Renal Flashcards
s/s of cystitis (UTI)
urgency, frequency, burning with urination, fever and confusion in older adults
does cranberry juice help cystitis
does NOT treat, changes pH urine in future
what is the treatment of cystitis
bacterialcidal (antibiotics), increased fluid intake, prevention
how do you diagnose cystitis
- dipstick will show blood, leukocytes, and bacteria in urine
- culture and sensitivity tells us what the culture is and what antibiotic can kill it
what meds are given empirically for cystitis
Cipro and Bactrim (if these do not work, do C & S)
what is the most common offender of UTI
E coli
teaching (preventative) for cystitis
no thongs, tight clothing, front to back wiping, no fragrance soaps/wipes, and urinate after sex
what are the two important things to remember with cystitis
education and prevention
s/s of pyelonephritis
flank pain, dysuria, fatigue, malaise, chills
describe what pyelonephritis is
bacteria travels up ureters
may require hospitalization
treatment for pyelonephritis
IV antibiotics if severe
monitor for sepsis
benign prostatic hy. (BPH) s/s
nocturia, frequency, urgency, decreased stream/force, incomplete emptying/dribbling, hematuria (elderly)
assessment of BPH
digital rectal exam, urinalysis, **PSA level
*PSA just shows prostate enlargement (does not indicate if BPH or cancer)
what occurs with BPH
enlarged prostate prevents urine from being able to flow out, constant flow builds up in bladder
_______ mL in bladder gives sensation to urinate
500
prostate differences in BPH and cancer
BPH: prostate enlarges in uniformular manner
cancer: prostate enlarges more rough and nodular
what are the meds and goals of treatment of BPH
- shrink size of prostate (Proscar, finasteride) takes 6 mos
- Alpha adrenergic blockers (Hytrin, Cardura, Flomax)
what is the treatment (not meds) of BPH
- surgery (TURP)
- avoid meds that cause urinary retention
- don’t take in large amounts of fluid
- CBI
describe CBI and nursing interventions for it
continuous bladder irrigation
- continuous drainage (pink color)
- blood is okay, but there should NOT be clots
- usually discontinued after 24 hrs
what does TURP stand for
transurethral resection of the prostate
what is the main thing to remember for renal calculi
assessment, prevention, pain, hydration
broadly describe renal calculi
(kidney stones)-more common in men
- calcium stones are most common
- urine is backed up in ureter behind stones
- ureter begins to expand
when is pain most prevalent with renal calculi
when stone goes down ureter
what are the types of renal calculi
- hypercalcemia
- hyperoxaluria
- hyperuricemia
- struvite (magnesium ammonium)
- cystinuria (genetic defect of amino acid)
renal colic = _______
PAIN
what is common of renal calculi
oliguria (decreased urine output)
anuria (no urine output)
what should be implemented after you have renal calculi
increase fluids intake (2-3 L/ day)
what is the drug therapy for renal calculi
ketorolac, opioid analgesic
describe Lithotripsy
- used if it takes too long to pass stone (>3 days)
- sound waves to break up stone
- put pt on EKG
- *strain urine after to monitor for stone fragments
- bruising on back after is normal
how do you know if lithotripsy worked
- if you see stone fragments come out
- pain does NOT indicate stone passage
describe glomerulonephritis
- glomerulous loses selective filtering ability
- usually occurs d/t STREP infection
- body builds antibiotic complexes that build up on glomerulous and pokes holes in it (makes it a low pressure system)
if protein in urine….
means filtering has been compromised in the kidneys
glomerulonephritis s/s
increased BP, decreased urine output, concentrated urine, increased specific gravity, CVA tenderness, facial edema
treatment of glomerulonephritis
antibiotic**PRIORITY
monitor intake and output
fluid replacement
daily weights
nursing interventions for glomerulonephritis
- decrease sodium and increase carbs
- treat aggressively to prevent DIALYSIS
- educate about s/s of renal failure
describe what insensible fluid loss is
- how to determine intake for glomerulonephritis pt
- loss after 24 hrs plus 500 mL = TOTAL amount of fluids that can be given
broadly describe nephrotic syndrome
- more acute, more severe than glomerulonephritis (100 times worse)
- MASSIVE fluid retention
- strep is not the lone cause
patho of nephrotic syndrome
- lose severe amount of protein (albumin)
- lose ability to hold fluid in vascular space which causes fluid to travel to tissue (EDEMA)
- goes to 3rd space where blood is not supposed to be
what is anasarca
total body edema
describe liver in association with nephrotic syndrome
liver attempts to replace albumin which decreases triglycerides which causes high cholesterol (hyperlipidemia)
what renal can strep. cause
endocarditis or glomerulonephritis
can you give albumin to nephrotic syndrome pt
yes but it will increase fluid so give with DIURETIC (ie/ Lasix)
treatment of nephrotic syndrome
- ACE inhibitor (will stop cycle because cannot hold extra fluid)
- prednisone (shrinks holes in glomerulous)
- lipid lowering agent
- Albumin and Lasix
broadly describe renal failure
- 3 types: prerenal, intrarenal, postrenal
- failure of both kidneys
- you CAN function with one kidney
describe prerenal failure
- anything that affects blood getting to kidney
- only takes about 20 min of decreased blood supply for renal failure to occur
- causes: hypotension, diabetes, decreased cardiac output, hypovolemic shock
describe intrarenal failure
something wrong inside kidneys
scans with dyes inside kidneys can cause this
describe psotrenal failure
- urine cannot get out of kidneys
- prostate issues, kidney stones
what increases in blood with renal failure
increased BUN levels
describe fixed specific gravity
- pt is given fluid challenge
- expect urine to be dilute after fluid
- does NOT dilute, stays concentrated and thus fixed specific gravity
what is decreased in the blood with renal failure
- erythropoetin, kidneys do NOT make enough RBC
- causes ANEMIA
