Renal Conditions Flashcards
What is incontinent urinary diversion?
Diversion to the skin requiring a pouch to collect the urine
Most simple form is the cutaneous ureterostomy
What is a double J catheter?
Also known as ureteral stent
What is the best way to prevent Acute Post-Streptococcal Glomerulonephritis (APSGN)?
Early diagnosis and treatment of sore throats and skin lesions
What is another name for anti-glomerular basement disease?
Goodpasture syndrome
What is Goodpasture syndrome or anti-glomerular basement disease?
Autoimmune disease where antibodies attack the glomerular and alveolar basement membrane damaging kidneys and lungs
What are the symptoms of Goodpasture syndrome or anti-glomerular basement disease?
-Cough
-Shortness of breath
-Hemoptysis
-Crackles
-Pulmonary insufficiency
-Hematuria
-Proteinuria
-Anemia
What is hemoptysis?
Coughing up blood
What kind of medications are used to treat Goodpasture syndrome?
Glucocorticoids and immunosuppressive
How is Goodpasture syndrome treated?
-Plasmapheresis to remove anti-GBM antibodies from circulation
-Dialysis and kidney transplant
What is nephrotic syndrome?
Occurs when the glomerulus is excessively permeable to plasma protein causing proteinuria
What kind of diet should the patient with nephrotic syndrome adopt?
-Low-sodium
-Low/moderate protein
What is nephrolithiasis?
Kidney stone disease
What are the 5 stones that occur with renal calculi?
-Calcium oxalate
-Calcium phosphate
-Cystine
-Struvite
-Uric acid
What is the most common type of renal stone?
Calcium oxalate
What is the treatment of calcium oxalate urinary stones?
-Increase hydration
-Reduce oxalate intake
-Reduce animal protein and sodium
-Increase calcium, fruits, and vegetables
-Thiazide diuretics
What renal stone is more common in women?
Struvite; always associated with UTIs
What are clinical manifestations of renal stones?
-Flank pain
-Can’t sit still (kidney dance)
-Pain can be present and severe or absent if not obstructing
-Mild shock with cool, moist skin
-Testicular or labial pain
-Groin pain
-UTI manifestations (dysuria, fever, and chills)
What is lithotripsy?
A method of using shock waves to break up kidney stones
What manifestations are common in a patient with nephrotic syndrome?
-Peripheral edema
-Hypoalbuminemia
-Hyperglycemia
What kind of kidney stone is associated with a genetic defect?
Cystine
Why is fluid intake important for a patient with a UTI?
-Dilutes the urine
-Decreases irritation of the bladder
-Flushes out bacteria
What is pyelonephritis?
Inflammation of the renal collecting system usually beginning with infection of the lower urinary tract
What are clinical manifestations of pyelonephritis?
-Tenderness during percussion of the costovertebral angle
-Urinalysis indicating pyuria, bacteria, and hematuria
-Anatomic abnormalities detected by CT scan and ultrasound
What is interstitial cystitis (Painful bladder syndrome)?
Chronic, painful urinary condition caused by:
-Neurogenic hypersensitivity of lower urinary tract
-Immune system attacking the bladder
-Production of toxic substance in the urine
What drug is commonly used to treat Polycystic Kidney Disease?
Tolvaptan
What is Alport syndrome?
Inherited disorder that damages tiny blood vessels in the kidneys when a mutated gene deposits bad collagen in the basement membrane of the kidneys making it difficult for them to filter
What does intravesical mean?
Within the bladder
Drugs can’t be used to treat what kind of urinary incontinence?
Stress UI
What kind of drugs can be used to treat urinary incontinence?
-Anticholinergic drugs
-Botox
-Antimuscarinic
What kinds of things can cause overflow incontinence?
-Herniated disc
-Cystoscopy
-Neurogenic bladder
-Diabetic neuropathy
What kinds of things can cause urge incontinence?
Interstitial cystitis (bladder pain syndrome)
CNS disorders (brain tumors)
Bladder disorders
What medication is used in a patient with a voiding dysfunction to increase the bladder’s storage capacity?
Mirabegron
What criteria is required for the surgeon to perform a lithotripsy?
-Stones that are 9+mm in diameter (5+ are too large to pass)
-Stones affecting kidney function (removed asap)
-Stones causing symptomatic infection (risk of kidney damage)
When do patients use bladder neck support devices?
To treat stress incontinence
Which medication is used to enhance bladder contractions?
Bethanechol
What 2 medications are used to reduce bladder contractions in urge incontinence?
-Oxybutynin (also used to treat bladder spasms)
-Fesoterodine
What is the nursing priority when changing a patient’s ileal conduit appliance?
Keep the skin free of urine
What indicates urinary retention?
Inability to urinate with pain in the lower abdomen with a PVR volume of 100mL+
What is the purpose of Tamsulosin in treating urinary incontinence?
Treats overflow incontinence by relaxing the muscles in the prostate and opening the bladder
How is Tolterodine used to treat urge incontinence?
An anticholinergic medication
What complications would be seen in a patient that overdosed on tolterodine?
Constipation
Decreased sweating
Eye pain
Blurred vision
Difficulty starting urination
Difficulty emptying the bladder
What kind of medication is phenazopyridine?
Urinary analgesic
How can low calcium level lead to urinary tract stones?
When there isn’t enough calcium in the digestive system, it can’t bind to oxalate which leads to more oxalate in the blood stream to be excreted in the urine making it a higher chance to form stones
For a patient with calcium oxalate urinary tract stones, do you want to increase or decrease sodium intake?
Decrease. Increased sodium can cause fluid retention when we want is the patient to pee a lot
For a patient with calcium oxalate urinary tract stones, do you want to increase or decrease calcium?
Increase; calcium can bind to oxalate making it less likely for it to form a stone when it’s peed out
What complication can the nurse expect with long-term indwelling catheters?
-Bladder spasms
-Fistula formation
-Periurethral abscess
What clinical manifestations are common for a patient with glomerulonephritis?
Hypertension (Damages filtering system which causes buildup of fluid and sodium)
Edema (Damages fluid removal system)
Hematuria
What manifestations are associated with acute pyelonephritis?
Chills
Flank pain
Fever
N/V
What are some things that can lead to urinary stasis?
Urinary retention
Renal impairment
Urinary Tract Calculi
What immune diseases cause glomerulonephritis?
Scleroderma
Goodpasture syndrome
Systemic Lupus erythematosus
What antibiotic would be used to treat a complicated UTI?
Ciprofloxacin
What medication is used to treat a Trichomonas infection?
Metrodiazole
What is doxycycline used to treat?
Chlamydial infections associated with urethritis
What are symptoms of interstitial cysititis?
Severe, suprapubic pain
Hesitancy
Incontinence
What operation is performed on patients with severe interstitial cystitis?
Ileal conduit diversion
What other serious complication is related to polycystic kidney disease?
Cerebral aneurysms
What is azotemia?
Retention of too much nitro compounds in the blood caused by failure of kidneys to remove urea from the blood
What does RIFLE stand for in Acute Kidney Injury?
Risk
Injury
Failure
Loss
End stage
What is the best serum indicator of Acute Kidney Injury?
Creatinine
How much urine output characterizes the oliguric phase of acute kidney injury?
Less than400mL/day
Why is insulin given to patients with hyperkalemia in acute kidney injury?
Insulin causes potassium to move into the cells; glucose is given at the same time to prevent hypoglycemia
What is GFR at to be considered end-stage renal disease?
Less than 15mL/min
What are the GFR values for each stage of Chronic Kidney Disease? (Think 15’s)
Stage 5: <15
Stage 4: 15-29
Stage 3b: 30-44
Stage 3a: 45-59
Stage 2: 60-89
Stage 1: 90+
What happens to BUN and serum creatinine levels as GFR decreases?
They increase
What can cause BUN to increase?
-Kidney disease
-Protein intake
-Fever
-Corticosteroids
-Catabolism
What are symptoms of increased BUN?
-N/V
-Lethargy
-Fatigue
-Impaired cognition
-Headaches
What is the gold standard for diagnosing Chronic Kidney Disease-Mineral & Bone Disorder? (CKD-MBD)
Bone biopsy
Why are blood transfusions avoided in a patient with anemia caused by CKD unless there is acute blood loss?
Blood transfusions increase the development of antibodies which makes it harder to find a compatible donor for a kidney transplant
What restrictions will you expect to place on a patient with CKD?
-Fluid restriction (usually only for patients on hemodialysis)
-Sodium restriction
-Potassium restriction
-Phosphate restriction
What kinds of foods are high in phosphates?
-Meat
-Dairy products
What are typical signs of high potassium?
-Muscle weakness
-Shortness of breath
-Chest pain and palpitations
-N&V
-Weak pulse
Why should Iron and Calcium supplements not be taken together?
Calcium inhibits absorption of iron
What are the 3 phases of the peritoneal dialysis cycle?
-Drain
-Inflow
-Dwell
How long does 1 peritoneal dialysis exchange take?
30-50 minutes
What is the difference between Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis?
Automated is done at night while the patient is asleep
Continuous is done every few hours during the day
What is the primary manifestation of peritonitis in a patient doing peritoneal dialysis?
Cloudy peritoneal effluent draining from the catheter
Which electrolyte abnormality causes cerebral edema in a patient with chronic kidney disease?
Hyponatremia; since there isn’t a lot of sodium in the blood, there will be more in the brain which causes water to flood the brain cells
How long can kidneys be preserved for for transplantation?
72 hours
Sodium Polystyrene Sulfonate is usually given to patients with high potassium levels. When should it not be given?
When the patient has paralytic Ileus
