renal exam - study guide Flashcards by Amanda S.

IVP (Intravenous pyelogram) - what does it do?

Visualizes urinary tract, shape, size position of kidneys, ureters, & bladder;

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IVP detects

Detects cysts, tumors, lesions, obstructions.

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IVP contraindicated in who?

Test contradicted for pt with decreased renal function because the contrast media can be nephrotoxic.

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Side-effect of metformin is (increases what and stop before..)

increased lactic acid production. This may lead to lactic acidosis & death. Stop taking the metformin 48 hrs before & 48 hrs after the test or when renal function returns back to normal.

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meds for IC - Calcium phosphorus - for (IC calcium before it’s too late)

Calcium phosphorus (Prelief)

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BPH - If the DRE and PSA levels are abnormal, what is the next step? (visualize it)

then a transrectal ultrasound with possible biopsy is done to R/O prostate cancer.

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5α-reductase inhibitors finasteride (Proscar) reduces size of (fin blocks androgens)

prostate gland by suppressing androgens.

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α-adrenergic receptor blockers terazosin (Hytrin) & tamsulosin (Flomax) promote (tez and tam relax me)

smooth muscle relaxation in prostate facilitating urinary flow through urethra.

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Saw palmetto action is the same as the

α-adrenergic receptor blockers.

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Never use what with prostate?

Never use zinc because it stimulates the growth of the prostatic tissues.

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TURP - what type of foley catheter?

A three-way foley cath is inserted after surgery. Continuous bladder irrigations are done to flush all the blood out of the bladder to prevent clots from developing.

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priapism - complications (need hydro for my priapism)

penile tissue necrosis; Hydronephrosis (kidneys become stretched and swollen) from bladder distention; inability to achieve a normal erection after priapism subsides.

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Transillumination is used to (illuminate the fluid)

identify solid tumors/cancer versus fluid in the scrotum

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Epididymitis is (one or both sides?)

unilateral

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Most common cause of infertility is (vari infertile)

varicocele.

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Testicular torsion common in

young boys and is a surgical emergency to untangle the blood supply that is twisted around the vas deferens.

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Vasectomy is performed where?

Vasectomy is performed in the MD office.

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vasectomy - Should use contraception for

6 weeks or 10 ejaculations to evacuate sperm distal to surgical site.

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drug therapy for prostate cancer

Drug therapy is called Hormonal therapy (androgen deprivation therapy – ADT).Goal: reduce the androgen level. Androgen promotes the tumor growth. Causing a castration effect will prevent the release of any androgen. Hence, the cancer will stop growing and begin to shrink in size

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ADT is used as (ADP alone isn’t enough)

an adjunct therapy before surgery or radiation.

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Complication of ADT is (adt security is bare bones)

osteoporosis

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Glomerulonephritis (glum’s basement is damaged)

caused by Ab induced injury to the glomerular basement membrane.

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glomerulonephritis - symptoms (glum has a swollen face)

Generalized body edema. May start with periorbital edema & progress to peripheral edema or ascites.

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Polycystic kidney disease - both kidneys? is it genetic?

both kidneys and is genetic.

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PKD - where are cysts?

Large thin walled cysts develop in cortex & medulla of kidneys. Cysts grow to the size of golf balls & filled with blood or pus. Large cysts compress surrounding tissues & destroy them. May lead to cysts in liver; Affect heart valves;

PKD - aneurysms and diverticulosis? how?

Aneurysms especially cerebral aneurysm (enlarged kidneys have tamponade effect on aorta); Diverticulosis (kidneys grow so large that it applies pressure against intestinal tract).

Elevated creatinine levels indicate

AKI.

pre-renal AKI - when is it reversible? how long?

There is no damage to the parenchyma so with hydration AKI is reversible if rehydrated in 48 hrs.

pre-renal AKI - If no hydration is performed

then the nephrons will eventually die off and become to stage 2 intrarenal

Intrarenal AKI results from direct damage to the kidneys caused by

prolonged ischemia, nephrotoxins, hemoglobins released from hemolyzed RBCs, or myoglobins released from necrotic muscle cells

causes of acute tubular necrosis (ATN) (ant is caused by SIN)

Ischemia, nephrotoxins, or sepsis

Postrenal is reversible if the obstruction is relieved within

48 hrs.

Prolonged obstruction leads to (the atrophy and fibrosis are prolonged)

tubular atrophy & irreversible kidney fibrosis resulting in CKD.

AKI - oliguric phase - signs of

dehydration, JVD, LE edema, lung congestion

oliguric phase - risk factors - IV fluids

CHF due to over hydrations with IVF for treatment during oliguric phase

Bruises occur when

renal not producing erythropoietin. Pt becomes anemic.

Oliguric Phase - onset (olga's onset was 17 days)

<400 ml urine output per day Onset: within 1-7 days of AKI

oliguric phase - If caused by ischemia, then oliguria occurs within (olga and ishmail married in 24 hrs)

then oliguria occurs within 24 hrs

oliguric phase - If caused by nephrotoxic drugs, then the onset may be (toxins in my system for a week)

then the onset may be delayed for as long as 1 week.

oliguric phase - duration (olga could only endure until 10:14)

Duration is usually 10 to 14 days but can last months in some cases. Just remember the longer the oliguria lasts the poorer the prognosis for recovery of kidney function

In the oliguric & anuric phases, IVF cause

neck vein distention, bounding pulse, HTN, edema & result in HF, pulm edema, pericardial & pleural effusion.

oliguric - metabolic acidosis

NaHCO3 normally binds with the excess H but in the oliguric phase NaHCO3 production is reduced due to a defective reabsorption & regeneration of bicarbonate ions.

Pts with severe metabolic acidosis develop (blow off the acid)

Kussmal breathing (rapid deep respirations) trying to exhale the excess CO2

If AKI is caused by a massive tissue trauma

then those damaged tissue cells releases K into the ECF. This increases the already high K level

In Metabolic acidosis the extra H - it takes action

enters the cell & pushes K out there by increasing the K level.

Hematologic disorders (RBCs, bone marrow) occur in those with (heman is sick)

multi-organ failures or hematologic disorders

Leukocytosis is often present in (luke is friends w/ aki)

AKI

The most common cause of death in AKI is

infection.

The most common site of infection are from the (think catherter and breathing)

urinary & respiratory systems.

BUN may be caused from - think infections and bleeding

dehydration, corticosteroids, catabolism from infections, fever, severe injury, or GI bleed.

The best serum indicator of AKI is

elevated creatinine levels

excess BUN accumulates in

the brain and nervous system. Causes fatigue, difficulty concentrating, seizures, stupor, coma

chronic kidney disease - cardiovascular - but why?

HTN (renal medulla gone so prostaglandins cannot be synthesized to vasodilate)

chronic kidney disease - symptoms (chronic breath smells like feta)

Uremic fetor (breath smells like urine)

chronic kidney disease - GI (this is about anorexia)

GI bleed occurs when stomach continues to produce gastric acids and there is no food in the stomach

chronic kidney disease - GI - Constipation occurs with the (selma has constipation)

intake of sevelamer/phoslo, limited po fluids, & reduced physical activity

Chronic kidney disease - women

decreased level of estrogen, progesterone, luteinizing hormone that results in amenorrhea. Menstruation recurs with dialysis.

chronic kidney disease - men

inconsistent levels of testosterone, low sperm count

chronic kidney disease - neurologic

Increased nitrogenous waste products, electrolyte imbalance, metabolic acidosis, atrophy & demyelination of nerve fibers

atrophy & demyelination of nerve fibers (mom demylenates)

slows the nerve conduction to BLE (bilateral lower extremities) so peripheral neuropathy occurs

Dialysis reduces the CNS manifestations except it cannot reverse

the motor neuropathies

Increased BUN & HTN leads to (tu has a high BUN)

seizures, coma

pruritis caused by - (calcium makes me itch)

dry skin, Ca Phosphate deposits in the skin,

Uremic frost comes from extremely high BUN levels

(>200). Urea seeps thru skin & forms white itchy flakes.

dialysis - hypotension - fluid is reduced before or after?

Hypotension: dialysis rapidly reduces vascular volume which results in reducing the preload & cardiac output

dialysis - to prevent hypotension

less fluid is removed & NS IVF may be given

dialysis - hep b

Hepatitis B is avoided by vaccination. Hep C can occur due to poor infection control during dialysis.

Peritoneal dialysis - how much? and for how long? (Tone just needs 10 min)

As per physician order. Usually fill - 2 L Dialysis solution (room temp) instilled into peritoneal space (10 mins) Larger abdomen takes up to 3 L.

peritoneal dialysis - Equilibration takes how long? (tone needs 30 min to get right)

Leave solution so it can dwell (diffusion/osmosis between blood & peritoneal cavity) 20-30 mins or as per order depending on desired outcome.

peritoneal dialysis - drain how long? (I was drained already at 15)

Drain - 15-30 mins. May have to massage abdomen or change positions.

peritoneal dialysis - after - assess what? (3 things) (tone is SEC)

Assess the effluent, site , catheter and report any signs of infection, or complications.

kidney transplant - steroids - given with what?

Corticosteroid use leads to aseptic necrosis of the joints (hips, knees, etc.). Tacrolimus & other immunosuppressants helps lower the required steroid dose.

Kidney transplant post-op care in addition to standard post-op care: - what is the #1 priority???

* Monitor incision, renal function, bleeding, URINE OUTPUT IS PRIORITY ASSESSMENT * Pain management * Immunotherapy * Signs of rejection

meds for IC - Antidepressants & Elmiron (Elmo w/ glyco)

Antidepressants; Pentosan (Elmiron) for IC enhances the protective effects of glycosaminoglycan layer of the bladder

meds for IC - (IC a dime)

Dimethylsulfoxide (DMSO); Reduce stress; Relaxation techniques; Avoid tight clothing around suprapubic area.

glomerulonephritis - Can be caused by (glum, inside and out)

Can be caused by endogenous (autoimmune antigen) or exogenous (infection such as strep antigen).

glomerulonephritis - HTN and oliguria? (glum is too extra)

HTN (too much ECF); oliguria (decreased GFR)

epididymis is caused by (p diddy has infection and trauma)

infection, trauma, urinary reflux down the vas deferens

what drugs are given to prevent osteoporosis with ADT? (Bison against osteoporosis)

Bisphonate drugs are given to prevent osteoporosis.

uncomplicated UTI

just involves bladder. complicated = catheter, pregnancy, recurrent infection, immune compromised

uncomplicated UTI - how long for antibiotics?

3 days

Complicated UTI - how long for antibiotics?

7-14 days

about what % of UTIs are asymptomatic?

50%

uretheral trauma - s/s classic triad

blood visible at the meatus, inability to void, distended bladder

struvite stones

ask if pt has had UTIs

bladder cancer - post op - how often to assess output? (assess Jean every hour)

every hour

Saw palmetto

promotes smooth muscle relaxation. action is the same as the α-adrenergic receptor blockers.

AKI is reversible for the

the prerenal and postrenal stages.

Intrarenal AKI results from direct damage to the kidneys caused by

prolonged ischemia, nephrotoxins, hemoglobins released from hemolyzed RBCs, or myoglobins released from necrotic muscle cells.

chronic kidney disease - GI (metal is chronic)

stomatitis with exudate & ulcerations & metallic taste in mouth

chronic kidney disease - Restless legs syndrome

Restless legs syndrome begins with burning sensation then later muscular weakness & atrophy leading to foot drop, Muscle twitching, asterixis, nocturnal leg cramps

renal exam - study guide Flashcards

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