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NCLEX-RN (5) Adult Health > Renal/Urinary > Flashcards

Flashcards in Renal/Urinary Deck (74)
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What is the function of the kidneys?

Function of the kidneys "A WET BED":

  • A: Acid-base balance
  • W: Water balance
  • E: Electrolyte balance
  • T: getting rid of Toxins
  • B: Blood pressure control
  • E: making Erythropoietin
  • D: Vitamin D production


What are the general interventions for any kidney problem?

  • assess vital signs for FVO or FVD
  • check electrolytes
  • monitor intake and output
  • weigh daily
  • monitor renal labs - BUN, creatinine, GFR


What 2 groups can have decreased kidney function?

Elderly and infants can have decreased kidney function.

Be more concerned with nephrotoxicity from meds and substances in these 2 groups.


What are some common classifications of medications that are nephrotoxic?

Common nephrotoxic meds:

  • antibiotics
  • antineoplastics
  • NSAIDs


Acute kidney injury (AKI)

Acute kidney injury is the rapid loss of kidney function.

The client can recover but it can take years.


What causes prerenal AKI?

Prerenal AKI is damage to the kidneys caused by problems before the kidneys such as:

  • decreased cardiac output from shock
  • prerenal infection or obstruction

The kidneys aren't getting get blood flow causing damage.


What causes intrarenal AKI?

Intrarenal AKI is damage to the kidneys caused by problems inside the kidneys such as:

  • renal infection
  • nephrotoxic meds or substances


What causes postrenal AKI?

Postrenal AKI is damage to the kidneys caused by problems in the bladder which is after the kidneys such as:

  • bladder obstruction, infection or cancer
  • kidney stones


What are the 3 phases of AKI?

3 phases of AKI are:

  1. oliguric phase: pee very little
  2. diuretic phase: pee a lot
  3. recovery phase: pee normally


Oliguric phase of AKI

Oliguric phase of AKI:

  • lasts 1 - 2 weeks
  • urine output is very low at < 400 mL/day
  • will get signs of fluid volume overload


What are the labs in the oliguric phase of AKI?

Labs of oliguric phase of AKI are due to fluid volume overload and retaining toxins and electrolytes:

  • ↑ BUN and ↑ creatinine
  • ↓ GFR
  • ↑ potassium and ↓ sodium (or sodium will be normal)
  • ↑ phosphorus and ↓ calcium



Diuretic phase of AKI

Diuretic phase of AKI:

  • lasts 10 - 14 days
  • urine output is excessive at 4 - 5 liters/day
  • will get signs of fluid volume deficit



What are the labs in the diuretic phase of AKI?

Labs of diuretic phase of AKI are due to fluid volume deficit:

  • gradual decline in BUN and creatinine (but both still ↑)
  • ↓ GFR, but improving
  • ↓ potassium and ↓ sodium
    • kidneys are able to get rid of extra electrolytes



Recovery phase of AKI

Recovery phase of AKI:

  • may take 1 - 2 years
  • urine output is normal

Can progress to chronic kidney disease if damage was extensive.


Why can clients with AKI get confused and eventually go into a coma?

The client with AKI is retaining fluids and electrolytes and is unable to get rid of nitrogenous waste products.

This causes metabolic acidosis, which can cause confusion.


Oliguric phase of AKI

Oliguric phase of AKI interventions focus on the problems associated with fluid volume overload:

  • restrict fluids
  • if hypertension is present, restrict fluids to < 1000 mL/day
  • give diuretics


Diuretic phase of AKI

Diuretic phase of AKI interventions focus on the problems associated with fluid volume deficit:

  • give IV fluids
  • replace electrolytes


Chronic kidney disease (CKD)

Chronic kidney disease is a slow and progressive loss of kidney function.

GFR is < or = to 60 mL per minute for 3 months or longer.


Chronic kidney disease (CKD)

Chronic kidney disease is caused by damage to kidneys from:

  • diabetes mellitus
  • chronic hypertension
  • chronic urinary obstruction
  • recurrent infections
  • autoimmune disorders
  • after AKI


The signs and symptoms of CKD can affect every system.

Q: Why is this?

The kidneys have many functions including fluid and electrolyte balance, acid-base balance, and getting rid of toxins.

If the kidneys cannot do their job, the entire body will be affected.


What are the neuro symptoms with CKD?

Neuro symptoms with CKD are due to toxins and electrolytes building up in blood:

  • asterixis (flapping of hand)
  • can't concentrate and lethargic
  • paresthesias and twitching
  • late sign is coma


What are the cardiovascular symptoms of CKD?

Cardiovascular symptoms of CKD are due to fluid volume overload and electrolyte imbalances:

  • edema and heart failure
  • hypertension
  • dysrhythmias
  • pericardial effusion and friction rub

Put clients on continuous telemetry.


What are the respiratory symptoms of CKD?

  1. crackles and tachypnea due to fluid volume overload
    • pulmonary edema is a late sign
  2. Kussmaul's due to metabolic acidosis


What are the hematological symptoms of CKD?

  • anemia due to decreased erythropoietin
  • decreased platelets and bleeding due to hormone imbalances
    • ecchymosis


What are the skin symptoms with CKD?

Skin symptoms with CKD are due to toxins coming through the skin:

  • pruritis
  • yellow-gray pallor
  • late sign: uremic frost (crystals on skin)


What are the musculoskeletal symptoms of CKD?

Musculoskeletal symptoms of CKD are due to calcium and general electrolyte imbalances:

  • bone pain and fractures
  • muscle weakness and cramping


What happens psychologically to the client with CKD?

Because CKD affects all the systems and lifestyle changes are necessary, the client with CKD can become:

  • lethargic
  • depressed
  • suicidal

Use teaching and therapeutic communication to help the client cope.


What is the prescribed diet for a client with AKI and CKD?

  1. low to moderate protein intake
    • to reduce workload of kidneys and prevent toxicity
  2. high carb
    • need extra calories
  3. low potassium and phosphorus
    • kidneys are unable to get rid of these electrolytes


What is dialysis?

Diaylsis is the treatment for AKI (oliguric phase) and CKD. 

Dialysis removes excess water, electrolytes, and toxins from the blood.


How is anemia treated for a client with CKD?

  • give erythropoietin to increase the RBCs
  • possible blood transfusion


What is hemodialysis?

Hemodialysis is when blood is pumped out of the body to clean the blood of toxins and electrolytes.

Assess for hypotension.



Which medications are typically held before dialysis?

Before dialysis, hold cardiac meds that affect blood pressure and heart rate. Give after the client comes back from dialysis.

If given before dialysis, the meds will be excreted during dialysis.


What can be used temporarily​ for hemodialysis?

For temporary hemodialysis a CVAD such as a subclavian or femoral catheter, especially for those with AKI.

When using a catheter for hemodialysis, DO NOT use it for anything else (such as meds or fluids). 


What is used for long-term hemodialysis?

Arteriovenous (AV) fistula or graft for those with CKD.


How long does it take for an AV fistula or graft to heal and mature after it is made?

An AV fistula or graft takes 4 - 6 weeks to heal and mature for use.

Have client squeeze a ball to help it heal.



What are the basic assessments while an AV fistula or shunt is healing?

While an AV fistula or shunt is healing assess for:

  • bleeding and clots
  • infection
  • decreased circulation by checking the pulses distal (below) the fistula or shunt



What should NEVER be done on an arm with an AV fistula or graft?

NEVER use the side with the AV fistula or graft for:

  • blood pressure
  • IV lines
  • giving injections

These actions can cause damage. Tell client to tell everyone to NOT touch that arm for invasive procedures.


What is assessed before using an AV fistula or shunt for hemodialysis?

Assess circulation by checking for a bruit and thrill:

  • bruit: use stethoscope to hear a "whoosh-whoosh" sound
  • thrill: put hand over fistula to feel a "whoosh-whoosh".

If absent, notify the HCP.


What is peritoneal dialysis?

Peritoneal dialysis is when fluids are pumped out of the abdominal cavity to clean the body of toxins and electrolytes. 


What are the basic interventions before peritoneal dialysis is started?

  • warm the bag of fluids to prevent discomfort and to help the veins to dilate
  • get vital signs, weight, fluid and electrolyte values
  • check dressing for wetness


What are the basic interventions during peritoneal dialysis?

  • get vital signs
  • watch for respiratory distress, hyper- or hypertension due to fluid shifts
  • monitor intake and output


What color should the dialysate be when it comes back out?

The dialysate coming out should be clear.

  • cloudy is a sign of infection
  • red is a sign of bleeding

Report any abnormal color to HCP.


Should more or less dialysate come out after peritoneal dialysis is finished?

More dialysate should come out since the client needs to get rid of the extra fluids.


What is the intervention if all the dialysate isn't coming out of the client?

If all the dialysate isn't coming out turn the client to the side to move the tube into a different spot and see if the fluid starts coming out.

Complete the sentence:

Peritoneal dialysis is a ________ procedure. _________  can occur.

Peritoneal dialysis is a sterile procedure. Peritonitis can occur.

Prevent infection and assess for signs of peritonitis (rigid, hard abdomen).


What is the last resort treatment if dialysis doesn't work for CKD?

Kidney transplant


What types of meds are given to prevent kidney rejection after a kidney transplant?

Immunosuppression meds


What type of precautions are implemented after a kidney transplant?

Neutropenic precautions due to immunosuppression.


Urinary tract infection (UTI)

A UTI is an infection in the urinary tract for many different reasons.

It is more common in women due to a short urethra.

Risk factors:

Urinary tract infection

Risk factors of getting a UTI are due to bacteria imbalances:

  • using soaps that are irritants
  • foley and straight catheters for draining urine
  • sex
  • polyester underwear
  • not urinating or drinking enough water



What are the characteristic signs and symptoms of a UTI?

  • small amounts of urine that is frequent and urgent
  • burning sensation
  • back discomfort
  • foul urine smell
  • chills/fever/high WBC count


What is a common symptom of a UTI in the elderly?



How is a UTI diagnosed?

UTI is diagnosed by doing a urine culture and sensitivity test:

  • The test will be:
    • + for leukocyte esterase
    • + for nitrates


Urinary tract infection

  • antibiotics
  • encourage fluids
  • pain meds


Urinary tract infection

  • drink fluids
  • urinate after sex
  • wear cotton underwear
  • don't take bubble baths or use irritating soap
  • drink cranberry juice


Polycystic kidney disease

Polycystic kidney disease is a genetic disorder where cysts form on the kidneys and the client gets hypertension.

The client will eventually need dialysis or a kidney transplant.



Hydronephrosis is too much water in the kidneys caused by obstructions, stones, scar tissue or a big prostate.

Client may need nephrostomy tubes to drain urine.


Why is the urine strained for a client with a kidney stone?

The urine is strained to catch the stone and determine which type it is:

  • purine stone?
  • calcium stone?
  • oxalate stone?

The diet will be modified to prevent that type of stone.


What type of pain does a client experience when they are passing a kidney stone?

Pain from kidney stones starts in the lumbar region and radiates down to the genitals.

It can be sudden pain that is sharp and severe.


Kidney stones

  • drink plenty of fluids
  • don't eat foods that contribute to kidney stone formation


Why does immobilization cause kidney stones?

When a client is immobile, calcium from the bones goes into the blood.

Too much calcium can cause a kidney stone.


What is lithotripsy?

Lithotripsy is a procedure used to break up a kidney stone using ultrasonic waves.


What are the interventions after a lithotripsy?

  • encourage fluids to flush out small stones and sediment
  • monitor for bleeding and infection


Benign prostate hyperplasia (BPH)

BPH is a large prostate that occurs in older men due to the gradual growth of the prostate.

The large prostate blocks the ability to urinate. Urination is in smaller amounts and more frequent.


Which meds are avoided with BPH?

Avoid meds that cause urinary retention such as:

  • anticholinergics - benztropine (antiparkinson meds)
  • antihistamines - diphenhydramine
  • antidepressants - SSRIs


What is a transurethral resection of the prostate (TURP)?

A TURP is a surgical procedure to decrease the size of a prostate or to take the entire prostate out due to cancer.


What type of foley catheter is inserted after a TURP procedure?

After a TURP, the client will have a foley catheter with continuous bladder irrigation to prevent bleeding.


What is continuous bladder irrigation?

Continuous bladder irrigation is when there are 3 lumens (tubes) coming from the foley:

  • Lumen 1: inflating the balloon to keep the foley in the bladder
  • Lumen 2: instillation of sterile solution for irrigating the bladder
  • Lumen 3: for urine and fluid to leave the bladder

It is used to prevent bleeding after a TURP.


What are the main interventions for a client with continuous bladder irrigation?

Continuous bladder irrigation interventions focus on preventing bleeding:

  • keep traction on catheter: taut, taped, and keep leg straight
  • keep sterile solution running to keep urine light pink
  • increase the solution rate if bright red drainage or clots appear


What are the steps if the urinary catheter becomes obstructed and no urine is coming out?

  1. turn off the continuous bladder irrigation
  2. irrigate the catheter with 30  - 50 mL of normal saline.

If it's still obstructed, notify the HCP.


When will the continuous bladder irrigation for TURP be discontinued?

The catheter is taken out 24 - 48 hours after the surgery.


What are normal findings after the catheter is removed after a TURP?

After catheter removal from a TURP, the client may experience some burning, frequency, and dribbling of urine. 

Passing small clots and tissue debris for a few days is also normal.



Transuretheral resection of the prostate (TURP)

  • no driving, sex or heavy/strenuous activity for up to 6 weeks
  • drink up to 3000 mL of fluid each day before 8 p.m.
  • don't stimulate the bladder
    • avoid alcohol, caffeine, and spicy foods 


What should the client do at home if they start to bleed after a TURP?

Tell the client to rest and increase fluid intake.

If bleeding still doesn't stop, call the surgeon.