Week 3: Renal + Urinary Health

Question 1

Function of the Kidneys

Answer 1

Urine formation

Excretion of waste products

Regulation of electrolytes and acid-base balance

Question 2

where are the kidneys located?

Answer 2

retroperitoneal space

Question 3

RAAS System Low Aldosterone

Answer 3

low aldosterone = decreased Na retention, fluid volume, and blood pressure - increased urinary output (diuresis)

Question 4

RAAS System High Aldosterone

Answer 4

Increased Na retention, fluid volume, blood pressure - decreased urinary output

• there is a decrease in urinary output because the water and sodium are increased aka staying in the kidney

Question 5

Renal Nursing assessment

Answer 5

• Health history & family health history

physical expaminations (pain, GI, integumentary, urinary)

Lab values: Cr, BUN, eGFR, Hbg

Signs/symptoms of compromised kidney function

Comorbidities (diabetes, hypertension, neuromuscular disease)

Family history of kidney disease

Age

Older clients may have more comorbidities.

Medications (long term use may be nephrotoxic)

Question 6

medications for renal injury

Answer 6

NSAIDs

Antibiotics

Loop diuretics (causes kidneys to work harder to excrete fluid)

Contrast dyes (hold metformin for 48 hours post dye)

Metformin (Type 2 diabetes med. Excreted by the kidneys)

Nephrotic drugs = cause damage to kidney’s over time

• Cautious with contrast dye for patients with diabetes, metformin should be held after the administration of contrast dye for 48 hours to allow the kidneys to function

Question 7

neurogenic Bladder

Answer 7

difficult time emptying the bladder which causes upstream impacts on the kidneys

lack bladder control in your brain

Question 8

micturition

Answer 8

normal voiding (30 mL / day or 1-2 L/day)

Question 9

anurea

Answer 9

no urinary output

Question 10

oliguria

Answer 10

low urinary output

Question 11

polyurea

Answer 11

excessive urinary output

Question 12

hematuria

Answer 12

blood in urine

Question 13

proteinurea

Answer 13

protein in urine

Question 14

azotemia

Answer 14

elevation of nitrous products such as BUN and creatinine in the blood and other secondary waste products

integument examination

Question 15

Pruritus

Answer 15

itching
integument examination

Question 16

physical examination: GI

Answer 16

nausea, vomiting, diarrhea, abdominal discomfort + distention

Question 17

physical examination: neurological

Answer 17

Waste product buildup in the body interrupts normal neurological functioning

Early signs: lethargy, forgetfulness, mild confusion

Late signs: seizures, coma

Build-up of BUN – interrupts our normal neurological functioning – is going to cause uremic encephalopathy the early and late signs of this are above

Question 18

Serum Creatinine (Cr)

Answer 18

Meaning: elevated values indicate poor function

Creatinine is a waste product of creatine phosphate which is a by-product of muscle breakdown.

Patients with HIGH serum creatinine levels likely have severe renal impairment – the nephrons are destroyed so they aren’t able to filter through and excrete that waste

Question 19

Blood Urea Nitrogen (BUN)

Answer 19

elevated values indicate poor function

BUN = measures the amount of urea nitrogen in the body - also a waste product of protein metabolism. So when BUN or creatine values are HIGH we know the body is retaining waste

Question 20

eGFR (estimated glomerular filtration

Answer 20

Decreased value indicates poor kidney function

Nursing role:
24-hour urine collection
Keep refrigerated
Document start and end time
Void at beginning of test and discard first urine specimen
At end, ask client to empty bladder

Blood draw
End of specimen collection

its a Measure of how our body is able to clear the creatine (if we are unable to excrete waste then eGFR would be decreased)

Question 21

Kidney Dysfunction: Lab findings

Answer 21

Increased creatinine and BUN, decreased eGFR

Fluid volume deficit

High protein

Decreased renal perfusion

Fluid volume excess (end stage kidney failure/disease)

Question 22

Kidney dysfunction Lab findings in end-stage renal

Answer 22

Increased or decreased Na (due to water retention, could cause either hyper or hypotension)

Increased K (due to cardiac arrythmias)

Decreased vitamin D

Increased phosphate

Decreased bicarbonate

Bone dysfunction (fall risk)

Question 23

Hemoglobin (Hbg)

Answer 23

Decreased erythropoietin causes anemia

Do not use hematocrit (Hct) as a measure of RBC (can be impacted by fluid
volume imbalance)

Question 24

Acute Kidney Injury (AKI)

Answer 24

Impacts renal function for less than 3 months

Sudden loss of renal failure

rapid decrease in U/O

Results in fluid, electrolyte, and pH imbalances (metabolic acidosis), waste buildup

** reversible

Question 25

Chronic Kidney Disease (kidney failure)

Answer 25

progressive, permanent nephron degeneration, irreversible

Question 26

Classifications of Acute kidney injury (AKI)

Answer 26

1. Prerenal – hypoperfusion of kidneys (not enough blood flow - likely due to hypovolemia or anything that decreases BP, CO, total peripheral resistance) 2. Intrarenal – damage to kidney tissues Comorbidities, medications, infections (typically UTI) 3. Postrenal – obstruction of urine flow Tumour, clot, kidney stone

Question 27

Phases of Acute Kidney Injury

Answer 27

Initiation – initial insult to kidney function Oliguria – rapid reduction in urine output Increased Cr, BUN, K May present with pruritus and/or hyperkalemia Diuresis – normal urinary output Recovery – labs normalize (typically afer 3 months)

Question 28

nursing role in preventing acute kidney injury

Answer 28

Monitor kidney function Be aware of nephrotoxic drugs Follow blood transfusion protocols (transfusion reactions can cause AKI) Provide adequate hydration - Surgery, contrast agents, chemotherapy, marginal kidney reserve (older adults) Treat hypotension promptly Prevent infection (especially UTIs)

Question 29

S&S Acute kidney inury

Answer 29

Hyperkalemia (cardiac arrythmias, muscle weakness, diarrhea) Metabolic acidosis (Kussmaul respirations) Hypervolemia (edema, bounding pulses, lethargy, confusion, weight gain, decreased urinary output) Decreased erythropoiesis Hemodynamic instability Neurologic changes

Question 30

Nursing Interventions: AKI

Answer 30

Monitor fluid and electrolyte balance Promote pulmonary function Infection prevention Integument health Edema and uraemic pruritus Increased risk for breakdown Psychosocial support

Question 31

Goals of care for AKI

Answer 31

Treat the underlying cause of AKI Dialysis to remove toxins/fluids Diuretic medications

Question 32

AKI: continuous renal replacement therapy (CRRT)

Answer 32

Filters extracellular fluid: - Removes H2O, electrolytes, and solutes through hemofilter - Clears urinary toxins - typically used in ICU settings Last effort, not a long-term treatment CRRT = type of blood purification therapy that is used with patients who are experiencing acute kidney injury/ acute renal failure

Question 33

Chronic Kidney Disease

Answer 33

No cure Process: Preventative measures are encouraged Disease is diagnosed, goal is to slow the progress Disease progresses to severe Dialysis or transplant will occur Death will eventually occur

Question 34

Stages of Chronic Kidney Disease

Answer 34

Use the eGFR to stage kidney disease Stage 1 – 90+, damage but normal function Stage 2 – 60-89, mild decrease in function Stage 3 – 30-59, moderate decrease in function Stage 4 – 15-29, severe decrease in function Stage 5 – less than 15, end-stage kidney disease

Question 35

causes of chronic kidney disease

Answer 35

hypertension & diabetes

Question 36

S&S of chronic kidney disease

Answer 36

Oliguria, hematuria, proteinuria Hypervolemia (FVO) Increased BP, pulmonary edema (crackles), JVD and bounding pulses, lethargy/confusion Metabolic acidosis (pH less than 7.35) Hyperkalemia Cardiac arrythmias, muscle weakness, diarrhea Hyperphosphatasemia (bone demineralization) Hypocalcemia Hypernatremia Hemodynamic instability Result of abnormal BP Intestinal issues Urea is converted into ammonia, which can cause ulceration and bleeding Decreased hct and hbg Melena or occult stool Anemia Measure Hbg, not Hct Infection risk Asepsis, catheter care Integument Uremic pruritis

Question 37

Nursing Interventions: Chronic Kidney disease

Answer 37

Monitor fluid and electrolyte balance - Hyperkalemia - I&O monitoring, daily weights - Monitor for hypertensive crisis - Headache, nausea and vomiting, change in mental status o Avoid nephrotoxic medications Infection prevention - Integument health - Edema and uraemic pruritus may cause increased breakdown Psychosocial support

Question 38

Patient education: chronic kidney disease

Answer 38

Control BG in diabetes Control blood pressure in HTN Diet - Restrict fluid, Na, K, phosphates - Consume low protein, high carb diet Smoking cessation Minimal alcohol intake May need to lose weight Encourage exercise Avoid NSAID

Question 39

PRILs : treatment for chronic kidney disease

Answer 39

Antihypertensives, ACE inhibitors Action – treat HTN, lower BP Side effects – drowsiness, dizziness, headache, persistent dry cough Nursing considerations: Monitor for hypotension, Advocate for change in medication if patient is having trouble coping with dry cough

Question 40

SARTANs - treatment for chronic kidney disease

Answer 40

Antihypertensives, ARBs Action – treat HTN, lower BP Side effects – dizziness, headache, nausea, vomiting, diarrhea Nursing considerations: Monitor for hypotension, May be appropriate for patients who cannot tolerate PRILs angiotensin 2 receptor blockers. Prevents RAAS from increasing blood pressure

Question 41

Metformin: treatment for chronic kidney disease

Answer 41

Antihyperglycemic, biquanide Action – treat hyperglycemia, lower BG Side effects – stomach pain, GI upset, gas, bloating, NVD, constipation Caution – hepatotoxic Nursing considerations: Monitor BG (hypoglycemia), Monitor ALT and AST, Do not use in eGFR under 30

Question 42

STATINs - treatment for chronic kidney disease

Answer 42

Antihyperlipidemia, HMG-CoA reductase inhibitor Action – treat dyslypidemia Side effects – headache, dizziness, insomnia, GI upset, muscle pain Caution – hepatotoxic (monitor ALT and AST) Nursing considerations: - Lipid labs (require fasting) o HDL, LDL

Question 43

Dialysis Assessment

Answer 43

Monitor vitals, respiratory, and cardiac function (hypovolemia) Monitor fluid balance & weight (shows efficacy) Measure weight pre-dialysis and compare with weight following last treatment Monitor labs ofen

Question 44

Peritoneal Dialysis

Answer 44

Run by gravity or continuous cycle Treatment occurs overnight Nursing actions: - Warm hypertonic solution before administration - Infection prevention: Wash hands, Wear mask - Monitor for peritonitis: Febrile, cloudy drainage, tachycardia

Question 45

hemodialysis

Answer 45

Diffusion of dissolved solutes from one fluid compartment to another Fistula care (vascular access point) and assessment Avoid BP on dialysis arm Perform neurovascular assessments Do not touch the site without proper care Hold medications

Question 46

Transplant

Answer 46

Healthy kidney replacement Most effective treatment for stage 5 CKD Afer transplants, recipients MUST be on immunosuppressants for life 80% survival rate 5 years post-transplant