Renal System Flashcards
(124 cards)
1
Q
Glomerulus
A
ball of capillaries that exchange nutrients and oxygen; capillaries are permeable
- small (water, electrolytes, waste, BUN, creatinine) get pushed through
- Large (proteins, RBCs) cannot get through
2
Q
Glomerular filtration rate
A
125 ml/min
3
Q
tubular function
A
regulation of water balance/electrolytes
acid base balance
eliminate unnecessary substances from blood
4
Q
erythropoietin
A
stimulates RBC production
5
Q
Vitamin D
A
activated by kidneys when there is a deficiency in Ca - weakens the bones
6
Q
Renin
A
important in maintaining BP
7
Q
Prostaglandins
A
protective factor of the kidneys
blocked by steroids and NSAIDS
8
Q
Aging Process of Kidneys
A
decreased renal blood flow r/t atherosclerosis (calcified and narrowed)
Decreased ability to concentrate urine (UTIs0
Under normal conditions continue to maintain homeostasis
9
Q
Aging Process of Ureters, Bladder, Urethra
A
female urethra, bladder, pelvic floor has a loss of elasticity = incontinence
men may have enlarged prostates which causes urinary hesitancy and retention, bladder infections
10
Q
First s/s of UTI in elderly
A
change in mental status
11
Q
Assessment of Urinary System
A
Health Hx
Meds - a lot are nephrotoxic
Surgery
Functional Health Patterns:
- nutrition
- elimination pattern (number, amount, color, odor)
- activity/exercise
- sleep
- cognitive-perceptual pattern
- self-perception
12
Q
Urinary System Assessment: Inspection
A
Skin - dehydration, coloration issues r/t removal of BUN (yellowish)
Mouth -wounds
Abdomen - distention, heaviness, bladder distention
Weight - daily weight (fluid status)
13
Q
Urinary System Assessment: Palpation
A
Kidney - sometimes can palpate in really thin people
Bladder - feel distention -> rely on scanner more now
14
Q
Urinary System Assessment: Percussion
A
Flank area (blunt percussion) - costovertibral area (pain = kidney infection)
15
Q
Urinary System Assessment: Auscultation
A
abdominal aorta and renal arteries = bruites
16
Q
Anuria
A
no urine output
- usually in dialysis pt’s
17
Q
dysuria
A
pain/burning on urination
18
Q
enuresis
A
bed wetting
19
Q
frequency
A
urge to urinate
20
Q
hematuria
A
blood in the urine
21
Q
nocturia
A
night time urination
22
Q
oliguria
A
decreased urine output
23
Q
polyuria
A
urinating a lot
24
Q
hesitancy
A
difficulty starting to urinate
25
BUN levels
6-20 mg/dl
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Creatinine levels
0.6 - 1.3 mg/dl
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Bun/Creatinine ration
12:1 - 20:1
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Sodium levels
135-145 mEq/L
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Potassium levels
3.5-5.0 mEq/L
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Calcium levels
8.6-10.1 mg/dl
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Phosphorus levels
2.4-4.4 mg/dl
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Bicarbonate levels (HCO3)
22-26 mEq/L
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pH levels
7.35 - 7.45
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PaO2 levels
80-100 mmHg
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SaO2 levels
93 to 100%
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PaCO2 levels
35-45 mmHg
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Urine Dx Studies
urinalysis
Creatinine clearance: 70-135 ml/min --> 24 hr test
```
urine culture >100,000
Protein dipstick 0 - trace
specific gravity:
- very low = diabetes insipidus
- very high = SIADH
```
38
Specific Gravity
1.003 - 1.030
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Dx Study: Kidneys, Ureters, Bladder (HUB)
x-ray to look at the structures
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Dx study: Intravenous Pyelogram
IV contrast given to highlight areas (kidneys, ureters, bladder)
Need to know: allergies and kidney function b/c dye is nephrotocxic
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Dx Study: Renal Arteriogram
looking at the arteries; blood flow
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Dx Study: renal ultrasound
best choice - no pain, not invasive
Looks for structural abnormalities and blood flow
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Dx study: renal biopsy
collecting a sample using a needle
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Dx study: Cystoscopy
examining the bladder with a scope
May have hematuria afterwards; UTI if bacteria gets in
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Classifications of Renal disorders
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Hereditary
Infectious
Obstructive
Immunological
Degenerative
Tumors and Traumas
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Polycystic Kidney Disease (PKD)
inherited autosomal dominant or recessive trait
- fluid filled cysts in epithelial cells of nephron (both kidneys), replace normal kidney tissue with non-functioning cysts; kidney enlarge
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Symptoms of Polycystic Kidney Disease
HTN, abdominal or flank pain/heaviness, nocturia, hematuria
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PKD Dx. studies
CT scan, IVP, ultrasound, urinalysis for proteinuria, hematuria, serum creatinine, BUN, urine culture
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PKD management
control infection, diet modifications (restrict Na), fluid restrictions, antihypertensives
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PKD Treatment
nephrectomy (to relieve pain), kidney transplant (new kidney will not get PKD)
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Upper UTI
Renal parenchyma, pelvis, ureters
Acute pyelonephritis vs. Chronic
MOST ARE ACUTE!
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Acute Pyelonephritis
Upper UTI -> Kidneys
| Begins in the renal medulla and spreads to the cortex; begins w/ infection in the lower tract that made its way upward
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Chronic Pyelonephritis
Upper UTI
| Kidneys become small, atrophied, loss of function b/c of scarring - can cause renal failure
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Lower UTI
bladder storage or emptying problems
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Urethritis
Lower UTI
inflammation of the urethra (usually males if it is infectious)
-Usually STD's in males
(Trichamonas, monilial infection, chlamydia, gonorrhea)
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Cystitis
Lower UTI
inflammation of the bladder
*Traditional UTI - bacterial infection causing a bladder infection
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Uncomplicated UTIs
lower UTI (bladder), not systemic, female, no structural abnormalities (no foley, kidney stones, strictures), normal immune system, not hospital acquired
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Complicated UTIs
Risk for urosepsis, pyelonephritis, renal damage
Male
Diabetics
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Initial Infection
one infection thats treated and goes away
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Recurrent UTI
one infections thats treated and goes away but comes back
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Predisposing Factors for Infectious Disorders
factors increasing urinary stasis, foreign bodies (catheters), anatomic factors (females have shorter urethras, males may have BPH causing a UTI), compromised immune system, functional disorders, and other factors such as hygiene, sexual intercourse, and being in the hospital
62
Clinical Manifestations of Lower UTIs
dysuria, frequent urination, urgency, suprapubic pressure, hematuria, cloudy appearance, odor
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Clinical Manifestations of Upper UTIs
All Lower UTI's s/s
PLUS: flank pain, fever, chills, N/V
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Dx assessment/studies of UTIs
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costovertebral tenderness (flank pain) -> UUT
Bacteria in the urine, IVP, CT, CBC, imaging studies
```
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Collaborative Care for UTIs
Meds: Pyridium (stains bodily fluids ORANGE); Trimethoprim/sulfamethoxazole, Fluoroquinolones
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Acute UTI interventions
adequate fluids
avoid caffeine, alcohol, citrus fruit, chocolate, spicy foods
local heat to suprapubic area/lower back
watch for changes:
- urine (color, consistency, amount)
- fever (recurrent -> change antibx)
- Flank (Pain - change antibx)
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UTI prevention
good hygiene, adequate fluid intake, use bathroom when needed, use bathroom after sexual intercourse, proper hand washing, taking out catheters when not needed
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Immunologic Disorders
Acute or Chronic glomerulonephritis
immune process, antibody induced injury
affects both kidneys equally
usually from STREP
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s/s of immunologic disorders
hematuria, increased WBC, casts, proteinuria
increased BUN and creatinine
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Acute post streptococcal glomerulonephritis
re throat of 5-21 days ago; usually from untreated B-hemolytic streptococci
urine - electrolytes, protein
serum - BUN, creatinine
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acute post streptococcal glomerulonephritis s/s
periorbital edema, body edema, HTN, oliguria, hematuria, rust, abdominal or flank pain
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acute post streptococcal glomerulonephritis treatment
conservative: rest, fluid restriction, BP management, diuresis
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Nephrotic Syndrome
glomerulus is excessively permeable to plasma protein, proteinuria, low plasma albumin, general issue edema
excessive protein loss, hypercoagulation, elevated cholesterol
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nephrotic syndrome treatment
edema: fluid and sodium restriction, I&Os, daily weight
Thromboembolism: anticoagulants
Cholesterol elevation: meds to lower
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Obstructive Disorders
Nephrolithiasis/Urolithiasis
stone formation anywhere in the urinary tract
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obstructive disorders s/s
abdominal or flank pain, hematuria, N/V, fever, chills
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obstructive disorders dx tests
urinalysis and CT scan
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obstructive disorders treatment
1st: pain, infection, obstruction
2nd: cause of stone
3rd: endourologic procedures and surgery if stone is too large to pass
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Urinary Tract Calculi tx
dietary modifications, adequate hydration, varies depending upon stone composition
Avoid foods: high sodium (canned soups), colas, coffee, teas , purine foods, oxalate foods
80
Purine foods
high in uric acid
sardiness, liver, herring, mussels, venison, kidney, beef, chicken, pork
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oxalate foods
dark roughage, spinach, cabbage, asparagus, beets
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lipotripsy
shockwaves to break up stones; often place stents as well
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ureteral strictures
ducts that carry urine from the kidney to the bladder; secondary to surgical interventions that form scar tissue
threatens kidney function
84
ureteral strictures s/s
Mild colic, decreased output
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ureteral strictures dx studies
IVP
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ureteral strictures tx
dilation and stent, nephrostomy tube, excision and reanastomosis of the ureter to the renal pelvis
87
urethral stricture
obstructive disorder
caused by trauma, infection, congenital defect
repeated STI infectinos
88
urethral stricture s/s
diminished force of stream, straining to void, post void dribbling, incomplete bladder emptying, difficulty inserting a catheter
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urethral stricture dx studies
retrograde urethrography (RUG), voiding cysturethrography
90
urethral stricture treatment
dilation and stent
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urethral stricture teaching
self cath for dilation, urethroplasty
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Nephrosclerosis
sclerosis of small arteries and arterioles of the kidney
"hardening of the kidney arteries"
dx: HTN screening
Tx: control HTN
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nephrosclerosis risk factors
HTN, atherosclerosis associated w/ aging
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diabetic nephropathy
damage of small blood vessels that supply the glomeruli
dx: microalbuminuria in the urine and serum creatinine
tx: control glucose and HTN w/ ACE inhibitors
95
diabetic nephropathy risk factors
HTN, smoking, chronic hyperglycemia
96
Renal Trauma
minor: contusions, small lacerations
major: lacerations to cortex, medulla, or renal artery/vein
risk factors: sports, vehicle, falls, GSW, abdomen and flank areas
dx tests: IVP, MRI, arteriogrhy; screening for kidney trauma w/ urine sample
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renal trauma s/s
hematuria
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renal cancer risk factors
smoking, familial, obesity, HTN, exposure to chemicals and end stage renal disease
dx: IVP, ultrasound, CT, MRI
tx: radical nephrectomy, radiation therapy, chemo
99
renal cancer s/s
incidental findings, hematuria, flank pain, mass, HTN, weight loss, anemia
100
bladder cancer risk factors
transitional cell carcinoma
smoking, exposure to dyes (rubber), radiation for cervical cancer (close to bladder)
dx: urine for cytology, IVP, ultrasound, CT, MRI
tx: surgery, radiation, chemo, intravesical therapy
DIVERSION devices when taking out the bladder
101
bladder cancer s/s
dysuria, frequency, urgency, hematuria (mimics UTI s/s)
102
Nephrostomy Tube
drainage tube inserted directly ingot he kidney for removal of urine
always ensure unobstructed drainage
risk for infection, skin irritation at tube site, occlusion
nurses DO NOT flush tube
103
Suprapubic Tube
drainage tube directly into the bladder for removal of urine; bypasses the urethra
always ensure unobstructed drainage
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Ileal condiut
urinary diversion
portion of bowel is resection, ureters are implanted into part of the ileum; abdominal stoma, external pouch at all time
should be beefy, red
105
continent urinary diversion
urinary diversion
intraabdominal urinary reservoir replaces the bladder, reservoir constructed from ileum or bowel
emptied by self cath every 4-6hrs
needs to be irrigated regularly to prevent closure
106
orthotopic bladder reconstruction
urinary diversion
construction of new bladder from the bowel, reservoir replaces the bladder, elimination via the urethra
need to train the new bladder
107
Renal surgery - post op
shock - from blood loss; respiratory complications (pneumonia); obstruction of urine, infection, thromboplebitis (DVTs), small bowel obstruction (scar tissue formation can cause obstruction)
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renal surgery post op nursing interventions
urine output: q1-2hrs, more than 1 catheter, dressing,daily weight
respiratory: pulmonary care (incentive spirometer), pain management, early ambulation
abdominal distention: risk for bowel obstruction, NPO until bowel sounds return
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renal surgery post-op patient teaching
skin care, maintenance of urinary diversion
s/s of obstruction: lack of urine output, cannot get cath in
s/s of infection: fever, foul smelling urine, cloudy urine
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Acute kidney injury
sudden loss of kidney function indicated by rise in creatinine and/or decreased urine output
Pre-renal, intra-renal, post-renal
time-limited loss of renal function
a majority of people get function back
111
Pre-renal
before the kidneys; not perfusing the kidneys
hypovolemia:
- hemmorhage, burns (dehydration)
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intra-renal
directly at the kidneys
IV dyes, meds, NSAIDS, transfusion rxn, problem from not fixing pre or post renal problems
113
post-renal
after the kidneys that causes harm to the kidney
obstruction r/t urinary output: urine retention, BPH, stones, tumor, strictures
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Initial phase
phase of acute kidney injury
when the insult happens
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oliguric phase
phase of acute kidney injury
holding on to everything
low urine output, hypervolemia, hyperkalemia, metabolic acidosis, CNS problems
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Diuretic phase
phase of acute kidney injury
kidneys try to repair itself; throwing everything out
fluid and electrolyte loss; loss of urea and creatinine
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recovery phase
phase of acute renal injury
can take months to years
everything starts to balance out; kidneys are able to function properly again
keeping what is needed and getting rid of what's not
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metabolic acidosis
pH is low
CO2 is normal
Bicarb is low
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metabolic alkalosis
pH is high
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indications for dialysis
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metabolic acidosis
hyperkalemia
hypervolemia
severe HTN
severe mental status changes
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common causes of chronic renal disease
diabetes and HTN
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Chronic renal disease
progressive irreversible loss of kidney function
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chronic kidney disease manifestations
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altered BS
elevated triglycerides
fluid overload
anemia
weight loss/ malnutrition
mineral and bone disorder
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*most important F&E imbalance: K
most s/s are same as AKI
124
#1 cause of death in chronic kidney disease
cardiovascular problems
