G/U Test #3

Card Set Information

G/U Test #3
2013-11-20 09:14:10
Pgs 851 869

Nursing care of patients with disorders of the urinary system
Show Answers:

  1. Diabetic nephropathy
    • Most common cause of chronic kidney disease
    • Long term complication of diabetes that results in damage to small blood vessels in kidneys
  2. Patho of diabetic nephropathy
    • Starts with microalbuminuria (small amounts of protein in urine)
    • Large amt of diluted urine is excreted w/o waste products
    • Also commonly develop pyelonephritis
    • Massive edema b/c of low levels of albumin
    • Smaller doses of insulin needed
  3. S/S diabetic nephropathy
    • Microalbuminuria
    • Proteinuria
    • ↓ urine output

    • Toxic waste accumulates
    • Chronic kidney disease develops
  4. Therapeutic measures for diabetic nephropathy
    • Strict control of blood glucose and blood pressure can slow down progression
    • ACE inhibitors
    • Dialysis
  5. Nephrotic syndrome
    • Excretion of 3.5 g or more of protein in urine per day
    • Edema
    • ↑ cholesterol
    • ↑ blood coagulation
    • Low protein intake ordered
  6. Nephrosclerosis
    • Thickening and hardening of renal blood vessels
    • S/S: proteinuria, hyaline casts in urine
    • Treatment: reduce BP and treat hypertension, low sodium diet
  7. Glomerulonephritis
    • Inflammation of glomerulus
    • Most commonly assoc. with Group A strep
    • Protein, casts or RBCs in urine
  8. S/S of glomerulonephritis
    • Urine dark or cola colored from old RBCs
    • Foamy urine
    • Fluid volume overload
    • Hypertension
    • Periorbital edema
    • Flank pain
  9. Azotemia
    Rapid accumulation of toxic wastes in blood
  10. 3 stages of acute kidney injury
    • Oliguric phase: <400 mL urine in 24 hours. Low sodium level.Lasts 2 wks - several months
    • Diuretic phase: 1-3L urine/day. BUN & Creatnine high. Lasts 1-3 weeks
    • Recovery phase: BUN & creatnine decrease. Can take up to a year
  11. 3 classifications of acute kidney injury  (causes)
    • Prerenal injury: Interruption of blood supply to kidneys. (dehydration, blood loss, shock, NSAIDS)
    • Intrarenal: Inside kidneys. (ischemia, toxins, aminoglycosides)
    • Postrenal injury: Obstruction of urine flow out of body. (stones, tumors, enlarged prostate)
  12. Chronic kidney disease
    • Nephrons are damaged or destroyed
    • End stage renal disease occurs when 90% of nephrons are lost
    • Uremia
  13. Most common S/S of chronic kidney disease
    • ↓ urine output
    • Fatigue
    • Nausea/vomiting
    • SOB
    • Platelet dysfunction
    • Anemia
  14. Nursing care for hyperkalemia patients
    Should be placed on cardiac monitor and observed for cardiac dysrhythmias
  15. Diet for chronic kidney disease
    • Restricted sodium
    • Restricted potassium
    • Increased calcium
    • Restricted phosphorus
    • Restricted fluids
  16. How does hemodialysis work
    Blood is removed from the kidney and filtered through a dialyzer. The waste products from the blood move into the dialysate by diffusion.  Then the cleansed blood is returned to the body
  17. Purpose of dialysis
    • Filters waste
    • Removes extra fluid  
    • Balances electrolytes (sodium, potassium, bicarbonate, chloride, calcium, magnesium and phosphate).
  18. How long does hemodialysis take and how often do you need it
    • 3-4 hours
    • 3-4 times a week
  19. What can/does occur after dialysis
    • Patient is very tired/weak
    • Dysrhythmias and angina may occur
    • Hypotension
  20. What medication is given to patients during dialysis?
    Heparin to prevent clotting in artificial kidney
  21. 3 types of vascular access for hemodialysis
    • Arteriovenous (AV) fistula: (best option) Made by sewing a vein and artery together under the skin. May take 2-6 months to mature
    • AV graft: Uses tube of synthetic material to attach to an artery and vein.  
    • Central venous catheter: Temporary. Can't be used long because of risk of infection. Placed in subclavian vein, jugular vein, or femoral vein.
  22. How are fistulas and grafts checked for patency?
    • Palpating for a thrill (tremor) and auscultating for a bruit (swishing sound)
    • Any decrease in either indicates occlusion
  23. Severe pain after vascular surgery may indicate what?
    Occlusion of the graft
  24. Steal syndrome
    When AV grafts cause distal ischemia
  25. Nursing care after vascular surgery
    • Neurovascular checks every hour
    • Extremity is elevated
    • Range of motion exercises encouraged
    • Teaching of care of access point
  26. Peritoneal dialysis
    • Provides continuous dialysis 
    • Dialysate solution instilled into peritoneal cavity (usually 1500 - 2000 mL)
    • 3 steps of exchange: filling, dwell time (left for several hours), draining
    • Repeated 3-4 times a day
  27. Major complication of peritoneal dialysis
    • Peritonitis caused by poor technique.
    • First sign is abdominal pain
  28. Advantage of a fistula over a two-tailed subclavian catheter
    There is a larger blood flow, and dialysis is more efficient
  29. Foods high in potassium
    • Citrus fruits and juices
    • Bananas
    • Raisins
    • Lima beans
    • Tomato products
    • Salt substitutes
    • Potatoes
    • Excessive dairy products
    • Excessive meats
    • Chocolate