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162 Cards in this Set
- Front
- Back
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Normal GFR
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125ml/min
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Where 80% of electrolytes are reabsorbed
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Proximal Convoluted Tubule
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Hormone required for water reabsoption in the kidney; also very important for water balance
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Antidiuretic Hormone (ADH)
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Normal adult urine output per day
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1500ml/24hrs
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An abnormal murmur or "swooshing sound" heard over the abdominal aorta and renal arteries.
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Bruit
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The bladder is not percusable until it contains ml of urine.
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150
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A waste product of protein breakdown.
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Creatinine
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Diagnostic test used to approximate to GFR.
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24hr Creatinine Clearance
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Evaluates renal concentration ability.
Normal finding: 1.020-1.035 |
Concentration test
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Normal BUN
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10-30
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Normal Creatinine
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0.5-1.5mg/dl
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Normal BUN/Creat ratio
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10/20:1
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Diagnostic test also known as a "flat plate".
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KUB
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an x-ray that visualizes the urinary tract after IV injection of contrast material.
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Intravenous Pyelogram (IVP)
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Prep required for IVP
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NPO x 8hrs, Cathartic or enema (fleets) for bowel prep, Assess for contrast allergy!!, Caution with renal patients!! (contrast)
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Diagnostic test used to visualize renal blood vessels. Used to rule out Renal Artery Stenosis
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Renal Arteriogram
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Prep required for Renal Arteriogram
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Assess iodine sensitvity, Give Cathartic or enema evening prior to exam.
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Post-procedure nursing assessment for Renal Arteriogram
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Apply pressure dressing over femoral artery injection site, Pt to remain bedrest with affected leg straight,
Assess peripheral pulses in affected leg Q 30-60min. |
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Diagnostic test used to inspect the interior of the bladder with a tubular lighted scope.
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Cystoscopy
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Prep required for Cystoscopy
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Ensure consent form is signed, If general anesthesia is to be used, force fluids or give via IV.
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Radiology procedure using contrast medium via catheter/cystoscope to assess bladder injury and vesicoureteral reflux.
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Voiding Cystourethrogram
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Diagnostic test used to evaluate bladder tone, sensations of filling, and bladder stability.
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Cystometrogram
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Diagnostic test done to obtain renal tissue for examination to determine type of/or follow renal disease.
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Renal Biopsy
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Post-biopsy nursing care
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Apply pressure dressing, keep on affected side 30-60min, bed rest x 24hrs, assess VS Q5-10min for first hour, assess site for bleeding, flank pain, and serial urine specimens.
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Infections that occur in a otherwise normal urinary tract and usually only involves the bladder.
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Uncomplicated UTI
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infections that include a coexisting presence of obstruction, stones, or catheters. Pt is at risk for pyelonephritis, urosepsis, and renal damage.
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Complicated UTI
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Uncomplicated UTI in a person who has never had an infection or experiences one that is remote from any previous UTI.
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Initial Infection
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Reinfection caused by a second pathogen in a person who experienced a previous infection that was successfully eradicated.
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Recurrent UTI
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Risk factors for UTI's
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Poor Hygiene, Retention, calculi, Reflex, Catheterization, Short Urethra (females), DM, Pregnancy, Neurogenic Bladder, Enlarged Prostate,
Aging, MS |
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Lower Urinary Tract Infection Symptoms
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Dysuria, Frequency, Urgency, Suprapubic discomfort, Hematuria, Cloudy appearing urine
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Upper Urinary Tract Infection
Symptoms |
Flank Pain, Chills, Fever
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S/S of UTI in older adults
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Nonlocalized abdominal discomfort
Cognitive impairment Increased incontinence |
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Diagnostic studies done to detect UTI's
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Dipstick UA
Urine Culture |
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Preffered way to collect a urine culture
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Midstream void, clean catch
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Treatment for Uncomplicated Cystitis
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Short term antibiotics x 1-3 days
Meds include: TMP/SMX bid or Macrodantin tid-qid |
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Treatment for Complicated Cystitis
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Long term antibiotic treatment lasting 7-14 days or longer
Meds include: Cipro, Levaquin, Noroxin, Floxin, and Tequin |
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Advise patients to wear protective clothing, avoid sunlight, and wear suncreen while taking this medication
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nitrofurantoin (Macrodantin/Macrobid/
Furadantin) |
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The use of this OTC med may turn the urine a reddish orange color
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Pyridium
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Long term use of this med may cause hemolytic anemia
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Pyridium
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Advise patients that when taking this med, it may turn the urine blue or green
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Urised
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People at high risk for UTI
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Debilitated persons, older adults, HIV, DM, cancer, pt's treated with immunosuppressives or corticosteroids
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Preventative measures to teach UTI patients
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Emptying the bladder regularly
and completely, Evacuating the bowel regularly, Wiping the perineal area from front to back after urination and defecation, Drinking an adequate amount of liquid each day |
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The recommended daily liquid intake for the ambulatory adult
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15ml per pound of body weight
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Diagnosis criteria for Interstitial Cystitis
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Pain during bladder filling that is relieved by voiding, Bothersome urinary frequency and urgency, Small bladder capacity on urodynamic testing, Cystoscopic evidence of ulcerations or glomerulations, Have at lease 1 negative urine culture during period of active symptoms.
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Treatments used for non-infectious cystitis
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BCG, TCA antideppressents (Elavil, Aventyl), Bladder instillations of Heparin, DMSO, or Hyaluronic acid
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Nurse teaching for patients with Cystitis
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Take sitz bath, Maintain a generous fluid intake, Avoid Caffeine, Alcohol, coffee, tea, Acidify urine, Empty the bladder Q3-4 hrs, Do not use high potency vitamins.
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S/S for Acute Pyelonephritis
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Fever, chills, flank pain, CVA tenderness, malaise, signs of UTI (may or may not be present), GI s/s.
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S/S for Chronic Pyelonephritis
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Intermittent low grade fever and non-specific flank or abdominal pain.
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Urinalysis results for acute pyelonephritis
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Pyuria, Bacteriuria, Hematuria
WBC casts, CBC will show elevated Leukocytosis |
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Treatment for acute pyelonephritis
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14-21 days of antibiotics
meds used: Rocephin and ampicillin |
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Caused by Mycobacterium tuberculosis, usually occurs 5-8years after primary infection
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Renal Tb
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S/S of Renal Tb
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c/o fatigue, low grade fever, cystitis, frequent urination, burning on voiding, epididymitis, Renal colic, lumbar/iliac pain, hematuria
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Diagnostic testing for Renal Tb
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Pulmonary Tb screening, 3 clean-catch first urine specimens for AFB
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Treatment for Renal Tb
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Anti-Tb meds x 24mths
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Glomerulonephritis
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Inflammation of glomerulus d/t immunologic processes (accumulation of antigen, Ab, and complement).
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S/S of Glomerulonephritis
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Hematuria (microscopic to gross), Excretion of formed elements (WBC, RBC, casts), Protenuria, Elevated BUN/serum creatinine
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Most common form of Acute Glomuerulonephritis
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Post-streptococcal glomerulonephritis (APSGN)
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Manifestations of APSGN
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Abrupt onset of hematuria, protenuria, and edema (periorbital), cola/coffee/cocoa colored urine, fatigue, N/V, anorexia.
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Nursing Interventions for APSGN
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Encourage rest until HTN and glomerular inflammation subsides, Restrict sodium and fluid intake, Administer diuretics (Loop or Diazide) and antihypertensives, If BUN is elevated, restrict dietary protein.
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Diagnostic testing used for APSGN
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H&P, U/A, CBC w/ Diff, BUN, Creatinine and albumin, Complement levels and ASO titer, Renal biopsy (if needed).
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Rapidly progressive glomerulonephritis (RPGN)
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Glomerular disease associated with acute renal failure where there is rapid, progressive loss of renal function over days to weeks (FATAL!!)
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Manifestations of RPGN
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Hypertension, Edema, Protenuria, Hematuria, RBC casts
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Treatment RPGN
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Plasmapharesis, coritcosteroids, cytoxic agents, dialysis, and transplantations
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Primary cause of end stage renal disease
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Chronic Glomerulonephritis
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Seen in patients with SLE
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Lupus Nephritis
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An idiosyncratic reaction to drugs and chemicals
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Chemical Induced Nephritis
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Common manifestations of Lupus Nephritis and Chemical Induced Nephritis
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Proteinuria and Hematuria
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Not a specific disorder but a group of clinical s/s associated with disease conditions
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Nephrotic Syndrome
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S/S of Nephrotic Syndrome
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Massive Proteinuria (frothy urine), Proteinuria (>3.5g/day), Hypoalbuminemia,
Hyperlipidemia (elev Trig), Edema (measure daily wts and abd girth!) |
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A rare autoimmune disease where both kidneys and lungs are involved; affects primarily male smokers
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Goodpasture's syndrome
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S/S of Goodpasture's Syndrome
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Hemoptysis, cough, crackles, rhonchi, hematuria and s/s of renal failure.
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Treatment for Glomerulonephritis
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Antibiotics, Immunosuppressents including steroids, ACE inhibitors and diuretics, Antilipemics (Mevacor, Colestid).
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Dilation of the kidney with urine
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Hydronephrosis
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Dilation of the ureter with urine
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Hydroureter
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Hypercoagulability and thromboembolism are serious complications of this:
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Nephrotic Syndrome
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S/S of hydronephrosis/ureter
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PAIN!! may also have increased BUN/Creat.
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Emergency situation caused by obstruction or deficient strength of the bladder to contract
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Urinary Retention
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Treatment of urinary retention
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Behavior therapy.
Catheterization and treat the cause. Urecholine (cholinergic!) and alpha andrenergic blockers (Cardura, Hytrin, Flomax). Avoid anticholinergic meds!!! |
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Risk factors for urinary calculi
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Increased urine concentration, dehydration/warm climate, sedentary lifestyle, urine stasis, diet, genetic acidity/alkalinity of urine.
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Manifestations of urinary calculi
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PAIN!! (back/abd/flank), UTI/GI symptoms (anorexia, N/V), Hematuria, Renal colic
Cool, moist skin, Lateral flank pain down to testicles, labia, or groin. |
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Diagnostic testing for urinary calculi
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U/A and C&S, KUB, IVP, U/S, CT, Cystoscopy, Serum calcium, phosphorus, uric acid, 24hr urine for calcium/phosph, uric acid or oxalate excretion, Stone analysis
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Therapeutic measures for calcium oxalate stones
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Increase hydration, Reduce dietary calcium and oxalate, Give thiazide diuretics, Give Potassium Citrate to alkalinize the urine, Give Chlestyramine to bind oxalate, Reduce daily Na+ intake
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Therapeutic measures for calcium phospate stones
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Low calcium, low phosphate diet, Treat underlying causes
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Therapeutic measures for uric acid stones
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Low purine diet,Alkanalize urine with food and Potassium Citrate, Give anti-gout drugs (allopurinol), Reduce dietary purines.
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Therapeutic measures for struvite stones
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Give antimicrobials or Lithostat, Acidify urine (with Vit C, ASA, cranberry, plum, protein)
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Therapeutic measures for cystine stones
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Alkanalize urine with potassium citrate, Give alpha-penicillamine
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Complications of Lithotripsy
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Hemorrhage, sepsis, abcess formation
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Recommended daily urinary output to prevent stone recurrence
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2L/day
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Most malignant form of bladder cancer
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Transitional Cell Carcinoma
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Risk factors: Bladder Cancer
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Cigarette smoking, Exposure to dyes in rubber/cable industries, Chronic abuse of phenectin containing analgesics, Women treated for cervical cancer with radiation, Pt's receiving Cytoxan
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Risk factors: Squamous Cell Carcinoma of the bladder
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Recurrent renal calculi, Chronic lower UTI
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S/S of Bladder Cancer
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Microscopic or gross, painless hematuria, Bladder irritability, Dysuria, Frequency, Urgency.
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Diagnostic testing: Bladder Cancer
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Bladder tumor antigens (u/a), IVP, u/s, CT, MRI, Cystoscopy (most reliable test)
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Treatment: Bladder Cancer
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BCG, Chemo, Radiation, Partial/radical cystectomy w/ urinary diversion for invasive tumor w/o mets
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BCG side effects
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flu-like symptoms, increased frequency, hematuria, systemic infection
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This type of urinary diversion requires an external appliance for collection
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Incontinent urinary diversion
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This type of urinary diversion is catheterizable
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Continent urinary diversion (Koch/Indiana/Florida pouch)
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Preop nursing intervention: urinary diversion
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Bowel prep (neomycin enema to sterilize the bowel), Teach to self cath Q6 hours and irrigate pouch daily, Stoma care
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Post op care: urinary diversion
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Pt will be NPO with NGT for a few days, Encourage high fluid intake to flush the diversions (after NPO status), Keep urine acidic to prevent alkaline crustations, Fit for permanent appliance 7-10 days after surgery, again at 4 wks, Monitor I&O, Stoma care, Encourage pt's to void q 2-4hrs, sit while voiding, and practice pelvic floor muscle relaxation.
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Most common type of kidney cancer
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Renal cell carcinoma (adenocarcinoma)
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What is the most significant risk factor for kidney cancer?
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Cigarette smoking
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Risk factors: kidney cancer
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Smoking!!, Obesity, HTN, Exposure to asbestos, gasoline, or cadmium, Male 55 and over, Renal calculi
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S/S of Kidney Cancer
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Hematuria, Flank pain, Paplable mass in the flank or abdomen, Wt loss, Fever, HTN, Anemia
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Diagnostic testing: Kidney cancer
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IVP w/ tomo, Ultrasound, Angiography, CT, MRI, Percutaneous needle aspiration
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What is the treatment of choice for kidney cancer?
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Radical nephrectomy with regional lymph node resection
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Nursing care after nephrectomy
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Pain control, TCDB to prevent atelectasis, I&O q 1-2 hrs, Daily weight, Encourage early ambulation, Monitor for adrenal insufficiency (hypoglycemia or Na+/H2O retention)
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This type of neurogenic bladder has upper motor neuron dysfunction, and causes incontinence with unpredictable or incomplete voiding
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Reflexic
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This type of neurogenic has lower motor neuron dysfunction, pt will have no control over micturation and may experience overflow incontinence or bladder distention.
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Areflexic
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What is the most common complication of neurogenic bladder?
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Infection d/t stasis and catheterization
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What medication is used to stimulate bladder contraction?
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Urecholine
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What medication is used to relax the bladder and contract internal sphincter?
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Probanthine
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What is the most common recommended treatment for neurogenic bladder management?
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Intermittent catheterizaton
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What type of patients should NOT be taught the Crede or Valsalva maneuvers?
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Those with spinal cord injury d/t risk of autonomic dysreflexia
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This type of incontinence if charecterized by an increase in intrabdominal pressure that cauese an involuntary passage of urine.
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Stress incontinence
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This type of incontinence is characterized by a strong uncontrollable urge to void.
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Urge incontinence
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This type of incontinence occurs when the pressure of urine in overfull bladder overcomes the sphincter control; characterized by frequent loss of small amounts of urine.
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Overflow incontinence
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This type of incontinence is characterized by a loss of urine resulting from cognitive, funtional, or enviromental factors.
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Functional incontinence
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What tests are used to diagnose urinary incontinence?
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PVR, Urodynamics, Ua and C&S, Cystoscopy
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What is the treatment of stress incontinence?
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Pelvic floor muscle exercises (kegel)/Vaginal cones, Topical estrogen creams, Weight loss if obese.
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What is the treatment of urge incontinece?
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Bladder retraining, Anticholinergic meds/CCB's, Vaginal estrogen creams, Pelvic floor muscle exercises
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What is the treatment for overflow incontinence?
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Urinary catheterization to decompress the bladder, Crede's or Valsalva maneuver, Alpha-andrenergic blockers, 5alpha-reductase inhibitors, Urecholine, Intermittent catheterization, Intravaginal devices (pessary).
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What is the treatment for functional incontinence?
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Environment modifications: easy toilet access, better lighting, ambulatory assistance/devices, clothing alterations, timed voiding.
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What type of meds increase the resistance of urethra/bladder outlet or suppress bladder contraction? For what type of incontinence?
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Anticholinergic.
For stress or urge incontinence. |
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What type of meds increase bladder pressure/contraction and decrease outlet resistance? For what type of incontinence?
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Cholinergic meds
For overflow incontinence |
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What medications are considered alpha-andrenergic blockers?
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Cardura, Hytrin, Flomax, Uroxatrol
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What medication is considered an alpha5 reductase inhibitor?
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Proscar
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What medications are considered anticholinergic?
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Diropan, Sanctura, Oxytrol, Detrol, Enablex, Vesicare, Tofranil.
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What are the signs of kidney/bladder/or urethra trauma?
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Hematuria, increased abdominal pain, no urine output.
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What tests are used to diagnose renal trauma?
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KUB, Cystogram, IVP, Renal angiogram, CT, MRI
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If blood is seen on the urethra, this indicates what?
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Trauma!! Do NOT insert a foley if noted
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Treatment: Renal Trauma
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Bed rest, Fluids, Analgesia, Surgical exploration/repair
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Nursing Interventions: Renal Trauma
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Monitor VS, Monitor I&O, Assess s/s of shock, Ensure increased fluid intake, Observe for hematuria, Observe for myoglobinuria, Assess cardiovascular status,
Monitor nephrotoxic abx |
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A renal artery tear can put a patient at risk for what?
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Vascular collapse
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What is the best diagnostic tool used to identify renal artery stenois?
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Renal arteriogram
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How is renal artery stenosis and nephrosclerosis treated?
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With antihypertensive meds
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Malignant nephrosclerosis is characterized by what?
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a sharp increase in BP with a diastolic pressure greater than 130mmHg
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What are the s/s of renal vein thrombosis?
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Flank pain, Hematuria, Fever, May have nephrotic syndrome
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How is renal vein thrombosis treated?
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With anticoagulant therapy (heparin, coumdadin).
*surigical thrombectomy may be performed along with anticoagulation. |
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What are the s/s of Polycystic Kidney Disease?
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Flank/abd pain, HTN, Hematuria
Proteinuria, Nocturia, Polyuria, Signs of infection Constipation, Severe headache (Berry aneurysm) |
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How is PKD diagnosed?
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Ultrasound and renal function tests, CT, Family history
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How is PKD treated?
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Prevent infections of the urinary tract.
*Kidney transplant is the only cure |
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What are the HIV related renal syndromes?
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Proteinuria and Nephrotic syndrome.
HIV-associated nephropathy. Acute renal failure. |
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Factors that reduce renal blood flow and lead to decreased glomerular perfusion and filtration are known as:
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Prerenal
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Causes of prerenal ARF
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Volume depletion(Hemorrhage, diuretics, GI loss), Impaired cardiac insufficiency MI, CHF, Dyrhythmias), Vasodilation (sepsis, anaphylaxis, anti-HTN meds).
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This type of ARF is a result of direct parenchymal damage
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Intrarenal
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Causes of Intrarenal ARF
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Prolonged ischemia (surgery, severe hypovolemia, sepsis, trauma, burns), Nephrotoxins (antibiotics, NSAIDS, contrast), Myoglobin (muscle trauma, infection), Hemoglobin (transfusion reactions) *released from hemolyzed RBC
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This type of ARF is caused as a result of an obstruction of urine flow.
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Postrenal
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Causes of Postrenal ARF
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Prostate cancer, Urinary calculi, BPH, Extrarenal tumors
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The most common initial manifestation of ARF is:
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Oliguria caused by a reduction in the GFR
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Characteristics of Oliguric phase
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Salt/Water retention (wt gain), Metabolic Acidosis,
Hyperkalemia |
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Characteristics of Diuretic phase
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Increased urinary output, Lowered Na+ and K+, BUN/Creat should begin to lower, Dehydration, Decreased BP
* pt is at r/f hyponatremia, hypokalemia, and hypochloremia |
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Characteristics of Recovery phase
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Begins when the GFR increases
BUN/Creat will be stable *may take up to 12mths to stabilize |
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Why does acidosis occur in ARF?
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Because the kidney cannot synthesize ammonia
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How is ARF diagnosed?
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UA, Renal ultrasound, Renal scan, CT, MRI, Renal biopsy
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How is ARF managed?
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Diuretics (loop diuretic-Lasix or osmotic diuretic-Mannitol), Hemodyalsis
CCRT, Fluid, Na+ restriction, Adequate calories, Rest |
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How can hyperkalemia be treated?
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Kayexalate, Insulin IV(regular), Sodium Bicarb, Calcium Gluconate IV, Dialysis, Dietary restriction (limit to 40 mEq)
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What type of renal disease is fatal without dialysis or a kidney transplant?
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Chronic Kidney Disease
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How is fluid restriction calculated?
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Add all losses for the previous 24hrs + 600ml(insensible loss)
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What is the leading cause of death in ARF?
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Infection
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How is renal insufficiency characterized?
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GFR 20-50% of normal (<60ml/min x 3mths or longer), Azotemia with oliguria & edema
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How is End Stage Renal Disease (ESRD) characterized?
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GFR <5% of normal or below 15ml/min, Uremia
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Clinical Manifestions of ESRD:
Cardiovascular- Hematologic- GI- Neurologic- Musculoskeletal- Endocrine- Integumentary- Immune- |
-HTN, -Epistaxis, Low RBC, Unable to produce EPO, Anemia, -Anorexia, N/V, Uremic Fetor, -Fatigue, H/A, confusion, lethargy, -Weakness, cramping, -Hypothyroidism, Low T3 &T4, -Yellow, pale, gray, itchy skin, increased bruising, -Increased r/f infection d/t low WBC
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