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NUR372 > Renal > Flashcards

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

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2
Q

Kidney characteristics

A

Highly vascular
Perfusion is important
Filter 1/2 to 1 liter of blood every minute

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3
Q

What is the functional unit of the kidney?

A

Nephron

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4
Q

Renal Functions

A

Create renin-BP control
Erythropoetin
Activation of vitamin D
Prostaglandins

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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)
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6
Q

Are males or females more likely to get a UTI and why?

A

Females; urethra is shorter

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7
Q

What medications are we assessing for nephrotoxicity?

A

NSAIDS
Vancomycin
Sulfas
Acyclovir

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8
Q

What race has a higher risk of developing kidney disease?

A

African Americans

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9
Q

Serum Creatinine

A

Muscles or proteins are broken down

DOES NOT ELEVATE UNLESS PROBLEM HAS REACHED THE KIDNEYS

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10
Q

Serum Creatinine normal range

A

0.5-1.1

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11
Q

BUN

A

Blood Urea Nitrogen
Proteins broken down in the liver
IF ELEVATED, COULD BE KIDNEYS OR POSSIBLY SOMETHING ELSE

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12
Q

BUN normal range

A

7-20

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13
Q

Glucose, ketone bodies, and protein should all be what in urine?

A

absent

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14
Q

Leukoesterase, nitrites, cells, casts, crystals and bacteria in urine indicate

A

infection

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15
Q

Clean catch urine sample

A

wipe front to back

catch midstream

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16
Q

Urine culture

A

grow stuff to see what bacteria is there

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17
Q

Creatinine clearance

A

Best indication of overall kidney function

Estimate GFR

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18
Q

Kidney biopsy

A

Tissue sample

Needle through the skin into kidney

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19
Q

Whats the highest risk for a kidney biopsy?

A

bleeding bc kidneys are very vascular

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20
Q

Contrast medium

A

NEPHROTOXIC and can cause acute kidney injury

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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

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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

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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

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24
Q

Cystitis

A

Inflammation of bladder

Caused by bacteria moving UP urinary tract

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25
Q

What is cystitis usually caused by?

A

E.Coli

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26
Q

Other things that lead to cystitis

A

Kidney stones

Intercourse

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27
Q

Cystitis S/S

A

Frequency urinating
Dysuria
Urgency

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28
Q

Cystitis Treatment

A

Antibiotics
Antispasmodics
Antifungals
Pain relief

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29
Q

Cystitis Education

A 
wipe front to back
use bathroom before and after sex
hydrate and use bathroom regularly 
don’t hold urine
take all of antibiotic dose
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30
Q

Catheter Associate UTI’s (CAUTIs)

A

If a patient develops a UTI while in the hospital the cost is on the nurse $$$$$$

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31
Q

When inserting a catheter, what should be made sure of?

A

STRICT SEPTIC TECHNIQUE

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32
Q

CAUTIs treatment

A

Prevention is key!!!
Limit the duration
GU bag always below the bladder
Frequent catheter care

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33
Q

Urethritis

A

Inflammation of urethra causing symptoms similar to urinary tract infection

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34
Q

Urethritis is most common in

A

young women and men and often linked to STIs

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35
Q

Urethritis S/S

A

Pain, burning with urination
Frequency
Mucopurulent drainage
Abdominal discomfort

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36
Q

Urethral Strictures

A

(think stasis)

Narrowed areas of urethra

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37
Q

Urethral Strictures most common symptom is

A

obstruction of urine flow

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38
Q

Urethral Strictures treatment

A

Surgical treatment by urethroplasty has the best chance of long term use

short-term: stent

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39
Q

Incontinence

A

inability to control urine

controlled by sphincter tone

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40
Q

Types of Incontinence

A

Stress
Urge
Overflow
Functional

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41
Q

Stress

A

pressure or weight overcoming the tone of the bladder (pregnancy, sneezes)

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42
Q

Urge

A

problem with translation from the brain to the bladder about when they need to go(aka hyperactive bladder)

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43
Q

Overflow

A

bladder is at max capacity

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44
Q

Functional

A

not a problem with the anatomy, just can’t get to the bathroom, ex. Bed bound

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45
Q

Stress Incontinence treatment

A 
Pelvic floor (kegel) exercises
estrogen cream: increase blood flow
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46
Q

Urge Incontinence treatment

A

Drugs: Anticholinergics, antihistamines
Diet therapy: Avoid caffeine and alcohol
Behavioral interventions: Exercises, bladder training, habit training, electrical stimulation

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47
Q

Overflow Incontinence treatment

A

Surgery to relieve obstruction
Intermittent catheterization
Bladder compression: pressure on the bladder to fully urinate

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48
Q

Functional Incontinence

A

Urinary habit training: permanent, put on schedule (if incontinence not reversible)
Applied devices: diaper
Catheter: if needed

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49
Q

Urolithiasis

A

Presence of calculi (stones) in urinary tract

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50
Q

Urolithiasis S/S

A

high pain scale
Nausea
Hematuria

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51
Q

Urolithiasis treatment

A

pain management is priority
Extra fluids IV
Depending on where the stone is will tell us what to do
Strain urine for stones

Surgery

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52
Q

Lithotripsy

A

Uses sound, laser, or dry shock wave energy to break stones into small fragments

conscious sedation
continuous monitoring

53
Q

Urothelial Cancer

A

Malignant tumors of urothelium

54
Q

Urothelial Cancer treatment

A

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
Q

Bladder Trauma

A

Causes may be from injury to lower abdomen or stabbing/gunshot wounds

56
Q

Bladder Trauma treatment

A

surgical intervention required: repair bladder wall and peritoneum

57
Q

Polycystic Kidney Disease

A

Inherited disorder; fluid-filled cysts develop in nephrons, no cure, will end in kidney failure

58
Q

Polycystic Kidney Disease S/S

A 
Abdominal pain
Hypertension
Nocturia
Increased abdominal girth
Constipation
Bloody/cloudy urine: cysts can pop leading to blood
Kidney stones
59
Q

Goal for Polycystic Kidney Disease

A

delay as much impact as possible

early detection

60
Q

Hydronephrosis, Hydroureter, & Urethral Stricture

A

problems of urine outflow obstruction

can be caused by stones or masses

61
Q

Hydronephrosis

A

stone closer to the kidney
could lead to damage within hours

worse of the two

62
Q

Hydroureter

A

Stone closer to the bladder

63
Q

Hydronephrosis, Hydroureter, & Urethral Stricture treatment

A

Removal of obstruction

64
Q

Pyelonephritis

A

Bacterial infection in kidney and renal pelvis (upper urinary tract)

65
Q

Pyelonephritis S/S

A

More systemic bc upper urinary tract

fever, chills, tachycardia, tachypnea

More signs of infection

66
Q

Chronic Pyelonephritis

A

Repeated or continued pyelonephritis

67
Q

Chronic Pyelonephritis treatment

A

Antibiotics, hydration

Surgical (nephrectomy, ureteroplasty): depends on extent

68
Q

Acute Glomerulonephritis

A

Inflammation of the glomerulus in the nephron due to an immune response

protein and blood in the urine

69
Q

Acute Glomerulonephritis S/S

A

Edema, HTN, dysuria, fatigue

70
Q

Care for glomerulonephritis

A

Manage infections
Dialysis
Plasmapheresis
Patient education

71
Q

Plasmapheresis

A

take plasma and filter out antibodies

72
Q

Chronic Glomerulonephritis

A

Develops over period of 20 to 30 years or longer

Will always lead to chronic kidney disease

73
Q

Chronic Glomerulonephritis interventions

A

slowing progression
diet changes
fluid intake
dialysis and transplant: less likely to get a transplant

74
Q

Nephrotic Syndrome

A

Severe loss of protein into urine, edema formation, and decreased plasma albumin levels

Can happen with acute or chronic glomerulonephritis

75
Q

Nephrotic Syndrome treatment

A 
Immunosuppressive agents
ACE inhibitors: decrease protein loss
Heparin
Diet changes: increase protein
Mild diuretics: if become edematous
76
Q

Nephrosclerosis

A

Thickening in nephron blood vessels

results in narrowing of vessel lumen

leads to renal ischemia

77
Q

Nephrosclerosis treatment

A

control high BP

preserve kidney function

78
Q

Diabetic Nephropathy

A

Microvascular complication of type 1 or type 2 diabetes

79
Q

Diabetic Nephropathy S/S

A

persistent albuminuria

80
Q

Diabetic Nephropathy treatment

A

Avoid nephrotoxic agents and dehydration

81
Q

Renovascular Disease

A

Processes affecting renal arteries; may severely narrow lumen, greatly reduce blood flow to kidneys

sudden onset of HTN

82
Q

Renal Cell Carcinoma

A

Obstruction

common treatment: take the whole kidney out

83
Q

Which assessment parameter requires immediate attention in a patient with polycystic kidney disease?

A

Hypertension

84
Q

Acute Kidney Injury

A

Rapid reduction in kidney function

Types: prerenal, intrarenal, postrenal

85
Q

Prerenal

A

Hypovolemic shock
Heart failure
THINK PERFUSION

86
Q

Intrarenal

A

Intrinsic kidney damage
THINK INSIDE KIDNEY

think meds that can cause this

87
Q

Postrenal

A

Problems with outflow

THINK OBSTRUCTION

88
Q

Acute Kidney Injury phases

A

Onset
Oliguric: decrease urine output
Diuretic: increase urine output
Recovery: return of normal GFR and urine output

could take weeks to months

89
Q

Chronic Kidney Disease (CKD)

A

Progressive, irreversible kidney injury; kidney function does not recover

90
Q

Chronic Kidney Disease (CKD) stage 1

A

GFR >90 mL/min

91
Q

Chronic Kidney Disease (CKD) stage 2

A

GFR 60-89 mL/min

92
Q

Chronic Kidney Disease (CKD) stage 3

A

GFR 30-59 mL/min

93
Q

Chronic Kidney Disease (CKD) stage 4

A

GFR 15-29 mL/min

94
Q

Chronic Kidney Disease (CKD) stage 5

A

GFR <15 mL/min

95
Q

Cardiac changes CKD

A

HTN
Hyperlipidemia: fatty metabolism
Heart failure: fluid changes
Pericarditis

96
Q

Pericarditis in CKD

A

build up of toxins can cause this, irritate the lining of the heart

97
Q

Hematologic changes CKD

A

Think ANEMIA
erythropoietin
Decrease red blood cell survival time

98
Q

GI changes CKD

A

urea converted to ammonia, foul smelling ammonia breath, stomatitis, weight loss common

99
Q

Chronic Kidney disease impacts

A

EVERY SYSTEM

100
Q

Neurologic

A

tired, lethargic, coma

101
Q

Cardiovascular

A

edema, fluid over load, pericarditis

102
Q

Respiratory

A

fluid overload, crackles

103
Q

Hematologic

A

pallor, pale nail beds

104
Q

GI

A

lose taste

105
Q

Skeletal

A

vitamin d issue, osteoporosis

106
Q

Urinary

A

later stages-oliguria, little to no urine at all, how much how often (ask)?

107
Q

Skin

A

puritis, redness and itchiness, later stages- uremic frost (crystalized on the skin)

108
Q

CKD dietary restrictions

A

decrease protein, sodium, fluid intake. Increase carbs

109
Q

Uremic frost

A

late signs of CKD

110
Q

Excess fluid volume CKD

A

daily weights, fluid restrictions possibly, start dialysis

111
Q

Drug Therapy for CKD

A 
Cardioglycides: Dig
Vitamins and minerals
Synthetic erythropoietin
Phosphate binders
folic acid, iron
Vitamin D
Phosphate finder
BP meds: control hypertension
112
Q

What electrolyte can’t be excreted in CKD?

A

Phosphorus

113
Q

Dialysis therapies

A

Continuous renal replacement therapy (CRRT)
Hemodialysis
Peritoneal dialysis

114
Q

Vascular Access for dialysis

A

Arteriovenous (AV) fistula or graft for long-term permanent access

115
Q

Always ask dialysis patients

A

Do you have a graft and is it mature? 3-6 months to mature

116
Q

Precautions/complications for dialysis vascular access

A

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
Q

Hemodialysis

A

have to go to appointments, if not build up of waste, do not miss, 3-4 hr appointment, changing blood volume, very tired

118
Q

Complications of Hemodialysis

A

Dialysis disequilibrium syndrome

infectious disease: less common now

119
Q

Dialysis disequilibrium syndrome

A

rate at which the filter can differ, too fast can cause problems, dizzy, nausea, sick. Eat before

120
Q

Hemodialysis Nursing S/S

A 
Hypotension
Headache
Nausea, vomiting
Malaise, dizziness
Muscle cramps or bleeding
121
Q

Peritoneal Dialysis

A

Involves siliconized rubber catheter placed into abdominal cavity for infusion of dialysate

Expands independence

122
Q

Continuous ambulatory peritoneal dialysis (CAPD)

A 
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
Q

Peritoneal Dialysis Complications

A

**Peritonitis: rigid-like abdomen
Dialysis looks cloudy or bloody
Pain
Infections

124
Q

Nursing Care for Peritoneal Dialysis

A

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
Q

Continuous Renal Replacement Therapy (CRRT)

A

Standard treatment for those who are hemodynamically unstable

Vascular access
Continuous filtration: slow rate

126
Q

Kidney Transplantation

A

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
Q

Postoperative Care for transplant

A

Urologic management: Urine output, H&H, WBC count, signs of rejection, if urine output drops, first sign of rejection

128
Q

hourly urine output should be

A

30mL/hr

129
Q 
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?

A

Assess heart rate and rhythm.

bc of potassium levels

NUR372 (13 decks)

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