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Fundamentals SEM2 > WEEK 9 + WEEK 11 > Flashcards

WEEK 9 + WEEK 11 Flashcards

Renal system- adults + ATI peds

1
Q

expected structure of the renal system

A

two kidneys
two ureters
bladder
urethra

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2
Q

what size are kidneys approximately

A

size of a fist

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3
Q

where are the kidneys located

A

retroperitoneum on either side of the spine

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4
Q

what are the functional units of the kidneys

A

nephrons

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5
Q

what do the nephrons house

A

glomerulus

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6
Q

define glomerulus

A

network of blood vessels: blood passes through vessels and it cleaned of waste and excess water

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7
Q

what do the kidneys help maintain

A

fluid and electrolyte balance by regulating osmolarity

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8
Q

define osmolarity

A

Concentration of a solution in terms of osmoses of solutes per liter of solution.

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9
Q

ERYthropoietin

A

produced by the kidneys

helps stimulate RBC production

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10
Q

Renin

A

produced by kidneys

helps regulate blood pressure

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11
Q

what do the kidneys convert vitamin D from?

A

its inactive form to the active form of calcitriol

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12
Q

nephrons

A

functional units of the kidneys that form urine

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13
Q

RENAL SYSTEM FUNCTIONS

A

revmoves toxins
maintains fluid and electrolyte balance
REG SERUM OSMOLALITY
balance acid-base in blood
secretes erythropoietin
reg blood pressure
converts vitamin D to calcitroil

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14
Q

renal circulation

A

blood enters the kidneys via the renal artery and flows through mulitiple arteries until it reaches the interlobular arteries

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15
Q

Match the renal system or function with its correct description or role: glomerulus

A

A bundle of tiny capillaries within the Bowman capsule that filters the blood

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16
Q

Match the renal system or function with its correct description or role: erythropoietin

A

A hormone produced by the kidneys that promotes the formation of red blood cells by the bone marrow

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17
Q

Match the renal system or function with its correct description or role: nephron

A

The functional unit of the kidney that filters waste from the blood and produces urine

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18
Q

Match the renal system or function with its correct description or role: ureter

A

Tubes that transport urine from the kidneys to the bladder

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19
Q

Match the renal system or function with its correct description or role: renin

A

An enzyme produced by the kidneys that regulates blood pressure and fluid balance

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20
Q

define the glomerular filtration rate (GFR)

A

the amount of blood and plasma filtered over one minute

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21
Q

Which of the following muscular structures must contract for urine to be evacuated from the body?

A

Detrusor muscle

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22
Q

what is GPR estimated based on

A

serum creatinine
age
gender
race

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23
Q

what are some labs that indicate how well the kidney is functioning?

A

BUN
serum creatinine
GFR

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24
Q

expected reference range for BUN

A

10 to 20 mg/dL

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25
Q

expected reference range for creatinine levels

A

females: less than 1.2 mg/dL

males: less than 1.3 mg/dL

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26
Q

what will happen to BUN and creatinine levels in blood if there is kidney alterations?

A

they will rise

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27
Q

normal GFR reference ranges

A

75-116 mL/minute/1.73m2

lower is older people

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28
Q

define UTI

A

infection in the bladder, kidneys, ureters, or urethra

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29
Q

how does a UTI occur?

A

when bacteria in the urine travels through the urethra and migrates up to the bladder

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30
Q

are males or females more at risk for UTIs?

A

females, shorter urethra (and proximity of urethra to the rectum)

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31
Q

uncomplicated UTI vs complicated UTI

A

uncomplicated: occurs when bladder is infected with bacteria but NO COMORBIDITES

complicated: UTI that occurs in clients who have comorbidities (diabetes, pregnant, immunocompromised)

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32
Q

what is the most frequent causative agent in BOTH complicated and uncomplicated UTIs?

A

uropathogenic Escherichia coli (E. coli)

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33
Q

classifications of UTIs

A

uncomplicated UTI

complicated UTI

acute uncomplicated cystitis

acute uncomplicated pyelonephritis

asymptomatic bacteriuria

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34
Q

acute uncomplicated cystitis (and acute manifestations?

A

only affects the lower urinary tract structures

acute manifestations:

urgency
dysuria
suprapubic pain

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35
Q

acute uncomplicated pyelonephritis ( and clinical manifestations?

A

only UPPER urinary tract structures

clinical manifestations: flank pain and fever over 100.4

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36
Q

asymptomatic bacteriuria

A

positive urine culture but NO MANIFESTATIONS

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37
Q

recurrent UTI

A

if client has occurrence of two or more incidences of Sx within six months or three within 12 months

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38
Q

patho of UTI

A

usually, E. coli goes up the urethra and into the bladder

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39
Q

when are UTIs common

A

use of catheter
immunocompromised patient
or using antibiotics

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40
Q

UTI locations and names: urethritis

A

UTI involving the urethra

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41
Q

UTI locations and names: cystitis

A

UTI involving the bladder

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42
Q

UTI locations and names: pyelonephritis

A

UTI involving the kidney

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43
Q

risk factors/incidence for UTI

A

females (shorter urethra/near the rectum)
indewelling cather
bad hygiene
sexual intercourse
frequent pelvic exams
use of diaphrams
condoms with spermicidal foam

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44
Q

what can happen if a UTI goes untreated?

A

can lead to urosepsis

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45
Q

comorbidities with UTIs

A

DM type 1 and 2
immunocompromised
pregnant

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46
Q

older client UTI manifestations

A

onset confusion!!!
new onset urinary incontinence
lack of appetite
lethargy
low grade or no fever

INCREASED RISK FOR UROSEPSIS TOO!

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47
Q

most COMMON clinical manifestations of a UTI!!

A

increased urination urgency and frequency
dysuria
hematuria
suprapubic pain

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48
Q

UTIs affecting the kidneys (pyelonephritis) manifestations

A

FLANK/back PAIN
N/V
chills
high fever

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49
Q

UTIs affecting the bladder (cystitis) manifestations

A

bloody urine
lower abd pain
frequency
dysuria

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50
Q

UTIs affecting the urethra (urethritis) manifestations

A

discharge from the urethra and burning with urination

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51
Q

lab testing: clean catch

A

A clean catch is collected by the client first spreading the labia apart and cleaning the urethral meatus with the three sterile wipes provided in the clean catch kit by first using the first to wipe the inner folds on one side front to back, the second wipe to clean the inner folds to the other side and using the third wipe directly over the opening of the urethra. Then the client collects the urine midstream without the specimen cup encountering the perineum.

52
Q

labs for UTI: dipstick

A

tests…

pH
hematuria
leukocyte esterase
nitrites

53
Q

The most accurate dipstick test is for

A

nitrates since urine must contain bacteria for the conversion of nitrates to nitrites

54
Q

normal pH for urine

A

4.5-8.0 with usual range between 5.5-7.5

55
Q

labs for UTI: urine culture

A

urine collected midstream and sent to patho

blood also taken to do CBC

56
Q

treatment for UTIs (at home kind of thing)

A

use of cranberry!! prevent and treat

57
Q

what should nurse educate on for females with recurrent UTIs?

A

don’t take baths, showers instead to prevent infection

gentle soap or baby shampoos

58
Q

how much water to drink daily with UTI?

A

2-3 L

59
Q

UTI: treatment!

A

antibiotic regime

first line: trimethoprim/sulfamethoxazole (Bactrim) for first three days

60
Q

incontinence

A

involuntary loss of urine

61
Q

types of incontinence

A

stress
urge
overflow

62
Q

define stress incontinence

A

weakness of the urethral sphincter or pelvic floor muscles

manifestations: urine leakage with sneezing, coughing, or physical exertion

pregnant or women who have had kids!

63
Q

define urge incontinence

A

detrusor muscle overactivity that causes bladder contraction and may also be caused by the loss of neurologic control or by irritation of the bladder

manifestations: complain of a sense of urgency that either precedes or is accompanied by leakage of urine

64
Q

define overflow incontinence

A

urine leakage of an overdistended bladder, which is caused by a bladder obstruction that blocks urine excretion or impaired contractility of the detrusor muscle

causes: pelvic organ prolapse, abdominal or pelvic masses, or benign prostatic hyperplasia (BPH)

65
Q

define BPH

A

noncancerous enlargement of the prostate through which the urethra passes

66
Q

BPH manifestations (risk for overflow incontinence)

A

urination problems, such as difficulty initiating a urine stream, dysuria, nocturia, urinating more frequently than the client’s normal pattern and urination with a sense of urgency, urine retention due to inability to thoroughly drain the bladder, and weak urine stream

67
Q

clinical presentation of BPH

A

usually present with lower urinary tract manifestations, such as difficulty initiating urine stream, dysuria, nocturia, increased frequency and urgency for urination, urine retention due to inability to thoroughly drain the bladder, and weak urine stream

68
Q

Clinical Presentation: urinary incontinence

A

involuntary loss of urine or with sudden desire to void with urinary leakage

69
Q

treatments for urinary incontinence

A

urinary antispasmodics such as oxybutynin (Ditropan XL) or bladder relaxants such as Mirabegron (myrbetriq) to decrease bladder spasms

70
Q

define urinary retention

A

inability to void or empty the bladder

71
Q

patho of urinary retention

A

disruption of muscles, bladder, urethra that allows urine to flow right

72
Q

what is the most common cause of urinary retention with males

A

obstruction due to BPH

73
Q

risk factors for urinary retention include

A

constipation
BPH
pelvic organ prolapse

74
Q

clinical presentations: CHRONIC urinary retention

A

no Sx or subtle symptoms such as…

slow urine stream
bladder not feeling empty
reduced urge to void
urinary leakage without warning

75
Q

what can happen if chronic urinary retention is not treated?

A

UTIs, bladder damage, kidney damage, and overflow incontinence, and increased risk for urosepsis

76
Q

What are the key nursing interventions for a client experiencing acute urinary retention?

A

Key nursing interventions for a client who has acute urinary retention include assessing for bladder distention, monitoring vital signs, providing pain relief, preparing for catheterization to relieve retention, and educating the client on the importance of reporting manifestations early to prevent complications.

77
Q

acute pyelonephritis

A

severe kidney infection that occurs suddenly and causes the kidneys to swell

78
Q

chronic pyelonephritis

A

aka reflux neuropathy

rarer than acute fand is Dx when there is repeated acute pyelonephritis

79
Q

patho of pyelonephritis

A

develops from a lower UTI when bacteria has entered urethra and spread to bladder then ureters then kidneys

80
Q

risk factors for pyelonephritis include

A

any condition that leads to an interruption of normal flow of urine

females (shorter urethra)

renal stones

kidney/bladder disorders

immunosuppression

enlarged prostate

use of catheters

cystoscopic procedures

certain medications

81
Q

most common causative agent for acute pyelonephritis?

A

E. coli

82
Q

What risk factor increases the likelihood of developing acute pyelonephritis in females?

A

Females have an increased risk of developing acute pyelonephritis due to the short urethra’s proximity to the rectum, which facilitates the ascent of bacteria to the bladder and kidneys

83
Q

What serious complication is linked to diabetes and acute pyelonephritis?

A

Emphysematous pyelonephritis is a serious, necrotizing infection that destroys kidney tissues and is often linked to clients who have diabetes.

84
Q

clinical presentation of pyelonephritis (acute)

A

usually present 48 hours after the start of the infection

fever over 102!
pain in side, back, groin
dysuria
cloudy/bloody urine
fishy odor to urine
chills
N/V
fatigue
mental confusion

85
Q

important to remember with chronic pyelonephritis

A

might have slight to no manifestations, or manifestations of chronic kidney disease (pruritus, swelling in the ankles, and fatigue)

86
Q

labs for pyelonephritis

A

urinalysis
renal ultrasound
DMSA

87
Q

manifestation of kidney damage

A

fluid overload (weight gain and edema)

88
Q

treatments for pyelonephritis

A

anti-infectives (levofloxacin, cipro, co-trimoxazole, ampicillin)

89
Q

define pyuria

A

high WBC count in the urine

90
Q

when would the nurse be able to tell that the interventions (antibiotics) were successful in treating pyelonephritis?

A

no pyuria, blood, or nitrates in the urine

91
Q

define polycystic kidney disease (PKD)

A

inherited disorder! that causes fluid-filled cysts to develop in the kidneys

92
Q

what are the two types of PKD?

A

autosomal dominant (ADPKD) and autosomal recessive (ARPKD)

93
Q

PATHO of PKD

A
  1. cysts grow and multiply
  2. kidney structures get damaged
  3. renal functions get impaired

PROGRESSIVE AND LEADS TO RENAL FAILURE

94
Q

what is primary risk factor for PKD?

A

family history is only really risk, as it is a GENETIC disorder

95
Q

is PKD curable or preventable?

A

no

96
Q

clinical presentation of PKD

A

Flank pain
Polyuria, Nocturia,Hematuria
PalpableKidney Masses
Hypertension
Proteinuria

97
Q

what happens as PKD progresses?

A

ESRD develops

between age 50-60

98
Q

can people a number other than two kidneys

A

yes can have one, two, three, etc

most people have two kidneys

99
Q

lab testing with PKD

A

renal ultrasound to assess how big or how many cysts there are/how many healthy kidneys there are

100
Q

elimination: PKD

A

polyuria and nocturia

101
Q

fluid and electrolytes: PKD

A

progress to renal failure so…

fluid overload
SOB
weight gain
edema

102
Q

client education with PKD

A

maybe low protein diet
low sodium
NO NSAIDs (ibuprofen, naproxen, etc)
support group
refrain from smoking

103
Q

nursing process: assessment for PKD (what cues indicate PKD)

A

high BP
abd fullness
headaches
UTIs
kidney infections
kidney stones

104
Q

nursing process: analysis for PKD (what are complications)

A

can lead to uremia (condition where kidneys can’t filter out bad stuff) and lead to back/flank pain that can affect quality of life

105
Q

nursing process: implementation PKD (what to educate on?)

A

regulate blood pressure!!
take Tolvaptain as prescribed (to slow growth of cysts)
take acetaminophen as prescribed (for back and flank pain)

106
Q

nursing process: evaluation PKD (desired outcomes?)

A

maintain BP !!!
notify health provider of any bladder/kidney infections

107
Q

what is Tolvaptan used for?

A

PKD: to slow down growth of cysts

108
Q

Tx for PKD!!

A

management to slow down growth of cysts: Tolvaptan (Jynarque) !

109
Q

what will you see on a urinalysis that would indicate pyelonephritis?

A

cloudy and smelly
positive WBC and nitrates!

110
Q

cloudy urine means what?

A

bacteria in the urine

111
Q

key difference between UTI and pyelonephritis?

A

same Sx as a UTI but FAR WORSE! also, different pain location like…

dull flank pain on the SIDE (towards the umbilicus, NOT the groin)

112
Q

case study question: client has…

102.5 temp
grabbing left side
dull pain
cloudy urine

A

pyelonephritis

key words:

DULL pain
pain on SIDE
temp over 102
CLOUDY urine

113
Q

peds Tx for glomerulonephritis?

A

supportive care first so…

monitor Is and Os
monitor weight
restrict fluid and salt intake

medications:

loop diuretics (Furosemide)

antihypertensives (Captopril)

maybe antibiotic if presenting with evidence of active strep infection (Penicillin)

114
Q

nephrotic syndrome

A

kidney disorder that causes your body to pass too much protein in your urine

causes fluid flow to shift, leading to edema and ascities

115
Q

risk factors for nephrotic syndrome

A

typically without cause but sometimes…

family Hx
vesicoureteral reflux

116
Q

epidemiology of nephrotic syndrome

A

higher in males than females

age 2-6 is usually seen

117
Q

clinical presentation of nephrotic syndrome

A

fatigue
FOAMY urine
proteinuria
hematuria
facial and abdominal edema
anorexia

118
Q

important urinalysis for nephrotic syndrome (to differentiate it from other kidney issues)

A

massive proteinuria (+2)
heamturia
glycosuria
lipiduria (hyperlipidemia)
fatty casts in urine

119
Q

important CMP for nephrotic syndrome

A

normal GFR
increased BUN and creatinine
decreased albumin

120
Q

what are you at risk for with nephrotic syndrome if left untreated

A

BLOOD CLOTS
infection
chronic or acute kidney injury

121
Q

main goals of nephrotic syndrome

A

to decrease protein excretion and fluid, restore fluid and electrolyte balance, prevent infection

122
Q

main pharmalogical treatment for nephrotic syndrome

A

12-week course of oral corticosteroids

Prednisone

other meds for other manifestations:

ACE inhibitors
antibiotics
statins

123
Q

diet recommendations for nephrotic syndrome

A

low salt
low fluid
high protein (since you are loosing so much in urine)

124
Q

define CAKUT

A

congenital anomalies of the kidneys and urinary tracts

umbrella term used to describe several congenital anomalies with a wide variety of implications

125
Q

what are the alterations (CAKUT) for peds to know?

A

cryptorchidism
bladder exstrophy
epispadias
hypospadias
hydrocele
phimosis
vesicoureteral reflux
hydronephrosis

126
Q
A

Fundamentals SEM2 (7 decks)

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