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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
Q

Acute vs chronic UTI
(urinary tract is sterile except external)

A

Acute-infectious organism
Chronic/recurrent- 2 or more (6 mo) 3 or more a year

26
Q

Complicated vs uncomplicated UTI

A

males almost always complicated

27
Q

Contributing factors UTI

A

Obstruction
Stones
Reflex
Use of antibiotics
Sexual activity
Organism’s virulence
Age/Gender
DM
Urine characteristics
Catheters
Stool(E.coli)
Decreased Immunity

28
Q

Protective factors UTI

A

Mucin (mucosal integrity)
Urine pH
WBC’s in urine(engulf)
Males (prostrate gland)
Frequent voiding

29
Q

S/S UTI

A

frequency/urgency, dysuria
complicated: pain, fever, chills, confusion

30
Q

Cystitis (bladder)

A

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
Q

Cysitits health promotion

A

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
Q

Assessment Cystitis

A

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
Q

lab tests Cystitis

A

clean catch
culture
serum wbc
pevlvic US, cystoscopy

34
Q

Antibiotics for UTI

A

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
Q

Complications

A

interstitial cysitits(chronic/entire urinary tract),
can lead to pyelonephritis/glomerulonephritis, bacteremia/Urosepsis

36
Q

Urethritis

A

-inflammation urethra
-sti most comon cause
mucopurulet or purulent dishcharge, dysuria, discomfort
-test for STI
-usually resolves spontaneously

37
Q

Crystal formations

A

-uric acid,calcium, vit D, drugs(steroids, topiramate, indinavir, acetazolamide), struvite, cystine

38
Q

Urolithiasis (Calculi)

A

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
Q

Interventions for kidney stones

A

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
Q

diagnostics kidney stones

A

Urinalysis(type of stone and location)
, Helical CT, Xray or US
strain urine- funnel, coffee filter

41
Q

comfort with Calculi

A

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
Q

meds to pass calculi

A

Allopurinal(for gout)
thiazide diuretics
citrate to alkalinize urine
alpha adrenergic and CA channel blockers (relax smooth muscle of ureters

43
Q

surgical for calculi

A

Lithotripsy (ESWL)- sound laser to break stones up, bruising can occur, STRAIN URINE
stents
surg removal (percutaneous;open)

44
Q

post op open surg for calculi

A

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
Q

pyelonephritis symptoms(infection UTI based)

A

flank pain, costo tenderness, tachycardia, dyspnea , chills fever
chronic- htn
frequent urination, swelling face and ankle
affects fluid- swelling in face ankles

46
Q

glomerulophritis(usually infection based but more inflammation )(affects more body systems)

A

suddenly from an excess immunity response within the kidney tissues
can be from htn
crackles in lungs

47
Q

pyelnonephritis

A

xray, KUB, increased wbc
treatment-antibiots

48
Q

glomerulonephritis symptoms

A

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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