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52 Cards in this Set
- Front
- Back
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6 Functions of the Kidney |
1. Fluid Balance 2. Metabolic Waste Secretion (uremia, Cr, BUN, K, PO4) 3. Electrolyte Balance 4. Acid-Base Balance (body fluids too acidic- kidneys secrete H+ ions, return bicarbonate ions to blood; too alkaline- H+ ions returned to blood, bicarbonate ions secreted in urine) 5. Role in RBC Production (produce erythropoietin during hypoxia- stimulates red bone marrow to produce RBC) 6. Role in converting Vit. D to active form |
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UA Results- Color |
-Variable -Hydration (conc. or dilute) -Bilirubin excretion (liver/GB obstruct- drk grn) -Cloudy (UTI) |
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UA Results- Odor |
-Variable -Foul- UTI -Fruity- DKA -Ammonia- old urine sample |
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UA Results- pH |
4.6-8.0- varies with food eaten (below-metabolic/resp acidosis; above- urine has been standing or infection- bacteria decompose to form ammonia)
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UA Results- Specific Gravity |
1.002-1.026 (lower= dilute, higher= dehydration; fixed at 1.010 indicates kidney dysfunction bc 1.010 is SpGr of glomerular filtrate) |
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UA Results- Protein |
Persistent proteinuria= renal disease Intermittent= fever, dehydration, strenuous exercise |
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UA Results- Should NOT be found in urine (and what they indicate if found) (5) |
1. Glucose (diabetes) 2. Ketones (break down fat for energy- DKA or starvation) 3. Bilirubin (liver disorders, may appear before jaundice) 4. Nitrite (infection/UTI) 5. Leukocyte Esterase (infection/UTI)
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UA Results- RBCs and WBCS |
RBCs- 0-4/hpf (poss. kidney stones, trauma, infections, cx, renal dis) WBCs- 0-5/hpf (infection/inflammation/UTI) |
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UA Results- Casts |
Should have none-occasional Formed when abnormal urine contents settle into molds of renal tubules (protein, WBC, RBC, bacteria) Indicates renal damage/infection |
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UA Results- Bacterial count |
>100,000 bacteria/mL= UTI |
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Renal Function Tests- Serum Creatinine |
-Creatinine= waste product from muscle metabolism, released into bloodstream at steady rate (normal is <1.5mg/dl) -Best measure of kidney function, higher value=more impaired |
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Renal Function Tests- BUN (blood urea nitrogen) |
-Urea=waste product of protein metabolism (normal value <25mg/dl) -Not as good indicator of kidney function as Cr -Higher value (kidney disease, decreased blood flow to kidney [shock, CHF], dehydration, high protein diet [increased urea formation], GI bleed [increase urea from RBC breakdown], steroid use [increased rate protein breakdown] |
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Renal Function Tests- Uric Acid |
-Uric acid is end product of purine metabolism and breakdown of body proteins (normal is <7 mg/dl) -Not as diagnostic as Cr -Elevated (kidney disease, gout [metabolize uric acid abnormally], malnutrition, leukemia, use of thiazide diuretics [impaired uric acid clearance of kidneys]) |
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Renal Function Tests- Creatinine Clearance |
-Measures amount of creatinine cleared from blood in specified time period compared to amount cleared in urine -Expressed in volume of blood cleared of Cr in one min -Very good indicator of renal fxn, helps determine need for dialysis -24hr urine collection (start&end with empty bladder, store on ice/refridgerated), serum creatinine checked during 24hrs -100ml/min cleared=100% renal fxn; 10mL/min needed to live without dialysis |
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Other Renal Diagnostics- KUB (kidney-ureter-bladder x-ray) |
"flat plate of abd" -outlines renal structures -evaluates for tumors, swellings, kidney stones |
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Other Renal Diagnostics- IVP (Intravenous Pyelogram) |
-outlines renal structures (kidneys, ureters, bladder) -added risk r/t radiopaque dye (ask if allergy to iodine or shellfish and eval renal fxn post-test) -prep: admin laxatives before test, NPO 6-8hr before -post: push fluids to dilute dye and minimize renal damage potential; check renal fxn |
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Other Renal Diagnostics- Renal Angiography |
-visualize renal arteries to identify cause of renal disease -added risk r/t radiopaque dye -added risk r/t arterial puncture (post procedure arterial site checks) -prep: NPO 6-8hr prior -post: arterial site checks, check arterial pulse distal to arterial puncture site, keep HOB flat 6-12hr, immobilize leg so can't bend knee 6-12 hr, push fluids to dilute dye and minimize renal damage, check renal fxn tests |
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Other Renal Diagnostics- Renal Endoscopic Procedures |
-use scopes to allow camera view of internal anatomy -cystoscopy- tube inserted up urethra, look into bladder and shoot dye into kidney; remove tumors/stones; biopsy tissues; post- assess for urinary output, dysuria, bleeding r/t swelling/trauma -renal ultrasound (tumors, kidney enlgmt, stones, chronic UTI) |
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Other Renal Diagnostics- Renal Biopsy |
-percutaneous (needle thru skin in flank) to examine and diagnose cells causing kidney problems -prep: NPO 6-8hr, mild sedative, hold anticoags, local anesthetic -post: observe site closely for bleeding (inclu obs of urine), maintain pressure dressing to site, push fluids |
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Types of Incontinence (5) |
1. Stress (involuntary loss of <50mL associated with increasing abd pressure during laughing, sneezing, etc; kegels) 2. Urge ("overactive bladder," abrupt/strong desire to void; kegels) 3. Functional (inability to reach toilet d/t barriers, physical limitations, memory loss, disorientation) 4. Overflow (distention of bladder, acute/chronic with dribbling, unable to empty normally despite freq urine loss- spinal cord injuries or enlarged prostate) 5. Total (continuous and unpredictable loss of urine- surgery, trauma, malformation, neurological, bladder training is I/e) |
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Nephrotoxic Substances |
1. Antibiotics (Aminoglycosides, Cephalosporins Sulfonamides, Tetracyclines) 2. Analgesics (Acetaminophen, NSAIDs, Salicylates) 3. Other meds (ACE inhibitors, amphetamines, Dextran, Heroin, Mannitol) 4. Heavy Metals 5. Contrast Dyes (ex: IVP, cardiac cath) 6. Organic Solvents |
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UTI- Urethritis |
-inflammation of urethra -cause: irritants (chemical, bacterial, trauma, exposure to STD) -diagnose: UA w/ culture (neg UA sent for culture if s/s are present) -treat: remove irritant or treat bacteria -Pyridium or OTC urostat- urinary analgesic (can turn urine orange or stain contact lens)
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UTI- Cystitis |
-inflammation/infection of bladder wall -causes: bacteria, virus, fungus, parasite -diagnose: clean catch midstream UA (+results= cloudy, bacteria, possible RBCs, +nitrates) -treat: simple (combo sulfa med), complicated (ciprofloxacin) |
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UTI- Pyelonephritis |
-infection of renal pelvis, tubules, interstitial tissue of one/both kidneys -usually begins with colonization/infection of lower urinary tract and follows urethral route; can get infection thru bloodstream and enter kidneys thru glomerulus -formation of small abscesses thru kidney; gross enlargement
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UTI- Pyelonephritis Cont |
-diagnose: blood cultures (increase WBC, and sed. rate), UA (casts, >100,000 colonies bacteria, +nitrates) -Meds: check culture and sensitivity -Severe: IV antibiot and hosp -Pyridium: urine orange/red, stain contact lens, if sclera/skin become yellow-may indicate decreased excretion/toxicity -Complications: urosepsis, chronic kidney disease |
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UTI- Nursing Interventions |
1. Push fluids (2-3L/day) 2. Antimicrobial therapy 3. Finish prescribed meds 4. Antipyretics 5. Encourage voiding every 3hr 6. Avoid coffee, cola, tea, alcohol 7. Consume cranberry juice (10oz/day) or capsules 8. Heat to suprapubic area 9. Empty bladder when urge is felt and following intercourse |
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UTI- Nursing Interventions Cont |
10. Avoid bubble bath, scented toilet paper 11. Good peri-care, wipe front to back 12. Cotton underwear 13. Monitor urinary output 14. Follow-up urine culture/imagining studies when indicated |
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Obstructions- Urethral Strictures |
-narrowing of lumen of urethra caused by scar tissue -injury, infection, trauma, STDS, cath insertion -diminished urinary stream, prone to UTI -often seen in elderly men -mechanical dilation by urologist (painful, often insert indwelling cath after, risk of infection) |
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Obstructions- Renal Calculi |
-stone formed in renal structure (mass of crystal and protein when urine becomes supersaturated with salt which collects around nucleus) -majority contain calcium (oxalate or phosphate) -risk factors: fam hx, dehydration, infection, dietary, immobility, urinary stasis |
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Obstructions- Renal Calculi Cont |
-s/s: severe flank pain, pain radiating to genital area, N/V, hematuria, anuria, costovertebral angle pain -diagnose: UA, KUB, IVP, ultrasound -if larger than 5 mm- surgical removal (lithotripsy- sound waves, cystoscopy, nephrolithotomy) |
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Obstructions- Renal Calculi- Nursing Interventions |
1. Collect UA 2. Push fluids (IV or PO) 3. Pain med (IV morphine) 4. Ambulation 5. Heat to flank 6. Vitals (fever=infection, decreasing BP=shock d/t severe pain) 7. I&Os 8. Strain urine 9. Send stones to lab for UA
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Obstructions- Hydronephrosis |
-results from untreated obstruction in urinary tract (kidney becomes reservoir of urine instead of functional) -obstruction in urinary flow can be from stricture, kidney stones, tumor, enlarged prostate -distended renal pelvis -remove obstruction (if unable- stent or nephrostomy tube-prevent kinking of tube) |
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Diabetic Neuropathy |
-most common cause of renal failure -risk factors: HTN, genetics, smoking, chronic hyperglycemia -increased osmotic pressure from hyperglycemia, increased diuresis, increased glomerular filtration rate, atherosclerotic changes to blood vessels (decreased blood flow to kidneys) -Protein excreted in urine- nephrotic syndrome- edema d/t low albumin in blood -Large amounts of dilute urine w/o usual amounts of waste products |
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Diabetic Neuropathy Cont |
-Less insulin required (kidney can no longer break down/excrete it) -Control blood glucose/ BP to prevent -ACE inhibitors or angiotensin II receptor blockers (ARBs) to slow decline -Usually need dialysis or kidney/pancreas transplant |
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Glomerulonephritis (Patho/Cause) |
-inflammatory disease of glomerulus (filtering units of kidney) -occurs as result of antigen-antibody complexes in basement membrane- immune reaction causes inflammation- glomerulus becomes more porous- allows proteins, WBC, RBC to leak into urine -abrupt onset (6-10 days after infection) -Group A Strep (or other viral infections) most common initiating event |
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Glomerulonephritis (s/s) |
Fluid volume overload, HTN, electrolyte imbalance, edema, flank pain |
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Glomerulonephritis (Meds/interventions) |
-often resolve spontaneously in about a week but could progress to chronic kidney disease -Na/fluid restrictions, diuretics to treat fluid retention -anti-HTN or antibiotics (if cause such as strep) -dialysis if severe fluid overload |
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Acute Kidney Injury (Patho) |
-sudden (hours-days) loss of kidneys ability to clear waste products and regulate fluids -hypotension, dehydration, vascular obstruction, glomerular disease, acute tubular necrosis (tubules damaged by contrast media) -causes waste products to accumulate in bloodstream (azotemia) -complications- can progress to chronic kidney disease; infection, pneumonia, septicemia |
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Acute Kidney Injury Classifications (Prerenal) |
-"before the kidney" -decrease/interruption of blood supply to kidneys -55-60% of cases -nephrons receive inadequate blood supply=unable to make urine=waste products not adequately removed -causes- dehydration, blood loss, shock, trauma, blockage of arteries, some drugs (NSAIDs), HF, burns, sepsis |
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Acute Kidney Injury Classifications (Intrarenal) |
-"inside the kidney" -damage to nephrons -35% of cases (50% mortality rate) -most common causes- ischemia, reduced blood flow, toxins -other causes- trauma, nephrotoxins, contrast dye, glomerulonephritis, diabetic neuropathy, some drugs (antibiotics) |
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Acute Kidney Injury Classifications (Postrenal) |
-"after the kidney" -obstruction that blocks flow of urine out of body -5% of cases -causes- kidney stones, tumors of ureter or bladder, enlarged prostate, neurogenic bladder |
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Acute Kidney Injury- Oliguric Phase |
-less than 400mL urine produced in 24hr -24hr-7days (prognosis decreases longer it lasts) -fluid retained, electrolytes imbalanced, waste products accumulate -serum potassium retained, sodium lost in urine -metabolic acidosis, neuro effects (seizures, coma) |
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Acute Kidney Injury- Diuretic Phase |
-kidneys begin to excrete wastes again (1-3L urine/day) -kidneys can not yet concentrate urine (dehydration and hypotension are concerns) -monitor for hypovolemia, hyponatremia, hypotension -Serum BUN and Cr still raised until end of this phase -1-3wks |
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Acute Kidney Injury- Recovery Phase |
-glomerular filtration rate rises -waste product levels decrease -can take up to 1 year |
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Chronic Kidney Disease (Patho, Cause) |
-progressive, irreversible deterioration in renal function -nephrons are damaged/destroyed -early/silent stage (up to 50% nephron function lost, often no s/s) -renal insufficiency stage (75% nephron function lost, some s/s, slightly elevated BUN/Cr) -end stage (90% of nephrons lost, require dialysis or kidney transplant) -Diabetes mellitus and HTN= 70% of all chronic kidney disease |
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Chronic Kidney Disease (s/s) |
1. Disturbance in water balance (fluid accumulation, edema, SOB, crackles/wheezes, distended blood vessels in neck, HTN, polyuria, oliguria, anuria) 2. Disturbance in electrolyte balance (hyper or hyponatremia, hyperkalemia, decrease in calcium, hyperphosphatemia)- muscle weakness, GI, arrhythmias, itching 3. Disturbance in waste product removal (weakness, fatigue, confusion, seizures, N/V, metallic/bad taste in mouth, yellowish skin, urea crystals on skin cause itching)- must have dialysis 4. Disturbance in maintaining acid-base balance (metabolic acidosis- resps fast/deep to get ride of CO2 [Kussmals]) 5. Disturbance in Hematologic Function (don't produce adequate erythropoietin- less RBC production, impaired WBC, platelets, immune function [risk for infection]) |
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Chronic Kidney Disease Interventions (Meds) |
-diuretics if kidney functions -anti-HTN (ACE inhibitors, beta blockers, CCB) -phosphate binders (TUMS)- reduce phosphate levels -less insulin and meds closely monitored for toxicity |
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Chronic Kidney Disease Interventions (Diet) |
-adequate calories -limit protein, NA, K, Phosphorus -limit fluids -limit salt subs -supplements (irons, folic acid, vitamins, minerals) -calcium increased or supplemented -sat fat and cholesterol restricted |
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Dialysis |
-movement and diffusion of particles from area of high concentration to area of low concentration thru semi-permeable membrane |
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Hemodialysis |
-use of artificial kidney to remove waste products/excess water from blood -AV fistula or vascular access graft,]) can use central line short-term until fistula/graft is ready [fistula-best-2-6 months, graft- 1-2weeks -blood with waste products out, blood cleansed by dialysate solution returned to body -3-4hr/ 3-4 times/week -rapid and efficient, most common -SE: (d/t sudden drop in fluids/electrolytes) weakness, fatigue, lowered BP, cardiac dysrhythmias, angina, muscle cramps
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Hemodialysis Nursing Interventions |
1. Heparin (keep blood from clotting while in artificial kidney) 2. Determine which meds to hold (ex: anti-HTN) 3. Weight before/after 4. After breakfast/cares (pts very tired after) 5. Check site for bleeding, monitor vitals 6. Listen for bruit (swishing sound of turbulent blood flow) and palpate for thrill (buzzing/pulsing) at periph pulses 7. Fistula/graft arm- restricted extremity, don't lift heavy objects or wear tight clothing
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Peritoneal Dialysis |
-continuous tx, done at home -dialysis solution flows thru tube into abdominal cavity where it collects waste products from the blood, periodically the used dialysis solution is drained from the abdominal cavity, carrying away waste products/excess water from blood -major complication is peritonitis (infection of peritoneum), major cause is poor technique connecting bag to cath, first sign is usually abdominal pain -fewer dietary/fluid restrictions than hemodialysis bc it is continuous and maintains serum waste levels, proteins are lost thru membrane so increased proteins are needed |
