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Renal

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warning signs of kidney disease
burning or difficulty urinating, increased frequency of urination @ night, blood in urine, puffiness around eyes, swelling in hands and feet especially in children, back pain, increased BP.
kidneys do what?
assist in acid based balance, raise BP by secreting renin, and produce the hormone erythropoietin (production of RBC's and their release)
Nephrons
responsible for urine production.
Glomerulus
filtration occurs there, filters H2O, sugar, salts, uria and other wastes.
Loop of Henley
Loop diuretics work here.
3 layers of the kidney
cortex(outer), medulla(middle), and the nephron(functional unit.)
subjective data collection
family hx, color, odor, or mucus in urine, diuretics, pruritis, HTN medications, antibiotics.
objective data collection
skin, vital signs, edema, wt.gain, lung sounds, I&O's, urine.
characteristics of urine
pale yellow, amber color, aromatic.
vegetarians will have?
very alkalitic urine
meat eaters will have ?
very acidic urine.
with age these changes occur
decreased production, filtration, decreased renal clearance of drugs, unable to conserve sodium, and decreased bladder capacity.
Lab values for urine
PH 4.6 - 8.0, specific gravity 1.010 - 1.025, protein 0-18mg/dl, RBC0-4hpf, WBC0-5, serum creatinine0.6-1.5, BUN 8-25.
invasive kidney procedures
renal biopsy, IVP, angiography, cystoscopy.
NI for angiography
NPO 4-8hrs. before, bedrest of 12hrs. after, monitor for bleeding @ injection site.
cystitis ( UTI)
inflammation of the bladder. more common in females. common bacteria that causes it is E-coli, or yeast.
diagnostic test for UTI
midstream urine test.
medications for UTI
bactrim unless pt. has sulfa allergy, then Cipro. Monural for yeast, and pyridium.
pyridium
non opioid analgesic, turns urine orange/red color, will stain skin and clothes.
Pyeloneohritis
bacterial infection of renal pelvis, caused by backflow, trauma, E-coli most common cause. Urine is cloudy, bloody, or has mucos or pus.
treatment for pyelonephritis
push fluids, daily wt., pain relief, light diet @ first then high cal, high protein.
acute glomerulonephritis
strepp infection, can lead to CHF, and pulmonary edema. inflammation of the glomerulus.
medications for acute glomerulonephritis
penicillin, lasix, and imuran.
chronic glomerulonephritis
slower progression, can take up to 30 yrs. for signs of renal insufficiency. Meds. are the same as acute, high carb, low sodium diet.
complications of CRF
insomnia, anemia, GI bleed, hyperkalemia, hypermagnisemia, hypervolemia, hypovolemia, HTN, hypocalcemia, and infection.
Uremic syndrome
accumulation of nitrogenous waste products in the blood caused by kidneys inability to filter out these waste products. may occur from CRF or ARF.
S/S of uremic syndrome
oliguria, presence of protein, RBC's, casts in the urine, Increased levels of uric acid, potassium, and magnesium. hypotension, hypertension, and changes in LOC.
NI for uremic syndrome
monitor vitals, serum electrolytes, I & O's for oliguria, limited sodium, potassium, and nitrogen diet.
Hemodialysis
process of cleansing the pts. blood. removes by products such as urea, creatinine, and uric acid. removes excess fluids and maintains the buffer system of the body. maintains electrolyte levels of the body.
complications of hemodialysis
air embolus, disequilibrium syndrome, and dialysis encephalopathy.
peritoneal dialysis
works on the principles of osmosis, diffusion, and ultrafication. PD occurs via the transfer of fluid and solute from the bloodstream through the peritoneum.
Tenckhoff catheter
a rubber siliconized catheter that is surgically inserted into the peritonel cavity to allow infusion of dialysis fluid.
complications of PD
abdominal pain, abnormal outflow, leakage @ catheter site, peritonitis.
urosepsis
a gram negative backteria caused by E-coli, usually with indwelling catheter. can cause septic shock if left untreated, fever is the most common and earliest manifestation.
NI for urosepsis
obtain urine specimen for C&S, before giving antibiotics. administer IV antibiotics for 3-5 days, then by PO after.
renal calculi
stones that form in the kidneys.
urolithiasis
stones that form in the ureters.
cause of stones
family hx, urinary stasis, obstruction, dehydration, diuretics, UTI's, increased uric acid level, and a diet high in vitamin D, calcium, milk, and protein.
epididymitis
inflammation of the epididymis, caused by UTI or STI.
Benign Prostatic Hypertrophy (BPH)
enlargement of the prostate gland, with hypertrophy and hyperplasia of normal tissue.
data collection for BPH
diminshed size and stream of urine, urgency, frequency, nocturia, hesistancy, hematuria, dysuria, and UTI's.
NI for BPH
increase fluids to 2000-3000 cc, avoid giving anticholinergics, antihistamines, decongestants, and antidepressants. Give meds to shrink and relax prostate.
overflow incontinence
bladder retraining, keep skin dry and clean, moral support.
total incontinence
vitals, skin clean and dry.
urge incontinence
fluids @ 3000 ml per day, bladder retraining, skin clean and dry.
stress incontinence
kegal exercises, bladder retraining, skin clean and dry.
nocturnal enuresis
no fluids after 6pm, empty bladder directly before bedtime, skin clean and dry.
prerenal acute renal failure
decrease in kidney perfusion that reduces glomerular perfusion. S/S pale cool skin, orthostatic hypotension and oliguria.
intrarenal acute renal failure
tissue damage of glomeruli and tubules, antigens and antibodies complexes formed in glomerulonephritis become trapped in the basement of the membrane and cause inflammation.
postrenal acute renal failure
caused by an obstruction.