Genitourinary 1 Flashcards
(73 cards)
1
Q
How much does a bladder typically hold?
A
400-500 ml of urine
2
Q
Osmolality
Definition
A
- The concentration of a solution in terms of osmoles of solutes per kg of solution (by weight)
Osmoles = standard unit of osmotic pressure
3
Q
Osmolarity
Definition
A
- Ratio of solute to water
- The concentration of a solution in terms of osmoles of solutes per liter of solution (by volume)
Osmoles = standard unit of osmotic pressure
4
Q
What are the 9 functions of the kidney?
A
1️⃣ Urine Formation
2️⃣ Control water balance: through absorption/secretion of water, regulated through ADH
3️⃣ Excretion of waste products: secretes urea, creatinine, phosphates, sulfates, uric acid, drug metabolites
4️⃣ Regulation of electrolytes: Absorption/secretion of K+, Na+, Mg, etc.
5️⃣ Regulation of Acid-Base Balance: via bicarbonate, ammonia, acid, ammonium chloride secretion/reabsorption
6️⃣ Regulation of RBC production via erythropoietin
7️⃣ Secretion of prostaglandins –> regulates renal blood flow
8️⃣ Synthesis of Vitamin D; converts Vitamin D to its active form to maintain normal Calcium balance
9️⃣ Autoregulation of BP; vasa recta blood vessels of kidney monitor BP, secretes Renin - activates RAAS
5
Q
Normal Urine Production
A
- 1-2 L / 24 hours
- 0.5mL/kg/hr or avg. or 30 - 50 mL/hour
6
Q
Which substances are normally filtered/reabsorbed at the glomerulus?
A
- Amino acids
- Glucose
7
Q
Normal Glomerular Filtration Rate (GFR)
A
125 mL/min to 200 mL/min
8
Q
What is the best indicator of renal function?
A
Creatinine clearance
As renal function declines, Creatinine clearance declines…. serum creatinine increases
9
Q
When is bladder fullness typically felt?
A
- 150 - 200mL in adults
- discomfort and strong urge happens at 400-500mL
10
Q
Gerontologic considerations for Renal Function
A
- More susceptible to kidney injury d/t structural and functional changes
- Sclerosis of the glomerulus and renal vasculature
- Decreased blood flow
- Decreased GFR
- Altered tubal function and acid-base balance
- Decreased drug clearance
- Decreased stimulation of thirst
- Incomplete emptying of bladder (Urinary stasis)
- Urinary incontinence (15-30% of older adults)
11
Q
Common clinical manifestations of
Kidney Dysfunction
A
- Pain (distention of urinary tract)
- Changes in voiding: frequency, urgency, dysuria, oliguria (< 400ml/day), anuria (< 100ml/day)
- GI symptoms: n/v/d, discomfort and distention
12
Q
Urine Specific Gravity
Things to know
A
Normal 1.005 - 1.025
* When fluid intake decreases ➡️ specific gravity increases
* Pts with kidney disease often have a “fixed” specific gravity
* Causes of ⬇️ decreased specific gravity: Diabetes insipidus, glomerulonephritis, severe renal damage.
* Causes of ⬆️ increased specific gravity: diabetes mellitus, nephritis, fluid deficit
13
Q
Definition of
Nephrosclerosis
A
- Hardening of the renal arteries
- A major cause of CKD and ESRD
Two forms: - Acute Hypertensive: associated with significant and prolonged HTN
- Benign: found in older adults, associated with atherosclerosis, hypertension, and diabetes
14
Q
Clinical Manifestations of
Nephrosclerosis
A
- Increasing Blood Urea Nitrogen (BUN)
- Increasing Creatinine
- Mild proteinuria
15
Q
Risk factors of
Nephrosclerosis
A
- African Americans
- Uncontrolled HTN
- Underlying CKD
- Diabetic nephropathy
16
Q
Treatment of
Nephrosclerosis
A
- ACE Inhibitors
- Other antihypertensives
17
Q
Glomerular Filtration Rate
Diagnostics
A
- < 90 mL/min/1.73 m2 = chronic kidney damage
- < 60 mL/min/1.73 m2 = irreversible kidney damage
18
Q
Definition of
Acute Nephritic/ Glomerulonephritis Syndrome
A
AKA Acute Glomerulonephritis
* Inflammation of the glomerular capillaries
* Kidneys become large, edematous, and congested
19
Q
Clinical Manifestations of
Acute Glomerulonephritis
A
- Hematuria
- Edema
- Pus, cellular, and granular casts in the urine
- Proteinuria
- Azotemia (nitrogenous waste in the blood)
- Cola colored urine
Severe cases: flank pain, headache, malaise
20
Q
Causes of
Acute Glomerulonephritis
A
- Postinfection (HIV, Hep. B)
- Autoimmune
- Idiopathic
21
Q
Complications of
Acute Glomerulonephritis
A
- Hypertensive encephalopathy
- Heart Failure
- Pulmonary edema
22
Q
Diagnostics for
Acute Nephritic/ Glomerulonephritis Syndrome
A
- Electron microscopy, immunofluorescent analysis
- Renal biopsy
- Urinalysis
23
Q
Treatment for
Acute Glomerulonephritis
A
- Corticosteroids
- Manage hypertension (be very careful with diuretics… ACE inhibitors are better)
- Control proteinuria (control protein intake)
- Antibiotics if infection is cause
24
Q
Definition of
Chronic Glomerulonephritis
A
Chronic inflammation of the glomerular capillaries
25
Causes of
**Chronic Glomerulonephritis**
* Repeated acute nephritic syndrome
* Hypertensive nephrosclerosis
* Hyperlipidemia
* Chronic tubulointerstitial injury
* Hemodynamically mediated glomerular sclerosis
26
Clinical Manifestations of
**Chronic Glomerulonephritis**
* Commonly asymptomatic
* Fixed 1.01 specific gravity
* GFR < 50 mL/min
* Loss of weight and strength
* Increased irritability
* Nocturia
27
Treatment of
**Chronic Glomerulonephritis**
* Reduce BP
* Manage symptoms
* Balance electrolytes
* Daily weights
* Treat UTIs promptly
* Avoid NSAIDs *(and other nephrotoxic drugs)*
* dialysis
* diuretics for fluid overload
28
Diagnostics for
**Chronic Glomerulonephritis**
* Urinalysis
* Serum lab tests
* Chest X-Rays
* ECG
* Renal Ultrasound *(decreased renal mass)*
29
Definition of
**Nephrotic Syndrome**
A type of kidney disease characterized by increased glomerular permeability and manifested by massive proteinuria.
30
Clinical Manifestations of
**Nephrotic Syndrome**
* Massive proteinuria *(foamy urine)*
* Hypoalbuminemia
* Diffuse edema *(commonly around eyes, sacrum, ankles, hands, and ascites)*
* High serum cholesterol
* Hyperlipidemia
* Irritability
* Headache
* Malaise
31
Complications of
**Nephrotic Syndrome**
* Infection from deficient immune response
* DVT
* Renal vein thrombosis
* Pulmonary embolism
* Acute Kidney Injury d/t hypovolemia
* Accelerated atherosclerosis
32
Treatment of
**Nephrotic Syndrome**
* Treat the cause
* Diruetic agents for edema
* ACE Inhibitors to reduce proteinuria
* Lipid lowering agents for HLD
* Dietary sodium restriction (< 2 g/day)
33
Diagnostics for
**Nephrotic Syndrome**
* Proteinuria exceeding 3.5g/day (24 hr urine collection)
* Urine protein electrophoresis and immunofixation
* Inc. WBCs in urine
* Needle biopsy of the kidney can confirm diagnosis
34
Definition of
**Polycystic Kidney Disease**
* Genetic disorder characterized by the growth of numerous fluid-filled cysts in the kidneys which destroy the nephrons
35
Clinical Manifestations of
**Polycystic Kidney Disease**
* Increased kidney size
* Hematuria
* Hypertension
* Renal calculi *(kidney stones)*
* Proteinuria
* UTIs
* Abdominal fullness
* Flank pain
36
Treatment of
**Polycystic Kidney Disease**
**No cure**
* Tolvaptan - slows the decrease in kidney function
* Blood pressure control
* Pain management
* Antibiotic agents for infections
* Renal Replacement Therapy once kidneys fail
37
Diagnostics for
**Polycystic Kidney Disease**
* Genetic testing
* Ultrasound imaging
38
Things to know about
**Renal Cancer**
* Accounts for 4.2% of all cancers
* 90% of renal cancers derive from the renal parenchyma = renal cell carcinomas or renal adenocarcinomas
* 5 year survival with local involvement is 92%, regional spread = 62%, distant metastases = 12%
* Over 50% of renal cancers are found incidentally on radiologic studies in pts with no symptoms
39
Risk factors for
**Renal Cancer**
* African American
* Diuretic and antihypertensive use
* Genetics
* HTN
* Male
* Obesity
* Occupational exposure to industrial chemicals, heavy metals, herbicides, or organic solvents
* Smoking
40
Clinical Manifestations of
**Renal Cancer**
***Commonly asymptomatic***
Symptoms in just 10% of patients:
* Hematuria
* Pain
* Mass in flank
* Colicky pain
* Signs of metastasis: unexplained weight loss, fatigue, anemia
41
Medical Management for
**Renal Cancer**
Surgical management:
* nephrectomy *(radical or partial)*
* Renal artery embolization *(occludes tumor's blood supply)*
* Minimally invasive: Radiofrequency ablation, cyroablation, microwave ablation
* Immunotherapy
* Radiation therapy
42
Nursing Management for
**Renal Cancer**
* Post surgical care
* Monitor catheter, drains
* Accurate I&Os
* Pain management
* Monitor for infection
* Monitor for complications: pneumonia hemorrhage, shock, paralytic ileus
* Encourage pt to eat a healthy diet, drink adequate liquids, avoid constipation
* Educational and emotional support
43
Typical causes of
**Renal Trauma**
* Motor vehicle accidents
* Falls
* Assaults
* Athletic injuries
* Gun Shot Wounds
* Stabbing
44
**Blunt Renal Trauma**
Terms of injury
* Contusion *(bruising)*
* Minor Laceration *(superficial disruption)*
* Major laceration *(deep disruption)*
* Vascular Injury *(tears of renal artery or vein)*
45
Clinical Manifestations of
**Renal Trauma**
* Hematuria
* Pain
* Renal Colic
* Mass/swelling in flank
* Ecchymosis
* Lacerations/wounds
* Hypovolemic shock *(severe injury)*
46
Medical Management of
**Renal Trauma**
* Control hemorrhage, pain, and infection
* Restore renal function
* Surgical treatment - vascular injuries
47
Nursing Management of
**Renal Trauma**
* Monitor HgB and Hct
* Monitor UOP
* Encourage fluids
* Monitor BMP
* Assess for hematoma
* Monitor BP
* Pt. Education: report fever, hematuria, inc. flank pain, s/s of dec. kidney function, restrict activities for 1 month
48
Different types of
**Renal Replacement Therapy**
* Hemodialysis (HD)
* Continuous Renal Replacement Therapy (CRRT)
* Peritoneal Dialysis (PD)
* Kidney Transplantation
49
**Hemodialysis**
Definition and what it treats
* Removes toxins, waste products, and excess fluid as blood is filtered through a dialyzer *(through diffusion, osmosis, and ultrafiltration)*
* Used to treat acute and chronic kidney disease
* Does NOT cure or compensate for hormone function loss
50
**Hemodialysis**
Vascular access option for Acute Use
Double lumen large bore catheter in the internal jugular or femoral vein
51
**Hemodialysis**
Vascular access option for Chronic Use
* Arteriovenous fistula (AVF)
* Arteriovenous graft
*Take ~ 3 months to mature before usable*
51
**Hemodialysis**
Complications
* Lipid metabolism disturbance --> causes cardiovascular complications
* Anemia
* Gastric Ulcers
* N/V
* Metallic taste in mouth
* Sleep problems
* Hypotension
52
**Hemodialysis**
Nursing Management
* Monitor dialyzer for clotting, air embolism, inadequate or excessive fluid removal
* Monitor for hypotension, cramping, vomiting, blood leaks, access complications
* Protect vascular access
53
**Continuous Renal Replacement Therapy**
Vascular Access option
Double Lumen venous catheter, large bore
54
When is **CRRT** used?
* When patient is clinically unstable for HD *(unable to tolerate rapid change in fluid volume)*
* Monitored closely in the ICU
55
**Peritoneal Dialysis**
Definition
Uses the lining of the abdomen as a filter to remove waste products and excess fluids
56
**Peritoneal Dialysis**
Complications
* Risk of peritonitis
* Risk of abdominal infections
* Hyperglycemia
* Bowel or bladder perforation
57
When is **PD** used?
* Treatment of choice for patient with kidney disease who is unable or unwilling to undergo HD or kidney transplantation
* Likely candidates: pts. with diabetes, cardiovascular disease, older adults
58
What is **dialysate**?
The electrolyte solution that circulates through the dialyzer or through the peritoneal membrane to remove toxins from the blood
59
Concerns for
**AV Fistula/AV Graft**
* Limb restriction: signs in room, bracelet on patient
* Monitor for signs of infection
* Assess for bruit and thrill
* Pt. education: not to let anyone use that arm for IVs, BP, venipuncture, etc.
60
**Prerenal**
Causes of AKI
***Diminshed renal blood flow***
* Hypovolemia
* Reduced Cardiac Output
* Vasodilation
61
**Intrarenal**
Causes of AKI
***Damage to the renal parenchyma***
* Prolonged renal ischemia
* Nephrotoxic agents
* Infectious processes
62
**Postrenal**
Causes of AKI
Urinary tract obstruction
63
Collaborative Complications associated with Renal Disease
* Hyperkalemia
* Pericarditis
* Pericardial effusion
* Pericardial tamponade
* Hypertension
* Anemia *(lower production of erythropoietin)*
* Bone disease and metastatic calcifications *(related to vit. D synthesis)*
64
**Treatment of choice for pts with End Stage Renal Disease (ESRD)**
**Kidney Transplant**
65
**Kidney Transplantation**
Sources
* Voluntary donors *(Living or deceased)*
* Paired exchanges/chains
66
**Kidney Transplantation**
Donor Contraindications
* Hypertension
* Diabetes
67
**Kidney Transplantation**
Recipient Contraindications
* Malignancy
* Active or chronic infection
* Severe irreversible disease
* Class II Obesity
* Current substance use disorder
* Active pyschiatric disease
* History of nonadherence to treatment regimens
* Inability to give informed consent
68
How long does a kidney last from a living donor?
~ 15 - 20 years
69
How long does a kidney last from a deceased donor?
~ 10 - 15 years
70
How long do kidney recipients need to be on immunosuppressive agents?
Lifetime
71
Signs of kidney transplant rejection
* Oliguria
* Edema
* Fever
* Increasing Blood Pressure
* Weight gain
* Swelling or tenderness over the transplanted kidney or graft
72
**Is the following statement true or false? A 24-hour urine collection is the primary test of renal clearance.**
**True**
**Rationale:**
A 24 hour collection of urine is the primary test of renal clearance used to evaluate how well the kidney performs this important excretory function. Renal clearance depends on several factors: How quickly the substance is filtered across the glomerulus, how much of the substance is reabsorbed along the tubules, and how much of the substance is secreted into the tubules
