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Med Surge 1 > Test 4 Renal Shi > Flashcards

Test 4 Renal Shi Flashcards

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1
Q

What do kidneys and urinary system do?

A

Regulate fluid and electrolytes
Remove waste and provide hormones involved in RBC production
Bone metabolism
Control of BP

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2
Q

What are some gerontologic considerations about the kidneys?

A

Older adults susceptible to kidney injury
* Sclerosis of glomerulus and renal vasculature
* Decreased blood flow
* Decreased GFR
* Decreased renal reserve
* Altered tubal function and acid base balance

Incompelte empyting of bladder
Decreased drug clearence

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3
Q

Creatinine levels

A

Male: 0.6-1.2
Female: 0.4-1.0

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4
Q

What’s the normal adult bladder capacity?

A

400-500 mL

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5
Q

True or false: A 24 hour urine collection is the primary test of renal clearance?

A

TRUE

Evaluates how well kidneys perform renal clearance

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6
Q

What’s acute kidney injury?

A

Rapid loss of renal function due to damage to kidneys
50% or greater increase in serum creatinine above baseline
Hypovolemia (cause)
Hypotension (cause)
Reduced cardiac output and heart failure

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7
Q

What categories and phases of kidney injury are there?

A

Categories: Prerenal, intrarenal, postrenal

Phases: Initiation, oliguria, diuresis, recovery

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8
Q

What’s prerenal stage?

A

Volume depletion resulting from GI losses, bleeding, renal losses
Impaired cardia effeciency: From arrhythmias, cardio shock, heart failure
Vasodilation resulting from: Anaphylaxis, sepsis

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9
Q

What’s intrarenal stage?

A

Prolonged renal ischemia resulting from: Hemoglobinuria, pigment nephropathy
Nephrotic agents like : Heavy metals, NSAIDS, aminoglycoside antibiotics
Rhabdomyolysis: Trauma, burns
Infectious processes

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10
Q

What’s post renal stage?

A

Urinary tract obstruction like: Benign prostitic hyperplasia, blood clots, calculi, tumors

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11
Q

What’s chronic kidney disease?

A

Prolonged acute inflammation
5 stages based on GFR

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12
Q

The 5 stages of chornic kidney disease

A
  1. > 90 ; kidney damage with normal or incresed GFR
  2. 60-89 ; Mild decrease in GFR
  3. 30-59 ; Moderate decrease in GFR
  4. 15-29 ; severe decrease in GFR
  5. <15 ; end stage kidney disease or end stage kidney disease
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13
Q

What’s Kidney Failure? ESRD

A

When kidneys cannot remove waste or perform regular functions
Acute kidney disease is reversible and results in decreased glomerular filtration rate and oliguria
ESRD is progressive, irreversible and results in azotemia

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14
Q

What’s some problems and complications of chronic kidney disease and acute kidney injury?

A

Hyperkalemia
Pericarditus
Pericardial effusion
Pericardial tamponade
HTN
Anemia

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15
Q

What’s hemodialysis used for?

A

When patient is acutelt ill until kidneys resume function and for long term therapy in CKD and ESKD
Exract toxic nitrogenous substances from blood and remove excess fluid
Vascular Access: Arteriovenous fistula and arteriovenous graft

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16
Q

What’s peritoneal dialysis?

A

Goal is to remove toxic substances and waste and re-establish normal fluid and electrolyte balance
Peritoneal membrane serves as semipermeable membrane: Ultrafiltration and Peritoneal catheter

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17
Q

What are some complications of peritoneal dialysis?

A

Peritonitis
Leakage
Bleeding

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18
Q

What’s the assessment of a patient on dialysis?

A

Protect vascular access
Assess for patency, signs of infection, don’t use blood pressure or blood draws
Carefully monitor fluid balance, IV therapy, I and O
Signs of electrolyte imbalance and uremia
Monitor cardiac and respiratory status
Cardiovascular meds must be held before dialysis

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19
Q

Nursing interventions for hospitalized patient on dialysis

A

Monitor medications dosage carefully
Skin care: pruritis, keep skin clean and well moisurized, trim nails, avoid scratching

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20
Q

Renal cancer facts

A

Tobacco use is a significant risk factor
Higher incidence in men with high BMI and african american
May be asymptomatic with painless hematuria and dull back pain
Treatment w surgery and pharmacological treatment

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21
Q

Kidney surgery

A

Pre and Perioperative considerations
Postoperative considerations: Potential hemmorrhage and shock, potential abdominal distention and paralytic ileus, potential thromboembolus

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22
Q

Postoperative nursing interventions

Study These Flashcards
A

Pain relief
Promote airway clearance: Incentive spirometer, positioning
Maintain potency of urinary drainage systems
Use strict asepsis with catheter
Monitor for signs and symptoms of bleeding
Encourage leg exercises , early ambulation, and signs of DVT

23
Q

What are some patient education for post surgery?

Study These Flashcards
A

Drainage system care
Strategies to prevent complications
Signs and symptoms
FOllow up care
FLuid Intake
Health Promotion and screening

24
Q

What is nephroscleorosis?

Study These Flashcards
A

Hardening or renal arteries
Major cause of CKD
Icreased risk In African AMercians and diabetic nephropathy
Acute hypertensive criris benign
Treatment for hypertension

25
What's glomerular disease?
Acute nephritic syndrome Glomerulonephritis ; chronic and acute Nephrotic syndrome Diseases that destroy glomerulus of kidney
26
Acute nephritic syndrome
Postinfectious glomerulonephritis ; rapidly progressive , and membrane glomerulonephritis Manifestations: Hematuria, edema, azotemia, proteinuria, HTN May be mild or progrress to acute kidney disease or death Medical management: Supportive care , dietary modifications, antibiotics, corticosteroids, immunosuppresants
27
Nursing management of acute nephritic syndrome
Maintain fluid balance Fluid and dietary restriction Patient education and follow up
28
Chronic glomerulonephritis
Renal insuffiency or failure: Asymptomatic for years as glomerular damage increases before signs and symptoms develop Abnormal lab results: Urine with fixed specific gravity, casts, proteinuria, eletrolyte imbalance, hypoalbuminemia
29
Nursing management of chronic glomerulonephritis
Fluid and electrolyte imabalance risk Cardiac status Neurological status Emotional support education in self care
30
What's nephrotic syndrome?
Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins results in hypoalbumenia and edma Medican management includes drug and diet therapy Nursing management focused on education
31
Causes of nephrotic syndrome
chronic glomerulonephritis diabetes amyloidosis lupus Multiple myeloma renal vein thrombosis
32
What is polycystic kidney disease?
Genetic disorder and is most common inherited cause of kidney disease May have cysts in other organs Is autosomal dominant and recessive No cure, genetic counseling
33
What are the kinds of UTI?
Lower: * Cystitis * Prostatis * Urethritis Upper: * Pyelonephritis: acute and chronic * Interstitial nephritis * Renal abscess and perirenal abscess
34
What factors contribute to UTI?
Bacterial invasion of urinary tract Urethrovesical reflux, uretovesical reflux Uropathogenic bacteria Shorter urethra in women
35
What's the assessment of a patient with a UTI?
Pain, burning with urination, frequency, nocturia, incontinence, hematuria Many are asymptomatic Assessment of urine, urinalysis, and urine cultures
36
What potential problems can happen with a UTI?
Sepsis Acute kidney injury Chronic kidney disease
37
What are some goals when treating UTI?
Relief of pain and discomfort Increased knowledge of preventive measures Absence of complications
38
Nursing interventions of a patient with a UTI
Relief of pain Medications as prescribed: Antibiotics, analgesics, antispasmodics Applicaiton of heat to perineum to relieve pain and spasm Increase fluid intake AVOID URINARY TRACT IRRITANTS: COFFEE, TEA, CITRUS, SPICES, COLA, ALCOHOL Frequent voiding Education
39
What are the types of urinary incontinence?
Stress: During physical activity ; coughing, sneezing, laughing, exercise Urge: Sudden intense urge to pee and then you involuntary pee lol ; overactive bladder, neurological problems like parkinson Functional: Urine leakage from inability to reach toilet in itme ; physical or cognitive impairments Latrogenic: Caused by medications or interventions Mixed: Combination of stress and urge Overflow: Caused by bladder overdistention and incomplete emptying ; obstruction like the prostate
40
Patient education for incontinence
Tell em it aint inevitable and it fs is treatable gang Management takes time lil bro Educate verbally and in writing Use a voiding log Medication education
41
What is urinary retention?
Inability of the bladder to empty completely Residual urine: Amount of urine left behind in bladder after urinating
42
Causes of urinary retention
Adults 60 and above may have 50-100 mL or urine after voiding Postoperative spasms Diabetes, proastate cancer, urethral pathology, trauma, pregnancy, neurological disorders Medications
43
What's urolithiasis and nephrolithiasis?
Calculi in the urinary tract or kidney Causes: May be unkown Depends on location and presence of obstruction and infection Pain and hematuria Diagnosed by: radiography, blood chemistries, and stone analysis, strain all urine and save the stones
44
Patient education for renal calculi
Signs and symptoms to report Followm up care Urine pH monitoring Measures to prevent recurrent stones Importance of fluid intake Dietary education Med education
45
GU trauma
Ureteral: Motor vehicle accidents, sport injuries, falls Bladder: Pelvic fracture, multiple trauma, blow to lower abdomen Urethral: Blunt trauma to lower abdomen * Signs / symptoms: Blood visible at meatus, inability to void, distended bladder
46
Management of GU trauma
Control hemmorhage, pain and infection, monitor for oliguria, shock, s/s of peritonitis Nursing management: Assess frequently, instruction about incision care and adeqaute fluid intake Changes to report: fever, hematuria, flank pain
47
Urinary tract cancers
Bladder, kidney, renal pelvis, prostate More common after 65 Smoking biggest cause S/s: visible painless hematuria, pelvic or back pain,
48
Bladder cancer management
Chemo or radiation: depends on stage Surgical treatment: Cystectomy , uninary diversion
49
Nursing management of bladder cancer
Immediate post op: monitor urine volume hourly Provide stoma and skin care Test urine Encourage fluids
50
Urinary Diversion
Procedure to divert urine from bladder to exit new site, stoma Reasons: Bladder cancer or other pelvic malignancies, birth defects, trauma, strictures, neurogenic bladder, chronic infection or intractable cystitis, used as a last resort for incontinence Types: Ileal conduit ,orthotopic neobladder reconstruction, continent urinary diversion
51
Assessment of patient undergoing urinary diversion surgery
Preoperative: Cardiopulmonary function, nutritional status, learning seeds Postoperative: Signs and symptoms of complications, urine volume, drainage system , color of drainage, pain
52
Interventions of a patient undergoing urinary Diversion surgery
Preooperative: Relieve anxiety, ensure adequate nutrition, explaining surgery and the effects Postoperative: Maintaining skin integreity, relieving pain, improving body image, exploring sexuality issues, monitoring and managing potential complications, patient education
53

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