Upgrade to remove ads
Exam 3- Chapter 67: Care of patients with kidney disorders
Terms in this set (40)
Polycystic Kidney Disease
- disorder; fluid-filled cysts develop in nephrons
-Common; more common in Caucasians
Polycystic Kidney Disease symptoms
-Abdominal or flank pain
-Increased abdominal girth
-Bloody or cloudy urine
Physical assessment/clinical manifestations
-pain often first s/s
-kidney easily palpated due to increased size
What is the impact of this disease, as an inherited disorder?
-UA shows proteinuria, hematuria, creatinine/BUN increase
-may also have renal ultrasound, CT, MRI
-Acute and chronic pain: NSAIDS used cautiously because they decrease kidney blood flow; no ASA due to bleeding
-Constipation: maintain fluid intake, increase fiber and exercise; stool softeners often used
-Hypertension and renal failure: increase fluids to 2L/day
-ACE, CA channel blockers, beta blockers
-patient teaching: hypertension management, diet, protein restriction
Problems of urine outflow obstruction
Hydronephrosis, Hydroureter, and Urethral Stricture
What is caused by obstruction in the upper part of the ureter?
What is caused by obstruction in the lower part of the ureter?
-Problem of urine outflow
-Caused by an increase in kidney size; causes obstruction in the renal pelvis
-Obstruction causes renal damage
-Can occur in hours
-Enlargement of the ureter
-Obstruction is in the ureter itself
-Causes ureter dilatation above the obstruction
causes of hydronephrosis and hydroureter
-ALL NEED EARLY TREATMENT!!
1.remove stone if that is what is causing the obstruction
2. place a stent to keep tubules/ureter open (later removed)
nephrostomy: performed when a urologic procedure is not possible or is unsuccessful
-provides an external drain to an external bag or internally to the bladder
-remains until obstruction is resolved
-Bacterial infection in kidney and renal pelvis (upper urinary tract)
-Involves acute tissue inflammation, tubular cell necrosis and pssible abscess formation
-May be either acute or chronic
-Acute occurs with or without obstruction/reflux
-Chronic occurs with structural deformities, urinary stasis, obstruction or reflux
-Conditions that cause urinary stasis include bedrest or paralysis
-Most common bacteria: E. coli
pyelonephritis acute symptoms:
-Fever, chills, tachycardia, tachypnea
-Flank, back, or loin pain
-Turning, nausea and vomiting, urgency, frequency, nocturia
-General malaise or fatigue
Key Features of Chronic Pyelonephritis
-Inability to conserve sodium
-Decreased ability to concentrate urine
-Development of hyperkalemia and acidosis
-Physical assessment: inspect flanks
-palpate the kidneys
-if not tenderness, percuss; tenderness indicates infection
Pyelonephritis clinical manifestations:
fever, chills, tachycardia, flank pain, N/V, fatigue, burning, frequency, urgency
-WBCs and hematuria
-If stones are present, lithotripsy
-GOAL: prevent ESRD
-Assessment of treatment efficacy
-Connection with sore throat?
-Clinical manifestations: edema, fluid overload, hypertension, fatigue, anorexia, N/V
-Laboratory assessment: urine may be reddish brown/cola colored (microscopic blood), decreased GFR, 24 hour urine
Infectious causes: pg 1402**
-Group A beta-hemolytic Steptococcus
-Staphlococcal or gram-negative bactermia or sepsis.
-Pneumococcal, Mycoplasma, or Kelbsiella pneumonia
-Rocky mountain spotted fever
-Chalmydia psittaci infection
-Any bacterial, parasitic, fungal, ot viral infection
-manage fluid overload: fluid restrictions
-watch for hyperkalemia/uremia
-N/V or anorexia=uremia; may need dialysis
-use relaxation techniques
-Develops over period of 20 to 30 years or longer
-Slowing progression, preventing complications
Nephrotic Syndrome; chart pg1404**
-Condition of increased glomerular permeability
-Allows larger molecules to pass through the membrane into urine and be excreted
-Severe loss of protein into urine, edema formation, and decreased plasma albumin levels
-s/s: massive proteinuria, facial/periorbital edema, increased coagulation times, reduced kidney function
-Cause identified through kidney biopsy
-Treatment will depend on biopsy results
Nephrotic syndrome treatment:
-Thickening in nephron blood vessels
-Results in narrowing of vessel lumen
-Occurs with all types of hypertension, atherosclerosis, diabetes mellitus
-Control high blood pressure
-Preserve kidney function
Processes affecting renal arteries; may severely narrow lumen, greatly reduce blood flow to kidneys
Renovascular Disease assessment
-significant, hard to control hypertension
-poorly controlled DM or sustained hyperglycemia
-elevated serum creatinine/decreased creatinine clearance
Renovascular Disease interventions
-identify the type of defect and condition of surrounding vessels
-may be managed with meds to control hypertension/hyperglycemia and preserve renal function
-may have renal artery bypass surgery: major surgery/long recovery time
-Microvascular complication of type 1 or type 2 diabetes
-First manifestation: Persistent albuminuria
-Pts w/either type of DM ALWAYS considered at risk of developing nephropathy
-Avoid nephrotoxic drugs and dehydration
Priority goals in prevention of ESKD
1) Normalize glucose (A1C <6.5%)
2) Normalize BP
3) Treat dyslipidemia
4) Use meds that block the renin-angiotensin-aldosterone system (aldosterone)
Renal Cell Carcinoma
-Adenocarcinoma of kidney
-Increased sedimentation rate
Renal cell carcinoma assessment
-Physical assessment/clinical manifestations: dull/achy pain, palpable mass, bloody urine (late sign)
-Nonsurgical management-chemo not effective
-Surgical management-usual treatment; blood loss major concern/very painful
-Minor injuries - Contusions, small lacerations
-Major injuries - Lacerations to cortex, medulla, or branches of renal artery
-Nonsurgical management - Drug therapy, fluid therapy
-Surgical management - Nephrectomy or partial nephrectomy
Preventing kidney trauma
1. wear a seat belt
2. practice safe walking habits
3. use caution when riding bicycles/motorcycles
4. wear appropriate protective clothing when playing contact sports
5. avoid contact sports and high risk activities if you only have 1 kidney
The patient is diagnosed with possible acute pyelonephritis and is admitted to the acute medical unit.
What is the nurse's priority concern on admission?
A) Acute pain
B) Potential for infection
C) Activity intolerance
D) Insufficient knowledge
The primary problem for this patient is acute pain.
Which are the priority interventions to be implemented on admission to the unit? (Select all that apply.)
A) Administer analgesics as ordered.
B) Assess patient pain level often.
C) Send a daily urinalysis to the laboratory.
D) Encourage 2 to 3 L of fluid intake per day.
E) Administer nitrofurantoin (Macrodantin) 50 mg with meals and at bedtime.
-Daily urinalysis is not necessary.
-The major patient concern with acute pyelonephritis is acute pain.
-Pain should be assessed regularly and analgesics administered.
-Nitrofurantoin is a urinary antiseptic drug that can also help with comfort.
-Adequate fluid intake of 2 to 3 L per day is essential.
Two days later during morning assessment, the patient expresses embarrassment about his illness. He says that he did not take all of the antibiotics prescribed to treat his UTI 2 weeks ago.
What is the nurse's best response?
A) "You should always take antibiotics as prescribed."
B) "Why did you choose not to take all of your medication?"
C) "Do you realize that when you don't take your antibiotics, superbugs can develop?"
D) "Can you tell me more about why you didn't take all of your antibiotics?"
-Response D is nonjudgmental and encourages the patient to open up and share more.
-This response may also offer an opportunity for patient teaching.
-Responses A and C are true, but will not help relieve the patient's embarrassment.
-Response B is somewhat judgmental.
Which condition is often misdiagnosed in the older adult patient with acute glomerulonephritis?
A) Aortic aneurysm
B) Congestive heart failure
C) Cerebrovascular accident
D) Transient ischemic attack
-Rationale: The less common manifestation of acute glomerulonephritis is more likely to occur in older adults.
-Circulatory congestion often dominates the patient's clinical picture.
-Acute glomerulonephritis is easily confused with congestive heart failure.
Which assessment parameter requires immediate attention in a patient with polycystic kidney disease?
D) Urine output less than 30 cc/hour
-Rationale: Patients with polycystic kidney disease often have high blood pressure.
-The cause of hypertension is related to kidney ischemia from the enlarging cysts.
-As the vessels are compressed and blood flow to the kidneys decreases, the renin-angiotensin system is activated, raising blood pressure.
-Control of hypertension is a top priority because proper treatment can disrupt the process that leads to further kidney damage.
THIS SET IS OFTEN IN FOLDERS WITH...
Chapter 67 - Care of Patients with Kidney Disorders
Renal Part I - IGGY Ch. 67: Care of Patients with…
Chapter 66, 67, 68 (In-Class Questions)
Chapter 63: Thyroid and Parathyroid Glands
YOU MIGHT ALSO LIKE...
Renal- NCLEX Qs and Lecture Notes
Renal- NCLEX Qs and Lecture Notes
Chapter 25: Disorders of Renal Function- Prep-U
Ch. 45-47: Renal & urologic problems
OTHER SETS BY THIS CREATOR
Care of the child with Special Needs
OTHER QUIZLET SETS
How far did relations between the GDR and the FRG…
Exam 4: Glaucoma
SOC 003 Midterm 1
Fit & Well: Chapter 4, 6-10