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60 Cards in this Set
- Front
- Back
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What is acute renal failure?
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The sudden loss of kidney function caused by renal cell damage from ischemia or toxic substances. Acute renal failure occurs abruptly and can be reversible. Acute renal failure leads to hypoperfusion, cell death, and decompensation in renal function. The prognosis depends on the cause and condition of the client. Near-normal or normal kidney function may resume gradually.
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What is anuria?
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Urine output of less than 100 mL/day
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What is azotemia?
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The retention of nitrogenous waste products in the blood
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What is hemodialysis?
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The process of cleansing the client's blood via the movement of dissolved particles from one fluid compartment into another across a semipermeable membrane. The client's blood flows through one fluid compartment, and the dialysate is in another fluid compartment
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What is oligaria?
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Urine output of less than 400 mL/day
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What is the normal blood urea nitrogen level?
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8-25 mg/dL
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What is the normal serum creatinine level?
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0.6-1.3 mg/dL
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What is the normal serum uric acid level?
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2.5-8.0 mg/dL
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What is creatinine?
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An end product of protein and muscle metabolism
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What does creatinine reflect?
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Creatinine reflects glomerular filtration rate (GFR).
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What does renal disease do to the serum creatinine level?
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Renal disease increases the serum creatinine level. Serum creatinine level increases only when at least 50% of renal function is lost.
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What is BUN?
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BUN, nitrogenous urea, is a byproduct of protein metabolism in the liver. BUN levels indicate the extent of renal clearance of urea nitrogenous waste products.
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Does an elevation of BUN mean that a renal disease is present?
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No
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What factors may elevate BUN level?
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dehydration, poor renal perfusion, intake of high protein diet, infection, stress, corticosteroid use, and GI bleeding
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How is a urinalysis performed?
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Wash perineal area and use a clean container for cellection
Obtain 10-15 mL of the first morning voiding Note if the client is menstruating |
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What is the normal value for specific gravity? What do increased and decreased values mean?
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1.01-1.024
Increased-more concentrated urine, occurs w/ insufficient fluid intake, decreased renal perfusion, or increased ADH decrease-less concentrated urine, occurs with increased fluid intake or DI |
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What is a urine culture and sensitivity test?
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A urine test that identifies teh presence of microorganisms and determines the specific antibiotics to treat the existing microorganism appropriately
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How do you collect a urine culture and sensitivity test?
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Clean the perineum and urinary meatus with a bacteriostatic soln
Collect the midstream sample in a sterile container Send the collected specimen to the lab immediately Urine from the client who drank a very large amount of fluid may be too dilute to provide a positive culture |
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What is the purpose of a creatinine clearance test?
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Evaluates how well the kidneys remove creatinine from the blood. The test includes obtaining a blood sample and timed urine specimens. Blood is drawn at the start of the test and when the urine specimen collection is complete. The urine specimen for the creatinine clearance is usually collected for 24 hours.
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How is the creatinine clearance test done?
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Encourage fluids before the test. Tell client to avoid caffeine and medications as prescribed during testing, check with doctor. At the start time, ask the client to void and discard. Collect all urine for the prescribed time. Keep the urine specimen on ice or refrigerate and check about adding a preservative. At the end of the prescribed time, ask pt to empty bladder and add it to the collection container. Send to the lab in a biohazard bag.
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What is ARF?
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Acute renal failure, the rapid loss of kidney function from renal cell damage. Occurs abrumptly and can be reversible. ARF leads to cell hypoperfusion, cell death, and decompensation of renal function.
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What are the s/sx of ARF?
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S/sx are primarily caused by
-the retention of fluids -the retention of wastes -the inability of the kidneys to regulate electrolytes |
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What are the causes of ARF: prerenal?
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Outside the kidney prerenal:
caused by intravascular volume depletion, dehydration, decreased cardiac output, decreased peripheral cascular resistance, decreased renovascular blood flow, and prerenal infection or obstruction |
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What are the causes of ARF: intrarenal?
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Intrarenal: within the parenchyma of the kidney, caused by tubular necrosis, prolonged prerenal ischemia, intrarenal obstruction and nephrotoxicity (like from drugs)
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What are the causes of ARF:
postrenal? |
Postrenal: between the kidney and urethral meatus:
such as bladder neck obstruction, bladder cancer, calculi, and postrenal infection |
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What are the phases of ARF?
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Onset
Oliguric phase Diuretic phase Recovery phase |
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What is the onset phase of ARF? The oliguric phase?
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Onset: begins with precipitating event
Oliguric phase: sudden decrease in UO, less than 400 mL/day Signs of excess fluid volume: HTN, edema, pleural and pericardial effusions, dysrhythmias, CHF, and pulmonary edema -Signs of uremia: anorexia, n/v, pruitus -Signs of metabolic acidosis: Kussmaul respirations -Signs of neurologic changes: tingling of extremities, drowsiness progressing to disorientation, and then coma -Signs of pericarditis: friction rub, chest pain with inspiration, low grade fever |
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What are expected lab values with the oliguric phase?
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evevated BUN and serum creatinine
High specific gravity decreased GFR hyperkalemia normal or decreased serum Na level hypervolemia hypocalcemia hyperphosphatemia |
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What are treatments for teh oliguric phase?
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-Restrict fluid intake, if HTN is present, fluid daily allowances may be 400-1000 mL plus the measured UO
-administer meds as prescribed such as diuretics to increase renal blood flow and diuresis |
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What electrolytes are primary extracellular ions and are decreased in ARF?
What electrolytes are primary intracellular ions and are increased in ARF? |
Extracellular:
Sodium & Chloride (decreased) Intracellular: Potassium and Phosphate (increased) |
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What is the diuretic phase of ARF?
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Urine output rises slowly, followed by diuresis (4-5 L/day)
-excessive UO indicates that damaged nephrons are recovering their ability to excrete wastes but not to concentrate urine. -dehydration, hypovolemia, hypotension, and tachycardia can occur -LOC improves |
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What is the treatment in the diuretic phase of ARF?
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Administer IV fluids as prescribed, which may contain electrolytes to replace losses
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What is the recovery phase of ARF?
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Recovery phase (convalescent) is a slow process, complete recovery may take up to 1-2 years. Urine volume returns to normal. Memory and strength increases.
-Acute renal failure can progress to chronic renal failure |
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What are the signs of hyperkalemia? What is the safe range of potassium?
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-Potassium 3.5-5.0
-s/sx of hyperkalemia: dizziness, weakness, cardiac irregularities, muscle cramps, diarrhea, and nausea |
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What kind of diet do you give someone with ARF?
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Limit fluid
Limit electrolytes Low protein Moderate fat High carbohydrates |
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What is a UTI? What are common causes?
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Urinary tract infection (cystitis if its in the bladder)
-is an inflammation fo the bladder from an infection, obstruction of the urethra, or other irritants Common causes: allergens, bladder distention, calculi, hormonal changes like vag flora, indwelling urinary catheters, invasive urinary tract procedures like catheter, microorganisms, sex, synthetic underwear and pantyhose, urinary stasis, wet bathing suits Most common microbe: E Coli |
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Why is UTI more common in women than men?
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Women have shorter urethras
Urethra is closer to the rectum in women |
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Who is the most prone to getting UTIs?
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sexually active and pregnant women
Elderly women Catheterized clients BPH pts Diabetics Immuno suppressed |
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What are common findings in UTI?
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frequency, urgency, pain, burning of urination, foul smell, voiding in small amounts, inability to void, incomplete emptying of bladder, lower abdominal discomfort or back discomfort, cloudy dark foul smelling urine, hematuria, bladder spasms, malaise, chills, fever, nause/vomitting
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What are common findings in the elderly with UTIs?
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Altered mentation, confusion
Frequency and urgency and classic symptoms may not occur |
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What are teaching and nursing interventions for UTI pts?
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encourage pt to increase fluids up to 3 L/day
maintain an acid pH of 5.5, tell pt to consume cranberry juice to maintain acidic urine Avoid hot tubs/whirlpools, incomplete bladder emptying Provide meticulous perineal care for those with catheters Discourage caffeine products Take all antibiotics, the key to resolving UTI is maintaining serum antibiotic level constant |
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What is diagnostic for UTI?
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clean catch midstream urine collection
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What is pyelonephritis?
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-an inflammation of the renal elvis and parenchyma commonly caused by bacterial invasion, usually E Coli
-acute py often occurs after bacterial contamination of urethra or following invasive procedure of urinary tract -chronic py most commonly occurs following chronic urinary flow obstruction with reflux |
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What is acute pyelonephritis?
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It occurs as a new infection or recurs as a relapse of a previous infection
-it can progress to bacteremia or chronic pyelonephritis |
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What are assessment findings with pyelonephritis?
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fever, chills
nausea flank pain on affected side costovertebral angle tenderness headache dysuria frequency with urgency cloudy, bloody, or foul smelling urine increased WBC count in urine |
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What is chronic pyelonephritis?
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a slow, progressive disease usually associated with recurrent acute attacks
-causes contraction of the kidneys and dysfunctioning of the nephrons, which are replaced by scar tissue -causes the ureter to become fibrotic and narrowed by strictures -can lead to renal failure |
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What are assessment findings with pyelonephritis?
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frequently diagnosed incidentally when pt is being evaluated for HTN
poor urine concentrating ability pyuria azotemia proteinuria |
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What are interventions for pyelonephritis?
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Monitor VS, especially elevated temp
encourage fluid intake up to 3 L/day Monitor weight encourage adequate rest instruct client in a high calorie, low protein diet provide warm, moist compresses to the flank area to help relieve pain encourage the pt to take warm baths for pain relief administer analgesics, antipyretics, antibiotics, urinary antiseptics, and antiemetics as prescribed monitor for signs of renal failure encourage follow up urine culture |
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What are risk factors for developing renal calculi?
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strictures
BPH neoplasms hx calculi family fx calculi diet high in Ca, Vit D, milk, protein, oxalate, purines, or alkali obstruction or urinary stasis dehydration use of diuretics, which can cause volume depletion UTI infxs and prolonged catheterization immobilization elevated uric acid level, like in gout |
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What are problems resulting from renal calculi?
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Pain
obstruction tissue trauma secondary hemorrhage infection |
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What is done after the stone passes?
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A stone analysis to determine the type of stone and assist in determing tx
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If the renal calcuili is not removed, what can happen?
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Urinary stasis, resulting in:
infection impairment of renal function on the side of blockage hydronephrosis irreversible kidney damage |
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What are common assessment findings in pts with renal calculi?
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sharp, severe pain of sudden onset
dull, aching pain in the kidney N/V, pallor, and diaphoresis during acute pain urinary frequency with alternating retention signs of UTI low grade fever high numbers of RBC, WBC, bacteria in urinalysis hematuria |
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What are nursing plans and interventions with renal calcuili?
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administer narcotic analgesics, scheduled not prn
apply moist heat to the painful area unless prescribed otherwise encourage high oral fluid intake to help dislodge stone and prevent infection administer IV antibiotics if infx is present **Strain all urine** send any stones found when straining to the lab accurately document I&O |
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With renal calculi..
What does flank pain indicate? What does abdomen or scrotum pain indicate? |
Flank: stone is in kidney or upper ureter
Abdomen or scrotum: ureter or bladder |
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What is colic?
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With renal calculi, colic is excruciating, spastic type pain
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What is percutaneous nephrostomy?
Lithrotripsy? |
A needle or catheter is inserted through the skin into the calyx or the kidney. The stone may be dissolved by percutaneous irrigation with a liquid that dissolves the stone or by ultrasonic sound waves (lithotripsy) that can be directed thru the needle or catheter to break up the stone, which can then be eliminated in the urinary tract
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What should you teach a pt wtih renal calculi?
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pursue follow up care, b/c stones tend to reoccur
maintain a high fluid intake of 3/4 L/day Follow prescribed diet based upon composition of stone avoid long periods of remaining in supine position |
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What kind of stones necessitate an acid ash diet?
What is the diet? |
Stones composed of:
calcium phosphate oxalate struvite acid ash diet: cranberries, plum, grapes, prunes, tomatoes, eggs, cheese, whole grains, meat and poultry (purple fruits, breakfast sandwich) |
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What kind of stones necessitate a alkaline ash diet?
What is the diet? |
Uric acid stones necessitate an alkaline ash diet
Diet: legumes, milk and milk products, green veggies, rhubar, fruits except acid ash ones (dairy, veggies, non purple fruits) |
