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OCT 26

renal
STUDY
PLAY
"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
renal calculi interventions
focus is on pain management and prevention of infection and urinary obstruction, analgesics (opiods, NSAIDS, antispasmodics), stenting (small tube is passed in the ureter by ureteroscopy dilating the ureter allowing for passage), strain all urine
renal calculi nursing care
hydration, ambulation, analgesics: opioids (demerol), NSAIDS (toradol) (may have increased risk for bleeding, delay in shock tx if needed), antispasmodics, stenting: small tube is passed in ureter by ureteroscopy dilating ureter allowing for passage
renal calculi risk factors
infection, urinary stasis and retention, immobility, dehydration, high uric acid, high urinary oxalate
renal calculi signs and symptoms
Pain (renal colic). Dull flank pain: a calculus in renal pelvis or stretching of renal capsule from urine retention (hydronephrosis), if calculus lodges in ureter, excruciating pain in abdomen, radiates to groin or perineum, nausea, vomiting, hematuria may accompany pain
renal calculi surgical treatment
Lithotripsy, Lithotomy
renal calculi symptoms
high incidence in males, N/V, Agonizing Flank pain that may radiate to the groin, testicles, and abdominal area, Sharp, sudden severe pain (may be intermittent depending on stone movement), Hematuria, dysuria, urinary frequency
renal calculi surgical treatment
Lithotripsy: aka extracorporeal shock wave lithotripsy (ESWL) use of sounds, laser, or dry shock waves to break stone into small fragments, ECG monitoring during procedure, strain urine post procedure to monitor passage of stone fragments, cystine stones often resistant to ESWL, ~ Lasertripsy ~ Lithotomy
renal cell carcinoma
also known as adenocarcinoma of the kidney. Healthy tissue of the kidney is damaged and replaced by cancer cells. systemic effects are called paraneoplastic syndromes and include: anemia, erythrocytosis, hypercalcemia, liver dysfunction with elevated liver enzymes, hormonal effects, increased sedimentation rate, and hypertension. complications: metastasis and urinary tract obstructions. usually spreads to adrenal gland, liver, lungs, long bones, or other kidney
renal failure acute
rapid loss of function, progressive azotemia, hyperkalemia, BUN, Cr elevated, oliguria in 50%, follow a severe prolonged illness or problems w/low BP and hypovolemia and/or nephrotoxic drugs
renal failure anuria
100ml or less UOP per day
renal failure azotemia
excess of nitrogenous waste, elevated BUN and Cr
renal failure intrarenal
factors to kidney itself, direct damage, impairment of nephron function, 35 to 40% of acute renal failure, ischemia to kidney: lupus, acute glomerulonephritis, nephrotoxic drugs like aminoglycosides (crystallize)
pain in the hips, knees, and other joints.
To monitor for corticosteroid-related complications after a kidney transplant, the nurse teaches the patient to report
Pain Management for PKD
Drug Therapy and complementary approaches, NSAIDS are used w/caution b/c of the tendency to reduce renal blood flow. Aspirin-containing compounds are AVOIDED to reduce the risk of bleeding. Apply dry heat to the abdomen or flank to promote comfort when renal cysts are infected. Needle aspiration for severe pain (this is temporary b/c the cysts fills back up). Methods of relaxation, deep breathing, guided imagery.
pain with urination.
When assessing the patient who has a lower urinary tract infection (UTI), the nurse will initially ask about
paired exchange
Can be done when two kidney donor/recipient pairs have blood dypes that are not compatible within one pair, two recipients trade donors so that each recipient can receive a kidney with a compatible blood type, two kidney transplant operations are scheduled to occur simultaneously
paresthesias
numbness w/ tingling sensation
pathogenesis
source or cause of disease together with its development
patients with diabetes who use CAPD have fewer dialysisrelated complications than those on hemodialysis.
A patient with diabetes who has chronic kidney disease (CKD) is considering using continuous ambulatory peritoneal dialysis (CAPD). In discussing this treatment option with the patient, the nurse informs the patient that
Penicillins
Amoxil, Augmentin. Reduce bacteria in the urinary tract by direct killin as a result of interrupting bacterial cell wall synthesis. Ask about drug allergies to PCN. Take w/food. Call MD if severe watery diarrhea develops. Women who use BC should be advised to use other measures of BC. Complete Drug Regimen
periorbital edema.
The nurse establishes a nursing diagnosis of excess fluid volume related to inflammation at the glomerular basement membrane in a patient with acute glomerulonephritis. To best evaluate whether the problem identified in the nursing diagnosis has resolved, the nurse will monitor for
peritoneal dialysis
exchanges of wastes, fluids, electrolytes in peritoneal cavity, slower than hemodialysis
peritoneal dialysis advantages and disadvantages
~ Advantages, can be done at home, ambulatory no machine needed, less stressful on body, hemodynamic tolerance, continuous process, better BP control, less dietary, fluid restrictions, greater freedom (scheduling, traveling) ~Disadvantages, time-consuming exchanges, protein wasting, excessive glucose load hyperlipidemia, sterile technique required, presence of permanent catheter, weight gain, peritonitis risk, peritoneum injury risk, cannot be done if patient has had many abdominal surgeries, chronic back pain, development of hernia
peritoneal dialysis automated
(APD) dialysis machine that controls the fill, dwell, and drain phases, and cycles four to eight exchanges per night with 1 to 2 hours per exchange.
peritoneal dialysis complications
peritonitis (cloudy dialysate outflow), pain, exit site and tunnel infections, poor dialysate flow, dialysate leakage, bleeding
peritoneal dialysis continuous ambulatory
(CAPD) dialysis carried out manually by exchanging 1.5 to 3 L of peritoneal dialysate usually four times daily with dwell times of 4 to 10 hours; an indwelling catheter permits fluid to drain into and out of the peritoneal cavity by gravity.
peritoneal dialysis nursing care
baseline VS, weight, "dry weight", baseline laboratory tests (electrolytes, glucose), continually monitor patient during PD, VS q 1530 minutes, assess for S&S of respiratory distress, pain, discomfort, check dressing at exit site q 30 min for wetness, monitor prescribed dwell time, initiate outflow, observe outflow pattern, measure, record outflow after each exchange, maintain I&O
peritoneal dialysis patient selection
PD is less hazardous than HD for those who are unstable and cannot tolerate anticoagulation, vascular access problems may eliminate PD as an option, may use PD until a new AV fistula matures, treatment of choice for older adults offers more flexibility, cannot be performed if peritoneal adhesions present or extensive intraabdominal surgery has been performed
peritoneal dialysis types
continuous ambulatory, multiple-bag continuous ambulatory, automated, intermittent, continuous cycle
peritoneal dialysis catheter caring for patient
mask yourself and patient, wash hands, put on sterile gloves, remove old dressing, remove contaminated gloves, Assess area for S&S of infection (swelling, redness, discharge around catheter site), use aseptic technique, open sterile field, place two precut 4X4 gauze pads on field, place three cotton swabs soaked in povidone-iodine on field, put on sterile gloves, use cotton swabs to clean around catheter site, use circular motion starting from insertion site, moving toward abdomen, repeat with all three swabs, apply precut gauze pads over catheter site, tape edges
peritoneal dialysis procedure
siliconized rubber catheter surgically placed into abdominal cavity, usually 12 L of dialysate infused by gravity (fill) into peritoneal space over 1020 minutes, fluid dwells in cavity for specified time prescribed by physician, fluid flows drains by gravity into drainage bag, peritoneal outflow contains dialysate, then excess water, electrolytes, nitrogen-based waste products fill, dwell, drain makes up 1 exchange, number of exchanges prescribed by MD, PD occurs through diffusion and osmosis across semipermeable peritoneal membrane and capillaries
Phases of Oliguric Acute Kidney Injury
Onset Phase, Oliguric Phase, Diuretic Phase, Recovery Phase
Phenergan
Promethazine Phenothiazine It is used to prevent and control nausea and vomiting during and after surgery .
Physical Assessment for Pyelonephritis
Ask to describe any vague or nonspecific urinary symptoms or abdominal discomfort. Inquire about any hx of repeated or low grade fevers. Inspect flanks and gently palpate the costovertebral angel (inspect for enlargement, asymmetry, edema, or redness). Tenderness or discomfort may indicate infection or inflammation
pitting edema
occurs when fluid collects in tissue (lower extremities often affected)
Place a bedside commode near the patient's bed.
A patient in the hospital has a history of urinary incontinence. Which nursing action will be included in the plan of care?
Place one hand flat at the costovertebral angle (CVA) and strike it with the other fist.
How will the nurse assess the flank area for tenderness?
place the patient on bed rest.
A patient with acute renal failure (ARF) requires hemodialysis and temporary vascular access is obtained by placing a catheter in the left femoral vein. The nurse will plan to _______________
Place the patient on the right side to put pressure on the site.
A patient with diabetic nephropathy is admitted for a right renal biopsy. Immediately after the biopsy, which of these is an essential nursing action?
plasmapheresis
removal and filtering of the plasma to eliminate antibodies
polycystic
having many cysts
Polycystic Kidney Disease
inherited disorder in which fluid-filled cysts develop in nephrons; result of an abnormal kidney cell division, gradually allows your kidneys to lose the ability to lose waste, most pts have high BP (cause is r/t renal ischemia from the enlarging cysts); control of HTN is top priority, at high risk for kidney stones, cysts may occur in other tissues like the liver and blood vessels (reduces kidney and liver function), Cerebral Aneurysms higher, Heart Valve Problems
polycystic kidney disease
most common genetic, autosomal recessive disorder that can progress rapidly (children), autosomal dominant disorder, usually stays dormant until 30 to 40 y/o, cortex and medulla fill up w/cysts and enlarge and destroy tissue, usually involves both kidneys and don't have kidneys until enlarge, abd or flank pain, hematuria when cyst ruptures, damage to kidney causes HTN, 50% can develop cysts outside kidneys, i.e. liver
polycystic kidney disease
genetic kidney disorder in which cortex and medulla are filled with thin-walled cysts that enlarge and destroy surrounding tissue
polycystic kidney disease
inherited disorder in which fluid-filled cysts develop in nephrons, cysts develop anywhere in the nephron, usually as a result of abnormal kidney cell division, over time cysts grow and become widely distributed, growing cysts damage glomerular and tubular membranes; nephron and kidney function become less effective, kidney tissue is eventually replaced by nonfunctioning cysts, which look like clusters of grapes, each cystic kidney may enlarge to 23 times its normal size, becoming as large as a football, can weight up to 10 lbs!, most of these patients have high blood pressure r/t renal ischemia from enlarging cysts, control of hypertension is top priority because proper treatment can disrupt the process that leads to further kidney damage
polycystic kidney disease etiology, genetic risk
several forms & can be inherited as ~Autosomal Dominant PKD, most common form, adult autosomal disorder, nearly 100% develop cysts by age 30, 1/2 will develop chronic kidney disease (kidney failure) by age 50 ~ Autosomal Recessive PKD, less common form, nephrons have cysts from birth, usually die in early childhood, caused by a gene mutation different from ADPKD
polycystic kidney disease interventions
~ Pain management, drugs and complementary approaches, NSAIDS used cautiously because they reduce renal blood flow, aspirin avoided to reduce bleeding risk, give antibiotics: monitor creatinine levels because they can be nephrotoxic, apply dry heat for comfort, if pain is severe, cysts can be reduced by needle aspiration ~ Infection prevention ~ Bowel management/constipation, maintain adequate fluid intake, increase dietary fiber, exercise regularly ~ Hypertension control, education to promote self management, restrict sodium intake, anti-hypertensives, diuretics, teach to measure and record BP, daily weights ~ Prevention of chronic kidney disease
obstructive uropathies
urine flow obstruction, could be anatomical, congenital, stones, tumors, fibrosis/scarring, prostate enlargement, prolapsed uterus, spinal injuries, symptoms depend on where the obstruction is, hydroureter dilation of renal pelvis and ureter, hydronephrosis dilation/enlargement of renal pelvis and calcacyes, if one is involved symptoms may not be present b/c other kidney will function, need to remove obstruction
obtain serum potassium levels.
The health care provider orders IV glucose and insulin to be given to a patient in ARF whose serum potassium level is 6.3 mEq/L. To best evaluate the effectiveness of the medications, the nurse will
oliguria
< 400 ml of urine in 24 hours
oliguria
< 400 ml of urine in 24 hours
oliguria
production of an abnormally small amount of urine
Oliguric Phase
Urine output 100400mL/24hr that does not respond to fluid challenges or diuretics, lasts 1 to 3 weeks, Lab data include: increasing serum creatinine and BUN levels, hyperkalemia, bicarb deficit (metabolic acidosis), hyperphosphatemia, hypocalcemia, and hypermagnesimeia, Sodium retention occurs, but is marked by the DILUTIONAL EFFECTS of water retention (it is possible to have a false negative)
Onset Phase
Begins with the precipitating event and continues until oliguria develops, lasts hours to days, gradual accumulation of nitrogenous wastes, such as serum creatinine and BUN may be noted
organ meats and fish with fine bones.
The composition of a patient's renal calculus is identified as uric acid. To prevent recurrence of stones, the nurse teaches the patient to avoid
osmolality
concetration of solute in a solution
osmotic pressure
(physical chemistry) pressure exerted by a solution necessary to prevent osmosis into that solution when separated from pure solvent by semipermeable membrane
osteitis fibrosa
complication of hyperparathyroidism, bone becomes softened and deformed, may develop cysts
osteomalacia
abnormal softening of bones caused by phosphorus, calcium or vitamin D deficiencies
osteoporosis
abnormal loss of bony tissue (fragile, porous bones) caused by calcium deficiency
osteosclerosis
abnormal hardening or eburnation of bone
nephrectomy
cancer, polycystic kidney disease, trauma, UOP to determine kidney function after removed to make sure other is compensating, large flank incision, patient may not want to move or breathe due to pain pre-medicate before walking/ moving
nephrolithiasis
Caucasian men between 20 and 55, more in summer, diets high in protein increases excretion of uric acid, drinking lots of tea or juices increases oxylate levels, low fluid intake concentrates the urine, genetic, sedentary lifestyle, urinary stasis, UTI can alter pH of urine which can develop stones, high urine pH makes less soluble to Ca and Ph which can cause Ca stones, cystine stones have lower pH
nephrolithiasis
presence of kidney stones (calculi) in kidney
nephrolithiasis calcium oxalate
calcium levels increased, genetic, greater than 1gm of vitamin C/day, small stones that get trapped in ureters
nephrolithiasis calcium phosphate
alkaline environment, excessive calcium excreted w/hyperparathyroidism, spinach, chocolate, nuts, berries, coffee, black pepper
nephrolithiasis cystine stones
genetic autosomal recessive defect, increased cystine level in urine, acidic environment
nephrolithiasis diagnosis
ultrasounds, IVP
nephrolithiasis management of symptoms
strain urine, fluids, send stones found for analysis for future prevention, diet modifications, abx if infection present, if stone is too large, may other procedure lithotripsy which crushes stone, if stone is in body of kidney may nd endoscope thru skin into renal pelvis, hematuria common after lithotripsy procedure, after stone is identified, teach preventative measures, fluid intake (3L/day so output is 2L/day), avoid urinary stasis, encourage empty w/first urge, avoid foods that cause, correct hyperparathyroidism if related, if stone is present, too much fluid can cause more pain
nephrolithiasis struvite
women, associated w/UTI
nephrolithiasis symptoms are site specific
higher=flank, renal colic, N/V. lower=colicy pain d/t peristalsis in ureters. renal pelvis=costovertebral pain. bladder=lower abd or pelvic pain
nephrolithiasis uric acid stones
gout, atkins diet, lower urine pH
nephron
functional unit of kidney, 1 million in each kidney, glomerulus, bowman's capsule, tubules are all part of nephron
nephrosclerosis
sclerosis of small arteries in kidney, blood flow of parenchyma is decreased, ischemia and necrosis, if have arthrosclerosis, good possibility to have nephrosclerosis, benign can have renal insufficiencies, HTN. malignant=malignant HTN diastolic is >130, more in young adults and more in men than women. malignant is more progressive and more damage to kidneys, control HTN
Nephrosclerosis
thickening in nephron blood vessels, resulting in narrowing of the vessel lumen, decreased kidney blood flow. Kidney tissue is Chronic Hypoxia. Occurs w/all types of HTN (rarely seen when BP is below 160/110mmHg; may be reversible if caused by HTN; may lead to ESKD w/in months or years)
nephrosclerosis
vascular disease of the kidney characterized by sclerosis of the small arteries and arterioles of the kidney resulting in renal tissue necrosis
nephrosclerosis
problem of thickening in the nephron blood vessels, resulting in narrowing of the vessel lumen. This change decreases renal blood flow, and kidney tissue is chronically hypoxic. Ischemia and fibrosis develop over time. May be reversible if caused by hypertension, may lead to end stage kidney disease, rarely seen when BP is below 160/110, occurs with all types of hypertension, atherosclerosis, and diabetes mellitus
nephrosclerosis treatment
aims to control high blood pressure and reduce albuminuria to preserve kidney function, ACE inhibitors, diuretics
Nephrosclerosis: if renal artery stenosis
associated w/arthrosclerosis: sudden onset of high BP (30 to 50 y/o), renal scan, can do a stint to correct
Nephrosclerosis: if renal vein thrombosis
trauma, surrounding organs may have tumors pressing, pregnancy, anticoagulants, thrombectomy, high risk for PE
nephrotic syndrome
can be caused by many different disease: lupus, hodgkins, AIDS, strep infection, presents w/peripheral edema, massive proteinuria, hyperlipidemia, and hypoalbumin, low serum protein levels, low Ca levels, most times r/t immune process may also have problems w/infections, when protein is lost in urine, clotting factors lost, so hypercoagulation, treatment based on symptoms: diuretics, antihypertensives, antiinflammatory drugs, corticosteroids, cholesterol lowering drugs, manage edema and HTN, watch for skin breakdown, may need to monitor protein intake, be careful w/ACE inhibitors to not lower BP too much, Cholestin and Nevicor, accurate I/O, measure area of edema daily, daily weight, six small meals throughout day b/c of problems w/anorexia
Nephrotic Syndrome
condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted, main feature is SEVERE PROTEINURIA (more than 3.5g of protein in 24 hours), most common cause is an immune or inflammatory process, can be result of genetic defect (Fabry Disease)
nephrotic syndrome
abnormal condition of kidney characterized by peripheral edema, massive proteinuria, hyperlipidemia, and hypoalbuminemia; may occur in a severe primary form or secondary to many systemic diseases
nephrotic syndrome signs and symptoms
massive proteinuria! peripheral & facial edema, hyperlipidemia, hypoalbuminemia, lipiduria, increased coagulation, reduced kidney function
Nephrotoxic Substances Aminoglycosides Antibiotics
Genatmicin, Kanamycin, Neomycin, Netilmicin Sulfate, Tobramycin
Nephrotoxic Substances Antibiotics/Anti-Infectives
Amphotericin B, Colistimethale, Methicillin, Polymyxin B, Rifampin, Sulfonamides, Tetracycline Hydrochloride, Vancomycin,
Nephrotoxic substances Chemotherapy Agents
Cisplatin, Cyclophosphamide, Methotrexate
Nephrotoxic Substances Heavy Metals and Ions
Arsenic, Bismuth, Cooper Sulfate, Lead, Mercuric Chloride
Nephrotoxic Substances Non-Drug Chemical Agents
Radiographic contrast dye, Pesticides, Fungicides, Myoglobin (from breakdown of skeletal muscle)
Nephrotoxic Substances
NSAIDS, Ibuprofen, Nabumetone, Naproxen
Nephrotoxic Substances Other Drugs
Acetaminophen, Captopril, Fluinate Anesthetics, Quinine
Neurologic Manifestations of CKD
Lethargy and daytime drowsiness, Inability to concentrate or decreased attentions span, seizures, coma, slurred speech, Asterixix (jerking movements), Tremors, twitching, or jerky movements, Ataxia (alteration in gait), Parathesias (sensation of feeling "pins and needles")
NHBDs
dead by cardiopulmonary criteria, kidneys harvested immediately, if immediate removal must be delayed, organ preserved by infusing cool preservation solution into abdominal aorta
Noninfectious Cystitis
Caused by irritation from chemicals or radiation
Nonsurgical Management for Pyelonephritis
Drug Therapy (antibiotics to treat infection). Nutrition Therapy (Adequate calories (this is necessary for patient to heal); fluid intake of 23L/daily unless contraindicated)
Nursing Diagnosis for Cystitis
acute Pain R/T Bladder Spasms. Deficient Knowledge R/T Information Misinterpretation or unfamiliarity w/information resources. Risk for Sepsis. Risk for Impaired Skin Integrity R/T moisture from incontinence
Nutrition Therapy for AKI
protein, sodium, fluids calculated on patient caloric needs, Hyperalimentation or TPN, assess food intake each shift
Labs for Cystitis
UA (clean catch, midstream, 10 mL needed from specimen collection) testing for leukocyte esterase and nitrate, WBCs, RBCs, Urine Culture: confirms infection type, # of colonies (takes 48 hours)
Labs for Hydronephrosis & Hydroureter
UA, BUN and Creatinine levels increase with a reduced GFR, Electrolytes (these may be altered w/ and elevation in potassium, phosphorus, and calcium)
Labs for Pyelonephritis
UA and Urine C&S
leave a light on in the bathroom at night.
When the nurse is planning care for an 82 year old man, an appropriate intervention based on an understanding of age related changes of the urinary system is for the nurse to
Leftsided flank pain
Which information noted by the nurse when caring for a patient with a bladder infection is most important to report to the health care provider?
lipiduria
presence of lipids in urine
lithotripsy
use of sound waves to break renal stones into small particles
Lower Urinary Tract
Urethritis (urethra), Cystitis (bladder), Prostatitis (Prostate Gland)
maintaining cardiac output.
A patient with severe heart failure develops elevated BUN and creatinine levels. The nurse plans care for the patient based on the knowledge that collaborative care of the patient will be directed toward the goal of
Manifestations in Older Adults for UTIs
AMS, Unexplained Falls. Sudden onset or worsening of incontinence. Fever, tachycardia, tachypnea, hypotension. May be signs of urosepsis. Loss of appetite, nocturia, dysuria
Manifestations of AKI in Intrarenal and Postrenal
Oliguria or anuria, Increased urine specific gravity, HTN, Tachycardia, Jugular Vein Distention, Increased Central Venous Pressure, EKG changes (tall T waves), SOB, Orthopnea, Rales and crackles, Pulmonary Edema, Friction Rub, Anorexia, N/V, Flank Pain, Lethargy, HA, Tremors, Confusion, Generlaized Edmea, Weight Gain, Micturation (Postrenal only), Hematuria (postrenal only and late sign)
Manifestations of AKI in Prerenal Azotemia
Hypotension, Tachycardia, Decreased cardiac output, Decreased central venous pressure, Decreased Urine output, Lethargy
blood-tinged urine and urinary frequency.
The nurse informs the patient undergoing cystoscopy that following the procedure, the patient may experience
Medications/Treatments used for Nephrosclerosis
ACE Inhibitors (management of HTN reduces albumin), Diurectics (if potassium sparing diuretics are used, want to prevent hyperkalemia), Dialysis and renal transplant
megace
megestrol acetate derived from progesterone. helps glucocorticoid cortisol which increases appetite, enhances fat synthesis
metabolic acidosis
acidosis and bicarbonate concentration in body fluids resulting from accumulation of acids or abnormal loss of bases from body (as in diarrhea or renal disease)
Metabolic Changes during Chronic Renal Failure
Urea and Creatinine Excretion are disrupted by kidney failure
Milk of magnesia 30 ml administered orally
A patient with CKD brings all home medications to the clinic to be reviewed by the nurse. Which medication being used by the patient indicates that patient teaching is required?
Monitor the urine output after the procedure.
A hospitalized patient with renal insufficiency is scheduled to have an IVP. Which nursing action will be needed during this procedure?
monitoring and recording blood pressure.
In planning teaching for a patient with benign nephrosclerosis, the nurse should include instructions regarding
more protein will be allowed because of the removal of urea and creatinine by dialysis.
A patient begins hemodialysis after having had conservative management of chronic kidney disease. The nurse explains that one dietary regulation that will be changed when hemodialysis is started is that
Musculoskeletal Manifestations of CKD
Muscle Weakness, Cramping, Bone Pain, Pathologic Fractures, Renal Osteodystrophy
keep the patient on bed rest until the ureteral catheter is discontinued.
A patient undergoing a left ureterolithotomy returns to the surgical unit with a left ureteral catheter and a urethral catheter in place. When caring for the patient, the nurse will plan to
Key Features of Uremia
Metallic Taste in Mouth, Anorexia, Vomiting, Muscle Cramps, Itching, Fatigue, Hiccups, Edema, Dyspnea, Muscle Cramps, Paraesthesias
kidney aging
decrease in size and weight of kidney, loss of nephrons in cortex, by age 70, loss of 30 to 50% of glomerular function, monitor Cr and BUN for kidney function because of kidney changes, tubules and loop of henle can cause changes in excretion of drugs and ability to concentrate urine—dehydrate quicker, more problems with nephrotoxic drugs, Cr is direct correlation with kidney function, loss of estrogen can cause less vascularity and muscle relaxation of bladder, enlarged prostate can cause pressure or obstruction of urethra
kidney bladder scan
determines residual in bladder
kidney cortex
outer layer of kidney, primary function is internal homeostasis and acid-base balance, filtration, reabsorption, secretion, excretion, urine formation
medulla
middle part of kidney (renal pyramids)
kidney creatinine clearance
good indication of GFR (85 to 135 ml/min), waste product produced by muscles, muscle activity in body, must be kept on ice, throw first specimen away and then start (empty foley)
kidney cystometrogram
measures bladder tone and function of musculature
kidney cystoscopy
visualize urethra in bladder
kidney diagnostic studies
kidney function; first study routine UA composition, specific gravity (1.001 to 1.035 is normal), first morning specimen
kidney radiologic studies
procedures may require prep (laxatives, enemas, etc), if allergic to dye, patient may not be able to have or need different contrast
kidney urine cultures
used to determine organisms causing infection; clean catch (wipe, catch midstream), in and out catheter
Kidney Biopsy or Punch Biopsy
Provides a precise diagnosis of condition. Assists in determining the prognosis. Helps outline treatment.
kidney cancer
most tumors are malignant, most common type is renal cell carcinoma, usually occurs age 50 to 70, cigarette smoking most important risk factor, twice as common in men, obesity can cause it, chronic use of phenacetin, exposure to asbestos, does not have early symptoms
kidney cancer signs and symptoms
gross hematuria, flank pain, palpable mass, easily metastasize to liver and lung, if diagnosed early usually accidental, CT guided needle biopsy, if in early stages it is highly curable, treatment is radical nephrectomy (kidney, adrenal gland and part of ureter, lymph nodes)
Kidney Function with Chronic GN
Abnormal Electrolyte levels. Sodium Retention. Hyperkalemia occurs because potassium not excreted (when levels exceed 5.4 mEq/L), Hyperphosphatemia develops; calcium levels are usually at a LOWER end of normal range, Acidosis develops from hydrogen ion retention and loss of bicarb, Breaths are more rapid, RR increased. They are not compensating.
kidney transplant
do not removed damaged kidney; add new one, HLA typing, postop F&E balance is first priority, 1:1 fluid replacement, want to avoid 'cold' time immunosuppressant drugs to reduce rejection
kidney transplant complications
rejection is leading cause of graft loss, acute tubular necrosis, thrombosis (possible continuous bladder irrigation), renal artery stenosis, wound problems, infection (low grade fevers, mental status changes, vague reports of discomfort may be only manifestations before sepsis)
kidney transplant operative procedures
~ donor nephrectomy procedure, varies depending on donor, living donor procedure lasts 34 hours ~ transplant surgery takes 45 hours, patient's own kidneys not usually removed unless chronic infection present
kidney transplant postoperative care
ongoing physical assessment, evaluation of renal function, urine output assessment hourly for 48 hours, kidney graft function: oliguria or diuresis, mannitol
kidney transplant preoperative care
immunologic studies, blood typing, human leukocyte antigen, teach about procedure and care after surgery, in depth patient assessment, coordination of diagnostic tests, development of treatment plans
kidneys other functions
erythropoietin produced in response to hypoxia and decreased blood flow, renin released in response to decrease of BP or ischemia to kidneys or increase in urinary sodium concentration (low circulation), produce prostaglandins, act as vasodilators (missing in kidney failure), activation of vitamin D (kidney disease cannot do this so they have Ca and Ph problems)
intravenous pyelogram
(IVP) diagnostic study using IV contrast medium excreted through urinary system to examine structure and function
is much less likely to clot.
A patient needing vascular access for hemodialysis asks the nurse what the differences are between an arteriovenous (AV) fistula and a graft. The nurse explains that one advantage of the fistula is that it
ischemia
local anemia in a given body part sometimes resulting from vasoconstriction or thrombosis or embolism
kidneys A&P
between T12 and L3, 5 oz, 5 inches long, ureters 10 to 12 inches, 200 to 250 ml of urine causes urge to urinate, voiding controlled by stretch of bladder between T11 and L2, sphincter controls in S2 to S4, spinal cord damage can cause dysfunction depending on where injury is
acute pain related to irritation by the stone.
A patient with a history of renal calculi is hospitalized with gross hematuria and severe colicky left flank pain that radiates to his left testicle. In planning care for the patient, the nurse gives the highest priority to the nursing diagnosis of
Ibuprofen (Advil) 400 mg PO PRN for pain
A patient with renal insufficiency is scheduled for an intravenous pyelogram (IVP). Which of the following orders for the patient will the nurse question?
Insert 16 French retention catheter.
A 98 year old patient with benign prostatic hyperplasia has a markedly distended bladder and is agitated and confused. All the following orders are received from the emergency department health care provider. Which order should the nurse act on first?
grieving related to actual and perceived losses.
As the nurse reviews a diet plan with a patient with diabetes and renal insufficiency, the patient states that with diabetes and kidney failure there is nothing that is good to eat. The patient says, "I am going to eat what I want; I'm going to die anyway!" The best nursing diagnosis for this patient is
infuse a bolus of normal saline.
A patient complains of leg cramps during hemodialysis. The nurse should
initiate a 24hour collection of the patient's urine.
To determine glomerular filtration rate (GFR) for a patient with chronic kidney disease, the nurse will plan to
Ibuprofen (Motrin)
During assessment of a patient with a possible renal insufficiency, which of these medications taken by the patient at home will be of most concern to the nurse?
identify renal artery or aortic bruits.
The nurse uses auscultation during assessment of the urinary system to
high specific gravity.
A patient admitted with severe dehydration has a urine output of 380 ml over the next 24 hours and elevated blood urea nitrogen (BUN) and creatinine levels. A finding that the nurse would expect when reviewing the patient's urinalysis is
gonococcal urethritis.
When assessing a patient who complains of a feeling of incomplete bladder emptying and a split, spraying urine stream, the nurse asks about a history of
bladder cancer.
A 20 year old patient who is employed as a hairdresser and has a 10 pack per year history of cigarette smoking is scheduled for an annual physical examination. The nurse will plan to teach the patient about the increased risk for
bladder cancer.
When obtaining the health history for a 30 year old patient who smokes two packs of cigarettes daily, the nurse will plan to do teaching about the increased risk for
Fleet enema.
A patient with an elevated blood urea nitrogen (BUN) and serum creatinine is scheduled for a renal arteriogram. The nurse should question an order from radiology for bowel preparation with the use of
Fluid volume excess related to low serum protein levels.
A patient who is diagnosed with nephrotic syndrome has 3+ ankle and leg edema and ascites. Which nursing diagnosis is a priority for the patient?
empty the drainage appliance every 2 to 3 hours or when it is one-third full.
Following a cystectomy, a patient has an ileal conduit created. The nurse identifies the nursing diagnosis of risk for infection related to altered urinary structures. An appropriate nursing intervention for this problem is to
ensure restricted protein intake to prevent nitrogenous product accumulation.
A patient with CKD has a nursing diagnosis of disturbed sensory perception related to central nervous system changes induced by uremic toxins. An appropriate nursing intervention for this problem is to
collect the stone and bring it to the clinic.
The nurse instructs a patient seen in the outpatient clinic with symptoms of renal calculi to strain all urine and to
decrease the rate of dialysate infusion.
A patient who has been on continuous ambulatory peritoneal dialysis (CAPD) is hospitalized and is receiving CAPD with four exchanges a day. During the dialysate inflow, the patient complains of having abdominal pain and pain in the right shoulder. The nurse should
Check the chart for the most recent blood potassium level.
After noting increasing QRS intervals in a patient with ARF, which action should the nurse take first?
check the fistula site for a bruit and thrill.
In preparation for hemodialysis, a patient has an AV native fistula created in the left forearm. When caring for the fistula postoperatively, the nurse should
check which medications the patient is currently taking.
A patient's urine dipstick indicates a large amount of protein in the urine. The next action by the nurse should be to
catheterization technique and schedule.
A patient has a cystectomy and a Kock continent diversion created for treatment of bladder cancer. During postoperative teaching of the patient, it is important that the nurse include instructions regarding
A 26 year old patient with a history of polycystic kidney disease is admitted to the surgical unit after having knee surgery. Which of the routine postoperative orders is most important for the nurse discuss with the health care provider?
Give ketorolac (Toradol) 10 mg PO PRN for pain.
usual fluid allowance is _____ to the 24 hour urine output plus ______ mL.
equal, 500 to 600mL
drink 2000 to 3000 ml of fluid a day.
To prevent the recurrence of renal calculi, the nurse teaches the patient to
disturbed body image related to change in body function.
Two days after surgery for an ileal conduit, the patient will not look at the stoma or participate in care. The patient insists that no one but the ostomy nurse specialist care for the stoma. The nurse identifies a nursing diagnosis of
costovertebral angle (CVA) tenderness.
A 72yearold patient with benign prostatic hyperplasia and a history of frequent UTIs is admitted to the hospital with chills, fever, and nausea and vomiting. To determine whether the patient has an upper UTI, the nurse will assess for
causes the urine to turn reddish orange and can stain underclothing.
To relieve the symptoms of a lower UTI for which the patient is taking prescribed antibiotics, the nurse suggests that the patient use the OTC urinary analgesic phenazopyridine (Pyridium) but cautions the patient that this preparation
BUN and creatinine.
A new order for IV gentamicin (Garamycin) 60 mg BID is received for a patient with diabetes who has pneumonia. When evaluating for adverse effects of the medication, the nurse will plan to monitor the patient's
Assist the patient to take a 15minute sitz bath.
Following an open loop resection and fulguration of the bladder, a patient is unable to void. Which nursing action should be implemented?
assist the patient to the bathroom q2hr.
A 78 year old patient is admitted to the hospital with dehydration and electrolyte imbalance. The patient is confused and incontinent of urine on admission. In developing a plan of care for the patient, an appropriate nursing intervention for the patient's incontinence is to
azotemia
accumulation of nitrogenous waste products, such as blood urea nitrogen (BUN) and creatinine
allopurinol
Zyloprim, used to treat gout and other conditions in which there is an excessive buildup of uric acid
anticoagulants.
A patient with nephrotic syndrome develops flank pain. The nurse will anticipate treatment with
ask the patient about the usual urinary pattern and measures used for bladder control.
When admitting a patient who has a history of paraplegia as a result of a spinal cord injury, the nurse will plan to
Basin of ice
A creatinine clearance test is ordered for a hospitalized patient with possible renal insufficiency. Which equipment will the nurse need to obtain?