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MedSurg > Renal & Urinary Disorders > Flashcards

Renal & Urinary Disorders Flashcards

1
Q

Acute kidney injury

A
  • Rapid and acute dz process affecting kidney
  • Reversible in most cases
  • Delay in treatment = CKD
  • Increased incidence: hospitalized pts undergoing surgery or w acute illness, CV dz & DM, aged population
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2
Q

Chronic kidney disease

A
  • Develops after months to years (silent dz)
  • Irreversible
  • Eventual management is long-term dialysis or renal transplant
  • Careful monitoring and patient adherence improves outcomes
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3
Q

Prerenal causes of AKI

A

Conditions not related to kidney system (poor perfusion)
- Hypovolemia
- Decreased cardiac output
- Decreased peripheral vascular resistance
- Vascular obstruction

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4
Q

Infrarenal causes of AKI

A

Direct damage to renal parenchyma & result in impaired nephron function
- Prolonged ischemia
- *Nephrotoxins: Aminoglycoside, Antibiotics (Tobramycin, Gentamicin, Neomycin) = #1 cause
- Contrast dye used in imaging studies
- Hgb released from RBC hemolysis (eg. DIC)
- Myoglobin released from necrotic muscle cells

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5
Q

Postrenal causes of AKI

A

Mechanical obstruction of lower urinary tract (ureters, bladder, urethra)
- BPH
- Prostate CA
- Calculi
- Trauma
- Tumors

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6
Q

AKI complications

A

Hyperkalemia –> life-threatening cardiac arrythmias

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7
Q

AKI fluid volume

A

Initially fluid volume deficit, then fluid volume overload

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8
Q

AKI nursing assess

A
  • VS: initially hypotension & tachy (FVD), then hypertension (FVO)
  • Urine output: initially decreased, then increased
  • FVO signs: bounding pulse, edema, HTN, JVD
  • FVO causing decreased breath sounds, low O2 (rales)
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9
Q

AKI nursing assess (labs)

A
  • Elevated K, Phos, BUN/Cr
  • Decreased Na, Hgb, Hct, Ca
  • ABG: metabolic acidosis, low bicarb
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10
Q

AKI nursing intervention

A
  • Manage fluid balance & daily weights: I&Os, provide fluids to ensure vol, restrict fluids in FVO
  • Administer meds as ordered: diuretics, potassium lowering therapy
  • Mobility & skin care
  • Monitor and document food intake
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11
Q

AKI pt teaching

A
  • Knowledge of cause and treatment of AKI, rationale for fluid and dietary restricts
  • Help manage anxiety
  • Adherence w treatment, med education
  • Avoid nephrotoxic substances
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12
Q

CKD risk factors

A
  • Uncontrolled diabetes
  • Uncontrolled HTN
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13
Q

CKD clinical manifestations

A

Na/H2O balance:
- HTN, heart failure, pulm edema

Hyperkalemia:
- Lethal arrythmias

Metabolic waste build-up (uremia):
- GI (N/V, anorexia)
- Neuro (headache, lethargy, confusion)
- Untreated (sz & coma)

Hypocalcemia/Hyperphosphatemia:
- Bone breakdown
- Bone pain and fractures

Decreased acid clearance & bicarb prod:
- Metabolic acidosis

Decreased erythropoietin prod:
- Anemia

Endocrine and reproductive dysfunction:
- Infertility, amennorhea
- Hyperparathyroidism, thyroid abnormalities

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14
Q

CKD renal transplant contraindications

A
  • Untreated or metastatic cancer
  • Refractory CAD or heart dz
  • Psychosocial issues: hinder compliance w life-long treatment regimen (eg. persistent drug use or severe psychiatric disorder)
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15
Q

Renal transplant

A
  • Lifelong management of dz & immunosuppression (NOT a cure)
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16
Q

Renal transplant types of donors

A

Matched via national registry (UNOS)
- Deceased or cadaver donor (most common)
- Living-related donor or living unrelated donor

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17
Q

Renal transplant risks of immunosuppression

A
  • Infections of blood, lungs, CNS (fungal = high mortality)
  • Malignancies
  • Congenital anomalies in infants (of mothers undergone immunosuppressive therapy)
  • Corticosteroids: bone problems, GI disorders, cataracts
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18
Q

CKD nursing assess

A
  • VS: HTN, low O2 sat in FVO or atelectasis post surgery
  • FVO: rales on auscultation, JVD, peripheral edema

Labs:
- High K
- Na
- Low Ca, High Phos
- Low Hgb, Hct
- Metabolic acidosis, decreased bicarb prod, decreased H+ clearance
- Renal function tests

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19
Q

CKD nursing interventions

A
  • Cardiac monitoring: hyperkalemia
  • I&Os, daily weights
  • Restrict fluids/sodium
  • Skincare/proper positioning
  • Renal diet; low protein
  • Administer prescribed meds: antihypertensives, Ca supplements, erythropoietin, phosphate binders, folic acid and ferrous sulfate, immunosuppression, pain meds
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20
Q

CKD pt teaching

A
  • Dialysis & appointment sched
  • Dietary restrictions
  • Clinical manifestations of CKD & complications
  • Avoid nephrotoxic substances: NSAIDs, contrast media, certain abx, alc
  • Daily weights
  • Post-transplant: info regarding immunosuppression meds
  • Avoid exposure to infections
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21
Q

Dialysis

A

Blood separated from dialysis solution (dialysate) by semipermeable membrane
- Diffusion removes waste over semipermeable membrane
- Filtration removes excess water via hydrostatic pressure

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22
Q

HD access (AV fistula)

A
  • Long-term
  • Surgical anastomosis btwn radial artery and cephalic vein
  • Maturation required: low press vein becomes accustomed to higher press generated by artery
  • Can take weeks to months; alternative access for HD in meantime
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23
Q

Functional AV fistula assessment

A
  • Palpable pulsation (thrill)
  • Bruit upon auscultation
  • No BP, IV, blood draws
24
Q

HD basic process

A
  • Blood pumped from body to dialyzer
  • Blood moves across semipermeable memb
  • Concentration gradient causes diffusion, excess fluid removed via hydrostatic press
  • “Clean” blood moved back to vascular access
25
Q

Benefits of PD

A
  • Increased pt control and flexibility
  • Home therapy
  • Shorter learning period for pt
  • Performed by pt or family member
  • Fewer dietary restricts
  • Greater mobility for pt
26
Q

PD basic process

A

At peritoneal cavity
- Dialysate instilled into peritoneal cavity, remains w waste & electrolytes diffusing into dialysate
- Gravity drains fluid out of peritoneal cavity into sterile bag

27
Q

UTI risk factors

A
  • Female (short urethra, proximity to vagina and rectum)
  • Sexual activity
  • Diabetes
  • Poor hygiene
  • Estrogen deficiency
  • *Recent catheterizations
  • Foreign objects (eg kidney or bladder stones)
  • Conditions causing incomplete bladder emptying: pelvic organ prolapse, nerve or muscle damage post-surgery, neurological conditions
28
Q

UTI localized symptoms

A
  • Bladder irritability
  • Dysuria = painful urination
  • Urinary freq, urgency
  • Hematuria (gross/microscopic)
  • Small vol voiding
  • Suprapubic pain
29
Q

UTI systemic symptoms

A

Pyelonephritis: infection has spread to kidney OR urosepsis: infection has spread to blood
- Fever
- N/V
- Flank pain

30
Q

Uncomplicated UTI medical management (nonpregnant females)

A

3 day course of abx, usually Bactrim or Cipro

31
Q

Complicated UTI medical management (fever, male, diabetes)

A

7 day course abx based on culture and sensitivities

32
Q

UTI nursing assess

A
  • VS: elevated temp, HR, decreased BP
  • Urinary sympts: dysuria, urinary freq, urgency, gross hematuria
  • Abd exam: suprapubic tenderness, CVA tenderness
  • Urinalysis: hematuria, leukocytes, nitrites, cloudy urine w foul odor
  • Urine culture: > 100,000 bacteria, active infection, sensitivities dictate abx choice
33
Q

UTI nursing interventions

A
  • Administer abx as ordered
  • Administer bladder analgesics: Phenazopyridine (Pyridium), short-term use only 3 days in order not to mask UTI sympts
34
Q

UTI pt teaching

A
  • Reportable sympts of UTI: fever, flank pain, N/V, indicate pyelonephritis/renal abscesses
  • Increase fluid intake
  • S&S of UTI
  • UTI prevention: hygiene and hydration
35
Q

Pyelonephritis risk factors

A

Vesicouretal reflux (retrograde flow of urine from bladder to ureters):
- Primary: congenital defect in valve
- Secondary: failure of bladder to empty d/t obstruction

  • Obstruction: BPH, strictures & stones
  • Long-term indwelling catheter
  • Pregnancy
  • Sexual activity in women
36
Q

Pyelonephritis clinical manifestations

A
  • S&S of infection: fever, chills, tachy, N/V
  • Back or flank pain
  • CVA tenderness
  • Enlarged kidneys
  • Manifestations of UTI: urinary freq, dysuria, hematuria
  • Elderly: *delirium
37
Q

Pyelonephritis medical management

A
  • Broad-spectrum abx w an aminoglycoside
  • Bactrim or Ciproflaxin
  • *Fluid replacement
  • NSAIDS to reduce pain
  • Meds to reduce fever
  • *Pyridium relieves lower urinary tract pain, burning and urgency
38
Q

Pyelonephritis nursing assess

A
  • VS: hypotension, tachy, tachypnea, fever
  • Pain: location (flank, groin pain)
  • Assess urine output: urine characteristics, cloudy, odor
  • Neuro: AMS in elderly common w UTI/Pyelonephritis
39
Q

Pyelonephritis nursing interventions

A
  • Administer prescribed abx, pain meds, supportive care
  • Provide adequate hydration (prevent urinary stasis, ensure adequate circulating vol)
40
Q

Pyelonephritis pt teaching

A
  • *Explain dz condition
  • *How to avoid UTI: regularly empty bladder, hydration, hygiene, unsweetened cranberry juice
41
Q

Urolithiasis

A

Microscopic crystals in urinary tract come together and create stone

42
Q

Pyelonephritis

A

Inflamm of renal parenchyma and urinary collecting syst

43
Q

UTI

A

Bacteria enter sterile bladder and cause inflamm

44
Q

Urolithiasis risk factors

A
  • Male > female
  • Caucasians > blacks
  • Developed countries
  • Increased freq of occurence: southeastern states & summer months (d/t dehydration)
  • Family hx
  • Dietary habits (high sodium and/or protein intake)
  • Prev hx of stone formation
45
Q

Urolithiasis clinical manifestations

A
  • *Severe colicky pain when stone lodges in ureter d/t distension & obstruction of urine flow
  • N/V
  • Upper ureter: flank pain, lower ureter: genital and lower abd pain
  • Gross hematuria or microscopic hematuria
46
Q

Urolithiasis diagnosis

A
  • Non-contrast CT scan stone
  • KUB x-ray
47
Q

Urolithiasis complications

A
  • Pyelonephritis
  • Urosepsis
  • Irreversible renal damage
  • Ureteral stent or nephrostomy tube may be necessary
48
Q

Urolithiasis nursing assess

A
  • VS: increased HR/RR, increased temp/hypotension
  • Pain or renal colic: location of pain indicates stone location
  • N/V
  • Urine pH
  • Urine culture
  • Labs: WBC increase, BUN/Cr increase
49
Q

Urolithiasis nursing interventions

A
  • Administer meds: opioids, antiemetics, alpha-blockers (Flomax)
  • Maintain fluid status
  • Strain urine: collect stones for urinalysis
  • Foley catheter insertion if pt can’t void
50
Q

Urolithiasis pt teaching

A
  • Trial passage pts: when to call provider (fever, chills, pain, N/V), strain urine to obtain stone
  • Kidney stone prevention: hydration, low sodium diet, increase citrate in diet (lemons), decrease oxalate (coffee)
51
Q

Benign Prostatic Hypertrophy

A

Small gland surrounding urethra size of a walnut –> compress urethra and interfere w flow of urine from bladder

52
Q

BPH complications

A
  • AUR (acute urinary retention)
  • UTI
  • Bladder stones
  • Bladder damage
  • Kidney damage: increased press causing hydronephrosis
  • Pyelonephritis
53
Q

BPH alternatives

A

If meds & surgery are not an option:
- Intermittent catheterization or indwelling catheter to manage obstruction & incontinence

54
Q

BPH nursing assess

A
  • VS: fever can indicate UTI
  • Urinary sympts
  • Focused abd exam: bladder distension
  • Bladder scan: estimate of post-void residual, determine ability to empty bladder
  • Urinalysis
55
Q

BPH nursing interventions

A
  • 5 alpha reductase inhibitors: limit prod of DHT –> encourage prostatic hyperplasia
  • Alpha adrenergic blockers: relax smooth muscle
  • Catheterization: check for post-void residual
  • Relieve bladder distension
56
Q

BPH pt teaching

A
  • Watchful waiting: recognition of worsening sympts
  • Decrease liquid intake
  • Med therapy education
  • Info regarding surgical options
  • Routine follow-up w provider
57
Q

BPH med teaching

A
  • 5-alpha reductase inhibitors: decreased libido, erectile dysfunction, rash, breast enlargement & tenderness
  • Alpha-adrenergic blockers: HA, dizziness, drowsiness, nasal congestion, postural hypotension, reflex tachy

MedSurg (15 decks)

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