Renal System Flashcards
Glomerulus
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
Glomerular filtration rate
125 ml/min
tubular function
regulation of water balance/electrolytes
acid base balance
eliminate unnecessary substances from blood
erythropoietin
stimulates RBC production
Vitamin D
activated by kidneys when there is a deficiency in Ca - weakens the bones
Renin
important in maintaining BP
Prostaglandins
protective factor of the kidneys
blocked by steroids and NSAIDS
Aging Process of Kidneys
decreased renal blood flow r/t atherosclerosis (calcified and narrowed)
Decreased ability to concentrate urine (UTIs0
Under normal conditions continue to maintain homeostasis
Aging Process of Ureters, Bladder, Urethra
female urethra, bladder, pelvic floor has a loss of elasticity = incontinence
men may have enlarged prostates which causes urinary hesitancy and retention, bladder infections
First s/s of UTI in elderly
change in mental status
Assessment of Urinary System
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-perceptionUrinary System Assessment: Inspection
Skin - dehydration, coloration issues r/t removal of BUN (yellowish)
Mouth -wounds
Abdomen - distention, heaviness, bladder distention
Weight - daily weight (fluid status)
Urinary System Assessment: Palpation
Kidney - sometimes can palpate in really thin people
Bladder - feel distention -> rely on scanner more now
Urinary System Assessment: Percussion
Flank area (blunt percussion) - costovertibral area (pain = kidney infection)
Urinary System Assessment: Auscultation
abdominal aorta and renal arteries = bruites
Anuria
no urine output
- usually in dialysis pt’s
dysuria
pain/burning on urination
enuresis
bed wetting
frequency
urge to urinate
hematuria
blood in the urine
nocturia
night time urination
oliguria
decreased urine output
polyuria
urinating a lot
hesitancy
difficulty starting to urinate
BUN levels
6-20 mg/dl
Creatinine levels
0.6 - 1.3 mg/dl
Bun/Creatinine ration
12:1 - 20:1
Sodium levels
135-145 mEq/L
Potassium levels
3.5-5.0 mEq/L
Calcium levels
8.6-10.1 mg/dl
Phosphorus levels
2.4-4.4 mg/dl
Bicarbonate levels (HCO3)
22-26 mEq/L
pH levels
7.35 - 7.45
PaO2 levels
80-100 mmHg
SaO2 levels
93 to 100%
PaCO2 levels
35-45 mmHg
Urine Dx Studies
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
Specific Gravity
1.003 - 1.030
Dx Study: Kidneys, Ureters, Bladder (HUB)
x-ray to look at the structures
Dx study: Intravenous Pyelogram
IV contrast given to highlight areas (kidneys, ureters, bladder)
Need to know: allergies and kidney function b/c dye is nephrotocxic
Dx Study: Renal Arteriogram
looking at the arteries; blood flow
Dx Study: renal ultrasound
best choice - no pain, not invasive
Looks for structural abnormalities and blood flow
Dx study: renal biopsy
collecting a sample using a needle
Dx study: Cystoscopy
examining the bladder with a scope
May have hematuria afterwards; UTI if bacteria gets in
Classifications of Renal disorders
Hereditary Infectious Obstructive Immunological Degenerative Tumors and Traumas
Polycystic Kidney Disease (PKD)
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
Symptoms of Polycystic Kidney Disease
HTN, abdominal or flank pain/heaviness, nocturia, hematuria
PKD Dx. studies
CT scan, IVP, ultrasound, urinalysis for proteinuria, hematuria, serum creatinine, BUN, urine culture
PKD management
control infection, diet modifications (restrict Na), fluid restrictions, antihypertensives
PKD Treatment
nephrectomy (to relieve pain), kidney transplant (new kidney will not get PKD)
Upper UTI
Renal parenchyma, pelvis, ureters
Acute pyelonephritis vs. Chronic
MOST ARE ACUTE!
Acute Pyelonephritis
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
Chronic Pyelonephritis
Upper UTI
Kidneys become small, atrophied, loss of function b/c of scarring - can cause renal failure
Lower UTI
bladder storage or emptying problems
Urethritis
Lower UTI
inflammation of the urethra (usually males if it is infectious)
-Usually STD’s in males
(Trichamonas, monilial infection, chlamydia, gonorrhea)
Cystitis
Lower UTI
inflammation of the bladder
*Traditional UTI - bacterial infection causing a bladder infection
Uncomplicated UTIs
lower UTI (bladder), not systemic, female, no structural abnormalities (no foley, kidney stones, strictures), normal immune system, not hospital acquired
Complicated UTIs
Risk for urosepsis, pyelonephritis, renal damage
Male
Diabetics
Initial Infection
one infection thats treated and goes away
Recurrent UTI
one infections thats treated and goes away but comes back
Predisposing Factors for Infectious Disorders
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
Clinical Manifestations of Lower UTIs
dysuria, frequent urination, urgency, suprapubic pressure, hematuria, cloudy appearance, odor
Clinical Manifestations of Upper UTIs
All Lower UTI’s s/s
PLUS: flank pain, fever, chills, N/V
Dx assessment/studies of UTIs
costovertebral tenderness (flank pain) -> UUT Bacteria in the urine, IVP, CT, CBC, imaging studies
Collaborative Care for UTIs
Meds: Pyridium (stains bodily fluids ORANGE); Trimethoprim/sulfamethoxazole, Fluoroquinolones
Acute UTI interventions
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)
UTI prevention
good hygiene, adequate fluid intake, use bathroom when needed, use bathroom after sexual intercourse, proper hand washing, taking out catheters when not needed
Immunologic Disorders
Acute or Chronic glomerulonephritis
immune process, antibody induced injury
affects both kidneys equally
usually from STREP
s/s of immunologic disorders
hematuria, increased WBC, casts, proteinuria
increased BUN and creatinine
Acute post streptococcal glomerulonephritis
re throat of 5-21 days ago; usually from untreated B-hemolytic streptococci
urine - electrolytes, protein
serum - BUN, creatinine
acute post streptococcal glomerulonephritis s/s
periorbital edema, body edema, HTN, oliguria, hematuria, rust, abdominal or flank pain
acute post streptococcal glomerulonephritis treatment
conservative: rest, fluid restriction, BP management, diuresis
Nephrotic Syndrome
glomerulus is excessively permeable to plasma protein, proteinuria, low plasma albumin, general issue edema
excessive protein loss, hypercoagulation, elevated cholesterol
nephrotic syndrome treatment
edema: fluid and sodium restriction, I&Os, daily weight
Thromboembolism: anticoagulants
Cholesterol elevation: meds to lower
Obstructive Disorders
Nephrolithiasis/Urolithiasis
stone formation anywhere in the urinary tract
obstructive disorders s/s
abdominal or flank pain, hematuria, N/V, fever, chills
obstructive disorders dx tests
urinalysis and CT scan
obstructive disorders treatment
1st: pain, infection, obstruction
2nd: cause of stone
3rd: endourologic procedures and surgery if stone is too large to pass
Urinary Tract Calculi tx
dietary modifications, adequate hydration, varies depending upon stone composition
Avoid foods: high sodium (canned soups), colas, coffee, teas , purine foods, oxalate foods
Purine foods
high in uric acid
sardiness, liver, herring, mussels, venison, kidney, beef, chicken, pork
oxalate foods
dark roughage, spinach, cabbage, asparagus, beets
lipotripsy
shockwaves to break up stones; often place stents as well
ureteral strictures
ducts that carry urine from the kidney to the bladder; secondary to surgical interventions that form scar tissue
threatens kidney function
ureteral strictures s/s
Mild colic, decreased output
ureteral strictures dx studies
IVP
ureteral strictures tx
dilation and stent, nephrostomy tube, excision and reanastomosis of the ureter to the renal pelvis
urethral stricture
obstructive disorder
caused by trauma, infection, congenital defect
repeated STI infectinos
urethral stricture s/s
diminished force of stream, straining to void, post void dribbling, incomplete bladder emptying, difficulty inserting a catheter
urethral stricture dx studies
retrograde urethrography (RUG), voiding cysturethrography
urethral stricture treatment
dilation and stent
urethral stricture teaching
self cath for dilation, urethroplasty
Nephrosclerosis
sclerosis of small arteries and arterioles of the kidney
“hardening of the kidney arteries”
dx: HTN screening
Tx: control HTN
nephrosclerosis risk factors
HTN, atherosclerosis associated w/ aging
diabetic nephropathy
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
diabetic nephropathy risk factors
HTN, smoking, chronic hyperglycemia
Renal Trauma
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
renal trauma s/s
hematuria
renal cancer risk factors
smoking, familial, obesity, HTN, exposure to chemicals and end stage renal disease
dx: IVP, ultrasound, CT, MRI
tx: radical nephrectomy, radiation therapy, chemo
renal cancer s/s
incidental findings, hematuria, flank pain, mass, HTN, weight loss, anemia
bladder cancer risk factors
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
bladder cancer s/s
dysuria, frequency, urgency, hematuria (mimics UTI s/s)
Nephrostomy Tube
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
Suprapubic Tube
drainage tube directly into the bladder for removal of urine; bypasses the urethra
always ensure unobstructed drainage
Ileal condiut
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
continent urinary diversion
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
orthotopic bladder reconstruction
urinary diversion
construction of new bladder from the bowel, reservoir replaces the bladder, elimination via the urethra
need to train the new bladder
Renal surgery - post op
shock - from blood loss; respiratory complications (pneumonia); obstruction of urine, infection, thromboplebitis (DVTs), small bowel obstruction (scar tissue formation can cause obstruction)
renal surgery post op nursing interventions
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
renal surgery post-op patient teaching
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
Acute kidney injury
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
Pre-renal
before the kidneys; not perfusing the kidneys
hypovolemia:
- hemmorhage, burns (dehydration)
intra-renal
directly at the kidneys
IV dyes, meds, NSAIDS, transfusion rxn, problem from not fixing pre or post renal problems
post-renal
after the kidneys that causes harm to the kidney
obstruction r/t urinary output: urine retention, BPH, stones, tumor, strictures
Initial phase
phase of acute kidney injury
when the insult happens
oliguric phase
phase of acute kidney injury
holding on to everything
low urine output, hypervolemia, hyperkalemia, metabolic acidosis, CNS problems
Diuretic phase
phase of acute kidney injury
kidneys try to repair itself; throwing everything out
fluid and electrolyte loss; loss of urea and creatinine
recovery phase
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
metabolic acidosis
pH is low
CO2 is normal
Bicarb is low
metabolic alkalosis
pH is high
indications for dialysis
metabolic acidosis hyperkalemia hypervolemia severe HTN severe mental status changes
common causes of chronic renal disease
diabetes and HTN
Chronic renal disease
progressive irreversible loss of kidney function
chronic kidney disease manifestations
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
1 cause of death in chronic kidney disease
cardiovascular problems
