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54 Cards in this Set
- Front
- Back
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Chronic Glomerulonephritis
Clinical findings |
Urine SG 1.010
Protenuria Urine casts GFR below 50 |
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Chronic Glomuloronephritis
Tx |
Treat Symptoms
Moniter Weight Hypertensive/diuretics Proteins Tx UTI;s Promptly |
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NephroticSyndrome
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Increase in protein in urine
•Decrease in albumin in blood •Edema •Increased cholesterol, low density lipoproteins •Any condition damaging glomerularcapillary membrane/increased glomerularpermeability to plasma proteins Edema •Periorbital •Dependent areas •Proteinuriaexceeding 3.5 g/day* •WBC (urine) |
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NephroticSyndrome
•Complications: |
•Infection
•Thromboembolism •Pulmonary emboli •ARF •Atherosclerosis NephroticSyndrome •Preserve renal function •Diuretics •Ace •Antineoplasticagents •Immunosuppressant medications •Corticosteroids •Dietary restrictions of protein/cholesterol |
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NephroticSyndrome
Tx |
•Preserve renal function
•Diuretics •Ace •Antineoplasticagents •Immunosuppressant medications •Corticosteroids •Dietary restrictions of protein/cholesterol |
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Nephrosclerosis
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Major cause of ESRD
•Malignant/Benign •Malignant -HTN (diastolic bphigher than 130) •Young adults, men > women •Disease progresses rapidly •Dialysis •Benign –older adults •Atherosclerosis/hypertension •Treat with aggressive antihypertensives |
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Renal Failure*
Overview |
Kidneys cannot remove metabolic waste/perform regulatory function
•Reversible/sudden/almost complete loss of kidney function •Decreased GFR •Failure to excrete nitrogenous waste •Increase in creatinine/BUN •Oliguria(less than 400 ml/day) |
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Phases ARF
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•Initiation –begins with initial insult and ends when oliguriadevelops
•Oliguria–Increase in urea, creatinine, uric acid, organic acids, potassium, magnesium •Minimum amount is 400 ml to rid body of waste •Hyperkalemia–life threatening •Nonoliguricform of RF occurs with nephrotoxicagents, burns, traumatic injury, halogenated anesthetic agents Phases •Diuresis–gradual increase in urine output •Recovery –renal improvement 3-12 months •Lab values return to normal •Permanent 1% -3% reduction in GFR is common •Diuresis–gradual increase in urine output •Recovery –renal improvement 3-12 months •Lab values return to normal •Permanent 1% -3% reduction in GFR is common |
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Clinical Manifestations ARF
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•Pt. appear ill/lethargic
•Skin/mucous membranes dry •Drowsiness •Headache •Muscle twitching •Seizures Assessment/Diagnostics •Output varies •Hematuria •Low specific gravity (normal 1.003 –1.030) •Inability to concentrate urine •BUN increases •Creatinineincreases •K cannot be excreted normally, i.edysrhythmia, VT, cardiac arrest •Metabolic acidosis •Increase blood phosphate •Low calcium Medical Management •Pharmacologic Therapy •Nutritional Therapy •Monitor Fluid/Electrolytes •Reduce Metabolic Rate •Pulmonary Function •Prevent Infection •Skin •Care •Support |
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Assessment/Diagnostics ARF
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•Output varies
•Hematuria •Low specific gravity (normal 1.003 –1.030) •Inability to concentrate urine •BUN increases •Creatinineincreases •K cannot be excreted normally, i.edysrhythmia, VT, cardiac arrest •Metabolic acidosis •Increase blood phosphate •Low calcium |
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Medical Management ARF
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•Pharmacologic Therapy
•Nutritional Therapy •Monitor Fluid/Electrolytes •Reduce Metabolic Rate •Pulmonary Function •Prevent Infection •Skin •Care •Support |
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Chronic Renal Failure (ESRD)
Overview |
•Progressive, irreversible
•Dialysis •Kidney Transplant •Protein metabolism accumulates in blood •Uremia develops •Every system affected |
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Clinical Manifestations
CRF |
Cardiovascular
•Dermatologic •Gastrointestinal •Neurologic •See Chart 44-3 Stages of Chronic Kidney Disease •See Chart 44-4 S/S of Chronic Renal Failure |
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Assessment CRF
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•GFR amount of plasma filtered through glomeruliper unit of time
•Creatinineclearance/24 hour urine •GFR decreases/creatinineclearance decreases •Serum creatinine/Bun increases •Serum creatininemore sensitive indicator of renal function •Sodium/Water retention •Metabolic acidosis •Anemia •Calcium/Phosphorus Imbalance |
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Complications CRF
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•Hyperkalemia
•Pericarditis •Hypertension •Anemia •Bone Disease |
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Treatment CRF
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•Calcium/Phosphorus Binders
•Antihypertensive/Cardiovascular Agents •AntiseizureAgents •Erythropoietin •Nutrition •Dialysis Dialysis •Remove fluid/uremic waste products from the body when kidneys are unable. •Acute Dialysis –high level of K, fluid overload, pulmonary edema, acidosis, pericarditis, confusion •Chronic/Maintenance Dialysis ESRD •Kidney Transplant eliminates Dialysis •Review 44-5 Plan of Nursing Care |
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Dialysis overview
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•Remove fluid/uremic waste products from the body when kidneys are unable.
•Acute Dialysis –high level of K, fluid overload, pulmonary edema, acidosis, pericarditis, confusion •Chronic/Maintenance Dialysis ESRD •Kidney Transplant eliminates Dialysis •Review 44-5 Plan of Nursing Care |
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Hemodialysis- Overview
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•Most common
•Treatments 3x/week, 3-4 hours •Diffusion, osmosis, ultrafiltration •Toxins/wastes removed by diffussion •Excess water removed in blood by osmosis •Water moves under high pressure to lower pressure by ultrafiltratin |
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Complications Hemodyalysis
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•Atherosclerotic cardiovascular disease
•Sleep problems •Hypotension •Muscle cramping •Exsanguination •Dysrhythmias •Air embolism •Chest Pain |
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Peritoneal Dialysis
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•Remove toxic substances and metabolic wastes and to re-establish normal fluid /electrolyte balance
•Peritoneal membrane that covers abdominal organs/lines abdwall serves as semipermablemembraine •Abd. Catheter •VS, weight, electrolyyelevels, antibiotic, Aseptic technique |
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Complications Peritoneal Dialysis
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•Peritonitis
•Leakage •Bleeding •Hypertriglyceridema •Increase bp/fluid volume |
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Kidney Surgery Overview
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•Kidney vascular
•Preoperative: fluids, antimicrobial, coagulation studies •Perioperative: 3 surgical approaches, flank, lumbar, thoracoabdominal. See figure 44-10. •Postoperative: Hemorrhage/shock chief complications Nursing •Refer to Plan of Care 44-9 •Assessment: •Respiratory •Blood loss •Pain •Urinary drainage •Complications |
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Kidney Transplant
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•Treatment of choice for ESRD
•More successful with living, related (compatible ABO/HLA antigens) more successful •PE •Tissue typing, blood type, antibody screening •Free from infection •Psychosocial evaluation Block body’s immune reponseto transplanted kidney •Immunosuppressive agents, Cyclosporine, Tracrolimus, Mycophenolatemofetil. •Entire life •Risks: nephrotoxicity, hypertension, hyperlipidemia, hirsuitism, tremor, cancers |
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Nursing care s/p kidney transplant
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•Rejection: oliguria, edema, fever, increasing bp, weight gain, swelling/tenderness over transplanted kidney.
•Prevent Infection •Urinary Function •Psychological concerns •Complications |
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Renal Cancer
overview |
•3% of all cancers
•6thleading cause of cancer deaths •Men>woman •Men/Women with increased BMI •Tobacco significant risk •Most common renal epithelium 85% •Metastasize to bone, lungs, liver, brain, contralateralkidney •Classic Triad, only 10%, hematuria, pain, mass in flank. •1stsign painless hematuria •Goal: eradicate before matastasisoccurs •Radical nephrectomypreferred treatment •Currently, no pharmacological agents in widespread use Classic Triad, only 10%, hematuria, pain, mass in flank. •1stsign painless hematuria •Goal: eradicate before matastasisoccurs •Radical nephrectomypreferred treatment •Currently, no pharmacological agents in widespread use |
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Classification urinary disorders
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•Upper UTI: kidneys/ureters
•Lower UTI: bladder, structures below bladder •Complicated/Uncomplicated •Uncomplicated UTIs –community acquired •Complicated UTIs –urologic abnormalities, catheterization/hospitalization •2ndMost common reason seek healthcare •Women > Men •See 45-2 Risk for UTI Lower UTI •Bacteria •Reflux –urine flows into urethra and back into bladder •Bacteriuria> 10 .5 colonies of bacteria per milliliter of urine •Entrance: transurethral route, bloodstream, fistula from intestine •Most common: transurethral, fecal contamination, sexual intercourse, massage of urethra |
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Lower UTI
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•Bacteria
•Reflux –urine flows into urethra and back into bladder •Bacteriuria> 10 .5 colonies of bacteria per milliliter of urine •Entrance: transurethral route, bloodstream, fistula from intestine •Most common: transurethral, fecal contamination, sexual intercourse, massage of urethra |
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Signs/Symptoms lower uti
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•Dysuria
•Burning on urination •Frequency, voiding more than 3 hours •Urgency •Nocturia •Incontinence •Suprapubic/pelvic pain •Hematuria •Back Pain |
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Older Adults*
UTI |
•Bacteriuriaincreases with age
•UTI most common cause of acute bacterial sepsis over 65 y/o •Decreased bladder tone, neurogenicbladder increase •Postmenopausal •Antibacterial activity of prostate secretions decrease •Long-term care pathogens often resistan |
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lower uti
prevention |
•Handwashing
•PerinealCare •Frequent toileting •E coli most common organism •Indwelling catheters: Proteus, Klebsiella, Pseudomonas, Staphlyococcus •Previous AbtxEnterococcus |
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uti
symptoms |
Symptoms*
•Generalized fatigue •Change in cognitive function •Anorexia •New incontinence •Hyerventilation •Low grade fever |
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Treatment uti
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•Antibactialagent
•Single dose, 3-4 days, 7-10 day treatments •Complicated UTI (pyelonephritis), cephalosporin, ampicillin/aminoglycosidecombinaton •Commonly used: •Trimethoprim-Sulfamethoxaxole(TMP-SMZ, Bactrim, Septra) •Nitrofurantoin(Macrodantin, Furadantin) •Ciprofloxacin (Cipro) first line treatment Treatment* •Levofloxacin(Levaquin) –pathogen identified, less costly agents did not work •Nitrofurantoin–DO NOT USE IN RENAL INSUFFICIENCY •Penazopyridine(Pyridium) -analgesic , turns urine orange. (OTC Azo) •Review Nursing Process, Pt. with Lower UTI |
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••Stress
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: Involuntary loss of urine through an intact urethra, i.e. sneezing, coughing, changing position, multiparawoman.
•Vaginal birth, radical prostatectomy |
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Urge:
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Involuntary loss of urine d/t strong urge to void that cannot be suppressed. (Know to go!)
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Reflex
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: Involuntary loss, i.e. spinal cord injury
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Overflow:
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Involuntary loss d/t overdistentionof bladder; inability to empty normally. i.e. spinal cord lesions, tumors, strictures
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Functional:
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i.e. cognitive impairment, physical
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Iatrogenic :
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extrinsic factors, i.e. medications
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Urinary Retention
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•Inability to empty bladder completely
•Residual –amount of urine that remains in bladder after voiding •Healthy, less than 60 y/o complete bladder emptying •Older adults 50-100 residual urine d/t detrusormuscle, diabetes, prostatic enlargement, urethral pathology, pregnancy, neurologic disorders, medications |
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Urolithiasis/Nephrolithiasis
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•Urolithiasis–stones (calculi) urinary tract
•Nephrolithiasis–stones in kidney •Cause unknown •Pain varies according to location •KUB (kidneys, ureters, bladder) •Ultrasound •24 hour urine test •Blood Chemistries •Goals: remove stone, stone type, prevent nephrondestruction, control infection, relieve obstruction •Immediate objective RELIEVE PAIN •Hot baths •Moist heat to flank area •Encourage fluids unless contraindicated, 8-10 glasses of H2O daily, UOP 2L advisable |
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Urolithiasis/Nephrolithiasis
tx |
•Goals: remove stone, stone type, prevent nephrondestruction, control infection, relieve obstruction
•Immediate objective RELIEVE PAIN •Hot baths •Moist heat to flank area •Encourage fluids unless contraindicated, 8-10 glasses of H2O daily, UOP 2L advisable |
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Interventions kidney stones
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Ureteroscopy–visualize stone –DESTROY
•Extracorporeal Shock Wave Lithotripse(ESWL) –noninvasive procedure used to break up stones, then voided. Energy transmitted through water and soft tissue •Endourologic(percutaneous) removal -nephroscopeinserted into renal parenchyma, stone extracted with forceps •ElectrohydraulicLithotripsy –electrical shock wave used to break up stone. Probe passed through cystoscope •Chemolysis–stone dissolution through chemical infusions •Refer to Nursing Process, Patient with Kidney Stones and Chart 45-11 |
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Urinary Diversion
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Reroute urine from bladder to new exit site
•Bladder cancer, birth defects, strictures, trauma, neurogenicbladder, chronic infections, intractable interstitial cystitis, last resort in managing incontinence. •2 Types: Cutaneous, urine drains through an opening created in abdominal wall and skin •Continent Urinary Diversion portion of intestine is used to create a new reservoir for urine •Review Nursing Process, Patient Undergoing Urinary Diversion Surgery |
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Bladder Cancer
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Common 50 –70 years old
•Men > Women •Caucasians > African Americans •Bladder with Prostate most common urologic malignancy, 90% of all tumors seen •Tobacco leading risk factor •Smokers 2x greater risk for bladder cancer •Painless hematuriamost common symptom •Pelvic/back pain occur with metastasis •Cystoscopy, •CT, Ultrasound •Biopsy •Treatment depends on grade, stage, metastasis, pt’s age, physical, mental, emotional state •Radical cystectomey standard of care for invasive bladder cancer •Chemotherapy •BCG most effective intravesical agent for recurrent bladder cancer, enhances body’s immune response to cancer, 43% advantage in preventing tumor reoccurrence, eradicating more than 80% cases of carcinoma in situ, decrease risk of tumor progression •Radiation to reduce tumor size |
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bladder cancer
s/s |
Painless hematuriamost common symptom
•Pelvic/back pain occur with metastasis •Cystoscopy, •CT, Ultrasound •Biopsy •Treatment depends on grade, stage, metastasis, pt’s age, physical, mental, emotional state •Radical cystectomey standard of care for invasive bladder cancer •Chemotherapy •BCG most effective intravesical agent for recurrent bladder cancer, enhances body’s immune response to cancer, 43% advantage in preventing tumor reoccurrence, eradicating more than 80% cases of carcinoma in situ, decrease risk of tumor progression •Radiation to reduce tumor size |
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NephroticSyndrome
Ped |
•Kidney Disorder: proteinuria, hypoalbuminema, edema
•Primary/Secondary •Primary /Minimal Change NephroticSyndrome (MCNS): disorder within glomerulus, most common in children •Secondary from disease, hepatitis, lupus, heavy metal poisoning, cancer Primary NephroticSyndrome •2-6 y/o •Higher in boys •Prognosis good for MCNS •Edema –1stnoted in periorbitalspace and dependent areas •Anorexia •Fatigue •Abdominal Pain •Respiratory Infection •Increased Weight •Normal Blood Pressure |
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Primary NephroticSyndrome
ped |
•2-6 y/o
•Higher in boys •Prognosis good for MCNS •Edema –1stnoted in periorbitalspace and dependent areas •Anorexia •Fatigue •Abdominal Pain •Respiratory Infection •Increased Weight •Normal Blood Pressure |
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Primary NephroticSyndrome
clinical findings |
Urinalysis protein 3+, 4+
•Dark/frothy •Hematuria •Serum cholesterol, triglycerides, hematocrit, hemogloblinelevated •Albumin decreased |
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Primary nephrotic Syndrome
Treatment |
•Tested for TB/Varicellabefore treatment
•Steroids •No added slat diet •Diuretics •Penicillin •Live virus vaccines contraindicated •Routine killed virus vaccines/pneumococcal vaccine, influenza •See Nursing Care Plan, Child with Nephroticsyndrome |
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PED
Acute Renal Failure |
•Sudden, severe loss of kidney function
•Hemolytic Uremic Syndrome (HUS) most frequent cause of RF in children. •Characterized by anemia, thrombocytopenia and acute renal failure. •Prerenalfailure: dehydration, perinatalasphyxia, hypotension, septic shock, hemorrhagic shock, renal artery obstruction |
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Acute Renal Failure
PED s/s |
•Postrenalfailure: structural abnormalities
•Electrolyte/fluid imbalances •Increased BUN/serum creatinine •Acid/base imbalances •Poor feeding/decreased appetite •Vomitting •Lethargy •Seizures •Pallor •HUS: abd. Pain, fever, vomitting, bloody diarrhea |
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Acute renal failure
TX |
Management without dialysis
•Fluid balance, small amounts more frequently •High potassium 6mEq/L needs intervention •Gastric suction, Kayexalate, sodium bicarbonate, lucose/insulin •Maintain Sodium level, more common decreased •Metabolic acidosis, sodium bicarbonate administered •Risk for malnutrition, provide maximum calories/protein, foods low in sodium/potassium |
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Chronic Rena Failure/End-Stage Renal Disease
Overview |
Irreversible loss of kidney function
•CRF progresses to ESRD, which no longer can be managed conservatively •Dialysis/transplant required •Treatment when only 5-10% kidney function left |
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Chronic Renal failure
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Common cause: congenital anomalies, obstructions, renal dysplasia
•Young children 18:1 million •Higher in adolescents, boys, Caucasians •ESRD = dialysis/transplant •Transplantation is goal •Rejection most common complication |
