Urinary disorders Flashcards

Question

Polycystic kidney disease (PKD) CM and Tx

Answer 1

U/A - proteinuria (glomerular damage) and hematuria Manifestations – dull, aching pain (occurs early) due to increased kidney size (distended abdomen; kidneys palpable); sharp pain, ***bright red or cola-colored urine*** (from ruptured cyst), nocturia (decreased urine concentrating ability) Later S/S – increasing HTN, edema, and uremic problems (anorexia, N/V, fatigue, pruritus) Pain – drug therapy and complementary approaches Caution w/NSAIDs b/c reduces renal blood flow Severe pain – cyst aspiration and drainage of cysts Antibiotics if cysts infected HTN/Renal Failure – 2L fluid/day to prevent dehydration (reduces renal function); restrict Na intake; antihypertensives and diuretics; if renal failure progresses – limit protein intake

Answer 2

bacterial infection in the kidney and renal pelvis (most common organism – E.Coli) U/A - + leukocyte esterase and nitrites, WBCs, and bacteria

Answer 3

Acute – active bacterial infection; usually due to obstruction, pregnancy, reflux Chronic (may be asymptomatic) – repeated or continued infection; causes –urinary tract defect, obstruction (tumor, stone, and enlarged prostate in >65yo), or infected urine reflux (most common cause) from bladder to ureters - vesicoureteral junction Other causes of both – urinary catheter, DM (reduced bladder tone), NSAIDs (papillary necrosis and reflux)

Answer 4

glomerular injury resulting in proteinuria, hematuria, decreased GFR, edema, and HTN and headache maintain bed rest to protect kidney, restrict fluids, reduce protein and sodium but increase calories, monitor daily weight Penicillin, steroids, anti hypertensives

Answer 5

infection usually precedes; usually recover quickly and completely U/A – proteinuria, hematuria (usually microscopic – smoky, reddish brown, rusty, or cola colored urine); serum albumin decreased b/c of proteinuria and fluid retention causing dilution Elevated BUN, creatinine, and decreased GFR Diagnosed by renal biopsy

Answer 6

develops over 20-30 years; unable to determine cause b/c kidneys are atrophied and cannot be biopsied Always leads to ESKD - 3rd leading cause of ESKD Exact cause unknown, however, changes in kidney tissue result from HTN, DM, infections and inflammation, or poor blood flow to the kidneys (nephrotoxic drugs) Manifestations – mild proteinuria, hematuria, HTN, fatigue, decreased UOP, and fluid overload Nursing Considerations Management – slow the progression and prevent complications Dietary (restrict fluid and Na, but fluid intake sufficient to prevent reduced renal blood flow), medications for uremic symptoms (protein restriction) Assess for fluid overload- crackles, edema, increased BP, weight gain Fluid restriction = 24 urinary output + 500 ml

Answer 7

group of symptoms, not a disease | increased glomerular permeability leading to massive loss of protein in urine, edema and decreased plasma albumin levels

Answer 8

Kidney disorder in which the spaces between the kidney tubules become swollen (inflamed) affecting the kidneys' function If drug induced – often a rash and elevated eosinophil count Progression to ESKD unless cause is identified and removed (ex. – avoid medication)

Answer 9

thickening in the nephron blood vessels, resulting in narrowing in the vessel lumen Decreased renal blood flow, chronically hypoxic kidney tissue, ischemia and fibrosis develop over time Occurs with all types of HTN, DM, and atherosclerosis Nursing Considerations – control HTN and reduce albuminuria to preserve renal function (ACE inhibitors)

Answer 10

Renal artery stenosis (RAS) from atherosclerosis or blood vessel hyperplasia is the main cause of renovascular disease. Renovascular disease causes ischemia and atrophy of kidney tissue. CM: may have sudden onset of HTN Tx: control HTN

Answer 11

The leading cause of ESKD 1st manifestation – persistent albuminuria – often cause for a renal biopsy The leading cause of ESKD

Answer 12

Cancer of the lining of the renal tubules Most common renal cancer in adults (men aged 50-70 yo) Complications – metastasis and urinary tract obstruction CM: Flank pain, hematuria Tx: kidney needs to be removed bc chemo and radiation isnt effective

Answer 13

lacerations in the renal artery or vein; Rapid Hemorrhage and death may occur Kidneys are very vascular

Answer 14

Rapid decrease in kidney function Can be caused by trauma, allergic reactions, kidney stones or shock (drink 2-3L/day) Pre, intra or post renal failures Monitor Decreased urine specific gravity – loss of urine concentrating ability (earliest sign of renal tubular damage) Elevated BUN/Creatinine, electrolyte imbalances, usually NOT anemia Tx: phosphate biders to lower phosphorus while replacing calcium

Answer 15

reduced blood flow to the kidneys (severe hypotension from hypovolemic shock, dehydration, or heart failure) CM:hypotension, tachycardia; decreased UOP, cardiac output, and CVP; and lethargy

Answer 16

damage to the glomeruli, interstitial tissue, or tubules (infections, nephrotoxic drugs, glomerulonephritis, vasculitis, obstructed renal blood flow) CM: oliguria, anuria, edema, HTN, tachycardia, SOB, distended neck veins, elevated CVP, wt gain, crackles, anorexia, N/V, lethargy, LOC change, hypocalcemia and hyperkalemia

Answer 17

obstruction of urine flow from kidney (cancer, stones, strictures, BPH) oliguria, intermittent anuria, symptoms of uremia, and lethargy

Answer 18

build-up of nitrogenous wastes

Answer 19

Progressive and irreversible 5 stages of CKD – glomerular filtration rate decreases with each stage – 5th stage is End Stage Kidney Disease (ESKD) 2 most common causes are DM and HTN

Answer 20

Metabolic changes – urea and creatinine excretion is disrupted Early = hyponatremia Later = hypernatremia; hyperkalemia (fatal dysrhythmias); metabolic acidosis; hypocalcemia/hyperphosphatemia Cardiac changes – HTN; hyperlipidemia; HF; pericarditis Hematologic changes - anemia (later stages) GI changes – uremia leads to halitosis, stomatitis, anorexia, N/V, hiccups, and peptic ulcer disease

Answer 21

Removes excess fluids and wastes products and restores chemical and electrolyte imbalances Patient’s blood passes through an artificial semipermeable membrane to perform the filtering and excretion functions of the kidney When to start – not based on GFR, based on patient’s symptoms Requires good vascular access (large amount of blood flow – 250-300ml/min during the 3-4 hour treatment) Weight pt before and after, assess for thrill and bruit, withhold bp meds

Answer 22

hypotension (hold vasoactive drugs before HD), headache, N/V, malaise, dizziness, and muscle cramps Must be done gradually or risk for DDS (dialysis disequilibrium syndrome)- Clinical signs of cerebral edema, such as focal neurological deficits, papilledema[4] and decreased level of consciousness, if temporally associated with recent hemodialysis, suggest the diagnosis.

Answer 23

AV fistula – formed by connecting (anastomosis) an artery to a vein AV graft – the graft is make of synthetic material Want to hear a bruit and feel thrill over fistula or graft site- indicative of patent fistula or graft No IV sticks or lab draws or bp in arm with fistula or graft

Answer 24

Standard treatment for ARF (& CRF) in ICU setting Kinder gentler better tolerated type of dialysis Similar to HD, but temporary – avoids rapid shifts in fluid and electrolytes Indications - fluid volume overload, diuretic resistance, unstable blood pressure and cardiac output

Answer 25

A rubber catheter is surgically placed in the abdominal cavity for infusion of dialysate. Perineum is used as a filter for the kidney. 1-2L of dialysate infused by gravity or by PD machine, the fluid stays in the cavity for a specified time, the fluid then drains by gravity or PD machine into a drain bag which equals 1 exchange- fluid should be clear and pale yellow The peritoneal outflow contains dialysate and excess water, electrolytes, and nitrogen-based waste products Complications – peritonitis (connection site contamination) –cloudy outflow, fever, abdominal pain, malaise, N/V

Answer 26

Not a cure – requires lifetime medications; risk for rejection, infection, and cancer due to immunosuppression Typical age range – 2-70 yrs. Exclusion criteria – advanced cardiac disease, cancer in the last 2-5 years, all metastatic cancer, chronic infection, alcohol or other substance abuse

Answer 27

ATN – acute tubular necrosis – results from hypoxic damage when there is a delay in organ recovery to transplantation Thrombosis – occurs in major renal blood vessel usually 2-3 days after transplant – diagnosed by renal scan and requires immediate surgical repair Infection – major cause of death and must be prevented with drug therapy, aseptic technique, and hand washing Acute rejection: 1week-2 years after transplate Chronic rejection: months-years Symptoms of rejection: flu symptoms, fluid retention, oliguria, fever