L22 Flashcards
(20 cards)
Renal stones investigations
- Urinalysis:
- Urinary tract infection: cloudy, foul odor, pH>7, presence of RBC, WBC, and leukocyte esterase
- Uric acid calculi: pH<5
- Urea-splitting organisms: pH>7.5 - Urine culture: collect mid-stream urine for bacterial culture
- 24 hrs urine collection:
- test for high level of cystine, calcium, phosphorus, magnesium, oxalate, or creatinine
- second test done after diet restriction on sodium, oxalate and calcium - Kidney, urethra, and bladder radiography
- Renal ultrasound
- Intravenous pyelogram (IVP)
- CT scan with or without contrast medium
Treatment for renal stones
- Manage the acute attack by treating the pain, infection and obstruction
- opioids (relieve renal colic pain)
- alpha-adrenergic blockers, terazosin (relax smooth muscle of ureter for renal stone passage) - Evaluate the cause of stone formation and prevent further development
- adequate hydration, diet sodium restriction
- medication (alter urine pH, prevent excessive urinary excretion of a substance)
- control of infection
Interventional procedures for renal stones
- Ureteroscopy
- Endourologic methods of stone removal
- Extracorporeal shockwave lithotripsy
Health education for renal stones
- Adequate hydration, ~2-3L/day
- For uric acid stones:
- limit protein intake to 1g/kg/day
- may administer allopurinol or sodium bicarbonate - For calcium stones:
- limit diet intake of calcium and sodium (help intestinal absorption of calcium)
- may administer potassium acid phosphate or thiazide to decrease urinary secretion of citrate and pyrophosphate - For oxalate stones:
- limit diet oxalate intake (e.g. chocolate, caffeine)
- administer pyridoxine or cholestyramine 4g 4times daily
- avoid Vitamin C supplement
Hydronephrosis
Blockage of ureter –> backflow of urine to the kidney –> enlarged renal pelvis –> hydronephrosis
Clinical manifestations of hydronephrosis
- Flank pain (between the rib and hip)
- Nausea
- Fever
- Increased urge and frequency of urination
- Incomplete urination
- Kidney failure in severe cases
Treatment of hydronephrosis
Percutaneous nephrostomy tube
1. Monitor urine output, vital signs, sign of infection (UTI, exit site infection)
2. Monitor for any skin irritation at the insertion site; change dressing
3. Keep the drainage bag above floor and below waist; keep drainage tube patency
4. Encourage fluid intake and empty the drainage bag Q8H
5. Well taping to minimize tension and prevent disloadgement
Glomerulonephritis
Inflammation of the glomerular capillaries –> antigen and immune response –> antigen-antibody complex –> leukocyte infiltration of the glomerulus –> thickening of glomerular filtration membrane –> scarring and loss of glomerular filtration membrane –> decreased glomerular filtration rate
Clinic manifestations of glomerulonephritis
- Proteinuria
- Hematuria
- Oliguria (low urine output)
- Sodium and water retention
- Oedema
- Hypertension
- Decreased GFR
- Fatigue
- Azotemia (excessive nitrogen and waste product)
Investigations for glomerulonephritis
- Blood test
- Urinalysis
- Throat swab x C/ST
- Kidney, ureter, bladder CT scan
- Ultrasonography
Complications of glomerulonephritis
- Hypertensive encephalopathy
- Heart failure
- Pulmonary edema
- End stage kidney disease
Nursing management of glomerulonephritis
- Monitor vital signs, I&O, body weight daily, and blood results
- Assess s/s of complications (acute kidney injury)
- Promote bed rest
- Fluid and dietary sodium restriction
- Provide diet high in calorie, low in protein, sodium, potassium, and fluids
- Administer prescribed medications
- antibiotics
- corticosteroids
- diuretics
- antihypertensive - Educate patient to have follow-up examination on chronic kidney disease
Pyelonephritis
Inflammation of the renal parenchyma and collecting system
Clinical manifestations of acute pyelonephritis
- Chills, fever, nausea, vomiting, headache, malaise
- Pyuria (WBC present in urine), with an ammonia or fish odor
- Low back pain / flank pain
- Tenderness in the costovertebral angle
- Urgency, frequency, and painful urination
Investigations of acute pyelonephritis
- USG or CT
- IV pyelogram
- Urine x C/ST
- Blood test
Nursing management of acute pyelonephritis
- Monitor s/s of sepsis and hydration
- Relief of obstruction (surgical or correct the anomaly)
- Encourage fluid intake to achieve 2L urine output per day
- Administer urinary analgesic agents to relieve burning pain
- Administer 2-week of antibiotics
- Women cleanse the peritoneal area from front to back after voiding and defecating
Clinical manifestations of nephrotic syndrome
- Dependent edema of ankles or sacrum
- Periorbital edema
- Hypertension
- Ascites, pleural effusion, swollen external genitalia
- Foamy urine
- Postural hypotension
- Fatigue
- Anorexia, pallor
Investigations of nephrotic syndrome
- Blood test
- Urinalysis
- Kidney biopsy
Complications of nephrotic syndrome
- Infection
- Thromboembolism
- Pulmonary embolism
- Accelerated atherosclerosis
- Acute kidney injury
Nursing management for nephrotic syndrome
- Monitor I&O and daily body weight
- Assess urine for protein
- Restricted sodium intake
- Encourage activity and provide antiembolism stockings
- Administer prescribed medications:
- antibiotics
- lipid-lowering agents
- diuretics
- steroids with antacid or PPI
- 8-week course of corticosteroids
- combination course of prednisone and cyclophosphamide - Moderate protein and low sodium diet
