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adult ll > Renal System > Flashcards

Renal System Flashcards

1
Q

Glomerulus

A

ball of capillaries that exchange nutrients and oxygen; capillaries are permeable

  • small (water, electrolytes, waste, BUN, creatinine) get pushed through
  • Large (proteins, RBCs) cannot get through
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2
Q

Glomerular filtration rate

A

125 ml/min

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3
Q

tubular function

A

regulation of water balance/electrolytes

acid base balance

eliminate unnecessary substances from blood

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4
Q

erythropoietin

A

stimulates RBC production

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5
Q

Vitamin D

A

activated by kidneys when there is a deficiency in Ca - weakens the bones

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6
Q

Renin

A

important in maintaining BP

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7
Q

Prostaglandins

A

protective factor of the kidneys

blocked by steroids and NSAIDS

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8
Q

Aging Process of Kidneys

A

decreased renal blood flow r/t atherosclerosis (calcified and narrowed)

Decreased ability to concentrate urine (UTIs0

Under normal conditions continue to maintain homeostasis

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9
Q

Aging Process of Ureters, Bladder, Urethra

A

female urethra, bladder, pelvic floor has a loss of elasticity = incontinence

men may have enlarged prostates which causes urinary hesitancy and retention, bladder infections

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10
Q

First s/s of UTI in elderly

A

change in mental status

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11
Q

Assessment of Urinary System

A 
Health Hx
Meds - a lot are nephrotoxic
Surgery
Functional Health Patterns:
    - nutrition
    - elimination pattern (number, amount, color, odor)
    - activity/exercise
   - sleep
    - cognitive-perceptual pattern
   - self-perception
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12
Q

Urinary System Assessment: Inspection

A

Skin - dehydration, coloration issues r/t removal of BUN (yellowish)
Mouth -wounds
Abdomen - distention, heaviness, bladder distention
Weight - daily weight (fluid status)

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13
Q

Urinary System Assessment: Palpation

A

Kidney - sometimes can palpate in really thin people

Bladder - feel distention -> rely on scanner more now

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14
Q

Urinary System Assessment: Percussion

A

Flank area (blunt percussion) - costovertibral area (pain = kidney infection)

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15
Q

Urinary System Assessment: Auscultation

A

abdominal aorta and renal arteries = bruites

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16
Q

Anuria

A

no urine output

  • usually in dialysis pt’s
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17
Q

dysuria

A

pain/burning on urination

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18
Q

enuresis

A

bed wetting

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19
Q

frequency

A

urge to urinate

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20
Q

hematuria

A

blood in the urine

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21
Q

nocturia

A

night time urination

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22
Q

oliguria

A

decreased urine output

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23
Q

polyuria

A

urinating a lot

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24
Q

hesitancy

A

difficulty starting to urinate

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25
Q

BUN levels

A

6-20 mg/dl

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26
Q

Creatinine levels

A

0.6 - 1.3 mg/dl

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27
Q

Bun/Creatinine ration

A

12:1 - 20:1

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28
Q

Sodium levels

A

135-145 mEq/L

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29
Q

Potassium levels

A

3.5-5.0 mEq/L

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30
Q

Calcium levels

A

8.6-10.1 mg/dl

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31
Q

Phosphorus levels

A

2.4-4.4 mg/dl

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32
Q

Bicarbonate levels (HCO3)

A

22-26 mEq/L

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33
Q

pH levels

A

7.35 - 7.45

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34
Q

PaO2 levels

A

80-100 mmHg

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35
Q

SaO2 levels

A

93 to 100%

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36
Q

PaCO2 levels

A

35-45 mmHg

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37
Q

Urine Dx Studies

A

urinalysis
Creatinine clearance: 70-135 ml/min –> 24 hr test

urine culture >100,000
Protein dipstick 0 - trace
specific gravity: 
   - very low = diabetes insipidus
   - very high = SIADH
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38
Q

Specific Gravity

A

1.003 - 1.030

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39
Q

Dx Study: Kidneys, Ureters, Bladder (HUB)

A

x-ray to look at the structures

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40
Q

Dx study: Intravenous Pyelogram

A

IV contrast given to highlight areas (kidneys, ureters, bladder)

Need to know: allergies and kidney function b/c dye is nephrotocxic

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41
Q

Dx Study: Renal Arteriogram

A

looking at the arteries; blood flow

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42
Q

Dx Study: renal ultrasound

A

best choice - no pain, not invasive

Looks for structural abnormalities and blood flow

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43
Q

Dx study: renal biopsy

A

collecting a sample using a needle

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44
Q

Dx study: Cystoscopy

A

examining the bladder with a scope

May have hematuria afterwards; UTI if bacteria gets in

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45
Q

Classifications of Renal disorders

A 
Hereditary
Infectious
Obstructive
Immunological
Degenerative
Tumors and Traumas
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46
Q

Polycystic Kidney Disease (PKD)

A

inherited autosomal dominant or recessive trait
- fluid filled cysts in epithelial cells of nephron (both kidneys), replace normal kidney tissue with non-functioning cysts; kidney enlarge

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47
Q

Symptoms of Polycystic Kidney Disease

A

HTN, abdominal or flank pain/heaviness, nocturia, hematuria

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48
Q

PKD Dx. studies

A

CT scan, IVP, ultrasound, urinalysis for proteinuria, hematuria, serum creatinine, BUN, urine culture

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49
Q

PKD management

A

control infection, diet modifications (restrict Na), fluid restrictions, antihypertensives

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50
Q

PKD Treatment

A

nephrectomy (to relieve pain), kidney transplant (new kidney will not get PKD)

51
Q

Upper UTI

A

Renal parenchyma, pelvis, ureters

Acute pyelonephritis vs. Chronic

MOST ARE ACUTE!

52
Q

Acute Pyelonephritis

A

Upper UTI -> Kidneys

Begins in the renal medulla and spreads to the cortex; begins w/ infection in the lower tract that made its way upward

53
Q

Chronic Pyelonephritis

A

Upper UTI

Kidneys become small, atrophied, loss of function b/c of scarring - can cause renal failure

54
Q

Lower UTI

A

bladder storage or emptying problems

55
Q

Urethritis

A

Lower UTI
inflammation of the urethra (usually males if it is infectious)

-Usually STD’s in males
(Trichamonas, monilial infection, chlamydia, gonorrhea)

56
Q

Cystitis

A

Lower UTI
inflammation of the bladder
*Traditional UTI - bacterial infection causing a bladder infection

57
Q

Uncomplicated UTIs

A

lower UTI (bladder), not systemic, female, no structural abnormalities (no foley, kidney stones, strictures), normal immune system, not hospital acquired

58
Q

Complicated UTIs

A

Risk for urosepsis, pyelonephritis, renal damage

Male
Diabetics

59
Q

Initial Infection

A

one infection thats treated and goes away

60
Q

Recurrent UTI

A

one infections thats treated and goes away but comes back

61
Q

Predisposing Factors for Infectious Disorders

A

factors increasing urinary stasis, foreign bodies (catheters), anatomic factors (females have shorter urethras, males may have BPH causing a UTI), compromised immune system, functional disorders, and other factors such as hygiene, sexual intercourse, and being in the hospital

62
Q

Clinical Manifestations of Lower UTIs

A

dysuria, frequent urination, urgency, suprapubic pressure, hematuria, cloudy appearance, odor

63
Q

Clinical Manifestations of Upper UTIs

A

All Lower UTI’s s/s

PLUS: flank pain, fever, chills, N/V

64
Q

Dx assessment/studies of UTIs

A 
costovertebral tenderness (flank pain) -> UUT
Bacteria in the urine, IVP, CT, CBC, imaging studies
65
Q

Collaborative Care for UTIs

A

Meds: Pyridium (stains bodily fluids ORANGE); Trimethoprim/sulfamethoxazole, Fluoroquinolones

66
Q

Acute UTI interventions

A

adequate fluids
avoid caffeine, alcohol, citrus fruit, chocolate, spicy foods
local heat to suprapubic area/lower back

watch for changes:

  • urine (color, consistency, amount)
  • fever (recurrent -> change antibx)
  • Flank (Pain - change antibx)
67
Q

UTI prevention

A

good hygiene, adequate fluid intake, use bathroom when needed, use bathroom after sexual intercourse, proper hand washing, taking out catheters when not needed

68
Q

Immunologic Disorders

A

Acute or Chronic glomerulonephritis

immune process, antibody induced injury

affects both kidneys equally

usually from STREP

69
Q

s/s of immunologic disorders

A

hematuria, increased WBC, casts, proteinuria

increased BUN and creatinine

70
Q

Acute post streptococcal glomerulonephritis

A

re throat of 5-21 days ago; usually from untreated B-hemolytic streptococci

urine - electrolytes, protein
serum - BUN, creatinine

71
Q

acute post streptococcal glomerulonephritis s/s

A

periorbital edema, body edema, HTN, oliguria, hematuria, rust, abdominal or flank pain

72
Q

acute post streptococcal glomerulonephritis treatment

A

conservative: rest, fluid restriction, BP management, diuresis

73
Q

Nephrotic Syndrome

A

glomerulus is excessively permeable to plasma protein, proteinuria, low plasma albumin, general issue edema

excessive protein loss, hypercoagulation, elevated cholesterol

74
Q

nephrotic syndrome treatment

A

edema: fluid and sodium restriction, I&Os, daily weight

Thromboembolism: anticoagulants

Cholesterol elevation: meds to lower

75
Q

Obstructive Disorders

A

Nephrolithiasis/Urolithiasis

stone formation anywhere in the urinary tract

76
Q

obstructive disorders s/s

A

abdominal or flank pain, hematuria, N/V, fever, chills

77
Q

obstructive disorders dx tests

A

urinalysis and CT scan

78
Q

obstructive disorders treatment

A

1st: pain, infection, obstruction
2nd: cause of stone
3rd: endourologic procedures and surgery if stone is too large to pass

79
Q

Urinary Tract Calculi tx

A

dietary modifications, adequate hydration, varies depending upon stone composition

Avoid foods: high sodium (canned soups), colas, coffee, teas , purine foods, oxalate foods

80
Q

Purine foods

A

high in uric acid

sardiness, liver, herring, mussels, venison, kidney, beef, chicken, pork

81
Q

oxalate foods

A

dark roughage, spinach, cabbage, asparagus, beets

82
Q

lipotripsy

A

shockwaves to break up stones; often place stents as well

83
Q

ureteral strictures

A

ducts that carry urine from the kidney to the bladder; secondary to surgical interventions that form scar tissue

threatens kidney function

84
Q

ureteral strictures s/s

A

Mild colic, decreased output

85
Q

ureteral strictures dx studies

A

IVP

86
Q

ureteral strictures tx

A

dilation and stent, nephrostomy tube, excision and reanastomosis of the ureter to the renal pelvis

87
Q

urethral stricture

A

obstructive disorder

caused by trauma, infection, congenital defect

repeated STI infectinos

88
Q

urethral stricture s/s

A

diminished force of stream, straining to void, post void dribbling, incomplete bladder emptying, difficulty inserting a catheter

89
Q

urethral stricture dx studies

A

retrograde urethrography (RUG), voiding cysturethrography

90
Q

urethral stricture treatment

A

dilation and stent

91
Q

urethral stricture teaching

A

self cath for dilation, urethroplasty

92
Q

Nephrosclerosis

A

sclerosis of small arteries and arterioles of the kidney

“hardening of the kidney arteries”

dx: HTN screening
Tx: control HTN

93
Q

nephrosclerosis risk factors

A

HTN, atherosclerosis associated w/ aging

94
Q

diabetic nephropathy

A

damage of small blood vessels that supply the glomeruli

dx: microalbuminuria in the urine and serum creatinine
tx: control glucose and HTN w/ ACE inhibitors

95
Q

diabetic nephropathy risk factors

A

HTN, smoking, chronic hyperglycemia

96
Q

Renal Trauma

A

minor: contusions, small lacerations
major: lacerations to cortex, medulla, or renal artery/vein

risk factors: sports, vehicle, falls, GSW, abdomen and flank areas
dx tests: IVP, MRI, arteriogrhy; screening for kidney trauma w/ urine sample

97
Q

renal trauma s/s

A

hematuria

98
Q

renal cancer risk factors

A

smoking, familial, obesity, HTN, exposure to chemicals and end stage renal disease

dx: IVP, ultrasound, CT, MRI
tx: radical nephrectomy, radiation therapy, chemo

99
Q

renal cancer s/s

A

incidental findings, hematuria, flank pain, mass, HTN, weight loss, anemia

100
Q

bladder cancer risk factors

A

transitional cell carcinoma

smoking, exposure to dyes (rubber), radiation for cervical cancer (close to bladder)

dx: urine for cytology, IVP, ultrasound, CT, MRI
tx: surgery, radiation, chemo, intravesical therapy

DIVERSION devices when taking out the bladder

101
Q

bladder cancer s/s

A

dysuria, frequency, urgency, hematuria (mimics UTI s/s)

102
Q

Nephrostomy Tube

A

drainage tube inserted directly ingot he kidney for removal of urine

always ensure unobstructed drainage

risk for infection, skin irritation at tube site, occlusion

nurses DO NOT flush tube

103
Q

Suprapubic Tube

A

drainage tube directly into the bladder for removal of urine; bypasses the urethra

always ensure unobstructed drainage

104
Q

Ileal condiut

A

urinary diversion

portion of bowel is resection, ureters are implanted into part of the ileum; abdominal stoma, external pouch at all time

should be beefy, red

105
Q

continent urinary diversion

A

urinary diversion

intraabdominal urinary reservoir replaces the bladder, reservoir constructed from ileum or bowel

emptied by self cath every 4-6hrs

needs to be irrigated regularly to prevent closure

106
Q

orthotopic bladder reconstruction

A

urinary diversion

construction of new bladder from the bowel, reservoir replaces the bladder, elimination via the urethra

need to train the new bladder

107
Q

Renal surgery - post op

A

shock - from blood loss; respiratory complications (pneumonia); obstruction of urine, infection, thromboplebitis (DVTs), small bowel obstruction (scar tissue formation can cause obstruction)

108
Q

renal surgery post op nursing interventions

A

urine output: q1-2hrs, more than 1 catheter, dressing,daily weight

respiratory: pulmonary care (incentive spirometer), pain management, early ambulation

abdominal distention: risk for bowel obstruction, NPO until bowel sounds return

109
Q

renal surgery post-op patient teaching

A

skin care, maintenance of urinary diversion

s/s of obstruction: lack of urine output, cannot get cath in

s/s of infection: fever, foul smelling urine, cloudy urine

110
Q

Acute kidney injury

A

sudden loss of kidney function indicated by rise in creatinine and/or decreased urine output

Pre-renal, intra-renal, post-renal

time-limited loss of renal function
a majority of people get function back

111
Q

Pre-renal

A

before the kidneys; not perfusing the kidneys

hypovolemia:
- hemmorhage, burns (dehydration)

112
Q

intra-renal

A

directly at the kidneys

IV dyes, meds, NSAIDS, transfusion rxn, problem from not fixing pre or post renal problems

113
Q

post-renal

A

after the kidneys that causes harm to the kidney

obstruction r/t urinary output: urine retention, BPH, stones, tumor, strictures

114
Q

Initial phase

A

phase of acute kidney injury

when the insult happens

115
Q

oliguric phase

A

phase of acute kidney injury

holding on to everything

low urine output, hypervolemia, hyperkalemia, metabolic acidosis, CNS problems

116
Q

Diuretic phase

A

phase of acute kidney injury

kidneys try to repair itself; throwing everything out

fluid and electrolyte loss; loss of urea and creatinine

117
Q

recovery phase

A

phase of acute renal injury

can take months to years

everything starts to balance out; kidneys are able to function properly again

keeping what is needed and getting rid of what’s not

118
Q

metabolic acidosis

A

pH is low
CO2 is normal
Bicarb is low

119
Q

metabolic alkalosis

A

pH is high

120
Q

indications for dialysis

A 
metabolic acidosis
hyperkalemia
hypervolemia
severe HTN
severe mental status changes
121
Q

common causes of chronic renal disease

A

diabetes and HTN

122
Q

Chronic renal disease

A

progressive irreversible loss of kidney function

123
Q

chronic kidney disease manifestations

A 
altered BS
elevated triglycerides
fluid overload
anemia
weight loss/ malnutrition
mineral and bone disorder

*most important F&E imbalance: K

most s/s are same as AKI

124
Q

1 cause of death in chronic kidney disease

A

cardiovascular problems

adult ll (11 decks)

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