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Nursing 3910 > Week 3: Renal + Urinary Health > Flashcards

Week 3: Renal + Urinary Health Flashcards

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1
Q

Function of the Kidneys

A

Urine formation

Excretion of waste products

Regulation of electrolytes and acid-base balance

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2
Q

where are the kidneys located?

A

retroperitoneal space

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3
Q

RAAS System Low Aldosterone

A

low aldosterone = decreased Na retention, fluid volume, and blood pressure - increased urinary output (diuresis)

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4
Q

RAAS System High Aldosterone

A

Increased Na retention, fluid volume, blood pressure - decreased urinary output

  • there is a decrease in urinary output because the water and sodium are increased aka staying in the kidney
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5
Q

Renal Nursing assessment

A
  • Health history & family health history

physical expaminations (pain, GI, integumentary, urinary)

Lab values: Cr, BUN, eGFR, Hbg

Signs/symptoms of compromised kidney function

Comorbidities (diabetes, hypertension, neuromuscular disease)

Family history of kidney disease

Age

Older clients may have more comorbidities.

Medications (long term use may be nephrotoxic)

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6
Q

medications for renal injury

A

NSAIDs

Antibiotics

Loop diuretics (causes kidneys to work harder to excrete fluid)

Contrast dyes (hold metformin for 48 hours post dye)

Metformin (Type 2 diabetes med. Excreted by the kidneys)

Nephrotic drugs = cause damage to kidney’s over time

  • Cautious with contrast dye for patients with diabetes, metformin should be held after the administration of contrast dye for 48 hours to allow the kidneys to function
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7
Q

neurogenic Bladder

A

difficult time emptying the bladder which causes upstream impacts on the kidneys

lack bladder control in your brain

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8
Q

micturition

A

normal voiding (30 mL / day or 1-2 L/day)

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9
Q

anurea

A

no urinary output

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10
Q

oliguria

A

low urinary output

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11
Q

polyurea

A

excessive urinary output

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12
Q

hematuria

A

blood in urine

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13
Q

proteinurea

A

protein in urine

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14
Q

azotemia

A

elevation of nitrous products such as BUN and creatinine in the blood and other secondary waste products

integument examination

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15
Q

Pruritus

A

itching
integument examination

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16
Q

physical examination: GI

A

nausea, vomiting, diarrhea, abdominal discomfort + distention

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17
Q

physical examination: neurological

A

Waste product buildup in the body interrupts normal neurological functioning

Early signs: lethargy, forgetfulness, mild confusion

Late signs: seizures, coma

Build-up of BUN – interrupts our normal neurological functioning – is going to cause uremic encephalopathy the early and late signs of this are above

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18
Q

Serum Creatinine (Cr)

A

Meaning: elevated values indicate poor function

Creatinine is a waste product of creatine phosphate which is a by-product of muscle breakdown.

Patients with HIGH serum creatinine levels likely have severe renal impairment – the nephrons are destroyed so they aren’t able to filter through and excrete that waste

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19
Q

Blood Urea Nitrogen (BUN)

A

elevated values indicate poor function

BUN = measures the amount of urea nitrogen in the body - also a waste product of protein metabolism. So when BUN or creatine values are HIGH we know the body is retaining waste

20
Q

eGFR (estimated glomerular filtration

A

Decreased value indicates poor kidney function

Nursing role:
24-hour urine collection
Keep refrigerated
Document start and end time
Void at beginning of test and discard first urine specimen
At end, ask client to empty bladder

Blood draw
End of specimen collection

its a Measure of how our body is able to clear the creatine (if we are unable to excrete waste then eGFR would be decreased)

21
Q

Kidney Dysfunction: Lab findings

A

Increased creatinine and BUN, decreased eGFR

Fluid volume deficit

High protein

Decreased renal perfusion

Fluid volume excess (end stage kidney failure/disease)

22
Q

Kidney dysfunction Lab findings in end-stage renal

A

Increased or decreased Na (due to water retention, could cause either hyper or hypotension)

Increased K (due to cardiac arrythmias)

Decreased vitamin D

Increased phosphate

Decreased bicarbonate

Bone dysfunction (fall risk)

23
Q

Hemoglobin (Hbg)

A

Decreased erythropoietin causes anemia

Do not use hematocrit (Hct) as a measure of RBC (can be impacted by fluid
volume imbalance)

24
Q

Acute Kidney Injury (AKI)

A

Impacts renal function for less than 3 months

Sudden loss of renal failure

rapid decrease in U/O

Results in fluid, electrolyte, and pH imbalances (metabolic acidosis), waste buildup

** reversible

25
Q

Chronic Kidney Disease (kidney failure)

A

progressive, permanent nephron degeneration, irreversible

26
Q

Classifications of Acute kidney injury (AKI)

A
  1. Prerenal – hypoperfusion of kidneys (not enough blood flow - likely due to hypovolemia or anything that decreases BP, CO, total peripheral resistance)
  2. Intrarenal – damage to kidney tissues
    Comorbidities, medications, infections (typically UTI)
  3. Postrenal – obstruction of urine flow
    Tumour, clot, kidney stone
27
Q

Phases of Acute Kidney Injury

A

Initiation – initial insult to kidney function

Oliguria – rapid reduction in urine output
Increased Cr, BUN, K
May present with pruritus and/or hyperkalemia

Diuresis – normal urinary output

Recovery – labs normalize (typically afer 3 months)

28
Q

nursing role in preventing acute kidney injury

A

Monitor kidney function

Be aware of nephrotoxic drugs

Follow blood transfusion protocols (transfusion reactions can cause AKI)

Provide adequate hydration -
Surgery, contrast agents, chemotherapy, marginal kidney reserve (older adults)

Treat hypotension promptly

Prevent infection (especially UTIs)

29
Q

S&S Acute kidney inury

A

Hyperkalemia (cardiac arrythmias, muscle weakness, diarrhea)

Metabolic acidosis (Kussmaul respirations)

Hypervolemia (edema, bounding pulses, lethargy, confusion, weight gain,
decreased urinary output)

Decreased erythropoiesis

Hemodynamic instability

Neurologic changes

30
Q

Nursing Interventions: AKI

A

Monitor fluid and electrolyte balance

Promote pulmonary function

Infection prevention
Integument health
Edema and uraemic pruritus
Increased risk for breakdown

Psychosocial support

31
Q

Goals of care for AKI

A

Treat the underlying cause of AKI

Dialysis to remove toxins/fluids

Diuretic medications

32
Q

AKI: continuous renal replacement therapy (CRRT)

A

Filters extracellular fluid:
- Removes H2O, electrolytes, and solutes through hemofilter
- Clears urinary toxins
- typically used in ICU settings

Last effort, not a long-term treatment

CRRT = type of blood purification therapy that is used with patients who are experiencing acute kidney injury/ acute renal failure

33
Q

Chronic Kidney Disease

A

No cure

Process:

Preventative measures are encouraged

Disease is diagnosed, goal is to slow the progress

Disease progresses to severe

Dialysis or transplant will occur

Death will eventually occur

34
Q

Stages of Chronic Kidney Disease

A

Use the eGFR to stage kidney disease

Stage 1 – 90+, damage but normal function

Stage 2 – 60-89, mild decrease in function

Stage 3 – 30-59, moderate decrease in function

Stage 4 – 15-29, severe decrease in function

Stage 5 – less than 15, end-stage kidney disease

35
Q

causes of chronic kidney disease

A

hypertension & diabetes

36
Q

S&S of chronic kidney disease

A

Oliguria, hematuria, proteinuria

Hypervolemia (FVO)

Increased BP, pulmonary edema (crackles), JVD and bounding pulses, lethargy/confusion

Metabolic acidosis (pH less than 7.35)

Hyperkalemia

Cardiac arrythmias, muscle weakness, diarrhea

Hyperphosphatasemia (bone demineralization)

Hypocalcemia

Hypernatremia

Hemodynamic instability

Result of abnormal BP

Intestinal issues

Urea is converted into ammonia, which can cause ulceration and bleeding

Decreased hct and hbg

Melena or occult stool

Anemia

Measure Hbg, not Hct

Infection risk

Asepsis, catheter care

Integument

Uremic pruritis

37
Q

Nursing Interventions: Chronic Kidney disease

A

Monitor fluid and electrolyte balance
- Hyperkalemia
- I&O monitoring, daily weights
- Monitor for hypertensive crisis
- Headache, nausea and vomiting, change in mental status o Avoid nephrotoxic medications

Infection prevention
- Integument health
- Edema and uraemic pruritus may cause increased breakdown

Psychosocial support

38
Q

Patient education: chronic kidney disease

A

Control BG in diabetes

Control blood pressure in HTN

Diet
- Restrict fluid, Na, K, phosphates
- Consume low protein, high carb diet

Smoking cessation
Minimal alcohol intake
May need to lose weight
Encourage exercise
Avoid NSAID

39
Q

PRILs : treatment for chronic kidney disease

A

Antihypertensives, ACE inhibitors

Action – treat HTN, lower BP

Side effects – drowsiness, dizziness, headache, persistent dry cough

Nursing considerations: Monitor for hypotension, Advocate for change in medication if patient is having trouble coping with dry cough

40
Q

SARTANs - treatment for chronic kidney disease

A

Antihypertensives, ARBs

Action – treat HTN, lower BP

Side effects – dizziness, headache, nausea, vomiting, diarrhea

Nursing considerations: Monitor for hypotension, May be appropriate for patients who cannot tolerate PRILs

angiotensin 2 receptor blockers. Prevents RAAS from increasing blood pressure

41
Q

Metformin: treatment for chronic kidney disease

A

Antihyperglycemic, biquanide

Action – treat hyperglycemia, lower BG

Side effects – stomach pain, GI upset, gas, bloating, NVD, constipation

Caution – hepatotoxic

Nursing considerations: Monitor BG (hypoglycemia), Monitor ALT and AST, Do not use in eGFR under 30

42
Q

STATINs - treatment for chronic kidney disease

A

Antihyperlipidemia, HMG-CoA reductase inhibitor

Action – treat dyslypidemia

Side effects – headache, dizziness, insomnia, GI upset, muscle pain

Caution – hepatotoxic (monitor ALT and AST)

Nursing considerations:
- Lipid labs (require fasting) o HDL, LDL

43
Q

Dialysis Assessment

A

Monitor vitals, respiratory, and cardiac function (hypovolemia)

Monitor fluid balance & weight (shows efficacy)

Measure weight pre-dialysis and compare with weight following last treatment

Monitor labs ofen

44
Q

Peritoneal Dialysis

A

Run by gravity or continuous cycle

Treatment occurs overnight

Nursing actions:
- Warm hypertonic solution before administration
- Infection prevention: Wash hands, Wear mask
- Monitor for peritonitis: Febrile, cloudy drainage, tachycardia

45
Q

hemodialysis

A

Diffusion of dissolved solutes from one fluid compartment to another

Fistula care (vascular access point) and assessment

Avoid BP on dialysis arm

Perform neurovascular assessments

Do not touch the site without proper care

Hold medications

46
Q

Transplant

A

Healthy kidney replacement

Most effective treatment for stage 5 CKD

Afer transplants, recipients MUST be on immunosuppressants for life

80% survival rate 5 years post-transplant

Nursing 3910 (12 decks)

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