Renal

Created by jillrickenbacker 

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warning signs of kidney disease

burning or difficulty urinating, increased frequency of urination @ night, blood in urine, puffiness around eyes, swelling in hands and feet especially in children, back pain, increased BP.

kidneys do what?

assist in acid based balance, raise BP by secreting renin, and produce the hormone erythropoietin (production of RBC's and their release)

Nephrons

responsible for urine production.

Glomerulus

filtration occurs there, filters H2O, sugar, salts, uria and other wastes.

Loop of Henley

Loop diuretics work here.

3 layers of the kidney

cortex(outer), medulla(middle), and the nephron(functional unit.)

subjective data collection

family hx, color, odor, or mucus in urine, diuretics, pruritis, HTN medications, antibiotics.

objective data collection

skin, vital signs, edema, wt.gain, lung sounds, I&O's, urine.

characteristics of urine

pale yellow, amber color, aromatic.

vegetarians will have?

very alkalitic urine

meat eaters will have ?

very acidic urine.

with age these changes occur

decreased production, filtration, decreased renal clearance of drugs, unable to conserve sodium, and decreased bladder capacity.

Lab values for urine

PH 4.6 - 8.0, specific gravity 1.010 - 1.025, protein 0-18mg/dl, RBC0-4hpf, WBC0-5, serum creatinine0.6-1.5, BUN 8-25.

invasive kidney procedures

renal biopsy, IVP, angiography, cystoscopy.

NI for angiography

NPO 4-8hrs. before, bedrest of 12hrs. after, monitor for bleeding @ injection site.

cystitis ( UTI)

inflammation of the bladder. more common in females. common bacteria that causes it is E-coli, or yeast.

diagnostic test for UTI

midstream urine test.

medications for UTI

bactrim unless pt. has sulfa allergy, then Cipro. Monural for yeast, and pyridium.

pyridium

non opioid analgesic, turns urine orange/red color, will stain skin and clothes.

Pyeloneohritis

bacterial infection of renal pelvis, caused by backflow, trauma, E-coli most common cause. Urine is cloudy, bloody, or has mucos or pus.

treatment for pyelonephritis

push fluids, daily wt., pain relief, light diet @ first then high cal, high protein.

acute glomerulonephritis

strepp infection, can lead to CHF, and pulmonary edema. inflammation of the glomerulus.

medications for acute glomerulonephritis

penicillin, lasix, and imuran.

chronic glomerulonephritis

slower progression, can take up to 30 yrs. for signs of renal insufficiency. Meds. are the same as acute, high carb, low sodium diet.

complications of CRF

insomnia, anemia, GI bleed, hyperkalemia, hypermagnisemia, hypervolemia, hypovolemia, HTN, hypocalcemia, and infection.

Uremic syndrome

accumulation of nitrogenous waste products in the blood caused by kidneys inability to filter out these waste products. may occur from CRF or ARF.

S/S of uremic syndrome

oliguria, presence of protein, RBC's, casts in the urine, Increased levels of uric acid, potassium, and magnesium. hypotension, hypertension, and changes in LOC.

NI for uremic syndrome

monitor vitals, serum electrolytes, I & O's for oliguria, limited sodium, potassium, and nitrogen diet.

Hemodialysis

process of cleansing the pts. blood. removes by products such as urea, creatinine, and uric acid. removes excess fluids and maintains the buffer system of the body. maintains electrolyte levels of the body.

complications of hemodialysis

air embolus, disequilibrium syndrome, and dialysis encephalopathy.

peritoneal dialysis

works on the principles of osmosis, diffusion, and ultrafication. PD occurs via the transfer of fluid and solute from the bloodstream through the peritoneum.

Tenckhoff catheter

a rubber siliconized catheter that is surgically inserted into the peritonel cavity to allow infusion of dialysis fluid.

complications of PD

abdominal pain, abnormal outflow, leakage @ catheter site, peritonitis.

urosepsis

a gram negative backteria caused by E-coli, usually with indwelling catheter. can cause septic shock if left untreated, fever is the most common and earliest manifestation.

NI for urosepsis

obtain urine specimen for C&S, before giving antibiotics. administer IV antibiotics for 3-5 days, then by PO after.

renal calculi

stones that form in the kidneys.

urolithiasis

stones that form in the ureters.

cause of stones

family hx, urinary stasis, obstruction, dehydration, diuretics, UTI's, increased uric acid level, and a diet high in vitamin D, calcium, milk, and protein.

epididymitis

inflammation of the epididymis, caused by UTI or STI.

Benign Prostatic Hypertrophy (BPH)

enlargement of the prostate gland, with hypertrophy and hyperplasia of normal tissue.

data collection for BPH

diminshed size and stream of urine, urgency, frequency, nocturia, hesistancy, hematuria, dysuria, and UTI's.

NI for BPH

increase fluids to 2000-3000 cc, avoid giving anticholinergics, antihistamines, decongestants, and antidepressants. Give meds to shrink and relax prostate.

overflow incontinence

bladder retraining, keep skin dry and clean, moral support.

total incontinence

vitals, skin clean and dry.

urge incontinence

fluids @ 3000 ml per day, bladder retraining, skin clean and dry.

stress incontinence

kegal exercises, bladder retraining, skin clean and dry.

nocturnal enuresis

no fluids after 6pm, empty bladder directly before bedtime, skin clean and dry.

prerenal acute renal failure

decrease in kidney perfusion that reduces glomerular perfusion. S/S pale cool skin, orthostatic hypotension and oliguria.

intrarenal acute renal failure

tissue damage of glomeruli and tubules, antigens and antibodies complexes formed in glomerulonephritis become trapped in the basement of the membrane and cause inflammation.

postrenal acute renal failure

caused by an obstruction.

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