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MedSurg > Lecture 5.2 - Renal > Flashcards

Lecture 5.2 - Renal Flashcards

1
Q

What are some predisposing factors to a UTI?

A

–> Renal scarring
–> Compression during pregnancy
–> Urinary retention
–> Caliculi (stones)
–> Diabetes

Concerning in older population.

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2
Q

What populations are UTIs most common in?

A

Older men d/t enlarged prostate
Also common in nurses

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3
Q

What are some S/S of UTI?

A

–> Dysuria (painful)
–> Frequency (<2h)
–> Urgency
–> Suprapubic discomfort or pressure

–> Chills/fever and lower back pain might indicate upper UTI.

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4
Q

What might the urine of someone with a UTI look like?

A

Urine
–> Sediment
–> Hematuria
–> Cloudiness

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5
Q

How do UTI presentations differ in older adults?

A

More generalized
–> ABD discomfort instead of dysuria
–> Sudden onset delirium

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6
Q

How to test for UTI?

A

Dipstick analysis for
–> Nitrates
–> bacteremia
–> Elevated WBC
–> Leukocyte extrase

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7
Q

What is leukocyte extrase?

A

An enzyme found in WBCs that might indicate infection (Used in UTI dipstick)

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8
Q

After a positive UTI dipstick, what might a physician also want to perform?

A

Microscope analysis for bacteria in urine + midstream urine analysis

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9
Q

How are UTIs treated?

A

–> Sulfonamide antibiotics (most common)
–> Older adults respond to nitrofurantoin
–> Ciprofloxacin for chronic infections

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10
Q

What is pyelonephritis?

A

Inflammation of the renal parenchyma
–> Usually bacterial, not always

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11
Q

Where does acute pyelonephritis usually start?

A

Renal medulla and spreads to cortex.

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12
Q

What are the possible complications of recurrent pyelonephritis?

A

Scar tissue development which effects kidney function

Possible development of chronic pyelonephritis

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13
Q

What are the S/S of pyelonephritis?

A

–> Fatigue
–> Sudden onset fever
–> Flank pain
–> Cystitis

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14
Q

What is a KUB?

A

A kidney, ureter, and bladder ultrasound

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15
Q

What is cystitis?

A

Inflammation of the bladder

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16
Q

How long are antibiotics given for pyelonephritis?

A

14-21 days

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17
Q

What antibiotics are used for acute pyelonephritis?

A

Ampicillins, vancomycin, cipros, septra

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18
Q

What is septra?

A

Combination of sulfamethoxazole and trimethoprim
–> Used to treat pyelonephritis

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19
Q

Which demographics are most affected by kidney stones?

A

More common in men and those aged 20-55. More common in the summer months - likely due to dehydration

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20
Q

Which diagnostic tests are done when a person is suspected to have kidney stones?

A

Urinalysis
Urine culture
Pyelogram/KUB
X-ray

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21
Q

What is the main priority when treating someone with kidney stones?

A

Main priority is pain control
–> opiates (10-15 mg)
–> Toradol/Ketorolac is very helpful IM for this kind of pain (NSAIDS)

Combination therapy can be used too

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22
Q

What precaution should be taken in those with kidney stones while they urinate?

A

Ensure to strain urine to detect is stone has been passed spontaneously.

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23
Q

What is Lithotripsy?

A

Blasting of kidney stones with high energy shock waves

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24
Q

What dietary changes should be made for those with kidney stones?

A

At least 3L fluid a day
–> Dehydration contributes to caliculi formations, UTI

Large intakes of dairy or other high protein high calcium foods can contribute to the formation

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25
What size of kidney stone is unlikely to pass spantaneously?
Larger than 4 mm are unlikely to pass through ureter
26
What percentage of people with have another kidney stone after the first incidence?
About half
27
What age group is most affected by kidney cancers?
50-70 years old
28
What is the most common cause of kidney and bladder cancer?
Cigarette smoking is most common cause Others include: --> Obesity --> Exposure to asbestos
29
What are early and late symptoms of kidney and bladder cancer?
No early symptoms, but later symptoms include: Hematuria, flank pain We also see common cancer symptoms: Weightless, weakness, anemia
30
Where do kidney and bladder cancer usually metastasize?
Liver, lungs, long bones
31
What diagnostic tests are used for kidney and bladder cancer?
Pyelogram primary examination where most masses are detected. KUB ultrasound to differentiate tumour vs cyst. CT scans
32
What should we focus on during an assessment of urinary retention or incontinence?
Focus on Hx and physical assessment --> Voiding record/nutritional log when possible --> urinalysis for UTI detection or DM --> Residual bladder volume measurement Be on alert for sudden onset retention or incontinence
33
What lifestyle recommendations should be made for a person experiencing urinary retention or incontinence?
Promote adequate fluid intake and reduce irritants such as coffee and alcohol. Frequent and routine urination (2-3 hours while awake) Quit smoking to reduce stress incontinence
34
Acute urinary retention is a ____ that should be managed with _____
Medical emergency --> Insert 3-way catheter (as prescribed) unless otherwise directed
35
What is a nephrostomy tube and when are they used?
Temporarily inserted into pelvis of kidney when a complete obstruction of the ureter is present.
36
What is the frequency of incidence of benign prostatic hypertrophy?
50% of men over 50 80% men over 80 and 25% of men require some treatment by the age of 80
37
What diagnostic tests and exams are used to diagnose BPH?
Hx and physical --> Size, symmetry, and consistency of prostate with digital examination Urinalysis and culture PSA - Prostate specific antigen might be considered to rule out cancer (but causes false positives)
38
What is a TURP?
Trans-Urethral Resection of the Prostate Removal of prostate tissue with retro scope through urethra --> No external incision made
39
What are the two most common procedures for a radical prostatectomy?
Retropubic --> Mid-line abd incision Perineal --> incision between scrotum and rectum (preserves lymph nodes)
40
What is the most common complication of a radical prostatectomy?
Incontinence --> nearly all men in first few months following surgery Over time bladder adjusts and control is regained
41
What is a uretosigmoidostomy?
Ureters detached from bladder (bladder is typically removed) and attached to sigmoid colon.
42
ileal loop/Conduit?
Urostomy --> Ureters are attached to portion of ileum and ostomy is brought through abdominal wall
43
What is a cutaneous ureterostomy?
A procedure than bring the ureters through the abdominal wall to create 1 or 2 stomas.
44
What are the three causes of AKI (Major)?
Prerenal Intrarenal Postrenal
45
What are some common causes of prerenal AKI?
Hypovolemia, GI loss, burns, decreased cardiac output
46
What are some common causes of intrarenal AKI?
Prolonged ischemia, gentamycin + Amphotericin B
47
What are some common causes of postrenal AKI?
BPH, cancers, caliculi formation
48
What is the most common cause of AKI and CKD?
AKI: Acute tubular necrosis CKD: Diabetic nephropathy
49
Can AKI be reversible?
Unlike CKD, the damage from AKI can potentially be reversed.
50
How does the mortality rate change between AKI and CKD?
AKI: 60% CKD: 19-24%
51
What is the diagnostic difference between AKI and CKD?
AKI: Acute reduction of output and/or elevation of serum creat CKD: GFR less than 60 and/or progressive kidney damage for over 3 months.
52
What are some S/S of AKI?
--> Urinary output decrease --> Fluid + waste retention (Neuro disorders) --> Metabolic acidosis --> Excess phosphate, Na, and K --> Deficit in Ca
53
What are the three phases of AKI? What occurs during each?
Initiation --> Increase in serum Creat & BUN & decreased output Maintenance (days-weeks) --> Oliguria or none at all (less than 400 ml in 24h) --> Dilute urine without filtering wastes Recovery --> Return of BUN and Creat to normal filtration level --> Pts may experience diuretic phase that can cause lyte imbalances (can lead to 4-5L or more per day --> Hypovolemia) --> Hypo K + Na, dehyration
54
The longer the oliguric phase of an AKI lasts...
Longer less chance for recovery and increased chance for permanent damage.
55
What is considered oliguria?
Less than 400 mls in 24 hours
56
functioning kidneys are required to activate which vitamin?
Vit D
57
How long can it take renal function to stabilize following AKI?
12 months
58
What lifestyle changes are necessary for someone with AKI?
Fluid restriction (600mls + previous 24 hours losses) K + Na restrictions Calcium supplementation Phosphate binding supplements Dialysis
59
Why are older adults for susceptible and sensitive to kidney damage?
Not able to compensate for fluid overload or loss More susceptible to AKI d/t decreasing nephrons with age
60
What is uremia?
Constellation of symptoms associated with buildup of wastes usually excreted by the kidneys --> Elevated Creat + BUN, abnormal lytes --> Acidosis --> Anemia --> Fluid Volume Excess --> N/V, Anorexia --> Fatigue --> Itchiness --> Neuropathy
61
Which hormone should we examine in a pt with CKD?
Parathyroid for calcium
62
What restriction would we put on someone with CKD?
Protein, Na, K, Phosphate
63
How many cycles of peritoneal dialysis should be performed in 24 hours?
4/day
64
How long does a person have to come to the hospital for hemodialysis?
4-8 hours
65
What is disequilibrium syndrome?
Complication of hemodialysis --> High osmotic pressure results in cerebral edema
66
What is a major complication of kidney transplant?
Rejection
67
What is aseptic necrosis of joints and what causes it?
Caused by corticosteroids --> Calcium and phosphate supplementation + weightbearing exercises to prevent this
68
Should phosphate binders be taken with or without food?
They should be taken with a meal as most phosphate absorption occurs within an hour of eating.
69
What weight gain should a client with kidney complications report?
2kg

MedSurg (14 decks)

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