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Med Surg 1 > Renal system > Flashcards

Renal system Flashcards

1
Q

What is Hydronephrosis

A

swelling of a kidney due to a buildup of urine

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2
Q

Hydronephrosis Causes

A

Obstruction in Urinary Tract

Can be secondary to prostate enlargement

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3
Q

Signs and symptoms of Hydronephrosis

A
  • Frequency
  • Urgency
  • Dysuria
  • Flank and Back pain
  • Renal failure
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4
Q

Interventions for Hydronephrosis

A
  • Treat cause
  • Urinary catheter
  • Stents (runs from kidney pelvis to bladder)
  • Nephrostomy Tube
    • intake and output
    • no clamping
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5
Q

What is Polycystic kidney disease

A
  • multiple cysts in the kidney

- inherited disease

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6
Q

Signs and symptoms of Polycystic kidney disease

A
  • Dull Heaviness in Flank/Back
  • Hematuria
  • Hypertension
  • UTI (prone)
  • Kidney would become enlarged (palpation possible)
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7
Q

Interventions for Polycystic kidney disease

A
  • Progressive

- No treatment

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8
Q

What is Glomerulonephritis

A
  • acute inflammation of the kidney, typically caused by an immune response
  • causes glomerulus to become more porous
  • tends to be a post-strep infection
  • can be caused by drugs or toxins
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9
Q

Signs and symptoms of Glomerulonephritis

A
  • Oliguria
  • Hypertension
  • Electrolyte Imbalances
  • Edema
  • Electrical imbalances
  • Flank Pain
  • Proteins, WBCs, RBC’s in urine
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10
Q

Dx for Glomerulonephritis

A
  • urinalysis
  • ultrasound
  • x-ray
  • biopsy
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11
Q

Interventions for Glomerulonephritis

A
  • Interventions
    • managing hypertension
    • quick treatment for strep
  • Renal Failure Treatment
  • renal dialysis
  • fluid, sodium, protein restrictions
  • Monitor Vital signs
  • Symptom support
  • rest
  • education
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12
Q

Acute Renal Failure

A

-Sudden loss of kidney function

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13
Q

Acute renal failure causes

A

types

  • prerenal failure
  • intrarenal failure
  • nephrotoxins
  • postrenal failure
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14
Q

Cause of prerenal failure

A
  • Decreased blood supply to kidneys
    • blood loss
    • heart failure
    • blockage
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15
Q

Cause of intrarenal failure

A
  • damage to nephrons
    • nephrotoxins
      • diagnostic contrast media (dyes)
      • medications (IV Aminoglycosides, Tobramycin, Amikacin, Cisplatin), Chemicals
    • damaging immune response
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16
Q

Causes for postrenal failure

A

-Obstruction (below kidney) causing backflow

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17
Q

Dx of acute renal failure

A
  • History
  • Prevention
    • check serum BUN and creatinine prior to dyes or meds
    • Hydrate before/after contrast media
    • Monitor peak/trough levels of nephrotoxic drugs per policy
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18
Q

Oliguric phase of acute renal failure

A
  • low output
  • Monitor labs
  • Restrict fluid, Na & poss. Protein
  • 24hrs-week
  • Fluid, electrolytes imbalance
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19
Q

Diuretic phase of acute renal failure

A
  • high output
  • Fluid electrolytes balance out of wack
  • dehydration – on high IV fluids
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20
Q

Recovery phase of acute renal failure

A

-takes up to 1 year

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21
Q

interventions for acute renal failure

A
  • treat cause
  • supportive treatment (fluid electrolytes, HbG, Hct,etc)
  • dialysis
  • continuous renal replacement
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22
Q

Chronic Renal Failure

A
  • Gradual decrease in kidney fx

- irreversible

23
Q

Causes of chronic renal failure

A
  • Diabetes
  • Hypertension
  • Chronic exposure to toxins
  • Hyperlipidemia
  • Diabetic Nephropathy
  • Nephrosclerosis
  • Glomerulonephritis
  • Autoimmune Diseases
24
Q

S/S of chronic renal failure

A
  • Large Proportion of Nephrons Damaged
  • Progressive
  • Renal Insufficiency: 75% of Nephrons Lost
  • End-stage: 90% of Nephrons Lost
  • Uremia: Urea in the Blood
  • Affects All Body Systems
25
Q

Interventions for chronic renal failure

A 
Treat causation 
   -Hypertension
   -Diabetes
   -Cholesterol
Fluid Restriction
Treat anemia (w/erythropoietin)
Treat Ca+/hyperparathyroidism
Treat metabolic acidosis
Diet
Medications
Dialysis
26
Q

Diet interventions for chronic renal failure

A
  • High Calorie
  • Low Protein (Unless Dialysis)
    • b/c of the byproducts that kidneys must filter
    • [controversial b/c lack of ability to repair tissue]
  • Low Sodium, Potassium, Phosphorus
  • Increased Calcium
  • Vitamins
27
Q

Medication interventions for chronic renal failure

A
  • Diuretics
  • Antihypertensives
  • Phosphate Binders
  • Calcium/Vitamin D Supplements
  • Kayexalate prn
28
Q

Dialysis intervention for chronic renal failure - occurs with specific symptoms

A
  • Symptoms of Fluid Overload
  • High Potassium
  • Neurological Signs
  • Uremia
29
Q

Vascular access care for acute renal failure

A
  • listen for thrill, bruit over access site
  • don’t take BP on arm with access
  • instruct pt to be careful with arm with access
  • keep watch for infection
  • take radial pulse, size, T etc of each arm to monitor for circulatory compromise
  • postop - NV checks, pain, elevate extremity
30
Q

Dialysis done by pt

A
  • Peritoneal Membrane Is Semipermeable Membrane, Across which Excess Wastes/ Fluids Move from Blood
  • Peritoneal Catheter
  • Exchange Process: Fill, Dwell Time, Drain
  • Takes about 8 hrs
  • must have frequent labs to determine solution concentrations
31
Q

Kidney transplant interventions

A
  • Living-Related Donor or Cadaver Donor
  • Antirejection Drugs
  • Donate kidney typically lasts ~10 yrs
32
Q

Nursing care for excess fluid volume

A
  • Monitor Weight
  • Intake and Output
  • Fluid Restriction
  • Monitor for Fluid Retention
33
Q

Nursing care for electrolyte imbalance

A
  • Monitor Levels
  • Dietary Restrictions
  • Monitor Dysrhythmias
34
Q

Nursing care for waste products

A
  • Oral Care
  • Skin Care
  • Lotion
  • Protect from Injury
35
Q

Nursing care for impaired hematological fx

A

-Protect from Injury/Infection

36
Q

Cancer of the Kidney

A
  • Rare
  • Exact cause unknown
  • Risk Factors
    • Smoking – lifetime risk
    • Obesity
    • Hypertension
    • Exposure to asbestos, lead, cadmium and phosphates
37
Q

S/S of cancer of the Kidney

A
  • Palpable abdominal mass found during routine exam.
  • Hematuria
  • dull pain in flank area
  • mass
38
Q

Dx for cancer of the kidney

A
  • IVP (intravenous pyelogram- x-ray examination of the kidneys)
  • Cystoscopy and Pyelogram
  • Ultrasound
  • CT Scan
  • MRI
  • Renal Biopsy
39
Q

Cancer of the Bladder

A 
Most Common Urinary Tract Cancer 
Men > Women
Ages 50-60 Years
Etiology 
 Smoking
 Industrial Pollution – aniline dyes, asbestos, and aromatic amines
40
Q

S/S of cancer of the bladder

A 
Early 
  -Painless 
  -Hematuria 
Late
  -Pelvic pain
  -lower back pain
  -dysuria, frequency, urgency
  -inability to void
41
Q

Dx for bladder cancer

A
  • Urinalysis
  • Urine for Cytology, Culture
  • Cystoscopy and Transurethral Biopsy
  • IVP (Intravenous pyelogram)
42
Q

Urological obstructions

A

Obstruction of Urine Flow Is Always Significant
Backup of Urine Destroys Kidney
-urethral strictures (lumen narrowing due to scar tissue)
-renal calculi
-hard, generally stones
-kidney stones (nephrolithiasis) - formed primarily in kidney

43
Q

Types of kidney stones

A
  • Calcium – found in 90% of stones
  • Uric acid
  • Oxalate
  • Struvite
  • Cystine
  • Xanthine
44
Q

Causes of kidney Calculi (stones)

A
  • Heredity
  • Chronic Dehydration
  • Infection
  • Immobility
  • Men >Women
45
Q

S/S of Renal Calculi (stones)

A
  • Flank Pain
  • Renal Colic
  • Dysuria
  • Costovertebral Tenderness
  • Hematuria
  • Frequency
  • Urgency
  • Enuresis
  • GI Upset
46
Q

Dx of Renal Calculi

A
  • Kidney-Ureter-Bladder X-ray
  • IVP - intravenous pyelogram
  • renal ultrasound
  • urinalysis (RBC, WBC)
47
Q

Complications of Renal calculi

A
  • UTIs
  • Hydronephrosis
  • Pain, spasm, or colic from peristalsis movement of ureter contracting on the stone
  • tissue trauma
48
Q

Tx for renal calculi

A

-Using pain medicine: Nonprescription medicine, such as NSAIDs, Narcotics
-Drinking enough fluids: drinking water and other fluids may help passing a calculi.
-Lithotripsy
-Surgery
-(Uric Acid)
Allopurinol

49
Q

Urinary Incontinence/ Urinary retention Types

A

Stress Incontinence
-Involuntary Urine Loss from Increasing Abdominal Pressure
Urge Incontinence
-Involuntary Urine Loss with Abrupt/Strong Desire to Void
Overflow Incontinence
-Incontinence for distension of bladder
-Commonly assoc. with obstruction of outlet or BPH (benign
prostate hypertrophy)
Functional Incontinence
-Incontinence from Impairment of Physical/Mental Function
Total Incontinence
-Continuous, Unpredictable Loss of Urine

50
Q

Urinary Retention

A

Acute
-Anesthesia, Medications, Local Trauma to Urinary Structures
Chronic
-Enlarged Prostate, Medications, Strictures, Tumors

51
Q

Urinary retention Dx

A

-Monitor Urine Output, Bladder distention
-Bladder Scan
-Residual Volume of more than100 ml Urine
-Indicates Need for Treatment
Nursing diagnosis – Risk for impaired tissue/tissue damage
Indwelling Catheters
Urinary Catheters Result in Infection

52
Q

Types of Urinary Catheters

A 
Intermittent Catheterization
  -Best
  -Reduces Risk of Infection
  -Patients May Self-cath
Suprapubic Catheter
  -Indwelling Catheter Inserted Through  Incision in Lower     
    Abdomen into Bladder
53
Q

Nursing Dx for Urinary Incontinence

A

Risk for

  • Stress incontinence
  • Urgency incontinence
  • Total incontinence
  • Functional incontinence
  • Overflow incontinence
  • Skin impairment
  • Self-care deficit r/t toileting
  • Situational low self esteem
  • Social anxiety
  • Disturbed body image
54
Q

Justifiable reasons for catheterization

A
  • Close monitoring of output
  • Urinary Tract Obstruction
  • Neurogenic Bladder
  • Treatment Related Immobility

Med Surg 1 (8 decks)

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