Beth - Week 9 - Exam 4 Flashcards
(74 cards)
1
Q
what is normal urine color?
A
yellow (light/pale to dark/deep amber)
2
Q
what is normal urine clarity/turbidity?
A
clear or cloudy
3
Q
what is normal urine pH?
A
4.5 - 8
4
Q
what is normal urine specific gravity?
A
1.005 - 1.025
5
Q
what is normal urine glucose?
A
= 130mg/dL
6
Q
what is normal urine ketones?
A
none
7
Q
what is normal urine nitrites?
A
negative
8
Q
what is normal urine bilirubin?
A
negative
9
Q
what is normal urine urobilirubin?
A
small amt (0.5-1 mg/dL)
10
Q
what is normal urine blood levels?
A
< 3 RBCs
11
Q
what is normal urine protein levels?
A
< 150 mg/dL
12
Q
what is normal RBCs in urine?
A
= 2 RBCs/hpf
13
Q
what is normal WBC levels in urine?
A
< 2 - 5 WBCs/hpf
14
Q
what is normal squamous epithelial cells in urine?
A
= 15-20 squamous epithelial cells/hpf
15
Q
what is normal casts in urine?
A
0-5 hyaline casts/lpf
16
Q
what is normal crystals in urine?
A
occasionally
17
Q
what is normal bacteria in urine?
A
none
18
Q
what is normal yeast in urine?
A
none
19
Q
when thinking BUN, think _____.
A
HYDRATE
20
Q
what is the normal values for BUN?
A
- 10 - 20 mg/dL
21
Q
what is BUN?
A
- nitrogenous and product of protein
22
Q
what might an increased BUN indicate?
A
- dehydration
- too much protein
- renal impairment
23
Q
what might a decreased BUN indicate?
A
- malnourished
- overhydrated
24
Q
when thinking creatinine, think ____
A
muscle
25
what are the normal values for creatinine?
0.5 - 1.5 mg/dL
26
T/F: creatinine is more sensitive to renal function
TRUE
27
what might an increased Cr indicate?
renal impairment
28
what might a decreased Cr indicate?
possible decreased muscle mass
29
when thinking of BUN/Cr ratio, think ____
source of the problem
30
what are the normal values for BUN/Cr?
10 - 20 (divide BUN (24) by Creatinine (0.6) = 40, which is very high
31
what is the BUN/Cr ratio?
- indicator of GFR
32
what does an increased BUN/Cr ratio indicate?
fluid volume deficit (diuresis, diarrhea,
vomiting), poor renal perfusion, protein catabolism (protein intake, surgery) & renal failure if creatinine is
high
33
what does a decreased BUN/Cr ratio indicate?
fluid volume excess or
| malnutrition/starvation state
34
when thinking of creatinine clearance, think _____
filtration pump
35
what is the creatinine clearance?
- rate of glomerular filtration
| - sensitive indicator of renal function
36
what is the formula for creatinine clearance?
urine creatinine/serum creatinine x urine volume/ time (hrs x 60)
37
how do you obtain the creatinine clearance?
- 24 hr urine collection
- refrigerate
- compare to serum creatinine
38
what are the diagnostics for complicated GU problems?
- Urine Studies
- Serum Studies
- Radiological
- Endoscopy
- Urodynamic
- Ultrasound
- Invasive-Biopsy
39
what are the characteristics of IV pyelogram?
- dye
| - visualize kidneys, bladder, ureters
40
what is the pt prep for radiographic IV pyelogram?
- allergies?
- consent signed?
- risk factors?
- laxatives the noc before
(bowel cleansing)
- liquids restricted 8-10
hrs before test
- warm/flush feeling
41
what is the post procedure for IV pyelogram?
- monitor renal function
| - encourage PO and IV fluids
42
what is a KUB?
xray of kidneys, ureters, bladder
- reveals abnormalities
- no prep needed
43
what does a renal angiogram do?
- visualize renal blood flow
44
what are the characteristics of renal angiogram?
- Arteries
- Renovascular hypertension
- Identify if a cyst or tumor
- Need IV access
- Enema prior to procedure
45
what is good post-op tx for renal angiogram?
- post-watch for insertion site bleeding
* *distal pulses
- watch creatinine for possible increase with clear on contrast
- IVF to hydrate the kidney
46
what are the complications of a renal angiogram?
hematoma
| local inflammation
47
what are the characteristics of renal biopsy?
- consent
- contraindicated if 1 kidney, bleeding, uncontrolled HTN
- kidney highly vascular (coag studies first)
- percutaneous or surgical
- pre-biopsy (fluoroscopy/UTZ, local, prone, hold breath)
48
what is important for post procedure for a renal biopsy?
- VS - detect bleeding
- report sxs of dysuria/backache
- compare U/O to pre-procedure
- avoid strenuous activity x 2 weeks
49
important to read.
```
¨ Why would concentrated urine be a problem?
¨ Think of the serum OSM (osmolality)
¨ Why does the urine concentrate?
¤ In response to OSM………..
¨ ↑ Serum OSM ↑ ADH = concentrated urine
¨ ↓ Serum OSM ↓ ADH = dilute urine
¨ Hypothalamus is responding to serum OSM
¤ Mostly happens in the loop of Henle
n H20 excreted or NOT
```
50
what are the urine characteristics of acute pyelonephritis?
UA +WBC in urine, bacteria, casts, foul
| odor, cloudy
51
what are the sxs of acute pyelonephritis?
Chills, fever, flank pain, Costavertebral
| angle tenderness
52
what is the common cause of acute pyelonephritis?
reflux from colonized UTI
53
what are the characteristics of chronic pyelonephritis?
- may have negative UA
| - early stage renal disease (ESRD)
54
what are the sxs of chronic pyelonephritis?
- fatigue, polyuria, excessive thirst exacerbation
55
what is the "normal" nursing assessment for a complicated UTI?
- no costovertebral tenderness
- nonpalpable kidney and bladder
- no palpable masses
56
what is the "abnormal" nursing assessment for a complicated UTI?
- costovertebral tenderness
- palpable kidney and bladder tenderness
- abnormal urine (foul odor/bladder tenderness)
- fever/chills
57
what is glomerulonephritis?
a group of diseases that injure the glomeruli
| - other diseases include: nephritis and nephrotic syndrome
58
what are the risk factors/causes for glomerulonephritis?
- acute infection (streptococcus, impetigo, bacterial endocarditis)
- vital infections (HIV, Hep B/C)
- other (illicit drug use)
- immune diseases (lupus, goodpastures syndrome, wegener's disease, polyarteritis nodosa, scleroderma, IgA nepropathy)
59
what are the sxs of acute complicated kidney/glomerular disease?
- facial edema in the AM
- oliguria
- hematruria (rust)
- proteinuria
- abd or flank pain
- sob
- high then normal BP
60
what is acute complicated kidney/glomerular disease?
inflammation of glomeruli
61
what is chronic complicated kidney/glomerular disease?
scarring of glomeruli and tubules
62
what are the sxs of chronic complicated kidney/glomerular disease?
- edema facial/dependent
- HTN
- proteinuria (bubbly/foamy urine)
- frequent nocturia
- signs of kidney failure
63
what is nephrotic syndrome?
increased glomerular membrane permeability
- massive loss of protein (proteinuria)
- leading to loss of plasma albumin
- 1/3 of pts have a systemic disease process that leads to this disease (diabetes, lupus)
64
what is the nursing assessment for nephrotic syndrome?
- peripheral edema
- HTN
- ascites
- anasarca
- massive proteinuria
- hyperlipidemia
- hypoalbuminemia
- thromboembolism (40% of pts can have PE)
65
what is the teaching for nephrotic syndrome?
- meds
- diet
- daily weights
- I + O
- abdominal girths
- skin care
- avoid exposure to infected people
66
what meds are used for nephrotic syndrome?
- steroids
- cyclophosamide
- antihypertensives
- diuretics
- anticoags
- lipid lower agents
67
what diet is important for nephrotic syndrome?
- low sodium (2-3 g/day)
| - moderate protein (1-2 g/kg/day)
68
T/F early in polycystic kidney disease there are no sxs
TRUE
69
how does PKD start out?
it begins as an outpouching of the nephron
** fluid secretion - the lining cells secret fluid into the empty sac which expands the cyst
70
what are the characterisitics of PKD?
- Congenital (hereditary)
- Children have 50% chance of getting from parent
- Fluid filled cavities in the kidney
- 1 of the leading causes of kidney failure
- No cure except Organ transplant
71
what are the nursing assessments for PKD?
- HTN (1st sign; affect 60-70% of pt; half have normal kidney function; 20-30% pedi)
- pain (severe flank pain d/t bleeding of cyst or infection)
- hematuria
- kidney stones (20-30% more in PKD pt)
- mitral valve regurgitation on assessment
72
what are the complications of PKD?
- liver cysts (polycystic liver disease, more likely in women, PKD pt under 30)
- mitral valve prolapse (regurgitation on assessment)
- intracranial aneurysms (5-10% greater risk)
- diverticulosis
- diabetes (after kidney transplant)
73
what are the nursing patient and family teaching for PKD?
- take BP meds
- avoid NSAIDs
- treat UTI
- treat kidney stones
- drink 2 - 3 quarts of H2O a day (pale yellow urine)
- exercise (avoid contact sports, horseback, cross country bike riding)
- nutrition (balanced diet, lower protein diet with declining GFR, low sodium diet (DASH)
74
a patient with PKD is admitted to the MS floor after a total knee surgery. the pt weight is 50kg. what routine post op order is of concern?
- lovenox 60 mg SQ q6hr
