WEEK 9 + WEEK 11 Flashcards
Renal system- adults + ATI peds
expected structure of the renal system
two kidneys
two ureters
bladder
urethra
what size are kidneys approximately
size of a fist
where are the kidneys located
retroperitoneum on either side of the spine
what are the functional units of the kidneys
nephrons
what do the nephrons house
glomerulus
define glomerulus
network of blood vessels: blood passes through vessels and it cleaned of waste and excess water
what do the kidneys help maintain
fluid and electrolyte balance by regulating osmolarity
define osmolarity
Concentration of a solution in terms of osmoses of solutes per liter of solution.
ERYthropoietin
produced by the kidneys
helps stimulate RBC production
Renin
produced by kidneys
helps regulate blood pressure
what do the kidneys convert vitamin D from?
its inactive form to the active form of calcitriol
nephrons
functional units of the kidneys that form urine
RENAL SYSTEM FUNCTIONS
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
renal circulation
blood enters the kidneys via the renal artery and flows through mulitiple arteries until it reaches the interlobular arteries
Match the renal system or function with its correct description or role: glomerulus
A bundle of tiny capillaries within the Bowman capsule that filters the blood
Match the renal system or function with its correct description or role: erythropoietin
A hormone produced by the kidneys that promotes the formation of red blood cells by the bone marrow
Match the renal system or function with its correct description or role: nephron
The functional unit of the kidney that filters waste from the blood and produces urine
Match the renal system or function with its correct description or role: ureter
Tubes that transport urine from the kidneys to the bladder
Match the renal system or function with its correct description or role: renin
An enzyme produced by the kidneys that regulates blood pressure and fluid balance
define the glomerular filtration rate (GFR)
the amount of blood and plasma filtered over one minute
Which of the following muscular structures must contract for urine to be evacuated from the body?
Detrusor muscle
what is GPR estimated based on
serum creatinine
age
gender
race
what are some labs that indicate how well the kidney is functioning?
BUN
serum creatinine
GFR
expected reference range for BUN
10 to 20 mg/dL
expected reference range for creatinine levels
females: less than 1.2 mg/dL
males: less than 1.3 mg/dL
what will happen to BUN and creatinine levels in blood if there is kidney alterations?
they will rise
normal GFR reference ranges
75-116 mL/minute/1.73m2
lower is older people
define UTI
infection in the bladder, kidneys, ureters, or urethra
how does a UTI occur?
when bacteria in the urine travels through the urethra and migrates up to the bladder
are males or females more at risk for UTIs?
females, shorter urethra (and proximity of urethra to the rectum)
uncomplicated UTI vs complicated UTI
uncomplicated: occurs when bladder is infected with bacteria but NO COMORBIDITES
complicated: UTI that occurs in clients who have comorbidities (diabetes, pregnant, immunocompromised)
what is the most frequent causative agent in BOTH complicated and uncomplicated UTIs?
uropathogenic Escherichia coli (E. coli)
classifications of UTIs
uncomplicated UTI
complicated UTI
acute uncomplicated cystitis
acute uncomplicated pyelonephritis
asymptomatic bacteriuria
acute uncomplicated cystitis (and acute manifestations?
only affects the lower urinary tract structures
acute manifestations:
urgency
dysuria
suprapubic pain
acute uncomplicated pyelonephritis ( and clinical manifestations?
only UPPER urinary tract structures
clinical manifestations: flank pain and fever over 100.4
asymptomatic bacteriuria
positive urine culture but NO MANIFESTATIONS
recurrent UTI
if client has occurrence of two or more incidences of Sx within six months or three within 12 months
patho of UTI
usually, E. coli goes up the urethra and into the bladder
when are UTIs common
use of catheter
immunocompromised patient
or using antibiotics
UTI locations and names: urethritis
UTI involving the urethra
UTI locations and names: cystitis
UTI involving the bladder
UTI locations and names: pyelonephritis
UTI involving the kidney
risk factors/incidence for UTI
females (shorter urethra/near the rectum)
indewelling cather
bad hygiene
sexual intercourse
frequent pelvic exams
use of diaphrams
condoms with spermicidal foam
what can happen if a UTI goes untreated?
can lead to urosepsis
comorbidities with UTIs
DM type 1 and 2
immunocompromised
pregnant
older client UTI manifestations
onset confusion!!!
new onset urinary incontinence
lack of appetite
lethargy
low grade or no fever
INCREASED RISK FOR UROSEPSIS TOO!
most COMMON clinical manifestations of a UTI!!
increased urination urgency and frequency
dysuria
hematuria
suprapubic pain
UTIs affecting the kidneys (pyelonephritis) manifestations
FLANK/back PAIN
N/V
chills
high fever
UTIs affecting the bladder (cystitis) manifestations
bloody urine
lower abd pain
frequency
dysuria
UTIs affecting the urethra (urethritis) manifestations
discharge from the urethra and burning with urination
lab testing: clean catch
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.
labs for UTI: dipstick
tests…
pH
hematuria
leukocyte esterase
nitrites
The most accurate dipstick test is for
nitrates since urine must contain bacteria for the conversion of nitrates to nitrites
normal pH for urine
4.5-8.0 with usual range between 5.5-7.5
labs for UTI: urine culture
urine collected midstream and sent to patho
blood also taken to do CBC
treatment for UTIs (at home kind of thing)
use of cranberry!! prevent and treat
what should nurse educate on for females with recurrent UTIs?
don’t take baths, showers instead to prevent infection
gentle soap or baby shampoos
how much water to drink daily with UTI?
2-3 L
UTI: treatment!
antibiotic regime
first line: trimethoprim/sulfamethoxazole (Bactrim) for first three days
incontinence
involuntary loss of urine
types of incontinence
stress
urge
overflow
define stress incontinence
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!
define urge incontinence
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
define overflow incontinence
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)
define BPH
noncancerous enlargement of the prostate through which the urethra passes
BPH manifestations (risk for overflow incontinence)
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
clinical presentation of BPH
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
Clinical Presentation: urinary incontinence
involuntary loss of urine or with sudden desire to void with urinary leakage
treatments for urinary incontinence
urinary antispasmodics such as oxybutynin (Ditropan XL) or bladder relaxants such as Mirabegron (myrbetriq) to decrease bladder spasms
define urinary retention
inability to void or empty the bladder
patho of urinary retention
disruption of muscles, bladder, urethra that allows urine to flow right
what is the most common cause of urinary retention with males
obstruction due to BPH
risk factors for urinary retention include
constipation
BPH
pelvic organ prolapse
clinical presentations: CHRONIC urinary retention
no Sx or subtle symptoms such as…
slow urine stream
bladder not feeling empty
reduced urge to void
urinary leakage without warning
what can happen if chronic urinary retention is not treated?
UTIs, bladder damage, kidney damage, and overflow incontinence, and increased risk for urosepsis
What are the key nursing interventions for a client experiencing acute urinary retention?
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.
acute pyelonephritis
severe kidney infection that occurs suddenly and causes the kidneys to swell
chronic pyelonephritis
aka reflux neuropathy
rarer than acute fand is Dx when there is repeated acute pyelonephritis
patho of pyelonephritis
develops from a lower UTI when bacteria has entered urethra and spread to bladder then ureters then kidneys
risk factors for pyelonephritis include
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
most common causative agent for acute pyelonephritis?
E. coli
What risk factor increases the likelihood of developing acute pyelonephritis in females?
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
What serious complication is linked to diabetes and acute pyelonephritis?
Emphysematous pyelonephritis is a serious, necrotizing infection that destroys kidney tissues and is often linked to clients who have diabetes.
clinical presentation of pyelonephritis (acute)
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
important to remember with chronic pyelonephritis
might have slight to no manifestations, or manifestations of chronic kidney disease (pruritus, swelling in the ankles, and fatigue)
labs for pyelonephritis
urinalysis
renal ultrasound
DMSA
manifestation of kidney damage
fluid overload (weight gain and edema)
treatments for pyelonephritis
anti-infectives (levofloxacin, cipro, co-trimoxazole, ampicillin)
define pyuria
high WBC count in the urine
when would the nurse be able to tell that the interventions (antibiotics) were successful in treating pyelonephritis?
no pyuria, blood, or nitrates in the urine
define polycystic kidney disease (PKD)
inherited disorder! that causes fluid-filled cysts to develop in the kidneys
what are the two types of PKD?
autosomal dominant (ADPKD) and autosomal recessive (ARPKD)
PATHO of PKD
- cysts grow and multiply
- kidney structures get damaged
- renal functions get impaired
PROGRESSIVE AND LEADS TO RENAL FAILURE
what is primary risk factor for PKD?
family history is only really risk, as it is a GENETIC disorder
is PKD curable or preventable?
no
clinical presentation of PKD
Flank pain
Polyuria, Nocturia,Hematuria
PalpableKidney Masses
Hypertension
Proteinuria
what happens as PKD progresses?
ESRD develops
between age 50-60
can people a number other than two kidneys
yes can have one, two, three, etc
most people have two kidneys
lab testing with PKD
renal ultrasound to assess how big or how many cysts there are/how many healthy kidneys there are
elimination: PKD
polyuria and nocturia
fluid and electrolytes: PKD
progress to renal failure so…
fluid overload
SOB
weight gain
edema
client education with PKD
maybe low protein diet
low sodium
NO NSAIDs (ibuprofen, naproxen, etc)
support group
refrain from smoking
nursing process: assessment for PKD (what cues indicate PKD)
high BP
abd fullness
headaches
UTIs
kidney infections
kidney stones
nursing process: analysis for PKD (what are complications)
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
nursing process: implementation PKD (what to educate on?)
regulate blood pressure!!
take Tolvaptain as prescribed (to slow growth of cysts)
take acetaminophen as prescribed (for back and flank pain)
nursing process: evaluation PKD (desired outcomes?)
maintain BP !!!
notify health provider of any bladder/kidney infections
what is Tolvaptan used for?
PKD: to slow down growth of cysts
Tx for PKD!!
management to slow down growth of cysts: Tolvaptan (Jynarque) !
what will you see on a urinalysis that would indicate pyelonephritis?
cloudy and smelly
positive WBC and nitrates!
cloudy urine means what?
bacteria in the urine
key difference between UTI and pyelonephritis?
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)
case study question: client has…
102.5 temp
grabbing left side
dull pain
cloudy urine
pyelonephritis
key words:
DULL pain
pain on SIDE
temp over 102
CLOUDY urine
peds Tx for glomerulonephritis?
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)
nephrotic syndrome
kidney disorder that causes your body to pass too much protein in your urine
causes fluid flow to shift, leading to edema and ascities
risk factors for nephrotic syndrome
typically without cause but sometimes…
family Hx
vesicoureteral reflux
epidemiology of nephrotic syndrome
higher in males than females
age 2-6 is usually seen
clinical presentation of nephrotic syndrome
fatigue
FOAMY urine
proteinuria
hematuria
facial and abdominal edema
anorexia
important urinalysis for nephrotic syndrome (to differentiate it from other kidney issues)
massive proteinuria (+2)
heamturia
glycosuria
lipiduria (hyperlipidemia)
fatty casts in urine
important CMP for nephrotic syndrome
normal GFR
increased BUN and creatinine
decreased albumin
what are you at risk for with nephrotic syndrome if left untreated
BLOOD CLOTS
infection
chronic or acute kidney injury
main goals of nephrotic syndrome
to decrease protein excretion and fluid, restore fluid and electrolyte balance, prevent infection
main pharmalogical treatment for nephrotic syndrome
12-week course of oral corticosteroids
Prednisone
other meds for other manifestations:
ACE inhibitors
antibiotics
statins
diet recommendations for nephrotic syndrome
low salt
low fluid
high protein (since you are loosing so much in urine)
define CAKUT
congenital anomalies of the kidneys and urinary tracts
umbrella term used to describe several congenital anomalies with a wide variety of implications
what are the alterations (CAKUT) for peds to know?
cryptorchidism
bladder exstrophy
epispadias
hypospadias
hydrocele
phimosis
vesicoureteral reflux
hydronephrosis
