex
Radiation
Systemic chemo (if metastasized)
Removal of bladder and/or reconstruction: depending on extent, divergent device
55
Bladder Trauma
Causes may be from injury to lower abdomen or stabbing/gunshot wounds
56
Bladder Trauma treatment
surgical intervention required: repair bladder wall and peritoneum
57
Polycystic Kidney Disease
Inherited disorder; fluid-filled cysts develop in nephrons, no cure, will end in kidney failure
58
Polycystic Kidney Disease S/S
```
Abdominal pain
Hypertension
Nocturia
Increased abdominal girth
Constipation
Bloody/cloudy urine: cysts can pop leading to blood
Kidney stones
```
59
Goal for Polycystic Kidney Disease
delay as much impact as possible
| early detection
60
Hydronephrosis, Hydroureter, & Urethral Stricture
problems of urine outflow obstruction
can be caused by stones or masses
61
Hydronephrosis
stone closer to the kidney
could lead to damage within hours
worse of the two
62
Hydroureter
Stone closer to the bladder
63
Hydronephrosis, Hydroureter, & Urethral Stricture treatment
Removal of obstruction
64
Pyelonephritis
Bacterial infection in kidney and renal pelvis (upper urinary tract)
65
Pyelonephritis S/S
More systemic bc upper urinary tract
fever, chills, tachycardia, tachypnea
More signs of infection
66
Chronic Pyelonephritis
Repeated or continued pyelonephritis
67
Chronic Pyelonephritis treatment
Antibiotics, hydration
| Surgical (nephrectomy, ureteroplasty): depends on extent
68
Acute Glomerulonephritis
Inflammation of the glomerulus in the nephron due to an immune response
protein and blood in the urine
69
Acute Glomerulonephritis S/S
Edema, HTN, dysuria, fatigue
70
Care for glomerulonephritis
Manage infections
Dialysis
Plasmapheresis
Patient education
71
Plasmapheresis
take plasma and filter out antibodies
72
Chronic Glomerulonephritis
Develops over period of 20 to 30 years or longer
Will always lead to chronic kidney disease
73
Chronic Glomerulonephritis interventions
slowing progression
diet changes
fluid intake
dialysis and transplant: less likely to get a transplant
74
Nephrotic Syndrome
Severe loss of protein into urine, edema formation, and decreased plasma albumin levels
Can happen with acute or chronic glomerulonephritis
75
Nephrotic Syndrome treatment
```
Immunosuppressive agents
ACE inhibitors: decrease protein loss
Heparin
Diet changes: increase protein
Mild diuretics: if become edematous
```
76
Nephrosclerosis
Thickening in nephron blood vessels
results in narrowing of vessel lumen
leads to renal ischemia
77
Nephrosclerosis treatment
control high BP
| preserve kidney function
78
Diabetic Nephropathy
Microvascular complication of type 1 or type 2 diabetes
79
Diabetic Nephropathy S/S
persistent albuminuria
80
Diabetic Nephropathy treatment
Avoid nephrotoxic agents and dehydration
81
Renovascular Disease
Processes affecting renal arteries; may severely narrow lumen, greatly reduce blood flow to kidneys
sudden onset of HTN
82
Renal Cell Carcinoma
Obstruction
| common treatment: take the whole kidney out
83
Which assessment parameter requires immediate attention in a patient with polycystic kidney disease?
Hypertension
84
Acute Kidney Injury
Rapid reduction in kidney function
Types: prerenal, intrarenal, postrenal
85
Prerenal
Hypovolemic shock
Heart failure
THINK PERFUSION
86
Intrarenal
Intrinsic kidney damage
THINK INSIDE KIDNEY
think meds that can cause this
87
Postrenal
Problems with outflow
| THINK OBSTRUCTION
88
Acute Kidney Injury phases
Onset
Oliguric: decrease urine output
Diuretic: increase urine output
Recovery: return of normal GFR and urine output
could take weeks to months
89
Chronic Kidney Disease (CKD)
Progressive, irreversible kidney injury; kidney function does not recover
90
Chronic Kidney Disease (CKD) stage 1
GFR >90 mL/min
91
Chronic Kidney Disease (CKD) stage 2
GFR 60-89 mL/min
92
Chronic Kidney Disease (CKD) stage 3
GFR 30-59 mL/min
93
Chronic Kidney Disease (CKD) stage 4
GFR 15-29 mL/min
94
Chronic Kidney Disease (CKD) stage 5
GFR <15 mL/min
95
Cardiac changes CKD
HTN
Hyperlipidemia: fatty metabolism
Heart failure: fluid changes
Pericarditis
96
Pericarditis in CKD
build up of toxins can cause this, irritate the lining of the heart
97
Hematologic changes CKD
Think ANEMIA
erythropoietin
Decrease red blood cell survival time
98
GI changes CKD
urea converted to ammonia, foul smelling ammonia breath, stomatitis, weight loss common
99
Chronic Kidney disease impacts
EVERY SYSTEM
100
Neurologic
tired, lethargic, coma
101
Cardiovascular
edema, fluid over load, pericarditis
102
Respiratory
fluid overload, crackles
103
Hematologic
pallor, pale nail beds
104
GI
lose taste
105
Skeletal
vitamin d issue, osteoporosis
106
Urinary
later stages-oliguria, little to no urine at all, how much how often (ask)?
107
Skin
puritis, redness and itchiness, later stages- uremic frost (crystalized on the skin)
108
CKD dietary restrictions
decrease protein, sodium, fluid intake. Increase carbs
109
Uremic frost
late signs of CKD
110
Excess fluid volume CKD
daily weights, fluid restrictions possibly, start dialysis
111
Drug Therapy for CKD
```
Cardioglycides: Dig
Vitamins and minerals
Synthetic erythropoietin
Phosphate binders
folic acid, iron
Vitamin D
Phosphate finder
BP meds: control hypertension
```
112
What electrolyte can't be excreted in CKD?
Phosphorus
113
Dialysis therapies
Continuous renal replacement therapy (CRRT)
Hemodialysis
Peritoneal dialysis
114
Vascular Access for dialysis
Arteriovenous (AV) fistula or graft for long-term permanent access
115
Always ask dialysis patients
Do you have a graft and is it mature? 3-6 months to mature
116
Precautions/complications for dialysis vascular access
no blood pressures or sticks in the arm, ischemia, hf, if we put blood in to fast it’ll put pressure on the heart
117
Hemodialysis
have to go to appointments, if not build up of waste, do not miss, 3-4 hr appointment, changing blood volume, very tired
118
Complications of Hemodialysis
Dialysis disequilibrium syndrome
| infectious disease: less common now
119
Dialysis disequilibrium syndrome
rate at which the filter can differ, too fast can cause problems, dizzy, nausea, sick. Eat before
120
Hemodialysis Nursing S/S
```
Hypotension
Headache
Nausea, vomiting
Malaise, dizziness
Muscle cramps or bleeding
```
121
Peritoneal Dialysis
Involves siliconized rubber catheter placed into abdominal cavity for infusion of dialysate
Expands independence
122
Continuous ambulatory peritoneal dialysis (CAPD)
```
most common one you will see
Exchange throughout the night and take it out, put dialysate into abdomen during the day,
gain weight
abdominal pain
More common at home
```
123
Peritoneal Dialysis Complications
****Peritonitis: rigid-like abdomen
Dialysis looks cloudy or bloody
Pain
Infections
124
Nursing Care for Peritoneal Dialysis
Before treatment: Evaluate baseline vital signs, dry weight, laboratory tests
Continually monitor patient for respiratory distress, pain, discomfort
Monitor prescribed dwell time, initiate outflow
Observe outflow amount and pattern of fluid
Make sure what you put in comes back out
125
Continuous Renal Replacement Therapy (CRRT)
Standard treatment for those who are hemodynamically unstable
Vascular access
Continuous filtration: slow rate
126
Kidney Transplantation
Donors: living donors, can still function with one kidney, brain dead
Immunologic studies: HLA match so they don’t reject, less likely to reject,
127
Postoperative Care for transplant
Urologic management: Urine output, H&H, WBC count, signs of rejection, if urine output drops, first sign of rejection
128
hourly urine output should be
30mL/hr
129
```
A patient with end-stage kidney disease (ESKD) has this serum laboratory analysis:
K+ 5.9 mEq/L
Na+ 152 mEq/L
Creatinine 6.2 mg/dL
BUN 60 mg/dL
```
What is the priority nursing intervention?
Assess heart rate and rhythm.
bc of potassium levels
