Renal Alterations

5 Written Questions

1. Balance rest and activity
   Dietary/Fluid restrictions: low Na, K+, protein; Hich carbs
   Medication therapy: Diuretics-don't give K+ sparing. ACE and ARBS= bad if K+ creeps up
2. Symptomatic relief, aggressive treatement of infections and HTN, Diet; phosphate and protein restriction, Fluid intake adjustment. End stage; dialysis, transplant
3. Acute: fatigue, chills/fever, N?V, malaise, flank pain, CVA tenderness, +/- urinary symptoms.
   Chronic: HTN, inability to conserve sodium, decreased urine concentrating ability, hyperkalemia and acidosis
4. GFR increases. Serum BUN/Creatinine levels stabilize & decrease.
   Improvement; recovery may take >1year.
   Healthy living-best treatment.
5. An excellent diagnostic indicatior of renal function. The most sensitive test of early renal disease. Decrease renal function. Provides an estimate of GFR

5 Matching Questions

1. Pyelonephritis (Collaborative care)
2. Pyelonephritis
3. Diuretic Phase (ARF)
4. Acute Glomerulonephritis (Diagnostics)
5. Cystitis

1. a Bacterial infection in the kidney and renal pelvis (upper urinary tract) inflammation of renal parenchyma and collection system.
   Cause: INfection, ie, Ecoli, Proteus, Klebsiella, Enterobacter. Lower tract-ureters-renal medulla-cortex.
2. b Urinalysis: RBCs, casts, albumin/protein
   Other: CBC, BUN/Creatinine, Antistreptolysin O titers, complement levels, renal biopsy
3. c 2-6 weeks after oliguric stage. May last 1-3wks.
   Gradual increase in urine output may reack 10L/day. Tubular patency restored; nephrons unable to concentrate urine. Hypovolemia, hypotensive, hypokalemia, dehydration. Uremia may be severe Increse in BUN/Creatinine.
   Client remains biochemically imbalanced.
4. d bladder
5. e Severe infection: hospitalize, IV antibiotics, antipyretics, analgesics
   Relapses: 6 weeks of antibiotics, follow-up urine C&S, imaging
   Reinfections: tx as individual episodes or long-term therapy

5 Multiple Choice Questions

1. BUN/Creatinine, UA, Ultrasound, IVP, KUB, CT
   1. Urolithiasis (Diagnostics)
   2. Urolithiasis (prevention)
   3. Pyelonephritis (Diagnostics)
   4. Urolithiasis (Assessment)
2. Fluid retention (Edema, HTN< CHF)
   Electrolyte imbalances (K+, BUN/Creatinine & P increase, Na+ & Ca+ decrease)
   Anemia & platelet abnormalities, Neurological changes.
   UA: hematuria w/ casts, RBCs, WBCs, SG, 1.01; osmolality, 300 osm/L (Same as SG plasma)
   Onset w/i 1-7 days of the event
   Duration: 1-3 weeks
   The longer the phase, the poorer the prognosis
   1. Recovery Phase (ARF)
   2. Oliguria Phase <400cc/24hr (ARF)
   3. Initiating phase (ARF)
   4. Diuretic Phase (ARF)
3. Personal and FH, diet, fluid intake, Manifestations: 'renal colic', N/V, Pale, diaphoresis, altered urine output
   1. Urolithiasis (prevention)
   2. Urolithiasis (Diagnostics)
   3. Urolithiasis (Assessment)
   4. Urolithiasis
4. An acute decrease in renal function--high serum levels of nitrogen, creatinine, olguria
   Pre-Renal: decrease renal blood flow-- glomerular perfusion & filtration. Most common cause 60-70%.
   Intra-Renal: direct damage to renal tissue-- malfunctioning nephrons.
   Glomeruli- decreased filtering
   Tubular necrosis
   Post-Renal: Acute process obstructs urine flow; wastes accumulate.
   1. BUN (Blood Urea Nitrogen)
   2. Serum Creatinine
   3. UTI (risk factors)
   4. AFR (Acute Renal Failure)
5. prostate
   1. Cystitis
   2. Urethritis
   3. Urosepsis
   4. prostatitis

5 True/False Questions

1. Nephrotic Syndrome (Collaborative care) → Fluid: assess edema, I/O, daily weight, measure girth/extremities.
   Diet: low-moderate protein, low sodium; small frequent meals
   Encourage rest and provide skin care
   Medications: diuretics, vitamins, antibiotics, corticosteroids, heparin, immunosuppressive agents. Considerations: ACE inhibitors and NSAIDS

   True        False

2. Pyelonephritis (Diagnostics) → Urinalysis: Pyuria, bacteriuria, hematuria, & WBC casts. Urine for culture and sensitivity. CBC w/ differential:leukocytosis, increase in immature bands, Blood culture; if present, , close observation, VS.
   C-reactive protein, ESR

   True        False

3. Urolithiasis (Collaborative care) → Severe infection: hospitalize, IV antibiotics, antipyretics, analgesics
   Relapses: 6 weeks of antibiotics, follow-up urine C&S, imaging
   Reinfections: tx as individual episodes or long-term therapy

   True        False

4. Initiating phase (ARF) → 2-6 weeks after oliguric stage. May last 1-3wks.
   Gradual increase in urine output may reack 10L/day. Tubular patency restored; nephrons unable to concentrate urine. Hypovolemia, hypotensive, hypokalemia, dehydration. Uremia may be severe Increse in BUN/Creatinine.
   Client remains biochemically imbalanced.

   True        False

5. Kidney → An infection that spreads from the urinary tract to the bloodstream.

   True        False