week 4 content Flashcards
(108 cards)
1
Q
_________- is breakdown/metabolism of muscle and protein, and released at a consistent rate
- Low ________= muscle atrophy/wasting, or maybe not significant
- High ________ = kidney damage
A
Cr
2
Q
AV fistula care
T/F
1. avoid BP and IV sticks in arm with AV fistula
2. assess for peripheral perfusion distal to site
o pain
o cap refill
o numbness
o tingling
o pulse – radial and ulnar
3. assess for thrill q shift
o “feel the thrill”
o Palpate for turbulent blood flow
4. asses for bruit q shift
o sounds like wooshing
5. thrill and bruit are unexpected findings with AV fistula
6. notify HCP if you feel thrill or hear bruit
A
- T
- T
- T
- T
- F - expected findings with AV fistula = patency of AV fistula
- F - - notify HCP if you can no longer feel thrill or hear bruit
3
Q
There are two main types of lithotripsies:
External lithotripsy (indirect) and Internal lithotripsy (direct)
________________
- Cystoscopy approach or
- percutaneous approach – through skin
- uses laser
_________________
- Stones broken down and washed out
- Major advantage = not invasive
- Possible complications
o Hemorrhage
o Infection
o Retention of stone fragments
A
There are two main types of lithotripsies:
Internal lithotripsy (direct)
- Cystoscopy approach or
- percutaneous approach – through skin
- uses laser
External lithotripsy (indirect)
- Stones broken down and washed out
- Major advantage = not invasive
- Possible complications
o Hemorrhage
o Infection
o Retention of stone fragments
4
Q
Outpatient procedure used to break up stones into smaller pieces, Disintegrates/pulverizes stones via shock waves, that may be passed naturally through the urinary tract.
A
Lithotripsy
5
Q
________ Cr = muscle atrophy/wasting, or maybe not significant
________ Cr = kidney damage
A
low
high
6
Q
is treating pain with kidney stones priority? Why or why not
A
Can cause hemodynamic compromise – pain is so bad it starts messing with vitals (treating pain may be priority so hemodynamic compromise doesn’t occur)
7
Q
hemodialysis, peritoneal, or complications of both?
- drastic and hard on body – difficulty adjusting, esp first few times
- infection
- decreased CO
- cardiac dysrhythmias
- disequilibrium syndrome - esp first few times
o disorientation
o seizures
o H/s
o Agitation
o n/v - air embolism
- FVE
- Respiratory insufficiency
- Abdominal pain
- Peritonitis
A
- H
- B
- B
- H
- H
- H
- P
- P
- P
- P
8
Q
Po and Ca are _______ related
A
inversely
9
Q
with CKD, kidneys aren’t excreting properly = Mg is ______
A
high
10
Q
with CKD fluid restrictions – alternate ways to reduce thirst
(3)
A
o sucking on ice cubes, lemons, hard candy
11
Q
what type of urinary diagnostic study
This is a type of X-ray that may be performed during a cystoscopy. A contrast dye is injected directly into the ureters, opposite direction of normal flow, allowing doctors to visualize the upper urinary tract, including the kidneys and ureters.
A
Retrograde pyelogram
12
Q
what type of urinary diagnostic study
- Main goal = inspect interior of bladder wall
- Position = lithotomy
- Consent form required
- Post procedure
o Expected – burning, pink tinged urine, frequency
o Unexpected – bright red blood
A
Cystoscopy
13
Q
kidney stones
Diagnostic studies
T/F
- Careful H&P
- Non-contrast spiral CT (CT/KUB) – gold standard exam
- Ultrasound
- IVP
- CBC
- Urinalysis – assess for hematuria, crystalluria, pH
- Retrieval/analysis of stones
A
- Careful H&P
- Non-contrast spiral CT (CT/KUB) – gold standard exam
- Ultrasound
- IVP
X- CBC - Urinalysis – assess for hematuria, crystalluria, pH
- Retrieval/analysis of stones
14
Q
Intravenous pyelogram (IVP)
T/F
- Bowel prep required?
- Uses contrast dye?
- check for _______ sensitivity, if anaphylaxis reaction AVOID
- unexpected – flushed feeling with injection
- Kidneys must be functional –
- contrast is taken up by kidneys and excreted by kidneys
- contrast is nephrotoxic
- requires force fluids afterwards to flush contrast out of system
- if creatinine is high = consider alternative test
- The dye is injected into a vein, and it travels through the bloodstream to the kidneys, ureters, and bladder
- local reaction expected, not systemic
A
- T
- T
- iodine
- F - expected
- T
- T
- T
- T
- T
- T
- F - in the blood stream is systemic, this is why allergic reaction is very serious, could cause systemic s/e
15
Q
upper UTI Systemic infection s/s
1.
2.
3.
A
o Fever
o Chills
o Flank pain “CVA tenderness” = triangle on each side of back where kidney is
o fatigue
o vomiting
16
Q
If excessive pain or drainage around exit site of nephrostomy tube = possible _____________
If irrigation is ordered
-Use clean or sterile technique
-Gently instill no more than ___ ml of _____
A
If excessive pain or drainage around exit site
- Possible bloackage
If irrigation is ordered
- Use strict aseptic technique – high risk for infection
- Gently instill no more than 5 ml of sterile NS
17
Q
CKD/kidney disease =
Ca is ___ = Po is ____
kidneys aren’t excreting properly = Po is ___
A
ca is low = po is high
18
Q
what type of urinary diagnostic study
This is an X-ray examination of the urinary tract that uses contrast dye. The dye is injected into a vein, and it travels through the bloodstream to the kidneys, ureters, and bladder. The X-rays allow doctors to visualize the urinary tract and identify any abnormalities.
A
Intravenous pyelogram (IVP)
19
Q
UTI diagnosis
1st test =
2nd test =
A
Type of Urinalysis – quick dipstick (done at bedside)
confirm with microscopic urinalysis
20
Q
which type of lithotripsy is this?
- Cystoscopy approach or
- percutaneous approach – through skin
- uses laser
A
internal/direct
21
Q
Ileal conduit
incontinent diversion to skin
T/F
1. Indicated if pt has significant comorbidities or shorter life expectancy
2. Stoma is visible
3. no external collecting bag
4. Skin integrity concerns
5. Body image concerns
6. Unexpected finding – mucus in urine
7. Ileal conduit = urine
8. Ileostomy = urine and stool
9.most closely mimics normal voiding
A
- T
- T
- F - - Permanent external collecting bag required
- T
- T
- F - - Expected finding – mucus in urine (part of ileum/small intestine used so urine will have mucus in it from that)
- T
- F - - Ileostomy = stool
- F
22
Q
CKD/kidney disease = calcium reabsorption is ____creased = renal osteodystrophy (bone break risk)
A
decreased
low ca
23
Q
CKD s/s
SATA
- FVD
- Hypokalemia
- Metabolic acidosis
- Mineral and bone disorder
- HTN
- Anemia
- Hyperlipidemia
- Malnutrition
A
X- FVE
X- Hyperkalemia
- Metabolic acidosis
- Mineral and bone disorder
- HTN
- Anemia
- Hyperlipidemia
- Malnutrition
24
Q
T/F
Older adults with UTI
- will present with classic s/s
- localized abdominal pain
- Cognitive impairment – confusion
- Generalized clinical deterioration
A
F - will not present with classic s/s
F - non- localized abdominal pain
T- Cognitive impairment – confusion
T- Generalized clinical deterioration
25
what type of urinary diagnostic study?
uses calculation that takes patient’s age, sex, weight, and ethnicity into consideration
eGFR
26
Retrograde pyelogram
T/F
1. Indicated if IVP doesn’t visualize adequately
2. Indicated if Allergy to contrast/iodine
3. Indicated if Decreased renal function
4. Uses cystoscope and ureteral catheter
5. Bowel prep not required
6. Post procedure unexpected – burning, pink tinged urine, frequency, bright red blood
7. allergic reactions or systemic responses may be possible
1. T
2. T
3. T
4. T
5. F - required
6. F
Expected – burning, pink tinged urine, frequency
Unexpected – bright red blood
7. F - Contrast dye is not in blood stream – no allergic reactions or systemic responses
27
- issue is with actual kidney
- ex: acute tubular necrosis (ATN)
AKI - prerenal, intrarenal, or postrenal?
intrarenal
28
Predisposition to UTI
T/F
1. Anything that causes renal stasis
2. Neurogenic bladder
3. Foreign bodies or anything that obstructs urine from exiting
4. Kidney stones
5. male urethra
6. Anything compromising immune system or response
7. DM
8. Aging
9. diarrhea
10. pregnancy
11. poor hygiene
12. delay in urination
1. Anything that causes renal stasis
2. Neurogenic bladder
3. Foreign bodies or anything that obstructs urine from exiting
4. Kidney stones
F - 5. female urethra
6. Anything compromising immune system or response
7. DM
8. Aging
F - 9. constipation - impedes urine outflow
10. pregnancy
11. poor hygiene
12. delay in urination
29
urinalysis
best time to collect?
analyze within ___hr of void
morning first void
1 hr
30
CKD prevention
- Diagnosis and control of underlying problem causing CKD
1.
2.
- Early detection and treatment of CKD
HTN and DM
31
creatinine clearance is checked with a 24 hour urine collection
- Discard first urine, then 24 hour collection window begins
- Save all urine for 24 hours
- During this 24 hour window, we will also test serum creatinine
- The 24 hour urine container should be kept ______
- At end of 24 hour collection window, pt voids one last time and that last void is added to the collection
cold
32
AV fistula or AV graft?
- permanent
- artery and vein sewn together
- most common – forearm anastomosis (surgical procedure that involves connecting two hollow structures, such as blood vessels) of own artery and vein
- after procedure you have to wait ____ weeks for it to “mature” before you can use it for dialysis
AV fistula
6
33
CKD teaching
importance of reporting
o weight gain > 4 lbs
o increasing BP
o SOA
o Edema
o thirst
o Increasing fatigue/weakness
o Confusion/lethargy
o weight gain > 4 lbs
o increasing BP
o SOA
o Edema
Xo thirst
o Increasing fatigue/weakness
o Confusion/lethargy
34
creatine clearance is checked with a _______________
24 hour urine collection
35
renal biopsy Post procedure
T/F
1. Apply pressure dressing
2. Keep on unaffected side for 30-60 mins
3. Bedrest 24 hours
4. Vitals q 5-10 mins for 1 hour
5. high BP and low Hr may indicate bleed
6. Assess for chest pain and signs of bleeding
7. No heavy lifting for 7 days
1. T
2. F - Keep on affected side for 30-60 mins
3. T
4. T
5. F - low BP and high HR
6. F - Assess for flank pain and signs of bleeding
7. T
36
CKD nursing problems
1.
2.
3.
4.
5.
6.
EFV = kidneys can’t excrete fluid
- Monitor for FVE
- Daily weights
- Fluid restriction
Malnourishment = restricted intake of nutrients
- Monitor for n/v
- Weight trends
- Serum protein levels
- H&H
- Provide desirable foods
Risk for injury = decreased bone structure, 2ndary to renal osteodystrophy (low Ca)
- Monitor electrolyte levels
- Admin ordered supplements – calcium, vitamin D
Grieving = loss of kidney function, dialysis life long treatment
- Listen
- Support resources
- Encourage family involvement
Infection = suppressed immune system
- Monitor for s/s infection
- Screen and limit visitors
- Aseptic technique of dialysis line care
Activity intolerance = low RBC 2ndary to low erythropoietin production
- Rest periods
- Admin anti-anemic agents
- H&H
37
AV fistula or graft?
- adv = can be used quicker
- disadv = body often recognizes it as foreign and it gets infected
AV graft
38
4 hemodialysis access points
________- permanent
_______ – permanent
_______– temporary
________ – temporary
o AV fistula - permanent
o AV graft – permanent
o Right IJ – temporary
o Femoral – temporary
39
Adv –
- less complicated
- home dialysis possible
- increased mobility
- fewer dietary restrictions
- less CV stress
- mimics normal urine routine more
Disadv
- risk for peritonitis
- requires high motivation
- body image issues – catheter
HD or PD?
PD
40
CKD diet
o High/Low calorie
o High/Low protein
o what type of CHO
o High/Low K
o High/Low PO
o High/Low Na
o High/Low Mg
o fluid rules?
o High calorie
o Low protein, High protein (after starting dialysis)
o Slow-release CHO
o Low K
o Low PO
low Na
low Mg
fluid restriction
41
End stage CKD s/s
- No longer maintains F&E balance=
1.
2.
3.
4.
5.
- No longer rids the body or wastes via urine =
1.
2.
3.
4.
5.
- Decreased production of erythropoietin =
1.
- Decreased activation of vitamin D =
1.
No longer maintains F&E balance =
- Edema
- Hyperkalemia
- Hyperphosphatemia
- Hypermagnesemia
- Metabolic acidosis – accumulate acidic waste products
No longer rids the body or wastes via urine =
- Anorexia
- Malnutrition
- Itching
- CNS changes
- Metabolic acidosis – accumulate acidic waste products
Decreased production of erythropoietin =
- Anemia
Decreased activation of vitamin D =
- Renal osteodystrophy, weakened bones from low Calcium
42
what type of urinary diagnostic study
- Confirms suspected UTI
- Identifies causative agents of UTI
- Sterile container used
- Meatus must be cleaned prior to urine collection
- Collect specimen 1-2 seconds after voiding starts
Clean catch urine
43
Types of kidney stones
(5)
Types of kidney stones
1. Calcium oxalate – most common
2. Calcium phosphate
3. Uric acid
4. Cystine
5. Struvite – magnesium ammonium phosphate
44
kidney stones
diet changes may be indicated depending on stone type
1. diet change for calcium oxalate stones = low oxalate food or low calcium food?
2. low purine food diet for which stone?
3. low oxalate foods - SATA
dark roughage
spinach
cocoa
nuts
milk
1. low oxalate food, stones don’t come from dietary calcium
2. o for uric acid stone = low purine food
3. dark roughage
spinach
cocoa
nuts
45
Cutaneous reservoir
continent diversion to skin
T/F
1. Names – Indiana, Kock, Miami
2. Intermittent
3. Life-long
4. sterile technique self catheterization required
5. external bag
6. most closely mimics normal voiding
1. T
2. T
3. T
4. F- clean technique
5. F - - no external bag
6. F
46
If pt has
High BUN and WNL Cr =
if pt has
high BUN and high Cr =
explore other factors outside of kidneys
- GI bleed? Check H&H
- hydration status? FVE/FVD
kidney thing
47
treatment for AKI
T/F
Treatment
1. Find cause
2. Correct F&E imbalances
3. treat Hypokalemia – can be deadly
4. do FVD assessments
5. Fluid restriction
6. check Dilution lab values
7. Daily weights
8. Diuretics
9. Manage BP
10. Prevent/treat infections
11. Maintain nutrition
12. Give IV fluids
13. Avoid nephrotoxic drugs
14. high potassium diet
15. Patiromer (Veltassa)
16. Sodium zirconium cyclosilicate (Lokelma)
17. Sodium polystyrene sulfonate (Kayexalate)
18. Calcium gluconate IV
19. Dextrose and insulin
20. Sodium bicarbonate
21. Hemodialysis
3. F - Hyperkalemia
4. F - FVE assessments
12. F
14. F - Hyperkalemia restrict dietary potassium
15, 16, 17 - - Potassium binders in the GI tract
18 - treats hypocalcemia
19 - treats hypokalemia
20 - treats acidosis and hypokalemia
21 - only permanent way to treat hypokalemia
48
what kidney problem is likely to follow severe and prolonged
- hypotension
- hypovolemia
- exposure to nephrotoxic agent
and why?
AKI
r/t decreased perfusion to kidneys
49
small tube that is surgically inserted into the renal pelvis/kidney through the back (small flank incision)
- It is used to drain urine when the normal flow of urine is blocked
- Attached to external bag for closed drainage to collect urine
- Temporary option
nephrostomy tube
50
- issue is below kidney
- ex: prostate issue
AKI - prerenal, intrarenal, or postrenal?
postrenal
51
___________ peritoneal dialysis (APD)
- Uses cycler
- Automatically cycles times
- controls fill, dwell and drain phases
- used at night while sleeping
- does ~4 cycles/exchanges per night, about 1 hour per cycle
______________ peritoneal dialysis (CAPD)
- manual exchanges
- at least 4x/day
- dwell times vary
- may be able to disconnect from bag during dwell period
Automated
continuous ambulatory
52
- Specific gravity = 1.010 – 1.030
shows concentration of urine so
hydrated = low/high?
dehydrated = low/high?
hydrated = low
dehydrated = high
53
Cystoscopy
- Main goal = inspect interior of bladder wall
- Position = __________
- Consent form required
- Post procedure
o Expected or unexpected – burning, pink tinged urine, frequency?
o Expected or unexpected – bright red blood?
Cystoscopy
- Main goal = inspect interior of bladder wall
- Position = lithotomy
- Consent form required
- Post procedure
o Expected – burning, pink tinged urine, frequency
o Unexpected – bright red blood
54
____________ – medical procedure used to filter waste products and excess fluids from the blood when the kidneys can no longer do it.
- substances move from______ through a semi-permeable membrane and into __________
- ___________concentrations are unique to each person and is selected based on what we want the movement to do
Dialysis
blood, a dialysis solution (dialysate)
dialysate
55
Adv –
- rapid removal of fluid, urea/Cr, K
Disadv –
- requires vascular access/may require heparin
- dietary/fluid restriction more stringent
- hypotension during dialysis
HD or PD?
HD
56
BUN vs Cr
Most reliable indicator of renal function
Cr - specific to kidneys
57
diagnostics for Pyelonephritis
1st - _______ done at bedside
2nd _________ confirms results
3rd unique to pyelonephritis
- WBC w/ diff will show =
- image testing
- Blood culture – if we suspect _______
dip stick urinalysis
microscopic urinalysis
shift to the left (bands, neutrophils) = infection
if we suspect bacteremia (bacteria in blood)/urosepsis (UTI infection spread to blood) = we think UTI got into blood
58
high K = __________ and __________
cardiac dysrhythmias and muscle weakness
59
Endourologic procedures
example:
minimally invasive surgical techniques used to treat conditions of the urinary tract.
Lithotripsy
60
lower UTI Symptoms r/t bladder emptying or storage
o Urinary frequency
o Urgency
o Incontinence
o Nocturia
o Nocturnal enuresis – bed wetting
storage
61
if BUN is high what are 5 reasons could be causing it?
1. High nitrogen (maybe from tube feeds)
2. High protein (dietary)
3. GI bleed (blood is rich in protein)
4. Hydration status (false high/dehydrated or false low/overhydrated) = High or low BUN
5. poor kidney function
62
lower vs upper UTI
- Involves parenchyma (functional tissue of an organ), pelvis or ureters
upper UTI
63
- most common
- related to decreased CO = low BP, hypovolemia, decreased perfusion
AKI - prerenal, intrarenal, or postrenal?
prerenal
64
which electrolyte lab could be affected by
o nitrogen
o protein
o GI bleed
o Hydration status
o kidney function
BUN
65
Cystitis
Inflammation of bladder wall
66
Types of dialysis
____________ – uses semi-permeable membrane (dialyzer) outside of the body
___________ – uses peritoneum (inside body) as semi-permeable membrane
Hemodialysis
Peritoneal dialysis
67
Renal biopsy
T/F
1. Indications – suspicious for kidney cancer
2. Consent form required
3. Assess coagulation history
4. No ASA
5. No warfarin
all true
3. kidneys are very vascular, bleed risk if coagulation is not adequate
4. and 5. antiplatelet, thins blood
68
kidney stones - Care
Acute attack
1. treat
2. treat
3. treat
1. treat symptoms - pain NSAIDS and opioids
2. treat infection - systemic abx
3. treat obstruction - pass, stent, surgical removal
69
___________
inflammation of the peritoneum
- major complication of PD or HD?
- caused by not aseptic technique
peritonitis
PD
70
AV fistula or AV graft?
- Looped graft under skin connecting vein and artery
AV graft
71
drug therapy and HD
1. drug level build up = __________ possible
2. why is this assocaited with HD and not PD?
3. ________ may need to be altered to reduce chance of toxicity
4. some drugs cross semiperm membrane and are lost during dialysis = _________
5. be aware of which drugs are dialyzed out and admin when?
toxic levels
2. o since we only do it 3 days a week, drugs cant be excrete from body regularly, can circulate in active forms for prolonged periods = toxic
3. drug dose
4. subtherapeutic
5. after dialysis
72
At stage ____ CKD = kidney transplant or dialysis
5
73
Indications for a urine culture/clean catch
SATA
-Complicated UTI
-Nosocomial/hospital acquired UTI
-Frequent UTI
-UTI is unresponsive to therapy
-lower UTI
-Questionable diagnosis – don’t know what it is
-Complicated UTI
-Nosocomial/hospital acquired UTI
-Frequent UTI
-UTI is unresponsive to therapy
X-lower UTI
-Questionable diagnosis – don’t know what it is
74
dialysis care - HD, PD, or both?
1. monitor vitals
2. i&o
3. daily weight
4. monitor s/s complications
5. monitor lab values
6. daily cath/fistula care
7. no BP, injections, IV insertions on affected limb
8. do not use that IV access for anything except dialysis
9. turn side to side to facilitate drainage PRN
10. observe color of dialysate = dark, cloudy = Implies peritonitis
1 - 6 = Both
7. HD
8. HD
9. PD
10. PD
75
- Possible complications of the external lithotripsy?
1.
2.
3.
o Hemorrhage
o Infection
o Retention of stone fragments
76
kidney stone
T/F
1. 3L/day to prevent
2. force fluids not advised while managing obstructed stone
3. any fluid is preferred
4. strain urine in order to collect stone for analysis
5. stand/sit up to void on regular basis helps to prevent stones
6. ambulate/turn helps to treat stones
7. PCA pump may be indicated
8. pain is hard to control
1. T
2. T
3. F - water
4. T
5. T
6. F - prevent stones
7. T
8. T
77
manifestations AKI
1. UOP?
2. begins __ day after hypotensive event and lasts __-__ weeks
3. FVE or FVD?
4. Metabolic acidosis or alkalosis?
5. waste product accumulation?
6. Hypo or hyper natremia
7. Hypo or hyper kalemia
8. Neurologic disorders are r/t _____
9. AKI can develop into CKD if pt doesn’t recover?
1. oliguria = < 400 ml/day or < 30 ml/hour
2. begins 1 day after hypotensive event and lasts 1-3 weeks
4. Metabolic acidosis
5. waste product accumulation – no excretion, build up of waste
6. Hyponatremia – no excretion, dilution issue
7. Hyperkalemia – no excretion, accumulation issue
8. Neurologic disorders – r/t hyponataremia
9. AKI can develop into CKD if pt doesn’t recover
78
why are Urinary diversion devices indicated?
Patient has lost bladder and no longer has a urine reservoir
79
urinalysis
includes (with expected findings)
- bilirubin =
- color =
- glucose =
- ketones =
- odor =
- pH =
- protein =
- RBCs =
- Specific gravity =
- WBCs =
includes (with expected findings)
- bilirubin = none
- color = amber yellow
- glucose = none
- ketones = none
- odor = aromatic
- pH = 4.6 – 6
- protein = zero – trace
- RBCs = 0 – 4
- Specific gravity = 1.010 – 1.030 (shows concentration so hydrated = low, dehydrated = high)
- WBCs = 0 – 5
80
what type of urinary diagnostic study
Xray of abdomen and pelvis
- Bowel prep may be ordered (cleans out the intestines)
- Delineates organs (outline or define something clearly and precisely)
Kidneys, ureters, bladder (KUB)
- size, shape, and position of kidneys
- Radiopaque stones are gallbladder, kidney, etc. stones that can be seen on X-rays
81
how many types of hemodialysis?
how many types of peritoneal dialysis?
1
2 - automated and continuous ambulatory
82
Post op lithotripsy
1. Expected or unexpected finding – hematuria
2. Expected or unexpected finding – low urine output
3. low urine output might imply ___________
4. Stent placement – helps facilitate passage of fragments. Removed after __-__ weeks
Post op
- Expected finding – hematuria
- Unexpected finding – low urine output = might imply obstruction
- Stent placement – helps facilitate passage of fragments
o Removed after 1-2 weeks
83
what type of urinary diagnostic study
- Done at bedside
- Calculates presence of residual urine
bladder scanner
84
_________ – movement of particles from higher to lower
_________– movement of water from lower to higher concentration
Goal = _________
Diffusion
Osmosis
equalize concentrations
85
what type of urinary diagnostic study
type of X-ray imaging technique used to visualize the kidneys, ureters, and bladder (KUB).
It provides detailed cross-sectional images of these organs without the use of contrast dye.
- Gold standard exam for diagnosing renal colic symptoms
- Quick
- Noninvasive
- No IV contrast
Non-contrast Spiral CT (CT/KUB)
86
which type of dialysis?
- uses peritoneum (inside body) as semi-permeable membrane
- need a catheter – tenckhoff most common
- required 4x every day, but can do it anywhere, don’t have to go to dialysis clinic
Peritoneal dialysis
87
UTI diagnosis
o Positive nitrites = indicates _______
o Increased WBC = indicates _________
o Positive leukocyte esterase (an enzyme present in WBCs) = indicates ______
o Positive nitrites = indicates bacteria
o Increased WBC = indicates pyuria
o Positive leukocyte esterase (an enzyme present in WBCs) = indicates pyuria
88
CKD care
o Keep HTN and DM controlled
o Be mindful of nephrotoxicity drugs
1.
2.
o Be mindful of nephrotoxicity Contrast dye
Admin _________ – prior to contrast to lower risks
Force fluids – prior to and after
- Prevention
o Keep HTN and DM controlled
o Be mindful of nephrotoxicity drugs
NSAIDS and aminoglycosides
o Be mindful of nephrotoxicity Contrast dye
Admin acetylcysteine – prior to contrast to lower risks
Force fluids – prior to and after
89
which dialysis?
- uses semi-permeable membrane (dialyzer) outside of the body
- required 4 hours/3 days a week
- needs an access
o AV fistula - permanent
o AV graft – permanent
o Right IJ – temporary
o Femoral – temporary
hemodialysis
90
Orthotopic neobladder
continent diversion to urethra
T/F
1. internal reservoirs (fake bladder) connected to native/natural urethra
2. internal reservoir constructed from a segment of intestine (ileum) that is separated from bowel and anastomosed to the native urethra
3. most closely mimics normal voiding
4. procedure of choice after cystectomy (bladder removal)
5. requires temporary external bag
1. T
2. T
3. T
4. T
5. F
91
AV fistula temp access
_________
Temporary access used until AV fistula has matured
- tunneled, cuffed cath
- 1-3 weeks
____________
Temporary access used until AV fistula has matured
- Up to 1 week
- Not ideal but used if they cant get anywhere else
- Minimal movement, bed rest likely
Right Intra Jugular (IJ)
Femoral
92
Reducing risk factors for Nosocomial/hospital acquired UTI
T/F
- Urinary catheters are bad!
o Avoid use if possible
o Remove as soon as possible
- Careful aseptic technique with urinary tract instrumentation
o Sterile technique
o what do you do If you put cath in vagina first?
- Hand washing and glove wearing when giving peri care
- Avoid incontinence episodes
o Clean up asap
o Toilet regularly
all true
o If you put cath in vagina first, leave it
o Never pull it out and try again
93
1. _____________ catheter - A type of peritoneal dialysis catheter, used for continuous ambulatory peritoneal dialysis (CAPD).
2. Healing period?.
3. when can you shower?
4. Daily or weekly catheter care required?
5. use what to clean the catheter and exit site?
6. when is dressing required?
7. exam site for what?
1. tenckhoff catheter
2. Healing period: Requires 1-2 weeks for the exit site to heal.
3. Hygiene: Once healed, showering and patting the area dry are allowed.
4. Daily catheter care: Essential to prevent infections.
5. Antiseptic solution: Use an antiseptic solution to clean the catheter and exit site.
6. Dressing: During the healing period, a clean dressing should be applied. After healing, a dressing is not typically required.
7. Site examination: Examine the exit site daily for signs and symptoms of infection, such as redness, swelling, tenderness, or drainage.
94
Nephrolithiasis
kidney stones
95
Urosepsis
UTI that has spread to blood (systemic circulation)
Life threatening
96
what levels would you expect with AKI -
GFR?
UOP?
BUN?
Cr?
- decreased GFR = < 90 ml/min
- decreased UOP = < 30 ml/hr (with or without decrease in UO)
- increased BUN = > 20
- increased Cr = > 1.2
97
one of the first electrolytes to become abnormal if kidney damage
potassium
- kidneys excrete most potassium
- kidney disease = kidneys aren’t excreting properly
98
rank which urinary diversion device you would want if you had to have one, 1 being best - 3 being worst
Orthotopic neobladder
Ileal conduit
Cutaneous reservoir
1. Orthotopic neobladder
continent diversion to urethra
no bag, most closely mimics natural pee
2. Cutaneous reservoir
continent diversion to skin
no external bag, down side is the self cath required
3. Ileal conduit
incontinent diversion to skin
stoma, external bag, body image,
99
which type of lithotripsy is this?
- Stones broken down and washed out
- Major advantage = not invasive
external/indirect
100
what type of urinary diagnostic study?
gives Glomerular Filtration Rate (GFR) - a measure of how well your kidneys are filtering waste products from your blood, amount of blood filtered per minute by glomeruli.
(The higher/lower the GFR, the worse your kidney function is?)
Creatinine clearance
for GFR, lower = worse
101
kidney stones - Care
Acute attack
treat symptoms = Pain
- ______ pain - originates from the internal organs kidneys and ureters
- “renal colic” – constant or waxes and wanes
- Can cause __________ compromise – pain is so bad it starts messing with vitals
- what location of pain is typically especially severe pain?
treat with ___ and _____
o Pain
visceral - originates from the internal organs kidneys and ureters
“renal colic” – waxes and wanes
Can cause hemodynamic compromise – pain is so bad it starts messing with vitals (treating pain may be priority so hemodynamic compromise doesn’t occur)
Flank pain is typically especially severe pain
treat with NSAIDS and opioids
102
pts first time getting hemodialysis and they c/o
o disorientation
o seizures
o H/s
o Agitat
suspect what?
disequilibrium syndrome - esp first few times
103
kidney stone is < 4 mm =
kidney stone is > 4 mm =
o stone is < 4 mm = may pass spontaneously through urine
o stone is > 4 mm = usually doesn’t pass, may need stent placement (makes urethra opening larger)
o removal of stones
104
lower UTI Symptoms r/t bladder emptying or storage
o Hesitancy
o Intermittency
o Post void dribbling
o Urinary retention
o Dysuria
bladder emptying
105
dialysis cycle or complete exchange
___________
- 2 L of dialysate is introduced into abdomen – bag is elevated
- 10 mins
____________
- Diffusion and osmosis taking place via semiperm membrane (peritoneum)
- time varies
_____________
- Emptying out of used dialysate by gravity flow – bag is on ground
- 15 – 30 mins
Phase 2: dwell
Phase 3: drain
phase 1: inflow “fill”
phase 1: inflow “fill”
- 2 L of dialysate is introduced into abdomen – bag is elevated
- 10 mins
Phase 2: dwell
- Diffusion and osmosis taking place via semiperm membrane (peritoneum)
- Dwell time varies
Phase 3: drain
- Emptying out of used dialysate by gravity flow – bag is on ground
- 15 – 30 mins
106
UTI acute interventions
Avoid bladder irritants
SATA
Caffeine
Alcohol
ruff-age foods
Citrus juice
Chocolate
Spicy foods
cranberry juice
Caffeine
Alcohol
X ruff-age foods
Citrus juice
Chocolate
Spicy foods
X cranberry juice
107
Indications for a nephrostomy tube
1.
1. Ureter is totally obstructed for any reason
108
Types of urinary diversion devices?
1. Ileal conduit – _____ diversion to ______
2. Cutaneous reservoir – _______ diversion to ______
3. Orthotopic neobladder – _____ diversion to _______
Types:
- Ileal conduit – incontinent diversion to skin
- Cutaneous reservoir – continent diversion to skin
- Orthotopic neobladder – continent diversion to urethra
