Renal I

Question 1

what are the functions of the kidneys?

Answer 1

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

Question 2

what are common terms for collection of urine specimens?

Answer 2

The first voided morning urine
Clean catch midstream
Catheterized specimen
Random
Strain urine
24-hour urine

Question 2

what is an average urine volume for an adult?

Answer 2

1000 ml to 2000 ml/24 h
->30 ml/hour and <80 ml/hour

Question 3

what is considered increased urine output for an adult? what is the term?

Answer 3

Polyuria > 2000 ml/24 h

Question 4

what is considered decreased urine output for an adult? what are the terms?

Answer 4

Oliguria < 400 ml/24 h:
Anuria < 100 ml/24 h

Question 5

UTI is a broad term that includes:

Answer 5

cystitis, urethritis and pyelonephritis

Question 6

what is the most common bacteria for UTI’s?

Answer 6

E. Coli = 90% of uncomplicated acute UTI’s

Question 7

what are some predisposition factors to UTI?

Answer 7

-female
-pregnancy
-age
-catheterization
-Chronic diseases: DM

Question 8

why does DM make you more at risk for developing a UTI?

Answer 8

-increased glucose increases bacterial growth
-immunosuppression

Question 9

when does age from men and women put them more at risk for UTI’s? why?

Answer 9

oPost-menopausal women – decrease in estrogen levels
oMen over 50 – prostate obstruction and urinary stasis

Question 10

what are the 3 most common symptoms of cystitis?

Answer 10

Urgency, frequency, dysuria,

Question 11

what is a late stage symptom of cystitis?

Answer 11

fever (more often associated with pyelonephritis).

Question 12

what is the major symptoms of cystitis within the elderly population?

Answer 12

asymptomatic except they may demonstrate increased confusion

Question 13

what is needed to diagnose/treat an acute uncomplicated UTI

Answer 13

-based on history, physical exam and UA alone
-no need for culture to treat.

Question 14

How do we treat UTI’s?

Answer 14

-3-day ABO
-Phenazopyridine (Pyridium)– Can cause body fluids to turn reddish/orange
-hydrate
-void after intercourse
-avoid fragrance hygiene products

Question 15

what are the causes of urethritis?

Answer 15

-sexually transmitted pathogens
-new sexual partner
-postmenopausal women common due to low estrogen levels.

Question 16

what is considered acute pyelonephritis?

Answer 16

Active bacterial infection of the kidney and renal pelvis.
Bacteria triggers an inflammatory response, causing edema, tissue inflammation, and potential abscesses.

Question 17

what is considered chronic pyelonephritis?

Answer 17

Repeated or continued upper UTIs due to anatomical abnormalities of the urinary tract.

Question 18

what are the three major symptoms of pyelonephritis? others?

Answer 18

Fever, chills, shaking
—-Others: CVAT, deep abdominal tenderness or flank pain, foul smelling urine

Question 19

treatments for pyelonephritis?

Answer 19

-increase fluids
-2-weeks ABO
-pregnant mothers get IV ABO’s

Question 20

what are the 4 kinds of urinary incontinence?

Answer 20

-stress
-urge (overactive bladder)
-overflow
-functional

Question 21

stress incontinence is most common in?

Answer 21

women

Question 22

what is stress incontinence?

Answer 22

Small loss usually caused by increased intra-abdominal or bladder pressure (i.e. laughing, coughing, sneezing)

Question 23

what are some risk factors for nephrolithiasis/urolithiasis (renal calculi; kidney stones)

Answer 23

-males (2-3X more than women)
-prior personal or family history
-dehydration
-excess intake of Ca, oxalate, protein

Question 24

what is the most common type of kidney stone?

Answer 24

calcium oxalate and calcium phosphate

Question 25

other than Ca what other kidney stone did we learn about related to gout?

Answer 25

Uric Acid, which is also a cause of gout. -Avoid high-purine diet!

Question 26

what is the most common s/s of kidney stones?

Answer 26

Renal colic – severe kidney pain/flank pain.

Question 27

what are the radiology tests to diagnose kidney stones?

Answer 27

-CT
-KUB
-US
-IVP

Question 28

what prep is important for IVP?

Answer 28

-may include a laxative (better visual when the bowel is empty)
-Keep patient NPO.
-Avoid NSAIDS or anticoagulants.

Question 29

what 3 ways do we treat kidney stones?

Answer 29

1 pain control

#2 hydration
#3 strain urine

Question 30

what are the 3 nursing implications for kidney stones?

Answer 30

-Avoid dehydration
-NSAIDs or opioid analgesic administration for pain
-Assess urine (strain urine for fragments or stones; strict I & O’s)

Question 31

why do patients with kidney stones need to be monitored closely if taking opioids?

Answer 31

respiratory depression after the stone passes, the threshold for pain drops and they could crash

Question 32

what ways do we diagnose BPH?

Answer 32

-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;

Question 33

whsat sould you monitor when a BHP patient is taking alpha-1-selective blocking agents (tamsulosin)?

Answer 33

(relax smooth muscle of prostate)
-beware causes peripheral vasodilation, check blood pressure

Question 34

what is a TURP?

Answer 34

transurethral resection of the prostate – for those who are not candidates for nonsurgical management

Question 35

what is the post-op care for a TURP?

Answer 35

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

Question 36

what should the fluid from the CBI after a TURP look like? What indicated hemorrhage?

Answer 36

-Bright red bleeding for more than 2 hours indicates hemorrhage
-Urine should be pink with small clots.

Question 37

what is a common cause of glomerulonephritis?

Answer 37

infection—Post-streptococcal infection being the most common

Question 38

what are the 4 common symptoms of glomerulonephritis?

Answer 38

-hematuria
-proteinuria
-edema
-hypertension

Question 39

how do we confirm a diagnosis of glomerulonephritis?

Answer 39

-via renal biopsy (watch for bleeding)

Question 40

what are the 3 major treatments for glomerulonephritis? others?

Answer 40

1-Na and H2O restriction

#2-diuretics
#3-antihypertensives
-rest

Question 41

what are the two critical concerns regarding all invasive procedures?

Answer 41

-bleeding/hemorrhage first and foremost.
-Then second priority of invasive procedures is infection