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Define GFR, Creatinine, BUN, Ketones, Glucose, Protein and Osmolarity in regards to renal function
- Glomerular Filtration Rate: estimates how much blood passes through the glomeruli each minute (>90 is considered normal in adults, <15 indicates kidney failure)
- Creatinine: measured in serum or urine. Measures end product of muscle metabolism. This constant source clears the kidneys and is and indicator of kidney function (0.5-1.5 mg/dL)
- Blood Urea Nitrogen: urine in blood to be filtered (7-20 mg/dL)
- Ketones: present when fat is metabolized instead of glucose (should be none)
- Glucose: spills into urine when BS is >220 (<130 mg/d)
- Protein: should not be found in urine
- Osmolarity: particles in urine (300-900)
How are renal diseases commonly diagnosed?
- KUB (kidneys, ureters, bladder xray)
- IV Pyelogram (check for shellfish allergies)
- Kidney Biopsy
Define Cystitis, the s/s and some common methods of prevention
- Inflammation of the bladder, usually bacterial
- Interstitial cystitis- inflammatory disease with NKC
- 50% of pts with foley get UTI
- S/S: hematuria, frequency, dysuria, nocturia, bacteriuria/pyuria, foul oder
- more common S/S in elderly: confusion, incontinence, loss of appetite
- Prevention: Drink 3L/day, clean front to back, avoid irritating cleaners, empty bladder before and after intercourse, 50 ml cranberry juice daily, contact PCP with any symptoms
What medications are commonly used for cystitis?
- Sulfonamides: Trimethoprim/Sulfamethoxazole (Bactrim, Septra). Inhibits reproduction. Check for Sulfa allergy
- Fluoroquinolones: Ciprofloxacin (Cipro), Levofloxacin (Levaquin). Inhibits reproduction
- Penicillins: Amoxicillin (Amoxil). Interrupts cell wall synthesis
- Cephalosporins: Cefadoxil (Duricef). Interrupts cell wall synthesis
- Urinary Antiseptics: Nitrofurantoin (Microdantin). Inhibit cell wall synthesis
- Bladder Analgesics: Phenazopyridine (Pyridium, AZO), relieves S/S but not infection. Dyes secretions orange, staining clothes and soft contact lenses
Define stress and urge incontinence
- Stress incontinence: during sneezing, coughing, laughing etc. Common after childbirth and menopause. Kegal exercises may help
- Urge Incontinence: also called overactive bladder (OAB). Perception of an urgent need to urinate, leaking urine
Define Cystocele and prolapsed uterus
- Cystocele:herniation of the bladder into the vaginal space
- Prolapsed Uterus: herniation of the uterus into
How is incontinence medically treated?
- Weight loss, as obesity puts pressure on bladder
- Antispasmatics: Oxybutin (Ditropan). Bladder muscle relaxation suppresses urge to void
- Marshall-Marchetti (Bladder Tuck, Bladder suspension)
- Collagen injection
What is urolithiasis? Nephrolithiasis? Ureterolithiasis? What contributes to stone formation and what complications can occur?
- Urolithiasis: calculi anywhere in the renal tract
- Nephrolithiasis: kidney stones
- Ureterilithiasis: ureteral stones
- electrolyte imbalances and increased calcium intake can contribute to stone formation
- Hydroureter is an emergency complication, as it can lead to hydronephrosis and permanent kidney damage
What are the s/s of kidney stones?
- Renal Colic- unbearable flank pain
- Increased BP, HR
- Increase in WBCs in urine
- Oliguria-->anuria is a sign of obstruction and is an emergency
What is the treatment for urolithiasis?
- Lithotripsy (Extracorporal shock wave lithotripsy ESWL)(sound waves, laser, dry shock) to break stones up into small fragments (Strain urine afterwards)
- Stent placement by ureteroscopy opens urethra for stones to pass. Done under Monitored anesthesia care (MAC)
- Pain Management
- Monitor for WBCs in urine and hematuria
Describe a normal urinalysis
- Color: clear yellow or amber, never cloudy
- Specific gravity: Increase in fluid intake decreases specific gravity. 1.000-1.030
- Glucose: present in urine when BS >220 mg/dL
- Ketones: absent. Present when fat is metabolized instead of glucose
- Creatinine Clearance: over 24 hrs, measures GFR. Urine must be iced. Men and women have diff levels
- C&S: looks for bacteria. Generally taken clean catch mid stream
What bladder cancer is the most common and what are the two courses of action for treatment?
- Transitional Cell Carcinoma of the Bladder
- Bladder mucosal tumors are excised, tumors in muscle layer are excused with treatment if bladder chemo
- Radical cystectomy with urinary diversion for more extensive urothelium cancer followed by chemo and rad
What are the different surgical treatments for bladder cancer?
- Cystectomy: removal of bladder with urethral diversion
- Enterostomal therapist is usually consulted for stoma placement
- Transurethral Resection of Bladder Tumor (TURBT): done through cystoscope
- Segmental Cystoectomy: part of bladder is removed
What interventions and teaching should be done for bladder chemo?
- No fluids prior
- Admin through catheter into bladder
- No voiding for 2hr, change position q15 min to wash entire bladder
- 1x/wk for 6wk, then q6mo for 2 yr
- Look for special teaching about flushing and sharing toilets
What is Polycystic Kidney Disease? What are the s/s?
- Autosoma Dominant Inheritance
- Cysts develop in the nephron
- S/S include: flank pain, HTN, nocturia, increased BUN and creatinine, increased abd girth, hematuria and cloudy urine
- US positive for proteinuria and hematuria
What is the treatment for polycystic kidney disease?
- Decrease salt intake
- Track and balance I/O
- ACE inhib and CCB to control HTN
- Lasix as diuretic if kidneys functional
- Dialysis and transplant
What is Acute glomerulonephritis? What are the s/s and the treatment?
- Also called Acute Nephritic Syndrome
- An infection settles in the kidneys (syphillis, hep B, chicken pox, strep), occurs about 10 days post infection
- S/S include: edema of face, eyelids, hands.Pulmonary congestion, SOB, crackles upon auscultation. Hematuria, proteinuria, HTN, fatigue, anorexia, n/v/d
- 24hr creatinine clearance usually ordered, diagnosed by kidney biopsy
- Treatment: manage S/S such as pain, penicillin or erythromycin for infection, lasix, salt restriction, fluid restriction
- 24 fluids= 24hrs UO + 500 mL
- Dialysis or plasmaphoresis if uremia occurs
What is chronic glomerulonephritis and what does it lead to?
- Also called chronic nephritic syndrome
- Insidious onset as kidneys atrophy over years
- Mild S/S including proteinuria, HTN, fatigue, peripheral edema,tachycardia, e/f imbalances, uremia
- Biopsy confirms diagnosis
- Leads to end stage kidney disease, needing dialysis and transplant
- If caught early, progression can be managed with lifestyle changes
Describe the differences and similarities between Acute and Chronic Kidney injury?
- AKI has a rapid decrease in kidney function while chronic has a slow onset
- AKI has kidney involvement of about 50% where as 90-95% of the kidneys are involved in chronic
- Prognosis for AKI is good, while chronic has a prognosis of dialysis, transplant and fatal complications
- AKI is treated with meds, chronic is treated with dialysis
- Chronic causes anemia while AKI does not
- AKI will resolve while chronic is permanent
- Both are caused by kidney infection and blockage
- Both have decreased kidney function
- Both cause HTN, decreased UO
- Restrict sodium intake for both to prevent fluid overload
What is acute kidney injury and how is it classified?
- Also called acute kidney failure
- Sudden decrease in kidney function
- Classified by where the injury occurs, leading to the s/s displayed
- Can be caused by: decreased perfusion, ingested toxins, obstruction
- Classified by RIFLE for diagnosis and severity
What are the different types of AKI?
- Prerenal: decreased blood flow to kidneys, causing decreased UO and lethargy
- Intrarenal: physical or chemical damage causing decreased LOC, SOB, decreased UO and HTN
- Postrenal: obstructive flow from kidneys, causing decreased UO
What are the phases of AKI?
- Onset: precipitating event until oliguria occurs
- Oliguric phase: UO 100-400 mL/24hrs (4-17 mL/hr)
- Not responsive to diuretics, needs TPN, Lipids
- Lasts 1-3 weeks
- Diuretic phase: UO up to 10L/24 hrs. Risk for E/F imbalances
- Recovery phase: balanced I/O, 2-4L/24hr. May last for up to a year
Describe the difference stages of Chronic Kidney Disease
- It is progressive and irreversible, leading to ESKD
- Stage 1: DM, HTN, Toxin- no s/s
- Stage 2: Mild, reduced GFR. Manage DM and HTN
- Stage 3: Moderate. Fluid restriction and electrolyte balances
- Stage 4: Severe- dialysis and transplant
- Stage 5: ESKD. Increased Creat, Potassium & Sodium. EKG changes due to increased Potassium. Metabolic acidosis, increased depth and rate of resps. Breath smells like urine, uremic frost
Describe peritoneal dialysis and the required nursing care
- Dialysate into the peritoneum and drains out
- Intake should equal output, should not be cloudy
- Monitor for peritonitis (board like abdomen) and cloudy output
- Monitor electrolytes
What is the criteria for Hemodialysis? What is its purpose and how often does a patient generally go?
- Criteria includes uremia, increased potassium, metabolic acidosis, fluid overload
- Electrolytes, water, and heparin removes excess waste products from the blood
- 12hr/wk MWF, TTHS