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Adult Nursing II > Urinary and fluid balance > Flashcards

Urinary and fluid balance Flashcards

1
Q

How are the principles of osmosis and diffusion important in the body?

A

Movement of water and electrolytes in the body is necessary for homeostasis. It is the basis for how the nephron works in filtering blood to produce urine.

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2
Q

What data will the nurse look for in a patient with a fluid volume deficit?

A

Elevated temp, pulse, and respiratory rates. Low blood pressure, decreased urine output. Dry skin and mucous membranes, decreased skin turgor. Elevated hematocrit.

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3
Q

Examples that could cause fluid volume deficit.

A

Blood loss (hypovolemia), dehydration, shock, sepsis, loss of fluids from diuretic therapy.

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4
Q

What nursing interventions will be used with fluid volume deficit?

A

Replace lost fluids orally or IV, no caffeine-containing fluids, encouraging frequent intake of fluids, I&O, daily weights

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5
Q

What data will the nurse look for in a patient with fluid volume excess?

A

Elevated blood pressure, bounding pulse, elevated pulse, rapid respirations, moist skin, lung crackles, edema, distended neck veins, low serum osmolarity

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6
Q

Examples that could cause fluid volume excess.

A

Renal failure, heart failure, cirrhosis, excessive sodium or water intake

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7
Q

What nursing interventions will be used with fluid volume excess?

A

I&O, daily weights, monitoring lung sounds, observation for edema, administration of diuretics.

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8
Q

Explain “third spacing”

A

Additional fluid and protein leaving the capillaries and entering the intestinal space from the intravascular space. This causes edema, abdominal distention, and a lowered blood pressure.

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9
Q

What is the focus of treatment for “third spacing”?

A

Replacing fluid to intravascular space and preventing hypovolemia by infusing isotonic fluids.

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10
Q

Hypokalemia

A

Can develop due to diarrhea, vomiting, NG drainage, burns, diuretic use. Muscle weakness, leg cramps, N & V, falling BP, cardiac arrhythmias

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11
Q

Hyperkalemia

A

Can develop due to renal disease, overuse of potassium supplements, abdominal cramps, irregular pulse, muscle weakness, cardiac arrest More critical condition

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12
Q

Hyper- or Hypokalemia; which is more likely in a patient with renal disease? Why?

A

Hyperkalemia, because potassium cannot be adequately excreted by the diseased kidney.

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13
Q

What medications or treatments are given for hypokalemia?

A

Diet high in potassium, oral or IV potassium supplements.

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14
Q

What medications or treatments are given for hyperkalemia?

A

Sodium polysterene sulfonate/Kayexalate, helps force excretion of potassium.

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15
Q

Why might calcium be given in hyperkalemia

A

IV bicarbonate forces potassium into cells. Calcium IV helps block cardiac effects.

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16
Q

What foods should be avoided for the hyperkalemic patient?

A

Bananas, citrus fruits, dried fruits, raisins, peanuts, sweet potatoes, spinach, chocolate, artichokes, pumpkin, avocados, mushrooms, dried peas and beans, tomato products.

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17
Q

In what situation should a nurse be aware that sodium loss could occur?

A

Any large fluid loss: vomiting, NG tube drainage, diarrhea, open drainage wounds/burns, edema, ascites.

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18
Q

What symptoms should be noted with sodium loss?

A

Elevated temperature, postural hypotension, muscle weakness, vomiting, confusion, headache, fatigue, lack of appetite.

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19
Q

What is the treatment for sodium loss?

A

Drinking fluids or IV replacement balanced to return sodium levels to normal.

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20
Q

What is the best indicator of fluid balance in the body?

A

Daily weight

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21
Q

Normal sodium level

A

136-145 meg/l

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22
Q

Normal potassium level

A

3.5-5.0 meg/l

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23
Q

Critical levels for potassium

A

< 2.5 & > 6.5

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24
Q

Why does a patient taking diuretics often need potassium supplements?

A

Diuretics given to increase urinary output can cause too much potassium loss (hypokalemia) along with urine excretion.

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25
What are some signs that hypokalemia is occurring?
Weakness, fatigue, confusion
26
In what situation would sodium polysterene sulfonate/Kayexalate be given?
When blood levels of potassium are critically high (hyperkalemia)
27
Loop diuretic
Inhibit reabsorption of sodium in tubules (loop of Henle), causing then excretion of sodium and water in urine. Rapid and effective. furosemide/Lasix
28
Thiazide diuretic
Decreased reabsorption rate of sodium in tubules, thus excreting sodium, potassium, and water. HCTZ/Hydro-Diuril
29
K-sparing diuretic
Excretes sodium and water by inhibiting its exchange with potassium, thus conserving potassium. Weaker diuretic effect. May be used in conjunction with a thiazide or loop diuretic. spironolactone/Aldactone
30
What are expected therapeutic outcomes of taking diuretics?
Diuretics will decrease the amount of fluid in the tissues. Have antihypertensive effects as well. * Increase urinary output * Lower BP * Decrease edema *
31
Isotonic fluid
-
32
Diffusion
-
33
Osmosis
-
34
Filtration
-
35
Nitrogenous waste
-
36
Teaching and preparation for patient undergoing: Intravenous pyelogram (IVP)
NPO after midnight. Bowel cleansing. Check for iodine allergy. Encourage fluid afterwards to help flush dye.
37
Teaching and preparation for patient undergoing: Cystoscopy
Expect pink-tinged urine afterwards. Dysuria normal for several voidings.
38
UA/UC Normal components
Urea, ammonia, creatine, uric acid
39
UA/UC Abnormal components
Glucose, RBC/WBC/Nitrites, Protein (albumin), bacteria, casts
40
Residual urine
Patient voids, then catheterized or use bladder scanner within 15-20 minutes for amount of any remaining urine.
41
Midstream clean-catch
Sterile container. Have patient clean meatus with hygienic wipes, void first part of urinary stream into toilet and then collect specimen in the sterile container (middle of the stream)
42
What does glucose in urine suggest?
Diabetes/hyperglycemia
43
What does protein (albumin) in urine suggest?
Kidney disease such as diabetic nephropathy, glomerulonephritis, onset of chronic renal failure, acute renal failure
44
What found in urine would suggest a urinary tract infection?
Bacteria, casts, white blood cells, nitrites
45
What does red blood cells in urine suggest?
Glomerulonephritis, acute pyelonephritis, bladder infection, urolithiasis
46
Red blood cells in the urine that are visible but without accompanying pain is concerning. Why?
May indicate bladder or renal cancer.
47
Why is checking for edema part of your data collection for this system?
If the kidneys are having difficulty filtering and excreting waste, fluids will accumulate in the tissues.
48
What is the most important indicator for fluid accumulation?
Daily weight changes
49
List the likely data collection if a patient has cystitis
Complaints of urgency, frequency, dysuria. Urine foul-smelling, cloudy, possibly hematuria. Perineal, abdominal, pelvic, or back pain. Fever, chills, malaise. In elderly: confusion or change in mental status.
50
What teaching advise can be given to a patient to prevent cystitis?
Increase non-caffeinate, non-carbonated fluids. Void frequently, especially after intercourse. Acidify urine (cranberry juice), hygiene practices such as wiping front to back, cotton underwear, avoid bubble baths, avoid perfumed sprays/wipe. showers may be preferable to baths.
51
What teaching must be given to a patient taking phenazopuridine/Pyridium?
Not curative. Treating symptoms only. Causes red-orange color to urine that can stain. It is working effectively if dysuria is decreased.
52
Describe nursing and medical interventions for a patient with acute pyelonephritis
Antibiotics (IV, oral), analgesics, antipyretics, monitoring edema with daily weights, bed rest, increased fluids, I&O, prompt assistance to void, follow-up care for 6 months that includes observation and monitoring of fluid status and frequent visits to doctor to check for the resolution of hematuria and bacteria.
53
A patient had strep throat two weeks ago. Now the patient is sick with symptoms of renal disease. Is this acute pyelonephritis or acute glomerulonephritis?
Acute glomerulonephritis: infection, usually poststreptococcal, triggers an autoimmune reaction, attacking the glomerulus, resulting in inflammation and glomerular permeability. Allows loss of protein and blood into urine.
54
What is included in the treatment plan for a patient with Acute glomerulonephritis?
Antimicrobials if appropriate, bedrest while albumunuria and hematuria present, restriction of visitors with URIs. Fluid restrictions. Protein restrictions.
55
What factors are important to monitor in a patient with chronic glomerulonephritis?
1. Hematuria - blood in urine | 2. Albuminuria - protein in urine
56
What patients could be at risk for developing urolithiasis?
Hyperparathyroidism (abnormal calcium excretion), prolonged immobility, history of recurrent UTIs, chronic dehydration, family history, osteoporosis
57
What are key nursing interventions in patients with kidney stones?
Maintain a dilute urine. Strain urine, looking for passage of stones. I & O. Pain relief.
58
What are key prevention strategies for urolithiasis?
Increasing fluid intake to maintain dilute urine (#1), increasing activity/exercise, adjusting diet if necessary to restrict purines or oxalates, less meats/animal protein and less sodium. Prompt treatment of UTIs, administration of medications if ordered.
59
Treatment for bladder tumors
1. Surgery: Fulgeration (burning) lesions off bladder wall via cystoscope. Cystectomy with urinary diversion such as ileal conduit. 2. Chemotherapy: Intravesical- instilled into bladder via catheter. Patients turns every 1 minutes to distribute medication, then voids. 3. Ileal conduit: Bladder removal. Creation of abdominal stoma with part of ileum. Ureters implanted into section of detached ileum and urine will drain continually from the abdominal opening.
60
Type of renal failure: A patient with a growing kidney tumor
.
61
Type or renal failure: A cirrhosis patient who is third-spacing
.
62
Type of renal failure: A patient with acute glomerulonephritis
.
63
Type of renal failure: A patient with a sudden, severe hemorrhage
.
64
Type of renal failure: A patient with a migrant kidney stone
.
65
Type of renal failure: A patient with acute tubular necrosis caused by a blood clot in the kidney
.
66
Explain the mechanism of prerenal acute failure:
Loss of blood pressure equals loss of perfusion to the nephrons of the kidney. Nephrons unable to filter blood adequately and urine output while serum nitrogenous wastes rise.
67
How can prerenal acute renal failure be resolved?
Re-establishment of sufficient blood pressure to restore blood flow to the nephrons of the kidney.
68
Explain how Acute Tubular Necrosis (ATN) can develop and how it and the resulting intrarenal acute renal failure (ARF) is treated.
ATN: Common cause of intrarenal failure; usually caused by ischemia of nephrons due to prerenal failure that did not resolve or toxicity (nephrotoxins). Treatment is temporary dialysis while the cause is treated.
69
How is postrenal failure developing and how is it treated?
The flow of urine is blocked. Removing the obstruction can restore urine flow and resolve renal failure.
70
Symptoms of Chronic Renal Failure (CRF)
Lethargy, confusion, fatigue, impaired concentration, uremic frost, uremic halitosis, pruritis, rapid respirations, joint pain, chest pain, nausea and vomiiting, hiccups, anorexia
71
What is involved in the nursing care of hemodialysis patient?
Patient must be weighed before and after each session. Most medications are held prior to dialysis. No BPs, blood draws on arm with dialysis access site.
72
How can fluid be monitored?
Daily weight, I & O, abdominal girth, lung sounds. Enforcing fluid restrictions, observing peripheral edema, monitoring serum electrolyte levels.
73
How often is hemodialysis performed?
Every other day, 3-6 hours per treatment.
74
What are the benefits for peritoneal dialysis?
More ambulatory during dialysis, less stressful, can be performed at home by patient, easier to perform, less expensive.
75
What are the risks for peritoneal dialysis?
Mainly infection (peritonitis)
76
What care must be taken with the graft/fistula site for hemodialysis?
Strict aseptic care. No BPs, blood draws, IVs, restraints on affected arm.
77
What care must be taken with the catheter site and patient undergoing peritoneal dialysis?
Strict aseptic care of cath site due to potential for peritonitis. Observe abdomen for excessive girth. Check weights before and after. Observe dialysate drainage for clarity.
78
furosemide/Lasix
Lood diuretic
79
cephalexin/Keflex
Anti-infective, cephalosporin
80
amoxicillin/Amoxil
Pennicillin anti-infective
81
levofloxacin/Levaquin
Anti-infective, Quinolone
82
mycophenolate/CellCept
Immunosuppressive
83
spironolactone/Aldactone
K-sparing diuretic
84
phenazopyridine/Pyridium
Urinary analgesic
86
hydrochlorothiazide/Hydro-Diuril
Thiazide diuretic
86
trimethoprim sulfamethazole/Bactrim, Septra
Sulfonamide anti-infective
87
Why is protein the food group restricted when BUN/Creatinine levels are high?
Metabolism of proteins produces waste that contains nitrogen: Urea, Uric acid, Creatinine. By restricting proteins, waste should accumulate less easily.
88
Describe diet limitations for a renal failure patient.
Many limitations in protein, potassium, sodium, phosphorus, and fluids. If a diabetic, will need glucose limitations. If heart disease present, will need restrictions in saturated fat and cholesterol intake.
89
Explain protein diet restrictions for a renal failure patient.
Kidneys cannot excrete protein waste adequately. Blood levels checked.
90
Explain fluid diet restrictions for a renal failure patient.
Restricted and then divided into small amounts during the day.
91
Explain sodium diet restrictions for a renal failure patient.
Aids in restricting fluids.
92
Explain potassium diet restrictions for a renal failure patient.
Hyperkalemia possible as kidneys cannot adequately excrete potassium.
93
Explain phosphorus diet restrictions for a renal failure patient.
Also typically high and must be restricted.
94
nitrofurantoin/Macrodantin
Urinary antiseptic
95
bumetanide/Bumex
Loop diuretic
96
chlorothiazide/Diuril
Thiazide diuretic
97
K-lyte/Slow K, K-Dur
Potassium supplement; mineral & electrolyte replacement
98
sodium polysterene sulfonate/Kayexalate
Hypokalemic, electrolyte modifiers. Cationic exchange resins.
99
tolterdine/Detrol
Anticholinergics
100
K-sparing diuretics
Acts on distal tubules to excrete sodium by inhibiting its exchange with potassium, thus conserving potassium.
101
Loop diuretics
Decreases reabsorption rate of sodium in distal tubules, thus excreting sodium, potassium, and water.
102
Thiazide diuretics
Decreases reabsorption rate of sodium in distal tubules. thus excreting sodium, potassium, and water.

Adult Nursing II (5 decks)

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