Test 4 Renal Shi Flashcards
What do kidneys and urinary system do?
Regulate fluid and electrolytes
Remove waste and provide hormones involved in RBC production
Bone metabolism
Control of BP
What are some gerontologic considerations about the kidneys?
Older adults susceptible to kidney injury
* Sclerosis of glomerulus and renal vasculature
* Decreased blood flow
* Decreased GFR
* Decreased renal reserve
* Altered tubal function and acid base balance
Incompelte empyting of bladder
Decreased drug clearence
Creatinine levels
Male: 0.6-1.2
Female: 0.4-1.0
What’s the normal adult bladder capacity?
400-500 mL
True or false: A 24 hour urine collection is the primary test of renal clearance?
TRUE
Evaluates how well kidneys perform renal clearance
What’s acute kidney injury?
Rapid loss of renal function due to damage to kidneys
50% or greater increase in serum creatinine above baseline
Hypovolemia (cause)
Hypotension (cause)
Reduced cardiac output and heart failure
What categories and phases of kidney injury are there?
Categories: Prerenal, intrarenal, postrenal
Phases: Initiation, oliguria, diuresis, recovery
What’s prerenal stage?
Volume depletion resulting from GI losses, bleeding, renal losses
Impaired cardia effeciency: From arrhythmias, cardio shock, heart failure
Vasodilation resulting from: Anaphylaxis, sepsis
What’s intrarenal stage?
Prolonged renal ischemia resulting from: Hemoglobinuria, pigment nephropathy
Nephrotic agents like : Heavy metals, NSAIDS, aminoglycoside antibiotics
Rhabdomyolysis: Trauma, burns
Infectious processes
What’s post renal stage?
Urinary tract obstruction like: Benign prostitic hyperplasia, blood clots, calculi, tumors
What’s chronic kidney disease?
Prolonged acute inflammation
5 stages based on GFR
The 5 stages of chornic kidney disease
- > 90 ; kidney damage with normal or incresed GFR
- 60-89 ; Mild decrease in GFR
- 30-59 ; Moderate decrease in GFR
- 15-29 ; severe decrease in GFR
- <15 ; end stage kidney disease or end stage kidney disease
What’s Kidney Failure? ESRD
When kidneys cannot remove waste or perform regular functions
Acute kidney disease is reversible and results in decreased glomerular filtration rate and oliguria
ESRD is progressive, irreversible and results in azotemia
What’s some problems and complications of chronic kidney disease and acute kidney injury?
Hyperkalemia
Pericarditus
Pericardial effusion
Pericardial tamponade
HTN
Anemia
What’s hemodialysis used for?
When patient is acutelt ill until kidneys resume function and for long term therapy in CKD and ESKD
Exract toxic nitrogenous substances from blood and remove excess fluid
Vascular Access: Arteriovenous fistula and arteriovenous graft
What’s peritoneal dialysis?
Goal is to remove toxic substances and waste and re-establish normal fluid and electrolyte balance
Peritoneal membrane serves as semipermeable membrane: Ultrafiltration and Peritoneal catheter
What are some complications of peritoneal dialysis?
Peritonitis
Leakage
Bleeding
What’s the assessment of a patient on dialysis?
Protect vascular access
Assess for patency, signs of infection, don’t use blood pressure or blood draws
Carefully monitor fluid balance, IV therapy, I and O
Signs of electrolyte imbalance and uremia
Monitor cardiac and respiratory status
Cardiovascular meds must be held before dialysis
Nursing interventions for hospitalized patient on dialysis
Monitor medications dosage carefully
Skin care: pruritis, keep skin clean and well moisurized, trim nails, avoid scratching
Renal cancer facts
Tobacco use is a significant risk factor
Higher incidence in men with high BMI and african american
May be asymptomatic with painless hematuria and dull back pain
Treatment w surgery and pharmacological treatment
Kidney surgery
Pre and Perioperative considerations
Postoperative considerations: Potential hemmorrhage and shock, potential abdominal distention and paralytic ileus, potential thromboembolus
Postoperative nursing interventions
Pain relief
Promote airway clearance: Incentive spirometer, positioning
Maintain potency of urinary drainage systems
Use strict asepsis with catheter
Monitor for signs and symptoms of bleeding
Encourage leg exercises , early ambulation, and signs of DVT
What are some patient education for post surgery?
Drainage system care
Strategies to prevent complications
Signs and symptoms
FOllow up care
FLuid Intake
Health Promotion and screening
What is nephroscleorosis?
Hardening or renal arteries
Major cause of CKD
Icreased risk In African AMercians and diabetic nephropathy
Acute hypertensive criris benign
Treatment for hypertension
What’s glomerular disease?
Acute nephritic syndrome
Glomerulonephritis ; chronic and acute
Nephrotic syndrome
Diseases that destroy glomerulus of kidney
Acute nephritic syndrome
Postinfectious glomerulonephritis ; rapidly progressive , and membrane glomerulonephritis
Manifestations: Hematuria, edema, azotemia, proteinuria, HTN
May be mild or progrress to acute kidney disease or death
Medical management: Supportive care , dietary modifications, antibiotics, corticosteroids, immunosuppresants
Nursing management of acute nephritic syndrome
Maintain fluid balance
Fluid and dietary restriction
Patient education and follow up
Chronic glomerulonephritis
Renal insuffiency or failure: Asymptomatic for years as glomerular damage increases before signs and symptoms develop
Abnormal lab results: Urine with fixed specific gravity, casts, proteinuria, eletrolyte imbalance, hypoalbuminemia
Nursing management of chronic glomerulonephritis
Fluid and electrolyte imabalance risk
Cardiac status
Neurological status
Emotional support
education in self care
What’s nephrotic syndrome?
Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins
results in hypoalbumenia and edma
Medican management includes drug and diet therapy
Nursing management focused on education
Causes of nephrotic syndrome
chronic glomerulonephritis
diabetes
amyloidosis
lupus
Multiple myeloma
renal vein thrombosis
What is polycystic kidney disease?
Genetic disorder and is most common inherited cause of kidney disease
May have cysts in other organs
Is autosomal dominant and recessive
No cure, genetic counseling
What are the kinds of UTI?
Lower:
* Cystitis
* Prostatis
* Urethritis
Upper:
* Pyelonephritis: acute and chronic
* Interstitial nephritis
* Renal abscess and perirenal abscess
What factors contribute to UTI?
Bacterial invasion of urinary tract
Urethrovesical reflux, uretovesical reflux
Uropathogenic bacteria
Shorter urethra in women
What’s the assessment of a patient with a UTI?
Pain, burning with urination, frequency, nocturia, incontinence, hematuria
Many are asymptomatic
Assessment of urine, urinalysis, and urine cultures
What potential problems can happen with a UTI?
Sepsis
Acute kidney injury
Chronic kidney disease
What are some goals when treating UTI?
Relief of pain and discomfort
Increased knowledge of preventive measures
Absence of complications
Nursing interventions of a patient with a UTI
Relief of pain
Medications as prescribed: Antibiotics, analgesics, antispasmodics
Applicaiton of heat to perineum to relieve pain and spasm
Increase fluid intake
AVOID URINARY TRACT IRRITANTS: COFFEE, TEA, CITRUS, SPICES, COLA, ALCOHOL
Frequent voiding
Education
What are the types of urinary incontinence?
Stress: During physical activity ; coughing, sneezing, laughing, exercise
Urge: Sudden intense urge to pee and then you involuntary pee lol ; overactive bladder, neurological problems like parkinson
Functional: Urine leakage from inability to reach toilet in itme ; physical or cognitive impairments
Latrogenic: Caused by medications or interventions
Mixed: Combination of stress and urge
Overflow: Caused by bladder overdistention and incomplete emptying ; obstruction like the prostate
Patient education for incontinence
Tell em it aint inevitable and it fs is treatable gang
Management takes time lil bro
Educate verbally and in writing
Use a voiding log
Medication education
What is urinary retention?
Inability of the bladder to empty completely
Residual urine: Amount of urine left behind in bladder after urinating
Causes of urinary retention
Adults 60 and above may have 50-100 mL or urine after voiding
Postoperative spasms
Diabetes, proastate cancer, urethral pathology, trauma, pregnancy, neurological disorders
Medications
What’s urolithiasis and nephrolithiasis?
Calculi in the urinary tract or kidney
Causes: May be unkown
Depends on location and presence of obstruction and infection
Pain and hematuria
Diagnosed by: radiography, blood chemistries, and stone analysis, strain all urine and save the stones
Patient education for renal calculi
Signs and symptoms to report
Followm up care
Urine pH monitoring
Measures to prevent recurrent stones
Importance of fluid intake
Dietary education
Med education
GU trauma
Ureteral: Motor vehicle accidents, sport injuries, falls
Bladder: Pelvic fracture, multiple trauma, blow to lower abdomen
Urethral: Blunt trauma to lower abdomen
* Signs / symptoms: Blood visible at meatus, inability to void, distended bladder
Management of GU trauma
Control hemmorhage, pain and infection, monitor for oliguria, shock, s/s of peritonitis
Nursing management: Assess frequently, instruction about incision care and adeqaute fluid intake
Changes to report: fever, hematuria, flank pain
Urinary tract cancers
Bladder, kidney, renal pelvis, prostate
More common after 65
Smoking biggest cause
S/s: visible painless hematuria, pelvic or back pain,
Bladder cancer management
Chemo or radiation: depends on stage
Surgical treatment: Cystectomy , uninary diversion
Nursing management of bladder cancer
Immediate post op: monitor urine volume hourly
Provide stoma and skin care
Test urine
Encourage fluids
Urinary Diversion
Procedure to divert urine from bladder to exit new site, stoma
Reasons: Bladder cancer or other pelvic malignancies, birth defects, trauma, strictures, neurogenic bladder, chronic infection or intractable cystitis, used as a last resort for incontinence
Types: Ileal conduit ,orthotopic neobladder reconstruction, continent urinary diversion
Assessment of patient undergoing urinary diversion surgery
Preoperative: Cardiopulmonary function, nutritional status, learning seeds
Postoperative: Signs and symptoms of complications, urine volume, drainage system , color of drainage, pain
Interventions of a patient undergoing urinary Diversion surgery
Preooperative: Relieve anxiety, ensure adequate nutrition, explaining surgery and the effects
Postoperative: Maintaining skin integreity, relieving pain, improving body image, exploring sexuality issues, monitoring and managing potential complications, patient education
