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adult 2 exam 2 > Renal > Flashcards

Renal Flashcards

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1
Q

Normal kidney function CAREER

A

Controls BP
Activates vitamin D
Regulates volume comp and ECP
Excretes waste
EPO production
Regulates acid base balance

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2
Q

how to prevent CAUTIs

A
  • secure catheter tubing dont let it dangle on the side of bed
  • make sure tubing is free of kinks
  • collection bag should be below bladder
  • perineal care WITH soap and water once a shift
  • don’t disconnect catheter from tubing because there is a separate port.
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3
Q

where is the kidney located

A

RP space
you have to palpate and percuss for the CVA pain

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4
Q

urine flow

A

kidney
ureters which have UVJ valves to prevent backflow
bladder
urethra

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5
Q

patho of pyelo

A

inflammation of renal parenchyma and collecting tubes

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6
Q

Pyelo Risk Factors

A

Vesi Reflux( the backflow of urine from the bladder to the ureters to the kidneys)

hydronephrosis: SWELLING of kidney because of the backflow of urine

BPH, Strictures, Stones
CAUTI

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7
Q

what can chronic pyelo can do

A

kidney damage so it can lead to ESRD which is why we might need a biopsy to see if there is any fibrosis or atrophy FROM the inflammation

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8
Q

how to get UA

A

clean catch stream!
midstream with soap and water NO antibio wipes
and you have one hour or refrigerate it.

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9
Q

pyelo expected findings

A

flank pain
fever
chills
malaise
N
V

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10
Q

pyelo lab tests

A

UA to see RBC, WBC, and bacteria
Urine for C/S this takes a while!!
CBC with WBC differential
Blood culture
Ultrasound: abnormal, hydronephrosis, masses, stones
CT urogram: infections

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11
Q

pyelo meds

A

BROAD spectrum antibiotics because C/S doesnt come back that fast. Switch to Bactrim or Cipro after the results come back
NSAIDs for PAIN and FEVER

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12
Q

Nursing Interventions for pyelo

A
  1. Assess vitals
  2. Monitor I and O’s
    1. we want to see 30 ml/hr, 1500 output
    2. remember patient can hold 600 to 1000ml
    3. 250 DISTENDED
    4. 400 UNCOMFY
  3. monitor fluid and electrolyte
  4. pain management
  5. encourage fluid 2-3 L to flush out bacteria
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13
Q

NANDAs

A

acute pain

impaired urinary elimination

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14
Q

renal stone patho

A

masses of crystals, PROTEINS, that can cause obstruction by sticking to each other. no single reason for stone formation

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15
Q

what are the most common types of stones

A
  1. calcium phosphate
  2. calcium oxalate
  3. struvite
  4. uric acid
  5. cysteine stones
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16
Q

renal stone risk factors

A

runs in family.

young white men who live in the south and live sedentary lifestyles.

in the summer

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17
Q

CIPP

A

calcium/citric acid/uric acid

immobility

protein

poor hydration: you drink tea

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18
Q

high urine pH and less soluble

A

calcium and phosphate

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19
Q

lower ph and less soluble

A

uric acid and cysteine

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20
Q

calcium oxalate

A

occurs: MEN
treatment: berries, tea, chocolate, peanuts, meat, REDUCE sodium and calcium

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21
Q

struvite stone

gender

what should we do

A

struvite: WOMEN

acidify urine and cranberry juice

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22
Q

uric acid

gender

treatment

diet

A

MEN

decrease purines: organ meats, mussels, shellfish, mushrooms, asapargus

ALKALIZE URINE.

TREATMENT: allopurinol

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23
Q

cystine

A

increase hydration and ALKALIZE URINE.

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24
Q

renal stone expected findings

A

-FIRST SYMPTOM RENAL Colic(sharp severe pain in the flank, back, lower abdomen. they are constantly moving around because of the pain.

Common sites of obstructions:

-UPJ: flank pain (renal colic)

UVJ: groin pain that radiates to labia and testes

severe pain: N/V

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25
renal stone dx
- Noncontrast CT scan: tells us if its a stone or tumor - Ultrasound: to see masses - IVP to see renal pelvis and tubules becuase of UPJ and UVJ - UA to see sepsis because bacteria, RBC, WBC, crystaluria, and we want to see if we should acidify or alkaline urine - Lab Electrolytes to see if turned into AKI - 24 hours urine collection: creatinine!!
26
interprofessional care
1. Pain management 1. relieve obstruction with **tamsulosin and terzosin** 2. STRAIN URINE to assess and prevent future stones
27
how does tamusolosin and terzosin relieve obstruction
relaxes smooth muscles of the ureters to allow passage
28
how can doctors remove stones
- cystoscopy: basically a doctor will put a telescope through your urethra if there is an obstruction in bladder or urethra. - pain: morphine and NSAIDs - lithotripsy
29
lithotripsy
monitor the urine output because we have to catch that stone and make sure the broken stone pieces don't obstruct the urine. educate patient that bruising and pain is normal at the site.
30
nutrition for renal stones
DO NOT FORCE FLUIDS BC PAIN MIGHT BE WORSE 1. MANAGE PAIN 2. REDUCE TEA AND COLA 3. LOW SODIUM FOR CALCIUM FORMING
31
nursing management for renal stones
ambulate pain management with meds positions strain all urine ADEQUATE FLUID INTAKE DIETARY INTAKE
32
what are allergy responses to IVP
itching hypotension respiratory distress tachy
33
AKI patho
kidney loss of function because of some infection and there is the reduction of UO and azotemia
34
how can AKI kill you
hypotension hypovolemic shock nephrotoxic drugs hyperkalemia IT CAN GO UNNOTICED AND UNTREATED
35
prerenal
MOST COMMON decreased perfusion from trauma, HF, and dehyration
36
intrarenal
prerenal ATN because of the nephrotoxic drugs or sepsis blood transfusion reaction
37
postrenal
hydronephrosis BPH prostate cancer trauma
38
level of UO in each phase
prerenal: oliguria interenal: polyuria or oliguria postrenal: oliguria eventually
39
Phases of AKI
Oliguria Diuresis Recovery
40
tell me about oliguric phase
UO is less than 400ml/day occurs for a week after injury lasts for two weeks UA will show cast from the mucoprotein necrosis, RBC, WBC because the infection(leukocytosis) metabolic acidosis: because of waste buildup volume overload: fluid being backed up can affect cardiac and lung potassium excess no EPO (anemia) Neuro issues: confusion, stupor, seizures,coma!! waste buildup
41
oliguric phase extra
hypovolemia JVD bounding pulses edema hypertension HF PE/PE Kussmaul respirations from the metabolic acidosis Hyponatremia because the blood is diluted \>cerebral edema Hyperkalemia: ECG! TELEMETRY
42
direutic phase
UO 1-3 L lasts 1-3 weeks kidneys cannot conc urine Hyponatremia Hypokalemia Dehydration
43
AKI DX
history and physical: what type? serum creatinine UA renal scan CT scan renal biospy
44
Prerenal Treatment
FORCE FLUIDS and DIURETICS because of the intravascular volume and cardiac output
45
How can we treat oliguric phase
1. fluid restriction: 600ml plus UO from the day before 2. Lower potassium with calcium carbonate, kayexlate, dialysis, sodium bicarb, insulin but make sure you give glucose because of hypoglycemia
46
what is kayexlate contraindicated with
loose stools paralytic ileus so assses their bowels to prevent necrosis
47
AKI nutrition
limit protein bc its harder to metabolize no sodium increase fat
48
nursing assess
* assess UO and color * assess crackles and rhonchi and diminished breath sounds * monitor F and E * I and O * monitor of infection * AMBULATEEEEEE * NO PROTEIN AND NO K *
49
Specific gravity
Specific gravity is an expression of the degree of concentration of the urine that measures the density of a solution compared to the density of water, which is 1.000. CONCENTRATION OF SOLUTES
50
Osmolality
Osmolality is the most accurate measurement of the kidney’s ability to dilute and concentrate urine.
51
NUMBER ONE DX FOR AKI
FLUID OVERLOAD
52
CKD ICD how?
GFR is less than 60 longer than 3 months or kidney damage longer than 3 months
53
CKD leading causes
**DM** damaged vessels so waste cannot be filtered **HTN** damages and weakens vessels
54
CKD urinary
polyuria because of DM eventually fluid retention anuria
55
CKD metabolic
waste elevated tri because hepatic stimulation altered carb metabolism
56
CKD electrolyte imbalances
hyperkalemia hypermagnesia hyperphosphatemia hypocalcemia metabolic acidosis
57
CKD hematologic
anemia infection bleeding easily because of altered platelet function GI bleeds because of ASA
58
CKD Cardiovascular
Hypertension Calcium deposits HF PVD
59
CKD Respiratory
Kussumals SOB pulmonary edema uremic pleuritis pneumonia and other infections because immune sys is trash
60
CKD GI
Stomatitis (stomach ulcers) Uremic fector because urea is converted to ammonia metallic taste DM Gastroparesis GI bleed Constipation
61
CKD Neuro
Lethargic apathy fatigue peripheral neuropathy RLS
62
CKD MSK
Vitamin D and calcium osteomalacia osteo fibrosa vascular calcifications hyperparathyroidism: bone demineralization. body thinks that we have a lot of phosphate and not enough calcium so PTH will be broken.
63
CKD skin
uremic frost itching
64
CKD reproductive
infertility libido low sperm count
65
CKD DX
H and P Dipstick to see PROTEIN in Urine UA Renal Biopsy Renal ultrasound CT scan first morning void because urine is most conc so we can get albumin and creatinine ratio **GOLD STANDARRD: GFR**
66
CKD Conservative Therapy
* correction of fluid volume overload with **diuretics and fluid restriction** * nutrition: **low sodium, potassium and protein** * EPO: give epogen * calcium and phosphate binders * Anti HTN: weight loss, diet, sodium and fluid restriction *
67
phosphate binders names
- calcium acetate - calcium carbonate - renagel
68
give phosphate binders with
meals
69
renagel can lower what
cholesterol
70
phosphate binder side effect
constipation
71
no foil for ckd means
avoid aluminum prep
72
Vitamin D supplements
Calcitriol Cincalcet
73
Anemia meds
EPO IV or SQ
74
when should we see increase in H and H
2 or 3 weeks
75
what can the anemia drugs cause
Thromboembolism and HTN
76
What drugs can cause drug toxicity
Digoxin Diabetic agents Antibiotics Opiods
77
Protein intake based on dialysis?
H: normal P: increase
78
oliguria diet
NO POTASSIUM NO PHOSPHORUS NO COFFEE HIGH CARB
79
IVP what should the patient give before the procedure? ask the patient what? assess for? how long will this procedure take? is there an NPO status? what can you see on an IVP?
signed consent allergies BUN and Creatinine 1 hours yes NPO midnight also no caffiene visualizes renal pelvis and tubules to see any obstruction

adult 2 exam 2 (3 decks)

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