CC Renal Disease

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  1. 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)
  2. How are renal diseases commonly diagnosed?
    • KUB (kidneys, ureters, bladder xray)
    • IV Pyelogram (check for shellfish allergies)
    • CT
    • Cystoscopy
    • Kidney Biopsy
  3. 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
  4. 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
  5. 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
  6. Define Cystocele and prolapsed uterus
    • Cystocele:herniation of the bladder into the vaginal space
    • Prolapsed Uterus: herniation of the uterus into
  7. 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
  8. 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
  9. What are the s/s of kidney stones?
    • Renal Colic- unbearable flank pain
    • N/V
    • Diaphoresis
    • Increased BP, HR
    • Pallor
    • Hematuria
    • Increase in WBCs in urine
    • Oliguria-->anuria is a sign of obstruction and is an emergency
  10. 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
  11. Describe a normal urinalysis
    • Color: clear yellow or amber, never cloudy
    • Specific gravity: Increase in fluid intake decreases specific gravity. 1.000-1.030
    • pH:4.5-8
    • 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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
Card Set
CC Renal Disease
For Gordon's Exam 2
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