renal exam - study guide Flashcards
IVP (Intravenous pyelogram) - what does it do?
Visualizes urinary tract, shape, size position of kidneys, ureters, & bladder;
IVP detects
Detects cysts, tumors, lesions, obstructions.
IVP contraindicated in who?
Test contradicted for pt with decreased renal function because the contrast media can be nephrotoxic.
Side-effect of metformin is (increases what and stop before..)
increased lactic acid production. This may lead to lactic acidosis & death. Stop taking the metformin 48 hrs before & 48 hrs after the test or when renal function returns back to normal.
meds for IC - Calcium phosphorus - for (IC calcium before it’s too late)
Calcium phosphorus (Prelief)
BPH - If the DRE and PSA levels are abnormal, what is the next step? (visualize it)
then a transrectal ultrasound with possible biopsy is done to R/O prostate cancer.
5α-reductase inhibitors finasteride (Proscar) reduces size of (fin blocks androgens)
prostate gland by suppressing androgens.
α-adrenergic receptor blockers terazosin (Hytrin) & tamsulosin (Flomax) promote (tez and tam relax me)
smooth muscle relaxation in prostate facilitating urinary flow through urethra.
Saw palmetto action is the same as the
α-adrenergic receptor blockers.
Never use what with prostate?
Never use zinc because it stimulates the growth of the prostatic tissues.
TURP - what type of foley catheter?
A three-way foley cath is inserted after surgery. Continuous bladder irrigations are done to flush all the blood out of the bladder to prevent clots from developing.
priapism - complications (need hydro for my priapism)
penile tissue necrosis; Hydronephrosis (kidneys become stretched and swollen) from bladder distention; inability to achieve a normal erection after priapism subsides.
Transillumination is used to (illuminate the fluid)
identify solid tumors/cancer versus fluid in the scrotum
Epididymitis is (one or both sides?)
unilateral
Most common cause of infertility is (vari infertile)
varicocele.
Testicular torsion common in
young boys and is a surgical emergency to untangle the blood supply that is twisted around the vas deferens.
Vasectomy is performed where?
Vasectomy is performed in the MD office.
vasectomy - Should use contraception for
6 weeks or 10 ejaculations to evacuate sperm distal to surgical site.
drug therapy for prostate cancer
Drug therapy is called Hormonal therapy (androgen deprivation therapy – ADT).Goal: reduce the androgen level. Androgen promotes the tumor growth. Causing a castration effect will prevent the release of any androgen. Hence, the cancer will stop growing and begin to shrink in size
ADT is used as (ADP alone isn’t enough)
an adjunct therapy before surgery or radiation.
Complication of ADT is (adt security is bare bones)
osteoporosis
Glomerulonephritis (glum’s basement is damaged)
caused by Ab induced injury to the glomerular basement membrane.
glomerulonephritis - symptoms (glum has a swollen face)
Generalized body edema. May start with periorbital edema & progress to peripheral edema or ascites.
Polycystic kidney disease - both kidneys? is it genetic?
both kidneys and is genetic.
PKD - where are cysts?
Large thin walled cysts develop in cortex & medulla of kidneys. Cysts grow to the size of golf balls & filled with blood or pus. Large cysts compress surrounding tissues & destroy them. May lead to cysts in liver; Affect heart valves;
PKD - aneurysms and diverticulosis? how?
Aneurysms especially cerebral aneurysm (enlarged kidneys have tamponade effect on aorta); Diverticulosis (kidneys grow so large that it applies pressure against intestinal tract).
Elevated creatinine levels indicate
AKI.
pre-renal AKI - when is it reversible? how long?
There is no damage to the parenchyma so with hydration AKI is reversible if rehydrated in 48 hrs.
pre-renal AKI - If no hydration is performed
then the nephrons will eventually
die off and become to stage 2 intrarenal
Intrarenal AKI results from direct damage to the kidneys caused by
prolonged ischemia, nephrotoxins, hemoglobins released from hemolyzed RBCs, or myoglobins released from necrotic muscle cells
causes of acute tubular necrosis (ATN) (ant is caused by SIN)
Ischemia, nephrotoxins, or sepsis
Postrenal is reversible if the obstruction is relieved within
48 hrs.
Prolonged obstruction leads to (the atrophy and fibrosis are prolonged)
tubular atrophy & irreversible kidney fibrosis resulting in CKD.
AKI - oliguric phase - signs of
dehydration, JVD, LE edema, lung congestion
oliguric phase - risk factors - IV fluids
CHF due to over hydrations with IVF for treatment during oliguric phase
Bruises occur when
renal not producing erythropoietin. Pt becomes anemic.
Oliguric Phase - onset (olga’s onset was 17 days)
<400 ml urine output per day
Onset: within 1-7 days of AKI
oliguric phase - If caused by ischemia, then oliguria occurs within (olga and ishmail married in 24 hrs)
then oliguria occurs within 24 hrs
oliguric phase - If caused by nephrotoxic drugs, then the onset may be (toxins in my system for a week)
then the onset may be delayed for as long as 1 week.
oliguric phase - duration (olga could only endure until 10:14)
Duration is usually 10 to 14 days but can last months in some cases. Just remember the longer the oliguria lasts the poorer the prognosis for recovery of kidney
function
In the oliguric & anuric phases, IVF cause
neck vein distention, bounding pulse, HTN, edema & result in HF, pulm edema, pericardial & pleural effusion.
oliguric - metabolic acidosis
NaHCO3 normally binds with the excess H but in the oliguric phase NaHCO3 production is reduced due to a defective reabsorption & regeneration of bicarbonate ions.
Pts with severe metabolic acidosis develop (blow off the acid)
Kussmal breathing (rapid deep respirations) trying to exhale the excess CO2
If AKI is caused by a massive tissue trauma
then those damaged tissue cells releases K
into the ECF. This increases the already high K level
In Metabolic acidosis the extra H - it takes action
enters the cell & pushes K out there by increasing the K level.
Hematologic disorders (RBCs, bone marrow) occur in those with (heman is sick)
multi-organ failures or hematologic disorders
Leukocytosis is often present in (luke is friends w/ aki)
AKI
The most common cause of death in AKI is
infection.
The most common site of infection are from the (think catherter and breathing)
urinary & respiratory systems.
BUN may be caused from - think infections and bleeding
dehydration, corticosteroids, catabolism from infections,
fever, severe injury, or GI bleed.
The best serum indicator of AKI is
elevated creatinine levels
excess BUN accumulates in
the brain and nervous system. Causes fatigue, difficulty concentrating, seizures, stupor, coma
chronic kidney disease - cardiovascular - but why?
HTN (renal medulla gone so prostaglandins cannot be synthesized to vasodilate)
chronic kidney disease - symptoms (chronic breath smells like feta)
Uremic fetor (breath smells like urine)
chronic kidney disease - GI (this is about anorexia)
GI bleed occurs when stomach continues to produce gastric acids and there is no food in the stomach
chronic kidney disease - GI - Constipation occurs with the (selma has constipation)
intake of sevelamer/phoslo, limited po fluids, & reduced physical activity
Chronic kidney disease - women
decreased level of estrogen, progesterone, luteinizing hormone that results in amenorrhea. Menstruation recurs with dialysis.
chronic kidney disease - men
inconsistent levels of testosterone, low sperm count
chronic kidney disease - neurologic
Increased nitrogenous waste products, electrolyte imbalance, metabolic acidosis,
atrophy & demyelination of nerve fibers
atrophy & demyelination of nerve fibers (mom demylenates)
slows the nerve conduction to BLE (bilateral lower extremities) so peripheral neuropathy occurs
Dialysis reduces the CNS manifestations except it cannot reverse
the motor neuropathies
Increased BUN & HTN leads to (tu has a high BUN)
seizures, coma
pruritis caused by - (calcium makes me itch)
dry skin, Ca Phosphate deposits in the skin,
Uremic frost comes from extremely high BUN levels
(>200). Urea seeps thru skin & forms
white itchy flakes.
dialysis - hypotension - fluid is reduced before or after?
Hypotension: dialysis rapidly reduces vascular volume which results in reducing the preload
& cardiac output
dialysis - to prevent hypotension
less fluid is removed & NS IVF may be given
dialysis - hep b
Hepatitis B is avoided by vaccination. Hep C can occur due to poor infection control during
dialysis.
Peritoneal dialysis - how much? and for how long? (Tone just needs 10 min)
As per physician order. Usually fill - 2 L Dialysis solution (room temp) instilled into peritoneal space (10 mins) Larger abdomen takes up to 3 L.
peritoneal dialysis - Equilibration takes how long? (tone needs 30 min to get right)
Leave solution so it can dwell (diffusion/osmosis between blood & peritoneal cavity) 20-30 mins or as per order depending on desired outcome.
peritoneal dialysis - drain how long? (I was drained already at 15)
Drain - 15-30 mins. May have to massage abdomen or change positions.
peritoneal dialysis - after - assess what? (3 things) (tone is SEC)
Assess the effluent, site , catheter and report any signs of infection, or complications.
kidney transplant - steroids - given with what?
Corticosteroid use leads to aseptic necrosis of the joints (hips, knees, etc.). Tacrolimus & other immunosuppressants helps lower the required steroid dose.
Kidney transplant post-op care in addition to standard post-op care: - what is the #1 priority???
- Monitor incision, renal function, bleeding, URINE OUTPUT IS PRIORITY ASSESSMENT
- Pain management
- Immunotherapy
- Signs of rejection
meds for IC - Antidepressants & Elmiron (Elmo w/ glyco)
Antidepressants; Pentosan (Elmiron) for IC enhances the protective
effects of glycosaminoglycan layer of the bladder
meds for IC - (IC a dime)
Dimethylsulfoxide (DMSO); Reduce stress;
Relaxation techniques; Avoid tight clothing around suprapubic area.
glomerulonephritis - Can be caused by (glum, inside and out)
Can be caused by endogenous (autoimmune antigen) or exogenous (infection such as strep antigen).
glomerulonephritis - HTN and oliguria? (glum is too extra)
HTN (too much ECF); oliguria (decreased GFR)
epididymis is caused by (p diddy has infection and trauma)
infection, trauma, urinary reflux down the vas deferens
what drugs are given to prevent osteoporosis with ADT? (Bison against osteoporosis)
Bisphonate drugs are given to prevent osteoporosis.
uncomplicated UTI
just involves bladder. complicated = catheter, pregnancy, recurrent infection, immune compromised
uncomplicated UTI - how long for antibiotics?
3 days
Complicated UTI - how long for antibiotics?
7-14 days
about what % of UTIs are asymptomatic?
50%
uretheral trauma - s/s classic triad
blood visible at the meatus, inability to void, distended bladder
struvite stones
ask if pt has had UTIs
bladder cancer - post op - how often to assess output? (assess Jean every hour)
every hour
Saw palmetto
promotes smooth muscle relaxation. action is the same as the α-adrenergic receptor blockers.
AKI is reversible for the
the prerenal and postrenal stages.
Intrarenal AKI results from direct damage to the kidneys caused by
prolonged ischemia, nephrotoxins, hemoglobins released from hemolyzed RBCs, or myoglobins released from necrotic muscle cells.
chronic kidney disease - GI (metal is chronic)
stomatitis with exudate & ulcerations & metallic taste in mouth
chronic kidney disease - Restless legs syndrome
Restless legs syndrome begins with burning sensation then later muscular
weakness & atrophy leading to foot drop, Muscle twitching, asterixis, nocturnal
leg cramps
