TOPIC 9 - renal / chronic kidney disease and dialysis Flashcards
most frequent cause of UTI
bacteria
manifestations of UTI
Fever, chills, dysuria, suprapubic pain, hesitancy, intermittent stream, postvoid dribbling, painful urination, urgency, incontinence, nocturia
Urine: cloudy, hematuria, foul odor
interventions for UTI
Encourage fluids, medication compliance, emptying bladder frequently, when to empty bladder
education for UTI
Empty bladder regularly & completely
Empty bowels regularly
Cleanse perineum front to back
Drink adequate fluids daily
Avoid caffeine, alcohol, citrus juices, chocolate, spicy foods
Take full course of prescribed antibiotics, even if symptoms subside
complications of UTI
The infections can migrate up to the kidneys, causing infection & injury to the kidney
interstitial cystitis
Pain varies in severity, UTIs, frequency, urgency, role of stress, frequent urination (60X/day)
what to assess in interstitial cystitis
PQRST of pain
Voiding dysfunction
Bladder or voiding log to identify diet & lifestyle factors for at least 3 days
Diet: quality nutrition, role of vitamins (avoid excess doses)
Clothing that avoids perineal & pelvic pressure
Psychosocial: frustration, guilt, anger, coping
systemic meds for interstitial cystitis
Tricyclic antidepressants – amitriptyline, nortriptyline, pentosan
Short course of opioids to treat acute pain
local meds for interstitial cystitis
Dimethyl sulfoxide (DMSO)
Heparin, hyaluronic acid, lidocaine
examples of bladder irritants to avoid with IC
Caffeine
Alcohol
Citrus products
Ages cheeses
Nuts
Foods containing vinegar
Curries
Hot peppers
chronic glomerular nephritis onset
Insidious onset, frequently clients are unaware of their declining kidney function
Potential to develop ESKD between 2-30 years
assessment of chronic glomerular nephritis
Hematuria, WBCs & casts in urine
Proteinuria
s/s of uremia
Elevated BUN & Creatinine
History of: drug use, Lupus, Scleroderma
labs and diagnostics for chronic glomerular nephritis
Kidney Biopsy
Ultrasound
CT
CBC, CMP
abnormal lab test results show
urine with fixed specific gravity, casts, proteinuria, electrolyte imbalances and hypoalbuminemia
different types of urinary incontinence
Stress
Urge
Overflow
Reflex
Trauma or surgery
Functional
causes (DRIP mneumonic)
D stands for – delirium, dehydration, depression
R stands for – restricted mobility, rectal impaction
I stands for – infection, inflammation, impaction
P stands for – polyuria, polypharmacy
anticholinergic med for urinary incontinence
tolterodine
diagnostic for chronic pyelonephritis
kidney biopsy
what can chronic pyelonephritis progress in to
progresses into end stage renal disease
Decreased kidney function depends on previous infections and subsequent scarring
change in kidney shape in chronic pyelonephritis
Kidneys are small, atrophic , shrunken, loss of function from scarring (fibrosis).
risk factors for bladder cancer
smoking, dyes, chemo, actos, recurrent renal calculi
assessment of bladder cancer
hematuria, IBS, frequency, urgency, dysuria
diagnostic testing for bladder cancer
U/A, cystoscopy with biopsy, CT, MRI
interventions for bladder cancer
surgery, urinary diversion, radiation, chemo, immunotherapy
three main types of urinary diversion surgeries
Cutaneous ureterostomy
Ileal conduit
Nephrostomy
post op nursing care for urinary diversion surgeries
Stoma care & appliances
Skin care
Psychosocial
causes for urinary diversion surgery
bladder cancer, neurogenic bladder, congenital anomalies, strictures, chronic infections with deteriorating renal function, renal trauma, bladder removal
CKD
progresses over time, is irreversible, azotemia, uremia, uremic syndrome
causes of CKD
DM, HTN, vascular disorders, chronic glomerulonephritis, pyelonephritis, nephrotic syndrome, meds or toxic agents, obstruction of urinary tract, hereditary lesions
GFR differences depending on stages
Stage 1 : >90mL/min
Stage 2 : 60-89mL/min
Stage 3 : 30-59mL/min
Stage 4 : 15-29mL/min
Stage 5 : <15mL/min
kidney failure results when
the kidneys cannot remove wastes or perform regulatory functions
acute renal failure
a reversible syndrome that results in decreased glomerular filtration rate and oliguria
chronic renal failure
progressive, irreversible deterioration of renal function that results in azotemia
complications of renal failure
hyperkalemia
hypervolemia
pericarditis
pericardial effusion
pericardial temponade
HTN
anemia
bone disease
metastatic calcifications
diagnostics images related to the kidneys
ultrasound
KUB
CT
MRI
aortorenal angiography
cystoscopy
retrograde pyelography
kidney biopsy
labs related to the kidneys
BUN, CBC, electrolytes Crt, Urinalysis, 24 hour urine, fluid volume overload
temporary vs long term access for hemodialysis
temporary : Hemodialysis catheter, dual or triple lumen, or AV shunt
long term : Arteriovenous (AV) fistula or graft
postdialysis assessment
Hypotension
Headache
Nausea, vomiting
Malaise, dizziness
Muscle cramps or bleeding
vascular access complications
thrombosis
stenosis
infection
aneurysm formation
tissue ischemia
heart failure
hemodialysis complications
Hep B and C
HIV
infections
dialysis disequilibrium syndrome
types of peritoneal dialysis
automated or continuous ambulatory
peritoneal dialysis
Involves siliconized rubber catheter placed into abdominal cavity for infusion of dialysate
what to assess prior to starting peritoneal dialysis
baseline vitals, weight, labs
continually monitor ___ during and after peritoneal dialysis
resp distress, pain, discomfort, prescribed dwell time, initiate outflow, outflow amount, pattern of fluid
complications of peritoneal dialysis
peritonitis
pain
exit site/tunnel infection
poor dialysate flow
dialysate leakage
