Nclex Renal And Urological

Front 1

What do you monitor with Diuretics?

Back 1

Monitor blood pressure, pulse, and weight in those receiving
in the geriatric population since orthostatic hypotension a problem with
diuretics.

Front 2

Lab effects with Diuretics

Back 2

Decreased Na
Decreased K
Decreased Mg
Decreased HCO3

Front 3

Three popular Loop Diuretics

Back 3

Bumetanide (Bumex)
Fumsemide (Lasix)
Torsemide (Demadex)

Front 4

What allergy cross action with Loop Diuretics to watch for?

Back 4

sulfa

Front 5

Thiazide and thiazide-like diuretics

Back 5

Bendroflumethiazide (Naturetin), lndapamide (Lozol), Benzthiazide (Exna), Methyclothiazide (Enduron, Aquatensen), Chlorothiazide (Diuril), Chlorthalidone (Hygroton, Thalitone), Metolazone (Zaroxlyn, Diulo, Mydrox), Cyclothiazide (Anhydron) • Polythiazide (Renese), Hydrochlorothiazide (HCTZ, Esidrix, HydroDIURIL) Quinethazone (Hydromox), Trichlormethiazide (Metahydrin, Naqua), Hydroflumethiazide (Saluron, Diucardin)

Front 6

Selective aldosterone blockers (SABs) (Potassium sparing diuretics- Where do they work?

Back 6

work in the distal tubule of the nephron.

Front 7

Name the 3 Selective aldosterone blockers (SABs) (Potassium sparing diuretics) Remember Amy Tried to Spy on in the distal tubule with potassium

Back 7

AMIloride (Midamor), TRIamterine (Dyrenium), SPIronolactone (Aldactone)

Front 8

Clients on diuretics are frequently on?

Back 8

potassium supplements to keep their blood levels normal. Do not crush potassium tablets.

Front 9

Cholinergic agents

Back 9

Bethanechol chloride (Urecholine)

Front 10

Cholinergic agents help?

Back 10

help the bladder to contract when the muscle has lost its tone such as in clients with flaccid neurogenic bladder or some types of incontinence. Usually work within one hour after oral administration

Front 11

Cholinergic side effects? Remember Sludge

Back 11

Increased Salvation and Sweating, Increased Lacrimation, Increased Urinary Incontinence, Increased Diarrhea, Increased GI cramps, Increased Emesis

Front 12

Anticholinergic agents

Back 12

Propantheline bromide (Pro-Banthine), Atropine (used in cardiac and pre-operative conditions)

Front 13

What do Anticholinergic agents do?

Back 13

Cause the bladder to relax and fill. They also help the client to contract the external urethral sphincter on command and regain control of continence.Usually work within one hour after oral administration.

Front 14

Signs of overdose on an anticholinergic (or an antihistamine)?

Back 14

Hot as a hare = Increased temperature
Mad as a hatter = Confusion, delirium, pupil dilation
Red as a beet = Flushed face
Dry as a bone = Decreased secretions, dehydration, thirst

Front 15

Anticholinergic side effects? opposite of cholinergics, remember Sludge as well

Back 15

Decreased salvation and sweating
Decreased lactrimation
Decreased urinary incontinence
Decreased diarrhea
Decreased GI cramps
Decreased Emesis

Front 16

Antispasmodics, what do they do?

Back 16

Prevent bladder spasms which can be very painful and lead to incontinence. The agents should be given one hour before meals

Front 17

Side effects of Antispasmodics

Back 17

constipation, dry mouth, and tachycardia.

Front 18

Antispasmodic Medications

Back 18

Dicyclomine (Bentyl), Oxybutynin chloride (Ditropan), Flavoxate (Urispas), Tolterodine (Detrol)

Front 19

Phosphate binders, what do they do?

Back 19

Used in renal failure to bind phosphate in the gastrointestinal tract so the body cannot absorb it.

Front 20

Three Phosphate binder agents include

Back 20

Aluminum hydroxide (Amphogel), Sucralfate (Carafate), Sevelamer hydrochloride (Renagel)

Front 21

Side effect of aluminum hydroxide (Amphogel)?

Back 21

Constipation

Front 22

Side effect of sevelamer hydrochloride (Renagel)?

Back 22

Diarrhea

Front 23

Precaution when giving Phosphate Binders?

Back 23

Do not administer phosphate binders and calcium supplements with other drugs.

Front 24

Vitamin and mineral supplements for renal and urological, what are they used for?

Back 24

Used to treat the anemia and electrolyte imbalances which occur with renal failure.

Front 25

Side effects of Erythropoietin (Epogen, Procrit)

Back 25

can cause hypertension and tachycardia with recombinant human erythropoietin.

Front 26

Iron supplements and folic acid are needed for?

Back 26

the red blood cells to duplicate.

Front 27

Sodium polystyrene sulfonate (Kayexalate) is given to treat?

Back 27

the high potassium levels seen in renal failure.

Front 28

Sultisoxazole (Gantrisin) and phenazopyridine (Pyridium, Urogensic) cause?

Back 28

the urine to be red-orange in color.

Front 29

Precautions for Ciprofloxin (Cipro)?

Back 29

drug is concentrated in the urine and goes through the kidney: Can get crystal formation with the medication. Important to push fiuids to 1-2 quarts per day.

Front 30

What are Urinary tract infections?

Back 30

Bacterial infection that affects any part of the urinary tract. Common infection especially in women. Very serious in the elderly and those with chronic disease because they can become septic.

Front 31

What is Cystitis?

Back 31

Inflammation of the bladder resulting in urinary incontinence, hematuria, low back or suprapubic pain, buming on urination, fever, nausea and vomiting. May be Acute or Chronic.

Front 32

What is Pyelonephritis?

Back 32

Ascending urinary tract infection that reaches the pelvis of the kidney. May affect one or both kidneys. Pain on percussion at the costovertebral angle. Other symptoms are the same as cystitis. May be Acute or Chronic.

Front 33

Lab effects of Urinary tract infections?

Back 33

Increased WBC in urine (>4), + leukocyte esterase, + Nitrites

Front 34

Encourage Client to?

Back 34

Take all of antibiotics. Do follow up cultures to make sure it is gone.

Front 35

What is the Diet Recommended with UTI?

Back 35

Acid ash diet recommended. These foods leave an acid residue to be excreted in the urine.

Front 36

Recommended foods for UTI

Back 36

Meat or fish, Eggs, Cereals. Minimal milk, fruits and vegetables excegt for: C = Cranberries P = Prunes P = Plums. Drink cranberry juice to decrease the pH of the urine to prevent UTIs (Only helps prevents UTI, will not fight UTI). Avoid urinary tract irritants especially when being treated for a bladder infection such as: Coffee, Tea, Citrus juices, Colas, Alcohol.

Front 37

How much fluid with UTI?

Back 37

3000ml/day

Front 38

Hygiene care with UTI?

Back 38

Void Every 2-3hours and wipe front to back! (ask Kim), Take showers instead of tub baths and wear clothes that can breathe such as cotton panty liners.

Front 39

Why estrogen creams are used with UTI’s?

Back 39

To restore the vaginal pH

Front 40

Renal calculi

Back 40

Solid, dissolved minerals in the urine which form inside the kidneys or bladder.

Front 41

Nephrolithiasis

Back 41

Stones in the calyxes ofthe kidneys.

Front 42

Urolithiasis

Back 42

Stones in the urinary tract.

Front 43

What is severe, spastic type pain caused by calculli called?

Back 43

Colic

Front 44

Signs and Treatment of Renal calculi

Back 44

Flank pain: stone in the kidney or upper ureter. Radiation to the abdomen or scrotum: the stone in the ureter or bladder. Give pain medications on schedule to decrease spasms and control pain. lf the calculi are in the calyxes of the kidney, may have a small incision made into the flank area. Measure uric acid levels.

Front 45

What is Renal insufficiency?

Back 45

A decline of 75% to 90% of renal function. Those with renal insufficiency do not require dialysis but they do have laboratory abnormalities and cannot excrete drugs as well due to a loss of functioning nephrons. HTN= decreased renal funchtion and failure.

Front 46

Which two groups have the highest risk of developing renal insufliciency and failure pecause of compromised blood flow to the kidneys?

Back 46

Those with HTN and Elderly

Front 47

Will be put on what medications to try to preserved renal function?

Back 47

ACE inhibitors, May develop nephrotic syndrome as an adverse effect. Monitor urine for protein every month for nine months and then periodically thereafter to detect nephrotic syndrome.

Front 48

What is Acute renal failure (ARF)?

Back 48

A sudden and almost complete loss of the function of the kidneys over a short period of time.

Front 49

What are the three phases of ARF?

Back 49

Oliguric, Diuretic, then Recovery

Front 50

What Lab effects are seen in ARF?

Back 50

Increased BUN, Creatinine and Potassium

Front 51

Diet Restrictions with ARF?

Back 51

Protein intake is restricted until blood chemistry shows ability to handle the protein catabolites, urea, and creatinine. Need high quality proteins to prevent muscle wasting. Ensure high calorie intake with carbohydrates so protein is spared for its own work. Give hard candy, jelly beans, flavored carbohydrate powders, and rice.

Front 52

What is important to watch for in ARF?

Back 52

Infections have a high mortality rate in clients with acute renal failure due to decreased phagocytosis associated with renal failure.

Front 53

What is Chronic renal failure (CRF)?

Back 53

A chronic and progressive condition where renal function is lost and less than 10% of function remains. Those with end stage renal failure require dialysis to live.

Front 54

What is Uremia or azotemia?

Back 54

High BUN and creatinine levels from protein metabolism. Must restrict protein in these clients. GFR is the most reliable indicator of the level of protein consumption. Will be seen in end stage renal failure.

Front 55

Lab Values associated with CRF?

Back 55

Increased potassium, phophorus, magnesium, PT, PTT, sodium, blood sugar, and uric acid, Decreased calcium, RBC, pH and HCO3, and albumin levels.

Front 56

What are complications of CRF?

Back 56

Anemia, Renal osteodystrophy, Severe resistant hypertension, Infection, Metabolic acidosis.

Front 57

What is Spastic bladder?

Back 57

Bladder empties on its own due to spasms.

Front 58

What is Neurogenic bladder?

Back 58

Difficulty or inability to pass urine without the use of a catheter or other method. The condition is associated with neurological disorders, major pelvic surgery, diabetes and strokes.

Front 59

What are exercises that may be beneficial to reduce incontinence?

Back 59

Kegal exercises.

Front 60

What group has the most difficulty with bladder control?

Back 60

Elderly

Front 61

What is Glomerulonephritis?

Back 61

Inflammation of the glomerulus of the kidney. Usually follows a beta hemolytic strep infection of the respiratory or integumentary systems.

Front 62

What are clinical manifestations of Glomerulonephritis?

Back 62

Hematuria, Proteinuria, Low urinary output, Third spacing, Fluid volume excess, Fatigue, Hypertension, Headache, Potential for seizures

Front 63

What are complications of Glomerulonephritis?

Back 63

Acute intrinsic or intra-renal failure, Chronic renal failure, Nephrotic syndrome.

Front 64

What are treatments of Glomerulonephritis?

Back 64

Fluid restrictions with intake and output and daily weights, Offer hard candy due to dry mouth, High calorie (carbohydrates), low protein, and low sodium diet, Rest for 4-10 days.

Front 65

What are lab effect of Glomerulonephritis?

Back 65

+ ASO titer, Increased BUN, creatinine

Front 66

What is Nephrotic syndrome?

Back 66

Disorder of the basement membrane of the glomerulus which becomes permeable to plasma proteins. lt is usually idiopathic and occurs over a 2-3 year period with exacerbations and remissions seen.

Front 67

Lab effects seen in Nephrotic syndrome?

Back 67

Decreased albumin and calcium, Increas in cholesterol and triglycerides

Front 68

Nephrotic Syndrome and Swelling?

Back 68

See swelling because of decrease onootic pressure due to low albumin levels. Increase protein in the diet unless glomerular Hltration rate is impaired. IV albumin followed by diuretic as needed.

Front 69

Nephrotic Syndrome and Ascites and fluid retention?

Back 69

Limit sodium but not fluids unless they are hyponatremic. Asses Acities daily.

Front 70

What do you measure daily to assess ascites?

Back 70

Abdominal Girth and Weight.

Front 71

Hyperlipidemia in Nephrotic Syndrome?

Back 71

this is seen because the liver cannot synthesis proteins due to low albumin levels.

Front 72

Diarrhea in Nephrotic Syndrome?

Back 72

this is seen from all the fluid retention that can occur.

Front 73

Medications for Nephrotic Syndrome?

Back 73

Steroids and cholenergics.

Front 74

What is Polycystic kidney disease?

Back 74

Progressive, genetic disorder of the kidneys which is characterized by the presence of multiple cysts in both kidneys. The disease can also damage the liver, pancreas, and rarely the heart and brain. This is a renal disorder.

Front 75

What will the BP reading be in PKD?

Back 75

High

Front 76

Bladder Injury?

Back 76

Could occur due to blunt trauma with a bladder that is full. If a Iaceration, it may need to be repaired.

Front 77

What is a Ileal conduit?

Back 77

This is the urinary diversion for a cystectomy due to bladder cancer.

Front 78

S/S of Fluid volume deficit?

Back 78

Urinary output of 30 mL per hour indicates adequate tissue perfusion. Tenting of the skin is more accurate to assess fluid volume deficit than dry mucous membranes and cracking of the lips. Replace fluids orally whenever possible. CVP readings will be low in fluid volume deficit.

Front 79

Lab effects with fluid volume deficit?

Back 79

Increased BUN, creatinine, Na+, specific gravity, Hct

Front 80

What to remember with Fluid volume overload?

Back 80

Monitor weight since it is the most accurate way to measure fluid balance and nutrition.

Front 81

Important thing to remember with intake and output questions?

Back 81

When given an intake and output question, don’t forget about insensible losses such as stool, perspiration, and respiration.

Front 82

What are the universal symptoms of electrolyte imbalances?

Back 82

Muscle weakness and paresthesia

Front 83

What are the Extracellular electrolytes?

Back 83

Sodium and ChIoride

Front 84

What are the Intracellular electrolytes?

Back 84

Potassium, Magnesium and Phosphate

Front 85

What are the Clinical manifestations of Hyperkalemia?

Back 85

Decreased urine output which increases K+, decreased HR, decreased muscle function= paralysis, Increased GI with diarrhea and nausea, Tall peaked T waves, Low voltage P wave and loss of the P wave, Prolonged QRS, Dysrhythmias, Death by cardiac arrest

Front 86

What are the Causes of Hyperkalemia?

Back 86

Acidosis, Addison’s disease, Oliguria and renal failure, Multiple blood transfusions

Front 87

What are the Treatments of Hyperkalemia?

Back 87

Insulin and Dextrose, Sodium Bicarbonate, Kayexalate and Calcium

Front 88

What are the Clinical manifestations of Hypokalemia?

Back 88

Increased urine ouput = decreased K+, Increased HR, Decreased muscle function, Decreased GI with constipation, anorexia, nausea, and vomiting, Dysrhythmias arid increased sensitivity to digitalis (Lanoxin), Flat T waves, ST segment depression, U waves, Death by cardiac arrest

Front 89

What are the causes of Hypokalemia?

Back 89

Diuretics, Diarrhea, Vomiting, Gastric suction, Steroid administration, Hyperaldosteronism, Cushing’s syndrome

Front 90

What are the Treatmemt of Hypokalemia?

Back 90

Potassium rich foods, Oral supplements, Intravenous supplements

Front 91

Can you push potassium?

Back 91

No

Front 92

How much potassium can you put in a bag of IV fluid?

Back 92

40mEq

Front 93

What are the Clinical manifestations of Hypercalcemia?

Back 93

Decreased Reflexes, Decreased Mental function and lethargy, Decreased Muscle function = Weakness and incoordination, Decreased Gl with constipation, anorexia, nausea, vomiting, Decreased Calcium in the bone = Deep bone pain, Increased Urine output and dehydration

Front 94

What are the Causes of Hypercalcemia?

Back 94

Hyperparathyroidlsm, Bone cancer, Bedrest, Excess calcium supplements

Front 95

What are the Treatments of Hypercalcemia?

Back 95

Push fluids to prevent renal calculi. How much? 3000ml, Furosemide (Lasix)

Front 96

What are the Clinical manifestations of Hypocalcemia?

Back 96

Increased Muscle twitching, tetany, seizures, Increased Neuromuscular symptoms, Increased Respiratory difliculty and laryngospasm, Increased irritability and memory impairment, Increased Calcium moving out of the bone = bone pain, + Chvostek’s and Trousseau’s signs, Prolonged QT interval and QRS complex. ST segment depression, Dysrhythmias

Front 97

What are the Causes of Hypocalcemia?

Back 97

Renal failure, Hypoparathyrcldism, Malabsorption, Pancreatitis, Alkalosis

Front 98

What are the Treatments of Hypocalcemia?

Back 98

Calcium rich foods, Oral supplements, Intravenous supplements

Front 99

Can you give calcium IM?

Back 99

No

Front 100

What to remember with Hypermagnesemia?

Back 100

Everything slows down like hypercalcemia.

Front 101

What to remember with Hypomagnesemia?

Back 101

Everything speeds up like hypocalcemia. When magnesium is low, the client is at risk for cardiac dysrhythmias.

Front 102

What to remember with Hypernatremia?

Back 102

Primary cause is dehydration. S=Skln flushed and swollen red tongue, A=Agitatl0n, restlessness, and convulsions, L=Low grade fever, T=Thirst and dry mucous membranes

Front 103

What to remember with Hyponatremia?

Back 103

Primary causes include fluid overload and renal insufficiency. Will see confusion with hyponatremia. Chloride imbalances usually follow sodium. Correct with intravenous fluids.

Front 104

Intravenous pyelogram (IVP)

Back 104

Contrast medium is used. Laxative may be ordered the night before the procedure.

Front 105

Voiding cystourethrogram

Back 105

Contrast material is inserted into the bladder by a catheter. The client then needs to void during the test.

Front 106

What are the need-to-knows of a Foley catheter?

Back 106

Always advance the catheter one to two inches after urine appears, Rapid emptying of the bladder may cause engorgement of pelvic blood vessels and hypovolemic shock, Encourage men to not urinate with the catheter in place, lf leakage around the foley, obstruction may be present.

Front 107

Who needs dialysis?

Back 107

A = Acid base problems, E = Electrolyte imbalances, I = Intoxications and poisonings, O = Overload of fluid, U = Uremic symptoms

Front 108

What temp shoud peritoneal fluids be?

Back 108

warm to increase the remeval of toxins.

Front 109

What happens when Peritoneal fluids are instilled too fast?

Back 109

pain in the left shoulder occurs during administration,

Front 110

What color should return peritoneal fluids?

Back 110

Clear

Front 111

What postion should the client be in for Peritoneal dialysis?

Back 111

Semi-fowler’s position

Front 112

In peritoneal dialysis, lf there is a reduced outflow of fluid:

Back 112

ask if a recent history of constipation and tum from side to side to try to enhance drainage.

Front 113

In peritoneal dialysis, lf acute dyspnea occurs with instillation:

Back 113

drain the fluid to relieve the intra- abdominal pressure.

Front 114

In peritoneal dialysis, Dialysate solution for peritoneal is much higher what?

Back 114

Glucose than hemodialysis. Monitor for hyperglycemia if the dwell time is too long.

Front 115

Hemodialysis Catheter is a?

Back 115

catheter with two lumens is inserted into the vena cava via the internal jugular or femoral veins. Allows blood to be withdrawn, cleansed, and then returned. Extemal device.

Front 116

Hemodialysis AV fistula is a?

Back 116

joining of an artery and a vein. Two needles are inserted during a treatment. Preferred method of long term dialysis. "Feel the thrill and hear the brult" of the fistula.

Front 117

Hemodialysis AV graft is?

Back 117

much like a fistula except that an artificial vessel is used to join the artery and vein.

Front 118

What to know about Hemodialysis?

Back 118

Sodium and waste products are passed during an exchange.Typical schedule is 3 days a week for 3-4 hours a treatment. Need to protect the site. Teach clients signs and symptoms of gastrointestinal bleed. Disequilibrlum syndrome can occur during an exchange and manifests as headache, hypotension, and confusion. Limit weight gain to 1-1.5 kg between treatments.

Front 119

What are important things to know about Kidney Transplants?

Back 119

Donor must have matching leukocyte antigen complexes. Must be ABO compatible but not the same blood type. Combination drug therapy after the transplant. Prednisone, tacrolimus (Prograf), and mycophenolate (CellCept) may be used. The transplant may not work immediately.

Front 120

What are the Signs of rejection for a Kidney transplant?

Back 120

Hypertension, Temperature elevation, Decreased urine output, Weight gain

Front 121

What to know about Lithotripsy?

Back 121

Crush the stones in the kidneys with lithotripsy. Done under regional or general anesthesia. Client will be NPO and an IV line will be in place.

Front 122

What to know about Percutanecus nephrostdmy?

Back 122

A needle or catheter is inserted through the skin into the calyx of the kidney. Any stones may be dissolved by percutaneous irrigation with a liquid that dissolves the stone or by ultrasonic sound waves that can be directed through the needle or catheter to break up the stone, which then can be eliminated through the urinary tract. A nephrostomy tube may be in place in the back. It is essential to keep the tube draining freely.

Front 123

What is a major problem for end stage renal disease?

Back 123

Puritis