Renal Disease

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Renal Disease
2015-03-05 23:04:07

Complex care; renal disease; exam 2
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  1. 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
  2. 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)
    • CT
    • Cystoscopy: tube is inserted through your urethra and into your bladder  
    • Kidney Bx
  3. 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
  4. What are the S&S of Cystitis?
    • frequency 
    • urgency 
    • dysuria
    • nocturia 
    • cloudy urine 
    • foul odor 
    • *confusion
    • *incontinence 
    • *Loss of appetite
    • *in the elderly
  5. 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
  6. 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
  7. What can be causes of altered anatomy of the urethra?
    • cystocele 
    • female circumcision 
    • uterine prolapse
  8. 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
  9. 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
  10. What are the S&S of Renal Colic?
    • Flank pain "unbearable"
    • N/V 
    • Pallor 
    • Diaphoresis 
    • increased BP and pulse 
    • Hematuria 
    • increased WBC in urine
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. What is the treatment for Polycystic kidney disease?
    decrease sodium intake; alanced I &O; anti-HTN; diuretics (furosemide); dialysis
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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