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3107 Exam 3

Terms in this set (50)

8 functions of the kidney
-urine formation: glomerular filtration & tubular reabsorption and secretion
-waste excretion
-electrolyte regulation
-acid-base balance regulation
-water balance
-blood pressure control
-renal clearance
-RBC production regulation
-activation of vit. D
-prostaglandin secretion
urinary tract infection (UTI)
presence of pathogens in the urinary tract which is normally sterile above the urethra; more commonly acute and in the lower urinary tract
UTI: causes & predisposing factors
gender: more common in women (shorter ureters)

poor hygiene: improper sterile technique with catheter use, wiping back to front, etc.
UTI: clinical manifestations
-burning, urgency, frequency
-pelvic discomfort (dysuria)
-hematuria
-WBCs (casts) in urine
-cloudy urine
-possible fever/chills
UTI: labs & diagnostics
specific gravity - elevated
acute pylenophritis
inflammation of the renal pelvis
acute pyelonephritis: clinical manifestations
-flank pain (back pain, costovertebral tenderness)
-fever/chills
-fatigue
-nausea
-UTI symptoms
acute pyelonephritis: labs & diagnostics
WBC count
specific gravity - elevated
CT scan (will show inflammation)
kidney/ureteral stone (urolithiasis): causes & predisposing factors
-geography: more common in southerners (hot weather > dehydration > increased urine saturation)

-age (elderly > decreased thirst mechanism > dehydration > increased urine saturation)

-gender: more common in men than women

-lack of physical activity, family history (families have similar lifestyles/activity levels)
kidney/ureteral stone (urolithiasis): pathophysiology
-crystallization: urine becomes dense and forms stone; stones may occur in bladder, ureter (MOST painful), or kidneys

-saturated urine formation
four types of lithiasis (stones)
*stones may be one type or a combo

-calcium stone: occurs in people w/ high dairy intake, postmenopausal women/people at risk for osteoporosis who supplement calcium

-oxalate stone: occurs w/intake of tannins/tannic acid foods (tea/coffee, red wine, dark sodas, spinach chocolate) & people on low protein diets consuming lots of greens

-struvite stone (bacterial): occurs in people w/ history of UTIs

-uric acid stone: occurs w/ increased uric acid levels which are common in people w/ diets high in protein/PURINES (sardines, shellfish, organ meats), patients with cardiac disease/gout (on diuretics to decrease edema > dehydration), and patients taking aspirin, diuretics
ureteral stone/calculi: clinical manifestations
-PAIN
-colic radiating form back to pelvis
-N/V
-diaphoresis
-increased specific gravity
-hematuria
-risk for secondary infection (stasis from stone obstructing urine flow, stone lacerating ureter)
glomerulonephritis
inflammation of the glomerular capillaries

-inflammatory issue but NOT an infection like pyelonephritis
glomerulonephritis: causes & predisposing factors
-patients under 18: glomerulonephritis is ACUTE and FOLLOWS strep infection

-adults: it is chronic and caused by autoimmune disorders such as lupus
glomerulonephritis: clinical manifestations
-pallor/cyanosis (low hemoglobin)
-high BP, periorbital/dependent edema/lung crackles (fluid volume overload)
-confusion (hyponatremia)
-numbness, tingling, muscle weakness, irregular HR (hyperkalemia)
-hematuria, proteinuria
glomerulonephritis: labs & diagnnostics
calcium: for hypocalcemia

hemoglobin: decreased

hyponatremia & hyperkalemia

c-reactive protein: elevation indicates inflammation

urinalysis: RBCs/hematuria, proteinuria, increased specific gravity

GFR

arterial blood gases

Blood urea nitrogen: increased from protein reabsorption

creatinine: elevated
acute renal failure: prerenal failure
PT not getting perfusion to kidneys due to some acute event (past 24-72 hrs) such as:
-MI
-Blood loss from traumatic injury
-Major burns
acute renal failure: intrarenal failure
something happening within the kidneys such as:

thrombus/emboli in renal artery (would have to be significant)

acute exacerbation of glomerulonephritis

renal cell cancer/tumor

toxicity (nephrotoxic substances/drugs such as antibiotics, motrin/aleve, ibuprofen, chemical dyes/sprays on farms/in factories)

arteriosclerosis in renal artery/vein
acute renal failure: postrenal failure
a blockage obstructs urine from leaving the bladder/ureters

occurs often in men with prostate/bladder tumors
acute renal failure: labs and diagnostics
urinalysis - pt will still make urine, but there will be hematuria, higher specific gravity

hemoglobin - decreased b/c kidneys won't produce erythropoietin
BUN- increased; BUN is a byproduct of protein (ammonia), kidney cant excrete it

hyperkalemia: irregular HR, muscle weakness, numbness/tingling

hyponatremia: sodium decreased b/c potassium will be increased and patient will be edematous, pt will be confused

hypocalcemia: seizure, cardiac issues

phosphorus: increased

GFR: decreased

arterial blood gases: Lower bicard, acidic pH

creatinine: increased
acute renal failure: clinical manifestations
BP: increased because of renin-angiotensin and fluid overload

HR: increased and irregular b/c of potassium

respirations: fluid in lungs will cause overload, putting pressure on the heart and the pt at risk for decreased CO and pulmonary edema
-pt first has tachypnea to blow offco2 and compensate for low bicarb/acidic blood, later they will have bradypnea as fluid continues to buildup and causes dyspnea


pallor, cyanois
edema (periorbital, abdominal, sacrum, dependent)
HF
dark urine & decreased urine output (less than 30ccs per hr)
end stage chronic renal failure
pt no longer has ability to make urine (they still excrete fluid, but it's not considered urine); require transplants/dialysis

IRREVERSIBLE
end stage chronic renal failure: CAUSES
long history of:
-hypertension
-HF
-diabetes
-glomerulonephritis
end stage chronic renal failure: red flags a pt has gone from insufficiency or acute failure to end stage failure
-LOW GFR, ex: 50-52

-High potassium, repeated admissions of hyperkalemic episodes (damages the heart)

-Super high BUN, ex: 380-500

-Super high creatinine ex: 10,12,20
end stage chronic renal failure: labs & diagnostics
same labs as acute renal failure

-urinalysis will look DIFFERENT: glomeruli still functions in acute failure but NOT in end stage, urine will be watery/dilute (no blood in urine) so SPECIFIC GRAVITY WILL BE LOW
end stage chronic renal failure: clinical manifestations
weakness/fatigure - due to high potassium, decreased hemoglobin, toxin buildup (AZOTEMIA)

pallor (low hemoglobin)

N/V - caused by HF [blood shunted away from GI] or azotemia [body trying to excrete toxins that aren't being excreted in urine]

confusion - caused by hyponatremia and edema, cerebral fluid overload

fluid & electrolytes: proteinuria (bad, means body isn't digesting and reabsorbing protein in the glomerulus), NO HEMATURIA IN END STAGE

hyperkalemia, hypocalcemia - irregular HR (will see EKG changes),

metabolic acidosis -
compensatory: tachypnea, clear lungs, good EF = lungs/heart can compensate to get rid of CO2
noncompensatory: lungs filled with fluid > crackles, low EF, bradypnea

HF

Anemia (no erythropoietin production)

Respiratory effects:
-increased infections, due to fluid buildup in lungs (assess temp and WBC count)
-pulmonary edema

GI effects:
-uremic fetor: when breath smells like urine/ammonia (toxins being excreted through breath)
GI bleeding: stress ulcers, bleeding lowers hemoglobin

endocrine/musculoskeletal effects:
-hyperparathyrodism: parathyroid enlarges to compensate for hypocalcemia which may cause trouble breathing
-risk for pathological fractures: renal failure > low calcium levels cause the fracture versus trauma

dermatologic effects - uremic frost: toxins excreted through skin; causes itching and skin looks like it has snow on it
end stage renal failure: nutrition
Fluid restrictions would be ordered (output in the last 24 hrs plus 500)

Decrease protein intake (dairy, fish, meat)

Limit sodium because of the edema, even though renal failure causes hyponatremia; AVoid foods high in sodium, salty snacks, canned foods/soups

Limit foods rich in potassium:
Bananas, citrus (orange/lemons/limes),spinach, watermelon, cantaloupe, baked potato SKINS not the potato itself, apples


Increase calcium rich foods:
Dark leafy greens (kale, spinach), broccoli, calcium supplement pills
BUT not too much leafy greens cause they may also be high in potassium...be careful


Increase calories with carbs:
Pastas, SKINLESS potatoes, some types of breads but not all
thyroid gland
produces hormones that regulate metabolism

-T3 AND T4 which work with TSH (anterior pituitary gland)
hypothyroidism: predisposing factors & causes
-more common in women
-underlying autoimmune diseases
-aging (thyroid degenerates with age)
-family history
hypothyroidism: labs
T3, T4 decreased

TSH increased (compensation from anterior pituitary gland)
hypothyroidism: clinical manifestations
-unexplained weight gain
-lack of energy
-increased sensitivity to cold
-constipation
-bradycardia
-numb/tingling hands
-dry/brittle skin, hair, nails
-thyroid crisis
(cardiac arrest due to bradycardia, hypotension)
hypothyroidism: medications/treatment
synthroid/levothyroxine: raises T3/T4, lowers TSH

-must be given in the morning at least 30 min before breakfast with a full glass of water
-take pulse before medication, if pulse is already high, synthroid may cause tachycardia because it raises pulse
hyperthyroidism/grave's disease: predisposing factors & causes
-mostly in women > 30
-autoimmune
-STRESS!
-family history
hyperthyroidism/grave's disease: labs
T3, T4 increased

TSH decreased
hyperthyroidism/grave's disease: clinical manifestations
-sudden weight loss
-nervous energy
-insomnia
-sweating
-tachycardia, palpitations
-diarrhea
-exophalmos (bulging eyes)
-tan, salmony skin color
-pretibial myxedema (anterior edema on legs, bulging)
-thyroid crisis (tachycardia, hypertension)
hyperthyroidism/grave's disease: medications
tapazole
-expected outcomes: lower HR, weight fain, normal bowel movements
-take pulse before
hypoparathyroidism: predisposing factors & causes
-surgical removal of the thyroid gland, maybe due to a cancerous tumor or goiter: inadvertent removal of parathyroid glands b/c they're so small
hypoparathyroidism: patho
destruction of gland >
hypocalcemia which may cause muscle twitching leading to seizure
hypoparathyroidism: clinical manifestations - hypocalcemia
THESE MANIFESTATIONS APPLY TO ANY CASE OF HYPOCALCEMIA

-brittle bones

-laryngospasm: difficulty speaking, swallowing, breathing; pt at risk for aspiration, choking

-carpopedal spasms (trousseau's): when you go to take blood pressure and pump the cuff, pt hand spasms

-cardiac dysrhythmias (possible arrest), seizures

-facial twitching (chvostek's sign): touch pt cheek, it will twitch
adrenal medulla
responsible for regulating epinephrine
adrenal medulla - pheochromocytoma
hypersecretion of adrenal medulla
-benign tumor
-age 20-50
-familial
-risk factors: smoking, strenuous exercise

increased release of epinephrine
adrenal medulla - pheochromocytoma: labs & diagnostics
CAT scan: observe adrenal gland to see overgrowth or tumor

24h urine
adrenal medulla - pheochromocytoma: clinical manifestations
- tachycardia: 110-130
- high energy, insomnia
- diaphoresis
- epi causes vasoconstriction > HYPERTENSION
- flushed, red
- pounding, constant headaches
adrenal medulla - pheochromocytoma: treatment
surgical removal
adrenal cortex
responsible for regulating aldosterone (mineralocorticoids), glucose (glucocorticoids), cortisol (helps with inflammation)
adrenal cortex - addison's disease (autoimmune)
hyposecretion/insufficiency

-more common in men
-unknown or cancer metastasis

risk factors: steroid usage with sudden stop
adrenal cortex - addison's disease (autoimmune): clinical manifestations
-decreased aldosterone = HYPOTENSION due to low blood volume, dehydration

-hyponatremia/hyperkalemia (fatigue)
-hypoglycemia
-tan, salmony skin
-decreased wound healing, secondary infections
adrenal cortex - cushing's syndrome
hypersecretion

-adrenal cortex tumor
-young women (late teens - 20s) with pituitary gland tumors
-increase/long-term steroid use
-females aged 20-40
adrenal cortex - cushing's syndrome: labs & diagnostics
increased aldosterone

HYPERnatremia and HYPOkalemia

check BP, weight, glucose
adrenal cortex - cushing's syndrome: clinical manifestations
-dry mouth/thirst
-hypokalemia: dysrhythmias and muscle CRAMPING/spasms (not weakness like with HYPERkalemia)
-hypertension
-weight gain, edema
-increased abdominal girth
-hyperglycemia
-decreased wound healing, secondary infections
-osteoporosis
-kyphosis (buffalo hump) and moon facies (fluid overload in face)
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