care 2 Flashcards
m (54 cards)
1
Q
What are the functions of the kidneys when working normally?
A
Blood pressure regulation
The kidneys play a crucial role in maintaining blood pressure through fluid balance and electrolyte regulation.
2
Q
What laboratory tests are used to assess kidney function?
A
- Specific gravity
- Urine osmolality
- 24 hour creatinine clearance
- Serum creatinine
- Urea nitrogen (BUN)
These tests help evaluate how well the kidneys are filtering waste and regulating fluids.
3
Q
Define azotemia.
A
Increased amounts of nitrogen in the blood
4
Q
What is proteinuria?
A
Increased excretion of protein in the urine (>150mg/24hr)
5
Q
What does pyuria indicate?
A
Clouded urine due to pus formation in the urinary tract
6
Q
What is oliguria?
A
Urinary output of < 400 cc per day
7
Q
Define anuria.
A
Decrease of urine volume to less than 200 ml per 24 hr
8
Q
What is pyelonephritis?
A
A bacterial infection of the upper urinary tract, affecting the kidneys and ureters
9
Q
What are the clinical manifestations of acute pyelonephritis?
A
- Chills
- Fever
- Nausea
- Vomiting
- Abdominal pain
- Diarrhea
- Hematuria
- Flank pain
- CVA tenderness
- Leukocytosis
- Bacteria and WBCs in urine
- UTI symptoms (urgency & frequency)
10
Q
What differentiates chronic pyelonephritis from acute?
A
Chronic pyelonephritis shows no symptoms of infection unless there is an acute exacerbation
11
Q
What are the diagnostic methods for acute pyelonephritis?
A
- Urine culture & sensitivity
- Ultrasound
- CT Scan
- IV pyelogram
12
Q
What is the management for acute pyelonephritis?
A
- High risk for bacteremia
- Antibiotics (parenteral for 24-48 hours)
- Hydration (3 L/day)
- Monitor urinary output
- Pain management
13
Q
What is hydronephrosis?
A
Distension of the kidney due to urine accumulation from obstruction
14
Q
What are the clinical manifestations of hydronephrosis?
A
- May be asymptomatic
- Pain
- Azotemia
- Oliguria or anuria
- Infection symptoms
15
Q
What is the nursing management for a nephrostomy tube?
A
- Observe for bleeding, stones, fistula formation, & infection
- Never clamp off the tube
- Irrigation only by MD with sterile saline
- Encourage fluid intake
16
Q
What is glomerulonephritis?
A
An autoimmune disorder characterized by inflammation of the glomerular capillaries
17
Q
What are the signs and symptoms of acute glomerulonephritis?
A
- Hematuria
- Edema
- Azotemia
- Decreased urine volume
- Abd pain
- Fever
- Cough
- SOB
- Proteinuria
18
Q
What underlying infection can precede glomerulonephritis?
A
Group A beta-hemolytic streptococcal infection of the throat
19
Q
What is nephrotic syndrome?
A
A chronic kidney disease characterized by increased glomerular permeability resulting in massive proteinuria
20
Q
What are the major complications of nephrotic syndrome?
A
- Infection
- Thromboembolism
- Acute renal failure
- Chronic renal failure
- Hypertension
- Hypercholesterolemia
- Elevated triglycerides
21
Q
What dietary restrictions are recommended for calcium oxalate stones?
A
- Reducing sodium (no more than 2.3 g/day)
- Reducing animal protein
- Adequate calcium intake
- Avoiding high oxalate foods
22
Q
What are the three types of acute kidney injury etiologies?
A
- Prerenal
- Intrarenal
- Postrenal
23
Q
What causes prerenal acute kidney injury?
A
Factors external to the kidneys that reduce renal blood flow
24
Q
What can cause intrarenal acute kidney injury?
A
Conditions that directly damage kidney tissue, such as nephrotoxins or prolonged ischemia
25
What is the main cause of postrenal acute kidney injury?
Obstruction after the kidneys, such as in the ureter or bladder
26
What are the causes of prerenal acute kidney injury?
Factors external to the kidneys that reduce renal blood flow, such as severe dehydration, heart failure, and decreased cardiac output.
## Footnote
These factors decrease glomerular filtration rate and can lead to oliguria.
27
What are the main causes of intrarenal acute kidney injury?
Conditions that cause direct damage to kidney tissue, including prolonged ischemia, nephrotoxins, hemoglobin from hemolyzed RBCs, and myoglobin from necrotic muscle cells.
## Footnote
Intrarenal injury results in cellular damage and impaired kidney function.
28
List some causes of postrenal acute kidney injury.
* Benign prostatic hyperplasia
* Prostate cancer
* Calculi
* Trauma
* Extrarenal tumors
## Footnote
These factors obstruct urine flow and can lead to kidney damage.
29
What is the urinary output characteristic of the oliguric phase?
Less than 400 mL/day.
## Footnote
This phase occurs within 1 to 7 days after injury and lasts 10 to 14 days.
30
What are the signs of fluid volume overload during the oliguric phase?
* Distended neck veins
* Bounding pulse
* Edema
* Hypertension
## Footnote
Fluid overload can lead to heart failure, pulmonary edema, and effusions.
31
What metabolic changes occur in the oliguric phase of kidney injury?
Metabolic acidosis with decreased serum bicarbonate levels and Kussmaul respirations.
## Footnote
These changes indicate severe acidosis and can affect respiratory function.
32
In the diuretic phase of acute kidney injury, what is the expected daily urine output?
1 to 3 L, which may reach 5 L or more.
## Footnote
Monitoring is essential for hyponatremia, hypokalemia, and dehydration during this phase.
33
What dietary restriction is often recommended for patients with chronic kidney disease?
Phosphate restriction; avoid foods high in phosphate, like dairy.
## Footnote
This is important to manage mineral and bone metabolism disorders.
34
What are the signs and symptoms of uremia?
Includes nausea, vomiting, lethargy, fatigue, and impaired thought processes.
## Footnote
Uremia occurs when GFR is 10 mL/min or lower and can lead to severe complications.
35
What is the most serious electrolyte disorder in kidney disease?
Hyperkalemia.
## Footnote
It occurs due to the inability of kidneys to excrete potassium and can lead to fatal dysrhythmias.
36
What nursing diagnosis is critical for patients with chronic kidney disease?
Risk for infection related to invasive lines and altered immune responses.
## Footnote
This risk is heightened by uremic toxins and kidney failure.
37
What is the purpose of continuous bladder irrigation after a prostatectomy?
To prevent and manage blood clots that can obstruct the urinary catheter.
## Footnote
This helps avoid complications like bladder spasms and urinary retention.
38
What should a nurse monitor in a patient undergoing hemodialysis?
* Vital signs every 30 to 60 minutes
* Weight before and after treatment
* Signs of complications like hypotension and bleeding
## Footnote
Close monitoring is essential to ensure patient safety during dialysis.
39
True or False: Uremic pruritus is a common symptom in patients with end-stage renal disease.
True.
## Footnote
It affects about 20%-50% of patients and can lead to significant discomfort.
40
What are the expected outcomes of peritoneal dialysis?
Effective removal of waste products and excess fluid, improved electrolyte balance.
## Footnote
It requires careful monitoring for complications such as infection and hernias.
41
Fill in the blank: The syndrome that incorporates all signs and symptoms seen in various systems throughout the body due to severe kidney dysfunction is called _______.
Uremia.
## Footnote
It is often associated with very low GFR levels.
42
What are the primary nursing interventions for a patient with impaired urinary elimination after a prostatectomy?
* Assess urine output
* Monitor for urinary retention
* Encourage fluid intake
* Educate on perineal exercises
## Footnote
These interventions help facilitate recovery and manage urinary function.
43
What is the purpose of continuous bladder irrigation?
To prevent and manage blood clots that can obstruct the urinary catheter and lead to complications like bladder spasm, urinary retention, and potential damage to the kidneys
## Footnote
Continuous bladder irrigation is often used post-operatively after procedures like TURP to ensure free flow of urine and reduce complications.
44
What types of discomfort are frequently voiced after a TURP?
Bladder spasms
## Footnote
After TURP, patients may experience bladder spasms along with pale pink urine due to irrigation.
45
What are the signs and symptoms of lupus?
* Malar rash (butterfly-shaped) 90%
* Discoid rash 40%
* Sensitivity to sunlight (photosensitivity) 40%
* Oral or nasal ulcers
* Non-erosive arthritis
* Heart or lung involvement (pleurisy, pericarditis)
* Kidney (glomerulonephritis)
* Immune system or CNS problems
* Anemia
* ANA present
* Neurologic issues
## Footnote
Lupus can present with a wide variety of symptoms affecting multiple systems.
46
What nursing management strategies are recommended for mild lupus symptoms?
* Bedrest
* Midafternoon naps
* Avoidance of fatigue
* Sun protection
* Topical steroids for isolated skin lesions
* NSAIDs for arthritis, arthralgia's, fever
* Hydroxychloroquine for rashes or joint symptoms not responsive to NSAIDs
* Glucocorticoids for life-threatening manifestations
* Proper nutrition
* Energy conservation & pacing techniques
* Support groups/counseling
## Footnote
Nursing management focuses on symptom relief and prevention of exacerbations.
47
What is the leading cause of death related to lupus?
Renal failure
## Footnote
Lupus nephritis can lead to serious kidney complications, including renal failure.
48
What are the signs and symptoms of gout?
* Joints: great toe (podagra), wrists, knees, ankles, metatarsal area of foot, olecranon bursa
* Sudden, excruciating pain
* Low grade fever
## Footnote
Gout attacks are characterized by intense pain, often occurring at night.
49
What triggers can lead to a gout attack?
* Surgery
* Trauma
* Alcohol (ETOH)
* Systemic infection
## Footnote
These triggers can precipitate acute episodes of gout.
50
What dietary issues should be managed in patients with gout?
* Maintain ideal body weight
* Eat more complex carbohydrates
* Maintain good hydration
* Cut back on saturated fats from red meat, fatty poultry, and high fat dairy products
* Focus on lean meat and poultry, beans
* Include Vitamin C, coffee, and cherries to help reduce attacks
## Footnote
Dietary management plays a crucial role in controlling gout symptoms.
51
What foods should be avoided in patients with gout?
* Organ and glandular meats
* Red meat
* Seafood (anchovies, sardines, tuna)
* Beer and distilled liquors
* Sugary foods and beverages
## Footnote
High purine foods can exacerbate gout symptoms.
52
What urine uric acid level indicates a potential problem in gout management?
Above 6
## Footnote
Monitoring uric acid levels is essential for managing gout and preventing flares.
53
What are the goals of therapy in managing gout?
Lower uric acid
## Footnote
The primary goal in treating gout is to reduce uric acid levels in the body.
54
What is a recommended sun protection strategy for lupus patients?
SPF >15; minimal sun exposure 11am-4pm
## Footnote
Sun protection is vital for lupus patients due to photosensitivity.
