Renal Part 1&2 Flashcards
(332 cards)
1
Q
Fluid and Electrolyte balance
Excretion of wastes
BP Maintenance
Erythropoietin- regulation of RBC production = stimulate red cell production, if in chronic in stage real disease you will be anemic bc you won’t have enough erythropoietin
A
Functions of Kidney
2
Q
Conversion of Vitamin D to active form
Regulation of calcium & phosphorous balance –
Acid/Base Balance
Prostaglandin and Kinin Secretion influencing arteriolar vasodilation
Activates growth hormone
- Children born with malfunction of kidney don’t grow of great stature
A
Functions of Kidney
3
Q
Kidneys protected by muscle (diaphragm- sits on top of kidneys), ribs (circle the kidneys), spine, liver,& spleen
Kidneys move with ventilation; during a kidney biopsy, patient must be able to hold breath to keep kidney still
A
True
4
Q
____ kidney tucked under 12th rib; frequently see compression between rib & spine in automobile accidents
A
Right
5
Q
Trauma with patient worrying rib being crushed into the kidney, Which will be protected the most?
A
Left Kidney: Most protected is the left kidney
Right kidney will get more bruising and contusion bc it is lower so not much protection
6
Q
Kidneys ____ so when taking deep breath, will descend when you let out breath they will float back up = imp point bc times where patient will need kidney biopsy
A
Float
7
Q
Go in with a needle and tip of needle there is a claw like prongs and tears some of kidney tissue pull it on a slide and analyze and that is called = ____ ____ (we look at this tissue to see presence of metastatic cells or to see if nephron damage…)
A
Kidney biopsy
8
Q
Kidney biopsy is done by ________
A
Fluoroscopy
9
Q
___ pelvis: where urine collects from the glomeruli
A
Renal
10
Q
Left & Right Ureters lined with transitional cells known as _______ that prevent reabsorption of urine
A
urothelium
11
Q
Within the Ureter: ______ contractions propel urine into bladder = only one direction, should not have reflux
A
Peristaltic
12
Q
______ reflux: backflow of urine from bladder into ureters, should NOT have this
A
Vesicoureteral
13
Q
Vesico
A
vessel that holds the bladder
14
Q
Bladder or Trigone: __ openings, _ ureteral orifices, 1 urethral opening-forms internal triangle,
A
3, 2
15
Q
Exit of the urine from the bladder
A
Urethra
16
Q
Urgent to void but typically they only dribble a little bit, burning, cloudy urine, CASTS (microscopic cylindrical structures) in the urine, hematuria
A
characteristics of a woman with a UTI
17
Q
Occurrence and symptoms increase with age, not a diseased prostate, it can be because over time gland becomes so englarged that men will have similar symptoms, frequency bc gland pushing on to the ureter, dribble peeing, struggle with good emptying of the bladder leading to UTI
A
Benign Prostatic Hypertrophy (BPH):
18
Q
Cortex: made of glomeruli & tubules
What layer?
A
Outer
19
Q
Medulla: (Middle of the kidney) divided into masses of collecting ducts called pyramids of the nephron, form papillae; each one has 10-25 openings
What layer?
A
Middle
20
Q
____-Pelvis: where urine empties, holds
A
Inner
21
Q
_____ is compromised of tubules in which urine is made and finally leaves the body but *surrounding the tubule are a whole blood vessels network and these blood vessel are putting things into the tubules and sucking things from the tubule,
2 way street in this network all the time, times where you are going to reabsorb potassium because body needs it, other times secrete potassium into the tubule for secretion via urine
A
Nephron
22
Q
What do we know about blood vessels and tubules?
A
semipermeable
23
Q
_____ fed by Afferent Arteriole, the vessel bringing blood to the kidney *(“all of the body’s blood circulates through the kidneys approximately 1200 mls/minute)
– very vascular, If you don’t have a good heart you don’t have a good kidney function
A
Glomerulus
24
Q
Glomerulus forms a tuft of capillaries
A
True
25
**The pressure in these capillaries forces fluid, and particles through the capillary wall into the tubules**
______ pressure: Pressure in capillaries forcing something out through the vessels
Hydrostatic
26
Fluid and particles are known as _____ filtrate
Glomerular
27
When stuff goes into the tubule we call that _____
Filtrate
28
We want a ____ glomerular filtrate
high
29
The best measure of renal functioning, it measures the speed at which blood moves through the glomerulus. GFR can be calculated using a formula that incorporates serum creatinine levels, age, gender, and ethnicity.
Glomerular filtration rate (GFR)
30
Usual GFR is approximately ___mL/min`
125
31
Decreased volume going through the tuft of capillaries - Dehydrated, hemorrhage - not blood circulating through glomeruli
Problem with decreased amount of glomerular filtration
32
What might inhibit blood in the tuft of capillaries from moving into bowman’s capsule?
Clot
33
What can happen to vessels over time?
Change in permeability, massive inflammation of the glomeruli
Glomerulonephritis
34
A bilateral inflammatory disorder of the glomeruli that typically follows a streptococcal infection
Get gunked up with purulent drainage and pus and that impedes good movement of filtrate into capsule so see major pain, swelling of glomeruli, purulent material in your urine
Glomerulonephritis
35
Hardening of those tiny capillaries
hardening of the glomeruli in the kidney. It is a general term to describe scarring of the kidneys' tiny blood vessels, the glomeruli, the functional units in the kidney that filter urea from the blood.
Glomerulosclerosis
36
can lead in stage renal failure, hardening and thickening of the glomeruli so decreased GFR
Chronic hypertension
37
Who gets vascular changes?
Diabetics have major vascular changes particularly in tiny vessels aka microvascular disease
38
Hemodialysis/kidney dialysis: Many are _____
diabetics
39
Autoimmune disorder like lupus can cause renal diseases
True
40
Once filtered, blood leaves nephron by way of the _______ arteriole. This vessel eventually empties into the venous system
Efferent
41
Why skinny efferent?
Thinner so it cant come out as fast ensuring good filtration is taking place, blood will take awhile to leave so we are going to ensure we have TIME to have good filtration, there is waste product in blood and we are going to rid it via tubule but this narrow efferent arteriole THIN in diameter allow long good filtration,
42
The Glomerular capillaries are _________
SEMIPERMEABLE
43
TO FILTER blood to eliminate waste, toxins, and excess fluid
Role of the glomerulus
44
Water
| SOME Electrolytes- not all potassium or sodium, etc
in the proximal tubule/filtrate
45
```
RBC’s
Unless pregnancy induced
hypertension, or have
nephrotic syndrome
Proteins, Albumin
Fibrinogen – Clotting factors
```
NOT in the filtrate
46
_____ syndrome is a kidney disorder that causes your body to excrete too much protein in your urine.
cause glomeruli to be too leaky spill protein
Usually caused by damage to the clusters of small blood vessels in your kidneys that filter waste and excess water from your blood. Causes swelling (edema), particularly in your feet and ankles, and increases the risk of other health problems
Nephrotic
47
Should glucose be in the urine?
No, unless you are diabetic then you may have some
48
20-25% of cardiac output flows through nephrons (1200 ml/min)
True
49
30-60mL an hour
| 1400mL a day
True
50
Blood Pressure
Osmolality of the blood: dehydration vs fluid overload
-Serum Osmolality: # of particles in blood
-Dehydration: Serum osmolality higher than 285
conserve fluid
-Fluid overload? Particles will be in a more dilute
situation, if you have too much fluid in blood stream,
serum osmolality will go down - serum osmolality
decrease so less than 285
Permeability of the membrane:Membrane of capillaries in the glomerulus
Stress Response
Factors that can alter glomerular filtration
51
Sodium level
135-145
52
What is normal serum osmolality?
serum sodium and multiply by 2 so it is around 285
53
serum osmolality decrease, less than 285
Volume excess
54
serum osmolality higher than 285
Dehydration
55
```
Stage 1 Disease - ≥ 90 = some kidney function, not yet on dialysis
Stage 2 Disease - 60-89
Stage 3 Disease - 30-59
Stage 4 - 15-29
Stage 5 - < 15
```
True
56
you need kidney transplant, you are on hemodyalis
Stage 4 and 5
57
______ tube-15 cm long, lined with millions of microvilli
Convoluted
58
Allows for REABSORPTION- movement of substances and fluid FROM tubule back into blood by way of the peritubular capillaries- VASA RECTA
"don’t send to goodwill, I like that shirt”
Proximal Tubule
59
Of the 180 Liters/day of filtrate, 99% is reabsorbed back into the blood
True
60
Electrolytes: NA+, K+. Cl-, HCO3-
Water- by OSMOSIS as a result of electrolyte reabsorption (How would you define osmosis?)
Glucose……Except…..
When the amount of glucose in the blood EXCEEDS the amount the tubules are able to reabsorb
Things that are reabsorbed
61
Movement of fluid, area of high to low concentration
Osmosis
62
```
Glucose is completely reabsorbed in the PCT as long as blood glucose is less than 200 mg/dl
Once glucose levels
are high enough can’t
suck back in blood so
then spill back in urine,
200 mark glucose in
the urine
```
Tubular Maximal Capacity
63
Blood glucose of 370, spilling in the urine what does glucose do to the fluid in his blood? It pulls ____ fluid
what would be the #1 tip off is he as diabetes? A lot of peeing (polyuria)
more
64
Glucose drawing fluid out of body and if losing all glucose in the toilet, blood glucose levels will go down = feel hungry =Polyphagia = starvation stage bc losing glucose = thirsty bc losing all that volume (polydipsia)
We reabsorb until 200
True
65
Contributes to maintaining Acid/Base balance by SECRETION of H+ ions
That is movement of H+ ions from the blood into the tubules
PCT
66
To maintain a normal pH, the body must get rid of excess hydrogen ions
True
67
The PCT also REABSORBS HCO3 making the blood more _______(
alkalotic
68
Kidneys chief regulator of fluid and electrolytes, exerts _____ pressure
OSMOTIC
69
90% of Na+ in filtrate (what goes into bowmans capsule, through tuft capillaries into proximal convoluted tubule) is reabsorbed
True
70
________ stimulates sodium reabsorption (secreted by adrenal cortex under control of angiotensin !!) and potassium excretion
Aldosterone
71
A hormone secreted by the adrenal cortex that increases blood volume by increasing the reabsorption of sodium in the kidneys, sodium attracts water. Increasing water reabsorption will increase blood volume. This is the principle mineralocorticoid
Aldosterone
72
Diuretics: Hydrochlorothiazide (HCTZ) blocks Na+ reabsorption – don’t retain sodium exits in urine with excess fluid
True
73
Estrogen increases reabsorption of water and sodium
True
74
Stimulates Na reabsorption particularly by when we need greater blood volume, we retain sodium which draws water in bloodstream which increase our blood volume that is circulating so in heart failure patient it’s not good bc not enough blood flow is being pumped from heart to kidneys so we have release of renin conversion of angio 1 to angio 2 and release of aldosterone and we reabsorb that sodium and water now that failing heart has more fluid and volume to pump
True
75
amount reabsorbed varies according to body’s need
Potassium
76
Potassium normal rang
3.5-5
77
Disruption of cardiac conduction,irritable cardiac cells, major life threatening dysrhythmias, lead to flat line
Reason to keep potassium in normal range
78
Potato, potato skins, oranges, bananas, dried fruit, certain salt substitutes, cantaloupes, raisins, lentils
Foods high in potassium
79
Patients in in stage renal disease lose ability to balance of potassium. Chronic renal failure will have prob with hyperkalemia bc they take in a quite bit of potassium but not good urine output to secrete potassium out
True
80
We will see that depending on serum potassium level, amount that is reabsorbed in PCT will vary so if we have high potassium then we might reabsorb less and get rid of more potassium. So if we have a low serum potassium, PCT will hang onto more potassium.
True
81
______is the primary intracellular cation
Potassium
82
Imp role in electrical conduction, acid-base balance, metabolism (carbohydrates, protein, glucose)
Potassium
83
Kidneys are responsible for excreting more than 90% of the total daily K+ intake
True
84
T wave becomes flattened and we begin to see U wave,
Hypokalemia
85
Nurse notices T wave becomes flattened and we begin to see U wave, and patient says to the nurse that her legs are cramping. Nurse also gave patient lasix. muscle cramping, weakness, nausea. What does the patient have?
Hypokalemia
86
What will the nurse do with abnormal EKG waves and cramping?
Assess, documents, notify doctor, lab values, serum potassium, expect low potassium
87
Muscle weakness, paresthesia, hyporeflexia, leg cramps, weak irregular pulse, hypotension, dysrhythmias (can be lethal), EKG changes- prolonged PR interval, depressed ST segment, flattened T wave and a U wave, decreased bowel sounds, abdominal distention, constipation or ileus, cardiac arrest
S/S of hypokalemia:
88
history physical examination, blood chemistry, 12-lead EKG and ABG’s. Management focuses on the ID and treatment of the cause (correcting any alkalosis), strategies are directed at increasing amount of potassium is administered for mild cases while diluted iv potassium is administered for more severe deficits
Diagnostic procedures for hypokalemia
89
_____ should be administered only after adequate urine flow has been established
Potassium
90
____ is NEVER administered by IV push; IV K+ must be administered DILUTED using an INFUSION PUMP-
Potassium
91
Why is potassium never administered by IV push?
Do not want to give patient too much potassium
92
Never syringe or iv port, if so putting patient in cardiac arrest and they could die
True
93
False high potassium
pseudohyperkalemia
94
Use of a tight tournequit around an exercising extremity while drawing blood
pseudohyperkalemia
95
Drawing blood above a site where K+ is infusing or patient exercising that extremity
pseudohyperkalemia
96
If patient receiving iv fluids with potassium in those IV fluids and draw blood in same extremity near site
pseudohyperkalemia
97
Addison disease causes _____
Hyperkalemia
98
Renal disease - Can't excrete potassium
Hyperkalemia
99
Damage to cell/trauma, burn, lot of blood transfusion. antibiotic like PNC that has potassium, crushing injury
Hyperkalemia, potassium leaves cells and goes to the bloodstream
100
How do we know patient has hyperkalemia?
Complain of paraesthesia, irritability, diarrhea, muscle weakness, peaked peaked T waves, prolonged Q T intervals
101
- Dialysis (draw off high potassium from blood),
- IV glucose amp D50 followed by regular insulin.
- insulin will carry glucose into the cells and also grabs potassium and carries it into the cells
Lowering Potassium
102
Does not really lower the potassium but it stabilizes the heart and keeps it contracted regularly because the high potassium can decrease activity of the heart. This medicine protects the heart.
Calcium Gluconate
103
As potassium levels go up, patients tend to go through _____ acidosis
Metabolic
104
Treatment for metabolic acidosis and hyperkalemia?
Sodium Bicarbonate
105
High potassium can result due to increase use of diuretic, = causes to get rid of excess fluid and cause potassium fluids go up
Potassium spearing diuretic (Aldactone-spironolactim)
106
Digoxin toxicity may have issues with potassium, either high or low
True
107
NSAID (ibuprofen, advil) cause _____
Hyperkalemia
108
K+ sparing diuretics (spironolactone) cause ____
Hyperkalemia
109
Normal Range: 8.5-10.2
Calcium
110
Exerts sedative action on nerve cells
Keep nerve cells quiet so they can do their job
If not enough calcium, nerves become irritable
Calcium
111
Plays key role in transmission of nerve impulses
Calcium
112
Regulates muscle contraction, and relaxation of heart rhythm
Calcium
113
Necessary for blood coagulation
Calcium
So if not enough calcium, then you may issues with clotting and bleeding
114
Dairy products, green leafy vegetables –kale, spinach, salmon, sardines, broccoli
Foods high in calcium
115
Calcium has a synergistic relationship with magnesium (calcium needs magnesium to fully function as well as balance its effects)
True
116
Levels of Calcium are regulated by the parathyroid hormones and calcitonin (a thyroid hormone)**
True
117
Common in Renal patients due to elevated phosphorous = can’t excrete phosphorus… so...
Hypocalcemia
118
Ca+ and Phosphorous have an INVERSE relation
| As phosphorous goes up, calcium goes down
True
119
Tetany- increased neural excitability (twitching), tingling (lips, side of face) all the way to SEIZURES
S/S of Hypocalcemia
120
+ CHVOSTEK’S & +TROUSSEAU’S
Hypocalcemia
121
Cardiac dysrhythmias
Hypocalcemia
122
______ glands watch calcium levels in the blood and when calcium levels drop
Parathyroid
123
______ gland is on alert & says “woah there’s not enough calcium in the blood, we have a problem, our patient has tetany then it says we gotta get calcium from somewhere-bone" (Hypocalcemia)
Parathryroid
124
Parathryoid gland release _____ hormone and it causes calcium to be pulled from the bone (Hypocalcemia)
Paratharmone
125
When calcium levels drop in renal patients due to phosphorous being too high, patients in renal failure can’t secrete phosphorus
True
126
When you tap on the 7th cranial nerve the mouth will pull up toward where you are tapping, tapping of nerve moves mouth up
--spasm or brief contraction of the corner of the mouth, nose, eye and muscles in the cheek indicated increased neuromuscular irritability
Positive Chvostek’s
127
When blood cuff is put on arm and the hand draws up into a claw like because we have exerted pressure on nerves that are already excitable, twitching and drawing up the hand,
-- The cuff is in place for about 3 mins. Test is considered positive for increased neuromuscular irritability if it elicits a carpal spasm.
Positive Trousseaus’s:
128
Correlate serum Ca+ with serum albumin
True
129
Medical emergency requiring IV calcium
| -Give slowly to avoid bradycardia that could lead to cardiac arrest
Treatment of hypocalcemia
130
Monitor for seizures/ provide safe environment
| Neurological damage
Treatment of Hypocalcemia
131
Airway management
Treatment of Hypocalcemia
132
______ are major route for phosphorous excretion
Kidneys
133
Normal level: 2.5-4.5mg/dl
Phosphorous
134
Necessary for muscle function, RBC production, nerve conduction, metabolism of carbohydrates, protein, and fat
Phosphorous
135
Too high level of phosphorous
Hyperphosphatemia
136
What causes hypocalcemia?
Hyperphosphatemia & Low Active Vitamin D
137
Renal function help activate and metabolize vitamin D therefore patient with renal failure will not have active vitamin D
True
138
What happens to a patient with hypocalcemia?
Phosphorous levels will increase, calcium level will decrease. Parathyroid gland will produce parathormone which will cause bone to release calcium and phosphate but most important calcium, calcium will be released to the blood.
139
In a hypocalcemia patient, Kidney will also try to reabsorb calcium but remember renal failure patient’s can’t reabsorb so we don’t see that happening much
True
140
If calcium is being pulled out the bone, patients will have _____
Osteoporosis
141
Renal Osteodystrophy/Osteoporosis: Patients with chronic renal failure will not have have stable bones
Hyperphosphatemia
142
Very susceptible to fracture
Hyperphosphatemia
143
Calcium deposited in sites throughout body where you normally wouldn't have calcium is called _____ (Hyperphosphatemia)
Calciphylaxis
144
High phosphorous levels will have inverse relationship = low calcium = parahtryoid will secrete parathormone will get calcium out of bone and cause bones to be weak and more likely to have fractures, will have hard things under skin like pebbles and skin will become irritated and sores will develop due to calcium rupturing through the skin (Calciphylaxis)
True
145
Horrible sores back of legs, inner thigh, bellys, wounds are hard to treat, can become infected, patients often do not survive
True
146
Overtime bc patients have poor reabsorption of calcium in bones, you will actually see the bones in the digits of the hand become harder to define, less calcium in the bones, bones are thinning, areas where you will see almost nothing due to ___
Lack of reabsorption of calcium in the bone bc its going out into the bloodsteam
147
Hyperphosphatemia: too high of a phosphorous bc can’t be excreted, patient not having good renal function, no urine output so can’t get rid of phosphorous
True
148
Parathyroidectomy
Remove parathyroid gland because that will stop the pulling of calcium out of the bone
149
Phosphate binders: Ex. Phoslo
w/ every meal patient will take a phosphate binder, these are big chalky like capsules. Phoslo binds the phosphorous in the gut and prevents phosphorous from being absorbed into the blood stream, binds high phosphorous foods in the GI tract and excrete via stool
150
Foods high in phosphorous
Hard cheeses, nuts, whole grains, dried fruits & vegetables, dairy products
151
Renal excretion of _____ keeps body’s level in check
Magneisum
152
Necessary for intracellular enzyme activity, carbohydrate & protein metabolism, neuromuscular function (nerve conduction and muscle contraction) particularly the heart
Magnesium
153
After MI may have irritability and dysrhythmias so will give patients _____
Magnesium
154
Diminished excitability of muscle cells- sluggish
Increase in magneisum
155
Increased neuromuscular irritability
Decreased magnesium
156
Magnesium and potassium are like sisters
True
157
Cardiac patients – If can’t get serum potassium levels up, magnesium will be given so if you have magnesium up then potassium will go up as well, they like sisters, same effects, too much magnesium will shut down the heart, too much potassium will shut down the heart, too little magneisum will cause heart to be irritable and dysrhythmia, too little potassium dysrhythmia as well
True
158
Give mothers magnesium to relax contractions**
True
159
Most common cause of hypermagnasemia
Renal failure
160
Why is renal failure the most common cause of hypermangasemia?
Bc can't excrete cus they got no urine output so hang up on magneisum
161
Hypermagnasemia patients need to avoid medication high in magnesium such as ___ __ _____
Milk of magnesia
162
Muscle weakness, lethargy, drowsiness, loss of reflexes-tapping of the knee-nothing happens, facial flushing, decreased blood pressure due to peripheral vasodilation
S/S of Hypermagnasemia
163
Hemodialysis: draw off the magnesium
IV calcium/ magnesium: protect heart
Avoid OTC medications
Ventilatory support
Treatment for hypermagnasemia
164
Heparin causes ___
hyperkalemia
165
**Chief role is concentration of the urine
In bottom of loop, osmolality is 1200 which is high
Loop of Henle
166
Chronic in stage renal disease: progressive, Low GFR rate
True
167
What disease would lead to in stage renal disease?
DIABETES (causes microvascular disease) Heart failure, hypertension (bc overtime high bp will make glomeruli thick so no good filtration)
168
More reabsorption of electrolytes, particularly Na+ by action of _____ and ____ (distal convoluted tubule)
Aldosterone and ADH
169
Sodium reabsorption happens in the distal convoluted tubule primarily under 2 hormones called aldosterone and ADH
true
170
What kind of patient will have increased aldosterone and ADH production?
They want these hormones being pumped into their body bc it would hold onto their fluid and bump up blood pressure-– Shock patients, hypovolemic shock, patient would be producing aldosterone and ADH bc blood volume is slow so we need to hang onto water so what better way to hang onto water to than to suck up sodium bc we know water follows sodium
171
occurs with brain tumors/surgery, what it means: overproducing ADH, so you are hanging onto fluid
Syndrome of inappropriate of ADH
172
Degree of dilution/concentration of urine -the number of particles dissolved per kg of urine
urine osmolality
173
Filtrate in glomerulus = Osmolality of blood (285-300) mmol/L
Getting ready to send It out to the tubule
True
174
This number varies as filtrate moves through tubules – loop of henle more concentrated
true
175
We can also do osmolality of the blood, number of particles dissolved per kg of blood, how concentrated is the blood, serum osmolality is 285-500mmol/L
Serum osmolality
176
In _____ stated, blood/serum osmolality is increased, urine output is decreased and urine is more concentrated/yellow = urine osmolality will also be high
dehydrated
177
In renal failure, the patient lose the ability to concentrate urine
True
178
***Overtime during in stage renal disease you will have NO urine output = great risk for heart failure and increase metabolic waste like ammonia and toxic particles they do not get rid of it =Impact thinking: confused, dull, fatigued, no erythropoietin so hemoglobin and hematocrit plumits, metallic taste, phosphorus levels go up so risk for fractures, skin probs-itchy, anemia, nausea, GI ptob
True
179
***_____ High serum and high urine osmolality, volume of urine output is decreased, high concentration
Dehydrated
180
Dialysis mimics the ____
glomeruli
181
Movement of a substance/fluid from tubule to Collecting Duct
Collecting Duct exits into pelvis of kidney
Into ____ then bladder
Excretion
182
```
Water products
Water
UREA
Creatinine
Uric Acid
Phosphates
Sulfates
Excess electrolytes
```
What DOES get excreted
183
a byproduct of protein metabolism
Burgers, chicken, protein source you will make UREA
UREA will
UREA
184
Everyday produce a certain amount of creatinine when you use your muscles, does not vary, same amount every day and you excrete through the urine,
GO UP if renal failure, if not getting rid then renal prob
Creatinine
185
BEST INDICATOR OF RENAL FUNCTION bc levels are the same
Creatinine
186
BUN = ______ for patients with chronic renal disease
Increases
187
Normal Bun Range
7-18
188
Will vary according to if you are dehydrated, protein intake, good indicator of renal function but ts NOT the best
BUN
189
BUN over age 60: age 60: 8-20 mg/dl
True
190
Influenced by protein intake, level of fluid balance, tissue breakdown
BUN
191
TPN: they can’t eat or absorb nutrients, so we put it in their central vein, comprised of lipids, carbs, proteins, can give magnesium or o/ electrolytes which will increase BUN that is why we want to be sure that we monitor _____ and _______
creatinine, BUN
192
Medications: steroids increase BUN
| Crushing injuring: increase BUN
True
193
End product of skeletal muscle metabolism
Creatinine
194
It is filtered at the glomerulus, passes through tubules with minimal change & is excreted in urine = which make it an ideal measure for renal function
EXCELLENT MEASURE OF GLOMERULAR FILTRATION RATE
Creatinine
195
0.6-1.2 mg/dl (0.5-1.0)
Normal range for creatinine
196
As serum creatinine increases, the amount of creatinine clearance decreases
Inverse relationship
197
As GFR decreases, greater decline of kidney function
True
198
How to assess creatinine clearance?
24 hour urine specimen is collected
***Ex: Start at 8am, discard first voiding, collect ALL of urine until 8am next day.
1st void you discard but from then on until 8am next morning you collect everything
Every time you pee, you need to collect it all day
199
If in renal failure, creatinine clearance will be decreased bc you’re not clearing as much creatinine now
True
200
If patient forgets to collect urine then have to:
start all over again
201
Midway through collection (8pm), a ____ creatinine is collected (part of formula)
serum
202
As GFR decreases, Creatinine Clearance will decrease and serum
Creatinine will ____
increase
203
_____ play major role to keep plasma pH
(indicator of hydrogen
ion concentration) at
7.35 – 7.45
Kidneys
204
Kidneys regulate the bicarbonate level in ECF by regenerating HCO3 ions and reabsorbing them from renal tubules into the blood
True
205
Kidneys also excrete excess acid into the _____ (about 70 mEqs/day)
urine
206
Urine pH
4.5
207
results from carbon dioxide retention. Which increases the amount of carbonic acid present and in turn decreases the pH level.
Respiratory acidosis
208
High PaCo2, high bicarbonate, compensated or decompensated
Respiratory acidosis
209
results from a deficiency of bicarbonate (base), or an excess of hydrogen (acid)
Respiratory acidosis
210
Low bicarbonate, low paco2, compensated or decompensated
Metabolic acidosis
211
Low bicarbonate, low paco2, compensated or decompensated
Metabolic acidosis
212
Renal failure patients cannot excrete or reabsorb bicarbonate so renal failure patients are retaining uric acids, other acids bc can’t excrete so their pH will _____ (less than 7.35),
the bicarbonate will go out the urine and won’t be reabsorbed in the blood, bicarb will decrease less than 22**** - they don’t make it or reabsorb it
decrease
213
_____ patients: Low pH, low bicarbonate, = metabolic acidosis = lungs will compensate by blowing off CO2, breathe rapidly and deeply to blow off CO2 = lowering co2 levels (lungs compensate bc kidneys aren’t healthy)
Renal
214
When body is in _____ state, the healthy kidney will excrete H+ ions and conserve HCO3 (Kidneys will make bicarb and reabsorb)
acidotic
215
In ____ state- kidney will reabsorb H+ ions and excrete HCO3
alkalotic
216
What imbalance would you expect to see in a patient who had lost renal function?
a) respiratory acidosis
b) respiratory alkalosis
c) metabolic acidosis
d) metabolic alkalosis
c) metabolic acidosis (bc kidneys can no longer or make bicarb and body is retaining all kids of toxic acids)-- Low pH & low Bicarb
217
Decreased pH and decreased HCO3
Metabolic acidosis
218
Headache, confusion, drowsiness, increased respiratory rate and depth (to blow off Co2 which makes carbonic acid), nausea and vomiting, peripheral vasodilation, decreased cardiac output if severe (7.2 and lower)
Metabolic acidosis
219
May also see hyperkalemia because K+ ions leave cell as more H+ ions enter the cell
Metabolic acidosis
220
We know that inside the cell, potassium lives in the cells, there is way more K in the cell than outside, when in an metabolic acidosis we have a lot of hydrogen ions in the blood bc pH is low so all these hydrogen ions are outside the cells and not so many in the cells so what happens is by movements of diffusion, hydrogen ions will go in the cell , hydrogen ions and potassium do not get along. Hydrogen ions flood the cells, potassium says “oh no they’’re moving in, I will not sleep with hydrogen ions, i’m leaving” so potassium moves outside the cells which increases
True
221
______ state: Hyperkalemic state so cardiac output drops which sedates heart, does not contract well. Can put patient in V tach then something Fib then fla tine
Metabolic
222
Patient missed his hemodialysis, nurse will worry about....
Potassium will be out the roof and potassium will be high af like 7.2
223
________- hormone necessary for production and maintenance of new
erythrocytes (RBC’s)
ERYTHROPOIETIN
224
Kidneys make erythropoietin when renal oxygen supply _____
Erythropoietin acts on bone marrow to produce RBC’s.
decreases
225
You would expect a patient in renal failure to have a(n) _____________ Hemoglobin level.
a. increased
b. decreased
b. decreased
226
A group of cells, the _______ apparatus, located in close proximity to the glomerulus are sensitive to blood pressure and Na+ levels.
juxtaglomerular
227
Juxtaglomerular release ______ when perfusion or pressure is low or if blood volume or Na+ levels are decreased.
_____ sets off a series of actions
RENIN
228
When blood flow (blood volume or sodium levels are decreased) to kidneys decreases the JGA releases Renin causes release of angiotensin 1 converts to angiotensin 2 cause major constriction = aldosterone, increase preload and afterload
True
229
2 ways to develop an acess
AV fistula
| AV graft
230
Surgically make an incision between an artery and a vein and then stitch it together. Now very large vessel that has the venous and arterial blood circulating in it but can withstand the pressure of pulling blood out of body going to the machine.1 This is called __ _____. vessel would not be able to withstand the pressure
Av fisutla
231
Patient care of patients with fistulas?
Never take bp on arm they have fistula, bc would occlude blood flow,
no elastic clothing that will be restrictive,
dont carry purses on arm,
dont sleep on their arm
232
This type of access lasts the longest and has the least risk for infections.
AV Fistula
233
For people whose arteries or veins can’t be sewn together, a piece of special plastic (called a __ _____) is used to connect them. Because there is no need to wait for the vein “to develop”, it can be used relatively quickly (days instead of weeks). Unfortunately, it doesn’t last as long as an AV fistula and it is still a risk for a serious infection
Graft
234
For both AV fistula and AV graft
Check for infection
Assess arm for heat, pain, redness for infection and inflammation – nurse will use mask and chlorehexedine and clean site real hard before putting needle in
235
*Palpate for a Thrill: Feels much like a “purring” kitten
Auscultate for a Bruit:
Sounds much like a loud “whoosing” sound. Use Bell of Stethoscope
Assessing Grafts and Fistulas
236
Make sure your nurse or technician checks your access before each treatment.
Keep your access clean at all times.
Use your access site only for dialysis.
Be careful not to bump or cut your access.
Teaching for those who have an access
237
Don’t let anyone put a blood pressure cuff on your access arm.
Don’t wear jewelry or tight clothes over your access site.
Don’t sleep with your access arm under your head or body.
Don’t lift heavy objects or put pressure on your access arm.
Check the (distal) pulse in your access every day.
Teaching for those who have an access
238
If access gets infected, patient may have -----
Endocarditis major infection
239
Disturbances of lipid metabolism – hypertriglyceridemia- increased incidence of atherosclerotic cardiovascular disease
--Huge risk for
atherosclerotic disease
Anemia/fatigue – don’t make erythrop.
Gastric ulcers/GERD/indigestion = Bad with digestion. GI issues
Renal osteodystrophy-bone pain/fractures
Fluid Overload-Heart Failure
Complications of Hemodialysis
240
Malnutrition- don’t really want anything
Infection – systemic/ access site,
Neuropathy: phosphorous level make skin itch,
Pruritus
Sleep disturbances
Hypotension: will see BP drop, N/V, tachycardia, diaphoresis
Complications of Hemodialysis
241
If have to remove more than 2 L in a day patient will not tolerate well..
Bp drops, nausea, weakness
242
1kg = 1 L = __mL
1000
243
We have to help in stage renal disease patients they just cant take in major fluids, its restricted, 12000-1500mL per day**
True
244
Muscle Cramping
Exsanguination
Cardiac Dysrhythmias
Air embolism – not putting hemodialysis correctly
Complications of hemodialysis
245
As fluid is removed from extracellular space = cerebral cellular fluid will shift.
Dialysis Disequilibrium Syndrome
246
Headache, N/V, restlessness, decreased LOC, seizures
Dialysis Disequilibrium Syndrome
247
The peritoneal membrane is semi-permeable
Involves a series of EXCHANGES: infusion- 5 to 10 minutes to instill 2 Liters, dwell- approximately 6 hours to allow diffusion and osmosis to occur
drainage- 10 to 30 minutes
Continuous Ambulatory Peritoneal Dialysis
248
Drainage is clear, colorless/straw-colored
CAPD
249
_____: Dextrose Solution of 1.5%, 2.5%, or 4.25
Dialysate
250
Why is Dextrose used for the dialysate and not normal saline?
Dextrose is Hypertonic and we are trying to increase osmotic gradient
The Higher the dextrose solution, the greater osmotic gradient, and the greater water removed.
251
If I happen to be 8kg overweight, what kind of solution will they want to use?
4.25 bc wanna be able to draw off a bit
252
Peritonitis (INFECTION) - most common problem and most serious complication
Usual Offenders: Staphylococcus aureus and Staphylococcus epidermidis
Gm - : Pseudomonas aeruginosa, E.coli,
Klebsiella
Risks of CAPD
253
Cover vents so that there aren’t air particles, wear mas, gloves
If doing it procedure in the hospital – close door, close the vents w towels to do the exchange
CAPD
254
Cloudy drainage with clots, fragments
Diffuse abdominal pain, rebound tenderness
Fever
Positive drainage cell counts = indicator of peritonitis (send urine to be analyzed)
Treatment: antibiotics
Recurrent: pull it out, have to go back to hemodialysis
Signs and Symptoms of Peritonitis
255
PREVENT FIRST: during exchange wear mask/gloves, use sterile technique when connecting/disconnecting ports. Close/cover air vents and close doors.
3 rapid exchanges of 1.5% dextrose solution
to flush mediators of inflammation
Obtain cell count, C&S
Antibiotics: Aminoglycosides/ Cephalosporins
Heparin to prevent fibrin clot formation
Treatment of peritonitis
256
Hypertriglyceridemia: these patients need to be closely monitored and treated for hypertension, CAD;
Benefit of antihypertensives, aspirin, and agents to lower cholesterol
Abdominal hernias, low back pain, anorexia, constant sweet taste
Complications of CAPD
257
Frequency: more than every 3 hours
Urgency: strong desire to void
Hesitancy: delay, difficulty in initiating voiding
Nocturia: excessive urination at night
Dysuria: painful or difficult voiding
Hematuria: red blood cells in urine
Proteinuria: abnormal amounts of protein in urine
Oliguria: urine output less than 400 ml/day
Anuria: urine output less than 50 ml/day
Incontinence: involuntary loss of urine
Enuresis: involuntary voiding during sleep
Just terms
258
```
When fluid intake is normal, specific gravity should be:
A. 1.000
B. Greater than 1.045
C. 1.003 – 1.030
D. Less than 1.010
```
C. 1.003 – 1.030
259
We insert a contrast dye into the vein and then under xray, we watch that dye as we disperses in the kidney and it kinda lights up in the xray to see if there are renal stones or are stenosed portion, so IVP helps to see the whole pathway of urinary tract.
Intravenous Pyelography
260
During intravenous pyleography, patient will tell you they feel hot flushed sensation, almost scary
This is expected
261
For some patients, contrasts agents may be nephrotoxic and allergenic reaction
Have available: Epinephrine, corticosteroids (anti-nflammatory), vasopressors, airway and suction equipment
Obtain allergy history & notify radiologist and physician
Patient Care During IVP
262
Metformin for diabetics: combo of metformin and dye = lactic acidosis and renal failure
during IVP
263
Contrast Agents should be used VERY cautiously in elderly, those with diabetes mellitus (Metformin should be discontinued 48 hours prior to testing with contrast media), renal insufficiency, volume depletion, multiple myeloma
Teach patients prior to testing: They will most likely feel flushing sensation, warmth, unusual taste when solution is injected
Post procedure: monitor urine output
Patient care IVP
264
is a special type of X-ray picture that helps doctors see the blood vessels in your kidneys
Renal Arteriogram
265
**Pre-Procedure: laxative to evacuate colon so unobstructed views can be obtained
Shave and prep groin site
Mark pulses = peripheral pulses bc we could occlude blood flow to the extremities
Teach brief sensation of heat
Renal Angiogram Care
266
Monitor vital signs
Examine injection site for hematoma, swelling, apply sandbag, ice bag to ensure there is not a hematoma
Check pulses peripheral distal to stick*****
Post Renal Angiogram
267
an instrument inserted into the urethra for examining the urinary bladder
Cystoscope
268
Allows visualization of urethra and bladder
Ureteral catheters can be passed through _____ to see into ureters and even pelvis of kidney
Cystoscope
269
Biopsy may be obtained, Small calculi can be removed
For lower tract exam, patient is awake; viscous lidocaine is used
Cystocope
270
POSTEXAM:***Monitoring for fever, chill, hematuria, burns = UTI
Cystocope
271
Sedatives and short term anesthesia to prevent muscle spasms when scope is being passed
Patient NPO several hours before test
Post procedure: Expect burning on voiding, blood-tinged urine, frequency
Warm showers may be helpful
Upper cystocopy
272
MONITOR FOR S/S OF INFECTION – fever, chills, hematuria, will have bladder spasm
Upper cystocopy
273
Done in the back, near flank area, tip of needle scissor like retractor which will allow to grab piece of tissue to put on slide to see analysis
Renal biopsy
274
Pre: Coagulation Studies- PT, INR, PTT, Platelets
NPO 6 to 8 hours prior to test
IV access
Urine specimen
Instruct patient to hold breath
Care of Renal Biopsy Patient
275
if prolonged bleeding time, then biopsy will not be happening, will biopsy happen?
no
276
Bedrest 6 to 8 hours,
Prone position immediately after
Monitor vital signs q 5 to 15 min for first hour,q 30 minutes second hour then q 1 hr x 2
= bleeding the most and see changes the most
Monitor for hematuria, backache, shoulder pain, abdominal aching, or dysuria
Post Renal Biopsy Care
277
Hgb & Hct within 8 hours
Inspect all urine
Push fluids – 3000 mls/day
Avoid strenuous activity or lifting for at least 2 weeks
Don't lift anything more than 8 pounds for 2 weeks
Post Renal Biopsy Care
278
What vital sign changes would occur with bleeding?
Hypotension & tachycardia (patient may go into circulatory shock)
279
________ is a test used to look for problems with the filling and emptying of the bladder.
Cystometrogram
280
How bladder handles the pressure of the fluid
Insert scope and Graphic recording of pressures in bladder during bladder filling and emptying
Cystometrogram
281
Helps diagnose stress incontinence
Cystometrogram
282
Describes loss of urine from pressure (stress) exerted on the bladder by coughing, sneezing, laughing, exercising, or lifting something heavy
Stress Incontinence
283
2 different types of disorders
1. Neurogenic disorders
| 2. Non-neurogenic disorders
284
Bladder dysfunction caused by an interruption of normal bladder nerve innervation
--CVA, Dementia,
Diabetes, Multiple
Sclerosis, Parkinson’s
Neurogenic Disorders
285
What kind of disease is Spinal Cord Dysfunction: Acute injury or Degenerative disease?
Neurogenic Disorders
286
Overactive bladder, Post surgery, Stress incontinence
| --Stroke problem,
Non-neurogenic Disorders
287
Caused by trauma or damage to nervous system/spinal cord (multiple sclerosis & diabetes) for both empty bladder by way of catheterization
Reflex incontinence
288
Result in a flaccid bladder that fills until it “leaks”
- Nerve that goes from anterior horn of spinal cord to the muscle/bladder
- Bladder/muscle is flaccid no more control of bladder, it fills and fills until leaks,
- Need catheterization to drain the bladder
Lower motor neuron injury
289
damage to the reflex arc
Lower motor neuron injury
290
- Spinal cord lesion above the voiding reflex arc; results in a spastic bladder
- brain until anterior horn of spinal cord
- CNS control
- Spastic bladder so it is always contracting (not strong) constant contracting so often urine dribbling
- Not good contraction of bladder so does not fully empty so need catheterization to empty it
Upper Motor Neuron Injury
291
In motor neuron injury patients, some need a bladder training program and have to sometimes catheterize themselves in order to adequately drain bladder and prevent UTI.
True
292
```
Strong urge to void that cannot be suppressed followed by involuntary loss of urine; often individuals have only a few seconds warning.
--Occurs with urinary
tract infections,
neurologic dysfunction
(Parkinson’s disease,
Alzheimer’s, Stroke),
nervous system
damage (multiple
sclerosis)
```
Urge/Overflow Incontinence
293
Urge Incontinence with no known cause
Overactive bladder
294
```
involuntary loss on urine due to over distention of bladder- may see dribbling because of a flaccid bladder, urethral damage, or diabetic neuropathy, tumors or obstructions, prostate conditions
--Inability to empty the
bladder/retention
--May also see weak urine
stream
```
Overflow Incontinence
295
urinary tract is intact but other factors involved – physical or mental impairment prevents toileting in time: Example- a person with severe arthritis may not be able to undress quickly enough to prevent incontinence.
Functional Incontinence
296
involuntary loss of urine due to extrinsic factors- medications like alpha adrenergic blockers that relax bladder neck to point where urine leaks with even minimal pressure
Iatrogenic:
297
What are the risk factors for developing urinary incontinence?
1. Being female
2. Advancing age
3. Overweight
4. Smoking
5. Other diseases (renal disease, diabetes)
298
DRIPS = causes of acute urinary incontinence
```
D = delirium, dehydration, diapers
R = retention, restricted mobility
I = impaction, infection, inflammation
P = Pharmaceuticals- opioids, calcium channel blockers, anticholinergics cause retention, alpha-adrenergic antagonists cause urethral relaxation, diuretics increase urine production, antidepressants have anticholinergic effects
S = Stool impaction (Constipation)
```
299
Treatments for incontinence
1. Determine the cause: history taking, urodynamic testing (cystometrogram – looking at filling pressures of bladder)
2. Biofeedback, behavioral therapy/bladder training
3. Scheduled toileting (helpful in elederly)
4. Anticholinergic agents: Ditropan, dicyclomine—blocks acetylcholine and an effect of this is urinary retention so these drugs are long acting are better with less cognitive decline in elderly. What would these do to bladder contraction?
5. Tricyclic Antidepressants: May have a urinary functions ex are nortriptyline, doxepin
6. Pseudoephedrine for Stress incontinence
7. Estrogen- restores mucosal, vascular, and muscular integrity to urethra
300
Strategies for management (Incontinence)
1. Be aware of fluid intake and times
2. Take diuretics in AM
3. No caffeine, alcohol, or aspartame (nutrasweet)
4. Avoid constipation
5. Void regularly
6. Pelvic floor exercises
7. Stop smoking- leads to coughing-leads to incontinence
301
Kidney stones aka ______/______:: You can have them in the ureter, pelvis of kidney, or calyces of the kidneys, can be anywhere a long the urinary tract
Urolithiasis-Nephrolithiasis
302
Stones or ____ in the urinary tract: Occur when substances like calcium oxalate, calcium phosphate, and uric acid
calculi
303
- Theory: Can form when deficiency of substances such as citrate or magnesium exist (These prevent crystallization of urine)
- Theory: Can form when patient in dehydrated state
Theories of Urolithiasis-Nephrolithiasis
304
Causes of ______: infection, stasis of urine, immobility, increased calcium
Urolithiasis-Nephrolithiasis
305
-Hyperparathyroidism
-Cancers
-TB or sarcoidosis-these cause increased Vitamin D production by the granulomatous tissue
-Excessive dairy intake
Leukemias, multiple myeloma: increased bone marrow production of blood cells
-Gout-uric acid stones
-Proteus, Pseudomonas, Klebsiella-cause struvite stones produced in a ammonia-rich urine
-Inflammatory bowel disease, ileostomy patients- absorb more oxalate
-Medications: antacids, laxatives, Diamox, high doses of aspirin
Causes of stone development
306
Myth is that most stones are made form calcium so let’s not tell patients to avoid dairy or calcium products
True
307
Only men get renal calculi: Not true, women can have them, eating certain foods will not cause kidney stones, some are just susceptible, high uric acid stones which you typically have
Eating certain foods will cause clculi to form: Eating certain fods will not cause calculi to form in persons who are not already susceptible to their formation.
- Most renal calculi form from calcium so dietary intake of calcium should be reduced: studies have shown that low calcium diets are not effective and may actually be harmful because they tend to increase the likelihood of low bone density and osteoporosis. More rather than less is better Normal intake is bettter
- Final myth if patient is most likely to have kidney stones, then they are likely to have gallstones – NOT true, NO relation.
True
308
- INTENSE deep pain in the Costovertebral region (in the pic, if have kidney then will CVA tenderness)
- Hematuria, foul-smelling
- Nausea, vomiting
-Spasming; renal colic/colicky pain (pain
fluctuates in intensity lasting
20-60 minutes)
-Fever, chills
signs/symptoms of Urolithiasis/Nephrolithiasis
309
- **Opioids and NSAID’s for pain
- **Fluids, fluids, fluids
- Dietary restriction of protein, sodium, perhaps calcium
- Protein diet linked to increased urinary excretion of calcium and uric acid
Medical treatment for Urolithiasis/Nephrolithiasis
310
NSAID’s inhibit prostaglandin E which causes _______ of ureters and increases renal blood flow
contraction
311
```
Medical treatment for ___________: low purine foods; avoid shellfish, anchovies, asparagus, organ meats, mushrooms-
-Treat Gout and for
Uric Acid stones: Take
allopurinol (Zyloprim) –
Decrease uric acid
production
```
Uric Acid Stones
312
Avoid spinach, strawberries, rhubarb, chocolate, tea, peanuts, wheat bran
Oxalate Stones
313
Calcibind, thiazide diuretics: Raise calcium levels so if we have calcium stones we will take patient off of these drugs
True
314
Extracorporeal Shock Wave Lithotrypsy
Disintegrating calculi
315
Delivering shock waves over the kidney area and that will cause busting up the major stones that could not otherwise be eliminated by voiding,
Extracorporeal Shock Wave Lithotripsy-
316
Noninvasive procedure to break up stones
May or may not use anesthesia, depending on size of stone and number and intensity of shock waves
Strain urine after procedure; look for stone fragments
Observe s/s of infection
Extracorporeal Shock Wave Lithotripsy
317
May also perform a
| percutaneous nephrolithotomy IF
If cannot be broken down by ESWL
318
Males more than females: (3 to 1)
50-70 years of age
More common in Caucasians
4th leading cause of death in males
Main Cause: cigarette smoking (people who smoke get bladder cancer twice as much as those who do not)
Cancers arising from prostate, colon, and rectum may metastasize to bladder.
bladder cancer
319
Visible, painless hematuria
Bladder cancer
320
Sometimes UTI, frequency, urgency and dysuria
Alteration in voiding pattern
Bladder Cancer
321
- environmental carcinogens
- High cholesterol
- pelvic radiation – for treatment of prostate cancer
Risk factors for Bladder Cancer
322
Cystoscopy
CT scan
Biopsy
Examination
Bladder tumor antigens, other markers
Diagnostic evaluation of bladder cancer
323
Cauterization of simple benign epithelial tumors
Cystectomy or removal of the bladder
Radical cystectomy in male: removal of bladder, prostate, and seminal vesicles
Also consider transurethral resection of bladder tumor, radiation, and chemotherapy
Management of Bladder Cancer
324
Combination of methotrexate, 5-fluorouracil, vinblastine, doxorubicin (Adriamycin), cisplatin
Chemotherapy for bladder cancer
325
instillation of antineoplastic agent directly into bladder-BCG-Bacillus Calmette Guerin- most effective intravesical agent for recurrent bladder cancer because it enhances body’s immune response to cancer.
BCG = instill this agent into the bladder
Topical chemotherapy
326
6 week course of weekly instillations
Followed by a 3 week course at 3 months in tumors that do not respond
BCG has 43% advantage in preventing tumor recurrence, compared to 16-21%
advantage with other intravesical agents
Patient retains intravesical solution for 2 hours before voiding
At end of procedure, patient must drink fluids liberally to flush medication from bladder
BCG-Bacillus Calmette Guerin
327
Immediately post-op: monitor urine hourly
Need to see more than 30 mls/hr
Catheter may be inserted through conduit if prescribed by MD
Stents may be placed in ureters to ensure urine flow
Bladder removal post op
328
When bladder has been removed, what do you do to help them eliminate urine?
Formation of ileal conduit (Illeostomy), this includes taking 2 ureters stitching them to a part of the bowel, a segment of ileum is removed and we stitch the 2 ureters to that segment of ileum, we bring ileum to the front of abdominal cavity which is formed into a stoma. Kidneys make urine, drains into ureters, illeal conduit, outside of body via stoma, bag sealed over stoma, collected in the bag is the urine.
we may have to place stents in the ureters to keep them open to ensure good urine flow
329
____ should be beefy red;
| If dark, purple indicates decreased blood supply
Stoma
330
Inspect skin for irritation, bleeding, encrustation
Keep urine acidic (pH below 6.5)
May prescribe vitamin C
Patient may be prescribed ascorbic acid po
Will see large amounts of mucus mixed with urine so it will look like urine – tell patient to be well hydrated so stoma will not be clogged
Avoid foods that have an odor like asparagus, fish
Stoma Care
331
Straw colored fluid like urine but you will see strands of mucous, does NOT mean patient has UTI bc inner lining of ileum produces mucous
True
332
Surgical procedure, not used often anymore. Part of the intestine and forming a pouch/stoma
surgically-created urinary diversion used to create a way for the body to store and eliminate urine for patients who have had their urinary bladders removed as a result of bladder cancer, pelvic exenteration, bladder exstrophy or who are not continent due to a congenital, neurogenic bladder.
Indiana pouch
