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Medsurg Exam 2 > Renal > Flashcards

Renal Flashcards

(105 cards)

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1
Q

What is the primary function of the renal and urinary system?

A

homeostasis

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2
Q

kidney’s specific role in homeostasis

A

regulating fluid and electrolytes, removing wastes, and providing hormones that are involved in red blood cell (RBC) production, bone metabolism, and blood pressure.

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3
Q

each kidney has how many nephrons

A

1 million

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4
Q

purpose of nephrons

A

filters blood

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5
Q

purpose of the glomerulus

A

filtration of waste

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6
Q

what can alter filtration

A

Increases in the glomerular capillary hydrostatic pressure cause increases in net filtration pressure and GFR
increases in Bowman space hydrostatic pressure causes decreases in filtration pressure and GFR

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7
Q

a substance moves from the filtrate back into the peritubular capillaries or vasa recta

A

tubular reabsorption

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8
Q

a substance moves from the peritubular capillaries or vasa recta into tubular filtrate

A

tubular secretions

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9
Q

What are some substances that should not be found in urine and why?

A

no protein = damage happens quickly to kidneys
no glucose in urine = diabetes
blood = internal bleeding

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10
Q

measuring the ratio of the amount of solutes (milliosmoles) to water using liters

A

osmolarity

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11
Q

calculates the ratio of the amount of solutes (milliosmoles) to water using weight or kilograms

A

osmolality

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12
Q

percentage of K filtered through the kidneys

A

90%

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13
Q

how is water regulated by kidneys

A

ADH/vasopressin

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14
Q

volume of electrolytes excreted each day by the kidneys

A

excretion is equal to intake per day

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15
Q

regulation of acid base balance by the kidneys

A

filtering bicarbonate and phosphate
results in metabolic acidosis

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16
Q

vessels constantly monitor blood pressure as blood begins its passage into the kidney

A

vasa recta

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17
Q

specialized juxtaglomerular cells near the afferent arteriole, distal tubule, and efferent arteriole secrete the hormone:

A

renin

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18
Q

Why is (MAP- Mean arterial pressure) important?

A

MAP of 65 maintains renal perfusion

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19
Q

how do kidneys regulate RBCs

A

releasing erythropoietin - which stimulates bone marrow to produce RBCs

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20
Q

purpose fo regulation of Vit D

A

production of calcium from active form of Vit D

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21
Q

purpose of prostaglandins

A

vasodilatory effects and important in maintaining renal blood flow

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22
Q

kidneys function of regulating waste

A

kidney is main excretory organ, eliminating body’s metabolic waste product

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23
Q

assessment involved for renal/urinary tract

A

Health History
Social History
Recognize cues (subjective data)
Costovertebral angle

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24
Q

labs for renal/urinary tract

A

Urinalysis and Urine Culture
Renal clearance
Creatinine clearance
Creatinine level (0.6- 1.2)
BUN (7-20)
GFR 120- 130mL/min

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25
diagnostics for renal
Imagining Ultrasounds Urologic Endoscopic Bladder Scan
26
what is post void residual
amount of urine left in bladder after urinating
27
what do we want a PVR to be
less than 50 less than 350
28
progressive loss of kidney (nephron) function
kidney disease 1
29
percentage of those with CKD that do not know
70%
30
nephron level classification for kidney disease
nephron functioning less than 20%
31
risk factors for kidney disease
diabetes and HTN proteinuria greater than 60 YO family history
32
GFR indication for end stage renal disease
less than 15
33
clinical manifestations of CKD
hypertension heart failure hyperkalemia metabolic acidosis pulmonary edema edema uremia GI and neuro symptoms anemia skeletal buffering hypocalcemia hyperphosphatemia hyperparathyroidism osteodystrophies
34
diagnostic testing for CKD
Lab work/ Urine Studies K+ - hyperkalemia Creatinine clearence – excreted in urine Creatine level – 0.6-1.2 Hgb BUN (7-20) Magnesium GFR – 120-130 Renal Ultrasound Renal Biopsy –risk for bleeding CT scan
35
medicatoins for CKD treatment
Sodium Polystyrene (Kayexalate) - Patiromoer (Veltassa) – decrease K ACE Inhibitors and ARBs –lower BP Svelamer carbonate (Renvela) - Calcium Acetate (PhosLo) – lowers phosphate Calcium and Vit D – supplementation Cinacalcet (Sensipar) Exogenous Erythropoietin - Epogen, Procrit Iron – reproduce RBC Statins (Atorvastatin-Lipitor) Gemfibrozil (Lopid)  -cholesterol – build up – stops blockages
36
medications for CKD to decrease potassium
Sodium Polystyrene (Kayexalate) Patiromoer (Veltassa)
37
medications for CKD to lower BP
ACE inhibitors ARBs
38
medications for CKD to lower phsophate
Svelamer carbonate (Renvela) Calcium Acetate (PhosLo)
39
medications for CKD to supplement
calcium Vit D
40
medications for CKD to treat hyperparathyroidism
Cinacalcet (Sensipar)
41
medications for CKD to reproduce RBCs
Exogenous Erythropoietin Epogen Procrit Iron
42
medications for CKD to lower cholesterol building and stop blockages
Statins (Atorvastatin-Lipitor) Gemfibrozil (Lopid)
43
nutrition restrictions for CKD
protein restriction fluid restriction sodium restriction potassium restriction phosphate restriction
44
why do we restrict protein for patients with kidney disease and how do we monitor
causing damage and increases toxins monitor lab work
45
why do we restrict fluid for patients with kidney disease and how do we monitor
avoid fluid overload based on urine output
46
why do we restrict sodium for patients with kidney disease and how do we monitor
hurt kidneys cannot filter and control with ADH 2-4 grams/day
47
why do we restrict potassium for patients with kidney disease and how do we monitor
kidneys responsible for filter of 90% of potassium 2000-3000mg monitor lab work
48
why do we restrict phosphate for patients with kidney disease and how do we monitor
hyperphosphatemia 1g/day limit meat and dairy products
49
purpose of renal replacement therapy
diffusion, osmosis, ultrafiltration remove waste filters blood
50
vascular access for hemodialysis
Temporary Vascular Access Arteriovenous fistula (AVF) – A Arteriovenous graft (AVGs) – B – IV drug users – scar tissue
51
how to assess fistula
feel thrill listen to bruit
52
assessment of vascular assess sites
Assess for maintenance Assess for infection Assess for possible obstruction
53
frequency and length of hemodialysis
Completed on average 3 times per week for 3-4 hours
54
what medications the nurse should hold before dialysis
cardiac glycosides antibiotic agents antiarrythmic medications antihypertensive agents blood products blood thinners
55
complications of hemodialysis and what causes thme
dysrhythmias - too much potassium and fluid chest pain - potassium - fluid shift - hemoglobin hypotension - fluid/blood loss muscle cramps - hyperkalemia hepatitis - sterility
56
process of PD
infuse 2 L of fluid allows both diffusion and osmosis to occur drainage portion of the exchange begins The solution drains from the peritoneal cavity by gravity through a closed, sterile system. Usually drainage is completed in 10 to 30 minutes.
57
peritoneal dialysis access
Tenckhoff Catheter Inserted through abdominal wall. Takes 2 weeks to heal. Can be used immediately with low volume of fluid. Monitor for signs of infection
58
complications for PD
exit site infection peritonitis hernias and lower back problems bleeding pulmonary complications protein loss
59
assessment for PD access
H&P Complete history of any existing kidney disease, family history Long-term health problems Drugs and herbal preparations Dietary habits Support systems Output Skin – itching and edema Chest pain or palpitations
60
nursing diagnoses for kidney disease
Excess fluid volume Risk for electrolyte imbalance Risk for injury Anemia Imbalanced nutrition: less than body requirements
61
overall planning goals for kidney disease
Demonstrate knowledge and ability to comply with therapeutic regimen Participate in decision making Maintain normal fluid volume status Preserve kidney function Minimize complications
62
health promotion fro kidney disease
Identify individuals at risk for CKD Diabetes mellitus Hypertension History or family history of kidney disease Repeated urinary tract infection Regular checkups and changes in urinary appearance, frequency, and volume should be reported
63
acute care for CKD
Most care for CKD occurs on an outpatient basis In-hospital care required for management of complications and for kidney transplantation
64
ambulatory care for CKD
Patient can complete evaluation for kidney transplant Explain what is involved in PD or HD, home dialysis modalities, transplantation, palliative care Teach patient and caregiver about Diet Drugs Common side effects Pill organizer Avoid over-the-counter drugs Take daily BP Identify signs of fluid overload, electrolyte imbalances
65
evaluation for CKD
The patient with CKD will maintain: Fluid and electrolyte levels within normal ranges Absence of complications An acceptable weight with no more than a 10% weight loss Adherence to treatment plan
66
possible complications for upper urinary tract infections
sepsis UTI
67
normal defense to prevent UTIs
urinating acidic PH high urea concentration glycoproteins
68
classification of UTIs
Upper tract infection Lower tract infection Complicated vs. Uncomplicated
69
causes and risk factors of UTI
Bacteria: E. Coli (70%-95% of cases that are uncomplicated), Staphylococcus, gram (+) bacteria Indwelling Catheter- CAUTIs/HAI: gram (-) bacteria such as Klebsiella and Pseudomonas Chronic antibiotic use Diabetes Sexual intercourse Women/ Pregnancy Compromised immune system Aging Immobility BPH in men.
70
infection of urethra and cause
urethritis sexual intercourse or viral infection
71
infection of bladder and cause
cystitis causes puss and mucosa becomes hyperemic
72
Occurs in the renal parenchyma and collecting system (upper tract) caused by a bacterial infection usually beginning in the lower tract.
pyelonephritis
73
risk for chronic pyelonephritis
Reoccurring upper urinary tract infections
74
clinical manifestations of pyelonephritis
Lower UTI symptoms Fever/chills N/V Malasie Flank pain CVA tenderness
75
risk factors for pyelonephritis
Failure to empty bladder Obstruction Immunosuppression DM Pregnancy Neurologic disorders Gout AMS
76
clinical manifestations of upper and lower tract infections
Dysuria Hesitancy Intermittency Post-void dribbling Hematuria Pyuria – puss Incontinence Nocturia Urgency Frequency
77
Upper and Lower Tract: Diagnostic Testing
Urinalysis Clean Catch Urine or Straight Cath + nitrates, WBCs, leukocyte esterase, blood, cloudy urine Pyelonephritis Blood Studies Elevated WBCs Urine Cultures (antibiotic sensitivities) Blood Cultures Ultrasounds CT scan Kidney biopsy Renal function panel
78
medical treatment for uncomplicated UTI 3 days
Fluoroquinolones (Levofloxacin, Cipro) Nitrofurantoin (Macrodantin)
79
medical treatment complicated UTI
Ampicillin Amoxicillin Cephalosporins
80
medical treatment for fungus related to UTI
Fluconazole (Diflucan)
81
treatment of UTI symptoms
Urinary analgesic (phenazopyridine) - Relieve discomfort caused by dysuria.
82
medication education for management of UTIs
Medication compliance. Side effects of antibiotics. Clean perineal area. Sexual health. Void regularly Fluid intake Educate women. Signs and symptoms of UTI/ infection. Follow up care.
83
fluid management for UTIs
generous intake of fluid, 15ml per pound of body weight is minimumq
84
maintainence of acidic urine for UTIs
cranberry juice vit C
85
bladder irritants to avoid with UTI
caffeine alcohol citrus juices
86
fever treatment for UTIs
NSAIDs and antipyretics
87
Care of a patient with Urinary Incontinence
Involuntary urinary leakage. Bladder pressure is greater than urethral closure pressure. OAB (overactive bladder)
88
causes of urinary incontinence
DIAPPERS stand for: Delirium Infection Atrophic vaginitis Psychological Pharmacologic Excess urine output Restricted mobility Stool impaction
89
risk factors for urinary incontinence
Neurogenic disorders Spinal Cord dysfunction Surgery Medications Stress
90
types of incontinence
functional after trauma/surgery overflow reflex stress urge iatrogenic
91
unable to get to bathroom in time
functional incontinence
92
PP, accidents, catheter, prostate, hysterectomy
incontinence after trauma or surgery
93
bladder doesn’t empty, pressure, obstruction, leakage
overflow incontinence
94
CNS – sphrincter relaxation
reflex incontinence
95
coughing, sneezing incontinence
stress incontinence
96
continuous need to pee
urge incontinence
97
medication side effects causes what incontinence
iatrogenic
98
inability to empty bladder
urinary retention
99
causes of urinary retention
Enlarged prostate Tumor Obstruction Neurologic disorders Diabetes Medications
100
diagnostics of urinary retention
Bladder Log Post Void residual – leftover urine after voiding Urinalysis
101
treatment for urinary retention
Treat the cause Kegel Exercises Medication Therapy Botox Surgical Intervention/ Bladder sling Schedule toileting Double voiding Straight Cath
102
uses for indwelling catheters
Urinary Retention Inability to void Obstruction Bladder decompression Accurate measurement of output Prevent contamination
103
uses for straight cath
Relieve retention Sterile sample Measure postvoid residual Neurogenic bladder Bladder outlet obstruction in men Every 3 to 5 hours
104
role of nurse in management of cathiterization
Peri care, infection prevention, monitor output, empty bag, placement
105
types of indwelling catherters
Ureteral Catheter Suprapubic Catheter Nephrostomy tubes

Medsurg Exam 2 (6 decks)

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