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Adult Health 2 :) > Renal/urinary 60-62 > Flashcards

Renal/urinary 60-62 Flashcards

1
Q

Age related changes urinary

A

Loss of cortical tissue & decrease in size & nephrons with decreased blood flow
Decreased GFR (decreased number of glomeruli as well as their surface area)
-65 is 65 (Risk for fluid overload)
-DM, HTN and heart failure complicate this)
-Consider meds/dyes used in diagnostics
Nocturia
Bladder capacity
Females (weakened sphincter/shorter)
Tendency to retain(straight cath per protocol)
Tubular changes lead to urgency & nocturnal polyuria (lesser ability to concentrate urine)
Less efficient regulation (acid/base, F/E)
Thirst mechanism less so risk dehydration

Muscles decrease capacity
Men (difficult start) hesitancy
Women (Incontinence) urgancy

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2
Q

cultural considerations

A

trauma informed care
beliefs
african american(more rapid changes in GFR_)
bias

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3
Q

primary prevention

A

intervention you do before- healht promotion and teaching

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4
Q

secondary prevention

A

screenings, immunizations

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5
Q

tertiary prevention

A

know you have the prob , prevent it further

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6
Q

Conditions affects kidneys

A

HTN, diabetes, lupus, prostate,

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7
Q

what meds affect urinary

A

Acetominophen, NSAids

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8
Q

Normal intake

A

2L/day

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9
Q

pruritus, uremia

A

itching, urea in blood?. In end stage kidney disease

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10
Q

physical assessment

A

General systems review ,KUB, look listen feel for pain, costoverterbral tenderness, distension, bruits; inspect urethra- is it red, fissures, UTI

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11
Q

Serum Creatinine (breakdown of muscle and protein)

A

(.5-1.2) Decreased in Older Adults
Increased with kidney impairment

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12
Q

BUN (excretion of urea nitrogen/liver PRO metabolism)

A

10-20 (Higher in older adults)
Increases: dehydration, kidney, stress, steroids, PRO diet, infection
Decreases: malnutrition, fluid excess, liver damage

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13
Q

BUN/Creat Ratio

A

6-25 (15.5)
Increases: FVD, PRO diet, obstructive uropathy
Decreases: FVE
determine if kidneys wokring

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14
Q

Cystatin-C

A

GFR indicator
Increases when GFR decreases

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15
Q

Blood Osmolarity (concentration)

A

280-300
Indicator of hydration status
Lower levels/more dilute
Normally if increased/ADH initiates reabsorption resulting in more concentrated urine

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16
Q

Specific gravity (1.005-1.030)

A

Increased with concentrated urine
Decreased in kidney disease

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17
Q

pH (4.6-8.0) 6.0

A

Acidic if less than 7
Alkaline if greater that 7
Specimens & temperature
urine helps with metabolic acidosis

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18
Q

24 hour urine

A

Creatinine Clearance/Urea & other
Electrolytes
Osmolarity

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19
Q

what shouldnt be in urine

A

PRO
Glucose
Ketones
Bilirubin
RBC
WBC
Casts
Sediment
Crystals
Bacteria
Parasites
Leukocyte esterase
Nitrates

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20
Q

Urinalysis vs C&S

A

urinalysis- wash hands cleane peri , pee then stop, pee more and fill cup- store in fridge or ice box
Culture and sensitivity identifies organisms and how many and what antibiotic for it; ; depends on whats found in urinalysis

21
Q

Urodynamic studies

A

vaginal probes help fem with sphincter control, studies to hold and empty urine for incontinence
diagnostic

22
Q

scopes

A

in ureter tract can put stents in and examine

23
Q

renal angio

A

inject dye - check if allergic to dye, it has to be excreted by kidneys so has to have good kidney function
angiograms look at vascular structure, no metformin

24
Q

kidney biopsy

A

invasive so anesthesia and have them or CRNA get consent; stay in prone position, can bleed internally or externally, flank pain, low BP and low urine output,1-2 weeklight activity, some hematuria , bed rest/back-roll, CT guided, local anesthetic

25
Acute vs chronic UTI (urinary tract is sterile except external)
Acute-infectious organism Chronic/recurrent- 2 or more (6 mo) 3 or more a year
26
Complicated vs uncomplicated UTI
males almost always complicated
27
Contributing factors UTI
Obstruction Stones Reflex Use of antibiotics Sexual activity Organism’s virulence Age/Gender DM Urine characteristics Catheters Stool(E.coli) Decreased Immunity
28
Protective factors UTI
Mucin (mucosal integrity) Urine pH WBC’s in urine(engulf) Males (prostrate gland) Frequent voiding
29
S/S UTI
frequency/urgency, dysuria complicated: pain, fever, chills, confusion
30
Cystitis (bladder)
Inflammatory condition of the bladder Usually refers to inflammation from infection of bladder Irritants can cause cystitis without infection Incidence of UTI is second only to URI in primary care Most common health-care associated infection More than 80% of UTIs are caused by E. coli Catheters are most common factor associated with new onset UTI in hospital and long-term care settings (CAUTI) Interstitial cystitis- within tissues of bladder
31
Cysitits health promotion
Sterile technique when inserting catheters Clean technique when using intermittent catheters at home Single-use catheter recommended for home settings NPSG(national patient safety goals) – CAUTI prevention Liberal intake of water (2-3 L) Education on proper hygiene and wiping/safe sex practices
32
Assessment Cystitis
Frequency, dysuria, urgency Fever, chills, nausea, etc. may indicate infection Assess catheter Have patient void for urine examination Vital signs, lower abdomen, bladder palpation
33
lab tests Cystitis
clean catch culture serum wbc pevlvic US, cystoscopy
34
Antibiotics for UTI
Nitro furantoin trimrthroprim/sulfamethoxazole(d/c with skin rash) fosfomycin (AB can cause yeast infection) other meds: antispasmodics, antiseptics(change pH and could be drying), analgesia, antifungal, antiitch, NSAIDSs
35
Complications
interstitial cysitits(chronic/entire urinary tract), can lead to pyelonephritis/glomerulonephritis, bacteremia/Urosepsis
36
Urethritis
-inflammation urethra -sti most comon cause mucopurulet or purulent dishcharge, dysuria, discomfort -test for STI -usually resolves spontaneously
37
Crystal formations
-uric acid,calcium, vit D, drugs(steroids, topiramate, indinavir, acetazolamide), struvite, cystine
38
Urolithiasis (Calculi)
Presence of calculi (stones) in urinary tract RISK IS DEHYDRATION Family history, obesity, diabetes, gout (hyperuricemia) increase risk Diet (e.g., increased sodium) Varies with geographic location, race, family history(Southeast US, Japan, Western Europe, Men) About 12% of adults will have at least one episode
39
Interventions for kidney stones
Avoid: Na, spinach black tea, rhubarb (Calcium Oxalate) Limit: Foods high in animal PRO, NA, Calcium, Phosphate (dairy, organ meats, whole grains) (Struvite) Decrease Purines: organ meats, fish, wine, poultry, sardines Limit Cystine: Na & animal PRO Encourage fluid intake
40
diagnostics kidney stones
Urinalysis(type of stone and location) , Helical CT, Xray or US strain urine- funnel, coffee filter
41
comfort with Calculi
SEVERE PAIN (RENAL COLIC) Sudden onset N/V, pallor, diaphoresis Frequency, dysuria, anuria, oliguria, hematuria OBSTRUCTION IS AN Emergency! Assess for retention May have decreased BP (impending SHOCK) avoid rapid rehydration filter urine antibiotics to prevent infection opiods, NSAIDs with caution bc bleeding, Oxybutrin (antispasmotic)
42
meds to pass calculi
Allopurinal(for gout) thiazide diuretics citrate to alkalinize urine alpha adrenergic and CA channel blockers (relax smooth muscle of ureters
43
surgical for calculi
Lithotripsy (ESWL)- sound laser to break stones up, bruising can occur, STRAIN URINE stents surg removal (percutaneous;open)
44
post op open surg for calculi
Infection- Antibiotics Drain care Urine monitoring-(nephrostomy tube has urine come out of it) Surgical site care/monitoring (irrigate tube-inject sterile water Prevent Obstruction- Fluid intake higher(3L/day), I/O May use drugs to minimize stone formation Ambulation to pass stones (also reduces bone CA resorption) Urine Strain & check pH Address psychosocial & home care needs
45
pyelonephritis symptoms(infection UTI based)
flank pain, costo tenderness, tachycardia, dyspnea , chills fever chronic- htn frequent urination, swelling face and ankle affects fluid- swelling in face ankles
46
glomerulophritis(usually infection based but more inflammation )(affects more body systems)
suddenly from an excess immunity response within the kidney tissues can be from htn crackles in lungs
47
pyelnonephritis
xray, KUB, increased wbc treatment-antibiots
48
glomerulonephritis symptoms
uremic symptoms-slurred speech, ataxia, tremors, or asterixis (flapping tremor of the fingers or the inability to maintain a fixed posture with the arms extended and wrists hyperextended ) frequent nose bleeds treatment- high bp meds, diuretics

Adult Health 2 :) (8 decks)

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