week 11 Flashcards
problems in the urinary system
infection what undergoes this and obstruction
infection
- urethra ( urethritis )
- bladder ( cystitis )
- kidney ( pyelonephritis )
obstruction
- calculi ( stones )
- benign prostatic hyperplasia ( BPH )
- cancer (urinary system )
what undergoes kidney failing
trauma /injury to kidney
acute/chronic kidney injury
what is the elimination
filters out blood and gets rid of things our body doesn’t need
what is this describing : from a human physiological perspective, the term is defined as the excretion of waste production
elimination
wha is this considered as a elimination
water is waste product ( kidney in large getting rid of extra )
the urinary system :
what are the 3 things that are pressure
capsular pressure
osmotic pressure
blood pressure
these are the three pressure
what is enlarge prostate?
prostate can interfere with urine
consider interventions that could be done drainage from the bladder
urinary system : what do we think about two things
what is the normal ( regular job )
filtering maintaining electrolyte balance ( acid base balance, regulating blood pressure
blood tells us ( report how kidney is doing )
abnormality , in electrolytes ( kidney is not working out , regulating our blood and filtering )
is this true or false.
this is true
urinary system : how we do we know if the urinary system is working ?
normal kidney functions
filter waste products
maintain fluid and electrolyte balance
acid base balancet
true or false . regulate blood pressure and eyrhtopoeitin, would indicate normal kidney functions
true
what should nurses monitor for ?
fluid balance
- intake ( IV , PO, NG feeding )
output ( u.o , diarrhea, ng suction, etc, suction,etc )
weight ( daily, trends )
should nurses monitor for edema nad ausculate lungs, for urinary system ?
yes this is practicedwha
t are the labs we are monitpring for when it comes to the urianry system
urea, creatine, K, hgb , abg, vital signs
wht do we do regular basis that kdiney is working ? fluid balance
this is true
what are the common meds for urinary system ?
nsaids
antibiotics
tmp-smx ( spetra, bactrim )
ciprofloxacin
what are the common medications
recall that diuretics is one ( what udnergoes this )
they do not help with kidney funtining but what do they help wtih ?
lasix ( loop, diuretic )
they dont help with kidney functioning but they help with the symptoms ( getting rid of the fludi )
force kidney to diuresis , used when kidneys declined
what type of relation do the nsaids have /
have negative effects in the kidneys ( especially low perfusion tot eh kidneys ) nsaids do in relation in kidney interfere with prostaglandin production , prostaglandin helps kidney vasodilator in low perfusion
if the pt is in renal failure , what do u question
question nsaid order, renal pt may be in nsaids, dont take it as they will never, but see how their kidneys are funcitoning.
what is the number one type of infections and what is the second one ?
urianry tract infections is the seocnd one
resp infections is the first one
with bladder symptoms : what type of common medications are we utilizing
pyridium ( urianry analgesic 0
oxybutin ( decrease of muscle spams of bladder and urinary tract )
what does pyridium help with ?
helps pain in the baldder : big nursing consieration is turns your urine into colour ( bright orange )
u might look into if they are on this med
what common meds are we using for bph
proscar ( decrease size of prostate )
flomax ( relaxes smooth muscle of prostate )
true or false. drugs that could be sued to decreased enlarged prostate , common for med and give these to older audlts gentlemen
true
what can go wrong with the kidney ?
big ideas
infection
obstruction
injury
from aki to ckd
true or false. AKI is something we can intervene and reverse situation quickly
this is true
true or false. we can prevent long term damage to our kidenys if we ca intervene if not treating infections appropriately or effectively we can build up scar tissue because of inflammation.
true
chronic infections can lead to chrinc kidney disease( kidney stones, scar tissue can form - if not fixed=
this is true
problem #1
infection
exemplars:
lower an upper uti
what is urinary tract infection
recognize cues ( review)
who is at risk?
what is uncomplicatede cystitis vs complicated cystitis
pts with diabetes, abnormality in urinary tract kidney stones, older adults ( older and pregnant female : high risk with pregnancy )
for children genetically abnormalities how the bladder drains ( prone to retaining urine and can have repeating urinary tract )
what is urinary complciated ? how long does it usually last
7-14 days usually starts in the bladder - ascending because of ecoli
we do not want infection getting close to the kidneys ( can affect kidney functioning scar tissue )
dysuria, urgency , frequency, palapted ( infected blader- sore )
what is the difference between puhyscial imple urine tract or to the kidenys
they have cvh tenderness , fever, and nausa and vomitting - blsadder infeciton
yes these are all true
what are hte diagnostics tests we are utulziing for uti
1 urianlysis
leukocytes nitrates wbc rbc and casts
all of thesea re going to beelevated
#2 urine culture
what does casts tells us
if there is a intra renal problem
what does rbc tells us in the diagnostic tests for uti
rbc - some areas that could be bleeding a little bit
casts - tells u tehe tubules of a nephron
is a screening of all compoennts found in the blood
this gives us specific ( blood which abx needs to be ordered )
is this true or false.
this is true
what is the important thing we look for someone who has infection : this is for analyzing cues for urinary tract infectiomn
important thing we look forif a pt has an infection
- gluco cytes and nitrates that indicates a bacterial infection and took both samples - now we can send th rine culutre 0 because we have evidence of urinary infection
urinary tract infection
plan/prioritize
what can go wrong ?
cystitis – pyelonephritis
urospesis
AKI
CKD ( chronic utis )
what is the wrost case scenario for someone who has uti
they will become ureaseptic : fever, chills, nausea, vomitting ( irritating symptoms )
starts seeing changes to the vital signs
what is our interventions for uti ?
interventions : take action
management of utis
what are the 4 as for drug theraphy
analgesic, antipyretic, anitbiotic, antispasmodic ( ditopran )
what is the other management for utis : interventions : take action for uti
fluid intake
sitz bath
suregry ( remove cause of recurrent utis )
is it okay to give both analgesic and antipyretic as management for uti
yes it is okay to do that
why is fluid bath given for uti
warm water calms the inflame area, u want to pish fluid and not want to retain
true or false. offer pt a sitz bath
true this is true
what is our intervention if al the other intefventions are not working ?
need surgery
uti evaluate and educate
who needs a urianry catheter
urinary retention
hourly u/o in critically ill
during surgert
sci
clots in the bladderr
recall that rthese poeple needs a urinary cathether who else:
* Urinary retention
* Hourly u/o in critically ill
* During surgery
* SCI
clots in the bladder
open wounds in perineum
immobolized patients ( ex: cva )
what is our role in preventing infection ?
sterile technique
push fluids ( encourage our patient drink )
flush out
mobility ( even helps with decrease try to advocate for ur patient )
got sedated and does not feel like peeing
- might need a foly
-critically ill ( how well kidenys are functioning.) ins oand pouts eveyr hour
surgery - put foley anyone going through general anaesthetic going after time
need straight cath - and regularly - lower incident of infection
true or false.
true
to protect skin
the wound not healing - cath may be required
A patient with a urinary tract infection (UTI) is prescribed antibiotics. What is the most important nursing intervention?
A. Encourage increased fluid intake.
B. Monitor blood glucose levels.
C. Apply a warm compress to the abdomen. D. Provide a high-protein diet.
A. encourage increased fluid intake
A patient is admitted with acute pyelonephritis. What is the priority nursing intervention?
A. Encourage ambulation.
B. Administer prescribed analgesics.
C. Monitor Urea and Creatinine.
D. Provide sitz bath.
C
con
think about seriousness, is it contained or spread
think abt interfere with renal functioning
concept connection : elimination
think about seriousness, is it contained or spread think about interfere with renal functioning
problem #2 obstruction exemplars :
nephrolithiasis/urolithiasis
bph
renal/bladder ca
the importance of forward flow into the kidneys
when we have obstruction ( overtime what will happen )
overtime it will increase pushing back into the blood pressure
if it cannot overcome the hydrostatic pressure we are going to lose ( and lose of filtration ) think abt that
worst case scenario for obstruction
major problem : hydronephoris/hydroureter
back flow if pressure really interrupt our gfr
reasons why we get obstruction in urinary tract or trauma
enlargement of kidney or ureter resulting from an outflow obstruction
hydronephrosis/hydroroureter
what is the potential causes of hydronephrosis/hydrorouter
kidney stones/tumors/trauma, etc
what can lead to kidney damage and necrosis if treatment doesn’t occur in a timely manner : what is this ?
hydronephorisis/hydroroureter
what is it physical pain for hydronephrosis
flank or abdominal pain
interventions for hydronephrosis/hydroureter
treat cause of obstruction
this is too much water in the roureter what is this describing :
hydroureter
and or kidney
develop sudden aki
and flow into the kidney is infected ( perfusion into the kidney is affected )Or necrosis in the kidney can occur
true
increase capsular pressure - alot of discomfort
YES THIS SI TRUE
IMPORTANT: to think abt is the kideny pain and what causes it
consider the emergency reverse this obstruction
assesment : recognize cues ( review ) nephrolithiasis/urolithiasis
risk factors: relative who had kidney stones , the genetic component ( differences in metabolism of some components more likely to absorbs calcium =, struviate , olciate, collecting the urine , crystallizing in high contraction
what is the most common cause of nephrolithiasis/urolithiasis
pain, pain pattern - where the stone is located, the pain is confined to the abdomen or the flank ( the usually in the kidney )
common symptoms
of nephrolithiasis/urolithiasis
where it starts to radiating on the over as it reaches ( rough edges , causes trauma , irritative symptoms bleeding and increase the risk of infection
this is painful ( travelling down , most painful experiences )
for men closed to experiencing labour
nephrolithiasis/urolithiasis
who is at risk for nephrolithiasis/ urolithiasis
diabetes people who are overnight people with gout
dehydration and present kidney stones in the summer months - become dehydrated: what is this describing
this is describing urolithiasis
what is complication for nephrolithiasis/urolithiasis
urine flow and too bad
nephrolithiasis/urolithaisis
analyze cues
more solute compare to the amount of water ( shows dehydration )
what are you doing ?
sending a urine analysis of a possible kidney stones
what undergoes urinalysis for nephrolithiasis/urolithiasis
specific gravity
osmolarity
pH
RBCs
WBCs
crystals
urine appearance
specific gravity
osmolarity
pH
RBCs
WBCs
crystals
urine appearance
info this gives
specific gravity
osmolarity
= hydration
pH- high acidity : uric acid and crystine stones
low acidity: calcium and struviate stones
RBC - bleeding
WBC - infection ( trauma and obstruction of urine flow )
crystals
urine appearance
present with stones ( if they are talking stones : crystals )
may be cloudy or hematuria
nephrolithiasis/urolithiasis
take action : non surgical interventions
medication:
opoids/nsaids/oxybutynin
how to decide between opoid and oxybutin
nauseated and vomiting if someone is vomitting - never pick the oral route easier to give them iv route
nephrolithiasis/urolithiasis
take action: non surgical interventions
medications
- Opioids, NSAIDs*, Oxybutynin
- Antibiotics
- Thiazide diuretic
- Allopurinol
antiobitocs is for infection
thiazude diuretic
allopurinol
allopurinol - is for uric acid
thiaziade diuretic - wash out for calcium
thiazide diuretic is for what ?
pass stones and can prevent future stones
hydration ( avoid under and over hydrating ) : don’t over hydrate , is this true abt nephrolithiasis/urolithiasis
yes this is true
strain urine ( catch stone ) can identify which type of stones it is , is this true or false.
true
what does walking help with nephrolithiasis/urolithiasis
help gravity helps us
is extracoporeal shock wave lithotripsy considered a non surgical: give more description about this
a bit more invasive
this person in the getting this ( shock wave going through the skin and at the kidney and breaking stones and consistency of sands )
nephrolithiasis/urolithiasis: ECSW lithotripsy : nursing care post procedure
what are things u look for immediately after someone who had a procedure done ?
make sure oxygen is hooked up to the wall
urianry tract ( make sure foley bad is down ) it is draining
always following foley abg up ( is it kinked? )
make sure urine is travelling down the bag
true or false. it is important to establish a baseline with nephrolithiasis/urolithiasis
this is true
what to expect for nephroliathiasis/urolithiasis
ecsw lithotripsy : nursing care post procedure
patient sedation
pain
hematuria ( should lessen over time )
flank bruising ( may ocucur )
utreteral stent ( may be placed 0
what is a ureteral stent ?
inside keeping urether open, cannot be seen on the outside
small in size and took a pen and little tube urether stent after a procedure like this -opne in urether reduce iritation as the come up and no obstruction
true or false someone who had a extracoroporeal shock wave lithoripsy we need to check sedation : in terms of this expand on it
check how sedation is doing
do we give water ? needs to decide ( loc ) make sure intanct
- ask for pain
-ask if they want pain med
true or false. u could ask a question like would u like a sip of water when smeone had ecsw lithotripsy
yes this si true
if loc is good, checked gag reflex ( when someone had freezing down the throat ) scope, henral anesthesia
general sedation u do not have to check for the gag reflex?
yes dont have to check
define if this statement is true. dont phone the doctor , is it normal ? if stones passed through ( thissi norm, note the colour, expect hematuria and pain )
what i wont expect : if bp is lower THAN baseline WHE HE COMES BAck BUT SHOULD BE COMING UP WHEN HE WAKES UP
IF BP is not improved, not recvering as i expect them too
true
what is teh complications of nephrolithiasis/urolithiasis
ecsw lithotripsy: nrsing care post procedure
hemorrhage
sepsis
- if come back half full of dark urine
can obstruct urinary tract and need irrigation
check vitals and blood pressure and temperature
nephrolithiasis/urolithiasis
interventions: take action ( surgical management )
what are the 3 that could be utilized
ureteroscopy
percutaneous ureterolithotomy, and percutaneous nephrolithotomy
and open surgical procedure
what undergoes ureteroscopy
where is the scope placed through
the scope is placed through urethra and bladder into ureter
what happens once stone is seen in ureteroscopy
once stone is seen, removed with grasping baskets, forceps, or loops
true or false. stenting of ureters can be performed, in ureteroscopy
this is true
true or false. stenting of ureters can be perfromed in ureteroscopy
true, and tithotripsy can also be performed
what is percutaneous ureterolithotomy , and percutaneous nephrolithomy
removal of a stone in the ureter or kidney through the skin ( 1 cm cut )
what type of anesthesia do we use for percutaneous ureterolithotomy , and percutaneous nephrolithomy
local or general anesthesia
what is this describing : through the skin or urether or straight to the kidney
percutaneous ureterolithotomy, and percutaneous nephrolithotomy
often a uretheral stent onnephoromy tube is placed permanently to drain urine , is this true.
false, its temporry
the tube sits in the renal pelvis
what is open surgical procedure nephrolithiasis/urolithiasis
remove large, impacted stone ( other methods have failed )
general anesthesia
may need ureteral stent, nephrostomy tube, wound drain
for percutaneoous ureterolithomy, and pecutaneous nephrolithotomy
where are they going to the stone?
fluroscopy or xray, they are going to the stone - to get the location
true or false. for open surgical procedure , impacted now we have to open up the pt
open procedure to remove a stone
true
where would the location be for open srugical procedure?
it would be on the back
kidney is located in the peritoneal space, they have dressing across the back
urether stet - not a lot of monitroing )
( if urine is coming out this is working , a lack of urine output if nothing ic oming out )
opstretomy tube - this is a big deal , made a little incision ove ht etop of kidney, cathete sits indie the renal pelvis ( kdieny )
this is true
if ureteris blocking stone s- what is it called ?
if alrger incision and nephrostomy tube and little bag hanging ther e- last option liekly had open surgical procedure andcut open and loke inside the kidney
hydronephrosis
yes that is true
what is this explaining : going through the skin urether to remove the stone very invasive, and more of recovery
drain coming out of his incision as well
open ureterolithotomy or pyelolithotomy
what is nephrostomy tubes
catheter coming into the renal pelvis and draining it out
bag is way up there and coming out of ur back look closer
interventions : take action ( surgical management ) nephrolithiasis/urolithiasis
place strain all urine - on the back of the sheet, who empties the urine , healthcare aid did have instructions to do that
what i expected during teh post op ?
hematuria ( is expected )
what should we have durin post op care for nephrolithiasis and urlothiasis ( getting thier stones removed )
vital signs
water jug ( kdieny basi n ). encourage fluidspass through
ins and out sheets
strainer
what undergoes the post op care for getting stones remove surgical
Post Op Care
* recover from sedation/anesthesia
——Vital signs, ABCs, LOC
* monitor for bleeding
——incisions & urine
- maintain adequate fluid intake/output
——– IV fluid until drinking, Ins=outs - strain urine
iv fluid ( patient is waig up and all of thse procedures need sedation , we do not immediately come ain force fluid )
they have fluid running, heo flush out urianry system and as they start dirning dslow down iv rat e
and take all
need pain meds ( have ordered prn )
true
what is the patient education for nephrolihaisis and urlothiasis
remian hydrated ) 3 L day
drugs ( thiazide diurteics, allopurinol )
walk
nutrtional therpahy ( na protein)
manage anxiety
BPH Benign Prostatic Hyperplasia
Recognize Cues
symptoms
see luts ( lower urinary tract symptoms ) – increase risk of infecion
retention, hesitanyc. leaking dribbling
incontinence (voerflow )
oncomplete bladder emptying
grows impeded urine outflow
someone can have enlarged prostate - but notinterfering with urethra
where the prostate is pressing ( what matters ) in the urianry tract
what is this describng
bph
BPH benign prostatic hyperplasia
analyze cues
diagnose testing :
DRE
TRUS
urinalysis/ucul
recall that :
DRE
TRUS
urinalysis/ucul
is how to diagnose testing
for bph
what else
cbc
urea/crea
psa ( prostate specific antigen )
bph ( benign prostatic hyperplasia )
analyze cues : what is this mean
screening
what does dre : finger in the rectum ( and palpate the prostate )
digital rectal exam
what does trus mean
trans rectal ultrasound
urinalysis/ucul
define the description for it
changes in urinary retention
retaining urine - increase the risk of infection
overtime if this i
overtime if this is overtime obstruction and kidneys are experiencing blood flow : urea and creatine
true
bph : benign prostatic hyperplasia
intervention : take action ( non surgical )
behaviour modification
avoid ++ fluid, drugs that cause retention ( incontinence is worse, and increase worse for retention )
what is the drug theraphy : for bph
alpha adnergic antagonists ( tamsulosin-flomax )
—- helps with shrinking the size of prostate and relaxing smooth muscle
recall that: alpha adnergic antagonists ( tamsulosin-flomax ) is for bph
—- helps with shrinking the size of prostate and relaxing smooth muscle
what else
5 alpha reductase inhibitors ( finasteride - proscar )
Minimally invasive approaches
◦ Prostate artery embolism
◦ Transurethral needle ablation (TUNA)
what else ?
◦ Transurethral microwave therapy (TUMT)
minimally invasive approaches
for prostate artery embolism :
decrease blood flow the prostate- interfere starts to shrink
transurethral needle ablation ( TUNA )
minimally invasive appraoches : BPH
using low frequency of energy trying to shrink the prostate
prostate- bph
intervetion : take action ( surgical )
transurethral resectin of the prostate ( TURP )
enlarged portion removed through endoscope
Prostate- BPH
Intervention: Take Action (Surgical)
Transuretheral resection of the prostate (TURP)
* Enlarged portion removed through endoscope
post op :
catheter placed, may need continous bladder irrigation
where is the surgery done for bph
surgery is done through urethra kinda scrape away the part of the prostate more room for urinary output
what is this describing : quite risk of bleeding inside the kideny or bladder - which can cause trauma
TURP
3 way bladder irrigation
what is this describing used to reduce the risk of clot formation and maintain indwelling urinary catheter (IUC) patency by continuously irrigating the bladder via a three‑way catheter
this is continous bladder irrigation
initially instil 2 full syringe before attempting to remove clots : this prevents sucking on the bladder wall : what is this ?
irrigating an obstructed 3 way catheter
cancer of the urinary system :
assesment : recognize cues ( review )
what are the three cancer types
1) bladder cancer
2) renal cancer
3) prostate cancer
what are the risk factors for bladder cancer
tobacco use, exposure to gasoline and diesel fuel, chemicals
what are the symptoms for bladder cancer
painless blood in urine, dysuria, frequency, urgency
what are the diagnostics for bladder cancer
ct/mri/us/cystosopy ( bx )
true or false. more room in the bladder ( would have to be large tumour to compress )
for symotoms in bladder cancer
true
what is the risk factors for renal cancer
tobacco use, exposure to heavy metals, asbestos
what are the symptoms for renal cancer
flank pain- dull or acing
late sign : blood in urine
what is the risk factors for prostate cancer
advancing age
what is the symptoms for prostate cancer
early : bladder outlet obstruction
late sign : gross, hematuria, abdominal pain
what is the diagnostics for prostate cancer
DRE ( digital rectal exam )
ct/mri/us/cystoscopy ( bx )
what is urothelial ( bladder ) cancer
intervention : take action
non surgical management :
intravesical chemo ( inside the baldder )
- use separate toilet
-wash clothing ( 10 % bleach solutin )
what is transurethral resection of the bladder tumor ( TURBT )
what is it ?
cutting part of the baldder out ( still left there, but removing part of it )
cut through abdomen do not remove bladder
what is complete cystectomy ( bladder removal )
should not be peeing as other people ( strong chemical of that urine )
men should sit down to void ( wash the toilet they are using
void in commode ( something we can control not affecting other people )
urothelial ( bladder cancer )
intervention : take action
think about how they are continent or incontinent : ask about those things : think abt if it cannot be taken out.
doesn’t have to cut through skin, going through urethra can take bladder out completely
just read it
okay
urothelial ( baldder cancer )
intervention : take action
types of urinary diversion methods
ureterostomies
conduits
sigmoidostomies
what is ureeterostomie : this is a type of urianry diversion
1 or 2 comibed together or have a stong
have a bag to collect it
incontienent ( no spincher anymore to control the body.)
what is a conduits : a type of urianry diversion method
conduits - portion of the instestines make cnnections to colelct ( still have osteomy ) saw up one end and other ennd comes through abdomimal wall
gives more room for urine to collect it
true or false. stoma : can be anywhere: bladder ( other things can have stoma )
if there is an opening into the body ( stoma )`
yes this is true
what is a sigmoidostomies
usually because of bladder cancer
combined with feced, this pt is continent ( but barely , extra fluid )
kind of make fake bladder
and comes in through soy
vecuase urine is her to collect, consider continent
illeal reservoir ( kock’s pouch )
true
sigmoidostomies
- have attach uretereties of clon
true or false.
true
cystectomy : post op
general post op monitoring ( pain bleeding, db + c , infection )
volume status
recall that we are doing this during the post op for cystectomy , but what else ?
- general post op monitoring (pain, bleeding, DB+C, infection)
- volume status
collaboration with enteral stoma ( ET ) nurse for ostomy care
- anxiety, body image, sexuality
infection, bleeding, drinking enough, teaching and help intrastoma nurse for post op cystectomy is something to look at
true
renal cancer
interventions : take action
non surgical management
- chemo is typically not as effective
yes this is true, it is not as effective
what is the surgical management for renal cancer
nephrectomy ( removal of part or all of the kidney )
what is the post op for nephrectomy
kidney function of remaining kidney
pain, bleeding, infection
recall that adrenal gland insufficiency. is something that could be seen in post op nephrorectomy
addisons disease ( not stress hormone, not enough cortisol )
hard time maintaining blood pressure, temp, heart rate blood sugar
what is important to see in a renal cancer ?
glucocortocoid and mineralcorticoid is important
urine output and urea/cretitine is important
urine output over 30mLs pre hour
blood work ( urea and creatine )
might see other component that are not normalize because of kidney
yes
what is the thing with open nephrectomy ?
atelectasis
all of their breathing muscles ( hurts to take deep breaths )
A laparoscopic nephrectomy involves removing an entire kidney through keyhole incisions in the flank, the side of the body between the ribs and the hip
yes
Prostate Cancer
Interventions: Take Action
Treatment Options;
Radiation therapy (external or internal)
Chemotherapy
Prostatectomy (surgical removal of prostate)
* laparoscopic or open
post op care for prostate cancer
Post-op care:
- kidney function of remaining kidney
- pain, bleeding, infection
- Kegal exercises if incontinence
blood clotting 0 3 ways catheter important in reducing that risk
yes
A patient with bladder cancer is scheduled for a cystectomy with ileal conduit creation ( part of bowl) What preoperative teaching should the nurse include?
A. Explain the need to report hematuria immediately. B. Discuss the importance of fluid restriction.
C. Instruct how to care for the stoma and appliance. D. Teach how to perform Kegel exercises.
c
Which order should the nurse question for her patient with urolithiasis?
A. Encourage ambulation. B. Administer oxybutynin
C. Restrict fluid intake.
D. Prepare for lithotripsy.
c
problem #3
injury
exemplars
trauma
aki/ckd
kidney trauma
recognize cues
urologic procedures
what is the cause ?
what is the assessment ?
penetrating or blunt wound, urologic procedures
assessment : observe for bleeding
what is the diagnosis for kidney trauma
dx: us or ct scan , urinalysis, cbc, urea, crea
true or false. severity of trauma depends on the extent of the injury
true
what is a big thing in kidney trauma ?
bleeding is a big thing ( million blood vessels on kidneys )
what is monitoring and treatment for kidney trauma
VS ( watch for shock ) , iv fluids if needed
ins and outs, fluid balance, hematuria
myoglobinuria
review meds- any nephrotoxic antibiotics
surgery if needed
nephrotic syndrome : review
diuretic to move fluid out of the body
causes fluid floss form intravascular spaces ( this diminishes edema could come back in circulation get rid of it )
restrict sodium - get heparin to prevent clots for forming
lipid lowering drugs
true or false.
true
nephrotic syndrome : review
assessment and intervention
what is it ?
immunologic kidney disorder when glomerular permeability increases so larger molecules pass through the filtration membrane into urine.
what is the pt population for nephrotic syndrome review
strange immune reaction
if u can i understand losing massive amount of proteins
nephrotic syndrome
issues with nephrotic syndrome : review
low serum albumin - edema ( diuretis, NA rest )
— i and o balance, weight, measure girth ( ascites )
— skin care
reduced kidney function
hypercoagulability- clots ( heparin )
nephrotic syndrome : review
recall that :
low serum albumin - edema ( diuretics, NA rest )
— i and o balance, weight, measure girth ( ascites )
— skin care
what else?
hypercoagbuality ( clots ) we use heparin
elevated serum cholesterol ( lipid lowering meds )
nutrition status – normal or high protein diet ( depending gfr )
altered immune response ( increased risk infection )
lose a lot of protein - blood pressure seep out , a lot of edema , and reduction in kidney functioning
is this true or false, amongst nephrotic syndrome.
true
nephrotic syndrome : depends on ______ : may need protein or not
GFR
increase protein if adequate no if not
what are some meds used to treat immunosuppresants
acei
lipid lowering
drugs
heparin
mild diuretics
one of the things we lose - clotting factors - result in this state
- critical thinking: elevated cholesterol : has to do with the liver respond
is this true amongst nephrotic syndrome
true
Practice Question
A patient with nephrotic syndrome is experiencing significant edema. What dietary intervention should the nurse implement?
A. Increase sodium intake.
B. Encourage high-protein foods.
C. Restrict fluid intake.
D. Provide a high-fiber diet.
B
Acute Kidney Injury (AKI)
Assessment: Recognize Cues
Cause:
S&S nurses must recognize Δ’s
pre, intra, and post renal
S and S must recognize
: * Fluid volume status (In&Out, weight)
* Urine characteristics/amount
* Lab results (Urea, Crea, Na,K, Ca, Phos)
any volume in patients : pressure coming in and has to overcome the resistanc in the capsule
we get worried about sudden drop of bp
what can this lead to ?
what is intra?
what is post renal ?
sudden aki
damage to self kidney
obstruction
Acute kidney injury : interventions : take action
depend on which is the cause : we give them a lot of fluids
what should we avoid ?
yes this is true
treatment is decided based on the cause of the aki
avoid hypotension/avoid nephrotoxic agents and drugs
what should we monitor for in acute kidney injury
monitor or signs of fluid overload ( may need fluid restriction or diuretic ) — look for edema/listen to their lungs
what is lab work for acute kidney injury : what should we watch out for ?
watch for imbalances and correct as needed
nutrition : dietician to balance protein, na, k ( restrict certain things )
dialysis as last resort if unable to manage symptoms
example : don’t stress the kidney further ( question if hard on the kidney )
chronic kidney disease : recognize and analyze cues
affect all system
neuro
cvs
resp
decrease loc
htn, edema, pericarditis
kussmaul’s, pulm edema
Chronic Kidney Disease
GI
GU
MUSK/SKEL
INTEG
gi : decrease apetite, metallic taste, nausea and vomitting
gu : urine/output
musk/skel: osteodystrophy
integ : pruritis, ecchymosis
what is uremia ?
end stage of chronic kidney disease
which reason which would be pre renal - the surgery jake is an 80 year pt who had surgery for colon caner 2 days ago, and developed fever overnight. he was started abx and this morn, he went for a ct scan of is abdomen, his urine output is decrease this am and his creatine is elevated
hang bolus of 500 ml to be give over an hour
strict ins and outs
because the next hour is going to be very important
- pre renal - should be able to tell if its pre renal ( if it gets better then ) urine output putting up
respond to that fluid ( likely pre renal cause )
ct dyes
abx
surgery ( is at risk usually cause people to bleed, and volume loss ) ‘multiple reason why this might’ve experience kidney injury
ckd: intervention : take action
what is our intevrentions ?
managing fluid volume
diet
blood pressure control
and preventing injury
what undergoes manging fluid volumes
weights, fluid restriction , input and output
monitor signs/symptoms of overload
what undergoes diet what undergoes ckd
invovle a dietician na k and phosphate restriction
what undergoes blood pressure control : for ckd
ace inhibtor, ccb , bb, diuretics
what is preventing injury for ckd
fractures, infection, bleeding
avoid antacids with Mg
use caution wit opoids
control their blood pressure
all connected to the blood vessels
look for any that is not working
( fractures, if they fall etc. ) minimize risk of infection is this true amongst the diet in ckd
this sit true
chrinic kidney , not able to get rid of mg s this true or false?
this is true
opioids can make someone ambulate - takes longer
what is dialysis : general ideasolutes and water move across the semipermeable membrane from the blood to the dialysate or from dialysate to the blood, in accordance with concentration gradients
what is this describing
dialysis
fluid very different from their blood , is this true amongst dialysis.
what is their blood like ?
this is true
thier blood is high elements like potassium, creatine, urea, and leave in the blood
we give them dialysis low contraction of those things
ckd : interventions: take action
this is the end stage of chronic kidney disease and need dialysis and push them into the category
indications for hemodialysis:
acidosis
electrolytes ( send dialysis usually potassium, if we cannot control - too dangerous )
intoxication/ingestions – drugs there own is building to toxic levels
overload
uremia – signs of uremia
ckd
interventions : take action
caring for a dialysis patient
- Know the pt’s dry weight
- May need to hold drugs prior to dialysis
- Measure VS on return to unit
recall that ckd interventions take action for caring for a dialysis patient :
recall that : * Know the pt’s dry weight
* May need to hold drugs prior to dialysis
* Measure VS on return to unit
- Assess vascular access site (bleeding)
- Assess LOC, headache, n&v after treatment * Monitor blood work after dialysis treatment
ckd : caring for a dialysis pt
know the pts weight why ?
optimal weight have gone
through dialysis - the trend with dialysis their weight is down.
between days goes up and down
we try to get them back up in dry weight ( if they got the fluid off, sometimes they get all them off and sometime they cant )
may need to hold drugs prior to dialysis for caring for a dialysis patient :
which drug is dialysis
measure VS on return to unit
they have
they may go hypotensive, usually this is taken care off in the dialysis unit
recall that assessing vascular access site ( bleeding ) for ckd
they have put needle in the fistula ( risk of bleeding )
ckd : assessing LOC, headache, nausea and vomiting after treatment
indicate fluid shift is too quickly
is this true or fale. monitor blood work after dialysis treatment for ckd.
always send post dialysis bloodwork
give a description through an av fistula
only way we can give patients dialysis
vein and artery sewn together to fistula = high pressure of artery
(vein expands , and what becomes thick) allows us to repeatedly puncture it and remove and return fluid quickly ( try to cool off , maybe fistulas to access )
dialysis through an av fistula
we want to feel it ( feel thrill, blood rushing through auscultate and hear bruit turbulate blood low )1
dialysis through an av fistula
what do u do ?
palpate thrill
auscultate bruit
dialysis through a central line
what is it called
give description
vas cath
very thick and hard
and got two huge clamps on it
as a bedside nurse do not ever touch and access a vas cath
this is only for dialysis
peritoneal dialysis
the blood ( permeable is the peritoneum so competent of out blood will leak to the dialysis and leave for a period of time and empty it )
it will go into abdominal cavity and empty it out and same thing as urine
gotten rid of waste product
component in the dialysis in the and will go to the pts blood
