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NURS 2514 > Week 4 - AKI and Urinary Tract Seminar > Flashcards

Week 4 - AKI and Urinary Tract Seminar Flashcards

1
Q

what is AKI characterized by

A
  • abrupt decline in kidney function

- elevated serum creatinine and/or reduction in urine output

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2
Q

is AKI reversible?

A
  • often it is
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3
Q

describe the mortality for AKI

A
  • high
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4
Q

what are the 3 main categories of AKI

A
  • pre renal
  • intrarenal
  • post renal
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5
Q

what is pre renal AKI

A
  • decreased profusion to the kidney (marked decrease in renal blood flow)
  • decreased glomerular filtration rate
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6
Q

what is an intrarenal AKI

A
  • direct damage to the renal tissue
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7
Q

what is a postrenal AKI

A
  • mechanical obstruction of urinary outflow
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8
Q

what are the 5 major roles of the kidneys

A
  1. filter & excrete metabolic wastes
  2. regulate blood vol & pressure
  3. produce erythropoietin
  4. regulate electrolytes
  5. regulate pH
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9
Q

what should we ask about for health history for AKI

A
  • history of current symptoms
  • PMHx
  • PSHx
  • family Hx
  • meds
  • social Hx (smoking, drugs)
  • occupation Hx
  • dietary/fluid intake
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10
Q

how long does it take for pre and post renal injuries to resolve if they have not caused intrarenal damage?

A
  • usually promptly with correction of cause
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11
Q

list 6 meds/drug that may be harmful to the kidney (6)

A
  • NSAIDs
  • aminoglycosides
  • ACE inhibitors at high doses
  • cocaine
  • heroin
  • chemo –> methotrexate
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12
Q

what is ATN?

A
  • acute tubular necrosis

- the most common intrarenal cause of AKI

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13
Q

what are the 3 phases of ATN? what is the timeline for each?

A
  1. initiation (24 hrs to a week)
  2. maintenance (10-14 days to months)
  3. recovery (up to a year)
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14
Q

what is the initiation phase of ATN characterized by

A
  • increase in serum creatinine

- drop in urine output

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15
Q

what is the most common manifestation of the maintenance phase of ATN

A
  • ologuria (<400 mL/24h)
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16
Q

what other symptoms are seen during the maintenance phase of ATN (9)

A
  • urinary changes (oliguria)
  • fluid retentions: HTN, edema
  • metabolic acidosis
  • sodium normal or low
  • hyperkalemia
  • anemia, platelet defects, WBC altered
  • calcium deficit, phosphate excess
  • azotemia (increased BUN and creatinine)
  • neurological disorders

(very similar to CKD)

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17
Q

even tho sodium is normal or below-normal, why should excessive intake of sodium be avoided during ATN

A
  • can lead to volume expansion, HTN, and CHF
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18
Q

what are characteristics of the recovery phase of ATN (6)

A
  • return of BUN, creatinine, and GFR towards normal
  • may experience diuretic phase & increased urine output
  • hypovolemia & hypotension
  • dehydration
  • hyponatremia
  • hypokalemia
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19
Q

why do people experience a diuretic phase during the recovery phase of ATN

A
  • bc the kidney’s have recovered their ability to excrete wastes but not concentrate the urine
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20
Q

describe physical assessment for ATN in the initiation phase (3)

A
  • vital signs (BP, HR) for signs of fluid retention
  • ins and outs (sign of drop in u/o)
  • lab work: BUN and creatinine
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21
Q

describe physical assessment for ATN during the recovery phase

A

monitor:

  • ins and outs
  • signs of hypokalemia
  • signs of hyponatremia
  • signs of hypovolemia/dehydration
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22
Q

what are signs of hyponatremia

A

Stupor
Abdominal cramping
Lethargy
Trouble concentrating (confused)

Loss of urine & appetite
Orthostatic hypotension, overactive bowel sounds
Shallow respirations
Seziures, spasm of muscles

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23
Q

what are signs of hypokalemia

A 
Lethargy
Low, shallow resp
Lethal cardiac dysrhythmias
Lots of urine
Leg cramps
Limp muscles
Low BP and HR
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24
Q

what are some signs of dehydration/hypovolemia (5)

A
  • tenting
  • dry mucus membranes
  • low BP
  • sunken eyes
  • dry, cool skin
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25
Q

what is glomerulonephritis

A
  • immune related inflammation of the glomeruli
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26
Q

what is glomerulonephritis characterized by (4)

A
  • proteinuria
  • hematuria
  • decreased urine production
  • edema (periorbital common)
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27
Q

what is important for assessment of glomerulonephritis

A
  • history! especially:
    1. recent viral or bacterial infections
    2. autoimmune conditions
    3. immunization history
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28
Q

what is glomerulonephritis often associated with

A
  • recent (1-3 weeks ago) history of strept A infection

= post-strep glomerulonephritis

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29
Q

list symptoms of post-strep glomerulonephritis

A
  • some are symptomactic (urinalysis)
  • hematuria
  • HTN
  • oliguria
  • periorbital/peripheral edema
  • abdominal or flank pain
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30
Q

what is a sign of hematuria in post-strep glomerulonephritis

A
  • coke/tea colored or smoky urine
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31
Q

describe the recovery for post-strep glomerulonephritis

A
  • 95% have complete recovery

- treatment is generally supportive in nature

32
Q

what would you see in urinalysis of post-strep glomerulonephritis

A
  • RBCs (hematuria)
  • erythrocyte casts
  • proteinuria
33
Q

what would you see in blood work for someone w post-strep glomerulonephritis

A
  • elevated creatinine/BUN
34
Q

describe the history interview for someon w urinary complaints

A
  • OPQRSTU r/t current complaint
  • PMHx
  • PSHx
  • FHx
  • nutritonal Hx
  • elimination Hx
  • meds
  • allergies
  • occupational Hx
  • social Hx
  • sexual H
35
Q

what do you specificaly want to ask about regarding someone’s current complain for urinary complaints

A
  • changes in bladder emptying (freq, urgency)
  • characteristics of urine
  • ask what their normal elimination is
36
Q

what do you want to specifically ask about regarding PMHx for someone with a urinary complaint

A
  • Hx of UT problems
  • recent illness
  • diabetes? (glucosuria = higher risk of infection)
37
Q

what do you want to specifically ask about regarding meds for someone w a urinary complaint

A
  • any that treat UT problems?

- cause UT problems (diuretics = increased u/o, opiods = retention)

38
Q

why do you want to ask about sexual history for someone w urinary compliant

A
  • possible STI exposure? –> can mimic UTI symptoms & can cause scarring = obstruction & stasis = risk of infection
39
Q

what do you want to ask about regarding social history for someone w a urinary complaint

A
  • smoking? (Bladder ca risk)

- drug use? (kidney injury risk)

40
Q

what do you want to monitor in all patients for assessment r/t bladder drainage (5)

A
  • ins and outs
  • urine output
  • patient comfort
  • signs of infection
  • integ changes (tissue integ from moisture)
41
Q

what do you want to monitor for patients regarding drainage changes

A

any:

  • kinks
  • obstructions
  • leakage
  • position –> needs to be below the bladder
42
Q

what do you want to monitor for patients regarding drainage changes

A

any:

  • kinks
  • obstructions
  • leakage
  • position –> needs to be below the bladder
43
Q

if you see sediment/shredded material in urine sample, what could it be (5)

A
  • mucous
  • protein strands
  • blood cells
  • casts
  • lymph
44
Q

what is cystitis?

A
  • lower UTI

- bladder infection

45
Q

what happens is cystitis is untreated?

A
  • can ascend up the urinary tract to cause pyelonephritis
46
Q

what is pyelonephritis

A
  • upper UTI/kidney infection
47
Q

what is the most common cause of UTIs

A
  • e.coli
48
Q

what are some signs of cystitis (4) what is this set of symptoms called?

A
  • dysuria
  • frequency & urgency
  • suprapubic discomfort
  • cloudy urine

= LUTS (lower urinary tract symptoms)

49
Q

what are 2 age related considerations for cystitis symptioms

A
  • older adults: delirium

- young kids: may have vague sx like headache, stomachache, bedwetting

50
Q

what are some signs of pyelonephritis (6)

A
  • LUTS +
  • fever
  • chills
  • malaise
  • vomitting
  • lower back & flank pain
51
Q

what should physical assessment of UTI look like (both upper and lower)

A
  • vitals (increased temp w pyelo)
  • suprapubic discomfort on palpation of abdomen
  • check CVA tenderness (only w upper)
52
Q

what is the difference between a complicated and uncomplicated UTI

A
  • uncomplicated = occurs in an otherwise normal urinary tract
  • complicated = occur with the presence of obstruction, stones, catheters, diabetes, neuro disease, infection = risk of renal damage
53
Q

what is CVA tenderness

A
  • percussing the costevertebral angle (where the kidneys are) to assess for pain, which would indicate pyelonephritis
54
Q

list diagnostic tests for UTIs

A
  • urine dipstick/urinalysis
  • urine C&S
  • CBC
  • KUB
  • renal US
55
Q

what will we see in urinalysis for both lower and upper UTI

A
  • cloudy urine
  • pyuria
  • hematuria
  • nitrites (due to bacteria)
56
Q

when is a urine C&S required?

A
  • always for pyelonephritis

- may not be for uncomplicated UTI

57
Q

what will we see in CBC for UTIs?

A
  • increased WBC with left shift (pyelonephritis only)
58
Q

when do we require a KUB or renal US

A
  • for repeated cystitis in childrren

- pyelonephritis

59
Q

list the types of treatment for UTIs

A
  • antibiotics

- possibly hospitalization

60
Q

how long does a pt need to be on antibiotics for an uncomplicated cystitis? complicated?

A
  • uncomplicated = 3-5 days

- complicated = 7-14 days

61
Q

what type of antibiotics are required for pyelonephritis? how long?

A
  • IV/oral Tx

- 14+ days

62
Q

when might someone with a UTI need to be hospitalized?

A
  • if severe infection
  • or for N/V r/t dehydration
  • high urea or creatining
63
Q

what is renal calculi

A
  • kidney stones
64
Q

who are renal calculi more common in?

A
  • men than women
65
Q

what age has high prevalence of renal calculi

A
  • 20-55
66
Q

what causes the pain r/t kidney stones

A
  • obstruction of urinary flow
67
Q

describe the health hisotry part of assessment for renal calculi

A
  • OPQRSTU of current symptoms
  • personal history of kidney stones
  • family history of kidney stones
  • social history
  • dietary history
68
Q

what are common symptoms of kidney stones

A
  • abdominal and/or flank pain
  • radiation of pain to groin
  • hematuria
  • NV
  • dysuria
  • urgency
69
Q

what should you specifically ask about regarding social hisotry for assessment of kidney stones

A
  • sedentary lifestyle/immobility
70
Q

what should you specifically ask about regarding dietary history for assessment of kidney stones

A
  • fluid intake
  • high protein?
  • high oxalate?
71
Q

describe the general physical exam for someone w kidney stones

A
  • VS (BP, HR, temp)
  • observe behavior (bent over in pain?)
  • abdominal exam (tenderness?)
  • CVA tenderness
72
Q

what is lithotripsy

A
  • treatment using ultrasound shock waves to break the kidney stone down into smaller pieces so it can be passed out by the body
73
Q

describe the physical assessment after lithotripsy removal of kidney stones

A
  • vital signs (BP, temp)
  • expect hematuria
  • assess & treat pain
  • signs of infection
74
Q

describe the assessment after surgical removal of kidney stones

A
  • same as lithotripsy
75
Q

what are diagnostic tests commonly used for renal calculi

A
  • blood work
  • urinalysis
  • urine C&S
  • abdominal xray
  • US
  • CT scan
76
Q

why would we use an abdominal xray, ultrasounds, and CT scan as a diagnostic for renal calculi?

A
  • to identify stones & their location

NURS 2514 (75 decks)

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