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What is Glomerulo filtration rate? What is creatinine? What is blood urea nitrogen? What are ketones? When will glucose spill in urine? Protein? What is considered WNL for Osmolarity?
- GFR: estimates how much blood passes through the glomeruli each minute
- Creatinine: measured in serum or urine; Measures end product of muscle metabolism. This constant source clears the kidneys and is an indicator of kidney function
- Blood urea nitrogen: Urine in blood to be filtered
- Ketones: present when fat is metabolized instead of glucose
- Glucose: spills into urine when BS is > 220
- Protein: should not be in urine
- Osmolarity: particles in solution 300-900 is WNL
What are common Diagnostics?
- KUB: Kidney, ureters and bladder x-ray
- IV Pyelogram: an X-ray that shows a picture of kidneys, the bladder, the ureters, and the urethra (urinary tract) can show size, shape and position of urinary tract)
- Cystoscopy: tube is inserted through your urethra and into your bladder
- Kidney Bx
What is the definition of cystitis?
- Inflammation of the bladder. Usually bacterial. Bacteria can attach to sperm or urinary catheter and travel up urethra to the bladder.
- 50% of pts with catheter get UTI
- Can be R/T abx or decreased immune system
What are the S&S of Cystitis?
- cloudy urine
- foul odor
- *Loss of appetite
- *in the elderly
What are the treatments for cystitis?
- CCMS Urinalysis, straight cath, FC
- Sulfonamides (Bactrim, Septra)- inhibit reproduction
- Fluorquinolones (cipro, Levofloxacin) inhibit reproduction
- PCN (Amoxial)- interrupt cell wall synthesis
- Cephalosporins (duricef)- interrupt cell wall sythesis
- Urninary Antispetics (Macrodantin)-inhibit bacterial reproduction
- Bladder Analgesics (Azo, pyridium) Relieves S&S but not the disease
What is incontinence? Stress inc? urge inc? Cyctocele? prolapsed uterus?
- Incont: involuntary loss of urine
- stress: during sneezing coughing, laughing, etc common after childbirth or menopause; (do pelvic floor exercises)
- Urge: (overactive bladder)- perception of an urgent need to urinate, leaking urine
- Cyctocele: herniation of the bladder into vaginal space
- Prolapsed uterus: herniation of uterus into vagina
What can be causes of altered anatomy of the urethra?
- female circumcision
- uterine prolapse
What is the treatment of cystocele/prolapsed bladder?
- Weight loss to decrease obesity which puts pressure on the bladder
- Antispasmotics: bladder muscle relaxation suppresses urge to void
- Marshall-Marchetti aka Bladder tuck, bladder suspension
- Collagen injection
What is Urolithiasis? Nephrolithiasis? Ureterolithiasis? What causes it? When is emergency tx needed?
- A calculi in the urinary tract. Renal colic when in ureters or urethra.
- Nephro: kidney stones
- Uretero: ureteral stones
- high acidity or alkalinity contributes to stone formation
- if blocking ureter, causes hydroureter-emergency treatment is needed
- Blockage leads to hydroureter leads to infection -> hydronephrosis -> permanent kidney damage
What are the S&S of Renal Colic?
- Flank pain "unbearable"
- increased BP and pulse
- increased WBC in urine
What is the treatment for Urolithiasis?
- Pain management
- Lithotripsy (shock waves)-breaks stone into small fragments
- Stent: placed by ureteroscopy-enlarges ureter for passage of stones; done under MAC
- Strain all urine
- Monitor WBC in urine
- Monitor for hematuria
What does a urinalysis test? what is normal for each?
- Color: should be clear yellow or clear, never cloudy. Can be dark yellow or amber when concentrated
- Specific gravity: particles in solution an increase in fluid = decreased sp gravity (1.010-1.030)
- pH: measures acidity or alkalinity
- Glucose: present in urine when BS > 220
- ketones: should be 0; present when fat metabolism instead of glucose
- C&S: do from front to back, look for bacteria
- Creatinine clearance: over 24 hours; measures GFR
How is bladder cancer treated? What if it is extensive? What is the care for bladder chemo?
- Bladder mucosal tumors are removed; tumor in muscle layers are excised and tx with chemo inside the bladder as a wash; Radical cystectomy with urinary diversion is used for more extensive CA followed by chemo and Radiation
- Bladder chemo: no fluids 1 hour prior
- administer thru catheter
- no voiding for 2 hours, change position q 15 minutes
- 1x/wk for 6 weeks and then q 6 mo x 2 years
What are the different type of surgical management for bladder Cancer?
- Cystectomy: removal of bladder with ureteral diversion
- Enterostomal therapist is consulted for stome placement
- TURBT: done through cystoscope (first line tx?)
- Segmental Cystoectomy: part of bladder removed
What is Polycystic kidney disease? S&S?
- autosomal Dominant inherited; cysts develop on nephrons
- S&S: pain in flank, HTN, Nocturia, increased UN and creat; increased abdominal girth
What is the treatment for Polycystic kidney disease?
decrease sodium intake; alanced I &O; anti-HTN; diuretics (furosemide); dialysis
What is Acute Glomerulonephritis? What are the S&S? how is it dx?
- AN infection that settles in the kineys, such as syphilis, Hep B, Chicken pox, M/M
- S&S: edema of face, eyelids, hands; Pulmonary congestion, SOB, crackles, Hematuria, proteinuria, increased BP, fatigue, anorexia N/V/A
- DX: kidney bx
What is the treatment for acute glomerulonephritis?
- Antibiotics: penicillin, erythromycin
- Diuretics-furosemide, NA restriction, H@O restriction
- Fluid 24 = 24 hr UO + 500mL
- manage s&s
What is chronic glomeruloneohritis? S&S? DX?
- Onset is incidious; over time kidneys may atrophy
- Mild S&S: proteinuria, hematuria, increased BP, fatigue, edema.
- Dx: biopsy
- *may lead to early stage renal disease -> dialysis -> transplant
What is Acute kidney injury? what are the causes?
- aka acute renal failure; sudden decrease in kidney function
- Causes: decreased perfusion; toxins-ingested, such as nephrotoxic drugs; obstruction
What are the types of AKI?
- Pre-renal: decreased blood flow to kindeys-> decreased UO-> lethargy
- Intrarenal: pysical or chemical damage- decreased LOC and UO, SOB, Increased P, crackles, edema
- Postrenal: Obstructive flow to kidneys- decreased UO
What are the phases of AKI?
- Onset: precipitating event
- Oliguric phase: UO is 100-400mL/24 hours (4-17 mLs/Hr (should be at least 30mL/hour; need hyperal, TPN, fat emulsion)
- Diuretic phase: UO up to 10L/24 hours
- recovery pase: balanced I&O, 2-4L/24 hr
What is Chronic Kidney Disease? What are the stages?
- Progressive and irreversible; leads to ESRD
- Stage 1: DM, HTN, Toxins-no S&S
- Stage 2: Mild- reduced GFR, manage DM, and HTN
- Stage 3: Moderate- Fluid restriction and electrolyte balance
- Stage 4: severe- dialysis and transplant
- Stage 5- ESRD- increased creat, potassium, sodium, EKG changes (from K+) metaolic acidosis; increased rate and depth of breaths (Koussmals?) breath may smell like urine, and uremic frost
What is peritoneal Dialysis? What should you monitor for?
- Dialysate infused through catherter in peritoneum
- Monitor inflow of dialysate
- Monitor outflow of dialysate
- Monitor electrolytes
- Monitor inflow site for infection
What is the criteria for hemodialysis? What does it do? What is in the dialysate? When do pts get it?
- Criteria: Uremia, increased K, metabolic acidosis, fluid overload
- Removes excess fluids and waste products from blood
- Hospital based or free standing dialysis center
- Dialysate: electrolytes, water, heparin
- 12 hrs/wk either MWF or TTHS