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NCLEX-RN® > NCLEX-RN (5) Adult Health > Renal/Urinary > Flashcards

Renal/Urinary Flashcards

Review the most important renal diseases.

1
Q

What is the function of the kidneys?

A

“A WET BED”:

  • A: Acid-base balance
  • W: Water balance
  • E: Electrolyte balance
  • T: getting rid of Toxins
  • B: Blood pressure control
  • E: making Erythropoietin
  • D: Vitamin D production
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2
Q

What are the general interventions for any kidney problem?

A
  • assess vital signs for FVO or FVD
  • check electrolytes
  • monitor intake and output
  • weigh daily
  • monitor renal labs - BUN, creatinine, GFR
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3
Q

What 2 groups can have decreased kidney function?

A

Elderly and infants.

Be more concerned with nephrotoxicity from meds and substances in these 2 groups.

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4
Q

What are some common classifications of medications that are nephrotoxic?

A
  • antibiotics
  • antineoplastics
  • NSAIDs
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5
Q

Describe:

Acute kidney injury (AKI)

A

The rapid loss of kidney function.

The client can recover but it can take years.

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6
Q

What causes prerenal AKI?

A

Prerenal AKI is damage to the kidneys caused by problems before the kidneys such as:

  • decreased cardiac output from shock
  • prerenal infection or obstruction

The kidneys aren’t getting blood flow causing damage.

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7
Q

What causes intrarenal AKI?

A

Intrarenal AKI is damage to the kidneys caused by problems inside the kidneys such as:

  • renal infection
  • nephrotoxic meds or substances
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8
Q

What causes postrenal AKI?

A

Postrenal AKI is damage to the kidneys caused by problems in the bladder which is after the kidneys such as:

  • bladder obstruction, infection or cancer
  • kidney stones
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9
Q

What are the 3 phases of AKI?

A
  1. oliguric phase: pee very little
  2. diuretic phase: pee a lot
  3. recovery phase: pee normally
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10
Q

Describe:

Oliguric phase of AKI

A
  • lasts 1 - 2 weeks
  • urine output is very low at < 400 mL/day
  • will get signs of fluid volume overload
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11
Q

What are the labs in the oliguric phase of AKI?

A

Due to fluid volume overload and retaining toxins and electrolytes:

  • ↑ BUN and ↑ creatinine
  • ↓ GFR
  • ↑ potassium and ↓ sodium (or sodium will be normal)
  • ↑ phosphorus and ↓ calcium
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12
Q

Describe:

Diuretic phase of AKI

A
  • lasts 10 - 14 days
  • urine output is excessive at 4 - 5 liters/day
  • will get signs of fluid volume deficit
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13
Q

What are the labs in the diuretic phase of AKI?

A

Due to fluid volume deficit:

  • gradual decline in BUN and creatinine (but both still ↑)
  • ↓ GFR, but improving
  • ↓ potassium and ↓ sodium
    • kidneys are able to get rid of extra electrolytes
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14
Q

Describe:

Recovery phase of AKI

A
  • may take 1 - 2 years
  • urine output is normal

Can progress to chronic kidney disease if damage was extensive.

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15
Q

Why can clients with AKI get confused and eventually go into a coma?

A

The client with AKI is retaining fluids and electrolytes and is unable to get rid of nitrogenous waste products.

This causes metabolic acidosis, which can cause confusion.

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16
Q

Interventions:

Oliguric phase of AKI

A

Focus on the problems associated with fluid volume overload:

  • restrict fluids
  • if hypertension is present, restrict fluids to < 1000 mL/day
  • give diuretics
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17
Q

Interventions:

Diuretic phase of AKI

A

Focus on the problems associated with fluid volume deficit:

  • give IV fluids
  • replace electrolytes
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18
Q

Describe:

Chronic kidney disease (CKD)

A

A slow and progressive loss of kidney function.

GFR is < or = to 60 mL per minute for 3 months or longer.

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19
Q

Cause:

Chronic kidney disease (CKD)

A

Damage to kidneys from:

  • diabetes mellitus
  • chronic hypertension
  • chronic urinary obstruction
  • recurrent infections
  • autoimmune disorders
  • after AKI
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20
Q

The signs and symptoms of CKD can affect every system. Why is this?

A

The kidneys have many functions including fluid and electrolyte balance, acid-base balance, and getting rid of toxins. If the kidneys cannot do their job, the entire body will be affected.

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21
Q

What are the neuro symptoms with CKD?

A

Due to toxins and electrolytes building up in blood:

  • asterixis (flapping of hand)
  • can’t concentrate and lethargic
  • paresthesias and twitching
  • late sign is coma
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22
Q

What are the cardiovascular symptoms of CKD?

A

Due to fluid volume overload and electrolyte imbalances such as hyperkalemia:

  • edema and heart failure
  • hypertension
  • dysrhythmias
  • pericardial effusion and friction rub

Put clients on continuous telemetry.

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23
Q

What are the respiratory symptoms of CKD?

A
  1. crackles and tachypnea due to fluid volume overload
    • pulmonary edema is a late sign
  2. Kussmaul’s due to metabolic acidosis
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24
Q

What are the hematological symptoms of CKD?

A
  • anemia due to decreased erythropoietin
  • decreased platelets and bleeding due to hormone imbalances
    • ecchymosis
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25
What are the **skin symptoms** with CKD?
Due to **toxins coming through the skin:** * pruritis * yellow-gray pallor * late sign: uremic frost (crystals on skin)
26
What are the **musculoskeletal symptoms** of CKD?
Due to **calcium and general electrolyte imbalances:** * bone pain and fractures * muscle weakness and cramping
27
What happens **psychologically** to the client with CKD?
Because CKD affects all the systems and **lifestyle changes are necessary**, the client with CKD can become: * lethargic * depressed * suicidal ## Footnote Use teaching and therapeutic communication to help the client cope.
28
What is the prescribed **diet** for a client with AKI and CKD?
1. **low to moderate protein intake** - to reduce workload of kidneys and prevent toxicity 2. **high carb** - need extra calories 3. **low potassium and phosphorus** - kidneys are unable to get rid of these electrolytes
29
What is **dialysis**?
The treatment for AKI (oliguric phase) and CKD. ## Footnote Dialysis removes excess water, electrolytes, and toxins from the blood.
30
How is anemia **treated** for a client with CKD?
* give erythropoietin to increase the RBCs * possible blood transfusion
31
What is **hemodialysis**?
When **blood is pumped out of the body to clean the blood** of toxins and electrolytes. ## Footnote Assess for hypotension.
32
Which **medications** are typically held before dialysis?
**Before dialysis, hold cardiac meds** that affect blood pressure and heart rate. Give after the client comes back from dialysis. ## Footnote If given before dialysis, the meds will be excreted during dialysis.
33
What can be used **temporarily** for hemodialysis?
A **CVAD** such as a subclavian or femoral catheter, especially for those with AKI. ## Footnote When using a catheter for hemodialysis, DO ***_NOT_*** use it for anything else (such as meds or fluids).
34
What is used for **long-term** hemodialysis?
**Arteriovenous (AV) fistula or graft** for those with CKD.
35
How **long** does it take for an AV fistula or graft to heal and mature after it is made?
It takes **4 - 6 weeks to heal and mature** for use. ## Footnote Have client squeeze a ball to help it heal.
36
What are the **basic assessments** while an AV fistula or shunt is healing?
* bleeding and clots * infection * decreased circulation by checking the pulses distal (below) the fistula or shunt
37
What should **NEVER** be done on an arm with an AV fistula or graft?
* blood pressure * IV lines * giving injections ## Footnote These actions can cause damage. Tell client to tell everyone to _NOT_ touch that arm for invasive procedures.
38
What is **assessed** before using an AV fistula or shunt for hemodialysis?
Assess circulation by checking for a bruit and thrill: * **bruit:** use stethoscope to _hear_ a "whoosh-whoosh" sound * **thrill:** put hand over fistula to _feel_ a "whoosh-whoosh". ## Footnote If absent, notify the HCP.
39
What is **peritoneal dialysis**?
When **fluids are pumped out of the abdominal cavity** to clean the body of toxins and electrolytes.
40
What are the **basic interventions** before peritoneal dialysis is started?
* warm the bag of fluids to prevent discomfort and to help the veins to dilate * get vital signs, weight, fluid and electrolyte values * check dressing for wetness
41
What are the **basic interventions** during peritoneal dialysis?
* get vital signs * watch for respiratory distress, hyper- or hypotension due to fluid shifts * monitor intake and output
42
What **color** should the dialysate be when it comes back out?
**Clear**. * _cloudy_ is a sign of **infection** * _red_ is a sign of **bleeding** ## Footnote Report any abnormal color to HCP.
43
Should **more or less dialysate come out** after peritoneal dialysis is finished?
**More dialysate should come** out since the client needs to get rid of the extra fluids.
44
What is the **intervention** if all the dialysate isn't coming out of the client?
**Turn the client to the side** to move the tube into a different spot and see if the fluid starts coming out.
45
# Complete the sentence: Peritoneal dialysis is a ________ procedure. _________ can occur.
Peritoneal dialysis is a **_sterile_** procedure. **_Peritonitis_** can occur. ## Footnote Prevent infection and assess for signs of peritonitis (rigid, hard abdomen).
46
What is the last resort **treatment** if dialysis doesn't work for CKD?
Kidney transplant
47
What types of **meds** are given to prevent kidney rejection after a kidney transplant?
Immunosuppression meds
48
What type of **precautions** are implemented after a kidney transplant?
**Neutropenic precautions** due to immunosuppression.
49
# Describe: Urinary tract infection (UTI)
An **infection in the urinary tract** for many different reasons. ## Footnote It is more common in women due to a short urethra.
50
# Risk factors: Urinary tract infection
**Due to bacteria imbalances:** * using soaps that are irritants * foley and straight catheters for draining urine * sex * polyester underwear * not urinating or drinking enough water * using douches that interfere with the normal pH of the vagina
51
What are the **characteristic signs and symptoms** of a UTI?
* small amounts of urine that is frequent and urgent * burning sensation * back discomfort * foul urine smell * chills/fever/high WBC count
52
What is a **common symptom** of a UTI in the elderly?
Confusion.
53
How is a UTI **diagnosed**?
By doing a **urine culture and sensitivity test:** * The test will be: * **+** for leukocyte esterase * **+** for nitrates
54
# Interventions: Urinary tract infection
* antibiotics * encourage fluids * pain meds
55
# Teaching: Urinary tract infection
* drink fluids * urinate after sex * wear cotton underwear * don't take bubble baths or use irritating soap * drink cranberry juice
56
When a client has a UTI, what types of substances irritate the bladder and should be avoided?
Avoid alcohol, caffeine and acidic foods.
57
# Describe: Polycystic kidney disease
A **genetic disorder where cysts form on the kidneys** and the client gets hypertension. ## Footnote The client will eventually need dialysis or a kidney transplant.
58
# Describe: Hydronephrosis
**Too much water in the kidneys** caused by obstructions, stones, scar tissue or a big prostate. ## Footnote Client may need nephrostomy tubes to drain urine.
59
Why is the urine **strained** for a client with a kidney stone?
To **catch the stone** and determine which type it is: * purine stone? * calcium stone? * oxalate stone? ## Footnote The diet will be modified to prevent that type of stone.
60
What type of **pain** does a client experience when they are passing a kidney stone?
Pain from kidney stones **starts in the lumbar region and radiates down to the genitals.** ## Footnote It can be sudden pain that is sharp and severe.
61
# Teaching: Kidney stones
* drink plenty of fluids * don't eat foods that contribute to kidney stone formation
62
Why does **immobilization** cause kidney stones?
When a client is immobile, **calcium from the bones goes into the blood.** ## Footnote Too much calcium can cause a kidney stone.
63
What is **lithotripsy**?
A procedure used to **break up a kidney stone** using ultrasonic waves.
64
What are the **interventions** after a lithotripsy?
* encourage fluids to flush out small stones and sediment * monitor for bleeding and infection
65
# Describe: Benign prostate hyperplasia (BPH)
BPH is a **large prostate** that occurs in older men due to the gradual growth of the prostate. ## Footnote The large prostate blocks the ability to urinate. Urination is in smaller amounts and more frequent.
66
Which meds are **avoided** with BPH?
Meds that cause urinary retention such as: * **anticholinergics** - benztropine (antiparkinson meds) * **antihistamines** - diphenhydramine * **antidepressants** - SSRIs
67
What is a **transurethral resection of the prostate (TURP)**?
A TURP is a **surgical procedure to decrease the size of a prostate** or to take the entire prostate out due to cancer.
68
What type of **foley catheter** is inserted after a TURP procedure?
After a TURP, the client will have a foley catheter with **continuous bladder irrigation** to prevent bleeding.
69
What is **continuous bladder irrigation**?
When there are **3 lumens (tubes) coming from the foley**: * **Lumen 1:** inflating the balloon to keep the foley in the bladder * **Lumen 2:** instillation of sterile solution for irrigating the bladder * **Lumen 3:** for urine and fluid to leave the bladder ## Footnote It is used to prevent bleeding after a TURP.
70
What are the **main interventions** for a client with continuous bladder irrigation?
Focus on **preventing bleeding:** * keep traction on catheter: taut, taped, and keep leg straight * keep sterile solution running to keep urine light pink * increase the solution rate if bright red drainage or clots appear
71
What are the **steps** if the urinary catheter becomes obstructed and no urine is coming out?
1. **turn off** the continuous bladder irrigation 2. **irrigate the catheter** with 30 - 50 mL of normal saline. ## Footnote If it's still obstructed, notify the HCP.
72
When will the continuous bladder irrigation for TURP be **discontinued**?
The catheter is taken out **24 - 48 hours** after the surgery.
73
What are **normal findings** after the catheter is removed after a TURP?
The client may experience **some burning, frequency, and dribbling of urine.** ## Footnote Passing small clots and tissue debris for a few days is also normal.
74
# Teaching: Transuretheral resection of the prostate (TURP)
* no driving, sex or heavy/strenuous activity for up to 6 weeks * drink up to 3000 mL of fluid each day before 8 p.m. * don't stimulate the bladder - avoid alcohol, caffeine, and spicy foods
75
What should the client do at home if they **start to bleed after a TURP**?
Tell the client to **rest** and **increase fluid intake**. ## Footnote If bleeding still doesn't stop, call the surgeon.

NCLEX-RN (5) Adult Health (13 decks)

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