Renal System Flashcards
Functions of the kidneys
Maintenance of proper fluid volume, regulation of electrolytes and acid-base balance, elimination of waste products such as urea, uric acid, ammonia, creatinine, regulation of BP through renin, enable RBC production through release of erythropoietin, convert vitamin D to active form essential for calcium absorption
Urinalysis should NOT include
Glucose, ketones, blood, protein, bilirubin, nitrates, leukocyte esterase
Normal creatinine
0.6-1.2
Normal BUN
10-20
Small amount of urine loss that occurs with abdominal pressure from laughing, coughing, sneezing caused by a weakened pelvic floor
Stress incontinence
Stress incontinence risk factors
Menopause, obesity, constipation, pelvic surgery
Stress incontinence treatment
Kegel exercises, weight reduction, estrogen, vaginal cone therapy
With _________ incontinence, the patient is unable to reach the bathroom in time due to an overactive destructor muscle (smooth muscle in bladder)
Urge
Urge incontinence treatment
Anticholinergics (oxybutynin), bladder training, toileting schedule, avoid caffeine and alcohol
Bladder analgesic that can decrease pain and urgency associated with UTI
Phenazopyridine
S/S of acute pyelonephritis
Costovertebral tenderness, flank or back pain, fever, chills, N/V, tachycardia, tachypnea, hypertension
Labs associated with pyelonephritis
Elevated WBC, creatinine, BUN, CRP, ESR
Autosomal dominant genetic disorder that causes the formation of fluid filled cysts in the kidneys
Polycystic kidney disease (PKD)
PKD S/S
Abdominal distention, flank or back pain, hypertension, hematuria
Glomerulonephritis risk factor
Strep infection
S/S of glomerulonephritis
Oliguria, s/s of fluid volume excess, brown cola-colored urine
Labs associated with glomerulonephritis
Elevated creatinine, BUN, WBC, ESR, CRP, (+) ASO titer, proteinuria, hematuria
Glomerulonephritis treatment
Antibiotics to treat strep infection, diuretics, Anti-hypertensive agents, corticosteroids, Plasmapharesis, dialysis, kidney transplant
Glomerulonephritis nursing care
Monitor I&Os, daily weight, decreased fluid, sodium, and protein intake until kidneys heal
Kidney disorder characterized by massive loss of protein in urine
Nephrotic syndrome
Symptoms of nephrotic syndrome
Edema — periorbital, ascites, peripheral; frothy urine
Labs associated with nephrotic syndrome
Hypoalbuminemia, hyperlipidemia, massive proteinuria (2+)
Nephrotic syndrome treatment
Corticalsteroids, diuretics, 25% albumin, statins
Nephrotic syndrome nursing care
Monitor I&Os, I&Os, daily weight, abdominal girth daily, implement fluid and sodium restrictions, moderate protein intake, prevent skin breakdown, monitor for infection d/t corticosteroids
S/S of urolithiasis
Severe pain on the flanks, the back, lower abdomen, dysuria, fever, diaphoresis, N/V, tachycardia, tachypnea, oliguria, hematuria
Urolithiasis post-lithotripsy nursing care
Screen urine for stone fragments that may be passed, monitor I&Os
Urolithiasis patient education
Increase fluid intake (3 L/day), limit foods according to type of calculi
Sudden loss of kidney function that is typically reversible
Acute kidney injury (AKI)
The gradual, irreversible loss of kidney function
Chronic kidney disease (CKD)
General underlying causes of acute kidney injury
Prerenal AKI: decrease blood flow to the kidneys due to sepsis, shock, hypovolemia
Intrarenal AKI: direct damage to the kidneys by trauma, hypoxic injury, or chemical injury due to toxins or medication‘s such as gentamicin
Post renal AKI: mechanical obstruction to urine leaving the kidneys caused by stone, tumor, or BPH
Phases of AKI
Onset, oliguria, diuresis, recovery
Labs associated with AKI
Hyperkalemia, hyponatremia, hypocalcemia, hypermagnesemia, metabolic acidosis, anemia
AKI nursing care
Implement seizure precautions,monitor I&Os and daily weight, educated patient to reduce/restrict potassium, sodium, phosphorus, and magnesium intake
CKD risk factors
Older age, dehydration, AKI, hypertension, diabetes, medication’s, autoimmune disorders
S/S of CKD
Fluid volume overload, pruritis, N/V, uremic frost
Labs associated with CKD
Elevated potassium, phosphorus, magnesium, creatinine, BUN
Decreased Sodium and calcium, Hgb, Hct, GFR
Stage five (end stage) renal disease GFR
<15
CKD nursing care
Monitor I&Os, daily weight, restrict fluid, sodium, potassium, phosphorus, and magnesium
CKD patient education
Avoid nephrotoxic drugs (NSAIDs, contrast dye, magnesium-containing antacids)
Nursing care/consideration of hemodialysis patient with AV fistula
Do NOT take BP or venipuncture on that arm, if advice, patient not to carry heavy objects or sleep on that arm
Nursing care for AV fistula
Auscultate bruit, palpate thrill
Nursing actions prior to dialysis
Obtain patient, vital signs, weight, and labs, hold certain medications until after dialysis
Nursing actions during dialysis
Monitor for hypotension and adverse effects like cramping, N/V, bleeding associated with heparin
Nursing actions post-dialysis
Measure patient weight and vitals (decrease in weight and BP is expected), compare weight to pre-procedure weight
Solution used for peritoneal dialysis
Hypertonic
Peritoneal dialysis nursing considerations
Sterile technique, keep outflow lower than patients abdomen, monitor color of outflow (should be clear or light yellow; if bloody or cloudy — could mean infection)
Complications of hemodialysis
Disequilibrium syndrome (neurologic deterioration associated with cerebral edema and increased ICP), hypotension (administer IV fluids and colloids, slow infusion rate and lower HOB)
Complications of peritoneal dialysis
Peritonitis (fever, cloudy outflow, N/V, abdominal pain and tenderness)
Kidney transplant post-op nursing care
Closely monitor UOP, monitor bladder irrigation for clots, monitor for infection, monitor for signs of organ rejection (fever, pain, weight gain, HTN, increased creatinine, BUN, WBC)
Kidney transplant patient education
No contact sports, monitor for infection and rejection, monitor BP daily, immunosuppression such as cyclosporine for life
