Renal I Flashcards
what are the functions of the kidneys?
Filtration-waste elimination
Fluid and electrolyte balance
Acid-base balance
Blood pressure regulation
EPO production for RBC synthesis
Vitamin D conversion and Ca+ balance
Glucose Homeostasis
what are common terms for collection of urine specimens?
The first voided morning urine
Clean catch midstream
Catheterized specimen
Random
Strain urine
24-hour urine
what is an average urine volume for an adult?
1000 ml to 2000 ml/24 h
->30 ml/hour and <80 ml/hour
what is considered increased urine output for an adult? what is the term?
Polyuria > 2000 ml/24 h
what is considered decreased urine output for an adult? what are the terms?
Oliguria < 400 ml/24 h:
Anuria < 100 ml/24 h
UTI is a broad term that includes:
cystitis, urethritis and pyelonephritis
what is the most common bacteria for UTI’s?
E. Coli = 90% of uncomplicated acute UTI’s
what are some predisposition factors to UTI?
-female
-pregnancy
-age
-catheterization
-Chronic diseases: DM
why does DM make you more at risk for developing a UTI?
-increased glucose increases bacterial growth
-immunosuppression
when does age from men and women put them more at risk for UTI’s? why?
oPost-menopausal women – decrease in estrogen levels
oMen over 50 – prostate obstruction and urinary stasis
what are the 3 most common symptoms of cystitis?
Urgency, frequency, dysuria,
what is a late stage symptom of cystitis?
fever (more often associated with pyelonephritis).
what is the major symptoms of cystitis within the elderly population?
asymptomatic except they may demonstrate increased confusion
what is needed to diagnose/treat an acute uncomplicated UTI
-based on history, physical exam and UA alone
-no need for culture to treat.
How do we treat UTI’s?
-3-day ABO
-Phenazopyridine (Pyridium)– Can cause body fluids to turn reddish/orange
-hydrate
-void after intercourse
-avoid fragrance hygiene products
what are the causes of urethritis?
-sexually transmitted pathogens
-new sexual partner
-postmenopausal women common due to low estrogen levels.
what is considered acute pyelonephritis?
Active bacterial infection of the kidney and renal pelvis.
Bacteria triggers an inflammatory response, causing edema, tissue inflammation, and potential abscesses.
what is considered chronic pyelonephritis?
Repeated or continued upper UTIs due to anatomical abnormalities of the urinary tract.
what are the three major symptoms of pyelonephritis? others?
Fever, chills, shaking
—-Others: CVAT, deep abdominal tenderness or flank pain, foul smelling urine
treatments for pyelonephritis?
-increase fluids
-2-weeks ABO
-pregnant mothers get IV ABO’s
what are the 4 kinds of urinary incontinence?
-stress
-urge (overactive bladder)
-overflow
-functional
stress incontinence is most common in?
women
what is stress incontinence?
Small loss usually caused by increased intra-abdominal or bladder pressure (i.e. laughing, coughing, sneezing)
what are some risk factors for nephrolithiasis/urolithiasis (renal calculi; kidney stones)
-males (2-3X more than women)
-prior personal or family history
-dehydration
-excess intake of Ca, oxalate, protein
what is the most common type of kidney stone?
calcium oxalate and calcium phosphate
other than Ca what other kidney stone did we learn about related to gout?
Uric Acid, which is also a cause of gout. -Avoid high-purine diet!
what is the most common s/s of kidney stones?
Renal colic – severe kidney pain/flank pain.
what are the radiology tests to diagnose kidney stones?
-CT
-KUB
-US
-IVP
what prep is important for IVP?
-may include a laxative (better visual when the bowel is empty)
-Keep patient NPO.
-Avoid NSAIDS or anticoagulants.
what 3 ways do we treat kidney stones?
1 pain control
#2 hydration
#3 strain urine
what are the 3 nursing implications for kidney stones?
-Avoid dehydration
-NSAIDs or opioid analgesic administration for pain
-Assess urine (strain urine for fragments or stones; strict I & O’s)
why do patients with kidney stones need to be monitored closely if taking opioids?
respiratory depression after the stone passes, the threshold for pain drops and they could crash
what ways do we diagnose BPH?
-DRE (Digital rectal exam) to exam physical changes in the prostate
-Rule out cancer or other causes of obstruction
-PSA (Prostate Specific Antigen) is most common laboratory test;
whsat sould you monitor when a BHP patient is taking alpha-1-selective blocking agents (tamsulosin)?
(relax smooth muscle of prostate)
-beware causes peripheral vasodilation, check blood pressure
what is a TURP?
transurethral resection of the prostate – for those who are not candidates for nonsurgical management
what is the post-op care for a TURP?
Management of Continuous Bladder Irrigation (CBI) via catheterization
-CBI is used for at least 24 hours post-op
-No heavy lifting (>10 lbs.), stressful exercise or sex for 2-6 weeks
-Notify physician if bleeding occurs
what should the fluid from the CBI after a TURP look like? What indicated hemorrhage?
-Bright red bleeding for more than 2 hours indicates hemorrhage
-Urine should be pink with small clots.
what is a common cause of glomerulonephritis?
infection—Post-streptococcal infection being the most common
what are the 4 common symptoms of glomerulonephritis?
-hematuria
-proteinuria
-edema
-hypertension
how do we confirm a diagnosis of glomerulonephritis?
-via renal biopsy (watch for bleeding)
what are the 3 major treatments for glomerulonephritis? others?
1-Na and H2O restriction
#2-diuretics
#3-antihypertensives
-rest
what are the two critical concerns regarding all invasive procedures?
-bleeding/hemorrhage first and foremost.
-Then second priority of invasive procedures is infection
