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COTAC GU

Terms in this set (94)

Gerontologic considerations
Older adults are more susceptible to kidney injury r/t renal structural and functional changes.
Older adults are more susceptible to what 3 things?
Sclerosis of the glomerulus and renal vasculature

Decreased blood flow and GFR

Altered tubal function and acid-base balance
Kidney disease is the ONLY condition that increases what lab level?
Creatinine
If we have an elevated BUN what could this suggest?
Kidney disease
UA: urinalysis 24 hour urine collection identifies what?
color and clarity
Specific gravity
pH
Drugs
Glucose
ketones
protein
WBC's
Urine collection 24 hour patient education
Do not collect first void
Record the start time
Keep all other urine - pour it into the collection container after each void.
Stop time. Void one last time - even if you don't feel the urge.
Patient education mid stream collection
Cleanse genital area with towelettes.

Begin urination into toilet. As urination continues, bring container into stream. FILL SPECIMEN CONTAINER ONLY HALF WAY.
U/S assess for?
Kidney size, obstructions, masses, cysts, calculi, images ureters and bladder
xray assess for?
KUB: calculi, strictures, calcium deposits, obstructions
CT scan assess for?
3D, contrast.

Assess: kidney size, obstruction, cysts, masses
Kidney biopsy
Remove kidney tissue by excision or needle aspiration

Assess for: cancer, hemorrhage and UTI
MRI assess for?
Cancer staging
Dialysis
Renal replacement therapy.

Procedure that filters the blood in place of the kidneys
Dialysis indications
80% Nephron loss
Hyperkalemia MOST LIFE THREATENING
Hypercalcemia
Fluid overload with impending pulmonary edema
Advanced uremia
Removal of medications or toxins
What are the goals for dialysis
Remove fluid. 1L=1 kg and remove toxins
Types of dialysis
Hemodialysis

peritoneal dialysis (PD)

Continuous renal replacement therapy (CRRT)
Hemodialysis: AV fistula
No BP or blood draws on that arm

Assess for bruit/thrill
Hemodialysis: AV graft
NO BP or blood draws on that arm
Assess for bruit/thrill
Time required for Hemodialysis pt's
CKD patients attend a dialysis center 3x week for 3-5 hours a day
Complications of Hemodialysis
Infection: tx with antibiotics. and use aseptic technique

Hypotension:
To avoid lower pt's dialysis exchange rate.
tx: replacing intravascular fluid volume. MIdodrine.

Anemia:
To avoid: adequate anticoagulation
Tx: Erythropoietin
Peritoneal Dialysis Indications
Unable to tolerate anticoagulants.
Difficult vascular access
Chronic infections
Time required for PD?
Performed at home every day for 4-8 hours
Complications for PD
Peritonitis
Protein loss
poor dialysate flow
SOB
How to prevent peritonitis in PD
Properly cleanse access
Tx: depends on infection
Patient: report cloudy dialysate return.
Protein loss in PD
To avoid: monitor albumin levels
Tx: increase dietary protein
Poor dialysate flow PD
To avoid: assess access priori to installation
Tx: untwisting catheter and prevent constipation
SOB in PD
To avoid: give small amounts of dialysate slowly
TX: lessen amount of dialysate.
Continuous renal replacement therapy (CRRT)
Indications: Critically ill pt with acute kidney injury
Access: hemodialysis catheter
Time required: continuous gentler than hemodialysis
Pt considerations for Kidney transplant
lifelong immunosuppression
Possible rejection
Between 2-70 years old
Chronic disease states
Preoperative interventions for Kidney transplant
Preop medications: prophylactic antibiotics.
Postop interventions for kidney transplant
Fluid and electrolyte imbalances
Monitor for hemorrhage and shock
Fluid replacemtn
organ rejection
Dressing changes
Monitor for abd distention and pralyit ileus
Monitor for potential infection and thromboembolism
What are the post medications for kidney transplants
Methylprednisolon - anti-inflammatory
cyclosporine - immunosuppresasnt
Complications for kidney transplant
Infection: Common cause of first-transplant - year morbidity and mortality.

Detection is difficult since pt is on immunosuppressives drugs
complications: organ rejection
Hyperacute:mwithin 48 hours: fever, HTN, pain at site

acute: 1 week - 2 years:oliguria, anuria, fever, HTN, tenderness, lethargy, increased BUN, fluid retention

chronic: Gradually over months to years: increased BUN, jFluid retention, electrolyte imbalance, fatigue.
Acute kidney injury Phase 1: onset
Injury

End with oliguria
Acute kidney injury phase 2: Oliguria
<400 ml/day or <30 ml/hr

Lasts 1-3 weeks
Acute kidney injury phase 3: diuresis
Increased UOP

Lasts 2-6 weeks
Acute kidney injury phase 4: Recovery
Until kidney function is fully restored

lasts up to 1 year.
Risk factors for AKI
Volume depletion
Impaired cardiac efficiency
Renal ischemia
Nephrotoxic agents
Infection
Expected findings for AKI
Fluid overload
Dysrhythmia
Dyspnea
Decreased UOP
Hematuria
Electrolyte imbalance
Dry integument
Diagnostics for AKI: Labs
Increased creatinine
Increased BUN
Urine specific gravity
Electrolytes
Decreased HCT
UA: positive WBC
Metabolic acidosis
Diagnostic procedures AKI
Xray
US
CT or MRI w/o contrast
Biopsy
Nuclear medicine tests
Nursing interventions for AKI
Monitor VS
Review lab values
Avoid nephrotoxic meds
Asses for pulmonary edema and HF
Diet: restrictive fluid intake, K+, Phos, Na+, Mg+
Increased PR< possible TPN
Monitor EKG
Daily weights
Admin meds
Medications for AKI
IV fluids
Diuretics
Calcium Channel blocker
Sodium polystyrene sulfonate and sorbitol
Dextrose, insulin, and calcium
Sodium bicarb
Phosphate binding drugs.
Chronic Kidney Disease
Progressive, irreversible kidney disease. Dialysis and transplant: prolong life but are not cures.
Stage 1 of CKD
Kidney damage with normal kidney function

GFR: 90 or higher
Stage 2 of CKD
kidney damage with mild loss of kidney function

GFR: 60-89
Stage 3a of CKD
Mild to moderate loss of kidney function

GFR: 45-59
Stage 3b of CKD
Moderate to severe loss of kidney function

GFR: 30-44
Stage 4 of CKD
severe loss of kidney function

GFR: 15-29
Stage 5 of CKD
kidney failure

Less than 15 GFR
Expected Findings of CKD
AKI symptoms increased

Symptoms in any body system

More chronic disease = higher chance of ESKD
Diagnostics labs for CKD
UA
Creatinine
BUN
Electrolytes
CBC
Diagnostics procedures for CKD
U/S
KUB
CT
MRI
Aortorenal angiography, cystoscopy, retrograde pyelography, kidney biopsy
Nursing interventions: DIET CKD
Restrict fluid intake
Restrict K+, Phos, Na+, Mg+
Decrease PR in CKD (Unless undergoing dialysis, than increase PR)
High -carb
Moderate fats
CKD medications
Digoxin
Sodium polystyrene
Epoetin alfa (stimulates production of RBCs)
Ferrous sulfate (Fe-supplement)
Calcium carbonate (Phosphate binder)
Furosemide
Polycystic kidney disease
Numerous fluid filled sacs on kidney
Polycystic kidney disease cause?
genetic
Expected findings for polycystic kidney disease
Familial hx
abd/flank pain
HTN
Increased and girth
constipation
hematuria
renal calculi
progressive kidney failure.
Diagnostics for polycystic kidney disease
UA, BUN/Creatinine
U/S, CT, MRI
Nursing interventions for polycystic kidney disease
Control HTN
Manage pain
Prevent infection
prevent constipatino
Pt education
Needle aspiration for chronic pain
UTI risk factors
renal
catheter use
stool distention
diabetes
older adults: briefs
UTI expected findings
Half are asymptomatic
lower back and lower abdominal discomfort
Flank and or costovertebral angle discomfort
burning urination
frequency and urgency
urine retention
nocturne
What must we do idk we have to raise the collection bag above the pt's bladder?
Clamp the drainage tube.
Can drain bags touch the floor?
NO
When should you empty the collection bag?
Every 8 hours at least
pyelonephritis
Infection an inflammation of the kidney pelvis, calves, and medulla
Risk factors for pyelonephritis
Men over 65 with prostatic and hypertrophy of the prostate
Chronic calculi
Spinal cord injury
pregnancy
diabetes, HTN, or cystitis
incomplete bladder emptying
Expected findings for pyelonephritis
N/V
Fever.chills
HTN
Inability to concentrate urine
Bacterima
Pain
Glomerulonephritis
ANY disorder that results in glomerular injury.
Risk factors: glomerulonephritis
Recent infection, travel
Presence of systemic disease
Recent surgery or illness
Expected findings: glomerulonephritis
Anorexia and nausea
Dysuria
Fatigue
HTN
Dyspnea
Cola-colored urine
Glomerulonephritis diagnostics: labs
UA: positive RBC and PR
Decreased GFR
24 hour urine
BUN and Creatinine
Increased K+, Phos, and decreased Ca++
Procedures: kidney biopsy
Nursing interventions for Glomerulonephritis
Coordinate cares to conserve pt energy
Assess for fluid restriction needs
Help decrease pt stress
Monitor VS, fluids, electrolytes
Admin meds: ABX, antihypertensives
Nephrotic syndrome
Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins.
Symptoms of Nephrotic syndrome
Hypoalbuminemia
Edema
Proteinuria
Nursing interventions for Nephrotic syndrome
Tx as a pt with glomerulonephritis all the way to ESKD (depending on the CKD stage)
Renal calculi
Presence of stones in the urinary tract
Causes of renal calculi
Hypercalcemia dn ahypercalciuria (75%)

Alkaline and ammonia rich urine: Struvite stones

Hyperuricemia and hyper uricosuria: uric crystals.
Passing stones: spontaneously
depending on the composition, size, and location
Risk factors for renal calculi
Male
Decreased and or concentrated urien flow
Metabolic defects: increase Ca++, oxalate, puriness
Expected findings for renal calculi
Severe pain
-flank- kidney or ureter
-abd or genitals - ureter or bladder

Fever
N/V
Hematuria
Diagnostics for renal calculi
UA
BCX
Interventions for renal calculi
I&O's
Monitor for urosepsis
Medications for Renal Calculi
analgesics
spasmotics
antibiotics
alpha blocker: flomax
Therapeutic procedures for renal calculi
KUB
CT/MRI
Renal U/S
Extracorporeal shock wave lithotripsy (ESWL) most common
Stenting
Retrograde ureteriscopy; emergency urethra or ureter obstruction
Pt education for renal calculi
Strain all urine
3L fluid/day
Ambulate to pass calculus
Urinary retention
Inability of the bladder to empty completely

Urine left in bladder after voiding
Symptoms of urinary retention
polyuria
urge
decrease urine flow
Complications of urinary retnetion
hydronephrosis
urine stasis
uti
Causes of urinary retention
Adults 60 and older
Postoperative spasma
Diabetes, prostatic enlargement, urethral pathology, trauma, preg, neurologic disorders
meds
urethral obstruction
Urinary diversions
diversion of urine to external source
Indications of urinary diversions
Bladder cancer or pelvic malignancies
birth defects
trauma
strictures
neurogenic bladder
chronic infection or intractable cystitis
used as a last resort for incontinence
Cutaneous urinary diversion
Ileal conduit
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