2.5 Renal/Urinary Flashcards

Question

Renal Arteriogram or Angiogram

Answer 1

Visualizes renal arteries using radiopaque dye. Dye injected via femoral or brachial artery. Seldom used as stand-alone diagnostic procedure. Usually done at time of renal angioplasty or other intervention.

Answer 2

Nursing Interventions Assess dye allergy & anticoagulant use NPO 8-12 h prior Oral hypoglycemic’s contraindicated with contrast medium

Answer 3

``` Post procedure: Monitor bleeding @femoral artery Restrict activity x 1 day Monitor output (dye is hard on kidneys) Monitor peripheral pulses ```

Answer 4

How the interaction occurs: If you are taking metformin when you have your imaging test procedure, your kidneys may not be able to properly remove metformin from your blood.

Answer 5

What might happen: The effects of metformin may increase and cause a serious condition called lactic acidosis, especially if you have kidney problems. Symptoms of lactic acidosis are: feeling very weak, tired, or uncomfortable, unusual muscle pain, trouble breathing, unusual or unexpected stomach discomfort, feeling cold, dizziness or lightheadedness, suddenly developing a slow or irregular heartbeat.

Answer 6

Examines: Perfusion, function & structure of the kidneys. Uses IV radioisotope- contains no iodine, less kidney injury risk.

Answer 7

Nursing Interventions Insert IV for isotope administration Enc. Fluid intake to aide in isotope elimination. Isotope generally eliminated within 6-24 hrs.

Answer 8

``` Pre-Procedure: Drink several glasses of water Obtain weight and have patient void Post-Procedure: Increase fluid intake ```

Answer 9

Helps determine cause of unexplained kidney problems guides care. Performed percutaneously (through skin) with a biopsy needle using ultrasound/CT guidance. Bleeding is a MAJOR risk.

Answer 10

Nursing care: Informed consent NPO 4-6 hrs. before. PT, PTT drawn prior r/t major risk of bleeding complication. Manage B/P (HTN increases bleeding risk). Strict bedrest 24 hrs. post biopsy. Limited bathroom privileges after 24 hr. if no evidence of bleeding. Discomfort expected at biopsy site. If pain radiates to flank, back and abdomen suspect bleeding. Monitor: Urine output, hematuria, vital signs. Bruising/flank pain (indicates internal bleed)

Answer 11

Provides info about bladder capacity, pressure and voiding reflexes.

Answer 12

Procedure: Pt. voids normally. Record amount and time of void. Insert catheter to measure residual urine volume. Cystometer attached to catheter and fluid is instilled (about 500 ml) into the bladder. Pt. reports when 1st feeling urge to void is felt & the point when strong urge to void is felt. Bladder capacity & pressure readings are recorded.

Answer 13

Bladder capacity is about 300-600 ml’s. Urge to void sensed @ >150ml Fullness sensed @ 300 ml

Answer 14

Tests of bladder capacity, pressure and tone Studies of urethral pressure and urine flow Tests perineal voluntary muscle function. Includes CMG (Cystometrogram), urethral pressure profile (UPP) urine stream testing (evaluates pelvic muscle strength). EMG (Electromyography) of perineal muscles to test strength of muscles used in voiding

Answer 15

Evaluates bladder, urethra and lower portions of ureters. Endoscope inserted through urethra into the bladder. Requires pre-op checklist and informed consent. Performed for diagnosis or treatment of: Bladder trauma Identify causes of urinary tract obstructions. Remove bladder tumors or implant radium seeds into a tumor. Stop areas of bleeding Resect an enlarged prostate gland.

Answer 16

Post-op care: Monitor airway patency & breathing. Urine may be pink tinged. Gross bleeding not expected. Monitor urine output. Enc. Fluids to decrease burning sensation. Urinary frequency expected initially due to irritation from procedure. Monitor for s/s bladder puncture- severe pain (including abdominal pain) nausea and vomiting. **Cystoscopy can be done under general or local anesthetic with conscious sedation. Done in surgery, outpatient clinics and doctors offices.

Answer 17

Measures glomerular filtration rate. Is a protein produced in the body at a constant rate & can be used as indicator of GFR. When GFR is reduced cystatin-c increases Increased levels can be considered a predictor of chronic renal disease. Not influenced by factors that influence BUN and creatinine. Maybe be better indicator of GFR. Increased blood concentration = indicate decrease GFR & kidney dysfunction. Nursing Interventions: No specific preparation is required.

Answer 18

Measures effectiveness of kidneys excretion of urea nitrogen. Urea nitrogen is by-product of protein breakdown in the liver. Kidneys filter urea nitrogen from the blood and excrete in the urine. Elevated BUN does not always mean kidney disease is present. Normal range 10-20 mg/dl. Slightly higher in older adults.

Answer 19

Contributing factors to increased BUN levels: Rapid cell destruction from infection, cancer Tx., or steroid therapy. Blood (protein) from injured tissues. Dehydration

Answer 20

Urea is an end product of protein metabolism. An elevated BUN level could be indication of dehydration, prerenal failure, or renal failure or GI bleeding. Dehydration from vomiting diarrhea or inadequate fluid intake is common cause of elevated BUN. If dehydration after hydrated the BUN should return to normal if not prerenal or renal failure should be suspected. Digested blood from GI bleeding is a source of protein and can cause the BUN to elevate. A low BUN usually indicates over hydration (hypervolemia).

Answer 21

Blood test that evaluates kidney function. Creatinine is produced when muscles & other proteins are broken down & excreted by the kidneys. Higher in men vs women r/t larger muscle mass. Normal value: 0.5-1.2 mg/dl Kidney disease is the only condition that raises serum creatinine. When serum creatinine levels doubled, it indicates a 50% reduction in GFR.

Answer 22

If kidneys are functioning properly you’d expect to see higher levels of creatinine in urine and less in blood. When kidneys do not function well less creatinine is seen in urine and more in the blood.

Answer 23

Best test to measure level of kidney function Determines stage of kidney disease. Calculated by blood creatinine, age, body size, and gender. Low numbers mean kidney is not working well.

Answer 24

Urine sample that is collected for 24 h period of time. Evaluates GFR & renal function. Done along with serum creatinine Normal 85-135 Expect low levels if kidney function impaired. Thought: “kidneys clear creatinine from blood” So higher levels would be seen in urine of normal kidneys

Answer 25

Nursing Interventions: First urine is discarded Keep urine on ice or in refrigerator during 24h period (unless preservative in the container) Instruct pt. and family to save all urine during 24h Assess meds: thiazides steroids may decrease creatinine while Methyldopa, vit c, cimetidine may increase levels.

Answer 26

Creatinine is removed, or cleared, from the body entirely by the kidneys. If kidney function is abnormal, creatinine level increases in the blood because less creatinine is released through the urine.

Answer 27

UA part of a physical exam. Provides useful info for pts. with suspected kidney disorders. Ideally collected 1st morning urine. Other specimens may be too dilute. Specimens become more alkaline when left unrefrigerated for more than 1 hr. or when bacteria are present. Promptly cover and deliver to the lab.

Answer 28

Yellow Dark amber= concentrated urine Very pale yellow= dilute urine Dark red or brown= indicates blood or increased bilirubin

Answer 29

Clear | Cloudy= infection, sediment or protein present.

Answer 30

1.005-1.020 Increased= decreased kidney perfusion, HF, Decreased= CKD, Diabetes,

Answer 31

0=8 mg/dl Protein is not normally present in urine r/t molecules being too large to pass through intact glomerular membranes. Increased = glomerular disorders, stress, infection or recent strenuous exercise.

Answer 32

None | Presence suggests UTI

Answer 33

None | Presence suggests urinary Escherichia coli

Answer 34

Think Infection!!!!! Repeated upper UTIs occurring in patients who almost exclusively have anatomic abnormalities of the urinary tract. Urinary stasis, reflux from bladder tumors/enlarged prostate Kidney stones

Answer 35

An active bacterial infection. Involves acute tissue inflammation, local edema & cell necrosis. Onset usually rapid s/s chills, fever, malaise, vomiting, flank pain, frequency, dysuria, costovertebral tend

Answer 36

Repeated infections causing scar tissue to develop from chronic inflammation in the kidney glomerular and tubular structures. Results in impaired reabsorption and kidney function is reduced.

Answer 37

Conditions causing chronic pyelonephritis: Kidney stones, scaring from pelvic radiation, reflux, diabetic neuropathy, SCI(Acute spinal cord injury), neurodegenerative diseases (MS, spina bifida). E-coli urine infections, immune diseases that cause systemic inflammatory response (lupus).

Answer 38

Assessment findings: May be asymptomatic Mild urinary frequency, dysuria, & flank pain Frequent s/s is HTN as kidney tissue is destroyed

Answer 39

``` Predisposing factors: UTI’s HTN or vascular conditions Obstructions of urinary tract (stones) Acute pyelonephritis looks like an infection Chronic looks like kidney failure ```

Answer 40

Chronic Pyelonephritis Common cause of CKD May develop r/t UTI’s or other conditions that damage kidneys such as HTN or vascular conditions, obstructions, reflux. May be asymptomatic or have mild manifestations (frequency, dysuria, flank pain) HTN may occur as kidney tissue is destroyed.

Answer 41

``` Radiologic imaging IVP CT Voiding cystourethrography (CMG) Cystoscopy **Radiologic imaging looks for functional or structural abnormalities of kidneys, ureters, and bladder. ```

Answer 42

Urinalysis to assess for Pyuria Bacteria Blood in urine Bacteria count >100,000 indicative of infection Urine dipsticks identify nitrates & leukocytes (indicative of bacteria in urine)

Answer 43

Teach measure to prevent UTI Encourage fluid intake Avoid holding urine when urge to go Teach Vit. C and Cranberry juice intake. Why? Avoid excess milk and milk products (renal stone risk) Teach importance of reporting change in urine color, clarity, of s/s of infection. PH urine increases (more alkaline) with age making more prone to UTI’s.

Answer 44

UTI prevention: void before and after sex, wipe front to back. Avoid bubble baths, vaginal douches, feminine sprays, cranberry juice and vitamin c to increase acidity of urine.

Answer 45

Milk and milk products increase chance of renal calculi r/t increased calcium levels

Answer 46

Glycosuria also more common in older adults due to high incidence of diabetes in this population. Sugar in urine makes good breeding ground for bacteria.

Answer 47

What is it? | Inflammation of the glomerular capillary membrane in the kidney.

Answer 48

Glomerulus functions: Water & electrolytes pass freely across this membrane Larger molecules (plasma proteins & RBC) do not cross this membrane and are retained in the blood. Inflamed glomeruli allows passage of large products (RBC & protein) to pass through & are present in the urine.

Answer 49

Think Immune Reaction!!! Develops over years to decades. Always leads to end-stage kidney/renal disease (ESKD/ ESRD). Exact cause unknown, but changes in kidney tissue result from: - Inflammation from -immunity excess (Lupus) - Infection. - Hypertension - Poor kidney blood flow. - Diabetic nephropathy- leading cause of CKD (r/t elevated BS causes scaring to the kidney & increases the speed of blood flow into the kidney placing strain on the filtering glomeruli & raising B/P).

Answer 50

Lupus causes inflammation of connective tissue in the body. The inflammatory process in lupus causes damage to the kidneys particularly the glomerulus.

Answer 51

Leading cause of glomerular disease and TKF Caused by elevated levels of blood glucose Scarring the kidney Elevated glucose levels increase speed of blood flow into kidney, putting strain on filtration and raising B/P

Answer 52

Let’s think about it Glomerulus is basic filtration system of the kidneys Damage to glomerulus= increased capillary permeability leads to membrane more permeable to proteins and blood cells.

Answer 53

``` UA- + RBC & + protein (1st indicator of disease) BUN increased Serum Creatinine increased Urine Creatinine decreased GFR decreased Oliguria (output <400ml/24h) Edema- protein loss causes fluid shift to interstitial spaces. HTN- Na & water retention Hyperkalemia ```

Answer 54

changes in elimination pattern: frequency, color, odor, clarity, nocturia (common). Frothy urine caused by proteinuria Recent infections (streptococcal). Exposure to nephrotoxic medications. Previous transfusion reaction, DM, HF. Fluid overload can occur with decreased urine output. Assess: SOB, lung sounds for crackles Respiratory rate, B/P, weight, edema. For s/s of uremia: slurred speech, tremors, skin rashes, bruises, itching or dryness.

Answer 55

Monitor vitals for s/s of fluid excess. B/P mgmt. essential! (tachycardia, HTN, weight gain, lung sounds= crackles) Document energy level- energy increases with improved glomerular filtration. Na+ restriction if edema or HTN (as ordered) Dietary protein restriction if azotemia (kidneys are no longer able to get rid of enough nitrogen) present. Instruct only complete proteins Complete proteins: milk, eggs, cheese, meat poultry, fish, soy. Incomplete proteins: veggies, bread, cereals, grains, seeds nuts, legumes.

Answer 56

Monitor use of diuretics – decrease edema but leads to electrolyte imbalances causing increased fatigue. Teach avoidance of nephrotoxic medications Monitor WBC’s- increase in immature WBC’s indicative of infection. ACE or ARB’s (have protective effect on kidneys) may be ordered to reduce protein loss and slow progression of renal failure.

Answer 57

Progressive irreversible loss of kidney function Classified into 5 stages based on GFR category. Presence of kidney damage or GFR<60 ml/min lasting> 3 months. CKD with greatly reduced GFR causes abnormal urine production, disruption of fluid & electrolytes and metabolic abnormalities.

Answer 58

Predisposing Factors: Significantly higher in 65 and older group. Cultural variances- African American highest incidence. Diabetes is leading cause, followed by HTN, glomerulonephritis, and cystic kidney disease ESRD the GFR is <10% of normal

Answer 59

Early Later Final

Answer 60

Early stages= polyuria | Inability to concentrate urine- nocturia

Answer 61

Later stages= oliguria to anuria Oliguria = <400 ml/24 hrs. Anuria= <100 ml/24 hrs. Amount of urine has nothing to do with quality Waste product accumulation in spite of amount of urine

Answer 62

``` Uremia (raised level in the blood of urea and other nitrogenous waste compounds that are normally eliminated by the kidneys), (final stage) occurs when toxins normally sent out in urine end up in the bloodstream. Uremia s/s: Metallic taste in mouth, anorexia, N&V Muscle cramps, fatigue, hiccups Edema, dyspnea, paresthesia's. ```

Answer 63

Stage 1 Kidney damage with normal or increased GFR >90 Asymptomatic normal BUN and creatinine. Screen for: nephrotoxic meds, glucose control, HTN to reduce progression.

Answer 64

Stage 2 Mildly decreased GFR 60-89 ml/min Asymptomatic possible HTN labs usually WNL Focus on reduction of risk factors.

Answer 65

Stage 3: Renal insufficiency Moderate GFR decrease 30-59 ml/min HTN, possible anemia, fatigue, anorexia, slight elevation of BUN & Creatinine. Implement strategies to slow progression.

Answer 66

Azotemia: is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood. It is largely related to insufficient filtering of blood by the kidneys It can lead to uremia if not controlled. Azotemia: Increased blood levels of nitrogenous waste products

Answer 67

Uremia can be translated as "urea in the blood". Urea is one of the primary components of urine. It can be defined as an excess of amino acid and protein metabolism end products, such as urea and creatinine in the blood that would be normally excreted in the urine.

Answer 68

Azotemia is another word that refers to high levels of urea, but is used primarily when the abnormality can be measured chemically but is not yet so severe as to produce symptoms. Uremia is the pathological manifestations of severe azotemia

Answer 69

Stage 4: Renal Failure=Start Dialysis Severely decreased GFR 15-29 ml/min Anemia, edema, hypercalcemia, possible uremia, azotemia with increasing BUN and serum creatinine

Answer 70

``` Stage 5: End Stage Renal Disease (ESRD) Kidney failure with azotemia and overt uremia Multi-system problems Kidney transplant/dialysis. GFR <15 mL/ min ```

Answer 71

Antibiotics -Aminoglycosides, Cephalosporins, mycins such as Gent, Tobramycin, Vancomycin, sulfonamides Diuretics: Lasix (overuse) NSAIDs Chemotherapy agents Magnesium containing antacids & laxatives Metformin Lead RADIOLOGIC CONTRAST DYES

Answer 72

Fluid and electrolytes Cardiovascular: atherosclerosis, HTN, pulmonary edema, HF Hematologic: anemia, impaired platelet function, bleeding risk Immune system: infection, inflammation, fever Gastrointestinal: N/V, anorexia, hiccups, peptic ulcers Neurologic: CNS fatigue, insomnia, diff concentrating Musculoskeletal: renal osteodystrophy, renal rickets Endocrine/Metabolic: glucose intolerance Dermatologic: anemia, retained pigment (pale/yellow), bruising, poor skin turgor

Answer 73

``` Primary goal Decrease HTN Minimize edema Decrease urinary protein losses Slow progression of renal disease. ```

Answer 74

``` Diet consists of Low sodium Low potassium & low phosphorus Moderate protein from complete proteins Avoid high glycemic index carbohydrates Sometimes fluid restrictions Nutritional needs vary depending on degree of kidney function & type of dialysis used (HD vs peritoneal) ```

Answer 75

Low Sodium Helps control HTN and edema Controls weight gain Na+ intake more limited as disease progresses.

Answer 76

Low Potassium- Stage IV& V Prevention of hyperkalemia (KCL increased in renal failure as GFR decreases). Varies by urine output If anuria K more restricted higher risk of hyperkalemia (serum K rises as GFR declines)

Answer 77

Low Phosphorus for CKD 3 & 4 Restricted in hemodialysis because high serum phosphorus contributes to secondary hyperparathyroidism and raises calcium-phosphorus levels in the plasma Healthy kidneys filter out extra phosphorus.

Answer 78

Functions of phosphorus Creates energy Maintains a normal PH balance Phosphorus added to many canned and bottled drinks. Rare to have phosphorus deficiencies usually excess in USA

Answer 79

Foods canned colas, drinks, & other bottled drinks high Phosphorus Prepared foods read labels for “phos” containing ingredients.

Answer 80

``` High Biologic Value Proteins: Eggs Meats Poultry Game Fish Soy Dairy products ```

Answer 81

Body cannot store proteins like it can carbohydrates and fats. Excess protein is changed into urea by the kidneys. Increase CHO & fat intake to maintain energy requirements.

Answer 82

Limit catheter use /use sterile technique when catheter is used Aggressively treat DM, HTN, Acute Glomerulonephritis, UTI’s Watch for low UO & BP; report promptly (Prevent ACUTE RENAL FAILURE) Monitor Nephrotoxic meds carefully Maintain hydration especially in presence of nephrotoxic meds.

Answer 83

Remove waste products & excess fluid | Restore electrolyte and acid base balance in body

Answer 84

Blood circulates through Artificial Kidney by dialyzer to: Remove waste products & excess fluid restoring fluid & electrolyte & acid-base balances. Manages symptoms does not cure Performed usually 3 times/week 3-4 h each run

Answer 85

Can be Permanent or Temporary Central catheter- temporary Arteriovenous Fistula (AVF)

Answer 86

Nursing Care: Palpate fistula for a Thrill each shift No B/P or lab draw in affected arm POST SIGN on wall/armband Monitor for bleeding and s/s infection New AVF takes 2 wks-4 months to mature in order to accommodate large bore needles. No lab draws or Iv’s on affected side.

Answer 87

Hold most medications check with RN clinically. - BP MEDS, WATER SOLUBLE MEDS HELD - Usually allow Insulin, Tums, protein & lipid bound meds - but check with HD staff. Hypotension common during HD Monitor patient VS, access site, and machine functioning during treatment Some patients may be able to eat Assess for possible complications Weight before and after dialysis to determine if correct amount fluid removed

Answer 88

Vital signs (B/P should decrease after dialysis) Labs Fluid status- weight “dry weight” (after dialysis) Assess for bleeding r/t heparin used during HD

Answer 89

Dialysis disequilibrium syndrome- results from rapid reduction in electrolytes & other particles. Rare in today’s HD practices. Occurs during or after HD. Causes mental status changes, seizures & coma. Mild form of disequilibrium syndrome s/s include: HA, vomiting, nausea Fatigue, restlessness. Why? blood-brain barrier causes slow removal of waste products from the brain that cause above symptoms

Answer 90

Exchanges wastes, fluid and electrolytes to occur in the peritoneal cavity. Slower than HD and more time needed to achieve the same effect. Use of PD is declining. <10% of dialysis population is using PD. Silicone catheter surgically placed into abdominal cavity. Fill, dwell, drain period. Frequency of PD is determined by physician based on s/s and lab data.

Answer 91

Advantages Allows more freedom for pt. More liberal fluid & nutrient intake allowed Fluids/solutes removed slower than HD= less risk to unstable patient

Answer 92

Disadvantages Less effective metabolite elimination Higher risk of infection- peritonitis= cloudy fluid return during drain. Use aseptic technique with catheter.

Answer 93

``` Vital Signs Daily weights Labs Measure and Record Abdominal Girth Monitor clarity of fluid drained –cloudy= infection ```

Answer 94

Risk Factors Cigarette smoking – primary risk factor Chronic UTI’s & renal calculi Exposure to chemicals & dyes in plastic, rubber, spray paint.

Answer 95

Assessment Painless hematuria 75% of cases Diagnostic: biopsies most specific to detect cancer.

Answer 96

Treatment Radiation- palliative in nature Chemotherapy- Surgery - cystectomy

Answer 97

Intravesical chemotherapy -Chemotherapy or immune stimulating agents instilled into bladder via urethral catheter.

Answer 98

Nursing interventions: bladder emptied prior to installation patient position changed frequently so solution contacts bladder tissue surface side effects tend to be more localized – hematuria, urinary frequency/urgency After dwell time pt. voids. Live virus excreted in urine. Teach clean toilet well, do not share toilet for 24 hrs. after Tx. Wear gloves to clean toilet.

Answer 99

S/S: Often silent dx occurs at advanced stages Late: gross hematuria, flank pain, palpable mass Hematuria(microscopic) consistent symptom

Answer 100

Treatment Nephrectomy – Tx of choice No chemo drug shows consistent tumor regression

Answer 101

``` Risk Factors: Smoking Obesity HTN Exposure to occupational chemicals ```

Answer 102

Stress: involuntary loss of urine during activities that increase abdominal pressure (cough, sneeze, exercise). Urge: overactive bladder (OAB). Involuntary loss of urine with strong desire to urinate. Mixed: combination of stress & urge incontinence. Overflow: involuntary loss of urine assoc. with overdistention of bladder when bladder has reached capacity. Functional: leakage of urine caused by factors other than disease of the lower urinary tract.

Answer 103

Measures that stimulate reflex voiding: Scheduled voiding Stroking or pinching abdomen or inner thigh, glans penis Pulling pubic hairs Tapping SP region Credes method (manual pressure on the abdomen at the location of the bladder)- caution in spinal cord injury r/t AD Insert finger into rectum and stretch anal sphincter Provide privacy.

2.5 Renal/Urinary Flashcards

(131 cards)