MS: Urinary + Kidney

Cause of stress incontinence?

Decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease

Which muscle loses contraction strength and is related to Urinary Retention as we age?

Detrusor muscle

A low urine specific gravity occurs in the following three situations:

Diabetes Insipidus (low ADH) Pyelonephritis & glomerulonephritis (dilute urine) Renal Failure (urine concentration is same as plasma)

most common cause of UTI

E. coli

Hypokalemia S/S

Fatigue, Anorexia, N/V, Muscle weakness, Decreased GI motility, Dysrhythmias, Paresthesia, Flat T waves on ECG

Excess calcium treatment

Fluid replacement (calcium is excreted in the urine), calcitonin, phosphate salts (calcium and phosphorus have an inverse relationship)

Creatinine is a good indicator for

GFR

Cause of glomerulonephritis

Group A strep infection occurs mostly in children after an infection of Impetigo or pharyngitis

diet for patients with acute kidney injury

High Calorie, LOW protein, LOW potassium, low sodium diet

Hyperkalemia treatment "KIND"

Kayexalate (orally/ enema) Insulin or IV diuretics Na HCO3 (reverse acidosis) Diuretics (Furosemide & Thiazides)

What are Ketones

Ketones are produced when the body burns fat for energy and fuel. Ketones occur when there is not enough insulin to help the body use sugar for energy. Since the body cannot use glucose for energy, it begins to breakdown fats leading to the formation of Ketones in the blood that spill over into the urine.

What diet restrictions should pt with CKD be on?

*Protein restriction (during elevated BUN)

Signs of transplant rejection

- Flank pain - Fever - Generalized edema peri-orbital edema - Oliguria or anuria - Hypertension - Malaise - Elevated BUN or creatinine levels - Decreased creatinine clearance

bladder retraining program

- establish voiding Schedule times - Hold urine until scheduled time - ask client to void BEFORE the scan - urinary catheterization is not performed unless the bladder scan indicates a residual greater than 300 ml

Normal Creatinine

0.6-1.2

normal urine specific gravity

1.002-1.028

normal urine specific gravity in infants less than four weeks old

1.003

Urine specific gravity for Hypervolemia

1.009

Normal BUN

10-20

Normal Urine Output

1200-1500mL/daily **postoperative period, urine volumes are monitored hourly. Notify Provider if less than 30 mL/hour

Normal GFR? 5 Stages of ESRD based on GFR?

125 mL/min Stage I diminished kidney function GFR 90 Stage II GFR of 60-89 Stage III GFR of 30-59 Stage IV GFR 15-29 Stage V GFR < 15 (require Dialysis or Transplant to prevent death)

Anuria

24 hr urine output <50 or 100ml

Normal urine output

30-50 mL/hr or 0.5-1 mL/kg/hr

Overflow Incontinence vs Functional Incontinence

Overflow incontinence - incomplete emptying of bladder leading to increased frequency or dribbling Functional - related to Alzheimer's, Parkinson's, arthritis in older adults inability to control bladder

Ditropan

Oxybutynin treat Overactive Bladder

Urinary catheter nursing interventions

Performed using Sterile Technique Urinary bags are kept lower than the hips to prevent flowback of urine Check for kinks Condom caths are changed daily

4 Phases of Acute Renal Failure

Phase 1 - Acute tubular necrosis (ATN) reduced blood flow to the nephrons Phase 2 - Oliguric Phase 3 - Diuresis (dehydration) Phase 4 - Recovery(Restoration of glomerular function, if it occurs)

RIFLE (5 point classification system of acute kidney injury)

R - risk I - injury F - failure L - loss E - ESKD/ESRD 1st 3 are grades of severity and the last 2 are outcomes

Stress Incontinence vs Reflex Incontinence (or urge)

Stress incontinence - involuntary loss of urine from sneezing, coughing, or changing position. Reflex incontinence is the involuntary loss of urine because of hyperreflexia in the absence of normal sensations usually associated with voiding.

Hyperkalemia symptoms

Symptoms- diarrhea, cramping, irritability, cardiac dysrhythmias, muscle weakness, paresthesia

Nephrotoxic drugs

aminoglycosides. amphotericin B. ACE inhibitors. cicplatin. cyclosporin. NSAIDS. Radiographic I V contrasts.

kidney stones (renal calculi)

clumping together of calcium phosphate crystals, uric acid, and other substances in the kidneys

Urine flows through the urinary system in which order?

collecting tubule of nephron > renal pelvis > ureters > bladder > urethra

What are the filtrates that are secreted in the urine?

contains water, sodium, chloride, bicarbonate, potassium, urea, creatinine, and uric acid.

Pain to __________ suggest nephritis/pyelonephritis/Renal calculi

costovertebral angle

Most accurate way to measure fluid volume deficit/overload

daily weights1 Kg loss or gain is equal to 1 Liter of fluid (or 2.2 lbs)

signs of glomerulonephritis

dark - cola colored urine, edema (starts in the face), oliguria, hematuria, proteinuria, azotemia

urine dipstick

detects nitrite, effective when used on first morning void

leading cause of CKD

diabetes hypertension (2nd)

24 Hour urine collection:

discard first urine if any urine is accidentally thrown away then collection needs to be repeated It tests for hormones and chemicals

Neobladder

diversion by creating a bladder from large or small intestine and urine flows through the urethra

Overflow incontinence is due to obstruction from?

fecal impaction or enlarged prostate.

Signs of a bladder infection

fever, chills, and suprapubic pain.

neurogenic bladder

impairment of bladder control due to brain or nerve conduction

struvite stones are associated with

infection in the upper tract, neurogenic bladder and foreign bodies. **A kidney stone is made from chemicals in the urine

enuresis

involuntary nocturnal urinating bed wetting

A client with hyperparathyroidism is at risk for

kidney stones

The normal BUN:Cr ratio is l

less than 15

Crede maneuver

massage or exert pressure on the bladder to help patient void, used in the case of clients who have lost control over their nervous systems, secondary to injury or disease.

Most common cause of urosepsis

obstruction of the free-flowing urine. More common in women than in men

Urine PH

pH scale ranges from 0-14 normal pH range is 4.6-8.0, below 4.6 is more acidic, and above 8.0 is considered alkaline.

The most common first symptom of a malignant tumor of the bladder

painless hematuria

Hallmark sign of nephrotic syndrome

proteinuria in the form of hyperalbuminuria > 3.5 - 4.8 (excretion of albumin in urine)

MAG3 Renogram

pt given injection containing radioactive material which shows how kidneys are functioning. Pt needs to lie still for 35 minutes while special cameras take images.

oliguria

scanty production of urine

Alerting signs of urosepsis

severe clinical manifestation of UTI, with systemic response. Hallmark signs: FEVER TACHYCARDIA TACHYPNEA RESP. ALKALOSIS

Anasarca

severe generalized edema

Foods high in purine

shellfish, anchovies, asparagus, mushrooms, and organ meats. Teach patient to avoid this diet to prevent uric acid stones

Aldosterone promotes _____ retention and _____ excretion

sodium potassium **helps control the balance of water and salts in the kidney by keeping sodium in (thereby increasing water in the body) and releasing potassium from the body

The most common site of renal calculi formation is

the kidney

percutaneous nephrolithotomy

the surgical removal of a nephrolith through a small incision in the back **Monitor for risk of Infection

azotemia

urea in the blood

ileal conduit

urinary diversion in which the ureters are connected to the ileum with a stoma created on the abdominal wall (non-continent type, no bladder control)

Oliguria

urine output less than 500 mL in 24 hours or output is less than 30 mL/h ( <0.5 mL/kg/h)

Formula for calculating Fluid retention based on patient weight

A 1-kg weight gain is equal to 1,000 mL of retained fluid. example: 4 kg × 1,000 = 4,000.

Urine gravity for frank dehydration

A urine specific gravity that is more than 1.035

kidney stone pharma treatment

Allopurinol (control acid in urine) HCTZ (decrease calcium) Thiola & Cuprimine Acetohydroxamic acid - used with antibiotics

Urine diagnostic tests: Angiography Radiography CT Cystoscopy

Angiography tests arterial supply to the kidneys. Radiography shows the size and position of the kidneys, ureters, and bladder. CT scan used for calculi, congenital abnormalities, obstruction, infections, and polycystic diseases. Cystoscopy visual examination of the internal bladder using lighted tube with a telescopic lens.

What is the most effective intravesical agent for recurrent bladder cancer?

Bacillus Calmette-Guérin (BCG)

Different color urine indicates?

Bright yellow = taking multivitamin Orange = taking phenytoin Amber = dehydration pink/red = bleeding yellow/cloudy = infection, pyuria cola color = glomerulonephritis

Magnesium excess treatment

Calcium Gluconate

Diet teaching for end-stage renal failure.

Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown of protein leads to urea, uric acid, and organic acids to accumulate quickly in the blood.

As renal failure progresses and the glomerular filtration rate (GFR) falls, which of the following changes occur?

Changes include hyperphosphatemia due to its decreased renal excretion, hypocalcemia and decreased vitamin D activation, hyperkalemia due to decreased potassium excretion, and metabolic acidosis from decreased acid secretion by the kidney and inability to regenerate bicarbonate.

What are the Functions of the kidneys?

Control of water balance and blood pressure, regulation of red blood cell production, synthesis of vitamin D to active form, and secretion of prostaglandins

24 hour kidney rejection

Hyper acute rejection (remove the new kidney immediately)

Sodium deficit treatment

Hypertonic saline solutions

Transient incontinence is due to?

Increased urine production related to metabolic conditions.

Indwelling vs. Straight catheter

Indwelling Catheter (Foley)-remains inserted in the bladder by means of a balloon for a period of time, the urine drains into a drainage bag. Straight Catheter performed by RN tube placed into bladder and removed immediately after urination.

peritoneal dialysis, interventions to facilitate drainage

NEVER milk tubing, turn patient side to side or elevate HOB. NEVER push catheter further in the abdomen. Check patency & abdominal girth. Maintain strict handwashing and wear mask (aseptic)

Which drugs are effective treatment for renal stone pain, and inhibit the synthesis of prostaglandin E, reducing swelling and facilitating passage of the stone?

NSAIDs, such as ketorolac (Toradol)

Differentiate: Nephrectomy Partial Nephrectomy Radical Nephrectomy

Nephrectomy - removal of all part of a kidney Partial Nephrectomy - (kidney sparing) only remove diseased tissue Radical Nephrectomy - remove entire kidney, plus other structures i.e. ureter, lymph nodes, adrenal gland

The Nephron is consist of?

Nephron-the functional unit of the kidney and is consist of: >Glomerulus (filtration) >Bowman's capsule >Tubular System

Why is a kidney, ureter, and bladder (KUB) x-ray used?

Reveal obstructions such as calculi, cysts, or tumors. NOT used to check renal function or diagnose CKD

__________ is the more sensitive indicator of renal function because of its constant production in the body.

Serum Creatinine

What is used to decrease potassium level seen in acute renal failure?

Sodium polystyrene sulfonate [Kayexalate]

Indiana pouch (kock pouch)

The surgeon introduces the ureters into a segment of ileum and cecum. Urine is drained periodically by INSERTING A CATHETER into the stoma. (continent type)