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NUR2226 > WK 6: Renal Disorders > Flashcards

WK 6: Renal Disorders Flashcards

1
Q

What is a Urinary Tract Infection?

A

Is an infection of the urinary tract causing inflammation of the urinary epithelium

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2
Q

What are the 3 classifications of a UTI?

A
  1. Location
  2. Complexity
  3. Presence or absence of associated symptoms
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3
Q

How do you classify UTI’s according to location?

A

Upper urinary Tract: Kidney, ureters

Lower urinary tract: Bladder, urethra

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4
Q

How do you classify UTI’s according to complexity?

A

Complicated: Associated with anatomical/functional abnormalities increasing the risk of complications
Uncomplicated: Inflammation/Infection that occurs in non-instrumented, non pregnant women without abnormalities

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5
Q

How do you classify UTI’s according to presence or absence of associated symptoms?

A

Asymptomatic: Presence of significant growth of bacteria which does not illicit symptoms
Symptomatic: Presence of frequency, dysuria and loin pain in combination with significant growth on urine culture

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6
Q

Identify 4 risk factors associated with UTI’s

A 
Female gender (Shorter urethra)
Obstruction e.g. calculi, tumour 
Urinary stasis e.g. retention 
Sexual trauma 
Instrumentation e.g. catheter
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7
Q

Identify 3 clinical manifestations of a lower UTI

A

Dysuria
Urinary frequency
Haematuria, proteinuria
Urinary urgency

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8
Q

Identify 3 clinical manifestations associated with an upper UTI

A

Pain: lower abdominal, suprapubic
Lethargy
Fever, chills, myalgia

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9
Q

Describe the pathophysiology of a lower UTI

A

Bacterial contamination of sterile urine causes pathogen colonisation in peri urethral area where it then moves into the urethra and bladder attaching to the epithelium

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10
Q

Describe the pathophysiology of an upper UTI

A

When the pathogen ascends further up into the ureters and towards the kidneys, undergoing pathogen replication and causing infection

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11
Q

Identify the 3 areas of factors which assist with preventing UTI’s

A

Functional e.g. micturition washes out bacteria
Bactericidal e.g. Low pH (acidic)
Combination of both (Long urethra in men)

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12
Q

Identify 3 causative agents for UTI’s

A

E. coli
Pseudomonas
Staphlococcus `

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13
Q

Identify 3 nursing interventions for UTI’s

A

Non pharmacological: Increased fluids, heat pack
Bladder scan PVR <200mLs
FBC
Urinalysis

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14
Q

Describe acute cysitis

A

Acute inflammation of the bladder (Lower UTI)

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15
Q

Identify 3 clinical manifestations associated with acute cysitis

A

Urgency, Frequency, Dysuria, Pain

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16
Q

Describe pyelonephritis

A

Acute infection of the kidney (Upper UTI), One or both kidneys involved

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17
Q

Identify 3 clinical manifestations associated with pyelonephritis

A

Symptom TRIAD:
Vomiting
Fever
Flank pain

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18
Q

What does CAUTI stand for

A

Catheter Acquired UTI

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19
Q

Describe why CAUTI’s occur

A

Due to increased risk of infection as the catheter has a large potential to introduce bacteria from the external environment into the bladder

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20
Q

Identify 3 ways to prevent CAUTI’s

A

Strict aseptic technique
Only change IDC if clinically indicated
Obtain urien samples aseptically

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21
Q

What is urinary retention?

A

Inability to voluntarily urinate presenting with incomplete. bladder emptying and complete lack of voiding

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22
Q

Describe Acute urinary retention

A

Sudden and painful inability to urinate despite having full bladder

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23
Q

Describe chronic urinary retention

A

Painless retention associated with increased volume of residual urine

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24
Q

Identify 3 causes of urinary retention

A

Diabetes
Prostatic enlargement
Trauma
Surgery

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25
Identify 3 nursing interventions associated with urinary retention
Pain assessment Bladder scan Physical assessment
26
What is PVR
Post ovoidal residual volume: The volume of urine left in the bladder after voiding. <200mL is normal
27
Identify 2 indications to undertake a bladder scan
Prior to catheter insertion | Suspected urinary retention
28
What is glomerulonephritis
Kidney disorder that involves damage/inflammation to the glomeruli
29
What are the glomeruli
Filters in the kidneys that are responsible for the removal of wastes and toxins from the blood
30
Identify the 4 classifications of glomerulonephritis
Acute Chronic Primary Secondary
31
Describe Acute GN
Occurs suddenly, usually 1-2 weeks post infection e.g. upper respiratory or skin. Can be reversible
32
Describe chronic GN
Develops gradually over many years. Often results in irreversible kidney failure
33
Describe primary GN
If it occurs on its own
34
Describe secondary GN
If it occurs in association with an immunological disorder such as diabetes
35
Identify 3 risk factors for glomerulonephritis
Kidney disease Infection e.g. viral infections Ilicit drug use Cancer
36
Identify 3 clinical manifestations associated with glomerulonephritis
``` Foamy urine (proteinuria) Pink urine (haematuria) HTN Fluid retention SOB ```
37
Describe the pathophysiology of glomerulonephritis
Occurs when the glomerular filtration membrane becomes inflamed, causing damage to glomerular epithelial cells increasing the permeability. This causes decreased hydrostatic pressure, haemturia and proteinuria
38
`What is nephrotic syndrome
Damaged glomeruli which usually only let small compounds into urine become more permeable allowing more proteins and particles to enter into the filtrate causing (Proteinuria) causes oedema
39
Identify 3 nursing interventions in the diagnosis of glomerulonephritis
Accurate assessment Urinalysis/Bloods, VS Documentation Education and support
40
What does AKI stand for
Acute Kidney Injury
41
What is AKI
Sudden decline in renal function inhibiting the kidney's ability to regulate fluid, electrolytes and acid base balance
42
What are the 2 main characteristics of AKI
Rapid onset = Hours-Days | Rapid loss of kidney function = 25% of normal or GFR 25-30mL/min
43
Identify 3 complications of AKI
Azotaemia Uraemia Electrolyte/Acid base imbalance
44
What is azotaemia
Elevated levels of urea and nitrogen and other compounds in the blood
45
What is uraemia
Abnormally high levels of waste products in the blood
46
Identify 3 risk factors for AKI
Trauma e.g. burns, stabbing Surgery Nephrotic agents e.g. drugs, heavy metals Dehydration
47
Identify 5 clinical manifestations of AKI
``` Proteinuria Haematuria Decreased specific gravity Nausea/vomitng Lethargy ```
48
Identify the 3 different types of AKI
Prerenal Intrarenal Postrenal
49
Describe the pathophysiology of pre renal AKI
Caused by conditions which decrease renal blood flow (occurs before the kidney). This means less blood flow into the kidneys e.g. from decreased systemic blood flow and hypoperfusion e.g. decreased CoO
50
Describe the pathophysiology of intra renal AKI
Loss of ability of to filter blood properly (Occurs within the kidney). Resorption/secretion impaired due to acute tubercular necrosis (most common) e.g. nephrotoxic agents
51
Describe acute tubercular necrosis
Occurs when the epithelium cells of the tubules don't receive enough perfusion due to decreased renal blood flow/hypotension so the cells die and cannot resorb/secrete particles
52
Describe the pathophysiology of post renal AKI
Occurs due to a mechanical obstruction of urinary outflow resulting in reflux and impaired kidney function (After the kidney). Pressure backs up into the tubules. This results in decreased GFR and less waste products filtered out of the blood
53
Identify the 4 stages of AKI
1. Initiation (Onset stage) 2. Maintenance stage 3. Diuretic stage 4. Recovery stage
54
Describe what occurs in the initiation stage of AKI
Begins with event that causes ATN (Acute tubercular necrosis), and ends when renal damage occurs. Can be assymtpomatic
55
Describe what occurs at the maintenance stage
Renal damage well established, persistent oliguria, inability to eliminate wastes causing electrolyte imbalance fluid retention etc.
56
Describe what occurs at the diuretic stage
Gradual rise in urine output, nephrons not fully functioning, excretes waste but doesn't concentrate urine
57
Describe what occurs at the recovery stage
Begins with renal tissues and GFR repair themselves and renal function is well established, progressive in increasing urine output, improvement in pathology results
58
Identify 3 areas of nursing mangement in AKI
Non pharmacological: heat/cold pack, positioning Provide adequate hydration Monitor urine output hourly Urine assessment
59
What is a nephrostomy tube
When a ureter becomes obstructed, a nephrostomy tube can be inserted to preserve urine function on a temporary basis
60
Identify 2 causes of ureter obstruction
Renal calculi | Trauma
61
Where is the nephrostomy tube inserted into?
Directly into the renal pelvis sutured in place, with imaging to confirm the correct spot
62
Identify 2 potential complications of nephrostomy tubes
Bleeding | Perforation to other organ during procedure
63
How long does the pt remain on bed rest after nephrostomy procedure?
4 hours
64
What 3 things should you inform to the doctor should they occur post nephrostomy procedure
Urine output <30mLs over an hour Urine heavily blood stained Abnormal vital signs
65
Identify 3 nursing considerations associated with nephrostotmy tubes
Monitor colour in drainage Encourage fluid intake Regular emptying of bag
66
Define anuria
Failure of the kidneys to produce urine
67
Define proteinuria
Presence of protein in the urine
68
Define haematuria
Presence of blood in the urine
69
Define pyuria
Presence of pus in the urine
70
Define dysuria
Difficult or painful urination
71
Define polyuria
The passage of large amounts of urine (2-3L per day in adults)
72
Define oliguria
The passage of less than 400mLs of urine per day in adults
73
Define glycosuria
The presence of glucose in urine
74
Trimethoprim - Class - Indication - Action - Adverse effects - Nursing consideration
- Urinary tract antimicrobials - First line of drug to treat uncomplicated UTI's - Inhibits bacterial folate production, essential for bacterial growth - Vomiting, diarrhoea, - Avoid in first trimester pregnancy
75
Cefalexin - Class - Indication - Action - Adverse effects - Nursing consideration
- Urinary tract antimicrobials - Second line of drug to treat uncomplicated UTI's and other bacterial infections - Interferes with bacterial cell wall synthesis by binding to penicillin binding protein=cell lysis and death - Vomiting, diarrhoea - Observe for allergic reaction in penicillin allergy
76
Gentamicin Sulphate - Class - Indication - Action - Adverse effects - Nursing consideration
- Aminoglycoside - First line treatment against gram negative organisms, where other antibiotics are contraindicated - Inhibits protein synthesis by irreversibly binding to the organisms cell wall causing cell membrane damage - dizziness, vomiting, ataxia - Strict FBC, adequate hydration
77
Identify the 4 urinary tract antimicrobials
Trimethoprim Cefalexin Gentamicin sulphate Urinary alkalisers
78
Urinary Alkalisers - Class - Indication - Action - Adverse effects - Nursing consideration
- Urinary tract antimicrobials - Symptomatic relief, acute use only, not used to treat or prevent UTI's - Raises the pH of urine making it less acidic to provide pain relief - Symptomatic relief - Ensure pt education about short term use only
79
Loop directics - Class - Indication - Action - Adverse effects - Nursing consideration
- Loop diuretics - Oedema in renal function, nephrotic syndrome, HF - Inhibits sodium, potassium and chloride reabsorption resulting in increased water excretion - Hypotension, dizziness - Can result in hyperkalaemia
80
What is an example of a loop diuretic?
Furosemide
81
Potassium sparing diuretics - Class - Indication - Action - Adverse effects - Nursing consideration
- Potassium sparing diuretics - Adjunct alongside loop diuretics, people at high risk of hyperkalaemia, oedema in renal function - Retain potassium, increased excretion of sodium, inhibits sodium, potassium and chloride reabsorption = increased water excretion - Headache, drowsiness
82
What is an example of a potassium sparing diuretic
Spironolactone
83
Thiazide and Thiazide like diuretics - Class - Indication - Action - Adverse effects - Nursing consideration
- Thiazide and thiazide like diuretics - Oedema, HTN chronic renal failure, prevention of renal calculi - Increase excretion of water and sodium, chloride, potassium, magnesium and reduced excretion of calcium - Headache, dizziness - Increased risk of orthostatic hypotension
84
What is an example of a thiazide or thiazide like diuretic?
Hydrochlorothiazide

NUR2226 (8 decks)

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