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NURS363 - Practice of Nursing IV > Week 8: Urinary and Kidney 2 > Flashcards

Week 8: Urinary and Kidney 2 Flashcards

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1
Q

What is less common upper or lower UTIs

A

Upper UTIs

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2
Q

Upper UTI

A

Infection above the bladder

It occurs from upward spread of bacteria - like if a stricture or stone is not allowing bacteria in the bladder to empty and it then spreads into the ureters and kidneys

Could also be from systemic infections like those in the blood that reach the kidnes - and systemic infection can lead to abscesses (Ex: Tb can lead to abscess in the kidney)

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3
Q

What are upper UTIs usually due to

A

ascension of pathogenic bacteria from a bladder infection, static urine d/t obstruction, or systemic infections that result in abscesses

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4
Q

Upper UTIs include what

A

acute or chronic pyelonephritis (inflammation of renal pelvis)

Interstitial nephritis (inflammation of the kidney

Kidney abscesses

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5
Q

Pyelonephritis

A

Can be acute or chronic inflammation/infection of the renal pelvis

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6
Q

Acute Pyelonephritis s/s

A

chills

fever

leukocytosis

bacteriuria

pyuria

low back pain

flank pain

NV

HA

malaise

painful urination

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7
Q

Chronic Pyelonephritis s/s

A

Usually NO symptoms of infection unless an acute exacerbation occurs

Noticeable signs may include fatigue, HA, poor appetite, polyuria, excessive thirst and weght loss

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8
Q

When is chronic pyelonephritis diagnosed

A

often incidentally when being evaluated for HTN

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9
Q

What to look for on assessment for chronic pyelonephritis

A

poor urine concentrating ability

pyuria

azotemia

proteinuria

anemia

acidosis

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10
Q

Azotemia

A

nitrogenous waste in urine

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11
Q

When do we usually see s/s of pyelonephritis

A

usually only in acute exacerbations not so much chronic

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12
Q

How is the extent of chronic pyelonephritis checked

A

usually by IV urogram and lab work (lab work includes creatinine clearance, BUN,, and creatinine levels)

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13
Q

What is an important vital to check whenver a kidney issue is expected

A

Blood pressure - it is an important function of the kidneys

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14
Q

Common Nursing Dx for pyelnoephritis

A

1 PAIN

Infection

Alterations in voiding patterns

Knowledge deficits r/t lack of understanding of tests and procedures

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15
Q

Goals with Pyelonephritis

A

Pain reduction

Medication compliance

proper hygiene

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16
Q

Patient education on pyelonephritis is focused on ___.

A

prevention

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17
Q

Interventions for Pyelonephritis

A

Monitor VS, I&O, and Weight

Encourage fluids up to 3000 mL a day

Encourage adequate rest

Instruct on high calorie low protein diet

warm moist compresses to flank area

encourage warm baths (this one can cause infection though)

administer antibiotics analgesics antipyretics urinary antseptics and antiemetics as prescribed

monitor for signs of renal failure

education

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18
Q

How much fluid should be given a day to dilute urine in pyelonephritis

A

3-4 L / 3000mL-4000mL

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19
Q

What is an important sign of concerning I&O changes

A

increases or decreases in weight

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20
Q

Education topics for pyelonephritis

A

prevent further infection by adequate fluid consumption and regular bladder emptying, perineal hygiene and taking meds as prescribed

keep follow up appointments

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21
Q

Chronic Kidney Disease

A

Umbrella term to describe kidney damage or a decrease in the glomerular filtration rate for 3+ months

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22
Q

Untreated CKD can result in…

A

ESRD and a need for kidney transplant or dialysis

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23
Q

Risk Factors for CKD

A

Primary Cause: Diabetes

HTN

CV Disease

Obesity

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24
Q

What is different between Acute Kidney Injury and CKD

A

Acute Kidney injury is one time and reversible if you ID and treat promptly before it damages the function of the kidneys

CKD is 3+ months of this and the kidneys may progress to CRF

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25
Q

Causes of Acute Kidney Injury

A

hypovolemia

hypotension (decreased blood flow to kidneys)

Reduced cardiac output and heart failure

obstruction of kidney or lower urinary tract

obstruction of renal arteries or veins

may result in CKD but does not always

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26
Q

Causes fo CKD

A

diabetes

HTN!!!!!!!!

chronic glomerulonephritis

pyelo/other infections

obstruction of urinary tract if not treated

hereditary lesions

vascular disorders

medications/toxic agents

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27
Q

CKD may lead to need for…

A

Dialysis or Kidney Transplant if enough damage occurs

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28
Q

Stages of Chronic Renal Failure (CRF)

A

Stage 1: Slight Damage

  1. Mild Decrease in Fxn
  2. Moderate Decrease
  3. Severe Decrease
  4. ESRD
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29
Q

What is the GFR (Glomerular Filtration Rate) like at all 5 stages of CRF

A
  1. GFR >90
  2. GFR 60-89
  3. GFR 30-59
  4. GFR 15-29
  5. GFR <15
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30
Q

Things to Assess with CKD

A

fluid status

ID potential sources of imbalance

assess nutritional status

knowledge of their nutrition and I&Os

assess potential complications like HTN, anemia, weight change, etc

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31
Q

Nursing Dx for CKD

A

Excess fluid volume

Imbalanced nutrition

Deficient knowledge

Risk for situational low self esteem

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32
Q

Goals for CKD

A

maintain ideal body weight and dont have excess fluid

work with their preferences for an appropriate diet

adequate intake

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33
Q

Diet is very important to CKD but…

A

can be very restrictive - especially regarding preferences

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34
Q

Gerontologic Considerations for CKD

A

Risks like aging, HTN, atherosclerosis, HF, DM, and cancer predispose elders to kidney disease

Polypharmacy and changes in renal bloodflow, decreased GFR, and decreased renal clearance are also assoc with changes in renal function

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35
Q

What is the double sided issues with the gerontologic risk factors for renal disease

A

while they increase CKD incidence they also mask th s/s of it and make it harder to diagnose

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36
Q

Why do diuretics need to be monitored carefully when given to elderly

A

We need to assess for dehydration that can further compromise renal function and contribute further to renal failure

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37
Q

Conservative Gerontological management of CKD includes

A

nutritional therapy

fluid control

phosphate binders

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38
Q

Renal Replacement Therapy

A

Dialysis: Hemodialysis and Peritoneal Dialysis

Replacement therapy is needed when the kidneys cannot remove waste products - the waste that is usually excreted is urea

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39
Q

Goal of Hemodialysis

A

to remove toxic nitrogenous waste and water from the blood

clean and remove blood then return it to the system

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40
Q

What is vascular access for hemodialysis like

A

double lumen, large bore catheter into a large vein OR AV fistula or AV graft

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41
Q

AV Fistula/Graft

A

permanent joinings of artery and vein that takes 3 mo to heal - for more permanent access for hemodialysis

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42
Q

When there is a hemodialysis vascular access…

A

never take BP on that side and assess for bruits or thrills

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43
Q

Nursing Management Considerations for Hemodialysis

A

VS (esp. BP) and hemodynamic Status

Protecting Vascular access device

Palpating for thrills

Observe for infection

Dressing changes

Adjusting IV rate and strict I&O

Assess for complications

Administer blood transfusions during dialysis

Education

pain management

psychological support

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44
Q

Ways to protect vascular access

A

avoid BPs (place colorful band to indicate this), tight dressings, restraints, or jewelry over the device

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45
Q

How often should a thrill be checked for over the access for dialysis

A

every 8 hours - if absent there may be a blockage or clot

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46
Q

What complications and s/s should be monitored for when a patient is on hemodialysis

A

infection at site: redness, draining, fever, chills, swelling

Fluid overload

HF

pulmonary edema secondary to fluid build up

substernal chest pain, low grade fever, pericardial friction rub –> All 3 indicate pericarditis

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47
Q

Why is it so important to use proper dressing change technique when dealing with hemodialysis patients

A

because renal patients are more prone to infection

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48
Q

Why does the IV rate for hemodialysis need to be as slow as possible

A

because dialysis patients cannot secrete water - use a pump

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49
Q

If a patient on hemodialysis progresses to pericardial effusion what can be telling of this

A

the friction rub will disappear and heart sounds will be distant and pulsus paradoxus is noticeably worse

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50
Q

Why are blood transfusions administered during dialysis

A

so excess K+ can be removed

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51
Q

Things to education Hemodialysis patients on

A

dietary intake to prevent complications of hypoalbuminemia and hyperkalemia

infection prevention

proper med complianace

proper care of the catheter site

proper nutritional choices

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52
Q

When is peritoneal dialysis appropriate

A

for patients who cannot tolerate hemodialysis or have severe HTN, HF, and pulmonary edema that does not respond to hemodialysis

may be tx of choice for those unwilling or unable to go to hemodialysis

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53
Q

Goal fo Hemodialysis

A

remove toxxi substances and metabolic wastes

reestablish normal F&E balance

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54
Q

Peritoneal Dialysis Procedure

A

sterile dialysate is introduced into the peritoneal cavity through an abdominal catheter at intervals

waste products move from an area of higher concentration (blood) to an area of lower concentration (dialysate) through a semi permeable membrane (peritoneum)

55
Q

How much longer is peritoneal dialysis

A

pretty continuous - does what hemodialysis does in 6-8 hours over 36-48 hours

56
Q

Types of Peritoneal Dialysis

A

Acute Intermittent Peritoneal Dialysis

Continuous Ambulatory Peritoneal Dialysis

Continuous Cyclic Peritoneal Dialysis

57
Q

Acute Intermittent Peritoneal Dialysis

A

A nurse warms, spikes, and hangs each container of dialysate

Requires strict asepsis

If dialysate does not drain right, nurse will facilitate draining by turning patient from side to side or raising the head of the bed - NEVER push the catheter further into the peritoneal cavity

58
Q

Common routine for acute intermittent peritoneal dialysis

A

hourly exchanges that involve 10 minute infusion, 30 minute dwell time and 20 minute drain time

59
Q

Impotant assessments to be done with acute intermittent peritoneal dialysis

A

I&O

VS

Weight

Patient status

Skin turgor and mucous membranes to evaluate fluid status

presence of edema check

60
Q

Continuous Ambulatory Dialysis (CAP)

A

2nd most common form

performed at home 4-5 times a day every day

Longer dwell time –> better results

managed by the patient or a trained caregiver

61
Q

Continuous Cyclic Peritoneal Dialysis

A

uses a cycler machine and combines overnight intermitted PD with a prolonged dwell time during the day

lower infection rates since fewer bag changes and tubing disconnections occur

greater freedom to work

May need home visits by nurse or f/u calls or visits to outpatient settings to make sure dialysate is ok and BP is monitored carefully

62
Q

Renal Calculi Cause what pain

A

RENAL COLIC - originating in lumbar region radiating around the side and down toward the testicle in mean and to the bladder in women

63
Q

Ureteral Calculi cause what pain

A

UTERAL COLIC radiates toward the genitalia and thigh

64
Q

s/s of Urinary Stone Disease

A

renal or ureteral colic

sharp severe sudden onset pain

dull aching kidneys

NV, pallor, diaphoresis during acute pain

urinary frequency with alternating retention

65
Q

Signs of a UTI during Urinary Stone Disease

A

low grade fever

RBCs and WBCs and Bacteria in Urinalysis

Hematuria

66
Q

Nursing Dx for Urinary Stone Disease

A

Pain - #1 until cause is eliminated

Risk for INfection

risk for inadequate renal function

Nutrition, risk for…

Patient specific dx

67
Q

Nursing Goals with Urinary Stone Disease

A

relieve pain of renal colic

eradicate stone

determine stone type

prevent nephron destruction

control infection

relieve obstruction

68
Q

Nursing interventions for Urinary Stone Disease

A

Monitor VS, I&O

Assess fever, chills, infection and Monitor for NVD

Force fluids to facilitate stone passage and prevent infection

Strain all urine and send stones for lab analysis

Provide warm baths and heat to flank area

Administer analgesics regularly to relieve pain and assess response to pain meds

Relaxation techniques to assist pain relief

Diet education based on stone composition

Maintain urinary pH depending on stone type

Turn and reposition

prep for surgeyr if needed

69
Q

How many fluids sould be forced a day with urinary stones

A

3000 mL/ 3 L

70
Q

What is the biggest concern with urinary stone disease regarding nursing dx

A

The pain

it can be so excruciating nothing seems to relieve it

71
Q

If a patient has an Alkalytic Stone/Urine what diet should we discuss with them?

A

Acid Ash Diet

72
Q

If a patient has an Acidic Stone/Urine what diet should we discuss with them?

A

Alkaline Ash Diet

73
Q

Acid Ash Diet

A

Drops pH

Cranberries
Plums
Grapes
Prunes
tomatoes
Eggs
Cheese
Whole Grain
Meat and Poultry
74
Q

Alkaline Ash Diet

A

Raises pH

Legumes
Milk and Milk Product
Green Vegis
rhubarb

75
Q

Calcium Stones

A

formed from high levels of calcium so avoid high calcium foods

76
Q

What is the confusing recommendation regarding calcium stones

A

new research says avoiding calcium can be bad due to low bone density and osteoporosis and may not really change stone results much so its best to have a little calcium in the diet rather than non

77
Q

High Calcium Foods

A

Milk and other dairy products

beans

lentils

dried fruits

flour

chocolate

cocoa

canned and smoked fish (NOT TUNA)

78
Q

High Oxalate Foods to avoid when you have an oxalate stone

A

asparagus

beets

celery

cabbage

nuts

tea

fruits

tomatoes

green beans

chocolate

beer

colar

dark green leafy vegis

79
Q

High Purine Foods to avoid when you have a purine stone (uracid stone)

A

organ meets

sardines

herring

venison

goose

80
Q

What can cause increases in calcium and uric acid and lead to stones that you should discuss with the patient about decreasing

A

high protein and sodium diets

81
Q

Cystoscopy

A

Surgical management for stones in the bladder or lower ureter

1-2 catheters are inserted past the stone and mechanically guide it down

NO INCISIONS

82
Q

What occurs after the cystoscopy removes the stone

A

the catheters stay in place for 24 hours to drain urine trapped proximal to the stone and dilate the ureter

and continuous chem irrigation is used to dissolve the stone

83
Q

Cystoscopy used to be the major mode of removing stones until…

A

lithotropsy

84
Q

Medical/Surgical procedures for Upper Ureteral Stones

A

ureteroscopy

ESWL

electrohydraulic lithotrpsy

85
Q

Stones that are how big usually are easier to pass

A

6 mm or less

86
Q

Medical/Surgical Procedures for Renal Stones

A

endourologic - pecutaneous nephrostomy

nephrolithotomy

nephrectomy

87
Q

Why is forcing fluids not going to help with ureteral stones and higher

A

because there is not enoguh peristalsis occurring for it to pass

88
Q

Nephrostomy

A

A tube is placed to dilateand allow the stone and urine to come through

89
Q

Nephrolithotomy

A

Make incision and remove calculus/stone

90
Q

Nephrectomy

A

removal of a kidney

91
Q

ESWL

A

Extracorporeal Shock Wave Lithotripsy

Non invasive method of stone removal where a shock wave breaks up the stone to pass it

Usually for non passable upper urinary stones

92
Q

Pre Procedure ESWL Care

A

NPO for 8 hours prior to procedure

A laxative may be prescribed

93
Q

Post Procedure ESWL care

A

monitor VS, I&O, bleeding, for pain and urinary obstruction

Instruct to increase fluid intake to wash out stone fragments

strain the urine

inform client that ambulation is important (get them up and walking)

94
Q

ESWL Management

A

Assess and manage foley cath if needed

Assess nephrostomy tube (may be placed 1-5 days for chemical irrigation)

Encourage 3-4 L of fluid a day following procedure

instruct client to monitor for complications of infection, hemorrhage, and fluid extravasation into retroperitoneal cavity

95
Q

Ureterolithotomy

A

Open surgical procedure performed if lithotripsy/ESWL is ineffective and stone is in the ureter or higher

Ureter incision occurs through the lower abdomen or flank incision to remove the stone

96
Q

What things are likely put inplace following ureterolithotomy

A

penrose drain

ureteral stent

indwelling bladder catheter likely

97
Q

3 Options of Ureterolithotomy

A

Nephrolithotomy

Pyelolithotomy

Nephrectomy

98
Q

Nephrolithotomy

A

Large flank incision made into the kidney to remove the stone from the renal calyx

may need a nephrostomy tube and indwelling catheter after

tube will need aspetic tecnique or pyelnephritis can occur

99
Q

Pyelolithotomy

A

Large flank incision into kidney to remove stones from the renal pelvis

penrose drain and indwelling catheter

100
Q

When is a partial or total nephrectomy done

A

for extensive kidney damage, renal infection, or severe obstruction and to prevent stone recurrence

101
Q

What is postoperative care of a partial or total nephrectomy like

A

Plan of care is based on incision location and type of drainage tubes (penrose drains lg amounts of urine - the tube is connected to a bag to collect urine)

Protect skin from urinary damage (ostomy pouch over penrose drain to protect it if excessive urinary drainage)

Monitor nephrostomy tube (attached to drainage bag for free flow of urine) and folet with strict I&O

102
Q

If there is urethral cathters in place after a nephrectomy…

A

NEVER IRRIGATE THEM - they are for draining urine

We can irrigate the nephrostomy tube if there is an order, but we never irriagate these

103
Q

What are important nursing interventions for any open procedure

A

maintaining airway clearance and breahting

relieving pain - heat, analgesia

promoting urinary elimination - neph tube

104
Q

Important interventions/care post nephrostomy

A

(percutaneous or surgical)

bleeding concerns

obstruction concerns

patency of nephrostomy tube concerns

105
Q

After a nephrostomy it is important to monitor and document what

A

every I&O from each tube separately

106
Q

Never do what to a nephrostomy tube

A

never ever clamp the tube

107
Q

Urinary Diversion

A

a surgical procedure that diverst urine from the bladder into an exit site

108
Q

Reasons for Doing a Urinary Diversion

A

Bladder cancer or other pelvic malignancies

birth defects

strictures

neurogenic bladder

chronic infection/intractable cystitis

109
Q

What is the last resort for incontinence

A

urinary diversion

110
Q

What are the3 types of urinary diversion

A

Indiana Pouch

Kock Pouch

Ureterosigmoidostomy

111
Q

Indiana Pouch

A

Type of continent urinary diversion

For patients whose bladder was removed or no longer functions

It is made from the terminal ileum and part of the cecum

One way flush valve that has a catheter drain it every 4-6 hours in order to empty it

112
Q

Kock Pouch

A

Similar to indiana, but has a nipple like valve/stoma - the end of the small intestine is connected to the outside

You need a bowel prep and oral antibiotics before doing this

113
Q

When is a kock pouch contraindicated

A

IBD - Irritable bowel disease

114
Q

Ureterosigmoidostomy

A

Continent urinary diversion

ureters attached to sigmoid colon - NOT a continent ostomy

products leave rectum

permanent ostomy and is non reversible

115
Q

What does it mean that uretersigmoidostomy is NOT a continent ostomy

A

it means there is always something draining from it - and it is the consistency of watery diarrhea

With this ostomy it allows urine to flow through the colon and out of the rectum - voiding goes through the rectum

116
Q

Kidney Transplantation

A

implanation of human kidney from compatible donor if recipient has irreversible kidney failure

117
Q

How does a kidney transplant cost compared to dialysis

A

it is 1/3 the cost of dialysis

118
Q

What must be done for life following a kidney transplantation

A

immunosuppressive medications - must be taken for life - but has risks

119
Q

Nursing Dx for Kidney Trnasplantation

A

Ineffective airway clearance/breathing pattern

acute pain/fear/anxiety

Impaired urinary elimination

Risk for fluid imbalance

120
Q

Post Op Assessments for Kidney Transplant

A

Assess pain. fluids, electrolytes

Monitor potential for hemorrhage and shock, abdominal assessment and paralytic ileus

MOnitor I&O and hemorrhage shock risk and distention and pneumonia

Have in semi fowler and monitor

121
Q

Post Op Kidney Transplant Interventions

A

Place in semi fowlers position

Monitor patency of Foley cath and gross hematuria and clots, (not expected) –> Notify physician if this occurs

Assess urine characteristic (Starts pink and bloody but gradually returns to normal wihtin days to weeks)

If 3 foley irrigation, monitor to prevent blood clot formation

Note the Foley should be removed ASAP to prevent infection

Maintain protective isolation precautions and monitor for infection

Monitor IV fluids closely for fluid overload or oliguria

Isolation Precautions

Monitor for s/s of rejection

122
Q

What are some s/s of Kidney transplant rejection

A

Oliguria (output less than 500 mL a day)

Edema (Check for weight - gain specifically)

Monitor for increased BP

*Some anti rejection meds may mask s/s of rejection so you really want to be diligent when assessing

123
Q

Aspects of Client Education with Kidney Transplants

A

avoid prolonged periods of sitting

recognize s/s of infection and rejection

avoid contact sports

avoid exposure to people with infections

take medications as prescribed and know importance of maintaining immunosuppressive therapy for life

124
Q

What is kidney transplant surgeyr like

A

sometimes the diseased kidney is left there and ureter is disconnected and attached to a new donor kidney

125
Q

Nephrotic Syndrome

A

glomerular disease characterized by proteinuria, hypoalbuminemia, diffuse edema, high serum cholesterol, hyperlipidemia

basically any condition that seriously damages the glomerular membrane and increases the permeability to plasma proteins

126
Q

Etiology of Nephrotic Syndrome

A

any renal condition that damages glomerular capillary membrane

salt and water retention contribute to edema

thromboemboli are common

prognosis is poor (<50% experience complete remission adn at least 30% develop ESRF)

127
Q

Assessment for Nephrotic Syndrome

A

severe generalized edema - results in edema which is usually dependent edema (hands, feet, and sacrum)

symptoms of renal failure

loss of appetite and fatigue

may also see ascites

128
Q

Potential Causes for Nephrotic Syndrome

A

Glomerular Nephritis

Diabetes

Lupus

Multiple Myeloma

Renal Vein Thrombosis

129
Q

Therapeutic Management for Nephrotic Syndrome

A

Non specific but therapeutic management for RF, edema, etc

Med management and diet therapy

130
Q

What is unique about nephrotic syndrome compared to other renal issues

A

because of the increase plasma protein permeability with this specific sydrome you have to talk to them about INCREASING PROTEINS IN THE DIET

131
Q

Nursing Dx for Nephrotic Syndrome

A

Fluid overload

Fatigue

Insufficent Ability to Perform Usual Roles

132
Q

Planning and Interventions for Nephrotic Syndrome

A

control edema

high protein diet

administer drug therapy as prescribed

bedrest

monitor laboratory and diagnostic tests

observe for s/s of pulmonary edema

I/O and weight

fluid restriction

immune system depression increase risk of infection

133
Q

Client Education Topics for Nephrotic Syndrome

A

efforts to maintain general health

avoid infection

nutritious diet

medications

knowledge of renal function

134
Q

Potential Complications due to Nephrotic Syndrome

A

Infection - deficient immune response

Thromboembolism - in renal vein

Could cause acute renal failure (d/t hypovolemia associated with nephrotic syndrome)

NURS363 - Practice of Nursing IV (17 decks)

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