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Med Surg 1 > Renal System > Flashcards

Renal System Flashcards

1
Q

What are five abnormal findings in urine

A
  1. Glucose
  2. Hematuria
  3. Proteinuria
  4. Bacteriuria
  5. WBC
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2
Q

What gives urine the color?

A

Urobilinogen

byproduct of bilirubin

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3
Q

Dark urine can be an indicator of?

A

Hepatic (liver) failure or rhabdomyolysis

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4
Q

Define

glomerulonephritis

What would it cause?

A

inflammation of the tiny filters in the kidneys (glomeruli) leading to increased permeability of abnormal constituents.

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5
Q

What 3 conditions can cause AKI pre-renal?

A
  1. Hypovolemia
  2. Hypotension
  3. Obstruction or vasoconstriction
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6
Q

What can causes issues post-renal (bladder/urethra)

A

Obstruction (e.g., kidney stones, inflammation of those structures)

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7
Q

What are 3 commonly used nephrotoxic agents?

A
  1. Contrast dyes
  2. Antibiotics
  3. NSAIDS

acetaminophen-induced nephrotoxicity is rare, more likely to dmg liver.

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8
Q

What are signs of renal (kidney) compromise?

A
  1. Decreased urine output
  2. Elevated Renal labs (BUN and Creatinine)
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9
Q

What is the treatment for AKI?

Acute Kidney Injury

A

Treat underlying cause (may use temporary dialysis, take away antibiotics)

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10
Q

What are the 4 causes of anemia in CKD?

Chronic Kidney Disease (CKD)

A
  1. Loss of ability to activate vitamin D.
  2. Loss of ability to produce erythropoietin
  3. Blood loss through damaged glomerulus
  4. Increased fluid retention dilutes the blood
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11
Q

What are the 3 causes of CKD?

Chronic Kidney Disease (CKD)

A
  1. Diabetes mellitus
  2. Hypertension
  3. AKI

2/3 of all cases of CKD is associated w/ DM and HTN.

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12
Q

What causes itching in CKD?

Chronic Kidney Disease

A

Uremic frost (build of up urea)

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13
Q

Why would patients w/ CKD experience difficulty concentrating?

Patients may state “fogginess or trouble remembering”

A

Build up of waste products in the blood (e.g., increase ammonia, uric acid)

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14
Q

What are 2 causes of fatigue in patients w/ CKD?

A
  • Main reason is anemia.
  • Secondary, low BP during dialysis
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15
Q

What causes HTN in patients w/ CKD?

A

CKD patients hold onto fluid increasing workload on heart.

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16
Q

What are the directions for completing a 24 hour urine test?

A

Discard the first urine output; then start the 24 hour clock. All subsequent urine is stored in refridgerator.

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17
Q
  1. What is the expected GFR in clinical settings?
  2. What is the normal GFR in laboratory setting?
A
  1. eGFR > 60 ml/min
  2. GFR = 125 ml/min
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18
Q

What are two types of dialysis systems?

A

Hemodialysis and peritoneal dialysis

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19
Q

What should fistulas be assessed for?

A
  1. Thrills (vibratory movement through stethoscope)
  2. Bruit (ascultation should heart turbulent blood flow)
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20
Q

what should be avoided with fistulas?

A
  1. IV sticks on fistula
  2. Assessing BP on that area
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21
Q

What are the 3 signs of peritonitis?

A
  1. Pain, firmness in abdomen area
  2. Cloudy dialysate
  3. Signs of infection (fever, WBC, malaise)
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22
Q

What intervention is recommended for patients of peritoneal dialysis that is experiencing SOB or difficulty emptying dialysate?

A

Repositioning

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23
Q

Where is the cather inserted for hemodialysis?

A

Superior vena cava

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24
Q

What is a fistula?

A

the fusion of a vein and artery as a permanant solution to dialysis through cath

makes vessel able to handle large blood flow from dialysis

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25
Q

What 4 things should be conisidered before a patient undergoes hemodialysis?

A
  1. Low BP (give vasopressors if low)
  2. Temperature
  3. Low electrolytes
  4. Hold antibiotics/medications that decrease BP

Monitor nutrition and fluid levels

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26
Q

What 4 medications are commonly prescribed to dialysis patients?

A
  1. Synthetic EPO (darbepoetin alfa)
  2. Iron (ferrous sulfate)
  3. Electrolyte supplement (especially potassium)
  4. BP medication can go either way
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27
Q

What is sodium polystyrene (Kayexalate) used for?

A

Treats hyperkalemia
(exchanges sodium with potassium ions from the intestinal cells)

Decreases K+ levels

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28
Q

What is the relationship b/w phosphorus and calcium?

A

Phosphorus in plasma takes calcium from bone and put it into plasma.

Risk of brittle bones

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29
Q

What foods should be avoided to decrease phosphorus?

A
  • Processed food (fast food, deli meats, pizza)
  • Dark cola, beer
  • Deli meats
  • Diary

P W/ 3 Ds

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30
Q

What would be the expected GFR for ESRD patient?

A

GFR < 15 ml/min

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31
Q

How is GFR collected in laboratory setting vs clinical setting?

A
  • Laboratory through 24-hr urine test
  • Clinical through blood test (eGFR)
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32
Q

What are the two normal UO measures?

A
  • 1mL/kg/hr
  • > 30 mL/hr*

*used when weight of patient is unknown

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33
Q

What are the parameters for anuria?

A

UO < 50 mL/day

34
Q
  • Define oliguria
  • What are the parameters?
A
  • Below normal UO levels
  • oliguira = 0.5 ml/kg/hr or < 30 ml/hr
35
Q

Convert the following:

  • 1 cup = ? oz
  • 30 ml = ? oz
  • 1 cup = ? ml
  • 1 L = ? ml
A
  • 1 cup = 8 oz
  • 30 ml = 1 oz
  • 1 cup = 240 ml
  • 1 L = 1000 ml
36
Q

Optimal daily fluid intake

A

3 L

Not just water

37
Q

Define

dysruia

A

Pain or difficulty voiding

38
Q

Define

Hesitancy

A

Delay, difficulty in initiating voiding

39
Q

Define

Azotemia

A

Accumulation of nitrogenous waste in blood

40
Q

Define

Uremia

A

Accumulation of urea in blood

41
Q

Define

Incontinence

A

Involuntary loss of urine

42
Q

Define

Urgency

A

strong desire to void

43
Q

What is BUN?

A
  • A BUN test measures the amount of urea, nitrogen that’s in your blood.
44
Q

Normal BUN range

A

5 to 20 mg/dL

5 digits per limb. 20 digits total.

45
Q

What two factors can elevate BUN levels, but have normal creatinine level

A
  1. Dehydration
  2. Increased protein intake

Dehydration causes a concentration of waste products in the blood

46
Q
  • Normal Creatinine range
  • What range would cause worry?
A
  • 0.6 to 1.2 mg/dL
  • ≥ 1.5 mg/dL
47
Q

What are 3 demographics that can affect creatinine levels? How is affected?

A
  • Age (Increased w/ age)
  • Sex (Increased in males)
  • Race (Increased in african-americans)
48
Q

What is the difference is specific gravity of urine compared to water?

Can help determine how well your kidneys are diluting your urine.

A

Specific gravity of urine: 1.003 to 1.030 (water is 1)

Urine is slightly higher

49
Q

Where do majority of UTI originate from?

A

E. coli located in rectum

50
Q

What are 3 common irritants that can increase risk of UTIs?

A
  1. Baths
  2. Nylon underwear
  3. Scented toilet tissue
51
Q

What the mininum ____ ml of urine needed for urinalysis

A

10 ml

52
Q

What are the 3 lower UTI’s in ascending order?

A
  1. Cystitis (bladder)
  2. Prostatits (prostate)
  3. Urethritis (urethra)
53
Q

Define Pyelonephritis

A

Inflammation of the kidney due to a bacterial infection.

Upper UTI infection

54
Q

Which UTI is associated w/ more blood in the urine compared to the other?

A

Pyelonephritis (Upper UTI)

55
Q

What is a s/sx of glomerulonephritis in urine?

A

Proteinuria (albumin)

56
Q

What would be a s/sx if the provider is unsure the patient has AKI after administering fluids for elevated renal labs?

A

Pulmonary edema

57
Q

Patient w/ elevated BUN and Creatinine. What is suspected?

A

AKI or CKD

Acute Kidney Injury or Chronic Kidney Disease

58
Q

What are 3 s/sx would indicate a UTI is becoming complicated?

A

Systemic signs
*Fever
*Increase WBC in blood not just urine
*malaise

59
Q

What are 3 additional s/sx of pyelonephritis compared to lower UTI?

A
  1. Flank pain (often unilateral)
  2. nausea, vomitting
60
Q

which is the most common lower UTI?

A

Cystitis = inflammation of the bladder, usually caused by a bladder infection.

61
Q

What is the nursing priority for urinary calculi (kidney stones)?

A

Acute pain unless stone prevents urination

62
Q

What are 3 possible medications a patient with kidney stones may be prescribed besides analgesics?

A
  1. Diuretics (increase UO)
  2. Anti-biotics
  3. Alpha-blocker (relaxes muscles in bladder)

Rarely given

63
Q

What nutritional recommendations would be made for a patient w/ reoccurring calcium oxalate stones?

A
  • Reduce oxalate foods (dark leafy greens [Spinach], soy products, potatoes)
  • Keep normal calcium intake (calcium binds to oxalate for removal)
64
Q

What nutritonal recommendations would be made for a patient w/ reoccuring calcium oxalate stones?

A
  • Reduce oxalate foods (dark leafy greens [Spinach], soy products, potatos)
  • Keep normal calcium intake
65
Q

What is recommended for large kidney stones?

A

Lithotripsy

66
Q

What are 3 normal findings s/p lithotripsy?

A
  1. Pain still occurs as fragments pass
  2. Hematuria (blood in urine)
  3. Brusing at site of procedure
67
Q

Define

Benign Prostatic Hyperplasia

A

non-cancerous enlargement of prostate

68
Q

at which age are 50% of men dx w/ BPH?
Which age for 90%?

Benign Prostatic Hyperplasia

A

50% by age 60,
90% by age 85.

69
Q

What serves as an indicator for the development of BPH?

A

elevation of Prostate specific antigen (PSA)

70
Q

What are the 3 different s/sx of BPH compared to UTI?

Both genitourinary conditions have similar s/sx

A

BPH urine
1. Weak stream
2. Hesitancy
3. Nocturia

71
Q

Identify the drug class that is quick acting and slow acting for the treatment of BPH.

A
  • Alpha Blocker (quick)
  • 5-alpha reductase inhibitor (slow)
72
Q

What conditions are Tamsulosin (Flomax) indicated for?

Alpha blocker

A
  1. Benign Prostatic Hyperplasia (BPH)
  2. Kidney stones

Relaxes bladder

73
Q
  • What condition is Finasterid (Proscar) indicated for?
  • What is the MOA?
A
  • BPH
  • Blocks an enzyme that changes testosterone to another hormone that causes growth of prostate
74
Q

What are 3 normal findings s/p TURP

Transurethral Resection of the Prostate

A
  1. Hematuria
  2. Temporary incontinece
  3. Retrograde ejaculation
75
Q
  • What is the purpose of flushing the catheter s/p TURP?
  • What is the expected finding w/ the flush?
A
  • Prevent blood chunks
  • Clear to light pink
76
Q

What should be checked before use of contrast dyes?

A
  • Renal Labs (BUN/Creatinine)
  • Urinary output
77
Q

Which antibiotics are considered “heavy hitters” on renal function?

A
  1. Mycins
  2. Aminoglycocides
78
Q

Which analgesic is known to be toxic to renal (kidney) vs hepatic (liver)

A
  • NSAIDS (ibuprofen) = renal impairment
  • Acetaminophen = hepatic impairment

Question use during impairment

79
Q

Which BP abnormality affects AKI vs CKD?

A

Hypotension = AKI
Hypertension = CKD

80
Q

Calculate the minimum UO per hour

A

0.5 (x) kg= how much they should urinate an hour minimum

Med Surg 1 (7 decks)

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