Renal System

Question 1

125 - EXPECTED VALUES: Creatinine, BUN, Urinalysis

Nursing Care during Cystography/Urography

Answer 1

CREATININE, BUN, URINALYSIS, CYSTOGRAPHY/UROGRAPHY

CREATININE: 0.6/1.2 mg/dL. Elevated levels indicated kidney disease (more definitive than BUN).

BUN (BLOOD UREA NITROGEN) 10-20 mg/dL. Elevated levels may indicated kidney disease or dehydration.

URINALYSIS: SPECIFIC GRAVITY SHOULD BE BETWEEN 1.01 - 1.O25. No glucose, protein, ketones, leukocyte esterase, or nitrites should be found in urine.

CYSTOGRAPHY/UROGRAPHY:
+ Check for allergies to iodine, shellfish.
+ NPO after midnight, bowel preparation night before procedure.
+ Encourage increased fluid intake after procedure. Pink tinged urine expected
+ Monitor for signs of infection: cloudy foul smelling urine, urinary urgency, urinalysis positive for leukoesterase, nitrites.

Question 2

131 - Glomerulonephritis:
\+ What is it?
\+ Risk factors
\+ S/S
\+ Labs

Answer 2

GLOMERULONEPHRITIS

GLOMERULONEPHRITIS: Immune complex disease resulting in inflammation of glomerular capillaries.

RISK FACTORS: STREPOCOCCAL INFECTION, lupus, hypertension, diabetes.

S/S: Decreased urine output, fluid volume excess (edema, weight gain, dyspnea, hypertension).

LABS: Throat culture positive for strep.
+ POSITIVE ASO (ANTISTREPTOLYSIN TITER)
+ Decreased GFR (obtained through 24 hour urine collection to determine creatinine clearance).
+ Urinalysis: increased urine specific gravity, proteinuria, hematuria (coffee-colored).
+ Elevated WBC, ESR.

Question 3

132 - Glomerulonephritis:
+ Nursing care
+ Therapeutic procedure

Answer 3

CREATININE, BUN, URINALYSIS, CYSTOGRAPHY/UROGRAPHY

NURSING CARE:
+ Monitor weight (report weight gain of 2 lbs in 24 hr or 5 lbs in 1 week).
+ Monitor I&Os, labs. RESTRICT FLUIDS, SODIUM, PROTEIN.
+ Administer antibiotics for strep infection
+ Administer diuretics, corticosteroids

PROCEDURE: Plasmapheresis (to filter antibody complexes out of blood).

Question 4

133 - Acute Kidney Injury:

+ 3 Types of AKI

Answer 4

ACUTE KIDNEY INJURY
+ PRERENAL AKI: Due to decreased blood flow to kidneys (shock, sepsis, hypovolemia, renal vascular obstruction)l.
+ INTRARENAL AKI: Direct damage to kidneys (physical trauma, hypoxic injury, chemical injury due to toxins or medications).
+ POSTRENAL AKI: Due to obstruction leaving the kidneys (stone, tumor, BPH).

Question 5

134 - Acute Kidney Injury:
+ Four phases
+ Recommended diet

Answer 5

ACUTE KIDNEY INJURY

AKI PHASES:
+ Onset to development of oliguria (hours-days)
+ OLIGURIA: Urine output is 100-400 ml/24 hours (1-3 weeks)
+ DIURESIS: Start of kidney recovery, large amount of urine excreted (2-6 weeks).
+ RECOVERY: Continues until complete recovery (up to 1 year).

DIET: Restrict potassium phosphate, magnesium intake. Increase protein intake.

Question 6

135 - Chronic Kidney Injury (CKD)
+ What is it?
+ Risk factors
+ CKD stages

Answer 6

CHRONIC KIDNEY INJURY (CKD)

CKD: Gradual, irreversible loss of kidney function,.

RISK FACTORS: Aging, dehydration, AKI, Diabetes, Hypertension, Chronic glomerulonephritis, medications (gentamicin, NSAIDs), autoimmune diseases.

STAGES:
\+ Stage 1;  GFR .> 90 ml/min
\+ Stage 2:  GFR 60-89 ml/min
\+ Stage 3:  GFR 30-59 ml/min
\+ Stage 4:  GFR 15-29 ml/min
\+ Stage 5:  GFR < 15 ml/min

Question 7

136 - Chronic Kidney Injury (CKD)

+ Symptoms, Labs

Answer 7

CHRONIC KIDNEY INJURY (CKD)

SYMPTOMS: (mostly result of fluid volume overload): jugular distention, hypertension, dyspnea, tachypnea, crackles, peripheral edema, lethargy, tremors, n/v, pruritus, uremic frost.

LABS:
\+ Elevated creatinine, BUN
\+ DECREASED SODIUM, CALCIUM
\+ INCREASED POTASSIUM, PHOSPHORUS, MAGNESIUM
\+ Decreased Hgb and Hct
\+ Urinalysis:  hematuria, proteinuria

Question 8

137 - Chronic Kidney Disease (CKD)

+ Nursing care, Meds

Answer 8

CHRONIC KIDNEY INJURY (CKD)

NURSING CARE:
+ Weigh patient daily (1 kg weight gain = 1 L fluid retained).
+ Diet: High carbs, moderate fat. RESTRICT SODIUM, POTASSIUM, PHOSPHORUS, MAGNESIUM.
+ Protect skin from breakdown.
+ Prepare patient for hemodialysis.
+ Promote frequent rest periods.

MEDS: Digoxin, sodium polystyrene (to reduce serum potassium), erythropoietin (to increase RBC production), furosemide. Avoid NSAIDs, contrast dye, and magnesium-containing antacids.

Question 9

138 - Urinary Tract Infection (UTI)
+ What is it?
+ Risk factors, S/S, Urinalysis results

Answer 9

URINARY TRACT INFECTION (UTI)

UTI: Infection in lower urinary tract, usually caused by E coli.

RISK FACTORS: Female gender (short urethra, close proximity to rectum), menopause, sexual intercourse, pregnancy, synthetic underwear, wet bathing suits, frequent baths, urinary catheters, stool incontinence, Diabetes, incomplete bladder emptying.

S/S: Abdominal pain, dysuria (urinary frequency/urgency), fever, n/v, hematuria, pyuria, cloudy/foul-smelling urine, confusion (in older adults!)

URINALYSIS: Presence of bacteria, WBC, POSITIVE LEUKOCYTE ESTERASE AND NITRATES.

Question 10

139 - Urinary Tract Infections (UTIs)
+ Medications
+ Complications
+ Prevention

Answer 10

URINARY TRACT INFECTIONS (UTIs)

MEDS: Antibiotics (fluoroquinolone, nitrofurantoin, trimethoprim, sulfonamides), Phenazopyridine (bladder analgesic - warn patient it will turn their urine orange).

COMPLICATIONS: Urosepsis (Symptoms: hypotension, tachycardia, tachypnea, fever).

PREVENTION:
+ Drink >= 3L of fluid daily
+ Maintain good body hygiene
+ Empty bladder regularly (every 3-4 hours)
+ Urinate before and after intercourse
+ Drink cranberry juice
+ Women: Wipe front to back, avoid bubble baths and perfume-containing feminine hygiene products, avoid sitting in wet bathing sits, avoid pantyhose or tight clothing.

Question 11

140 - Pyelonephritis:
+ What is it?
+ Risk factors
+ S/S, Labs, Meds, Complications

Answer 11

PYELONEPHRITIS

PYELONEPHRITIS: Kidney infection, usually caused by E coli. Starts in lower urinary tract and moves up to kidney.

RISK FACTORS: BPH, kidney stones, pregnancy, increased rinse pH, incomplete bladder emptying, chronic disease.

S/S: COSTOVERTEBRAL TENDERNESS, fever, flank/back pain, n/v, tachycardia, tachypnea, hypertension, chills.

LABS:
+ Urinalysis positive for leukocyte esterase, nitrites, WBCs, bacteria.
+ Elevaged creatinine, BUN
+ Elevated ESR, C- reactive protein

MEDS: Antibiotics, opioid analgesics

COMPLICATIONS: Septic shock (symptoms: hypotension, tachycardia, fever), CKD, hypertension.

Question 12

141 - Urolithiasis:
+ What is it?
+ Risk factors, S/S, Nursing care, Medications

Answer 12

UROLITHIASIS

UROLITHIASIS: Presence of stones (calculi) in urinary tract, composed of calcium phosphate, calcium oxalate, or uric acid.

RISK FACTORS: Male gender, damage to urinary tract lining, high acidity or alkalinity of urine, urinary retention, dehydration.

S/S: Severe pain (flank pain, possibly radiating to abdomen), dysuria, fever, diaphoresis, n/v, pallor, tachycardia, tachypnea, oliguria, hematuria.

NURSING CARE: Monitor I&Os, STRAIN ALL URINE (and save stone for lab analysis), increase fluids to 3 L/day, encourage ambulation.

MEDS: Opioid analgesics or NSAIDs, anti-spasmodic drugs (oxybutynin).

Question 13

142 - Urolithiasis:
+ Procedures
+ Patient education regarding nutrition

Answer 13

UROLITHIASIS

PROCEDURES:
+ Lithotripsy (uses laser or shock-wave energy to break up stones, done under moderate sedation). Strain urine following procedure. HEMATURIA, BRUISING at lithotripsy site is expected.
+ Stenting
+ Ureterolithotomy (extract stone)

EDUCATION:
+ Increase fluid intake (2-3 L/day)
+ For calcium phosphate stones, limit intake of animal protein and sodium
+ For oxalate stones, limit foods high in oxalates: spinach, rhubarb, strawberries, beets, chocolate, nuts, tea
+ For uric acid stones, limit foods high in purines (meat, whole grains, legumes)