Renal (test 10)

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What does renin do?
Regulates blood pressure
Where is the glomerulus
In the nephron - first step in urine formation
Normal GFR
125 mL/min
Older adult kidney points
- GFR and renal blood flow decrease - Lowered vitamin D - Lowered aldosterone and renin
Functions of the kidneys
- Excrete waste and water from body - maintain acid base balance and electrolyte balance - blood pressure regulation - erythropoietin (tells bone marrow to make RBC) - Synthesis of vitamin D
True or false? Kidneys and heart are closely related?
True. - Htn and kidney disease tend of be related.
- May color urine brown
May cause nephrotoxicity
Substances that may be nephrotoxic
- Anti-infectives - ACE inhibitors (prill) - antineoplastic agents - NSAIDS - Tylenol - Furosemide
What sound does a full bladder make
Dull sound
Normal Urine output
1-2 L in 24 hours (1,000-2,000 mL)
Normal urine specific gravity
Normal urine PH
Oliguria is defined as
less 30 mL/hr
urinary frequency
urinating more than every 2 hours
How quickly does a urinalysis need to be examined after collection
within one hour
Normal result of a urinalysis
-no protein - no glucose - no RBC - no WBC
Clean catch
wipe front to back - void 20-40 mL than collect rest midstream
Can you take a urine culture from a foley?
Yes, from the port or a brand new bag
24 hour urine collection
- Keep on ice or in fridge for 24 h - first void disgaurded - if any is spilled or lost, start over
Normal BUN
7-24 mg/dL
Normal creatinine
0.6-1.2 mg/dL
High BUN but normal creatinine?
Dehydration, HF, shock, high protein diet
X ray of kidneys, ureters, bladder - can see stones
IV pyelogram
IV dye given than x rays taken at different times after voiding
Retrograde pyelogram
-More intense than IV - dye directly into ureters - high risk of infection
Nsg care of patients post retrograde pyelogram
- dye may cause burning , flushing, bad taste in mouth - increase fluids after - antibiotics to prevent infection
- catheter into femoral artery into the renal artery - injects contrast dye - shows arterial supply to kidneys.
Nsg care post angiography
- increase fluids - check pedal pulses - bed rest 4-12 h
True or false: metformin is bad before contrast dye
Nitrates or nitrites normal in urine?
nitrites abnormal
Medications for incontinence
- Oxybutynin (anticholinergic) to lower bladder spasms - finasteride (androgen inhibitor) lower BPH
Nsg education for before measuring of residual urine
Instruct patient to empty bladder first
First sign of a UTI in the elderly
What is present in urine with a UTI
-Leukocytes - nitrites
What is the most common bacteria that causes a UTI
treatment for UTI
- Bactrim (trimethoprim-sulfisoxazole) - Cipro
Why does cranberry products help prevent UTIs
increases acidity of urine
- infection of the kidneys - untreated UTI can cause - repeated infections can cause scarring - effects overall kidney function
Symptoms of pyelonephritis (kidney infection)
flank pain that radiates to genitalia, fever, chills
Treatment of pyelonephritis
- Bactrim -Cipro
What can bactrim cause?
Urinary crystals - increase fluids to 3,000-4,000 mL
- Infection of glomerulus (in nephron) -becomes porous causing proteins, WBC, RBC, leak into urine - acute and chronic versions
Acute glomerulonephritis
- commonly related to strep infection - can lead to end stage kidney disease - kidney scarring
Chronic glomerulonephritis
- irreversible destruction of nephrons - kidneys atrophy - scar tissue replaces nephrons
S/S of glomerulonephritis
- fever - flank pain - edema - visual problems - smoky urine
Nsg management of glomerulonephritis
- Decrease sodium - decrease protein - overall lower work of kidney
Most common age group for bladder cancer
men 60-80
S/s of bladder cancer
- Painless hematuria - dysuria - urinary retention
- Flow of urine is obstructed, urine backs into renal pelvis - renal pelvis gets distended - increases pressure, damaging BV - kidneys stop working
Renal stones (lithiasis)
- r/t dehydration, urinary stasis, UTIs, increased uric acid and calcium
S/s of renal stones (lithiasis)
- sharp severe pain traveling from flank to suberpubic region - fever
Size of renal stones that can be passed
Less than 5mm
Uses laser and shock waves to break kidney stone apart
Continent urinary diversion
-Indiana/kock pouch - bladder created from ilium and ascending colon - emptied by inserting cath
Diabetic nephropathy
Hyperglycemia damages small BV in kidneys - most common cause of CKD - takes years to develop
True or false: patients with DM and kidney disease require less insulin
S/S of diabetic nephropathy
Oliguria (less than 30mL/hr)
Controlling diabetic nephropathy
- Strict control of CBGs - ACE or ARBS to slow progression - Dialysis if severe
widespread edema all over body
Acute renal failure
- Very sudden (hours to days) - Rapid accumulation of toxic waste (azotemia) - May be reversible - Kidney tissue is damaged, GFR decreases
What happens when GFR is decreased?
Less absorption and secretion in kidneys - holding onto waste
Why may a patient with kidney failure have low hemoglobin, RBC and other blood labs?
Because the kidneys secrete erythropoetin, which tells the bone marrow to produce RBC.
Nsg management for patients with acute renal failure
- Edema monitoring - I and Os - Daily weights - monitor for anemia - D/C nephrotoxic drugs
Three causes of acute renal failure
- Pre-renal -Intrarenal - Postrenal
Pre-renal acute kidney failure
Caused by low blood flow and oxygen to kidneys - r/t: shock - CHF - Sepsis - Anaphalxis - PE
Intrarenal acute kidney failure
Caused by direct tissue damage in the kidneys - r/t: nephritis - nephrotoxins - glomerulonephritis - DM
Postrenal acute kidney failure
Caused by obstruction in bladder, urethra, ureters - r/t: urethral obstruction - BPH - urethral stricture
Why are disarrythmias of the heart common in people with kidney problems?
Because of electrolyte imbalances
Chronic renal failure
-Progressive and irreversible damage - nephrons destroyed - body cannot maintain electrolyte and fluid balance
What can CRF lead to
- Fluid overload - HTN - dysarrythmias - anemia - dry itchy skin (with ammonia odor)
AV fistula
- Joining of artery and vein to make bigger - 6-8 weeks before usable
AV graft
Using synthetic tube to connect artery and vein - useable within 24 h
Nursing education for patients with dialysis access on arm
- Never sleep on arm - no watches on arm - no constrictive clothing - no severe bending - do not hang off bed
Nursing care for dialysis
- daily weights - intake and output - VS especially BP - assess site often
Kidney transplant
-Sometimes used for patients with CRF - many times 1 can do work of 2 kidneys - usually family donor - protective isolation and anti rejection drugs (lowers immune system)
Are anti hypertensive meds given day of dialysis?
No! - dialysis already causes pressure drop
Are nitroglycerine and other vasodialators given on the day of dialysis?
no! - dialysis already causes pressure drop
Do you hold anticoagulants before dialysis?
Yes. - anticoagulants already given while getting dialysis.
What three meds are held before dialysis
- antihypertenives - vasodialtors - anticoagulants
Nursing care after fistula or graft placement
Elevate fistula or graft for 24-48 hr to help with flow
Check the fistula or graft for a __
bruit (whooshing sound)
The kidneys metabolize what vitamin into active form
Vitamin D
recommended daily water intake
2000-2500 mL
Urge incontinence
loss of urine when there is a strong urge
Stress incontinence
Sneezing, laughing, coughing causes increased abd pressure and sphincter fails
Functional incontinence
caused by inability to recognize need to urinate such as during extreme depression
Neurological incontinence
Spinal cord injury, ect. causes loss of urinary control
Kegals steps and instructions
-practice for several days each time you urinate, stop stream - tighten muscles while counting to three - repeat 15 times - do once a day
Should inability to urinate 4-8 hours after cath removal
Report to provider
what is considered a normal amount of residual urine
inflammation of the bladder
BCG treatments
solution is instilled into bladder - tx for bladder cancer - pt position is changed every 15-30 min to coat bladder
Urinary stoma pouch cleaning
- One part vinegar one part water