Urinary Chapter 36 & 37 Med Surg

Front 1

creatine

Back 1

is a waste product from muscle metabolism and is released into the bloodstream at a steady rate

Front 2

creatine levels are a good indication of?

Back 2

kidney function

Front 3

normal levels of creatine?

Back 3

0.6 mg/dl - 1.5 mg/dl

Front 4

level above 1.5 of creatine means there is?

Back 4

kidney dysfunction
the higher the level the more impaired kidney function

Front 5

BUN=waste product of?

Back 5

protein metabolism

Front 6

BUN normal levels?

Back 6

8-20 mg/dl

Front 7

elevated BUN caused from?

Back 7

kidney dysfunction
kidney failure
decreased kidney blood supply
dehydration(decreased BUN with overhydration)
high protein diet(urea formation increases)
GI bleeding(bcs blood is absorbed as protein and converted into urea)
steroid use(bcs steroids increase rate of protein breakdown in body)

Front 8

sodium normal levels?

Back 8

134-145 mEq/L

Front 9

potassium normal levels?

Back 9

3.5-5.5 mEq/L

Front 10

calcium normal levels?

Back 10

4.5-5.5 mEq/L

Front 11

HCO3 levels?

Back 11

22-28

Front 12

magnisium normal levels?

Back 12

1.3- 2.1

Front 13

serum albumin normal levels?

Back 13

3.5-5.0

Front 14

urine culture levels

Back 14

<10,000=negative
100,000 positive

Front 15

specific gravity levels

Back 15

1.05-1.35

Front 16

hematuria

Back 16

blood in urine

Front 17

dysuria

Back 17

painful urination

Front 18

nocturia

Back 18

voiding during the night

Front 19

obliguria

Back 19

decreased urine output <400 mL per 24 hours

Front 20

polyuria

Back 20

excessive urination >2000 mL per 24 hours

Front 21

anuria

Back 21

absence of urination

Front 22

pyuria

Back 22

pus in urine

Front 23

the renal pyramids make up which of the kidney structures?

Back 23

renal medulla

Front 24

the process of tubular resorption takes place in which part of the kidneys?

Back 24

from the renal tuble to the peritubular capillaries

Front 25

common symptom of bladder cancer

Back 25

hematuria

Front 26

observing for renal failure?

Back 26

decrease in urine output

Front 27

best diagnostic test for acute renal failure?

Back 27

24 hour creatine clearance of 5mL/minute

Front 28

after hemodialysis imperative that he patient is?

Back 28

weighed

Front 29

how does a continuous ambulatory peritoneal dialysis work?

Back 29

a permanent peritoneal catheter is inserted. the peritoneum acts as a semipermeable membrane through which solutes move by difusiion and osmosis

Front 30

symptoms of end stage renal disease?

Back 30

edema, possible convulsions, then coma

Front 31

3 important nursing assessments of chronic renal failure?

Back 31

daily weights,
I & O
dangerous levels of electrolytes

Front 32

diet for ranal failure

Back 32

diabetic diet
low sodium
low potassium
decrease protein
and fluid restriction
low phospherus diet
very difficult to follow

Front 33

azotemia

Back 33

accumulation of toxic waste from protein metabolism in the blood (serum urea)

Front 34

acute reanl failure

Back 34

<30 mL/hr or 400mL/day

Front 35

acute reanl failure caused by?

Back 35

hypotension
vascular obstruction
glomerular disease
acute tubular necrosis(ATN)=the tubules are damaged after administration of contrast dye

Front 36

acute reanl failure

Back 36

waste products accumulate in the bloodstream
oliguria
decresed urine of <20mL/hr
dialysis is needed

Front 37

acute reanl failure=can progress through 4 stages

Back 37

1. oliguria phase:
less than 400mL per 24 hours
occurs from24 hrs to 7 days after intial phase
can last up to 2 weeks to several months
2. Diurectic phase:
kidneys begin to excrete waste products, 1 to 3 L/day of urine is produced
osmotic diuresis occurs from elevated waste products(urea) which the body is attempting to eliminate
kidneys are unable to concentrate urine ans so dehydration and hypotension are a concern
may last 1 to 3 weeks
3. Recovery phase:
as the glomerular filtration rate rises
waste products levels(BUN, creatine levels) decrease within the first 2 weeks of this phase
recovery can take up to 1 year

Front 38

oliguria phase

Back 38

metabolic acidosis from H+ excretion and sodium bacarbonate levels.
increased phophate
decreased calcium
abnormal blood cells(RBC, WBC Platelets)
confusion
seizures to coma
effects on all body system

Front 39

accute renal failure is classified as?

Back 39

preresnal
intrarenal
ed with the location of the cause

Front 40

accute renal failure-prerenal failure?

Back 40

before the kidneys
interuption of blood supply to the kidneys
causes:
decreased BP(result of dehyration, blood loss, shock, trauma, to or blockage in the arteries that carry blood to the kidneys)
Nephrons blood supply is inadequate=they are unable to make urine and waste products are not removed
drugs used that can lead to prerenal failure: :
NSAID's
cyclooxygenase 2(COX)inhibitors

Front 41

Intrarenal failure

Back 41

inside the kidney
damage to the nephrons inside kidneys
causes:
ischemia
reduced blood flow
toxins
other causes from infectious process leadint to glomerulonephritis, allergic reactions to radiographic dyes
severe muscle injury(releases substances harmful to the kidneys)

Front 42

postrenal failure

Back 42

after the kidneys
associated with an obstruction that blocks the flow of urine out of the body
common causes:
kidney stones
tumors of the ureters
or bladder
enlarged prostate

Front 43

acute reanl failure is treated?

Back 43

by reliveing the cause
prevention of permanent damage is the goal of treatment
S/SX are managed as they develop

Front 44

continuous renal replacement therapy CRRT

Back 44

in unstable patients
to remove fluid and solutes in a controlled, continuous manner
they are able to handle fluid shifts as in hemodailylsis, can be used along with hemodialysis, which is necessary if symptoms of uremia (hypokalemia) are present
temporary vascular access is used
can be done more than a month if needed

Front 45

chronic renal failure

Back 45

on the rise...290,000 people in US
a progressive, irreversiable deterioration in renal function where the body is unable to maintain metabolism, fluid, and electrolyte balance

Front 46

chronic renal failure

Back 46

as the nephrons die off, the damaged ones increase their work capacity-so Patient may not show signs of renal failure as they are experiencing kidney damage

Front 47

chronic renal failure-in the early or silent stage

Back 47

decreased renal reserve
usually without symptoms
50% of nephrons may have been lost-creatine levels 2X normal

Front 48

chronic renal failure-renal insufficiency stage?

Back 48

75% of nephrons function and soms mild signs of renal failure.creatine levels 4X normal
anemia and inability to concentrate urine may occur

Front 49

chronic renal failure-end-stage disease ESRD

Back 49

occurs when 90% of the nephrons are lost
chronic and persistant abnormal kidney function
BUN & creatine are always elevated
patient may make urine but not filter out the waste or urine production may cease
dialysis or kidney transplant is required to survive

Front 50

symptoms of renal failure

Back 50

fluid accumulation
edema early symptom of the extremities, sacral area, and abdomen
SOB
crackles & whezzing
blood vessles in neck distended &hypertensive
polyuria
oliguria
anuria

Front 51

disturbances in electrolyte balance in renal failure

Back 51

sodium=hypernatremia-excess of sodium=water retention, edema & hypertension
sodium lost=hyponatrema=confusion
Hyperkalemia=high levels of potassium=muscle weakness, abdomianal cramping, diarrhea.
when it exceeds 5mEq/L
monitor cor cardiac dyrhythmias

Front 52

disturbances in electrolyte balance in renal failure-treatments

Back 52

sodium polystyrene(Kayexalate)
orally or retention enema, causes potassium to be eleminated through the stool
hemodialysis is the definitive treatment-removes potassium from the body

Front 53

disturbances in electrolyte balance in renal failure

Back 53

calcium levels are decreased bcs the kidneys are unable to produce the hormone that activates vitamin D(which is necessary for calcium to be absorbed)
hypocalemia=when levels fall below 8.5 mg/dl and hyperphosphatemia a level above 5mg/dl=causes the imbalance causes the bones to release calcium, causing the bones to be prone to fractures
medication is given to bind phospherus with high levels:
tums, caltrate, renagel, Phos-lo, fosrenol...with meals, to bind with stools to be eleminated
high phospherus levels may cause itching, open sores from scraticng-infection risk''
muscle cramps & aches

Front 54

disturbance in removal of waste

Back 54

azotemia:
weakness and fatique
confusion
siezures
twitching movements of extremities(asterixis)
N&V
lack of appetite
metallic taste in mouth
smell of urin on breath
yellowish pale skin
itching due to urea crystals on the skin
dialysis to remove the waste is only treatment

Front 55

disturbance in maintaining acid-base balance

Back 55

renal failure effects Hydrogen ion excretion-results in metabolic acidosis.
headache
fatigue
weakness
N&V
lack of appetite
as it progresses: lethargy,stupor and coma
respirations become fast & deep as the lungs attempt to blow of carbon dioxide to correct the acidosis(Kussmauls respirations)

Front 56

disturbance in the Hematological function (primarily seen in chronic renal failure CRF

Back 56

disturbances in the blood cells over time
failingt kidneys do not produce adequate erythropoeitn, the hromone that stimulates RBC' production
treatment:
regular injections of epoetin(Epogen, Procrit) a synthetic form of erythropoetin help restore RBC production and prevent anemia
common side effect of erythropoetin is development of hypertension

Front 57

diet for renal failure

Back 57

high calories to maintain weight and energy
restricted protein unless on dialysis(may be incresed bcs protein is lost)
sodium restricted(fluid retention)
potassium restricted
calcium increased
phospherus restricted
saturated fats & cholesterol restricted for patients with hyperlipidemia
fluids restricted to prevent overload

Front 58

dialysis

Back 58

started when patients develops symptoms of fluid overlaod
high potassium
acidosis
pericarditis
vomitting
lethargy
fatigue
uremia-that are life threatening
both peritoneal & hemodialysis involve the movement and diffusion of particles from an area of high concentration to and area of low concentration through a semipermable membrane. the substances move through the semipermable membrane into the dialysate
can be used to treat drug over dose
and correct fluid and electrolyote imbalnces

Front 59

hemodialysis

Back 59

the use of a artificial kidney to remove waste products and excess water from patients blood
patients blood and the dialyzing solution move in opposite directions.
the waste product of the blood move into the dialysate by diffusion through the membrane bcs of the differance of their concentrations
It is carried away and the cleansed blood is returned into the blood with another tube takes 3-4 hours 3 to 4 X a week

Front 60

side effects of hemodialysis

Back 60

following treatment:
fatigue & weak
too tired to eat
sudden drops in BP=weak, dizzy & nauseated
cardiac dysrthyriams and angina
muscle cramps & lethargy with electrolyte & fluid drops\
Heparin is given while blood is in artifical kidney_this may cause bleeding from puncture site

Front 61

vascular access

Back 61

hemodialysis requires a permanent way to access the bloodstream for blood removal and return to the body:
1. vascular access graft
2. ateriovenous AV fistula
they are place in the arm when possible
*imperative the IV angiocaths are not placed in cephalic or basilic vein in a ptient who may need grafts or fistulas in the future
*temporary access is used for patients requiring hempdialysis befroe the graft or fistula is placed or usable
(a central venous catheter with 2 or 3 ports is placed in the subclavin vein, the jugular, or the femoral veins )
*central catheters cannot be used long term due to the rsik of infection
*

Front 62

vascular access graft

Back 62

arteriovenous graft AV
uses a tube of synthetic material to attach to an artery and a vein
needles are inserted into the graft to access patients blood
graft material is not sef-sealing so time is needed for tissue growth to plug up the needle puncture-1 to 2 weeks
The Vectra is self-sealing and does not reguire tissue growth-used almost immediatley

Front 63

ateriovenous AV fistula

Back 63

is made by sewing a vein and an artery together under the skin
may take up to2- 4 months to mature
temporay access is needed until the fistual matures

Front 64

vascular access care

Back 64

check for patency
palpating for a trill(a tremor) and auscultating for a bruit(swishing sound) athe the graft or fistula site

Front 65

UTI

Back 65

most common nosocomial infection

Front 66

UTI predisposing factors

Back 66

stasis of urine in the bladder caused obstruction: clamped catheter bag or not going enough
contamination of perineal and uretheral areas can be fecal soiling, sexual intercourse, from infection in the area-vaginitits, epididymitis or prostatitis
having intruments inserted into the urinary meatus(catheterization most common)
reflux of urine from urethra to the bladder or the bladder to the ureter bcs of vaulty valves to maintain one way flow
previous UTI provides a reservoir of persistant bacteria that causes reinfection
women with a short lenght of the female urethra and close proximity to the anus

Front 67

UTI's most common cause of acute bacterial sepsis in the patient over what age?

Back 67

65

Front 68

S/SX of UTI

Back 68

dysuria
urgency
frequency
incontinence
nocturia
hematuria
back pain
cloudy, foul smelling urine

Front 69

S/SX of UTI in the elderly

Back 69

generalized fatigue
with a change in cognitive functioning-patients without demintia
a decline in mental status and fever with an indwelling catheter meets the diagnosis for UTI

Front 70

types of UTI's

Back 70

urethritis
cystitis
pyelonephritis

Front 71

urethritis

Back 71

inflammation of the urethra \
caused from:
chemical irritant
bacterial infection
trauma
sexually transmitted disease
bubble bath and salts most common
spermicidals
gonorrhea and chlamydiosis can cause UTI in men

Front 72

urethritis
symptoms

Back 72

urinary frequency
and dysuria
male may have discharge

Front 73

cystitis

Back 73

inflammation and infection of the bladder
caused by:
bacteria, viruses, fungi, or parasites
fungal after long term use of antibiotics
E-coli
catheters
cloudy urine=presence of WBC's, bacteria and sometimes RBC
nitrates usua;lly positive
Treatment:
sulfa meds=bactrim, septa

Front 74

pyelonephritis

Back 74

is an infection of the renal pelvis, tubules and interstitual tissue of one or both kidneys
preexisting condition:
obstruction
strictures
stones
vesicoureteral reflux

Front 75

pyelonephritis pathophysiology

Back 75

formation of small abscesses throughout the kidney and gross enlargement of the kidney]
urosepsis is a systemic infection arising from a source within the urinary system
promt diagnoses and treatment is essential to prevent septic shock and death

Front 76

pyelonephritis S/SX

Back 76

fatigue
urgency
frequency
dysuria
FLANK PAIN
fever
chills
costovertebral tenderness
much sicker than cystitis and shows signs of systemic disease
urinalysis=shows casts
100,000 colonies of bacteria per milliter
presence of casts always indicates a problem with kidneys
increased sedimentation rate
CBC-elevated WBC
complications:
scarring and loss of kidney function
when septicemia occurs-urosepsis