Renal/Urinary System

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Medical-Surgical Nursing
Chapters 65-68
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1

Function of kidneys

Maintain body fluid volume and composition and filter waste products for elimination

regulate BP, acid-base balance, produce erythropoietin for RBC synthesis and convert vit D to an active form

2

larger than usual kidneys may indicate___

obstruction or polycystic disease

3

smaller than usual kidneys may indicate___

chronic kidney disease (CKD)

4

blood flow to kidneys ____mL/min

____ artery supplies kidney which branches from the _____

600-1300mL/min

renal artery supplies kidneys which branches from the abdominal aorta

5

smallest arteries that feed the nephrons to directly form urine

afferent arterioles

6

blood/urine flow through the nephron

afferent arteriole--> glomerulus(specialized capillary loops)-->water and small particles are filtered from the blood to make urine-->remaining blood leaves the glomerulus through the efferent arteriole(first vessel in kidney's venous system

7

renin is produced in the juxtaglomerular complex (special cells in the afferent and efferent arteriole)

when the macula densa sense changes in blood pressure, blood volume, or blood sodium levels are low

renin is converted to angiotension 1, which causes the production of angiotension 2, which causes secretion of aldosterone

8

what does angiotension 2 do?

increases systemic bp through powerful blood vessel constriction increasing peripheral resistance

triggers release of aldosterone

constriction of afferent arterioles in kidney nephron (which decreases glomerular filtration, which decreases urine formation, which increases water and sodium reabsorption)

9

what does aldosterone do

regulates fluid and electrolyte balance by increasing kidney reabsorption of sodium and water and restoring bp, blood volume, and blood sodium levels (preventing fluid loss and maintains circulating blood volume)

also promotes excretion of potassium

10

particles to large to pass through the glomerular capillary walls and not normally present in urine

blood cells, albumin, other proteins

11

when systolic bp drops below ____, the self-regulation processes are not effective at maintaining GFR

65-70 mm Hg

12

what does vasopressin (antidiuretic hormone) do?

increases arteriole constriction(which alters bp), increases tubular permeability to water, promotes reabsorption in PCT

13

renal threshold/transport maxium (tm)

the limit to how much glucose can be absorbed in the kidneys, about 220 mg/dL, if glucose is in the urine, it is because the threshold has been met

14

prostaglandins

produced in kidneys and other tissues

prostaglandins produced in kidneys regulate glomerular filtration, kidney vascular resistance and renin production

increase sodium and water excreion

15

erythropoietin

produced and released in response to decreased oxygen tension in kidney's blood supply. triggers RBC production in bone marrow

when kidney function is poor, erythropoietin production decreases and the person develops anemia

16

vitamin D active form

needed to absorb calcium in the intestinal tract and to regulate calcium balance

17

micturation

urination

18

normal GFR rate

125 mL/min

19

GFR above age 65

65mL/min (half the rate of a younger person)

20

drugs that can impair kidney function

gentamicin, contrast dye, dietary supplements with synthetic creatine, high dose or long term usage of NSAIDs and acetaminophen, metformin

21

renal colic

severe and spasmodic pain that radiates into the perineal area, groin, scrotum, or labia

diaphoresis, pallor, and hypotension may occur as well as other GI symptoms

22

uremia

build up of nitrogenous waste product in the blood as a result if kidney damage

23

manifestations of ureamia

anorexia, nausea and vomiting, muscle cramps, pruritus, fatigue, and lethargy

24

serum creatinine

produced when muscle and other proteins are broken down, normal range: male 0.6-1.2 mg/dL female 0.5-1.1 mg/dL

levels are slightly higher in men and athletes, older adults may be decreased

*no common pathologic condition other than kidney disease increases the serum creatinine level

25

BUN

10-20 mg/dL older adults 8-23 mg/dL

measures effectiveness of kidney excretion of urea nitrogen.

also increased with dehydration and cell destruction due to infection, cancer treatment, or steroid treatment or injured tissues

26

BUN to creatinine ratio

6-25

increased indicates fluid volume deficit

decreased indicates fluid volume excess

27

blood osmolarity

indicates hydration status

285-295 mOsm/L

28

specific gravity

1.005-1.030

increased indicates concentrated urine

decreased indicates dilute urine (CKD)

29

wbc in urine

indicate urinary tract infection or kidney infection

30

rbc in urine

indicates glomerulonephritis, acute tubular necrosis, pyeloephritis, kidney trauma, or kidney cancer

31

precautions for contrast dye

contrast-induced nephropathy is onset of AKI within 24-72 hrs post iodine administration

older patients, dehydrated, pre-existing renal insufficiency, creatinine >1.5, GFR <45, also taking other nephrotoxic drugs

Discontinue Metformin 24 hrs before and 48 hrs after contrast administration. Kidney function must be re-evaluated before resuming Metformin. At risk for lactic acidosis!

32

stress incontinence

unable to tighten the urethra sufficiently to overcome the increased pressure, then leak urine.

urine loss with physical exertion, cough, sneeze, or exercise.

diuretics, nicotine, citrus, caffine

teach kegel exercises 15x lying, sitting, standing, 3x a day

33

urge incontinence

involuntary loss of urine associated with a strong desire to urine .

an abrupt and strong urge to void, may loose large amounts of urine

34

mixed incontenice

more than one type ie. stress and urge

mostly in older women

35

overflow incontinince

when detrusor mscle fails to contract and the bladder becomes overdistended. bladder is at max capacity and some urine must leak out

36

functional incontinence

occurring due to other factors than the abnormal function of the bladder and urethra. ie loss of cognition, decreased mobility

37

cystitis

inflammation of bladder due to infection

38

pyelonephritis

inflammation of upper urinary tract (kidneys)

39

90% cystitis is due to ___

E. coli

40

prostatitis

inflamation of prostate

41

risk factors for UTI

  • Obstruction
  • Stones
  • Vesicoureteral reflux
  • Other disorders
  • Characteristics of urine
  • Gender
  • Age
  • Sexual Activity
  • Catheterization
  • Medications
42

How much to help with UTI?

cranberry juice

apple cider vineger

50mL

2tbs

43

cranberry juice is contraindicated in people who take ___

warfrin

44

urinalysis

need 10mL

45

how much urine needed for urine culture

need 3mL

46

how much urine for clean catch

30 mL

47

cystoscopy

used when a patient has multiple uti's a year

48

Nursing interventions

foods/drinks to avoid when you have a UTI

low heat

caffeine

citrus

chocolate

alcohol

spicy foods

49

Sulfonamides

*Trimethoprim

*Bactrim (sulfamethoazole)

watch for allergies

50

PCN

Amoxicillin (Amoxil)

Augmentin (amoxicillin/clavulate)

Can cause GI upset, take with food

51

Fluoroquinolones

Ciprofloxacin (Cipro)

Levofloxacin (Levaquin)

Hold antacids within 2hs of medication

52

Cephalosporins

cefpodoxime

be aware of possible allergy if allergic to pcn

53

Urinary Antiseptics

*Nitrofurantoin (Macrodantin, Macrobid)

nephro toxic, drink with full glass of water

54

Antifungal

  • Amphotericin - May be used with bladder irrigation
  • Flucanozole - Drug of choice for yeast infection
55

Bladder Analgesics

Phenazopyridine (Pyridium)

Take immediately after a meal

Urine will turn reddish

56

Antispasmodics

Hyoscyamine (Anaspaz & Cyctospaz)

57

Treatment of urethral strictures

  • Temporary (Dilation)
  • Permanent (Stent placement)
  • Urethroplasty – removal of affected are w/wo grafting
58

urinary retention can be caused by

opioids

sedative

anticholinergic

calcium channel blockers

59

how much urine should be in your bladder after urination

<50 mL

60

detrol

causes bladder to relax and suppresses the urge to void

61

ditropan

bladder relaxant

62

urolithiasis

stones in urethra

63

ureterolithiasis

stones in ureters

64

hydroureter

ureter dilates from the stone

65

hydronephrosis

blockage due to stone causes kidney to swell with urine

66

kidney stone risk factors

white, male, metabolic issues (obesity, diabetes, gout), those who first occurred by age 25, hyperthyroid issues, bowel disease/GI problems

67

oliguria

scant urine

68

prevention of kidney stones

walking, 2000-3000 mL fluid intake

69

polycystic kidney disease

fluid filled cysts develop in the neprons, as they get larger, kidney loses function

70

first symptom of PKD

abdominal pain, flank pain

71

problems with PKD

hematuria, high bp, nocturia, edema, constipation, sodium wasting, flank pain, progression to anuria

72

manage pain with PKD

  • NSAIDS, but NO ASA
  • Antibiotics
  • Dry heat to abdomen or flank
  • Needle aspiration
  • Deep breathing, relaxation
73

prevent constipation

  • Adequate fluid intake
  • Increased fiber
  • Exercise Regularly
  • Stool Softeners and Bulk Agents; use caution with laxatives
74

nephrosotomy

npo 4-6 hrs

pt, INR, ptt must be evaluated

drugs to decrease hypertension

assesss drainage in bags qhour for first 24 hr

blood tinged for first 12-24hr

75

pyelonephritis vs glomerulornephritis

pylelo-infection

glomerulo-immunologic

76

acute vs chronic pyelonephritis

acute-pain, n/v, burning, frequency

chronic- Hypertension, Inability to conserve Na+, Decreased urine concentrating ability à Nocturia, Tendency for hyperkalemia and acidosis

77

glomerulornephritis

urine looks like coffee

acute=positive throat culture for strep

always leads to end stage kidney disease

78

fluid restrition

last 24 hr urine output + 500mL (to account for insensible loss)

79

potassium sparing diuretic

spirinolactone

80

polycysitic kidney disease pt and family education

measure and record bp daily

notify hcp if you get a temp

weigh daily, notify hcp if sudden weight gain

limit salt intake to control bp, but not if sodium wasting

limit protein intake

notify hcp if urine smells foul or has blood in it

notify hcp if you had a ha that doesn't go away or with visual disturbances

monitor bowel movements to prevent constipation

81

AKI caused by reduced perfusion is called _____

prerenal

most common cause

82

AKI caused by damage to kidney tissue is called ____

intrarenal or intrinsic renal failure

reflects injury to the glomeruli, nephrons, or tubules

83

AKI caused by obstruction of flow is called _____

postrenal

84

Stage 1 CKD

AT RISK

GFR >90, screen for risk factors and manage care to reduce risk: uncontrolled hypertension, DM, chronic kidney or UTI, genetic hx, exposure to nephrotoxic substances

85

Stage 2 CKD

Mild CKD

GFR 60-89, focus on reduction of risk factors

Increased output of dilute urine, monitor for dehydration

86

Stage 3 CKD

Moderate CKD

GFR 30-59, Implement strategies to slow disease progression

restriction of fluids, proteins, and electrolytes

87

Stage 4 CKD

Severe CKD

GFR 15-29, Manage complications, discuss pt prefrences and values, educate about options and prepare for renal replacement therapy

88

Stage 5 CKD

End Stage CKD

GFR <15, implement renal replacement therapy