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94 Cards in this Set
- Front
- Back
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What are the 6 systems affected by the function of the renal system?
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1. fluid volume
2. neurological statu 3. integumentary status 4. musculoskeletal system 5. cardiovascular system 6. respiratory system |
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items to assess for fluid volume r/t renal system
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-intake
-output -weight -mucous membranes -edema -lytes -BUN -creatinine |
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how does impaired renal function affect neuro status?
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-interferes with normal activity on the CNS
-leads to increased BUN and creatinine, leading to an impaired CNS response to stimuli |
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Why does the CNS become impaired with renal dysfunction?
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the increased BUN and creatinine lead to an impaired CNS response to stimuli
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What qualities of skin can be noted in patients with renal dysfunction?
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-pallor
-yellow gray -bruising -crystal deposits under skin |
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why would skin be pale in someone with impaired renal function?
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due to decreased erythropoietin
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Why would skin bye yellow gray in someone with impaired renal function?
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due to deposits of puritine like substance
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Why would bruising be exhibited in someone with impaired renal function?
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due to an alteration in bleeding times
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Why would crystal deposits form under the skin in someone with impaired renal function?
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as a means to get rid of the waste, which the kidneys are failing to accomplish
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What assessment of the musculoskeletal system should take place in someone with impaired renal function?
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-assess movement during exam to determine tone of muscles
-assess ability to get to the bathroom |
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What is common r/t the cardiovascular system in someone with impaired renal function? Why?
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-hypertension
-due to fluid volume excess or -due to malfunction of the RAA system -due to fluid and electrolyte imbalances |
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What pH imbalance is common in someone with impaired renal function? Why?
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-metabolic acidosis
-due to the buildup of acids in the system |
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What happens in the respiratory system in someone with impaired renal function?
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As acidosis increases the lungs compenste in an attempt to maintain a normal pH, therefore leading to rapid, shallow breaths.
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What is the composition of urine?
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-95% water
-urea -creatinine -ammonia -chlorides -magnesium phosphate |
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What lab studies can be done for someone with impaired renal function?
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-urinalysis
-specific graviity -clearance studies -creatinine clearance -GFR -BUN -CBC |
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What happens to urine specific gravity in someone with impaired renal function?
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may either be elevated or decreased
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Def: specific gravity
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the weight of a substance compared with an equal volume of water
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normal SG of water
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1.000
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normal SG of urine
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1.010-1.025
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Does urine normally have WBC's or ketones in it?
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no.
WBC's could indicate a UTI |
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What do clearance studies measure?
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the amount of plasma totally cleared of a given substance in 1 minute.
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Clearance of a substance is done by...
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filtration and excretion
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Creatinine clearance helps determine and is closely related to
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GFR
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GFR is closely related to
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creatinine clearance
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What is creatinine
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a byproduct of the metabolism of muscle.
-decomposed product of metabolism of phoshpocreatine |
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how do the kidneys handle creatine
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they are filtered by the glomerulus... Anything Else?
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What is the coorelation between GFR and creatinine level?
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as GFR decreases, creatinine increases
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What is the best way to measure level of kidney function?
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GFR
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What is GFR
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-glomerular filtration rate
-how much blood passes through the glomeruli in one minute |
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What is GFR good for?
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-best way to measure level of kidney function
-also helps to determine stage of kidney disease |
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Normal GFR
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90-120
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5 Stages of Kidney Disease
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-Stage 1 - ~90 - some damage to the kidney, but normal function is occuring.
-Stage 2 - 60-89 - Kidney damage and mild kidney dysfunction. -Stage 3 - 30-59 - Moderate kidney damage. -Stage 4 - 15-29 - Severe kidney dysfunction/damage. Usually need dialysis. -Stage 5 - <15 - Kidney failure. Dialysis Necessary. |
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calculation of GFR
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(the concentration of urine x the flow of urine), divided by (plasma Cr.Cl.)
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What factors does GFR depend on?
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-age, gender, race, BMI
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How is creatinine clearance CrCl measured?
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24 hours of urine is collected
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normal CrCl females
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0.8-1.7 grams/24 hours
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normal CrCl males
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1.0-1.9 grams/24 hours
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As renal disease progresses, what happens to CrCl?
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it decreases
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the lower the CrCl, the ______ the renal disease
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more advanced
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How does BUN correlate to renal function?
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-It is a rough estimate of renal function.
-Any impairment in the renal system will result in an increase in BUN. -There are also non-renal cases for an increased BUN, however. |
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What are some non-renal causes of an increased BUN?
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-hypovolemia
-increased protein intake -starvation/malnutrition -bleeding -trauma -tetracycline |
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Tetracycline can cause an increase in what lab value?
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BUN
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What is a better indicator of renal function, BUN or creatinine? Why?
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creatinine, because it is not as affected by intake
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The greater the nephron loss, the greater the which lab value?
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creatinine
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What will a CBC show in someone with impaired renal function? Why?
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decreased H/H
decreased RBC -due to decreased EPO -if infection is present, increased WBC |
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What radiological studies are available to someone with impaired renal function?
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-KUB
-IVP -CatScan (CT) -U/S kidneys |
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What is the purpose of a KUB?
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-helps to identify any soft tissue masses, calculi, or malformations of the KUB
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How is an IVP performed?
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IV injection of a radiopaque dye that is filtered by the kidney and excreted through the urinary tract.
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What is the purpose of an IVP?
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It helps to identify the location, size, and configuration of the KUB
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Nursing Considerations for an IVP
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-NPO after midnight
-possible bowel prep -intra - supine position, feel warm flushed feeling while the dye is injected, and films are taken as the dye passes through the KUB |
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Why NPO after midnight for an IVP?
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allows the dye to be concentrated as it is injected
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What is the purpose of a CT in someone with impaired renal function?
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Examines the renal tract, assesses for masses, and is used to stage tumors.
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What is the purpose of an ultrasound U/S for the kidneys?
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It differentiates between fluid and solid masses, or cysts vs solid masses.
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What is the purpose of a cystoscopy?
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1. To directly inspect the bladder for tumors, stones, or ulcerations.
2. To collect urine directly from the kidney pelvis or separately from each kidney 3. For x-ray visualization through a cystoscope. 4. To measure bladder capacity and assess any reflux in the urinary tract. 5. To biopsy any area. 6. To resect tumors. 7. To remove stones. 8. To dilate ureters. 9. To implant radiation seeds. |
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porta, ae (f.)
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gate
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When the cystoscope is about to be inserted, what should the patient do?
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Take a deep breath on entrance
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Post cystoscopy
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-pt might feel great desire to void right after
-bed rest for a short time -do not stand immediately -pink urine is common for the first day -lower back spasms are common (use warm tub baths or analgesics -monitor complications (sudden pelvic pain or low abdominal pain, bright red bleeding, clots) |
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What color urine is common for the 1st day post cysto
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pink urine
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What symptoms should you report immediately post cysto?
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-bright red bleeding
-clots -sudden pelvic or low abdominal pain, may indicate perforation |
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After a cystoscopy, what might happen with men?
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they might develop retention.
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What symptoms are normal post cysto?
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pink urine and lower back spasms
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position for IVP
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supine
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position for cystoscopy
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lithotomy
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position for renal biopsy
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prone with pillow under the spine
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What is the purpose of a renal biopsy?
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To obtain renal tissue for evaluation.
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A nephrostomy is aka
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and open renal biopsy
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Open renal biopsy / nephrostomy, involves...
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An incision via the flank area, allowing direct visualization. Adequate tissue is obtained 100% of the time.
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Nursing considerations for an open renal biopsy
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the usually operative NAA
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A closed renal biopsy involves
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a cystoscope or percutaneous needle
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Percutaneous closed renal biopsy involves...
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a needle piercing the skin and the kidney is entered and a small amount of tissue is obtained. Ultrasound guides the needle.
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Nursing considerations pre-cysto-closed-biopsy
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same as for pre-cysto
-NPO -bowel prep -IVF -sedation -local anesthesia -lithotomy position |
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Nursing consideration pre-percutaneous-closed-biopsy
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-prior to...a. x-ray and b. blood work
-local anesthetic -prone position, pillow under spine -asked to take a deep breath, then on inhale, the percutaneous needle is inserted -pressure dressing after -monitor frequently for any bleeding, shock, or perforation -frequent VS |
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What is nephrectomy?
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removal of a kidney via a peritoneal incision
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Purpose of a nephectomy?
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usually done for renal cancer
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What is a nephrostomy?
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The formation of an artificial fistula directly into the kidneys.
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What is the purpose of a nephrostomy?
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-to drain an obstructed kidney
-to drain a hydronephrosis |
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What happens to urinary output with a nephrostomy?
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urinary output will be the same as usual
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outer layer of the kidney is called...
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renal capsule
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inner region of the kidney is divided into...
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-renal cortex
-renal medulla |
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How much of the cardiac output do the kidneys receive?
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25% of the CO
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How is blood supplied to the kidney?
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renal artery
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Where are the kidneys located?
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in the retroperitoneal space, behind the peritoneum
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What is the functional unit of the kidney?
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nephron
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What is the most adequate indicator for fluid and sodium retention?
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intake and output
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How is blood supply delivered to the nephron?
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afferent arteriole to the glomerulus
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Functions of the Kidneys
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1. Maintain fluid balance
2. Absorb water via tubules 3. Hormone regulation |
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What hormones do the kidneys regulate?
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-renin
-prostaglandins -bradykinin -erythropoietin -vitamin D -aldosterone -ADH |
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About renin
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-released if blood flow to kidney is low
-maintains blood pressure |
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About prostaglandins r/t renal fn
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-help regulate GFR
-promote Na and H20 excretion |
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About bradykinens r/t renal fn
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-dilate afferent arterioles to increase capillary membrane flow
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About EPO r/t renal fn
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-released by kidneys in response to a decrease in RBC or decreased perfusion
-stimulates bone marrow to produce RBC |
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About vitamin D r/t renal fn
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-converted to active form, calciferol, in the kidney
-calciferol is needed for intestinal Calcium absorption |
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About aldosterone r/t renal fn
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-increases sodium reabsorption, and water follows sodium
-produced in the renal cortex |
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About ADH r/t renal fn
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-decreases water excretion from the kidneys
-produced in the hypothalamus -stored in the posterior pituitary |
