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renal

"Do you have any pain when you urinate?"

When reading a patient's chart, the nurse notes that the patient has had dysuria. To assess whether there is any improvement, which question will the nurse ask?

"I get up several times every night to urinate."

A diabetic patient is admitted for evaluation of renal function because of recent fatigue, weakness, and elevated BUN and serum creatinine levels. While obtaining a nursing history, the nurse identifies an early symptom of renal insufficiency when the patient states

"I have a temperature of 101."

A patient who had a cystoscopy the previous day calls the urology clinic and gives the nurse all the following information. Which statement by the patient should be reported immediately to the health care provider?

"I should start taking a high-potency multiple vitamin every morning."

After teaching a patient with interstitial cystitis about management of the condition, the nurse determines that further instruction is needed when the patient says

"I will empty my bladder every 3 to 4 hours during the day."

The nurse determines that instruction regarding prevention of future UTIs for a patient with cystitis has been effective when the patient states

"I will measure my urinary output each day to help calculate the amount I can drink."

A patient is diagnosed with stage 3 CKD. The patient is treated with conservative management, including erythropoietin injections. After teaching the patient about management of CKD, the nurse determines teaching has been effective when the patient states

"I will wash the catheter with soap and water before and after each catheterization."

After the home health nurse teaches a patient with a neurogenic bladder how to use intermittent catheterization for bladder emptying, which patient statement indicates that the teaching has been effective?

"Your doctor will insert a lighted tube into the bladder through your urethra, inspect the bladder, and instill a dye that will outline your bladder on x-ray."

When teaching a patient scheduled for a cystogram via a cystoscope about the procedure, the nurse tells the patient

1000

A patient in the oliguric phase of acute renal failure has a 24-hour fluid output of 150 ml emesis and 250 ml urine. The nurse plans a fluid replacement for the following day of ___ ml.

Protein Excretion Rate for pts w/acute GN may be INCREASED from

500mg to 3g/24hr

Serum albumin levels are DECREASED because of

protein lost in the urine and because of fluid retention causing dilution

3 Types of Acute Kidney Injury

Prerenal Azotemia, Intrarenal (intrinsic) AKI, Postrenal Azotemia

5 Stages of Chronic Kidney Disease

Stage 1: At risk w/normal GFR of 90mL/min or greater (kidneys are still compensating), Stage 2: Midly decreased of 60-89mL/min (focus on reducing the risks), Stage 3: Moderately decreased GFR of 30-59 mL/min (implement any strategies to slow down progression), Stage 4: Severely decreased GFR of 15-29 mL/min (manage complications and prepare pt for RRT; kidneys are not filtering much), Stage 5: ESKD, GFR of <15mL/min (does require RRT and transplant is possible)

60

The result of a patient's creatinine clearance test is 60 ml/min. The nurse equates this finding to a glomerular filtration rate (GFR) of ___ ml/min.

Acid-Base Balance Changes during Chronic Renal Failure

In early stages, blood pH changes little b/c remaining healthy nephrons increase rate of acid excretion, as more nephrons are lost, acid excretion is reduced and metabolic acidosis results, ammonia production is decreased and reabsorption of bicarb does not occur; process leads to buildup of hydrogen ions, reduced levels of bicarb (base deficit).

Active Pyelonephritis

ACTIVE BACTERIAL infection, involves acute tissue inflammation tubular cell necrosis and possible abscess formation, infection is scattered w/in kidney, fibrosis and scar tissue develop from inflammation, calices thicken, scars develop in interstitial tissue

UTI prevention

drink at least 2 to 3 liters of fluid every day, get enough sleep, rest, and nutrition daily, clean perineum from front to back, avoid irritating substances (bubble bath, nylon underwear, scented toilet tissue), wear loose-fitting cotton underwear, empty bladder before and after intercourse, if you experience burning when you urinate, if you have to urinate frequently, or if you find it difficult to begin urinating, notify physician right away, especially if you have a chronic medical condition (such as diabetes) or are pregnant, empty bladder ASAP, regularly (q 4 hrs), even without urge, home therapies: cranberry juice (pure) 50 ml daily, apple cider vinegar 2 tbls three times daily in juice, vitamin c 500 mg daily to acidify urine, prevent recurrent infection: take prescribed antibiotic as directed even after symptoms go away, schedule follow-up appointment for 10 to 14 days after you finish the drug. At your follow-up visit, another urine sample may be taken for analysis or culture.

UTI signs and symptoms

fatigue, chills, fever, flank pain, older adults may have more generalized abd discomfort, not as specific, older adults may run a low grade fever

vasopressin

given to control diabetes insipidus and promote reabsorption of water in kidney tubules

venofer

iron sucrose used as iron supplement with erythropoietin therapy because adequate stores of iron are necessary for adequate response to erythropoietin

Vesicoureteral Reflux

bacterialaden urine forced backward from bladder into ureters, kidneys, pyelonephritis can develop

von HippelLindau Syndrome

most wellknown genetic familial syndrome that includes renal cancer, highly vascular and may occur with cancers of the pancreas, CNS, and adrenal glands.

waxy cast

grayish or colorless, highly refractile, appear very solid, broken off square ends

WBC: 20-26/hpf

When reviewing the results of a patient's urinalysis, which information indicates that the nurse should notify the health care provider?

When are PSA blood tests taken?

6 weeks after surgery, then 4 to 6 months to monitor progress

When to remove a stone

too big to pass, bacteria or infection associated, if it impairs renal function, persistent pain, ileus, not able to treat medically, if patient has one kidney

zemplar

paricalcitol/secondary parathyroidism from kidney disease

urinalysis

analysis of urine for color, pH, specific gravity, osmolality, and normal and abnormal constituents

Urinary Antiseptics

Macrobid, reduce bacteria in the urinary tract by inhibiting bacterial reproduction. Shake bottle well before measuring drug. Drink a full glass of water or milk w/each dose. Daily fluid intake 3L. Complete drug regimen.

urinary diversion

trauma, bladder cancer, congenital anomalies, most common is ileo-conduit, ureters attached to small intestines which is brought out abd wall, may see mucus production in urine from intestine, will decrease over time

urinary incontinence

uncontrolled leakage of urine as a result of cerebral clouding and/or physical factors that make it difficult to get to the bathroom facilities on time.

urinary incontinence and retention nephrostomy tubes

special procedure, incision into flank area, small cath into renal pelvis, done for blockages, may have ostomy bag over tube, never clamp , measure output separately

urinary incontinence, retention, suprapubic catheters

quadropolegic

Urinary Manifestations of CKD

Polyuria, nocturia (early sign), Oliguria, anuria (later sign), Proteinuria, Hematuria, Diluted, straw-like appearance in urine

urinary retention

inability to empty the bladder despite micturition or the accumulation of urine in the bladder because of an inability to urinate.

urine outflow obstruction

hydronephrosis, hydroureter, nitrogen waste products and electrolytes are retained in the blood, and acid-base balance is impaired, causes: tumors, stones, trauma, structural defects, and fibrosis, early treatment prevents damage, damage can happen in as little as 48 hrs in some people and weeks in others

Urine output

A patient with a confirmed urinary stone in the proximal left ureter undergoes extracorporeal shockwave lithotripsy. Which information is most important for the nurse to collect after lithotripsy?

Urine output is 20 ml/hr for 2 hours.

A patient undergoes a nephrectomy for massive trauma to the kidney resulting from a fall from a scaffold. Which assessment data obtained postoperatively is most important to communicate to the surgeon?

Urine output with Chronic Glomerulonephritis

DECREASES, but urine appears NORMAL unless UTI is present, UA shows protein (usually <2g in a 24 collection, specific gravity is fixed at a constant level of dilution (around 1.010), RBCs may be in urine

urosepsis

urinary tract infection that has spread into the systemic circulation; life-threatening condition requiring emergency treatment.

urosepsis

A 34 year old patient with diabetes mellitus is hospitalized with fever, anorexia, and confusion. The health care provider suspects acute pyelonephritis when the urinalysis reveals bacteriuria. An appropriate collaborative problem identified by the nurse for the patient is potential complication

Use an ultrasound scanner to check for residual urine after voiding.

Following rectal surgery, a patient voids about 50 ml of urine every 30 to 60 minutes. Which nursing action is most appropriate?

UTI

majority are bacterial, e-coli responsible for at least 80%, enters thru urethra and travels up (ascending), can be thru blood or, lymphatic, but not common, foley catheters responsible for most hospital acquired, urinary stasis d/t infrequent voiding, obstruction, scarring, stones, diabetics have altered immune response, immunosuppressed, multiple abx, women more prone, global term used for entire GU tract, upper UTI=inflammation of ureters of kidney, pyelonephritis, lower UTI=bladder and below, pyelonephritis acquired because bacteria travels from lower tract into kidneys

UTI diagnosis

UA, hematuria, WBCs in urine, no treatment can lead to urosepsis (systemic) which can lead to shock, bacteruria, bacteremia

UTI drugs

Sulfonamides: Bactrim, septra ~ Quinolones: ciprofloxacin, levaquin ~ Penicillins: amoxicillin, augmentin ~ Cephalosporins: duricef, suprax ~ Urinary Antiseptics: macrobid ~ Bladder Analgesics: pyridium ~ Antispasmodics: anaspaz

Teach the patient how to perform Kegel exercises.

After her bath, a 62 year old patient asks the nurse for a perineal pad, saying that she uses them because sometimes she leaks urine when she laughs or coughs. Which intervention is most appropriate to include in the care plan for the patient?

teach the patient to clean the urethral area, void a small amount into the toilet, then void into a sterile specimen cup.

The health care provider orders a cleancatch urine specimen for culture and sensitivity testing for a patient with a suspected urinary tract infection (UTI). To obtain the specimen, the nurse will plan to

Test and Diagnonsis for Glomerulonephritis

UA (shows RBCs (hematuria) and protein (proteinuria); early morning specimen should be obtained b/c urine is most acidic and formed elements (RBC, RBC cast, and proteins) are more intact at that time, Glomerular Filtration Rate (GFR), 24 Hour Urine Collection for Total Protein, Kidney Biopsy or Punch Biopsy

The LPN/LVN gives the iron supplement and phosphate binder with lunch.

The RN observes an LPN/LVN carrying out all these actions while caring for a patient with renal insufficiency. Which action requires the RN to intervene?

The NA disconnects the catheter from the drainage tube to obtain a specimen.

The nurse observes a nursing assistant doing all of the following when caring for a patient with a retention catheter. Which action requires that the nurse intervene?

the need to empty the bladder prior to treatment.

A patient with bladder cancer is scheduled for intravesical chemotherapy. In preparation for the treatment the nurse will teach the patient about

The patient describes allergies to shellfish and penicillin.

A patient with a possible renal cell tumor who is scheduled for an intravenous pyelogram (IVP) and computed tomography (CT) scanning of the abdomen gives the nurse all the following data. Which information has the most immediate implications for the patient's care?

the patient's bowel sounds.

Before administering sodium polystyrene sulfonate (Kayexalate) to a patient with hyperkalemia, the nurse should assess

The patient's central venous pressure (CVP) is decreased.

Two hours after a kidney transplant, the nurse obtains all these data when assessing the patient. Which information is most important to communicate to the health care provider?

The patient's peritoneal effluent appears cloudy.

The nurse is assessing a patient who is receiving peritoneal dialysis with 2L inflows. Which information should be reported immediately to the health care provider?

The respiratory rate is 38 breaths/min.

Following an intravenous pyelogram (IVP), all of these assessment data are obtained. Which one requires immediate action by the nurse?

There are clots in the urine.

The nurse working in a urology clinic receives a call from a patient who had a transurethral resection with fulguration for bladder cancer 3 days previously. Which information given by the patient is of most concern to the nurse?

There is a nontender lump in the axilla.

Which data obtained when assessing a patient who had a kidney transplant 8 years ago and who is receiving the immunosuppressants tacrolimus (Prograf), cyclosporine (Sandimmune), and prednisone (Deltasone) will be of most concern to the nurse?

to be determined hourly, based on every milliliter of urine output.

In the immediate postoperative period, the nurse caring for a patient who is a recipient of a kidney transplant would expect that fluid therapy would involve administration of IV fluids

Treatment for Nephrotic Syndrome

Depends on what process is causing the d/o that is identified by renal biopsy, Steroids, ACE inhibitors, cholesterols decreasing drugs may be given; mild diuretics, Sodium Restriction, Strict I & O's

Two Main Causes of ESKD

Diabetes, HTN

u waves

Hypokalemia causes what abnormality on ECG?

uremia

accumulation of nitrogenous wastes in the blood (azotemia); a result of renal failure, with clinical symptoms including nausea and vomiting, severe itching

uremic frost

layer of urea crystals from evaporated sweat on face, eyebrows, axilla, groin in patients with advanced uremic syndrome

uremic syndrome

manifestations of endstage kidney disease

ureterolithiasis

formation of stones in ureter

urethral strictures

narrowing of urethra, most common symptom = obstruction of urine flow, rarely cause pain, surgical treatment by urethroplasty = best chance of long-term cure, dilation of the urethra = temporary measure, urethroplasty: surgical removal of affected area with or without grafting to create a larger opening. The recurrence rate after surgery is still high, and most patients need repeated procedures, urethral stricture location and length are most important factors affecting choice of interventions and recovery

urethral strictures symptoms

obstruction of urine flow, may rarely cause pain, UTI, Overflow Incontinence

urethral strictures treatment

Urethroplasty (best chance of longterm cure). Dilation of the urethra (temporary measure not a curative one)

Urethritis

inflammation of urethra that causes symptoms similar to UTI (in men UTI, Women Cystitis). Most common cause in men is STDs (gonorrhea, ureaplasm (bacteria), chlamydia, trichomonas vaginalis); most men are asymptomatic. Women, urethritis is known as pyuriadysuria syndrome, frequencydysuria syndrome, trigonititis syndrome, and urethral syndrome; most common in postmenopausal women (probably caused by tissue changes r/t low estrogen). UA may show pyuria (WBCs in the urine) w/out a large number of bacteria; Culture results are negative for bacteria but symptoms persist

urethritis

inflammation of urethra, causes symptoms similar to UTI, symptoms similar to UTI in men or bacterial cystitis in women, most common cause in men is STDs (gonorrhea or nonspecific urethritis caused by ureaplasma, chlamydia, or trichomonas vaginalis, most men are asymptomatic, most common in postmenopausal women

urethritis and cystitis

trichomonas and monolialal infections can be transmitted thru sexual contact, men are more symptomatic than men, men have drainage and painful urination, usually caused by e-coli, frequency and burning in lower area, older adults will not present the same, supra-pubic pain, lower back pain, low-grade temps, older adults can present w/confusion d/t systemic infection

renal failure oliguria

400ml or less UOP per day

renal failure partial renal failure

renal insufficiency

renal failure postrenal

mechanical obstruction to outflow of urine, stones, tumors, strictures, enlarged prostate, narrowing ureters blockage causes backflow of urine = damages kidneys

renal failure prerenal

factors outside kidney, reduced blood flow (hypovolemia), decreased GFR, ex: hemorrhage, dehydration, severe burn, CHF w/decrease CO, septic, b/c of decrease in PVR, HTN, 55 to 60% of acute are pre-renal, if oliguria, kidney is responding to decreased blood-flow by conserving Na and H2O, if decreased blood-flow kidney cannot produce waste=azotemia

renal failure treatment, diagnosis

UA, US to evaluate whether disease or obstruction, get rid of what caused, manage s/s fluid volume replacement if hypovolemic, diuretics if fluid volume excess, 24 hr UOP + 600ml of insensible loss measured for fluid replacement, get rid of excess K: calcium gluconate, kaexolate, sodium bicarb, IV fluids w/D5W and insulin, may need temporary dialysis, identify at risk: elderly, extensive burn, surgical procedure, cardiac failure, renal insufficiency or decreased function

renal failure uremia

labs need to be monitored (Cl, Na, etc) for inadequate function

renal osteodystrophy

syndrome of skeletal changes found in chronic kidney disease as a result of alterations in calcium and phosphate metabolism; characterized by uneven bone growth and demineralization.

Renal Replacement Therapy

Hemodialysis, Peritoneal Dialysis

Renal replacement therapy is needed when...

pathologic changes of stage 4 and 5 CKD are life threatening or pose continuing discomfort, patient can no longer be managed with conservative therapies (diet, drugs, fluid restriction, dialysis is indicated)

renal stones dietary treatment

Calcium Oxalate: avoid oxalate sources such as spinach, black tea, rhubarb, decrease sodium. ~ Calcium Phosphate: Limit intake of animal protein to 57 servings per week, never more than 2/day. Some pts may benefit from reduced calcium. Decrease sodium . ~ Struvite: Limit high-phosphate foods (dairy products, organ meats, whole grains). ~ Uric acid: Decrease intake of purine sources (organ meats, poultry, fish, gravies, red wines, sardines). ~ Cystine: Limit animal protein, encourage oral fluids (500 ml every 4 hours while awake, 750 ml at night)

renal transplant

not a "cure", dialysis and kidney transplant are life-sustaining treatments for ESKD

renal transplant candidate selection

free of medical problems that might increase risks: diabetes mellitus/endocrine problems cause greater risks, advanced uncorrectable cardiac disease, metastatic cancer, chronic infections, severe psychosocial issues, respiratory issues, GI system disease, normal urine flow

renal trauma

blunt trauma problems w/injury to abd or flank areas, gross or microscopic hematuria UA , radiological exam: evaluate both kidneys, abd tenderness, bruising in flank area, tx is bed rest and fluids may nd nephrectomy if large damage

renin

enzymatic hormone synthesized, stored, secreted by kidney

renovascular Disease

narrowing of the renal artery lumen=reduced blood flow to the kidney tissue, often accompanied by sudden onset of HTN, particularly those that are older than 50 (this should be a RED FLAG)

renovascular disease

processes affecting the renal arteries may severely narrow the lumen and greatly reduce blood flow to the kidney tissues. causes: renal artery stenosis, renal aneurysm, atherosclerosis, or thrombosis, results in ischemia and atrophy of kidney tissue, often have sudden onset of hypertension, particularly those older than 50

renovascular disease key features

significant, difficult to control high blood pressure, elevated serum creatinine, decreased creatinine clearance

Reproductive Manifestations of CKD

Decreased Fertility, Infrequent or absent menses, Decreased libido, Impotence

Respiratory Manifestations of CKD

Uremic Halitosis, Tachypnea, Deep sighing, yawning, Kussmal Respirations, SOB, Uremic Pneumonitis, Pleural Effusion, Pulmonary Edema, Depressed Cough Reflex, Crackles

Restrictions for Glomerulonephritis

Pts w/fluid overload, HTN, edema, diuretics and sodium and water restriction are prescribed

retrograde pyelogram

radiologic technique for examining collecting system of kidneys, especially useful in locating urinary tract obstruction

RIFLE

R isk I njury F ailure L oss E nd Stage Kidney Disease, applies to pts w/no known kidney problems and pts w/chronic kidney dz. At RIFL stage normal kidney function is possible.

Scrambled eggs, English muffin, and apple juice

The nurse has instructed a patient who is receiving hemodialysis about dietary management. Which diet choices by the patient indicate that the teaching has been successful?

secondary glomerular diseases and syndromes

systemic lupus erythematosus, multiple myeloma, SchonleinHenoch purpura, goodpasture's syndrome, systemic necrotizing vasculitis, Wegener's granulomatosis, periarteritis nodosa, amyloidosis, diabetic glomerulopathy, HIVassociated nephropathy, alport's syndrome, viral hepatitis B and C, cirrhosis, sickle cell disease, non-streptococcal postinfectious acute glomerulonephritis, infective endocarditis, hemolyticuremic syndrome, thrombotic thrombocytopenic purpura

sensipar

(Generic Name:) Cinacalcet, (sin ah CAL set), (tablet), Renal Disease Agent (Used to treat hypoparathyroidism [decreased functioning of the parathyroid glands] in people who are on long-term dialysis for kidney disease. Is also used to lower calcium levels in people with cancer of the parathyroid gland.)

serum phosphate.

Before administration of calcitriol (Rocaltrol) to a patient with CKD, the nurse should check the laboratory value for

Signs and Symptoms for Acute Pyelonephritis

Fever, Back, flank or groin pain, Abdominal pain, Frequent urination, Strong, persistent urge to urinate, Burning sensation or pain when urinating, Pus or blood in your urine (hematuria)

Signs and Symptoms for Chronic Pyelonephritis

HTN. Inability to conserve sodium. Decreased urine concentration ability (nocturia). Tendency to develop hyperkalemia and acidosis

Signs and Symptoms of Nephrotic Syndrome

Massive Proteinuria, Hypalbuminemia, Edema, Lipiduria, Hyperlipidemia, Increased Coagulation, Renal Insufficiency

slow the rate for the next dialysis to decrease the speed of solute removal.

A patient with chronic kidney disease (CKD) is started on hemodialysis, and after the first treatment, the patient complains of nausea and a headache. The nurse notes mild jerking and twitching of the patient's extremities. The nurse will anticipate the need to

specific gravity

ratio of a mineral's weight compared with the weight of an equal volume of water

stricture

abnormal temporary or permanent narrowing of the lumen of a hollow organ, such as the esophagus, pylorus of the stomach, ureter, or urethra; caused by inflammation, external pressure, or scarring.

Surgical Management for Pyelonephritis

Used to correct structural problems causing urine reflux or obstruction of urine outflow or to remove the source of infection. Pyelolithotomy: stone removal from the kidney or renal pelvis. Nephrectomy: removal of the kidney; used as a last resort when all other measures have failed. Ureteroplasty: ureter repair or revision or ureteral re-implantation through another site in the bladder wall, preserves kidney function and eliminates infections

Symptoms of Chronic Glomerulonephritis

Mild proteinuria, Hematuria, HTN, Fatigue, Occasional Edema

Symptoms of Rapidly Progressive Glomerulonephritis

Fluid Volume Excess, HTN, Oliguria, Electrolyte Imbalance, Uremic Symptoms

Symptoms of Renovascular Disease

HTN, Poorly controlled DM, Elevated serum Creatinine, Decreased Creatinine Clearance

take the antibiotic for the full 7 days, even if symptoms improve in a few days.

Trimethoprim and sulfamethoxazole (Bactrim) BID for 7 days is ordered for a patient who has a recurrent relapse of an Escherichia coli UTI. The nurse instructs the patient to

take the blood pressure to check for hypotension.

A patient in ARF has a gradual increase in urinary output to 3400 ml a day with a BUN of 92 mg/dl (33 mmol/L) and a serum creatinine of 4.2 mg (371 μmol/L). The nurse should plan to

Restrictions for Glomerulonephritis

Pts w/fluid overload, HTN, edema, diuretics and sodium and water restriction are prescribed. Usual fluid allowance is equal to the 24hour urine output plus 500 mL. Postassium and protein intake may be restricted to prevent hyperkalemia and uremia as a result of the ELEVATED BUN

polycystic kidney disease key features

abdominal or flank pain, hypertension, nocturia, increased abdominal girth, constipation, bloody or cloudy urine, kidney stones

polycystic kidney disease labs

urinalysis shows proteinuria once the glomeruli are involved, hematuria may be gross or microscopic, bacteria in urine indicate infection, usually in the cysts, as kidney function declines, serum creatinine and blood urea nitrogen (BUN) levels rise

polycystic kidney disease signs and symptoms

pain is often first symptom, easily palpated because of increased size, flank pain as a dull ache or as sharp and intermittent discomfort, when cyst ruptures, patient may have bright red or cola-colored urine, infection is suspected if urine is cloudy or foul smelling or if there is dysuria, nocturia is an early sign because of decreased urine concentrating ability

polycystic kidney disease diagnosis

based on s/s pt is having, family hx, IVP, ultrasound, end up w/end stage renal disease, no cure, tx is to manage symptoms and maintain function

Postrenal azotemia

Obstruction of the urine collecting system anywhere from the calyces to the urethral meatus such as: ureter, bladder, or urethral cancer; kidney, ureter, or bladder stones; bladder atony; prostatic hyperplasia or cancer; urethral stricture; cervical cancer, Anuric <100mL/24hr of urine output

postrenal azotemia

Develops from obstruction to the outflow of formed urine anywhere within the renal or urinary tract.

potassium.

A patient with hypertension and stage 2 chronic kidney disease is receiving captopril (Capoten). Before administration of the medication, the nurse will check the patient's

potassium.

When reviewing the laboratory values for a patient admitted with a severe crushing injury after an industrial accident, the nurse will be most concerned about levels of

pravochol

antihyperlipidemic <HMGCoA reductase inhibitor>

prednisone

steroid, reduces inflammation

Prerenal Azotemia

any condition decreasing blood flow to the kidneys and leading to ischemia in the nephrons such as: shock (most common), heart failure (most common), Pulmonary Embolism, Anaphylaxis, Sepsis, and Pericardial Tamponade. Can be reversed by correction blood volume, increasing blood pressure, and improving cardiac output (in the Risk and Injury stage)

prerenal azotemia

renal failure caused by poor blood flow to kidneys, most common problems are hypovolemic shock and heart failure, can be reversed by correcting blood volume, increasing blood pressure, and improving cardiac output

primary glomerular diseases and syndromes

acute glomerulonephritis, rapidly progressive glomerulonephritis, chronic glomerulonephritis, nephrotic syndrome, persistent, vague urinary abnormalities with few or no symptoms

Primary Glomerulonephritis

Acute glomerulonephritis, Rapidly progressive glomerulonephritis (RPGN), Chronic Glomerulonephritis, Nephrotic Syndrome, Persistent, vague urinary abnormalities w/few or no symptoms

proteinuria

main feature of nephrotic syndrome is severe...

proteinuria

presence of excessive protein (chiefly albumin, but also globulin) in urine

purpura

multiple pinpoint hemorrhages and accumulation of blood under skin, producing purplish discoloration; merging ecchymosis and petechiae over body

pyelonephritis

either the presence of active organisms in the kidney or the effects of kidney infections. Bacterial infection in the kidney (upper urinary tract) and renal pelvis; most common cause is from E.coli. Organisms move up from lower urinary tract into kidney tissue

pyelonephritis

diffuse pyogenic infection of renal parenchyma and collecting system

pyelonephritis

bacterial infection in the kidney and renal pelvis the upper urinary tract. either the presence of active organisms in the kidney or the effects of kidney infection. acute: active bacterial infection. chronic: results from repeated or continued infections or effects of infections, organisms move up from the lower urinary tract into the kidney tissue. acute: involves acute tissue inflammation, tubular cell necrosis, and possible abscess formation. chronic: reflux of infected urine is most common cause

pyelonephritis

inflammation of kidney and its pelvis caused by bacterial infection

pyelonephritis treatment

~ Drug therapy, antibiotics to treat infection. At first, broad spectrum, then more specific urinary antiseptic drugs (macrodantin) ~ Nutrition therapy adequate calories from all food groups, fluid intake of 23 L/day ~ Surgical, pyelolithotomy: stone removal, esp for large stones, nephrectomy: removal of kidney. Last resort when other measures fail, ureteral diversion, reimplantation of ureter (through another site in the bladder wall), ureteroplasty (ureter repair or revision), preserves kidney function and helps eliminates infection

pyuria

white blood cells in urine

quinine

medication to relieve muscle cramps caused by the rapid changes of fluid and electrolytes from dialysis

Radiofrequency Ablation

can slow tumor growth, minimally invasive procedure carried out after MRI has precisely located the tumor, used most commonly for patients who have only one kidney or who are poor surgical candidates

rapid respirations.

A patient with acute renal failure (ARF) has an arterial blood pH of 7.30. The nurse will assess the patient for

Rapidly Progressive Glomerulonephritis

becomes very ill very quickly, type of Acute Nephritis, may develop over weeks or months, loss of kidney function, also known as Crescentic Glomerulonephritis b/c of the presence of crescent-shaped cells in the Bowman's capsule

recent sore throat and fever.

When admitting a patient with acute glomerulonephritis, the nurse will ask the patient about

Recent weight gain

A patient is admitted to the hospital with nephrotic syndrome after taking an OTC non-steroidal anti-inflammatory drug (NSAID) a week earlier. Which assessment data will the nurse expect to find related to this illness?

Recovery Phase

return to normal levels of activity may take up to 12 months for complete recovery, pt functions at a lower energy level and has less stamina than before the illness, residual renal insufficiency may be noted through regular monitoring of renal function, renal function may never return to pre-illness levels, but renal function sufficient for a long and healthy life is likely

reflux

reverse or upward flow of urine toward the renal pelvis and the kidney.

reglan

treat nausea and vomiting, treat diabetic gastroparesis, symptomatic GERD and facilitate bowel intubation.

renagel

reduce blood levels of phosphorus in people with chronic kidney disease who are on dialysis to prevent hypocalcemia.

renal arteriogram

diagnostic study performed by injecting contrast media into a renal artery to visualize the renal blood vessels.

renal artery stenosis

partial occlusion of one or both renal arteries and their major branches; a major cause of abrupt onset hypertension

renal biopsy

procedure to obtain renal tissue for examination to determine renal disease; usually performed percutaneously with a biopsy needle.

renal calculi

formation of calculi or stones in the urinary tract. Urinary tract obstruction. aka urolithiasis

renal calculi avoid or limit in diet

Purine (high sardine, herring , mussels, liver, kidney, venison, meat soups, sweet breads); Calcium (milk, cheese, ice cream, yogurt, beans, fish, nuts, fruit, chocolate, cocoa, Ovaltine) Oxalate (spinach, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, chocolate, cocoa, instant coffee, Ovaltine, tea, and Worcestershire sauce

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