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kol- Med Surg 320 Spring > PKD, BPH, Diabetic Nephropathy > Flashcards

PKD, BPH, Diabetic Nephropathy Flashcards

1
Q

what is pkd?

A

Polycystic Kidney Disease
• Fluid –filled cysts develop in the nephrons resulting in enlarged kidneys and causes compression on kidney itself and abdomen
• large abdomen causes pain and pressure on other organs
• kidney enlarges and fails
• These cysts develop as a result of abnormal cell division

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2
Q

3 types of PKD

A

Autosomal recessive
Autosomal dominant
New mutation/not inherited

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3
Q

most common type of PKD

A

Autosomal dominant

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4
Q

Type of PKD that results in childhood death usually

A

autosomal recessive

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5
Q

4 Major issues to consider with PKD

A

pain
infection
BP
Bleeding

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6
Q

How does PKD lead to HTN?

A

Kidney Ischemia/ lack of blood flow -> RAAS system activated–> Hypertension

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7
Q

can you have cysts other places with PKD?

A 
yes! 
	◦ Liver
	◦ Blood Vessels (Aneurysms) --> sudden death
	◦ Spleen
	◦ Thyroid
	◦ Pancreas
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8
Q

if you have PKD you are more likely to develop what 3 things- 2 related to other systems , 1 related to urinary system

A

kidney stones
cardiac problems
colon problems

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9
Q

what does PKD pain feel like

A

◦ Dull, Aching

◦ Sharp, Intermittent - when cyst ruptures + also have hematuria

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10
Q

what is your pee like with PKD

A
  • Dysuria
  • Foul-smelling urine- ruptured infected cyst rupture
  • Cola colored urine- ruptured cyst
  • Nocturia (early)
  • Uremia- later in disease, build up of uric acid
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11
Q

at risk for what electrolyte imbalance with PKD

A

Na

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12
Q

Assessment findings besides pain and urine changes with PKD

A
  • Distended Abdomen
  • Flank Tenderness/ Pain
  • Na loss - Only need to manage dietary Na decrease later in disease
  • Hypertension- activation of RAAS system
  • Edema- kidney’s cant get rid of fluid
  • Severe Headache- aneurysm, hypertensive crisis
  • Depression &Anxiety- psychosocial assessment
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13
Q

what test are we looking at for long term analysis of stage/progression with PKD? what is normal range?

A

GFR, >60

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14
Q

If you get diagnosis of PKD then you have stage ____ kidney disease

A

1

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15
Q

Diagnostics for PKD

A
  • Urinalysis
  • Culture if indicated
  • **GFR- long term
  • Serum Creatinine/ BUN- helpful in the minute
  • NA/ Electrolytes
  • Ultrasound
  • CT
  • MRI
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16
Q

what happens to Na levels in PKD (early vs late disease)

A

◦ Low NA in early disease

◦ High NA in late disease

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17
Q

Interventions for PKD

A
  • **Blood pressure control
  • Pain management
  • Prevention of infection
  • Prevention of constipation
  • Support (Dialysis)
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18
Q

pain management for PKD

A
  • Drainage of cyst
  • Opioids
  • Nephrectomy
  • Antibiotics
  • Relaxation Techniques
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19
Q

Constipation prevention for PKD

A
  • Adequate Fluid intake
  • Increase Fiber
  • Exercise
  • Stool Softeners
  • Bulking agents
  • Laxatives
20
Q

preferred drug to manage HTN for PKD?

A

Ace inhibitor! (ARB 2nd choice, CCB worst choice)

21
Q

Blood pressure management for PKD

A
  • Adequate fluid intake
  • Restrict Na intake around 2.5 g/day
  • Monitor Blood Pressure
  • Keep records of readings
  • Daily weights
  • ACE inhibitors
22
Q

What is the leading cause of renal failure?

A

diabetes

23
Q

what determines someone risk for diabetic nephropathy?

A

• Severity of kidney disease is related to the degree of hyperglycemia the patient has
◦ High A1C = increase risk of development

24
Q

first sign of diabetic nephropathy is….

A

microalbuminuria!

25
Q

When do we screen urine for protein- type 1 vs type 2 DM

A
  • Screen for protein in urine 5 years after Type I diagnosis
  • Screen for protein in urine 1 year after Type II diagnosis

• Check at least 1/year, increase if have higher a1c

26
Q

if you get a new diagnosis of diabetes you also get diagnosis of stage ____ kidney disease

A

1

27
Q

interventions for diabetic nephropathy

A 
• Avoid Dehydration 
• Avoid Nephrotoxic substances
• Overtime, as kidney function declines, hypoglycemic events may become more common
	◦ Kidney disease is risk factor for hypoglycemia 
• Glycemic control
• Keep blood pressure under 125/75
• ACE inhibitors and ARB’s
• Control lipids
28
Q

_____ disease is a risk factor for hypoglycemia

A

kidney!

• Overtime, as kidney function declines, hypoglycemic events may become more common

29
Q

What causes BPH?

A
  • Related to aging and increasing levels of dihydrotestosterone (DTH)
  • Glands in prostate undergo hyperplasia
  • Local inflammatory response
30
Q

What happens to detrusor muscle with BPH?

A

thickens

31
Q

What happens to residual urine with BPH?

A

increases

32
Q

BPH can lead to chronic urinary _____

A

retnetion

33
Q

What kind of incontinence w/ BPH?

A

overflow

34
Q

3 affects of BPH on urinary system

A
  1. thickened detrusor muscle
  2. increased residual urine
  3. Chronic urinary retention
35
Q

Name some conditions/disease processes BPH can lead to

A
  • Renal stones
  • Infection
  • Acute urinary retention
  • Hydroureter
  • Hydronephrosis
  • Kidney Disease
36
Q

Assessment for BPH

A
  • History , screening test asking about quality of life, lower urinary tract symptoms, and current elimination patterns
  • Frequency
  • Hesitancy
  • Intermittency
  • Urgency
  • Reduced force and stream
  • Sensation of incomplete emptying of bladder
  • Straining
  • Dribbling/ leaking
  • Hematuria
  • Bladder distension
  • Digital rectal exam
  • Irritability
  • Fear
  • Embarrassment
  • Depression/ Social Isolation
37
Q

Diagnostics for BPH

A
  • Urinalysis
  • Culture
  • Serum Creatinine/ BUN
  • Prostate Specific antigen
  • Transabdominal/rectal Ultrasound
  • Prostate tissue biopsy to rule out cancer
  • Cytoscopy
  • Residual urine test
  • Urodynamic Pressure-Flow tests
38
Q

5 drug therapies for BPH

A 
◦ 5-alpha reductase inhibitors
	◦ Alpha-blockers
	◦ Palmetto extract
	◦ African plum tree bark (Pygeum)
	◦ Rye Pollen
39
Q

Non surgical interventions for BPH

A
  • Drug Therapy
  • Frequent sexual intercourse
  • Spread fluids out over time (avoid large volumes at one time)
  • Avoid bladder stimulants
  • Void as soon as sensation occurs
  • Avoid medications that contribute to urinary retention
  • TUNA Transurethral needle ablation
  • TUMT Transurethral microwave therapy
  • ILC Interstitial Laser Coagulation (AKA Contact Laser Prostatectomy)
  • EVAP Electrovaporization of the Prostate
40
Q

What is the purpose of TUNA, TUMT, ILC, EVAP for BPH?

A

all involve reducing size of prostrate tissue

41
Q

Who needs surgery for BPH?

A

• Males who can’t or won’t take medications
• Males who are not candidates for non-invasive procedures
• Males with BPH causing
◦ Acute urinary retention
◦ Chronic UTI
◦ Hematuria
◦ Hydronephrosis

42
Q

What is a TURP?

A
  • Enlarged portion of the prostate is removed through endoscopic instrument
  • Gold Standard for surgical treatment of BPH
  • May have to be performed again (Remaining prostate tissue can become enlarged)
  • Risk of strictures
43
Q

TURP puts you at risk for…..

A

strictures

44
Q

Peoperative care for TURP

A
  • Education
  • Address Anxiety
  • Discontinue Anti-coagulants
  • Indwelling catheter with traction
  • Pain management
  • Continuous bladder irrigation (3 way urinary catheter)
45
Q

Post op care/consideration for TURP

A
  • H & H
  • Monitor bleeding
  • Presence of blood in urine/ clots/ debris
  • Fluid intake (2-2.5 L)
  • Painful Urination
  • Urinary output
  • Infection
  • Incontinence short term
  • Dribbling
  • Sexual Dysfunction
  • Retrograde ejaculation
  • Kegel Exercises- regain continence

kol- Med Surg 320 Spring (43 decks)

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