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314 Exam 2 > Renal/Urinary > Flashcards

Renal/Urinary Flashcards

(83 cards)

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1
Q

What does the kidney do?

A
  • Filters waste
  • Concentrates Urine
  • Secretes Renin
  • Secretes erythropoietin
  • Maintains acid base balance
  • Excretes excess K+
  • Synthesizes component of Vitamin D
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2
Q

How do we measure Renal function?

A
  • Serum Creatinine
  • Creatinine clearance
  • BUN (Blood urea nitrogen)
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3
Q

What is serum creatinine a measure of?

A

Byproduct of protein and muscle breakdown

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4
Q

What does creatinine clearnance measure?

A
  • Measures GFR
    (24 hour urine collection)
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5
Q

What does BUN measure? What can affect BUN?

A

Protein breakdown in the liver > Urea nitrogen
- Affected by dehydration, steroid use, etc

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6
Q

How to collect a urinalysis?

A

Clean catch vs catheterization
- Early morning sample if possible (Urine is most concentrated)

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7
Q

Process of 24 hour urinalysis

A

Discard 1st void, “ start time”
-Void in hat > Pour into specified container

  • Missed urine compromises sample
  • Store sample of ice or in refrigerator
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8
Q

Renal/Urinary Diagnostic procedures and what they are used to see?

A
  • CT scan (Contrast CT)
  • X-ray or KUB (Kidney, ureter, bladder)
  • MRI
  • Ultrasound
  • VCUG (cystourethography voiding cystourethrogram)
  • Cystoscopy
  • IVP (intravenous pyelogram)
  • Kidney Biopsy
  • Renal Scan (nuclear medicine study: Tech99m-DTPA, GFR study)
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9
Q

What does X-ray or KUB (Kidney, ureter, bladder) used for?

A

Visualization of kidney size and location, detect stones.

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10
Q

What is a Kidney MRI used for?

A

used for cancer staging, soft tissue visualization

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11
Q

What is a kidney ultrasound used for?

A

Used for hydronephrosis

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12
Q

VCUG (cystourethography voiding cystourethrogram)

A
  • Detects urethral or bladder injury
  • Involves instillation of contrast dye through urinary catheter
  • Provides image of bladder and ureter
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13
Q

Cystoscopy

A
  • Scope procedure to examine abnormalities of bladder, ureter, urethra
  • NPO after midnight, possible bowel prep
  • Normal to see mild hematuria
  • Encourage fluid intake post procedure
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14
Q

IVP (intravenous pyelogram)

A

Uses IV dye (injected into blood) to identify obstructions or disorders of ureters and renal pelvis

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15
Q

Kidney Biopsy

A
  • Removal of a sample of renal tissue
  • Excission or needle aspiration
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16
Q

Renal Scan (nuclear medicine study: Tech99m-DTPA, GFR study)

A

Assess renal blood flow
- Estimates GFR after IV injection of radioactive material

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17
Q

Suprapubic catheter

A
  • Oldest simplest form of urinary diversion
  • Catheter placed in bladder via a small incision in abdominal wall
  • Temporary or permanent
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18
Q

Issues with suprapubic catheter

A
  • Prone to poor drainage d/t mechanical obstruction of catheter tip on bladder wall
  • Bladder spasms may occur

Antispasmodics (oxybutynin)
Belladonna, opium suppositories

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19
Q

Ileal Conduit

A

Section of ileum > conduit for urinary drainage
- Ureters are anastamosed into one end of the conduit
- Other end brought through abdominal wall to form a stoma
- No voluntary control > Requires appliance (Ostomy bag)

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20
Q

Continent Urinary Diversion

A

Intrabdominal urinary reservoir
- Catheterized OR outlet controlled by anal sphincter
- If catheterized > Must self-catch every 4-6 hours
- Does not need ostomy bag

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21
Q

Cutaneous Ureterostomy

A
  • Urinary ostomy
  • Urinary analog to colostomy
  • No control of urine flow > Requires appliance
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22
Q

Nephrostomy Tubes

A

Temporary
- Preserve renal function when ureter is completely blocked (kidney stones)
- Catheter inserted directly into renal pelvis
- DO NOT CLAMP, COMPRESS, OR KINK
- High risk for infection

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23
Q

Bladder Reconstruction (Neobladder)

A
  • New bladder made in correct anatomical position
  • Made from segments of colon
  • Urine discharged through urethra (natural micturition)
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24
Q

UTI

A

Infection of the urinary tract

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25
Cystitis
Lower UTI - Bladder infection - Usually bladder specific syptoms
26
Pyelonephritis
Upper UTI - Kidney infection - Usually more systemic symptoms - Usually begins as cystitis - Repeat infections may cause scaring - Most commonlt caused by E.coli
27
Chronic, Asymptomatic UTI
- Bacteriuria without symptoms - May not need treatment
28
Female UTI Risk Factors
UTIs common - Predisposed to UTI - Short urethra - Proximity of urethra to rectum - Sexual intercourse (Pee after sex) - Tight or restrictive clothing
29
Male UTI Risk Factors
UTIs rare - More common in older (>50y) men - Mostly caused by urinary retention r/t BPH In young men with UTI symptoms > Test for STD too
30
Very common cause of UTI
Urinary catheterization
31
CAUTI
Catheter-associated UTI - Most common HAI - Commonly caused by E.coli or psuedomonas
32
CAUTIs are associated with increased ....
- Length of stay - Health care cost - Morbidity and Mortality
33
What is an important way to stop CAUTIs
Prevention is key - Catheters only when needed - HOUDINI or other nurse driven removal protocol
34
UTI manifestations
- Dysuria - Urinary frequency and urgency - Cloudy, foul smelling urine - Low back pain and abdominal tenderness - Fever? (unreliable indicator of UTI)
35
UTI manifestations - Geriatric Patients
- Confusion - Incontinence - Anorexia - Nocturia
36
UTI Diagnosis
Urinalysis with culture and sensitivity - Usually clean catch - positive leukocyte esterase - Bacteriuria - WBC in urine - Start antibiotic > Change as appropriate when C&S results come back - Serum WBC elevated - Consider ruling out STD
37
UTI Treatment
- Fluid intake (3L/Day) - Frequent urination (q 3-4 hrs) - Heat to lower abdomen for pain - Antibiotics - Cranberry Juice
38
What med can you give for UTI and what happens
Phenazopyridine - Decreases dysuria - Turns urine orange
39
Acute Pyelonephritis
Active Bacterial infection Can cause: - Interstital Inflammation - Acute tubular necrosis - AKI - Abscess
40
Chronic Pyelonephritis
Result of repeated infections > Progressive Inflammation > Scarring Can cause: - Thickened Calyces - Post-inflammatory fibrosis - Permanent renal tissue scaring
41
Pyelonephritis Complications
- Hypertension (Due to destruction of glomeruli) (Renal function decreases > Fluid overload) - CKD (Chronic kidney disease) (Due to renal fibrosis, scarring, vascular and tubular changes) - Sepsis (Hypotension, Tachycardia, Fever)
42
Pyelonephritis S&S
- Chills - Renal Colic - CVA tenderness - Flank and back pain - Fever - Hematuria
43
Pyelonephritis Treatment
Similar to Cystitis - Increase fluid intake - Antibiotics - Surgery (Pyleolithotomy - Removal of stones, Nephrectomy - Removal of kidney, Ureteroplasty - Repair or ureter)
44
Urosepsis
Sepsis due to UTI (LIFE THREATENING) - Shock and Organ failure
45
Urosepsis Treatment
Antibiotics Fluid intake Monitor for s&s of worsening sepsis (Hypotension, Tachycardia, oliguria)
46
When does Nephrotic syndrome typically occur, and what is its presentation
Glomerular changes at ages 2-5 Presentation - grOss prOteinuria - hypOablbuemia - swOllen (facial first > abdomen and extremities)
47
Nephrotic syndrome treatment
- sterOids - lOw sodium, pOtassium, fat diet - prOtein
48
When does Nephritic syndrome typically occur, and what is its presentation
Glomerular inflammation at age 2-10 Presentation - post Infection (strep) Inflammation - gross hematuria (pepsI-colored urine) - mIld proteinuria - mIld edema (facial) -h"I" pertension - h"I" BUN/creatine
49
Nephritis treatment
- dIuretics -h"I" pertension meds - moniter for h"I"perkalemia
50
Obstructive uropathy (common causes)
Any anatomic/functional condition that blocks urine flow - Urolithiasis (Kidney stones) - BPH
51
BPH Diagnosis and Treatment
BPH- Common reason for obstruction in men >60 y Diagnosis: PSA (prostate-specific antigen) Treatment: Gold standard is TURP (transurethral resection of prostate)
52
Renal Calculi types
- Calcium (Most common) - Struvite (associated with chronic uti) - Uric acid (Gout, high protein diet) - Cystiene (least common due to metabolic disorder) - Strong familial component (likely to recure)
53
Renal Calculi S/S
Severe pain Urinary frequency Dysuria Fever Diaphoresis N/V Hematuria May progress to hydronephrosis
54
Renal calculi diagnostic testing
UA KUB IVP CT Renal ultrasound
55
Renal calculi treatment
Opioids NSAIDs (ketorolac) Antispasmodic (oxybutynin) Therapeutic interventions - Lithotripsy Surgery - Stenting - Ureteroscopy, ureterolithotomy
56
Renal calculi education
Calcium Stones - Reduce calcium intake - Limit foods high in protein Uric Acid - Limit foods high in protein, organ meat Struvite - Avoid high phosphate diets
57
Polycystic Kidney Disease
- Congenital disorder (10-15% of CKD) A cluster of fluid-filled cysts develops on the nephrons (may also develop systemically - Heart, liver, intestine, brain)
58
Polycystic Kidney Disease Treatment
Needle aspiration of cysts Kidney transplant
59
Acute Kidney Injury + Phases
Sudden decrease in renal function Occurs when blood flow to the kidney is compromised - Onset (initial injury) - Oliguria (low urine output) - Diuresis (Not properly concentrating urine) - Recovery
60
Prerenal acute kidney injury
Usually due to decreased renal perfusion - Shock - Sepsis - Hypovolemia - Nephrotoxic medications (Can also be classified as intrarenal)
61
Intrarenal acute kidney injury
- Trauma - Hypoxic injury (thrombosis) - Chemical injury (Contrast dye, heavy metals, blood transfusion reactions) - Immunological injury (Infection, glomerulonephritis)
62
Acute tubular necrosis
The most common cause of Intrarenal acute kidney injury - primary result of ischemia - Necrosis > Cells slough off > form embolus in renal tubuls
63
Post renal acute kidney injury
Due to obstruction below the kidney - Stones - Tumor - Bladder - BPH - Spinal cord disease/injury
64
Acute kidney injury s/s
- Fluid overload - Dysthymia (hyperkalemia) - Crackles in lungs - Minimal urine output - Lethargy, twitching, seizures - Dry mucous membrane
65
Acute kidney injury treatment
IV fluids - Monitor for fluid overload Diuretics Correct electrolyte imbalances Temporary dialysis as necessary
66
Chronic Kidney disease
- Progressive, Irreverible Stages 1-5
67
CKD s/s
Neuro - Lethargy, slurred speech, tremors Cardiovasular - Fluid overload, edema, HTN, HF, dysrrhthmias Respiratory - SOB - Crackles - Kussmaul respirations - Uremic Halitosis Hematological - Anemia MSK - Osteodystrophy Integumentary - Uremic Frost
68
Dialysis
Life saving in renal disease Function - Rids body of excess fluid and electrolytes - Achieve acid base balance - Eliminates waste products - Restores internal homeostasis via osmosis, diffusion, ultrafiltration
69
Peritoneal dialysis
Instillation of hypertonic dialysate solution into the peritoneal cavity - Dwells for length of time then is drained (usually overnight) Complications - Peritonitis - Infection at access site
70
Hemodialysis
Shunts blood away from body through a dialyzer then back into circulation - Occurs usually 3x a week - Monitor client continuously during dialysis
71
Temporary hemodialysis
Usually Central venous catheter (CVC)
72
Permanent Hemodialysis
AV fistula - Anastomosis between atery and vein - Provides rapid blood flow and pressure for HD - Expect thrill and bruit Graft - Synthetic vessel
73
Continuous renal replacement therapy (CRRT)
- 24hr dialysis for hemodynamically unstable clients - Removes uremic toxins - Acid base balance adjusts slowly and continuously - Closer to normal physiology
74
Kidney transplant
Option for ESRD - Much high demand than supply Transplants are very successful - Usually last 12-15 years - Dead kidney is not removed
75
76
Kidney transplant aftercare
Monitor for infection - Clients on Life long immunosuppressants Monitor for organ rejection * Hyperacute (48hrs) - Fever, HTN, Pain * Acute (2 years) - Antibody-mediated response - Inflammation > Lysis of the donor kidney *Chronic (gradual) - Blood vessel injury > Fibrotic tissue > Kidney failure
77
Intake
Anything we can measure that is put into the body (Liquids) Measured in ML
78
Output
The fluid that leaves the body - Urine, Vomitm liquid stool, drainage Measured in ML
79
What is urine output meausred in
ml/kg/hr
80
Net fluid or fluid balance
Intake - Output = Net fluid or fluid balance
81
What are key differences in pediatrics than in adults
- Immature kidney function - Smaller bladder capacity - Higher risk for infections
82
Types of urine collection in pediatrics
- Clean catch - Urine bag (wee bag) - Catheterization - Suprapubic aspiration
83
Nursing priorities to monitor in pediatric clients
1.) Fluid and electrolyte balance (monitor I&O, recognize dehydration/fluid overload) 2.) Infection prevention (Promote good hygiene, timely administration of antibiotics 3.) Family education and support (Teach about condition, medication adherence, and lifestyle modifications)

314 Exam 2 (4 decks)

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