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Terms in this set (77)
What labs are done for renal function? (4)
Which are very indicative of failure? (2)
GFR & Creatinine = indicative of failure
What diagnostic tests are done for renal function? (5)
1. Intravenous Pyelography (IVP)
2. Voiding Cystourethrography (VCUG)
4. KUB (abd/pelvis x-ray)
What occurs with Intravenous Pyelography (IVP)?
What needs to be done before?
What needs to be monitored?
1. Contrast dye injected into vein & excreted by kidneys
2. X-rays or CT taken at 5, 10, & 15 min as dye excreted
3. Outlines urinary tract from kidneys through bladder/urethra
NPO 4-6 hrs prior with IV started
Watch rxn to contrast medium (iodine/shellfish allergy)
N-acetylcysteine to protect kidneys
Increase fluids to clear dye after
What renal function diagnostic test injects contrast dye into vein to watch kidney excretion & outline urinary tract; takes X-rays or CT at 5, 10, & 15 min
Intravenous Pyelography (IVP)
What needs to be done prior to IV start when doing Intravenous Pyelography? (IVP)
NPO 4-6 hrs. prior
What is done with Intravenous Pyelography (IVP) d/t dye? (3)
1. Check for allergies to iodine/shellfish
2. Use N-acetylcysteine to protect kidneys
3. Increase fluids to clear dye after
What occurs with Voiding Cystourethrography (VCUG) (3)
1. Cath inserted into bladder with dye
2. Visualizes bladder emptying problems & reflux into ureters (VUR)
3. X-rays taken before, during, & after voiding to look for reflux
What renal function diagnostic test inserts cath into bladder with dye & visualizes bladder emptying while taking X-rays and checks for reflux?
Voiding Cystography (VCUG)
With what d/o does urine go back up to ureters towards kidneys?
Vesicoureteral Reflux (VUR)
Common sign = freq. UTI's
What renal function diagnostic test directly visualizes bladder with scope?
What renal function diagnostic test is an X-ray of the abdomen & pelvis?
What may be given before to clear bowel so there is no visual obstruction?
Predisposing factors to UTI's (9)
1. Short urethra (girls)
2. Indwelling urinary cath
3. Poor hygiene (wiping; wet clothes)
4. Tight fitting clothes
5. Baths/hot tubs
7. Sexual intercourse & diaphragm contraceptives
8. DM & immunosuppression
9. Urinary stasis
What things can cause urinary stasis? (5)
What does this predispose pt to?
Predisposes to UTI
1. Neurogenic bladder
3. Urinary tract obstruction
4. Chronic constipation
5. Vesicoureteral Reflux (VUR)
Loss of bladder innervation; doesn't contract properly to push out urine
What d/o is this seen in? (2)
What med can be used to tx?
Seen in: 1. spina bifida 2. Lower body paralysis
Drug: Bethanechol (urecholine)
What drug is used to help with neurogenic bladder?
What occurs with this d/o?
loss of bladder innervation - can't contract
How does pregnancy cause urinary stasis? (2)
1. Pressure from baby
2. dilation of ureters from progesterone
What with pregnancy often causes preterm labor?
What can commonly cause urinary tract obstructions? (2)
1. Kidney stones
2. Congenital valves
Abnl insertion of ureters on bladder, allowing urine to reflux backwards toward kidney
Vesicoureteral Reflux (VUR)
What occurs with Vesicoureteral Reflux (VUR)
What d/o is this common with?
1. Abnl insertion of ureters on bladder; allows urine to reflux backwards
2. Ureter valves fail to close during voiding
3. Urine refluxes backwards
Common with neurogenic bladder
What is urine refluxing back up into kidneys with VUR called?
What could this potentially lead to?
Could potentially cause kidney failure
What dx tests are done for VUR?
VCUG (voiding cystourethrography)
How is VUR severity rated?
Grade I - V
I-II = prophylactic ATB
III+ = may req surery (ureteral reimplantation)
bacteria in urine
Bladder infection (lower UTI)
(only bladder + urethra)
S&S of cystitis (8)
2. Suprapubic pain
5. Urine odor
6. Daytime incontinence
7. Cloudy urine
8. Fever (rare)
What is seen in u/a with cystitis? (3)
1. High WBC
2. RBC (hematuria)
3. Organisms over 10^5 or 100,000/mL
(dipstick for nitrites)
What may be looked for with 2 UTI's in 1 year?
VCUG (vesicoureteral reflux)
Kidney infection (upper UTI)
S&S of pyelonephritis (6)
1. CVA (costovertebral angle tenderness* = main)
5. abd pain
6. back/flank pain
Treatment for UTI's (6)
1. ATB (IV if kidneys involved)
2. Follow up specimen after ATB finished
3. Urinary antiseptics (Mandelamine or Furadantin)
4. Increase fluids (100 mL/kg/day)
5. Warm vinegar sitz bath
6. Treatment of bladder spasms
What ATB's are often given for UTI's (3 - general)
Teach: finish ALL
1. Sulfonamides = Bactrim/Septra
What urinary antiseptics are often given for chronic UTI's (2)
What can be given to treat bladder spasms with UTI's? (3)
1. Pyridium (red urine)
2. B&O suppositories
3. Oxybutynin (Ditropan)
What should fluids be increased to with UTI?
(freq voiding; keep urine acidic - vit C, cranberry, apple...)
What can help with dysuria/pain associated with UTI
Warm vinegary sitz bath
What occurs with Nephrotic Syndrome?
Alteration of basement membrane of glomeruli -->
1. Plasma proteins leak into urine
2. Decreased protein in blood
What ages is nephrotic syndrome usually seen in?
What is often associated with nephrotic syndrome development
What is main sign of protein in urine?
What glomerular prob is this common in?
What is high risk with Nephrotic syndrome?
(& thromboembolism d/t hypovolemia)
BP with Nephrotic syndrome?
Nl to low
S&S of Nephrotic syndrome (6)
1. Massive proteinuria (+ 3,4)
2. Hypoalbuminemia (frothy urine)
3. Massive edema (3rd spacing) - anasarca; abd pain/diarrhea
4. Oliguria (decreased blood vol)
5. Hyperlipidemia with high cholest
6. Lethargy, anorexia, pallor
Main drug treatment of nephrotic syndrome
Need to get body to stop letting protein out of blood
Corticosteroids*** (PO or IV)
(anti-inflammatory & immunosuppressant)
SE of corticosteroids (12)
What glomerular prob are these tx for?
1. Immunosuppression (no live vax)
2. GI irritation (Ulcer risk)
3. Growth retardation (LT)
4. Decreased adrenal cortex fx (Addison's)
6. Increased Na, decreased K
8. Wound healing interference
9. Weight gain (esp. in trunk)
10. Thin, fragile skin
11. Depressed mood
12. Cushingoid symptoms
What type of symptoms are common with Corticosteroids?
What are these?
Moon face, acne, buffalo hump, increased hair/hirsutism, HTN...
Other non-steroidal tx for Nephrotic syndrome (7)
1. Increased immunosuppressant therapy (cell cept; cytoxan)
2. Decreased fluid & Na intake
3. IV albumin prior to Lasix
4. Prophylactic ATB (Bactrim/Septra)
6. Lipid-lowering agents (-statins)
What additional immunosuppressants can be given if steroids fail for Nephrotic Syndrome? (2)
1. Cell Cept
What tx is often done to prevent circulatory collapse with Nephrotic syndrome?
IV albumin prior to Lasix
(esp. with pleural effusion/pulmonary edema)
What prophylactic ATB are commonly given to treat/prevent infections with Nephrotic Syndrome?
Pulling fluid from abdomen
Pulling fluid from chest
S&S that steroids are working for Nephrotic Syndrome (4)
1. Increased u/o** (earliest)
2. Weight loss
3. Decreased urine protein
4. Decreased edema
(Can take several days to 2 weeks for steroids to work)
Basic nursing care for Nephrotic syndrome (10)
1. Fowler's/Semi-Fowler's (watch resp; & bedrest while edematous)
2. Good skin care**
3. Scrotal support
4. Measure abd girth
5. Strict I&O's
6. Monitor BP
7. Daily weights
8. Prevent infection
9. Increase cals
10. Body image effect
What occurs with Acute Glomerulonephriits?
(Acute Post-Streptococcal Glomerular Nephritis)
Immune rxn after Group A beta hemolytic strep infection
1. Result of antigen-antibody immune complexes formed after infection
2. Complexes go to glomerular capillaries & get stuck instead of broken down --> glomerular obstruction
Kidneys can't properly filter
What is commonly seen with Acute Glomerulonephritis? (7)
1. Increased ASO antibody titers
2. Decreased GFR
6. High specific gravity
7. Hematuria (tea/cola color)
Could progress to renal failure (rare)
What is peak age for Acute glomerulonephritis?
6 yrs (up to 12)
Is Nephrotic syndrome or Acute Glomerulonephritis relapsing/remitting?
S&S of Acute glomerulonephritis (7)
2. Severe hematuria (tea colored)
3. Mild edema
4. mild-mod proteinuria
5. Oliguria (decreased GFR)
6. Circulatory congestion (hypervolemia)
7. Fatigue, NV, mild anemia
What will urine look like in Nephrotic Syndrome vs. Acute Glomerulonnephritis?
NS: frothy (protein)
AGN: tea-colored (hematuria)
Labs with AGN (5)
1. NO bacteria**
2. Increased ASO titer
3. Decreased C3 complement
4. Increased BUN & uric acid wastes
5. If renal insufficiency --> creatinine with decreased GFR (renal failure)
Treatment for AGN (9)
How long to recover?
3-4 wks to recover
Supportive (no specific tx)
1. Anti-HTN (monitor BP)
2. Neuro checks
3. Daily weights
4. Strict I&O
5. NOT infection (NO ATB)
6. Protect from infection
7. Increase cals
8. Rest when fatigued
9. Na & K restriction with possible fluid restriction if renal insufficiency
Does AGN or NS have increased blood vol?
Increased = AGN
Decreased = Nephrotic
Does AGN or NS have massive proteinuria?
Massive = NS
Slight = AGN (hematuria instead)
Does NS or AGN have massive edema?
Massive = NS
Mild-mod = AGN
Does AGN or NS have HTN?
HTN = AGN
Nl or hypo = NS
Major complications with AGN?
CVA & seizure (d/t HTN)
What do AGN & NS both have symptom of?
Why for each?
NS = d/t decreased perfusion
AGN = d/t obstructed glomerulus
Most common age range for HUS (Hemolytic-Uremic Syndrome)
6 mo - 3 years
What are most common causes of HUS? (3)
1. Contaminated meat - e. coli**
3. Petting zoos
Patho of HUS (what occurs)
Glomerular capillaries become occluded with platelets & fibrin clots --> kidney failure
RBC's try to move through occluded capillaries --> damage/hemolysis
S&S Of RBC hemolysis (3)
(removed by spleen)
2. Increased retic count (immature RBC's)
3 Major probs that occur with HUS
1. Acute hemolytic anemia
2. Thrombocytopenia (bleeding; petechia)
3. Renal failure (oliguria & uremia)
How is HUS treated?
(Hemolytic Uremic Syndrome)
Tx: Dialysis & blood transfusions
Risk: mult organ dysfx --> death
What 3 things are congenital renal abnls associated with?
1. Low set ears
2. 2 Vessel cord (1 artery missing)
3. Palpable abd mass (Wilm's tumor - nephroblastoma; renal CA)
S&S of renal trauma (4)
1. Flank pain (CVA tenderness)
2. Contusions or abrasions on skin
3. Hematuria (esp. if renal rupture; "blush" on CT)
4. Watch for profuse bleeding (shock risk)
What is often seen on CT with renal trauma/bleed?
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