Renal and urologic problems part 1
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How much cardiac output goes to the kidneys?
What does the GFR measure?
measured by creatinine clearance
What does the creatinine measure?
by product of creatinine phosphate used in muscle contractions
which lab value indicates renal impairment?
What is the normal level of creatinine for males and females?
- males 0.6-1.2 mg/dl
- female 0.5-1.1 mg/dl
What things does the kidney regulate excretion of?
- acid-base balance
- water soluble waste
What are the functions of the kidneys?
- regulates BP
- secretes erythropoietin
- metabolizes vitamin D
Which diagnostic tests are done to see any damage in the kidneys?
- Urinalysis-positive for glucose, protein, wbc
- CT scan
What is the normal level of BUN and what is it measuring?
- BUN 8-18 mg/dl
- urea found in liver as end product of protein metabolism. Kidneys excrete urea.
Which kidney problem is a sudden, rapid, potentially reversible deterioration of kidney function?
Acute renal failure
What are the three areas that acute renal failure can happen?
- prerenal-before the kidneys
- intrarenal-in the kidneys
- postrenal-after the kidneys
What is the major problem of ARF in the prerenal area?
decreased GFR from renal hypo-perfusion (not enough blood getting to the kidneys)
What is the 3 causes of ARF in prerenal area?
- hypovolemia-hemorrhage, shock, burns, GI loss
- cardiac disorders-failure, MI
- renal arterial obstruction
What is the nurse priority in treating prerenal ARF?
increase renal blood flow
What symptoms will a patient have that might suggest prerenal ARF?
- concentrated urine with low NA
- increased urea, BUN, CREAT
- BUN/CREAT ratio grater than 15:1
What type of fluid will a nurse likely expect to be giving to treat prerenal ARF?
250 ml of D5W or bolus of Normal Saline
After you give a patient fluid to treat their prerenal ARF if there output increases what does this indicate? if it doesn't increase what does this indicate?
- output increase it is a prerenal failure
- output doesn't increase it is intra-renal failure
What is the major problem of postrerenal failure?
obstruction of flow of urine
What can cause an obstruction of urine flow with postrerenal failure?
- enlarged prostate
What will a patient be experiencing if they have postrerenal failure?
What can cause intra-renal failure?
- intratubular obstruction
What is acute tubular necrosis?
- damage to the tubules secondary to ischemia or toxins
- damaged because of edema, vasoconstriction, and waste
What problems can cause acute tubular necrosis?
- inflammatory process
- hypersensitivity reactions
- blood transfusion reactions
- systemic and vascular disordres
How can we prevent a patient from getting intra-renal failure?
- keep good blood supply
- maintain BP
- monitor output and fluid balance
- monitor patients getting blood
- monitor patients getting nephrotoxic agents
What are the four stages of intra-renal failure symptoms?
- 1. onset
- 2. oliguric/anuric stage
- 3. diuretic stage
- 4. recovery/convalescent stage
When is the onset stage of intra-renal failure seen?
precipitating event, hours or days before onset of oliguria/anuria
When is the oliguric-anuric stage of intra-renal failure seen?
- output < 500ml/24hrs
- nausea, vomiting, anorexia, HA, dizziness, coma, and convulsions symptoms start in 72 hours
How long does the oliguric/anuric stage last?
When does the diuretic stage in intra-renal failure begin?
- output is >500 ml/24 hours
- BUN rises, then fall again
- excrete volumes of 10L/day or more and lose electrolytes
When does the recovery/convalescent stage in intra-renal failure begin and last for?
- Begin when BUN is stable
- may take up to 6 months
- last until the patient is able to return to normal activity
True/False. after intra-renal failure the renal function will always return to normal function.
False. may never return to normal function.
How should a nurse manage a patient with acute intra-renal failure?
- treat underlying cause of ARF
- prevent progession of ARF
- treat serious complications (hyperkalemia & hypervolemia)
- monitor output + 500ml for sensible losses
- treat symptoms of uremia (itching, skin problems0
What is the definition of glomerulonephritis?
inflammation of the glomeruli
What are s/sx of a patient with glomerulonephritis?
- blood in the urine
- urine with RBC's, WBC's, proteins, and casts
Which type of glomerulonephritis develops 5 to 21 days after an infection of the tonsils, pharynx, or skin?
acute poststreptococcal glomerulonephritis (APSGN)
What is the problem with APSGN?
antibodies deposited in glomeruli cause inflammatory reaction cause decreased filtration of wastes cause increase permeability of glomeruli to large proteins
What are s/sx of a patient with APSGN?
- generalized body edema
- hematuria with a smoky or rusty look
- protein in the urine
What is the best way to prevent a patient from getting APSGN?
early diagnosis and treatment of sore throats and skin lesions
How is a patient treated with acute poststreptococcal glomerulonephritis?
- restrict Na and H20
- decrease dietary protein
- antibiotics only if strep still active
Which type of glomerulonephritis causes a rapid loss of renal function over days to weeks?
Rapidly progressive glomerulonephritis (RPGN)
What is the cause of RPGN?
- infectious disease that cause inflammation
What are s/sx a patient will have with rapidly progressive glomerulonephritis?
- fluid overload
- inflammatory injury to the kidney
How is a patient going to be treated with RPGN?
Which type of glomerulonephritis is the end stage of glomeruloinflamatory disease?
What causes chronic glomerulonephritis?
proteinuria > hematuria > uremia > renal failure
How is a patient diagnosed with chronic glomerulonephritis?
- may be asymptomatic
- renal biopsy
- CT scan
How is a patient treated with chronic glomerulonephritis?
- treat HTN
- treat UTI
- restrict protein & phosphate
Which type of renal problem occurs when the glomerulus is excessively permeable to plasma protein, causing proteinuria that leads to low plasma albumin and tissue edema?
infections (bacterial, strep, syphilis, viral, hepatitis, HIV, malaria), diabetes, Lupus, Leukemias, Hogkins lymphoma, tumors, bee stings, allergy to pollens, drugs (NSAIDs, penicillin, Captopril, heroin are all causes of what renal impairment?
What are complications to having Nephrotic Syndrome?
- peripheral edema (d/t low albumin)
- massive protein uremia
- Ascities, ansarca
- low immune response>infections>primary cause of death
- loss of clotting factors
What types of things will a dr order for a patient with nephrotic syndrome?
- treat symptoms to reduce edema
- thiazide or loop diuretics
- Ace inhibitors
- restrict Na diet
What type of things should the nurse have to manage for a patient with nephrotic syndrome?
- manage edema (elevate extremities)
- daily weights
- measure abdominal girth & extremities
- skin care
- avoid sick people
What are the two types of obstructive uropathies?
Which type of obstructive uropathy is a dilation and enlargement of renal pelvis that cause chronic pyelonephritis and renal atrophy?
What are s/sx of a patient with hydronephrosis?
- BUN/CREAT elevated
- oliguria and anuria
What occurs when an obstruction in the bladder is removed?
Adhesions & scarring post surgery, fibrosis, inflammation of urethral lumen, congenital, catheterizations, trauma, and infection are causes of what type of problem?
What are s/sx of a patient with a urinary stricture?
- colicky pain
- decreased force of stream
- straining to void
- sparyed stream
What are possible treatments for a patient with an urinary stricture?
- dilate ureters
- placement of stent
- nephrostomy tube inserted into the renal pelvis
- manage pain
What factors cause urinary stones?
- calcium diet
- obstruction with urinary stasis
What is the priority goals of the nurse to treat a patient with urinary stones?
- 1. relief of pain
- 2. no urinary tract obstruction
- 3. educate to prevent further recurrence
The nurse should educate a patient on preventing recurrence of urinary stones by how?
- drink adequate amount of fluid for 2L/day
- reduce metabolic or secondary risk factors
Which type of treatment is used to eliminate calculi from the urinary tract by using soundwaves and vibration?
What are three vascular problems involving the kidneys?
- renal artery stenosis
- renal vein thrombosis
Which vascular problem is defined as sclerosis of small arteries & arterioles of kidneys?
Which individuals are most likely to develop benign nephrosclerosis? what is benign nephrosclerosis caused by?
- 30-50 years old patients
- caused by HTN and atherosclerosis
What is the major cause of accelerated nephrosclerosis?
sharp increase in BP with diastolic > 130 mm/hg
What is the primary treatment of any nephrosclerosis?
treat HTN asap
Which type of vascular problem is a partial obstruction of renal arteries and causes sudden increase in BP?
renal artery stenosis
How is renal artery stenosis treated?
- treat HTN
- percutaneous trans luminal renal angioplasty
Which types of things cause renal vein thrombosis?
- extensive compression
- renal cell carcinoma
- nephrotic syndrome
What are s/sx of a patient with renal vein thrombosis?
What is a patient with renal vein thrombosis going to be treated with?
- anticoagulants to prevent pulmonary emboli
- corticosteroids to tx nephrotic syndrome
Which metabolic & tissue disorder is the primary cause of end stage renal disease. most common in type 1 diabetics and caused by the microangiopathic changes in diabetics?
Which metabolic & tissue disorder that is caused by hyperuricemia, urate crystals deposit in renal interstitium & tubules?
Which metabolic & tissue disorder is the main cause of glomerulonephritis?
Systemic Lupus erythematosis
Which kidney disorder is the most common genetic disorder in the US?
polycystic kidney disease
Which type of polycystic kidney disease is an autosomal recessive disorder and is often rapidly progressive?
Which type of polycystic kidney disease is an autosomal dominant disorder?
What is the problem with polycystic kidney disease?
- the cortex and medulla are filled with large thin walled cysts.
- Cysts enlarge and destroy the surrounding tissue by compression
- Cysts are filled with fluid, pus, & blood
When do you see early signs and late signs of PKD?
- no early signs
- late signs when the cysts enlarge
What are signs of PKD when the cysts enlarge?
- hematuria (when cysts rupture)
- feel of heaviness in back, side, abdomen
- renal stones
- chronic, constant, and server pain
- palpable kidneys
How do you diagnose PKD?
- CT scan
What other complications occur with polycystic kidney disease?
- increase risk of aneurysms
- systemic HTN
- cerebral/blood aneurysms can rupture
- cysts in the liver, heart valves effected
True/False. Polycystic kidney disease can be cured and treated.
False. PKD cannot be cured
What is the majority of the nurse in treating PKD?
- prevent and treat UTI
- pain management
- Dialysis & kidney transplant
If a patient has developed end stage renal disease what should the nurse educate the patient on?
- modify diet
- restrict fluid
- treat HTN
What is the most common major risk factor in developing Kidney and Bladder cancer?
Which individuals are most likely to develop Kidney cancer?
- 50-70 years of age
What are risk factors for developing kidney cancer?
- exposure to asbestos, cadmium, and gasoline
Hematuria, flank pain, palpable kidney, weight loss, HTN, anemia are signs/symptoms of what type of cancer?
How is kidney cancer diagnosed?
- CT scan
- percutaneous needle aspiration
What is the major treatment in Kidney cancer?
What is the purpose of treating kidney cancer with radiation?
- palliative to shrink the tumor when inoperative
- when it metastasize to the bones or lungs
Which individuals are most likely to develop bladder cancer?
- 60-70 years of age
What are the major risk factors of developing bladder cancer?
- chronic renal stones
- chronic UTIs
- indwelling catheters
hematuria, dysuria, frequency, and urgency are signs/symptoms of what type of cancer?
How is bladder cancer diagnosed?
- MRI cystoscopy
What is the most important thing to determine when diagnosing bladder cancer?
depth & invasion of bladder wall and surrounding tissue
what are the common indications for surgery of the urinary tract?
- kidney tumors
- PKD that is bleeding or severely infected
- trauma to kidney
- elective removal of kidney
After a patient has come from the operating room what is the nurses priority to monitor?
- output every 1-2 hours
- manage pain
- monitor VS (decrease in BP d/t hemorrhaging)
- manage fluid
- monitor for s/sx of infection
- monitor incision care
What are common peristomal skin problems associated with an ileal conduit?
- yeast infections
- product allergies
- shearing-effect excoriations
Which type of urinary diversion has the most problems? what is the major complication?
When a patient is getting discharged home with an ileal conduit what is the priority of the nurse to educate the patient?
- symptoms of obstruction
- signs/symptoms of infection
- care of the ostomy
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