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NCLEX RN Chapter 58 Renal System
Terms in this set (134)
The ______ are the functional unit of the kidney/
The kidneys secrete _____ to regulate the blood pressure and ______ to stimulate the bone marrow to produce RBCs.
When doing a urine culture and sensitivity testing, collect a _____ sample in a sterile container.
The ______ clearance test provides the best estimate of the glomerular filtration rate (GFR); the normal GFR is _____mL/min
What is this: an x-ray procedure in which an intravenous injection of radiopaque dye is used to visualize and identify abnormalities in the renal system.
While preparing a patient for intravenous urography, it is important to check the client for allergies to ____, ____ food, and radiopaque dyes.
After IV urography, it is important to reinforce instructions to the client to drink at least ____L of fluid unless contraindicated.
Contrast dye is potentially ____ to kidneys; the risk is greater in ____ clients and those experiencing dehydration.
The dye used in a renal angiography may be nephrotoxic; therefore, encourage increased _____ unless contraindicated, and monitor _______ _____.
What is this: the bladder mucosa is examined for inflammation, calculi, or tumors by means of a cystoscope; a sample for biopsy may be obtained.
cystoscopy and biopsy of the bladder
For a patient who has just had a cystoscopy of the bladder, monitor ____ and ____ and encourage _____-_____ exercises to relieve bladder spasms.
intake and output
A client has just had a cystoscopy of the bladder, their legs begin to cramp. What should you do?
Tell them that this is normal because of the lithotomy position maintained during the procedure.
After a client just had a cystoscopy of the bladder, how serious is burning on urination, pink-tinged or tea-colored urine, and urinary frequency?
not serious, these are normal and will resolve in a few days.
After a client just had a cystoscopy of the bladder, how serious is bright red urine and clots?
serious, notify the RN or HCP and check WBC count which will help diagnose an infection
What is this: insertion of a needle into the kidney to obtain a sample of tissue for examination; usually done percutaneously.
Before a patient undergoes renal biopsy, check baseline ______ studies. The HCP is notified if abnormal results are noted. Ensure an _____ ____ has been signed and obtained.
After a renal biopsy, apply _____ to the biopsy site for 30 minutes.
After a renal biopsy, place the client on strict ____ ____ in the ____ position, as prescribed, with a back roll for additional support for __-__ hours after the biopsy.
____ _____ ____ is the rapid loss of kidney function from renal cell damage. This occurs abruptly and can be reversible. It can lead to hypoperfusion, cell death, and decompensation of renal function.
Acute kidney injury
Phases of AKI (acute kidney injury) and interventions: Oliguric phase: Sudden decrease in urine output. Urine output is less than _____ mL/day. The patient will have signs of excess or deficit fluid volume?
excess: hypertension, edema, pleural and pericardial effusions.
Phases of AKI (acute kidney injury) and interventions: Oliguric phase: patient will have signs of _____: friction rub, chest pain with inspiration, and low-grade fever.
Phases of AKI (acute kidney injury) and interventions: Oliguric phase: fluid intake may be _____. If hypertension is present, daily fluid allowances may be ____mL to _____mL plus the measured urinary output.
Phases of AKI (acute kidney injury) and interventions: Diuretic phase: Urine output increases or decreases slowly? followed by diuresis (4-5 L/day)
The signs and symptoms of acute kidney injury are primarily caused by the retention of _______ wastes, the retention of fluids, and the inability of the kidneys to regulate ______.
Patients with AKI: how often should you monitor intake and ouput and urine color and characteristics?
Patients with AKI: how often should you take their weight? Note that an increase of ___ lbs indicates fluid retention.
Patients with AKI: monitor for signs of infection because the client may not exhibit an elevated _____ or an increased ______ count?
Patients with AKI: monitor the lungs for adventitious sounds and monitor for _____, which can indicate fluid overload.
Patients with AKI:assist to administer medications as prescribed. Be alert to the mechanism for ______ and ______ for all prescribed medications.
Patients with AKI:assist to prepare the client for _____ if prescribed. Continuous renal replacement therapy may be used in AKI to treat fluid volume overload or rapidly developing azotemia and metabolic acidosis.
________ ______ disease is a slow progressive, irreversible loss in kidney function with a GFR less than or equal to _____mL/min for 3 months or longer.
Chronic kidney disease affects ____ major body systems and requires _____ or _____ _______ to maintain life.
Chronic kidney disease: assist to administer epoetin alfa (Epogen Procrit) or darbepoetin alfa (Aranesp), or hematopoeitics, as prescribed to stimulate the _____ of ________
Chronic kidney disease: Assist to administer blood transfusions if prescribed. Blood transfusions are prescribed only when necessary ( _______ ______ ____, _________ ______) because they decrease the stimulus to produce RBCs; note that certain clients (e.g. Jehova's Witness) may refuse blood and blood products.
acute blood loss
Blood transfusions also cause the development of _______ against human tissues, which can make matching for organ transplantation difficult.
Chronic kidney disease: avoid the administration of ______(analgesic) because it is excreted by the kidneys. If administered, toxicity of this can occur and prolong the bleeding time.
Chronic kidney disease: monitor the serum potassium level. An elevated serum potassium level can cause tall peaked ___ waves, flat ____ waves, a widened _______ complex, and a prolonged ____ interval; decreased cardiac output; heart blocks; fibrillation; or asystole.
Think of a banana with the right end higher than the left on an EKG
Chronic kidney disease: provide a low-________ diet, avoiding foods high in _____.
Chronic kidney disease: avoid ________-retaining medications such as spironolactone (Aldactone) and triamterene (Dyrenium), because these medications will increase this electrolyte level.
Place the client with kidney disease on continuous _______ monitoring. The client can develop hyperkalemia and is at risk for dysrhythmias.
Chronic kidney disease: hyperphosphatemia: assist to administer phosphate ______ as prescribed with meals to lower serum phosphate levels
Chronic kidney disease: hyperphosphatemia: avoid the use of ______ _____ preparations to bind phosphates because they are associated with dementia and osteomalacia.
Chronic kidney disease: hyperphosphatemia: administer ____ _____ and ______ (both are general) as prescribed because phosphate binders are constipating.
Chronic kidney disease: hypervolemia: monitor _____ and _______ and daily ______ for indications of fluid retention.
Chronic kidney disease: hypervolemia: monitor for signs of _______ _______ and ____ ______such as restlessness, heightened anxiety, tachycardia, dyspnea, basilar lung crackles, and blood-tinged sputum. Notify the RN immediately if signs occur.
Chronic kidney disease: hypovolemia: monitor vital signs for ______ and ______. It is very important to monitor for _______.
Chronic kidney disease: the client is at risk for ______ caused by suppressed immune system, dialysis access site, and possible malnutrition.
Chronic kidney disease: neurological changes: peripheral nueropathy results from the effects of ______ on peripheral nerves.
Chronic kidney disease: ocular changes: because the client can't see as well, it is important to protect them from what?
Chronic kidney disease: psychosocial problems: provide _________ care for the client with end-stagekidney disease.
What syndrome is this: the accumulation of nitrogenous waste products in the blood caused by the kidneys' inability to filter out these waste products.
nitrogenous waste: Any metabolic waste product that contains nitrogen. Urea and uric acid are the most common nitrogenous waste products in terrestrial animals
Uremic syndrome: assist the client to cope with ____ _____ disturbances caused by uremic syndrome.
What is this: the process of cleansing the client's blood?
_______, _______, and some blood cells are too large to pass through the hemodialysis membrane.
A _______ bath is composed of water and major electrolytes.
_________ need not be sterile because _______ and ______ are too large to pass through the pores of the semipermable membrane; however, the dialysate must meet specific standards, and water is treated to ensure a safe water supply.
Hemodialysis: withhold _______ (major class of drugs) and other medications that can affect the blood pressure or result in hypotension until after the hemodialysis treatment. Also withhold medications that could be _______ by dialysis, such as water-soluble vitamins, certain antibiotics, and digoxin.
Access for hemodialysis: subclavian and femoral catheter: these catheters should only be used for _____treatments.
Access for hemodialysis: femoral vein catheter: monitor the extremitiy for ____, _____, and _____.
Access for hemodialysis: femoral vein catheter: prevent pulling or ______ of the catheter when giving care.
The client with a femoral vein catheter should not sit up more than ____ degrees or lean forward, because the catheter may kink and occlude.
External arteriovenous shunt: Interventions: avoid getting the shunt ______. A _____ is wrapped completely around the shunt to keep it dry and intact.
External arteriovenous shunt: Keep cannula clamps at the client's _______ or atttached to the arteriovenous dressing for use in the event of accidental disconnection.
External arteriovenous shunt: reinforce teaching the client that the shunt extremity should not be used for monitoring ____, drawing ____, placing ___ ____, or administering injections.
External arteriovenous shunt: auscultate for a _____ and palpate for a _____, although a bruit may not be heard with the shunt.
External arteriovenous shunt: notify the Rn immediately, who will notify the HCP, if signs of ____, hemorrhage, or ______ occur.
External arteriovenous shunt: firbin-white flecks in the tubing, separation of serum and cells, absence of a previously heard bruit; thrill absent on palpation all indicate what?
Arterial ______ syndrome can develop in a client with an internal arteriovenous fistula. In this complication, too much blood is diverted to the vein, and arterial perfusion to the hand is compromised.
Interventions for an arteriovenous fistula and arteriovenous graft: palpate pulses below the _____ or _____ and monitor for hand _____ as an indication of ischemia.
Interventions for an arteriovenous fistula and arteriovenous graft: inability to palpate a thrill or auscultate a bruit over the fistula or graft indicates what?
Interventions for an arteriovenous fistula and arteriovenous graft: monitor lung and heart sounds for signs of ______.
To ensure patency, palpate for a thrill or auscultate for a bruit over the fistual or graft. Notify the RN and the HCP if a thrill or bruit is ______.
Disequilibrium syndrome is a rapid change in the composition of the extracellular fluid that occurs during ______. Solutes are removed from the blood faster than from the CSF and brain; fluid is pulled into the brain, causing cerebral edema.
Do the RN and HCP need to be notified if disequilibrium syndrome occur?
Dialysis encephalopathy is an _______ toxicity from dialysate water sources containing this; also can occur from ingestion of ______-containing antacids (phosphate binders). This is not a common occurrence.
Do the RN and HCP need to be notified if dialysis encephalopathy occur?
________ _______: the peritoneum acts as a dialyzing membrane (semipermeable membrane) to achieve dialysis.
For peritoneal dialysis, the dialysate solution is ______(sterile or non-sterile).
For peritoneal dialysis: dialysate solution: the higher the glucose concentration, the greater the ________ and the amount of fluid _______ during a peritoneal dialysis exchange.
Peritoneal dialysis: before treatment, it is important to obtain the patient's ________(not informed consent).
Peritoneal dialysis: Monitor _____ time as prescribed by the HCP. Do not allow _____ (same as above) time to extend beyond the HCP's order because this increases the risk for hyper______.
Types of peritoneal dialysis: _______ _____ peritoneal dialysis. The client performs self-dialysis 24 hours a day, 7 days a week. Dialysate is instilled into the abdomen four times a day and is allowed to dwell. After dwell, the bag is placed lower than insertion site so that fluid drains by gravity flow.
Infection is a concern with peritoneal dialysis. Sites of infection are either at the ______ insertion site or in the _______, which can cause ________.
Compilations of peritoneal dialysis: monitor for symptoms of ________: fever, cloudy outflow, rebound abdominal tenderness, abdominal pain, general malaise, nausea, and vomiting.
Complications of peritoneal dialysis: Warm the dialysate before administration using a special dialysate warmer pad, because the cold temperature of the dialysate can cause _____ _____.
Complications of peritoneal dialysis: abnormal outflow characteristics are indicative of complications: bloody outflow after the first few exchanges indicates ____ _____ (the outflow should be clear and colorless after the initial exchanges).
Complications of peritoneal dialysis: Insufficient outflow: change the client's outflow position by turning the client to a _________ position or _______ the client.
Complications of peritoneal dialysis: leakage around the catheter site: _________ amounts of dialysate need to be used, and it may take up to ____ weeks for the client to tolerate a full 2-L exchange without leaking around the catheter site.
Kidney transplantation: How long will the patient have to take immunosuppressive medications?
Preoperative interventions for kidney transplantation: immunosuppressive medications will be administered to the recipient as prescribed for ___ days before the transplantation, if possible.
Preoperative interventions for kidney transplantation: maintain strict ______ technique for the recipient.
Kidney transplant: monitor urine output ________ (how often). Immediately report a urine output less than ______ mL/hour
Kidney transplant: postop: monitor IV fluids closely; for the first _____ to _____ hours, IV fluid replacement is based on hourly urine output.
Kidney transplant: postop: position the client in ________ position to promote ______ exchange, turning from the back to the nonoperative side.
Kidney transplant: postop: note that urine is _____ and _______ initially but gradually returns to normal within several days to weeks.
Kidney transplant: postop: notify the RN, who will notify the HCP if gross _____ and clots are noted in the urine.
Kidney transplant: postop: monitor the three-way bladder irrigation, if present, for ____; the RN may irrigate the catheter if a HCP's prescription is present.
Kidney transplant: postop: assist to remove the _____ ______ _____ as soon as possible to prevent infection.
indwelling urinary catheter
Kidney transplant: postop: monitor for signs of organ rejection by monitoring _____ results.
Kidney transplant: postop: assist the recipient to cope with the body-image disturbances that occur from long-term use of ________.
The following are clinical signs of _______ transplant ______: fever greater than 100 F, edema, hypertension, malaise, elevated BUN and serum creatinine, decreased creatinine clearance, elevated WBC count.
Altered mentation is a sign of ______ ______ ______ in older adults; ________ and _________ may not be specific symptoms of UTI because of urinary elimination changes that occur with aging.
urinary tract infection
UTI: encourage the client to increase fluids up to ______L/day, especially if the client is taking sulfonamide. Sulfmonamides can form ____ in concentrated urine.
UTI: note that if the client is prescribed any aminoglycoside, a sulfonamide, or nitrofurantoin, the actions of these medications are decreased by ______ urine.
UTI: use ______ technique when inserting a urinary catheter.
UTI: maintain _______ (open or closed) urinary drainage systems for clients with an indwelling bladder catheter and avoid elevating the urinary drainage bag above the level of the bladder.
UTI: provide meticulous _________ care for the client with an indwelling catheter.
Is it necessary to repeat the urine culture after treatment for UTI?
UTI: in a client who is immunocompromised, the most common cause of urosepsis is infection from an _____ _____ ___ or untreated _____.
indwelling urinary catheter
Polycystic kidney disease: monitor for gross hematuria, which indicates _____ rupture.
Hydronephrosis is the distention of the renal pelvis and calices caused by an ______ of normal urine flow.
Hydronephrosis: S/S include hypertension, headache, colicky or dull _____ pain that radiates to the _____.
Interventions for hydronephrosis: monitor ____ _____ frequently, monitor _____ and ________ imbalances including ______ after the obstruction is relieved.
Interventions for hydronephrosis: monitor for ______, which can lead to fluid depletion. Monitor ______ daily.
One of the biggest causes of renal calculi is what?
S/S of renal calculi: renal ____, which originates in the lumbar region and ratiates around the side and down to the testicle in men and to the ____ in women. Also Ureteral colic, which radiates toward the _______ and thigh
Interventions for renal calcui: encourage fluid up to _______L/day unless contraindicated, to facilitate the passage of the stone and prevent _____; monitor for obstruction.
Interventions for renal calculi: encourage client ______ if stable to promote the passage of the stone. What can you do for patients who are immobile?
turn and reposition
For the client with renal calculi, strain all urine for the presence of ______ and send the stones to the laboratory for analysis.
Treatment options for renal calculi: cystoscopy: a continuous ______ irrigation may be prescribed to dissolve the stone.
Treatment options for renal calculi: extracorporeal shock wave lithotripsy: reinforce instructions to the client to increase _____ intake to flush out the stone fragments. Inform the client that _______ is important.
Treatment options for renal calculi: percutaneous litotripsy: encourage the client to drink __-___L of fluid/day following the procedure as prescribed. Monitor for and instruct the client to monitor for complications of ______, _______ and extravasation of fluid into the retroperitoneal cavity.
Partial or total nephrectomy: monitor the incision, particularly if a _____ is in place, because it will drain large amounts of urine. Protect the _____ from urinary drainage, changing dressings frequently if necessary.
Postoperative interventions for partial or total nephrectomy: the nephrotomy or bladder catheters are not _____ unless specifically prescribed; if prescribed, this is done by the RN.
Postoperative interventions for partial or total nephrectomy: encourage fluid intake to ensure a urine output of _____-_______mL/day or more.
Kidney tumors: radical nephrectomy: postoperative interventions: monitor for abdominal ______, decreases in ______ output, and alterations in level of _____ as signs indicative of bleeding. Check the bed linens under the client for bleeding.
Kidney tumors: radical nephrectomy: postoperative interventions: monitor for signs of ____ insufficiency, which include a large urinary output followed by hypotension and subsequent oliguria.
Kidney tumors: radical nephrectomy: postoperative interventions: monitor for a urinary output of _____-____ mL/hour to ensure adequate renal function. Maintain patient in __________ position.
Kidney tumors: radical nephrectomy: postoperative interventions: if a nephrostomy tube is in place, it is or is not irrigated?
is not- unless is it specifically prescribed, then it is done by the RN
In men, a diminished size and force of urinary stream is most likely caused by what?
BPH is a slow enlargement of the prostate, with hypertrophy or hyperplasia or normal tissue?
Interventions for BPH, avoid administering medications that cause ______ _____, such as anticholinergics, antihistamines, deconestants, and antidepressants.
Bladder trauma: monitor for hematuria, bleeding, and signs of ______.
pg. 749 Q 546, 547, 549, 551, 555, 556, 558, 559
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