Kidneys
The nurse is providing discharge instructions to the client with acute post-streptococcal glomerulonephritis. Which statement by the client indicates a need for further teaching?
"I should drink as much as possible to keep my kidneys working."
A patient who has been diagnosed with a small kidney stone has been told to increase fluid intake. The patient wants to know why this is necessary. What is the nurse's best response?
"This will increase urine production and help move the stone from your system."
what is stage 5 kidney disease?
- GFR<15 - kidney failure - transplant or dialysis is necessary
what cardiovascular finding would be seen with ESRD?
- HTN - heart failure - pulmonary edema - pericarditis
what lab values would decrease with ESRD?
- Na - hyponatremia due to fluid retention - RBC - causes anemia - calcium - causes fractures
A client is experiencing a decreasing glomerular filtration. What laboratory values should the nurse expect to follow the change?
- Serum creatinine increases - Creatinine clearance decreases - Blood urea nitrogen (BUN) increases
what are the signs and symptoms of polycystic kidney disease?
- UTIs - hematuria - flank pain - hypertension - discomfort
what are the signs and symptoms of chronic pyelonephritis?
- acute exacerbation fatigue - headache - poor appetite - polyuria - thirst - weight loss
what are the signs and symptoms of hypokalemia?
- anorexia, nausea, vomiting - weak peripheral pulses - muscle weakness, paresthesias, decreased deep tendon reflexes - impaired urine concentration - ventricular dysrhythmias - an increased instance of dig toxicity - shallow respirations
how is peritoneal dialysis performed?
- aseptic technique with a mask - fluids should be body temperature
what drugs would be given for ESRD?
- calcium and phosphorus binder - due to decrease calcium causing bone issues - antihypertensives and diuretics - antiseizure medications for hyponatremia - erythropoietin to increase RBC production - 3% saline and salt tablets for hyponatremia
what are the two different types of peritoneal dialysis?
- continuous ambulatory peritoneal dialysis (CAPD) - continuous cyclic peritoneal dialysis (CCPD)
what is the treatment for polycystic kidney disease?
- control BP - diuretics
what lab values would increase with ESRD?
- creatinine - BUN - potassium
what is continuous cyclic peritoneal dialysis (CCPD)?
- cycler machine used over night to perform exchanges - final fill in the morning before the catheter is capped - dialysate remains in cavity until bedtime - lower infection rate than other forms of PD because of less hookup
what are the 5 major risk factors according to healthy people 2030 for ESRD?
- diabetes - HTN - proteinuria - family history - increased age
what should be monitored with peritoneal dialysis?
- drainage - pink haze in dialysate could mean bleeding - electrolyte
what are the symptoms seen with a UTI or other urinary tract dysfunctions?
- fatigue - pain - void changes (polyuria, oliguria, frequency, urgency, dysuria, and hesitancy)
what treatments are there for renal calculi?
- force fluids and strain urine to see if stone passed - medications: analgesics, anti-spasmodics, antibiotics - extracorporeal shock wave lithotripsy (ESWL) - blast stones - surgical interventions
what are other less common causes of ESRD?
- glomerulonephritis - pyelonephritis - polycystic kidney disease - urinary tract obstructions (causes inflammation and damage to kidneys)
what is continuous ambulatory peritoneal dialysis (CAPD)?
- machine free dialysis - 4-5 exchanges per day/4-6 hours - final exchange dwells in peritoneal cavity overnight - less extreme fluctuations in lab values - increased risk for infection due to increased hookups
what GI/GU finding would be seen with ESRD?
- metallic taste in mouth - N/V - hiccups - decreased libido - erectile dysfunction
what are 2 common occurrences with UTIs in elderly?
- might not have very many symptoms so they aren't caught early which can lead to a bladder infection and sepsis - can create confusion - don't assume confusion is normal for elderly
what nursing diagnoses would be seen with renal calculi?
- pain - decreased comfort
what is peritoneal dialysis?
- peritoneal is the dialyzing cavity - requires permanent catheter in peritoneal cavity - increased patient control and flexibility - typically overnight
what would a patient want to increase in their diet if they have ESRD?
- phosphorus - sodium (for hyponatremia)
what is the benefit of a fistula for dialysis?
- prevents needing a new line
what treatments are used for chronic pyelonephritis?
- prophylactic antibiotics - surgery if chronic pyelonephritis is caused by renal calculi (pyelolithotomy, nephrostomy, & ureteroplasty)
what would a patient want to restrict in their diet if they have ESRD?
- protein - potassium (for hyperkalemia) - fluids
what integumentary finding would be seen with ESRD?
- pruritus - uremic frost - waxy and yellow appearance of skin
what are the functions of the kidneys?
- renal clearance - regulation of RBC production - regulation of water excretion - regulation of electrolyte excretion - regulation of acid-base balance - vitamin D synthesis - autoregulation of blood pressure - excretion of waste product - drugs
what are complications of chronic pyelonephritis?
- septic shock - hypertension - chronic kidney disease
what are signs and symptoms of renal calculi?
- severe flank pain - renal colic - fever - urinary frequency - diaphoresis, pallor, N/V - hematuria - oliguria/anuria - if stone completely obstructs
what are some nursing considerations for glomerulonephritis?
- strict I and O's - labs - patient education - weighing patient
normal creatine
0.6-1.2
how many nephrons are in 1 kidney?
1 million
normal BUN
10-20
Normal BUN:Creatinine ratio
10:1
what is the normal glomerular filtration rate?
125 - 200 mL/min
what many stages of renal disease are there?
5
table 26-7
?
A patient with a history of type 1 diabetes is being assessed for possible diabetic nephropathy, and a component of the ordered diagnostic evaluation is a urinalysis. This patient's ability to concentrate urine would be reflected in what component of urinalysis?
Osmolality
what are the signs and symptoms of acute pyelonephritis?
acutely ill will chills, fever, elevated WBCs, abdominal/low back pain, N/V, fatigue, and symptoms of UTI - think s/s of infections in general
what hormone controls tubular reabsoprtion?
aldosterone
what is a nurses responsibility when it comes to a fistula for dialysis?
assess for a bruit and a thrill - this is good and means the fistula is open - if a bruit and a thrill are not found then this should be the nurse's priority because there is no access for dialysis
what is prerenal failure?
at risk for developing renal failure - occurs as a result of a reduction in blood flow to the kidneys
what is a complication of chronic glomerulonephritis?
end-stage renal disease - 3rd most common cause of kidney failure
how to the kidneys regulate RBC production?
erythropoietin - increases erythropoietin when there is a decrease in oxygen
how can you help prevent renal calculi?
especially important for people with hyperparathyroidism - decreased calcium in the diet - hydration
how can chronic glomerulonephritis sometimes be diagnosed?
eye exam - retinal damage or hemorrhage - vascular changes
A client with chronic renal failure (CRF) has developed faulty red blood cell (RBC) production. The nurse should monitor this client for:
fatigue and weakness - RBCs carry oxygen throughout the body. Decreased RBC production diminishes cellular oxygen, leading to fatigue and weakness - dyspnea and cyanosis are associated with fluid excess
what is the best and least invasive medical management for renal calculi?
force fluids and strain urine to see if stone has passed
what is nephrolithiasis?
formation of stones in the kidney
what can be another cause of UTIs that is not bacteria?
fungal infection - would require at antifungal drug
how do you get polycystic kidney disease?
genetic
what abnormal finding would be seen in an urinalysis of a patient with ESRD?
glucose and protein (especially with diabetes causing kidney damage)
what can be added to peritoneal dialysis?
heparin, insulin, antibiotics
A client in chronic renal failure becomes confused and complains of abdominal cramping, racing heart rate, and numbness of the extremities. The nurse relates these symptoms to which of the following lab values?
hyperkalemia
what are common symptoms of dialysis?
hypotension because of fluid being removed - also muscle cramping similar to dehydration - air embolisms are rare but serious
what can cause prerenal failure?
hypotension because the kidneys do not have adequate blood flow
What is pyelonephritis?
infection and inflammation in kidney, pelvis, medulla
what is acute glomerulonephritis?
inflammation of the glomerular capillaries often after a streptococcal infection - but not always after an infection (glomerulonephritis itself is not an infection of the kidneys)
What is glomerulonephritis?
inflammation of the glomerulus - kidney disease that affects blood filtering - can't get rid of toxins or waste
what is polycystic kidney disease?
inherited disorder - kidneys enlarged due to cysts - other organs such a liver and spleen may also have cysts
what is the fluid output like for peritoneal dialysis?
more fluid should be coming out than what is going in - what goes in most come out - if fluid is not coming out check for a kink or change positions
what are treatments for acute glomerulonephritis?
mostly treating symptoms - protein and sodium restriction - loop diuretics and antihypertensives - corticosteroids and immunosuppressants - antibiotics only if there is an infection causing acute glomerulonephritis
what is the functional unit of the kidney?
nephron
what is the urine output like for a patient on hemodialysis?
no urine output or minimal because fluid is already removed
if a patient has a predisposition for UTIs what might occur?
prophylactic antibiotics - low dose of an antibiotic given everyday - better than 4 rounds of antibiotics - prevents resistance - would occur if a patient gets 4-5 UTIs yearly
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?
renin
what is chronic pyelonephritis?
repeated infections that cause progressive inflammation and scarring - kidneys become contracted and non-functional - progressive kidney injury can lead to renal failure
what is the medical management for chronic glomerulonephritis?
reverse renal impairment and eliminate underlying cause
The nurse is instructing the client who was newly diagnosed with peptic ulcers. Which of the following diagnostic studies would the nurse anticipate reviewing with the client?
serum antibodies for H. pylori
how do the kidneys autoregulate blood pressure?
the RAA system - renin angiotensin aldosterone system
what is osmolality?
the concentration of a solution expressed as the total number of solute particles per kilogram
what is dialysate?
the fluid used in dialysis - removes waste material from the blood & keeps useful material from leaving blood - pulls out solutes from the blood so it can be refiltered into the patient - uses osmosis and semipermeable membrane - requires lab values before concentrating the dialysate
What is osmolarity?
the measure of the total concentration of solute particles in liters
What is tubular secretion?
the movement of substances from the blood into the tubular fluid
what is glomerular filtration?
the movement of substances from the blood within the glomerulus into the capsular space - 1200ml/min of blood is filtered into the nephron
What is tubular reabsorption?
the movement of substances from the tubular fluid back into the blood - goes back into system
what does osmolality and osmolarity measure?
the ratio of solute to water in the blood or urine - determine the concentration of urine
what is uremic frost?
urea crystals that come through the skin with perspiration
A client is admitted for treatment of chronic renal failure (CRF). The nurse knows that this disorder increases the client's risk of:
water and sodium retention secondary to a severe decrease in the glomerular filtration rate.
what are the risk factors for renal caliculi?
- 30-50 years old - men - metabolic defect - hyperparathyroidism and gout - genetic predisposition - spring and summer
what are the signs and symptoms of acute glomerulonephritis?
- hematuria - smoky urine - azotemia (toxic waste in urine from high BUN and Cr) - proteinuria - fluid volume excess - edema, puffy face, - HTN - headache - malaise - flank pain
what are complications caused by polycystic kidney disease?
- hypertension - valvular heart defects - aneurysms - loss of kidney function - 50% of people diagnosed will have renal failure by age 50-60%
what are some complications that could be caused by acute glomerulonephritis?
- hypertensive encephalopathy - heart failure - pulmonary edema
what are complications of peritoneal dialysis?
- infection from to hook up (patient should clean well) - bleeding - related to catheter - incomplete recovery of fluid - hyperglycemia - increased triglyceride - protein loss
what neurologic finding would be seen with ESRD?
- lethargy - decreased LOC - agitation - difficulty concentrating
The nurse coming on shift on the medical unit is taking a report on four clients. What client does the nurse know is at the greatest risk of developing ESKD?
A client with diabetes mellitus and poorly controlled hypertension
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?
Acute glomerulonephritis
The nurse instructs the client with gastroesophageal reflux disease (GERD) regarding dietary measures. Which action by the client demonstrates that the client has understood the recommended dietary changes?
Avoiding chocolate and coffee
what are 2 main lab values that are determinants of kidney function?
BUN and creatinine - an increase shows kidney impairment or dehydration
A client has come to the outpatient radiology department for diagnostic testing that will allow the care team to evaluate and remove polyps. The nurse should prepare the client for what procedure?
Colonoscopy
The nurse recognized that a patient with chronic kidney disease will need which hormone replaced?
Erythropoietin
A male patient is concerned about changes to his urinary stream. Which of the following are associated with lower urinary tract symptoms?
Frequency Dribbling Urgency
The nurse knows that a frequent cause of white blood cells (WBCs) in the patient's urine is which condition?
Genitourinary infection
Which diagnostic test would be used first to evaluate a client with upper GI bleeding?
Hemoglobin and hematocrit
A client with end stage renal disease receives continuous ambulatory peritoneal dialysis. The nurse observes that the dialysate drainage fluid is cloudy. What is the nurses most appropriate action?
Inform the health care provider and assess the client for signs of infection.
A female patient with a recent diagnosis of end-stage renal disease (ESRD) is scheduled to soon begin hemodialysis. A nephrology nurse has been conducting extensive patient teaching in anticipation of this treatment. What diet should the nurse recommend to minimize her patient's risk of complications and interdialytic weight gain?
Low protein, low sodium diet
what are the signs and symptoms of hyperkalemia?
Muscle weakness, arrhythmias, bradycardia, diarrhea and nausea.
A 42-year-old male patient complains of nausea, vomiting, and right flank pain. What is the most likely cause of these symptoms?
Renal colic
A client with chronic kidney disease is completing an exchange during peritoneal dialysis. The nurse observes that the peritoneal fluid is draining slowly and that the client's abdomen is increasing in girth. What is the nurse's most appropriate action?
Reposition the client to facilitate drainage.
The nurse is providing health education to a client with a gastrointestinal disorder. What should the nurse describe as a major function of the GI tract?
The absorption into the bloodstream of nutrient molecules produced by digestion
A male client has doubts about performing peritoneal dialysis at home. He informs the nurse about his existing upper respiratory infection. Which of the following suggestions can the nurse offer to the client while performing an at-home peritoneal dialysis?
Wear a mask when performing exchanges.
what is the most common route used for dialysis?
a fistula (a central line can be used but that is more common for emergencies)
what is hemodialysis?
a technique in which an artificial kidney machine removes waste products from the blood - 3x a week for life - ESRD - uses osmosis
what is acute pyelonephritis?
active bacterial infection - temporarily altered kidney function - interstitial inflammation with enlarged kidneys - tubular cell necrosis - abscess formation
what does kidneys do for acid-base balance?
acts as a long term buffer system (days)
what is the treatment for acute pyelonephritis?
antibiotics for the infection - severe: IV antibiotics that could last weeks - less severe: PO antibiotics
how does pyelonephritis usually begin?
as a lower UTI and ascends into the kidney, often caused by E. coli - untreated UTI or infection
if a patient has a UTI, what would be seen in their urine?
bacteria
what is the benefit of peritoneal dialysis?
better for an active lifestyle
if a patient is asymptomatic is is acute or chronic glomerulonephritis?
chronic glomerulonephritis
what can hyponatremia cause?
confusion and seizures
what is urolithiasis?
presence of calculi (stones) in the urinary tract or bladder - very painful
what is the most common cause of urinary obstruction?
renal caliculi
a urine analysis would be done to see what?
urinary function
is a patient with ESRD at risk for metabolic alkalosis or acidosis?
metabolic acidosis - too much bicarb
what are the signs and symptoms of chronic glomerulonephritis?
often asymptomatic - increased BUN and Cr - decreased urine output - sudden severe nosebleeds, stroke, or seizure - edema - loss of weight/strength - irritability - nocturia - headache and dizziness - progression to s/s of chronic renal failure
The nurse cares for a client with end-stage kidney disease (ESKD). Which acid-base imbalance is associated with this disorder?
pH 7.20, PaCO2 36, HCO3 14-
what is most important for managing renal calculi?
pain management
does creatinine clearance increase or decrease with ESRD?
decrease (blood levels build up)
what are the two major causes of ESRD?
diabetes (uncontrolled) and HTN
what can increased potassium cause?
dysrhythmias and tachycardia
if a patient has bacteria in the urine, what is the typically cause?
fecal contamination
what should people limit with acute post-streptococcal glomerulonephritis?
Dietary management of acute post-streptococcal glomerulonephritis includes restrictions of protein, sodium, potassium, and fluids.
Yes or no: is polycystic kidney disease genetic?
yes
