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NUR2226 > WK 6: Renal Disorders > Flashcards

WK 6: Renal Disorders Flashcards

1
Q

What is a Urinary Tract Infection?

A

Is an infection of the urinary tract causing inflammation of the urinary epithelium

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2
Q

What are the 3 classifications of a UTI?

A
  1. Location
  2. Complexity
  3. Presence or absence of associated symptoms
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3
Q

How do you classify UTI’s according to location?

A

Upper urinary Tract: Kidney, ureters

Lower urinary tract: Bladder, urethra

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4
Q

How do you classify UTI’s according to complexity?

A

Complicated: Associated with anatomical/functional abnormalities increasing the risk of complications
Uncomplicated: Inflammation/Infection that occurs in non-instrumented, non pregnant women without abnormalities

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5
Q

How do you classify UTI’s according to presence or absence of associated symptoms?

A

Asymptomatic: Presence of significant growth of bacteria which does not illicit symptoms
Symptomatic: Presence of frequency, dysuria and loin pain in combination with significant growth on urine culture

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6
Q

Identify 4 risk factors associated with UTI’s

A 
Female gender (Shorter urethra)
Obstruction e.g. calculi, tumour 
Urinary stasis e.g. retention 
Sexual trauma 
Instrumentation e.g. catheter
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7
Q

Identify 3 clinical manifestations of a lower UTI

A

Dysuria
Urinary frequency
Haematuria, proteinuria
Urinary urgency

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8
Q

Identify 3 clinical manifestations associated with an upper UTI

A

Pain: lower abdominal, suprapubic
Lethargy
Fever, chills, myalgia

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9
Q

Describe the pathophysiology of a lower UTI

A

Bacterial contamination of sterile urine causes pathogen colonisation in peri urethral area where it then moves into the urethra and bladder attaching to the epithelium

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10
Q

Describe the pathophysiology of an upper UTI

A

When the pathogen ascends further up into the ureters and towards the kidneys, undergoing pathogen replication and causing infection

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11
Q

Identify the 3 areas of factors which assist with preventing UTI’s

A

Functional e.g. micturition washes out bacteria
Bactericidal e.g. Low pH (acidic)
Combination of both (Long urethra in men)

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12
Q

Identify 3 causative agents for UTI’s

A

E. coli
Pseudomonas
Staphlococcus `

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13
Q

Identify 3 nursing interventions for UTI’s

A

Non pharmacological: Increased fluids, heat pack
Bladder scan PVR <200mLs
FBC
Urinalysis

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14
Q

Describe acute cysitis

A

Acute inflammation of the bladder (Lower UTI)

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15
Q

Identify 3 clinical manifestations associated with acute cysitis

A

Urgency, Frequency, Dysuria, Pain

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16
Q

Describe pyelonephritis

A

Acute infection of the kidney (Upper UTI), One or both kidneys involved

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17
Q

Identify 3 clinical manifestations associated with pyelonephritis

A

Symptom TRIAD:
Vomiting
Fever
Flank pain

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18
Q

What does CAUTI stand for

A

Catheter Acquired UTI

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19
Q

Describe why CAUTI’s occur

A

Due to increased risk of infection as the catheter has a large potential to introduce bacteria from the external environment into the bladder

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20
Q

Identify 3 ways to prevent CAUTI’s

A

Strict aseptic technique
Only change IDC if clinically indicated
Obtain urien samples aseptically

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21
Q

What is urinary retention?

A

Inability to voluntarily urinate presenting with incomplete. bladder emptying and complete lack of voiding

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22
Q

Describe Acute urinary retention

A

Sudden and painful inability to urinate despite having full bladder

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23
Q

Describe chronic urinary retention

A

Painless retention associated with increased volume of residual urine

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24
Q

Identify 3 causes of urinary retention

A

Diabetes
Prostatic enlargement
Trauma
Surgery

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25
Q

Identify 3 nursing interventions associated with urinary retention

A

Pain assessment
Bladder scan
Physical assessment

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26
Q

What is PVR

A

Post ovoidal residual volume: The volume of urine left in the bladder after voiding. <200mL is normal

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27
Q

Identify 2 indications to undertake a bladder scan

A

Prior to catheter insertion

Suspected urinary retention

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28
Q

What is glomerulonephritis

A

Kidney disorder that involves damage/inflammation to the glomeruli

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29
Q

What are the glomeruli

A

Filters in the kidneys that are responsible for the removal of wastes and toxins from the blood

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30
Q

Identify the 4 classifications of glomerulonephritis

A

Acute
Chronic
Primary
Secondary

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31
Q

Describe Acute GN

A

Occurs suddenly, usually 1-2 weeks post infection e.g. upper respiratory or skin. Can be reversible

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32
Q

Describe chronic GN

A

Develops gradually over many years. Often results in irreversible kidney failure

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33
Q

Describe primary GN

A

If it occurs on its own

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34
Q

Describe secondary GN

A

If it occurs in association with an immunological disorder such as diabetes

35
Q

Identify 3 risk factors for glomerulonephritis

A

Kidney disease
Infection e.g. viral infections
Ilicit drug use
Cancer

36
Q

Identify 3 clinical manifestations associated with glomerulonephritis

A 
Foamy urine (proteinuria)
Pink urine (haematuria)
HTN
Fluid retention 
SOB
37
Q

Describe the pathophysiology of glomerulonephritis

A

Occurs when the glomerular filtration membrane becomes inflamed, causing damage to glomerular epithelial cells increasing the permeability. This causes decreased hydrostatic pressure, haemturia and proteinuria

38
Q

`What is nephrotic syndrome

A

Damaged glomeruli which usually only let small compounds into urine become more permeable allowing more proteins and particles to enter into the filtrate causing (Proteinuria) causes oedema

39
Q

Identify 3 nursing interventions in the diagnosis of glomerulonephritis

A

Accurate assessment
Urinalysis/Bloods, VS
Documentation
Education and support

40
Q

What does AKI stand for

A

Acute Kidney Injury

41
Q

What is AKI

A

Sudden decline in renal function inhibiting the kidney’s ability to regulate fluid, electrolytes and acid base balance

42
Q

What are the 2 main characteristics of AKI

A

Rapid onset = Hours-Days

Rapid loss of kidney function = 25% of normal or GFR 25-30mL/min

43
Q

Identify 3 complications of AKI

A

Azotaemia
Uraemia
Electrolyte/Acid base imbalance

44
Q

What is azotaemia

A

Elevated levels of urea and nitrogen and other compounds in the blood

45
Q

What is uraemia

A

Abnormally high levels of waste products in the blood

46
Q

Identify 3 risk factors for AKI

A

Trauma e.g. burns, stabbing
Surgery
Nephrotic agents e.g. drugs, heavy metals
Dehydration

47
Q

Identify 5 clinical manifestations of AKI

A 
Proteinuria
Haematuria 
Decreased specific gravity 
Nausea/vomitng 
Lethargy
48
Q

Identify the 3 different types of AKI

A

Prerenal
Intrarenal
Postrenal

49
Q

Describe the pathophysiology of pre renal AKI

A

Caused by conditions which decrease renal blood flow (occurs before the kidney). This means less blood flow into the kidneys e.g. from decreased systemic blood flow and hypoperfusion e.g. decreased CoO

50
Q

Describe the pathophysiology of intra renal AKI

A

Loss of ability of to filter blood properly (Occurs within the kidney). Resorption/secretion impaired due to acute tubercular necrosis (most common) e.g. nephrotoxic agents

51
Q

Describe acute tubercular necrosis

A

Occurs when the epithelium cells of the tubules don’t receive enough perfusion due to decreased renal blood flow/hypotension so the cells die and cannot resorb/secrete particles

52
Q

Describe the pathophysiology of post renal AKI

A

Occurs due to a mechanical obstruction of urinary outflow resulting in reflux and impaired kidney function (After the kidney). Pressure backs up into the tubules. This results in decreased GFR and less waste products filtered out of the blood

53
Q

Identify the 4 stages of AKI

A
  1. Initiation (Onset stage)
  2. Maintenance stage
  3. Diuretic stage
  4. Recovery stage
54
Q

Describe what occurs in the initiation stage of AKI

A

Begins with event that causes ATN (Acute tubercular necrosis), and ends when renal damage occurs. Can be assymtpomatic

55
Q

Describe what occurs at the maintenance stage

A

Renal damage well established, persistent oliguria, inability to eliminate wastes causing electrolyte imbalance fluid retention etc.

56
Q

Describe what occurs at the diuretic stage

A

Gradual rise in urine output, nephrons not fully functioning, excretes waste but doesn’t concentrate urine

57
Q

Describe what occurs at the recovery stage

A

Begins with renal tissues and GFR repair themselves and renal function is well established, progressive in increasing urine output, improvement in pathology results

58
Q

Identify 3 areas of nursing mangement in AKI

A

Non pharmacological: heat/cold pack, positioning
Provide adequate hydration
Monitor urine output hourly
Urine assessment

59
Q

What is a nephrostomy tube

A

When a ureter becomes obstructed, a nephrostomy tube can be inserted to preserve urine function on a temporary basis

60
Q

Identify 2 causes of ureter obstruction

A

Renal calculi

Trauma

61
Q

Where is the nephrostomy tube inserted into?

A

Directly into the renal pelvis sutured in place, with imaging to confirm the correct spot

62
Q

Identify 2 potential complications of nephrostomy tubes

A

Bleeding

Perforation to other organ during procedure

63
Q

How long does the pt remain on bed rest after nephrostomy procedure?

A

4 hours

64
Q

What 3 things should you inform to the doctor should they occur post nephrostomy procedure

A

Urine output <30mLs over an hour
Urine heavily blood stained
Abnormal vital signs

65
Q

Identify 3 nursing considerations associated with nephrostotmy tubes

A

Monitor colour in drainage
Encourage fluid intake
Regular emptying of bag

66
Q

Define anuria

A

Failure of the kidneys to produce urine

67
Q

Define proteinuria

A

Presence of protein in the urine

68
Q

Define haematuria

A

Presence of blood in the urine

69
Q

Define pyuria

A

Presence of pus in the urine

70
Q

Define dysuria

A

Difficult or painful urination

71
Q

Define polyuria

A

The passage of large amounts of urine (2-3L per day in adults)

72
Q

Define oliguria

A

The passage of less than 400mLs of urine per day in adults

73
Q

Define glycosuria

A

The presence of glucose in urine

74
Q

Trimethoprim

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing consideration
A
  • Urinary tract antimicrobials
  • First line of drug to treat uncomplicated UTI’s
  • Inhibits bacterial folate production, essential for bacterial growth
  • Vomiting, diarrhoea,
  • Avoid in first trimester pregnancy
75
Q

Cefalexin

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing consideration
A
  • Urinary tract antimicrobials
  • Second line of drug to treat uncomplicated UTI’s and other bacterial infections
  • Interferes with bacterial cell wall synthesis by binding to penicillin binding protein=cell lysis and death
  • Vomiting, diarrhoea
  • Observe for allergic reaction in penicillin allergy
76
Q

Gentamicin Sulphate

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing consideration
A
  • Aminoglycoside
  • First line treatment against gram negative organisms, where other antibiotics are contraindicated
  • Inhibits protein synthesis by irreversibly binding to the organisms cell wall causing cell membrane damage
  • dizziness, vomiting, ataxia
  • Strict FBC, adequate hydration
77
Q

Identify the 4 urinary tract antimicrobials

A

Trimethoprim
Cefalexin
Gentamicin sulphate
Urinary alkalisers

78
Q

Urinary Alkalisers

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing consideration
A
  • Urinary tract antimicrobials
  • Symptomatic relief, acute use only, not used to treat or prevent UTI’s
  • Raises the pH of urine making it less acidic to provide pain relief
  • Symptomatic relief
  • Ensure pt education about short term use only
79
Q

Loop directics

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing consideration
A
  • Loop diuretics
  • Oedema in renal function, nephrotic syndrome, HF
  • Inhibits sodium, potassium and chloride reabsorption resulting in increased water excretion
  • Hypotension, dizziness
  • Can result in hyperkalaemia
80
Q

What is an example of a loop diuretic?

A

Furosemide

81
Q

Potassium sparing diuretics

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing consideration
A
  • Potassium sparing diuretics
  • Adjunct alongside loop diuretics, people at high risk of hyperkalaemia, oedema in renal function
  • Retain potassium, increased excretion of sodium, inhibits sodium, potassium and chloride reabsorption = increased water excretion
  • Headache, drowsiness
82
Q

What is an example of a potassium sparing diuretic

A

Spironolactone

83
Q

Thiazide and Thiazide like diuretics

  • Class
  • Indication
  • Action
  • Adverse effects
  • Nursing consideration
A
  • Thiazide and thiazide like diuretics
  • Oedema, HTN chronic renal failure, prevention of renal calculi
  • Increase excretion of water and sodium, chloride, potassium, magnesium and reduced excretion of calcium
  • Headache, dizziness
  • Increased risk of orthostatic hypotension
84
Q

What is an example of a thiazide or thiazide like diuretic?

A

Hydrochlorothiazide

NUR2226 (8 decks)

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