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151 Cards in this Set
- Front
- Back
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Reabsorb Bicarb
Secrete H+ |
Acid Base Balance
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Creatinine
Urea Electolytes |
Excreation of Metabolic wastes
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Volume (ADH)
Aldosterone/Renin |
Control BP
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Renin
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Erythropoeitin Secretion
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Ca+/Phosphate
-metabolism and reabsorption |
Conversion of Vitamin D to active form
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Don't excrete, build up, become toxic
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Drug excretion
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Below 12th rib next to the spine. High back off to the side
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CVA Costovertebral Angle
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Suprapubic, Groin, Perineum
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Pain from Urinary disorders
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Urination increases with?
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Urination or Abdominal Distention
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pain/burning
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Dysuria
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less than 100 ml/day
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Anuria
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less than 400 ml/day
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Oliguria
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night time voiding
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Nocturia
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blood in urine
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Hematuria
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Greater than 2500ml/day
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Polyuria
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below 12th rib next to the spine, high back pain off to the side
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CVA- Costovertebral angle
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Sites for Urinary pain
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Suprapubic, Groin, Perineum
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Pain increases with
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Urination or Abdominal distention
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pain/burning
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Dysuria
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less than 100ml/per day
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Anuria
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Less than 400ml/per day
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Oliguria
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Nightime Voiding
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Nocturia
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Blood in urine
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Hematuria
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Greater than 2500 ml/day
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polyuria
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first morning specimine
if not going to the lab must refrigerate |
Urinalysis
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Start with empty bladder(throw away), End with final voiding. 2-24hrs. Use this for creatinine clearance test
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composite urines
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85-135 ml/min
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Creatinine Clearance
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7-18 mg/dl
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Serum Bun
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Incresed nitrogen excretion, Dehydration, Protein Excess
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Serum Bun
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If the Serum Bun and Creatinine are elevating together and maintaining a 20:1 ratio what does this mean?
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Renal disease
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Looks at protein and muscle metabolism
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Serum Creatinine
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0.7-1.3 mg/dl
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Creatinine, male
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0.6-1.1 mg/dl
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Creatinine, female
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Indicates fluid balance
Hypovalemic if higher Hypervalemic if lower |
specific gravity
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1.005-1.035
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specific gravity
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-Used to diagnose Uti
-Bacteria count of greater than 100,000/ml -Identify's organism and perscribe antibx check to see if pt. antibiotic is listed as sensitive on lab sheet |
Urine culture and sensitivity
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should be less than 50ml
requires cath or bladder scan If high = stasis, UTI, Infection |
Residual urine
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If emptying and get greater than 1000cc clamp, stop and wait so body can adjust to changes in bp
500-1000 is a good range |
Catheterization
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Continuous Catheter
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Foley
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temporary catheter
used for specimins or to check residual |
Straight
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-Used to diagnose Uti
-Bacteria count of greater than 100,000/ml -Identify's organism and perscribe antibx check to see if pt. antibiotic is listed as sensitive on lab sheet |
Urine culture and sensitivity
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should be less than 50ml
requires cath or bladder scan If high = stasis, UTI, Infection |
Residual urine
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If emptying and get greater than 1000cc clamp, stop and wait so body can adjust to changes in bp
500-1000 is a good range |
Catheterization
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Continuous Catheter
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Foley
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temporary catheter
used for specimins or to check residual |
Straight
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through abdomen
used after gyn/gu surgeries lower infection rate causes natural edema, so urethra swells=problem Used in bladder sx- need to keep urine out as much as possible, promote healing used with spinal injury, more comfortable than foley |
Suprapubic
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Looks at kidney's, Ueters, and bladder
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KUB
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Is used to evaluate the structure and excretory function of the kidneys, ureters, and bladder
Assess allergies: iodine, shellfish |
IVP- Intraveneous Pyleogram/ dye
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X-rays passed thru kidney's at many angles gives detailed picture of renal tissue densities and composition.
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Cat scan, ct scan
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Reflected sound waves are used to assess kidney size and to identify, locate, and differentiate renal masses such as cysts, tumors, and calculi
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Renal Ultrasound
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Done in artery- can easily bleed out of site
Put on groin sandbag Freq checks Q4, next few days Can bleed back b/c of internal bleed |
Angiogram: Vascular xray
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direct visulization of the urethra and bladder through a cytoscope
causes hematuria |
Cytoscopy: bladder scope
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If blood pressure decreases and pulse pressure increases what does this mean?
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Arterial bleed
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Nursing Assessment for Bladder scope?
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Hematuria
pain I&O Force fluids (not with CHF) |
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Pecutaneous biopsy
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Needle through skin to kidney
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Open Biopsy
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Surgery to get to kidney
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Nursing assessment for Biopsy
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Supine for 24hrs
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Why does a patient need to be in supine position after a biopsy?
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trying to accomp. increased pressure on kidneys
kidneys have alot of vasculature and blood flow which increases risk for hemorrage |
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Congenital
can be fatal b/c it destroys kidneys |
PKD polycystc kidney disease
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Where are the cysts in PKD?
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in all segments of kidney, they are fluid filled sacs
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What is being compressed in PKD and what does it lead to?
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tubules, nephrons, and renal blood vessels. Leads to ischemia b/c of obstruction and necrosis
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What does PKD progress to?
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End stage renal failure/disease
It is slowly progressive |
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What is the nursing care related to PKD?
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No contact sports
Fluid intake 2000-25000 daily Monitor: UO, creatinine, bun, and GFR-using creatine cleance test |
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What do u expect the GFR to do in kidney disease?
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Go DOWN!
This is a measure of how much urine can filture thru. With PKD less is filtured. |
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Expanding,distention distention of the renal pelvis and calyces
blocked urine dilates renal pelvis |
Hyedronephrosis
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What causes hydronephrosis?
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Obstrution- stones, infection
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Signs and symptoms of hydronphrosis?
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Rising BUN and Creatinine
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Goal of Hydronphrosis treatment?
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reestablish drainage asap
done by putting in a urinary stenz |
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UTI
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Infection of any portion of tract
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Can a uti be acute or chronic or both?
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BOTH!
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What is the common cause of UTI?
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Ecoli
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What are the symptoms of UTI
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Burning, Urgency, Burning
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How do u diagnoses a UTI?
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Culture and sensitivity
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Bactim, Ditropan, Pyridium
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treatment of uti
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Anti infective- used to prevent reocurrence
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Bactrim
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Spasms
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Ditropan
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Urinary tract analgesic for burning
relief from pain buring frequency and urgency orange urine |
Pyridium
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Inflammation of kidney and renal pelvis
Infection of kidney itself, not urinary tract Acute vs chronic may lead to chronic renal failure due to damage of the kidney |
pyelonephritis
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Pyelonephritis risk factors?
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UTI
Poor immune system Poor hydration |
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Symptoms of Pyelonephritis?
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Fever, chills, malaise, flank pain, dysuria(pain,burings), cva tenderness, elevated serum wbc's, rbc's, and bacteria
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Antibiotics for 14 days and force fluids
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Tx for pyleonephritis
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Inflammation of glumerulous which causes a distruption of glumerular filtration
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Glomerulonephritis
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What is caused by infection, antigen/antibody reaction(step throat) or systemic disease(SLE,DM,HTN)
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Glomerulonephritis
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Necrosis of glomerulus, Decreases GFR, Dropping UO, Sx of fluid overload
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what u will see in glomerulonephritis
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Symptoms of glomerulonephrosis
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Hematuria, Proteinuria, Azotemia
Appearance is brown, salt&water retention, edema in periorbital, N/V/Anorexia/fatigue/hypertension |
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Treatment of glomerulonephrosis
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Antibiotics, Diuretics, HTN meds
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What is prostatitis?
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Inflamed prostate
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Treatment of Prostatitis?
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Antibiotics, forced fluids 3L per day, Analgesic(nsaids), Sitz bath, special diet (no spice, caffine, or etoh)
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Can be an autoimmune disorder or r/t DM,SLE, or glommerulonephritis
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Nephrotic syndrome
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Change in glomerular capillay
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1st step in pathology of nephrotic syndrome
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Protein/lipids in urine
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2nd step in pathology of nephrotic syndrome
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Proteinuria, Hypoalbuminemia, Hyperlipidemia, and edema
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3rd step in nephrotic syndrome
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Fluid Overload, edema crackles
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4th step in nephrotic syndrome
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50-75% progress to CRF
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Nephrotic syndrome
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Monitor BUN, creatinine, output, watch for infections, may need protein supplements b/c leaking protein
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NursingCare for nephrotic syndrome
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Renal arterioles slowly narrow(stenosis) or
Acute obstruction(aneurysm,emboli--stationary, thrombi--moves) |
2 pathways for arterial occlusion
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Treatment of Renal vein occlusion
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Anticoagulant therapy (heparin), TPA (clot busters)
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Major loss of perfusion to the kidney
It activates your renin angiotensin and aldosterone system |
Renal Artery stenosis
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S&S of hypertension, kidneys atrophy due to lack of blood supply
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Renal atery stenosis
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What will be heard with renal artery stenosis?
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Epigastric bruit
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What is the tx for renal artery stenosis
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Antihypertension meds, angioplasty, dietary
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Renal artery occlusion symptoms?
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Severe flank pain, HTN, N/V, fever
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Treatment of renal artey occlusion (severe blockage)
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treated by surgery
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Necrosis of teh arterioles
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Necrosis
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MAJOR cause of hypertension
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Nephrosclerosis
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HTN,Hematuria, Proteinuria, Creatininie/Bun elevations
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Sx that Nephrosclerosis is worsening
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Rx of Nephrosclerosis?
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Potent Vasodilatiors
-they decrease hypertension, open them up and BP drops |
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Leading cause of ESRD
Kidneys atrophy |
Diabetic Nephropathy
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Lipids leak and settle onto
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vessels
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Renal Arterioles narrow
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Nephrosclerosis
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Capillary loop scar then the kidneys do what?
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Atrophy
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Treatment of diabetic nephropathy
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only treatment is control of DM
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Made of crystal, pus, and blood
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Urolithiasis
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What is Urolithiasis?
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Kidney stones
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Treatment goes twoard what type of stone it is. What types of stones are there?
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Ca, Sturvite, Uric Acid, Cystine
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Symptoms of renal colic
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severe pain at
flank groin labia testicles |
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Symptoms of Urolitiasis
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Renal colic, N/V, Urine, Radiology exams, Hydronephrosis is possible if untreated
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Treatments for kidney stones
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fluids, pain/infection, ESWL, Surgical Tx lithotomy, Stents, ambulation, meds, strain urine
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sound waves, break up stone
urinate granules out red urine up to 72hrs |
EWSL (extracorporeal shock wave lithotripsy)
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open up are get pass the stone to drain urine out
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Lithotomy
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Types of lithotomy's
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Cystoscopy, Ureterostomy, Nephrostomy
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dilates urethra or ureter
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cytoscopy
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tube through skin to ureter
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Ureterostomy
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tube through skin to kidney
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Nephrosomy
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Used to keep ureter open
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stents
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Why shoud u ambulate a person with urolithiasis
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Ambulation helps move the stone
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What are some meds that help with urolitiasis?
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Prevent stone formation
Diuretics |
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what is done to catch stone and send to lab to be analyzed
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strain
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Ureterostomy-ureter
Nephrostomy-kidney |
inserted through abdomen
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No kinking of tube, aseptic irrigation 5-10 ml of sterile NS,empty bag q4/prn, note amount and color,aseptic dressing and anchor with tape
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teachin of kidney stones
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Primary sign fo bladder cancer
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hematuria
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how do u diagnose bladder cancer?
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cytoscopy
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treatment of bladder cancer
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Biopsy, chemotherapy, radiation treatment, surgery(bladder/urethra:removed)
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A illeal conduit and Continent Ileal bladder coduit (kock's pouch) are what?
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Urinary diversions
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In and Ileal conduit a piece of ileum connects to what?
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The ileum connects to the stoma
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How do u assess the stoma
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Size, color(beefy red),condition
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When u have an ileal why would u see mucoid(mucus shreds)?
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Because the illeum makes mucus
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a segment of ileum is separated from small intestine and formed into pouch, ureters are connected to the pouch
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Continent Ileal Bladder Conduit
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What is the diff between ileal conduit and continet conduit?
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the continent conduit has nipple valves at each end. The nipple is so that urine is held into the illium and not drained
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Patient teaching for Continet Conduit?
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Clean self cath every 2-4 hours
Stoma assessment Monitor output |
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Non-malignant enlargment of the prostate gland?
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BPH Benign Prostatic hyperplasia
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BPH Benign Prostatic hyperplasia is an obstruction of what?
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Urinary outflow from the bladder
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Sx of BPH?
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Weak urinary stream
Incresed time to void Hesitancy-stops and starts Nocturia Incomp. bladder emptying/powst void dribble Irritation |
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Treatment of BPH
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TURP- transurethral resection of the prostate
B&O suppositories for spasms |
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Nursing for BPH
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Monitor for bleeding-three way foly irrigation
Pain- bladder spasms, incisonal pain,abd cramps, monitor output closely monitor urine for color/clots |
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How do u diagnose cancer of the prostate?
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DRE & Prostate Specific Antigen (PSA)
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What is DRE?
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Direct rectal exam of prostate surface
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Normal- <4ng/ml
IF >10ng/ml, 2/3 have prostate cancer |
PSA
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Symptoms of prostate cancer
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May be asymptomatic
Hematuria Bph Symptoms |
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Treatment of prostate cancer
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Surgical: Prostatectomy
Radiation Therapy -external beam -brachytherapy- radioactive seeds(implanted) |
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Nursing of prostate cancer
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Suprapubic Catheter
MO Pain Risk for infection b/c of surgery Teaching Care of tubes and dressings MO Effect on erection |
