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Adult Nursing II > Urinary and fluid balance > Flashcards

Urinary and fluid balance Flashcards

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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
Q

What are some signs that hypokalemia is occurring?

A

Weakness, fatigue, confusion

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26
Q

In what situation would sodium polysterene sulfonate/Kayexalate be given?

A

When blood levels of potassium are critically high (hyperkalemia)

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27
Q

Loop diuretic

A

Inhibit reabsorption of sodium in tubules (loop of Henle), causing then excretion of sodium and water in urine. Rapid and effective. furosemide/Lasix

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28
Q

Thiazide diuretic

A

Decreased reabsorption rate of sodium in tubules, thus excreting sodium, potassium, and water. HCTZ/Hydro-Diuril

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29
Q

K-sparing diuretic

A

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

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30
Q

What are expected therapeutic outcomes of taking diuretics?

A

Diuretics will decrease the amount of fluid in the tissues. Have antihypertensive effects as well. * Increase urinary output * Lower BP * Decrease edema *

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31
Q

Isotonic fluid

A

-

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32
Q

Diffusion

A

-

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33
Q

Osmosis

A

-

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34
Q

Filtration

A

-

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35
Q

Nitrogenous waste

A

-

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36
Q

Teaching and preparation for patient undergoing: Intravenous pyelogram (IVP)

A

NPO after midnight. Bowel cleansing. Check for iodine allergy. Encourage fluid afterwards to help flush dye.

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37
Q

Teaching and preparation for patient undergoing: Cystoscopy

A

Expect pink-tinged urine afterwards. Dysuria normal for several voidings.

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38
Q

UA/UC Normal components

A

Urea, ammonia, creatine, uric acid

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39
Q

UA/UC Abnormal components

A

Glucose, RBC/WBC/Nitrites, Protein (albumin), bacteria, casts

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40
Q

Residual urine

A

Patient voids, then catheterized or use bladder scanner within 15-20 minutes for amount of any remaining urine.

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41
Q

Midstream clean-catch

A

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
Q

What does glucose in urine suggest?

A

Diabetes/hyperglycemia

43
Q

What does protein (albumin) in urine suggest?

A

Kidney disease such as diabetic nephropathy, glomerulonephritis, onset of chronic renal failure, acute renal failure

44
Q

What found in urine would suggest a urinary tract infection?

A

Bacteria, casts, white blood cells, nitrites

45
Q

What does red blood cells in urine suggest?

A

Glomerulonephritis, acute pyelonephritis, bladder infection, urolithiasis

46
Q

Red blood cells in the urine that are visible but without accompanying pain is concerning. Why?

A

May indicate bladder or renal cancer.

47
Q

Why is checking for edema part of your data collection for this system?

A

If the kidneys are having difficulty filtering and excreting waste, fluids will accumulate in the tissues.

48
Q

What is the most important indicator for fluid accumulation?

A

Daily weight changes

49
Q

List the likely data collection if a patient has cystitis

A

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
Q

What teaching advise can be given to a patient to prevent cystitis?

A

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
Q

What teaching must be given to a patient taking phenazopuridine/Pyridium?

A

Not curative. Treating symptoms only. Causes red-orange color to urine that can stain. It is working effectively if dysuria is decreased.

52
Q

Describe nursing and medical interventions for a patient with acute pyelonephritis

A

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
Q

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?

A

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
Q

What is included in the treatment plan for a patient with Acute glomerulonephritis?

A

Antimicrobials if appropriate, bedrest while albumunuria and hematuria present, restriction of visitors with URIs. Fluid restrictions. Protein restrictions.

55
Q

What factors are important to monitor in a patient with chronic glomerulonephritis?

A
  1. Hematuria - blood in urine

2. Albuminuria - protein in urine

56
Q

What patients could be at risk for developing urolithiasis?

A

Hyperparathyroidism (abnormal calcium excretion), prolonged immobility, history of recurrent UTIs, chronic dehydration, family history, osteoporosis

57
Q

What are key nursing interventions in patients with kidney stones?

A

Maintain a dilute urine. Strain urine, looking for passage of stones. I & O. Pain relief.

58
Q

What are key prevention strategies for urolithiasis?

A

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
Q

Treatment for bladder tumors

A
  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
Q

Type of renal failure: A patient with a growing kidney tumor

A

.

61
Q

Type or renal failure: A cirrhosis patient who is third-spacing

A

.

62
Q

Type of renal failure: A patient with acute glomerulonephritis

A

.

63
Q

Type of renal failure: A patient with a sudden, severe hemorrhage

A

.

64
Q

Type of renal failure: A patient with a migrant kidney stone

A

.

65
Q

Type of renal failure: A patient with acute tubular necrosis caused by a blood clot in the kidney

A

.

66
Q

Explain the mechanism of prerenal acute failure:

A

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
Q

How can prerenal acute renal failure be resolved?

A

Re-establishment of sufficient blood pressure to restore blood flow to the nephrons of the kidney.

68
Q

Explain how Acute Tubular Necrosis (ATN) can develop and how it and the resulting intrarenal acute renal failure (ARF) is treated.

A

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
Q

How is postrenal failure developing and how is it treated?

A

The flow of urine is blocked. Removing the obstruction can restore urine flow and resolve renal failure.

70
Q

Symptoms of Chronic Renal Failure (CRF)

A

Lethargy, confusion, fatigue, impaired concentration, uremic frost, uremic halitosis, pruritis, rapid respirations, joint pain, chest pain, nausea and vomiiting, hiccups, anorexia

71
Q

What is involved in the nursing care of hemodialysis patient?

A

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
Q

How can fluid be monitored?

A

Daily weight, I & O, abdominal girth, lung sounds. Enforcing fluid restrictions, observing peripheral edema, monitoring serum electrolyte levels.

73
Q

How often is hemodialysis performed?

A

Every other day, 3-6 hours per treatment.

74
Q

What are the benefits for peritoneal dialysis?

A

More ambulatory during dialysis, less stressful, can be performed at home by patient, easier to perform, less expensive.

75
Q

What are the risks for peritoneal dialysis?

A

Mainly infection (peritonitis)

76
Q

What care must be taken with the graft/fistula site for hemodialysis?

A

Strict aseptic care. No BPs, blood draws, IVs, restraints on affected arm.

77
Q

What care must be taken with the catheter site and patient undergoing peritoneal dialysis?

A

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
Q

furosemide/Lasix

A

Lood diuretic

79
Q

cephalexin/Keflex

A

Anti-infective, cephalosporin

80
Q

amoxicillin/Amoxil

A

Pennicillin anti-infective

81
Q

levofloxacin/Levaquin

A

Anti-infective, Quinolone

82
Q

mycophenolate/CellCept

A

Immunosuppressive

83
Q

spironolactone/Aldactone

A

K-sparing diuretic

84
Q

phenazopyridine/Pyridium

A

Urinary analgesic

86
Q

hydrochlorothiazide/Hydro-Diuril

A

Thiazide diuretic

86
Q

trimethoprim sulfamethazole/Bactrim, Septra

A

Sulfonamide anti-infective

87
Q

Why is protein the food group restricted when BUN/Creatinine levels are high?

A

Metabolism of proteins produces waste that contains nitrogen: Urea, Uric acid, Creatinine. By restricting proteins, waste should accumulate less easily.

88
Q

Describe diet limitations for a renal failure patient.

A

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
Q

Explain protein diet restrictions for a renal failure patient.

A

Kidneys cannot excrete protein waste adequately. Blood levels checked.

90
Q

Explain fluid diet restrictions for a renal failure patient.

A

Restricted and then divided into small amounts during the day.

91
Q

Explain sodium diet restrictions for a renal failure patient.

A

Aids in restricting fluids.

92
Q

Explain potassium diet restrictions for a renal failure patient.

A

Hyperkalemia possible as kidneys cannot adequately excrete potassium.

93
Q

Explain phosphorus diet restrictions for a renal failure patient.

A

Also typically high and must be restricted.

94
Q

nitrofurantoin/Macrodantin

A

Urinary antiseptic

95
Q

bumetanide/Bumex

A

Loop diuretic

96
Q

chlorothiazide/Diuril

A

Thiazide diuretic

97
Q

K-lyte/Slow K, K-Dur

A

Potassium supplement; mineral & electrolyte replacement

98
Q

sodium polysterene sulfonate/Kayexalate

A

Hypokalemic, electrolyte modifiers. Cationic exchange resins.

99
Q

tolterdine/Detrol

A

Anticholinergics

100
Q

K-sparing diuretics

A

Acts on distal tubules to excrete sodium by inhibiting its exchange with potassium, thus conserving potassium.

101
Q

Loop diuretics

A

Decreases reabsorption rate of sodium in distal tubules, thus excreting sodium, potassium, and water.

102
Q

Thiazide diuretics

A

Decreases reabsorption rate of sodium in distal tubules. thus excreting sodium, potassium, and water.

Adult Nursing II (5 decks)

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