Week 2 GU Flashcards
Kidney Disorders include
- Fluid and electrolyte imbalances
- Most accurate indicator of fluid loss or gain, in an acutely ill patient is weight
- Refer to table 48-1
Gerontologic Considerations for Kidney Disorders
- Less able to respond to F&E changes
- Atypical/ nonspecific/sx of altered renal function
- Fluid Balance diet
Fluid balance deficit includes?
- Constipation
- Falls
- Medication Toxicity
- UTIs/ URIs
- Delirium
- Seizures
- Hyperthermia
- Delayed Wound Healing
Name Primary Glomerular Diseases
- Diseases that destroy the glomerulus of the kidney
- 3rd most common cause of stage 5 CKD
- Glomerulonephritis
-acute or chronic
-Nephrotic Syndrome
Inflammation of the glomerular capillaries and can be acute or chronic
Glomerulonephritis
Kidney is damage with mild kidney loss of function
EGFR is 60-89
60-89 % kidney function
Stage 2
Kidney function is 90-100%
GFR is 90 or above
- May have kidney damage (Protein in urine with normal kidney function)
Stage 1
Mild to moderate loss of kidney function
eGFR is 45-59
45-59% Kidney function
Stage 3a
Moderate to severe loss of kidney function
eGFR is 30-44
Kidney Function is 30-44%
Stage 3b
Severe loss of kidney function
eGFR is 15-29
15-29% Severe loss of kidney function
Stage 4
Kidney Failure
eGFR is less than 15
Less than 15%
Stage 5
Glomerulus
The main function of the glomerulus is to filter plasma to produce glomerular filtrate, which passes down the length of the nephron tubule to form urine.
Bowman’s Capsule
Nephron
The nephrons work through a two-step process: the glomerulus filters your blood, and the tubule returns needed substances to your blood and removes wastes. Each nephron has a glomerulus to filter your blood and a tubule that returns needed substances to your blood and pulls out additional wastes.
Podocytes cooperate with mesyngal cells to do what
Support the structure and function of the glomerulus
Proximal loop located in
Renal cortex
closest to bowman’s capsule
Freely permeable cell membrane allows for reabsorption
Loop of Henle
Renal pyramids in the medulla
Distal Loop
Furthest away
Collecting tubule in renal cortex
Type of acute glomerular nephritis
Renal failure with glomerular inflammation
Acute Nephritic Syndrome
Manifestations of of Acute Nephritic Syndrome
Hematuria- may be microscopic or look like cola d/t glomerular bleeding
- Pus and cellular/ granular casts in urine
- Protein variable
- Sever cases decreased GFR
This may be mild or may progress to acute renal failure or death
Acute Nephritic Syndrome
What is the medical management of acute nephritic syndrome
Supportive care and dietary modifications
- Treat cause if appropriate- abx, corticosteroids, and immunosuppressants
Name the types of Nephritic Syndrome
- Post- infectious
- Rapidly progressive
- Membrane Proliferative
- Membranous
Inflamed glomerulus compromises blood flow and filtration
Post Infectious Nephritic Syndrome
Oliguria
Hematuria
Azotemia
HTN
Mild Edema
Post Infectious Nephritic Syndrome
This disease includes
-early fibrin crescent
-later cells move in Fibrin Scabs
in Bowman’s space prevent filtration and become permanent scars, ruining kidneys
Rapidly Progressive Glomerulonephritis
RPGN results when and with what?
When most of the glomeruli are damaged severely enough to allow fibrin to enter Bowman’s spaces
- Rapidly Progressive Glomerulonephritis
Thickening of the glomerular basement membrane type of nephritic syndrome
Membrane Proliferation
What is the sequence of Nephritic Syndrome ?
Antigen Group A Beta Hemolytic Strep
THEN
Antigen antibody product
THEN
Deposition of antigen- antibody complex in glomerulus
THEN
Increased production of epithelial cells lining the glomerulus
THEN
Leukocyte infiltration of the glomerulus
THEN
Thickening of the glomerular filtration membrane
THEN
Scarring and loss glomerular filtration membrane
THEN
Decreased GFR
Clinical Manifestations of Acute Nephritic Syndrome
- Decreased Hematuria
- Azotemia
- Proteinuria
- Edema
- HTN
Labs: Decreased albumin, increased Lipids, fatty casts in urine, Increased BUN/ Cr
Name complications of Acute Glomerulonephritis
- HTN Encephalopathy
- Heart Failure
- Pulmonary Edema
What is the medical management of Acute Glomerulonephritis ?
- Tx of sx
- Treatment of complications
- Managing HTN
Controlling proteinuria- diet low in prot and Na - Pharmacologic Therapy depends on cause / corticosteroids
Name the diagnostic findings of acute glomerulonephritis
1, Enlarged liver, neck veins
2. General swelling
3. Elevated BP
4. Tests include
- electrolytes
- BUN/Creatinine
- Urinalysis : protein, appearance, and color
- Kidney Biopsy
Repeated acute glomerular nephritis, HTN nephrosclerosis, hyperlipidemia, an other causes of glomerular damage
Chronic Glomerulonephritis
Renal insufficiency or failure: asymptomatic for years as glomerular damage increases before signs and symptoms develop
Chronic Glomerulonephritis
What are abnormal lab test results of acute Glomerulonephritis?
- Urine with fixed specific gravity
- Casts
- Proteinuria
- Electrolyte imbalances and hypoalbuminemia
Medical management is determined by symptoms
Name the clinical manifestations of Chronic Glomerulonephritis
- Appears poorly malnourished
- Yellow - grey skin coloring
- Peri- orbital- peripheral edema
-Retina: hemorrhage, exudate, papilledema. tortuous AV - Cardiomegaly: gallop rhythm, distended neck veins
- Crackles bases of lungs
Management of Chronic Glomerular Nephritis includes ?
- Aggressive tx of high blood pressure
- Na and water restriction
- Weights daily > diuretic fluid overload
- Diet: high in proteins, calories
- tx UTIs promptly
- Dialysis
Describe the Nephrotic Syndrome Concept Map
Glomerular Damage
—– Increased permeability to proteins - Proteinuria greater 3.5 g/ 24 hr
THEN
Leads to
PROTEINURIA
1. Decreased plasma oncotic pressure- Edema
2. Compensatory synthesis of proteins by liver - Hyperlipidemia
What is the nursing process of patients with Chronic Kidney Disease and Acute Kidney Injury - Assessment
- Fluid status
- Nutritional status
- Patient Knowledge
- Activity tolerance
- Self- Esteem
- Potential Complications
What do we also assess for in collaborative problems and complications?
- Hyperkalemia
- Pericarditis
- Pericardial effusion
- Pericardial Tamponade
- HTN
- Anemia
- Bone Disease and metastatic calcifications
The nursing process of patients with chronic kidney disease and acute kidney injury diagnosis includes what?
- Excess fluid volume
2 Imbalanced Nutrition - Deficient knowledge
- Risk for situational low self- esteem
Nursing process of planning for patients chronic kidney disease and Acute kidney injury planning includes ?
Goals may include maintaining of IBW without excess fluid, maintenance of adequate nutritional intake, increased knowledge, participation of activity within tolerance improved self esteem, and absence of complications
Kidneys are reduced to little as …
1/5th normal size
With excess fluid volume we do what?
Assess- s/s of fluid volume excess, keep accurate I&), and daily weights
Limit- Limit fluid to prescribe
Identify- Sources of fluid
Explain- Explain to pt and family the rationale for fluid restrictions
Assist- Patient to cope with the fluid restrictions
Provide or encourage- Frequent oral hygiene
What are some assessments one will do with imbalanced nutrition?
- Nutritional status, weight changes, lab data
- Nutritional patterns, history preferences
- Provide food preferences within restrictions
- Encourage high quality nutritional foods while maintaining nutritional restrictions
- Stomatitis or anorexia: modify intake related to factors tat contribute to alterations
- adjust medications times related to meals
Risk for Situational Low Self Esteem
Assess patient and family responses to illness and tx
- Assess relationships and coping patterns
- Encourage open discussion about changes and concerns
- Explore- Alternate ways of sexual expression
Discuss- role of giving and receiving love, warmth, and affection
Urolithiasis
Nephrolithiasis
- Calculi (stones) in the urinary tract or kidney
- Causes may be unknown
- Depend on location and presence of obstruction or infection
- Pain and hematuria
Diagnosis: Radiography, blood chem., and stone analysis, strain all urine and save stones
Name the potential sites of urinary calculi
-Right kidney
- renal stones
–Left kidney– renal stones
- Ureters
Bladder
Name the manifestations of urolithiasis and nephrolithiasis
Infection UTI: chills, fever
Intense CVA tendrness
- Hematuria
- Pyuria
- Pain radiates : Bladder -Female; Testes- Males
N/V
Urinary Retention
Name the Diagnostics of Urolithiasis and nephrolithiasis
- KUB
- Ultrasonography
- IV urography
- Retrograde Pylography
- 24 hr urine test Ca, uric acid, creatinine, Na, pH
- Passed stone
Management to eradicate the stone includes what?
-Pain- opioid analgesic
- Inflammatory - NSAIDs
- Hot baths or moist heat
- Prevention- Nutritional
- Fluids; Oral or IV
Name natural remedies for Kidney Stones include
- lemon juice
- Olive oil
- Raw apple cider vinegar
- Dandelion Root
- Celery
- Basil
- Leafy green vegetables
8 Exercise - Drink plenty of water
- Avoid sugar and soy
Name methods of removing or treating Renal Stones
- Use of cystoscope
- Use of ureteroscope
- Use of Xray imaging/ Lithotripsy
- Use of alligator forceps to remove kidney stone fragments
Patient Education of urolithiasis and nephrolithiasis includes
- S/ S to report
- Follow up care
- Urine ph monitoring
- Measures to prevent recurrent stones
- Importance of fluid intake
- Dietary education
- Medication education as needed
Nursing Diagnosis of preoperative urolithiasis and nephrolithiasis
- Anxiety
- Imbalanced Nutrition
- Deficient knowledge
Nursing Diagnosis Postoperative of Stones
- Risk of impaired skin integrity
- Acute pain
- Disturbed body image
- Potential sexual dysfunction
- Deficient Knowledge
