Kidney/Urinary Flashcards
(148 cards)
1
Q
Phenazopyridine used for
A
UTI pain
2
Q
Lower UTI (areas)
A
○ Cystitis (bladder)
○ Prostatitis (prostate)
○ Urethritis (urethra)
3
Q
Upper UTI/Pyelonephritis (types)
A
○ Acute and chronic
○ Renal abscess and perianal abscess
4
Q
S&S of a lower UTI
A
Burning sensation during urination Urinary frequency Urgency (>Q3h) Nocturia Pelvic pain/back pain Hematuria Incontinence & delirium in older adults
5
Q
S/S of upper UTI
A
Chills Fever Leukocytosis Bacteriuria Pyuria Low back pain Flank pain Nausea and vomiting Headache Malaise Painful urination Physical examination reveals pain and tenderness in the area of the costovertebral angle **In addition, symptoms of lower urinary tract involvement, such as urgency and frequency, are common.
6
Q
UTIs in older men
A
● The antibacterial activity of prostatic secretions that protect men from bacterial colonization of the urethra and bladder decreases with aging.
● The use of catheterization or cystoscopy in evaluation or treatment for prostatic hyperplasia or carcinoma, strictures of the urethra, and neuropathic bladder
● Confusion, dementia, or bowel or bladder incontinence.
● Most common cause of recurrent UTIs in older males is chronic bacterial prostatitis. Resection of the prostate gland may help reduce its incidence
7
Q
UTIs in older women
A
● Women often have incomplete emptying of the bladder and urinary stasis.
● Due to the absence of estrogen, postmenopausal women are susceptible to colonization and increased adherence of bacteria to the vagina and urethra.
→ Oral or topical estrogen can be used to decrease incidence
8
Q
What are renal calculi?
A
Formation of stones when concentration of calcium oxalate, calcium phosphate and uric acid increase.
Vary in size
9
Q
Risk factors of renal calculi
A
Infection
urinary stasis
Immobility (slows kidney drainage)
10
Q
Causes of renal calculi
A
Hyperparathyroidism Renal tubular acidosis Cancers (e.g., leukemia, multiple myeloma) Dehydration Granulomatous diseases (e.g., sarcoidosis, tuberculosis), which may cause increased vitamin D production by the granulomatous tissue Excessive intake of vitamin D Excessive intake of milk and alkali Myeloproliferative diseases such
11
Q
Clinical manifestations of renal calculi
A
Depends on the location and presence of obstruction, infection or edema.
Obstruction = pressure Infection = fever/chills Edema = pain
12
Q
Assessment and diagnosis of renal calculi
A
Dietary/medication history
Non contract CTBlood chemistry
24-hour urine test to measure calcium, uric acid, creatinine, sodium, pH, and total volume
Chemical analysis of stone
13
Q
treatment for renal calculi
A
Goal is to eradicate the stone, determine the stone type, prevent nephron destruction, control infection and relieve obstruction
opioids, antispasmodics, NSAIDS, hot baths,, ureteroscopy, ECP shock water lithotripsy, percutaneous nephrolithotomy,
14
Q
education of renal calculi
A
● Signs and symptoms to report ● Follow-up care ● Urine pH monitoring ● Measures to prevent recurrent stones ● Importance of fluid intake ● Dietary education Medication education as needed
15
Q
Stomas should be
A
pink and moist
16
Q
calcium stones
A
In the past, it has been recommended to restrict calcium in their diet. However, evidence has questioned this practice, except for patients with type II absorptive hypercalciuria (half of all patients with calcium stones), in whom stones are clearly the result of excess dietary calcium. Liberal fluid intake is encouraged. Medications such as ammonium chloride may be used, and if increased parathormone production (resulting in increased serum calcium levels in blood and urine) is a factor in the formation of stones, therapy with thiazide diuretics may be beneficial in reducing the calcium loss in the urine and lowering the elevated parathormone levels. Limit animal based protein and sodium intake. In calcium oxalate stone - limit foods high in oxalate.
17
Q
Uric acid stones
A
the patient is placed on a low-purine diet to reduce the excretion of uric acid in the urine. Foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats) are avoided, and other proteins may be limited. Allopurinol (Zyloprim) may be prescribed to reduce serum uric acid levels and urinary uric acid excretion.
18
Q
Ileal conduit
A
In the immediate postoperative period, urine volumes are monitored hourly. A urine output below 0.5 mL/kg/hr may indicate dehydration or an obstruction in the ileal conduit, with possible backflow or leakage from the ureteroileal anastomosis. A catheter may be inserted through the urinary conduit to monitor the patient for possible stasis or residual urine from a constricted stoma. The stoma is inspected frequently for color and viability. The patient and family are educated about how to apply and change the appliance so that they are comfortable carrying out the procedure and can do so proficiently. An average collecting appliance lasts 3 to 7 days before leakage occurs.
19
Q
where is ADH manufactured?
A
hypothalamus
20
Q
where is ADH stored?
A
posterior pituitary
21
Q
functions of ADH
A
maintaining the osmotic pressure of the cells by controlling the retention or excretion of water by the kidneys and by regulating blood volume.
22
Q
action of ADH
A
constricts blood vessels and reduces the excretion of urine by stimulating water resorption back into the bloodstream therefore increasing blood pressure
23
Q
What is the function of RASS?
A
manages blood pressure by increasing low blood pressure and blood volume
24
Q
What kind of cells release renin?
A
JG cells
25
what does renin do?
activates ANGIOTENSINOGEN in the liver and turns it into ANGIOTENSIN I
26
Where is ACE and what does it do?
in lungs and kidneys converts ANGIOTENSIN I to ANGIOTENSIN II
27
What happens when the adrenal cortex is stimulated to release aldosterone
INCREASES sodium/water reabsorption, DECREASING urine output and conserving fluid to maintain blood pressure.
Stimulates pituitary gland to release ADH (antidiuretic hormone)
28
what does ADH do?
Keeps in H20 and sodium to increase volume of blood
29
bladder capacity
300-500mL
30
overstretching of the bladder can lead to?
neurogenic bladder
31
urine specific gravity (lab value):
1.010-1.025
32
Urine pH (lab value):
4.5-8
33
anion gap (lab value):
8-12
34
Creatinine (lab value):
0.7-1.4
35
BUN (lab value):
10-20
36
Sodium (lab value):
135-145
37
potassium (lab value):
3.5-5
38
chloride (lab value):
98-106
39
bicarb (lab value):
24-31
40
pH (lab value):
7.35-7.45
41
CO2 (lab value):
35-45
42
glucose (lab value):
70-110
43
GRF (lab value):
125-200mL/min
44
BUN to creatinine ratio:
12-20 (15 optimal)
45
low BUN to creatinine ration means:
acute tubular necrosis, low protein intake, starvation, severe liver disease
46
High Bun to creatinine ratio means:
Pre renal disease, high protein intake, after GI bleed
47
high BUN to creatinine ration WITH raised creatine means:
post renal obstruction, pre renal uremia with renal disease
48
Why do we do 24 hour urine collections?
primary test of renal clearance used to evaluate how well the kidney performs this important excretory function.
49
How to do a 24 hour urine collection
● The client is initially instructed to void and discard the urine.
● The collection bottle is marked with the time the client voided.
● Thereafter, all the urine is collected for the entire 24 hours.
● The last urine is voided at the same time the test originally began.
● KEEP PEE ON ICE DURING COLLECTION
Midway through the collection, the serum creatinine level is measured.
50
Which drugs are nephrotoxic?
```
Vancomycin
Amphotericin B
Metformin
NSAID'S
Contrast agents!!
```
51
Major causes of chronic kidney disease:
```
○ Diabetes mellitus
○ Hypertension
○ Chronic glomerulonephritis
○ Pyelonephritis or other infections
○ Hereditary lesions
○ Vascular disorders
○ Medications or toxic agents
```
52
Required labs to diagnose CKD
GFR and Creatinine clearance
53
Persistent kidney injury
complete loss of kidney function >4 weeks
54
Acute kidney Injury RISK (GFR criteria):
GFR decrease >25%, creatinine increased 1.5x baseline and .5mL/kg/6 hours
55
Acute Kidney injury (GFR criteria):
creatinine increased 2x baseline, GFR decrease >50%, 0.5mL/kg/hr for 12 hours
56
Acute Kidney Failure:
increased creatinine 3x from baseline, GFR decreased >75%, <0.3mL/kg/hr for 24 hours OR anuria for 12 hours
57
End Stage Kidney Disease
ESKD >3 months
58
Kidneys and metformin:
increased risk for acute kidney injury and lactic acidosis with the use of iodinated contrast material for diagnostic studies; this drug should be stopped 48 hours prior to and for 48 hours after the use of contrast agent or until kidney function is evaluated and normal.
59
kidney disorder diet:
Low sodium
Low protein
High carbs
Increased water intake
60
describe glomerulonephritis?
Antigen-antibody complexes form in the blood and become trapped in the glomerular capillaries (the filtering portion of the kidney), inducing an inflammatory response.
61
What is Glomerulonephritis
Inflammation of the glomerular capillaries
62
Pathophysiology of glomerulonephritis:
Streptococcus infection puts patient at HIGH RISK
May be due to repeated episodes of acute nephritic syndrome, hypertensive nephrosclerosis, hyperlipidemia, chronic tubulointerstitial injury, or hemodynamically mediated glomerular sclerosis.
```
Kidneys are reduced to as little as ⅕ their normal size
Scar tissue distorts cortex
Rough and irregular surface of kidney
Scarring of glomeruli and tubules
Branches of renal arteries thicken
```
63
clinical manifestations of glomerulonephritis:
May have no symptoms with severe disease and might be discovered with hypertension or elevated BUN/creatinine levels
Peripheral neuropathy with diminished deep tendon reflexes, neurosensory changes and pericarditis can occur late in the disease
64
most patients with glomerulonephritis report:
```
Loss of weight
Loss of strength
Increasing irritability
Nocturia
Headaches
Dizziness
GI disturbances
```
65
Assessments/Diagnostics of glomerulonephritis:
Urinalysis to check specific gravity, protein and check for urinary casts
GFR
Chest x-ray (cardiac enlargement/pulmonary edema)
ECG (electrolyte abnormalities may show peaked T waves)
CT/MRI to show size of cortex
66
Treatment of glomerulonephritis
Management of symptoms
```
Reduce BP with sodium/water restrictions and antihypertensives
Diuretics
Monitor daily weights
Dialysis
Plasmapheresis
```
67
Polycystic Kidney Disease pathophysiology:
Characterized by the growth of numerous fluid-filled cysts in the kidneys, which destroy the nephrons.
**Can also cause cysts in the liver and problems in other areas, such as blood vessels in the
68
Polycystic kidney disease as a genetic disease:
Autosomal dominant (most common)
Symptoms usually develop between 30-40 years of age
** half of patients develop CKD stage 5 and require renal replacement therapy
Autosomal recessive
rare inherited form
Symptoms begin in the earliest months of life or in utero.
69
clinical manifestations of polycystic kidney disease:
Loss of renal function as cysts grow -
```
Hematuria
Polyuria (excessive urine production)
Hypertension
Development of renal calculi
Associated UTIs
Proteinuria
Abdominal fullness
Flank pain
```
70
Assessments/diagnostics of polycystic kidney disease:
Family history
Palpation of abdomen (enlarged kidneys)
Ultrasound of kidneys
71
treatments of polycystic kidney disease:
No cure
Supportive measures
```
Blood pressure control
Pain control
Antibiotics
Renal replacement therapy
Kidney donation
```
72
pathophysiology of nephrotic syndrome:
Characterized by increased glomerular permeability and is manifested by massive proteinuria
73
compilations of nephrotic syndrome:
Infection (due to a deficient immune response)
Thromboembolism (especially of the renal vein)
Pulmonary embolism
AKI (due to hypovolemia)
Accelerated atherosclerosis (due to hyperlipidemia).
74
clinical manifestations of nephrotic syndrome:
```
PENTAD
Edema
soft/pitting
Periorbital
Dependant areas
Proteinuria
Dyslipidemia
Lipiduria
Hypoalbuminemia
Increased risk of infection (loss of immunoglobulin/antibodies)
Ascites
Irritability
Headache
Malaise
```
75
assessment/diagnostics of nephrotic syndrome:
Proteinuria >3.5g/day
Hallmark sign
Increased WBC in urine
Needle biopsy to confirm diagnosis
76
treatment of nephrotic syndrome:
Treatment of underlying disease
Diuretics
ACE inhibitors
Lipid lowering agents
77
dialysis techniques:
Hemodialysis
CRRT
Peritoneal dialysis
78
Hemodialysis
prevents death but does not cure kidney disease and does not compensate for the loss of endocrine or metabolic activities of the kidneys
79
when is hemodialysis used?
for patients who are acutely ill and require short-term dialysis for days to weeks until kidney function resumes and for patients with advanced CKD and ESKD who require long-term or permanent renal replacement therapy
80
objective of hemodialysis
to extract toxic nitrogenous substances from the blood and to remove excess fluid.
81
how often do patients get dialysis?
Most patients will undergo dialysis anywhere from 3-5x per week, but it is decided by their nephrologist and their current needs
82
where do patients get hemodialysis?
can be performed at home or at a dialysis center.
83
how does hemodialysis work?
blood, laden with toxins and nitrogenous wastes, is diverted from the patient to a machine via the use of a blood pump to the dialyzer, where toxins are filtered from the blood and the blood is returned to the patient.
84
using a dialysis catheter for temporary vascular access for hemodialysis:
Immediate access to the patient's circulation for acute hemodialysis is achieved by inserting a double-lumen, non-cuffed, large-bore catheter into the subclavian, internal jugular, or femoral vein by the physician
85
using an arteriovenous fistula for permanent vascular access for hemodialysis
- (AVF) that is created surgically (usually in the forearm) by joining (anastomosing) an artery to a vein, either side to side or end to side. Needles are inserted into the vessel to obtain blood flow adequate to pass through the dialyzer.
86
using a arteriovenous graft for permanent vascular access for hemodialysis
- Can be created by subcutaneously interposing a biologic, semibiologic, or synthetic graft material between an artery and vein.
- Used in patients with compromised vascular systems whose vessels may not be suitable for an AVF
87
Precautions of fistulas and/or grafts:
Protect the fistula/graft arm (LIMB RESTRICTION)
No blood pressures
No blood draws
No PIV
Make sure to ask about the fistula/graft in report
Assess the patency of the fistula at the beginning of the shift
Bruit (swoosh sound)
Thrill (vibration to touch)
Signs of infection
Call provider with concerns ASAP
Hold Cardiovascular medications prior to dialysis - gets filtered out.
88
Peritoneal dialysis is the treatment of choice for patients with
Patients with kidney disease who are unable or unwilling to undergo hemodialysis or kidney transplantation.
- Patients who are susceptible to the rapid fluid, electrolyte, and metabolic changes that occur during hemodialysis experience fewer of these problems with the slower rate of PD.
- Patients at risk for systemic effects from heparin
89
complications of peritoneal dialysis:
Peritonitis
- Common and serious
- First sign is cloudy dialysate fluid
- Treated with antibiotics (10-14 days) and large amounts of protein into peritoneum
Leakage
- Usually stops if dialysis is withheld for several days and is allows it to heal
Bleeding
- Usually seen in menstruating women
- Common in first few exchanges after a new catheter insertion
90
What is peritoneal dialysis and how does it work?
Peritoneal membrane that covers the abdominal organs and lines the abdominal wall serves as the semipermeable membrane. A sterile dextrose dialysate fluid is introduced into the peritoneal cavity through an abdominal catheter at established intervals.
Once the sterile solution is in the peritoneal cavity, uremic toxins such as urea and creatinine begin to be cleared from the blood. Diffusion and osmosis occur as waste products move from an area of higher concentration (the bloodstream) to an area of lesser concentration (the dialysate fluid) through a semipermeable membrane (the peritoneum).
91
Primary causes of respiratory acidosis:
Basically anything that prevents a person from expelling CO2 or impairs gas exchange
- Respiratory depression/HYPOventilation
- Obstruction (COPD/Asthma)
- Pneumonia
92
Primary causes of metabolic acidosis:
direct loss of bicarbonate, as in diarrhea, lower intestinal fistulas, ureterostomies, and the use of diuretics; early renal insufficiency; excessive administration of chloride; and the administration of parenteral nutrition without bicarbonate or bicarbonate-producing solutes
93
primary causes of respiratory alkalosis:
hyperventilation, excessive "blowing off" of CO2
94
primary causes of metabolic alkalosis:
Excessive alkali ingestion from antacids containing bicarbonate or from the use of sodium bicarbonate during cardiopulmonary resuscitation can also cause metabolic, vomiting, NG suctioning
95
Blood gas normal values:
pH 7.35-7.45
PO2 80-100
CO2 35-45
HCO3- 22-28
96
if the CO2 is out of range, it is
respiratory
97
if the HCO3 is out of range, it is
metabolic
98
ISOTONIC SOLUTION: 0.9% NaCl (Normal Saline)
Mainly used for fluid resuscitation. Used in HYPOnatremia *can cause acidosis in large quantities
99
ISOTONIC SOLUTION: Dextrose 5% in water (D5W)
AKA sugar water → used in HYPERnatremia
100
ISOTONIC SOLUTION: D5 ½ NS
Good maintenance fluid, often used in surgery. Can be used in HYPERnatremia. (Can also be classified as hypotonic)
101
ISOTONIC SOLUTION: Lactated Ringers
used during surgery and resuscitation as pH doesn't change.
102
HYPOTONIC SOLUTION: 0.45% Sodium Chloride (0.45% NaCl) (NaCl 1/2 NS)
used in HYPERnatremia
103
HYPERTONIC SOLUTION: 3% sodium chloride (3% NaCl)
used in HYPOnatremia
104
What is an isotonic solution?
status quo, no change to fluid balance
105
What is a hypotonic solution?
few solutes in solution, water from solution drawn into the cells
106
What is a hypertonic solution?
lots of solutes in solution, drawing water out of the cells (think about why sea water dehydrates you, it's because it's a hypertonic solution)
107
Major symptoms of Hyponatremia:
depressed and depleted, tachycardia, weak pulses, seizure and coma
108
major symptoms of hypernatremia:
edema, bloating, thirst, DRY TONGUE, N/V, increase muscle tone
109
Major signs of hypokalemia:
paralyzed intestines, hypoactive bowel sounds, constipation, abdominal distention, ST depression
110
treatment protocol for hyperkalemia
Insulin, but be careful of hypoglycemia (can use dextrose concurrently)
Kayexalate
Dialysis
111
major signs of hyperkalemia
hypotension, bradycardia, tight muscles, hyperactive bowel sounds, diarrhea
112
Hyperkalemia ECG:
tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression
113
hypokalemia ECG:
flattened T waves, prominent U waves, ST depression, prolonged PR interval
114
pyuria:
white blood cells in urine
115
dysuria:
painful urination
116
diuresis:
increased urine volume
117
nocturia:
excessive urination at night
118
anuria:
decreased urine output of less than 50 mL in 24 hours
119
oliguria
urine output less than 0.5 mL/kg/hr
120
Pre-renal:
disrupted blood flow to the kidney
121
Intra-renal:
damage to the renal tissue
122
post-renal:
disrupted urine flow
123
chronic kidney diseases are?
irreversible and progress to renal failure
124
the most common kind of acute kidney injury is:
hypovolemia
125
most post-renal AKIs are caused by:
back flow and buildup of urine into the kidneys
126
common causes of CKD in older adults:
hypertension and diabetes mellitus
127
how much function do the kidneys have in Stage 1 kidney disease?
90% or >
128
how much function do the kidneys have in stage 5 kidney disease?
<15%
129
you cannot live without dialysis after your kidneys are at what % of functionality?
15%
130
most prominent manifestation of CKD?
Hyperkalemia
131
What is the leading cause of kidney failure in the US?
polycystic kidney disease
132
renal cancer is seen in more ____?
more ____?
| men
133
occupation exposure to petroleum, asbestos, and heavy metals are associated with:
renal cancer
134
Can you go home with a hemodialysis catheter?
no
135
What is the intracellular space?
fluid in the cells, makes up 2/3 of body fluid
primarily in skeletal muscle mass
136
what is extracellular space?
fluid outside of the cells
137
what are the three ECF spaces?
intravascular space- blood vessels (6L)
interstitial space- space between the cells (11-12L)
transcellular space- smallest compartment
138
what is oncotic pressure associated with?
proteins
139
What is third spacing?
large amounts of fluid shifting from intravascular to interstitial spaces with trauma, inflammation and sepsis
140
what amount of water do we gain and lose a day for balance?
2500mL
141
what is hydrostatic pressure?
pressure exerted by blood pressure on the walls of a blood pressure
142
what is osmotic pressure?
pressure exerted by the plasma protein
143
what is the most reliable indicator of urine concentration?
urine osmolality
144
what is the purpose of acid-base balance?
to determine how much hydrogen is in the vascular system
145
What happens when our pH is imbalanced?
the medulla tells the lungs to adjust the RR rate to blow off or retain CO2
146
In acidosis, the RR:
increases (to improve by blowing off CO2)
147
in alkalosis, the RR:
decreases (to improve by retaining CO2)
148
What is the anion gap?
refers to the difference between the sum of all measured positively charged electrolytes (cations) and the sum of all negatively charged electrolytes (anions) in blood
