Renal system Flashcards
What is Hydronephrosis
swelling of a kidney due to a buildup of urine
Hydronephrosis Causes
Obstruction in Urinary Tract
Can be secondary to prostate enlargement
Signs and symptoms of Hydronephrosis
- Frequency
- Urgency
- Dysuria
- Flank and Back pain
- Renal failure
Interventions for Hydronephrosis
- Treat cause
- Urinary catheter
- Stents (runs from kidney pelvis to bladder)
- Nephrostomy Tube
- intake and output
- no clamping
What is Polycystic kidney disease
- multiple cysts in the kidney
- inherited disease
Signs and symptoms of Polycystic kidney disease
- Dull Heaviness in Flank/Back
- Hematuria
- Hypertension
- UTI (prone)
- Kidney would become enlarged (palpation possible)
Interventions for Polycystic kidney disease
- Progressive
- No treatment
What is Glomerulonephritis
- 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
Signs and symptoms of Glomerulonephritis
- Oliguria
- Hypertension
- Electrolyte Imbalances
- Edema
- Electrical imbalances
- Flank Pain
- Proteins, WBCs, RBC’s in urine
Dx for Glomerulonephritis
- urinalysis
- ultrasound
- x-ray
- biopsy
Interventions for Glomerulonephritis
- Interventions
- managing hypertension
- quick treatment for strep
- Renal Failure Treatment
- renal dialysis
- fluid, sodium, protein restrictions
- Monitor Vital signs
- Symptom support
- rest
- education
Acute Renal Failure
-Sudden loss of kidney function
Acute renal failure causes
types
- prerenal failure
- intrarenal failure
- nephrotoxins
- postrenal failure
Cause of prerenal failure
- Decreased blood supply to kidneys
- blood loss
- heart failure
- blockage
Cause of intrarenal failure
- damage to nephrons
- nephrotoxins
- diagnostic contrast media (dyes)
- medications (IV Aminoglycosides, Tobramycin, Amikacin, Cisplatin), Chemicals
- damaging immune response
- nephrotoxins
Causes for postrenal failure
-Obstruction (below kidney) causing backflow
Dx of acute renal failure
- 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
Oliguric phase of acute renal failure
- low output
- Monitor labs
- Restrict fluid, Na & poss. Protein
- 24hrs-week
- Fluid, electrolytes imbalance
Diuretic phase of acute renal failure
- high output
- Fluid electrolytes balance out of wack
- dehydration – on high IV fluids
Recovery phase of acute renal failure
-takes up to 1 year
interventions for acute renal failure
- treat cause
- supportive treatment (fluid electrolytes, HbG, Hct,etc)
- dialysis
- continuous renal replacement
Chronic Renal Failure
- Gradual decrease in kidney fx
- irreversible
Causes of chronic renal failure
- Diabetes
- Hypertension
- Chronic exposure to toxins
- Hyperlipidemia
- Diabetic Nephropathy
- Nephrosclerosis
- Glomerulonephritis
- Autoimmune Diseases
S/S of chronic renal failure
- 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
Interventions for chronic renal failure
Treat causation -Hypertension -Diabetes -Cholesterol Fluid Restriction Treat anemia (w/erythropoietin) Treat Ca+/hyperparathyroidism Treat metabolic acidosis Diet Medications Dialysis
Diet interventions for chronic renal failure
- 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
Medication interventions for chronic renal failure
- Diuretics
- Antihypertensives
- Phosphate Binders
- Calcium/Vitamin D Supplements
- Kayexalate prn
Dialysis intervention for chronic renal failure - occurs with specific symptoms
- Symptoms of Fluid Overload
- High Potassium
- Neurological Signs
- Uremia
Vascular access care for acute renal failure
- 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
Dialysis done by pt
- 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
Kidney transplant interventions
- Living-Related Donor or Cadaver Donor
- Antirejection Drugs
- Donate kidney typically lasts ~10 yrs
Nursing care for excess fluid volume
- Monitor Weight
- Intake and Output
- Fluid Restriction
- Monitor for Fluid Retention
Nursing care for electrolyte imbalance
- Monitor Levels
- Dietary Restrictions
- Monitor Dysrhythmias
Nursing care for waste products
- Oral Care
- Skin Care
- Lotion
- Protect from Injury
Nursing care for impaired hematological fx
-Protect from Injury/Infection
Cancer of the Kidney
- Rare
- Exact cause unknown
- Risk Factors
- Smoking – lifetime risk
- Obesity
- Hypertension
- Exposure to asbestos, lead, cadmium and phosphates
S/S of cancer of the Kidney
- Palpable abdominal mass found during routine exam.
- Hematuria
- dull pain in flank area
- mass
Dx for cancer of the kidney
- IVP (intravenous pyelogram- x-ray examination of the kidneys)
- Cystoscopy and Pyelogram
- Ultrasound
- CT Scan
- MRI
- Renal Biopsy
Cancer of the Bladder
Most Common Urinary Tract Cancer Men > Women Ages 50-60 Years Etiology Smoking Industrial Pollution – aniline dyes, asbestos, and aromatic amines
S/S of cancer of the bladder
Early -Painless -Hematuria Late -Pelvic pain -lower back pain -dysuria, frequency, urgency -inability to void
Dx for bladder cancer
- Urinalysis
- Urine for Cytology, Culture
- Cystoscopy and Transurethral Biopsy
- IVP (Intravenous pyelogram)
Urological obstructions
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
Types of kidney stones
- Calcium – found in 90% of stones
- Uric acid
- Oxalate
- Struvite
- Cystine
- Xanthine
Causes of kidney Calculi (stones)
- Heredity
- Chronic Dehydration
- Infection
- Immobility
- Men >Women
S/S of Renal Calculi (stones)
- Flank Pain
- Renal Colic
- Dysuria
- Costovertebral Tenderness
- Hematuria
- Frequency
- Urgency
- Enuresis
- GI Upset
Dx of Renal Calculi
- Kidney-Ureter-Bladder X-ray
- IVP - intravenous pyelogram
- renal ultrasound
- urinalysis (RBC, WBC)
Complications of Renal calculi
- UTIs
- Hydronephrosis
- Pain, spasm, or colic from peristalsis movement of ureter contracting on the stone
- tissue trauma
Tx for renal calculi
-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
Urinary Incontinence/ Urinary retention Types
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
Urinary Retention
Acute
-Anesthesia, Medications, Local Trauma to Urinary Structures
Chronic
-Enlarged Prostate, Medications, Strictures, Tumors
Urinary retention Dx
-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
Types of Urinary Catheters
Intermittent Catheterization
-Best
-Reduces Risk of Infection
-Patients May Self-cath
Suprapubic Catheter
-Indwelling Catheter Inserted Through Incision in Lower
Abdomen into BladderNursing Dx for Urinary Incontinence
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
Justifiable reasons for catheterization
- Close monitoring of output
- Urinary Tract Obstruction
- Neurogenic Bladder
- Treatment Related Immobility
