med-surg renal

What question should you use to determine if the pt has HTN?

have you ever been told your blood pressure is high?

the ability of the body to maintain its internal environment at a "steady state" within very narrow ranges of normal regardless of external changes

homeostasis

Excruciating, unbearable pain (renal colic) or flank pain • Esp. when stone is moving or has obstructed Accompanying N/V, pallor/pale/ashen, diaphoresis Hematuria Bladder distention

how does lithiasis look like in pt

Monitor the patient closely during dialysis to recognize..

hypotension

In women decreased sphincter & detrusor muscles can lead to

incontinence

In women, shorter urethra

increase risk for UTI

Chronic health problems (i.e., HTN, DM)..

increase risk for development of kidney disease r/t kidney blood vessel damage

Which laboratory test provides evidence consistent with a client having renal impairment?

increased serum creatinine concentration, BUN, and potassium ion concentration levels

What is acute glomerulonephritis?

injury to the glomeruli

kidney tissue damage caused by disorders like allergic disorders, embolism of renal vessels, (leads to acute tubular damage, postischemia, nephrotoxicity)

intrarenal failure

Renal failure whether acute or chronic...

is a life-threatening condition

there is a risk for bleeding: check coagulation, site, VS, s/sx of internal bleed

kidney biopsy: percutaneously

- Leukocyte esterase & nitrate dipstick & WBC: positive- UA w/ C&S - Serum kidney test: BUN, creatinine & GFR for baseline kidney function - serum WBC, C- reactive & ESR to determine immunity response & presence of inflammation - KUB & CT

labs/imaging for pyelonephritis

In men, enlarged prostate gland..

makes starting urine stream difficult and may cause retention

Other UTI drugs...

may also be prescribed analgesic (i.e., pyridium) &/or antispasmodic (i.e., hyoscyamine.)

volume of urine in kidney pelvis triggers stretch receptors to increase ureteral smooth muscle contractions & move urine from kidney pelvis to bladder by peristalsis

movement of urine

confusion, falls, incontinence or change in continence, tachycardia, fever, tachypnea, hypotension, slight rise in temperature

older adult UTI hallmark symptoms

Often the older adult does not have the typical symptoms of UTI (i.e., flank pain, dysuria, fever). More common symptoms are grossly bloody, foul-smelling urine with increasing frequency of urination (Touhy & Jett, 2016). When UTI leads to urosepsis, mental status changes occur. Ask about these additional symptoms of UTI whenever you are assessing an older adult.

older adults UTI symptoms

: intra-abdominal catheter implanted in the peritoneum & the peritoneal cavity becomes the dialyzing membrane • At home, flexible schedule • Requires more time for same effect

peritoneal dialysis (PD)

obstruction caused by tumors, kidney stones, or strictures ( leads to obstructive uropathies [i.e., CAs, hypertrophy, lithiasis, clots])

postrenal failure

Who requires prompt and aggressive treatment because a UTI can lead to acute pyelonephritis during __________?

pregnant women with a bacterial UTI, pregnancy

reduced perfusion to kidneys caused by shock, dehydration, burns, sepsis (leads to hypovolemia, hypotension, hypoperfusion)

prerenal failure

How do we diagnose lithasis

presentation and symptomology, US, UA esp to check for infection, KUB

- Tylenol to reduce fever if present - Antibiotics- Broad spec. Until C&S results are known

Drug therapy for pyelonephritis

What is the most common pyelonephritis- causing organism

E. coli

Which assessment finding in a hospitalized client with a history of chronic kidney disease would alert the nurse to suspect kidney insufficiency?

Edema and pruritus (The accumulation of metabolic wastes in the blood (uremia) can cause pruritus; edema results from fluid overload caused by impaired urine production.)

Rapidly progressive glomerulonephritis often progresses to....

End stage kidney disease

Which decreased hormone level may cause a client's anemia?

Erythropoietin

has a strong association with stone formation and recurrence because of inherited metabolic variations. More than 30 genetic variations are associated with the formation of kidney stones, although single gene disorders are rare.

Family history

Presence of RBCs in urine

Hematuria

intermittent, over 3-6 hours • Bedside, HD unit, stand-alone dialysis centers • M/W/F or Tu/Th/Sat schedules are common

Hemodialysis (HD)

continuous RRT, over 12-24 hours • More unstable, in ICU; 1:1 patient-nurse ratio

Hemofiltration

What can reduce kidney function

High-dose or long-term use of NSAIDs or acetaminophen

Severity of AKI is based on s serum Cr & d UOP Serum Creatinine (Cr): 0.5-1.2 mg/dL BUN: 10-20 mg/dL UA, Urine electrolyte Serum electrolytes

How do we diagnose AKI

Stages of kidney failure based on GFR direct measurement using 3-hour or 24-hour urine collection Azotemia Serum Creatinine (Cr): 0.5-1.2 mg/dL Uric acid Urea BUN: 10-20 mg/dL UA, Urine electrolytes Serum electrolytes UOP & characteristics; specific gravity: 1.0-1.03

How do we diagnose CKD?

consult with the urologist or primary health care provider before attempting urinary catheterization, to avoid making the injury worse.

If the urethral opening is bleeding

UTI - what can cause it (7)

Incomplete bladder emptying, obstruction (stones, BPH), DM/uncontrolled glucose, antibiotic use, sexual activity, immunosuppression, irritants (douches, powders, perfume)

Which intervention would prevent urinary stasis and formation of renal calculi in an immobile client?

Increasing oral fluid intake to 2 to 3 L/day (if not contraindicated, will dilute urine and promote urine flow, thus preventing stasis and complications such as renal calculi. Bed rest and limited fluid intake may lead to urinary stasis and increase the risk for the formation of renal calculi.)

Common diagnostic imaging for renal

KUB (kidneys, ureter, bladder); CT (may be with or without contrast)

maintain body fluid volume & composition; filter waste for elimination; help regulate BP; help regulate acid-base balance; produce erythropoietin for RBC synthesis; convert vit D to active form; perform the actual work of determining which substances in body fluid will be eliminated

Kidney functions

IV analgesics for immediate pain relief • Possibly anti-spasmodic Proper hydration

Lithiasis interventions

Antibiotic therapy, if warranted Diet not clinically proven to totally cause, however has shown ability to help control in people who have had recurrent stones • Sometimes prescribed high intake of fluids, fruits, vegetables; low protein; balanced intake of calcium, fats, carbohydrates Stone recurrence may need drug therapy based on composition of stone Strain urine; send passed stone to lab for analysis Education on post-op care, activity, restrictions if appropriate

Lithiasis pt care intervention/ teaching

the use of sound, laser, or dry shock waves to break the stone into small fragments

Lithotripsy (as known as shock wave lithotripsy (SWL))

Which intervention would the nurse implement for a client with a ureteral calculus?

Monitoring intake and output Straining the urine at each voiding Administering the prescribed analgesic

• Fill: 1-2 L of dialysate infuses by gravity into peritoneal space over 10- 20 minutes • Dwell: fluid stays in cavity for specified time prescribed by physician • Drain: fluid flows out of body by gravity into drainage bag

PD exchange

removal of stone in ureter or kidney through the skin

Percutaneous uretero-/nephrolithotomy

The more concentrated morning 1st void is best; if clean catch, give good instructions to prevent contamination; do not delay delivery to lab; cover & refrigerate if delay in delivery

Proper method for UA collection

Which finding is expected in a client diagnosed with early glomerulonephritis?

Proteinuria and hematuria (are classic manifestations of the onset of glomerulonephritis because of the increased permeability of the vascular bed in the kidneys.)

what may be the reason macrodantin is given over bactrim or septra?

Pt had allergy to sulfa medications

Which instruction would the nurse provide to help a client prevent future attacks of glomerulonephritis?

Seek early treatment for respiratory infections (A common cause of glomerulonephritis is a streptococcal infection. This infection initiates an antibody formation that damages the glomeruli.)

A client with renal failure receives prescriptions for vitamin D and calcium supplements. The client asks the nurse, "Why do I need to take these?" The nurse explains that, with renal failure, which condition exists?

a decrease in the active metabolite of vitamin d in the body

auscultate before percussion & palpation (can enhance bowel but mask abdominal vascular sounds) BE CAREFUL WITH DEEP PALPATION leave palpation of kidneys/CVA assessment to adv. practioner; gently palpate & percuss bladder or use scanner if retention suspected may encounter cultural, privacy, embarrassment issues

proper renal assessment methods

Which nursing intervention helps prevent complications associated with a shortened urethra revealed by a recent intravenous pyelogram?

providing thorough perineal care after each voiding (Weakened urinary sphincters and shortened urethras are age-related physiological changes in older adults. Because a shortened urethra has an increased potential for bladder infections, the nurse should provide thorough perineal care after each voiding)

Which procedure involves the examination of the ureters and the renal pelvises?

pyelogram

Organisms ascend from urinary tract into kidney tissue (possibly by reflux or from already infected urine in the bladder [retention/stasis]) Bacteria triggers inflammatory response Localized edema/inflammation Infection scatters within the kidney itself, so widespread fibrosis/scar tissue/thickening Causes changes in tubular, glomerular, & blood vessel structure Filtration, reabsorption, & secretion are impaired Kidney function is reduced

pyelonephritis

Antibiotic therapy Pain management Patient/family/caregiver education r/t drug regimen Adequate hydration Proper nutrition, may need consult for registered dietician Lithotripsy if stones implicated Patient/family/caregiver education r/t and post-op care or activity restrictions

pyelonephritis pt care

Dyspnea, urgency, or frequency of urination CVA tenderness Flank, back, or loin pain Abdominal, often colicky, discomfort, Nocturia, General malaise or fatigue, Fever, Chills Tachycardia Nausea Tachypnea Vomiting

pyelonephritis symptoms

presence of WBCs in urine

pyuria

Common causes of AKI

reduced perfusion from volume depletion

Causes of AKI

reduced perfusion to the kidneys, damage to kidney tissue, and obstruction

What can cause pyelonephritis

reflux, organism growth in renal stones, manipulation, recent cystitis

• Nephrologist gives Dialysis RN orders for treatment • Blood passes through artificial semipermeable membrane to perform filtering & excretion functions of kidney

renal replacement therapy

specific catheter access for dialysis..

requiring informed consent

instill dye into area via catheter; take x-rays as dye is excreted to look for flow abnormalities or obstruction

retrograde pyelo/cysto/urethro- gram

Urinary catheters..

should be used appropriately and discontinued as early as possible

Sulfamethoxazole/trimethoprim should be stopped at the first appearance of a

skin rash (A rash may indicate the onset of Stevens-Johnson syndrome (aching joints and muscles; bilateral blistering skin) or toxic epidermal necrolysis (redness, blistering, and peeling skin and mucous membranes).)

Which electrolyte deficiency triggers the secretion of renin?

sodium (Low sodium ion concentration causes decreased blood volume, thereby resulting in decreased perfusion. Decreased blood volume triggers the release of renin from the juxtaglomerular cells.)

Hydronephrosis

stone blocks urine in lower urinary tract, kidney fills with urine and enlarges

hydroureter

stone occludes ureter, blocks flow of urine, ureter dilates

You are discharging a patient with acute glomerulonephritis. You should teach this pt to notify PCP if.....

sudden changes in weight or blood pressure

What is lithiasis

the formation of stones (uro: urinary tract, nephro: kidney, uretero: ureter)

Auto-immune disorders, genetic involvement Infectious processes, esp. systemic

these can cause acute glomerulonephritis (AGN)

drugs to treat hypercalciuria

thiazde diuretics

how to assess circulation in lower portion of arm

through distal pulses, cap. refill

what should urine specimens be free from

toilet tissue, fecal contamination, menstrual blood

Nephrostomy tube care

tube left in place to prevent stone fragments from passing through urinary tract

Nitrofurantoin (macrodantin): bacteriostatic Trimethoprim (TMP)/ sulfamethoxazole (Bactrim, septra): bactericidal/bacteriostatic

uncomplicated UTI 1st line drug therapy choices

store urine made by the kidney & eliminate it from the body

ureters, bladder, urethra

serves to eliminate urine from the bladder

urethra

Lower UTI

urethritis, cystitis, prostatitis

IDs the organism (i.e., candida, staphylococcus, Escherichia coli); guides to which antibiotic is effective

urinalysis (UA) may need to test further with C&S

often hear terms used for both infectious process & inflammatory process which may not be infectious

urinary tract infection

Spread of infection from urinary tract to bloodstream

urosepsis

ability to invade & infect

virulence

drugs to treat hyperoxaluira

vit b6 & thiazide diuretics

extracellular volume depletion, decreased renal blood flow, toxic/inflammatory injury to kidney cells

what can cause acute kidney injury

The damage may be occurring before manifestations appear abnormal urine, production, fluid & electrolyte imbalances, Fatigue and lethargy, Paresthesias, Uremic "frost" on skin, Pruritus, Dyspnea, Edema, osteodystrophy, anorexia, weight loss, N/V, metallic taste in mouth, halitosis or fetor & stomatitis

what does CKD look like

Insufficiency leads to failure which leads to end stage What is it? Sudden decline in kidney function; over a few hrs. or days F&E balance & acid-balance is no longer able to be maintained

what is acute kidney injury

Pre-op checklist any prep order (i.e., edema, laxative, bowel prep) NPO or diet orders

what the RN is responsible for

that carefully managing fluid volume, blood pressure, electrolytes, and other kidney-damaging diseases by following prescribed drug and nutrition therapies can slow progression to end-stage kidney disease (ESKD).

what to teach pt with mild CKD

Signage & Limb Alert bands • NO BP readings in affected extremity • NO IV lines in affected extremity • NO venipunctures in affected extremity

what you should not do in limbs with dialysis catheter

Insufficiency has progressed to failure, then possibly end-stage

what's going on in chronic kidney disease?

Excessive amounts of stone composing element Absorbed through intestinal tract Blood circulates through kidneys, excess element filtered into urine Slow urine flow or saturation of urine with stone composing element Abrasive crystallized element damages lining of urinary tract Crystal aggregation, combines with other compounds & form larger molecule, stone develops

what's going on with lithiasis

When is dialysis used?

when kidneys can no longer maintain homeostasis by urine elimination, not a cure

How much blood does the kidney receive

~ 600 to 1300 mL blood/min (20-25% of CO)

Cr levels

0.5-1.2 mg

What is the anatomy of the urethra in women

1-1 1/2 in long (slightly below clitoris & directly in front of vagina & rectum)

blood urea nitrogen (BUN) level

10-20

What is normal UOP for adults?

1500-2000mL/day or within 500 mL of volume of fluid ingested daily

Pt voids, discard this 1st void, note the time; if foley cath: empty tubing & drainage bag, discard, not the time; ensure all urine formed within the 24-hr period s collect, at the 24-hr mark, have pt void and include that urine in collection (do not remove urine from collection container for other specimens)

24 hour urine lab process

what is the anatomy of the urethra in men

6-8 in long (extends from bladder through prostate gland, then from prostate to wall of pelvic floor)

Consult nephrologist, dialysis RN, pharmacist on which drugs to give before or after dialysis • Many drugs are dialyzed out during dialysis patient gets no benefit • Some antihypertensive drugs can contribute to hypotension during dialysis

dialysis drugs

What can be associated with compromised kidney function

dietary supplementation (i.e. synthetic creatine, weight loss)

UA: Proteinuria, Hematuria, RBC casts decreased GFR 24-hr urine Throat cx if warranted for strep A

AGN how we diagnose

Antibiotic therapy (Penicillin, Erythromycin, azithromycin) Symptom management if pain, N/V Patient/family/caregiver education r/t drug regimen Principles of infection control Personal hygiene Possible sodium, protein, fluid restriction; may need consult for registered dietician Possible diuretics Possible antihypertensives

AGN pt care/interventions

Edema @ face, eyelids, hands; possibly ankles, feet, legs, abdomen s/sx of fluid retention & overload Urine described as smoky, reddish brown, rusty, cola color General fatigue, aches Anorexia, N/V

AGN symptoms

Early recognition & correction of problems can restore function before damage has occurred timely implementation of interventions is a must! Monitor renal function labs (i.e., BUN/Cr, electrolytes, UA, peak & trough levels) Accurate & careful monitoring of VS • Maintain a MAP of 60-70 mmHg for adequate perfusion of major body organs; MAP = (SBP + [2 × DBP]) ÷ 3 arterial pressure in vessels perfusing the organs Careful monitoring of UOP & urine characteristics Accurate I&O/daily weights Appropriate hydration, fluid replacement • Fluid challenge: give 500mL-1L NS over 1 hour • Monitor for s/sx of fluid overload during & after infusion; assess response Electrolyte replacement as warranted Diuretics only to help excretion of retained fluid & electrolytes

AKI nursing intervention

Vigilance with use of & patient education on nephrotoxic drugs, exposures • Consult pharmacy for drug dose adjustments Consult RD r/t potential for protein & muscle breakdown, nutrition support Educate on f/u with PMD, nephrologist, labs, diet/fluid regimen, dialysis

AKI pt teaching

Upper UTI

Acute pyelonephritis

Which intervention would the nurse implement first in a client who has a ureteral calculus and is admitted to the hospital with severe flank pain, nausea, and hematuria?

Administer a prescribed analgesic

one of the drug categories most frequently involved in the error of administration to patients who have documented allergies to these drugs

Antibiotics

Ensure appropriate use of indwelling urinary catheters Sterile/aseptic/clean technique during urinary catheter insertion Discontinue catheter use at earliest time frame Sufficient fluid intake when not contraindicated Proper hygiene Healthy urinary elimination patterns Knowledge of meds & med adherence Discussions of sexual intercourse

UTI pt teaching

pyelonephritis

Bacterial infection in the kidney & renal pelvis

Urgency, dysuria, frequency, difficulty starting urine stream, low back pain/flank pain, nocturia, incontinence, hematuria/blood-tinged, pyruia

UTI what does it look like

Diuretics, depending on kidney function: i.e., furosemide/Lasix, bumetanide/Bumex Sodium Potassium Vitamin D: i.e., calcitrol Calcium Phosphorus: phosphate binder i.e., calcium acetate/Phos-Lo, calcium carbonate Antihypertensives: i.e., ACEI, blockers, Ca channel blockers Antihyperlipidemics Heart failure meds: i.e., digoxin Anemia: i.e., epoetin/Epogen, darbepoetin/Aranesp Iron: i.e., ferrous sulfate Folic acid: vitamin B Stool softener

CKD medications

Life-long regimen: anxiety, denial, role disturbance, coping, social isolation, employment, discouraged, depressed, hopeless, dependent • Realistic expectations

CKD patient feelings

Stable body weight: notify if ±2 lbs overnight, +3 pounds between dialysis sessions Mouth care Case Management consult: equipment needs, home environment, home care • If home dialysis, patient &/or caretaker must know how equipment works, alarms, ... • Would need water treatment, generator power back-up

CKD pt care

Home care Social Services PT RD Psychiatry Pastoral care National Kidney Foundation (NKF) American Kidney Fund National Association of Patients on Hemodialysis and Transplantation (NAPHT)

CKD collaborative care

All urine within designated time frame must be collected, give pt/family/caretakers explicit instructions; use conspicuous signage as reminder; lab will instruct on need for special preservatives, ice or no ice

Timed urine collection (i.e., 24-hour urine)

Proper screening of risk factors Reduction of risk factors (i.e., glycemic & BP control) Lifestyle & treatment can slow progression • Diet, weight management, daily physical activity, smoking cessation • Consult PT, RD Patient education • Medications Consult with physician or pharmacist regarding nonprescription meds before use May need dose adjustments on abx's, hypoglycemics, opiods, anticoagulant • Diet, including proper fluid intake Monitor for s/sx of fluid overload, labs (esp. renal & electrolytes), VS, UOP, I/O, daily weights, dysrhythmias, lung sounds

CKD pt care/ intervention

Choice of catheter based on short- (IJ, subclavian, femoral) or long-term (AV fistula, AV graft) use Need time after anastomosis for AV fistula to mature Post-op elevation of extremity

Catheter for dialysis

UTIs: most common health care-associated infection due to.....

Catheters not draining to gravity, reflux of urine, inadequate hygiene

Reduced blood flow to kidneys (~10% per decade) causes kidneys to get smaller decreasing ability to filter blood & excrete waste products # of glomeruli decreases which decreases GFR

Changes associated with aging

What should you check with for CT

Check allergies, asthma, renal function, metformin; ensure hydration for dye dilution and excretion

Which condition can be prevented when a client with chronic kidney disease receives medication to manage anemia?

Chronic fatigue

Gradual decline in kidney function; Irreversible, Progressive End-stage (ESKD): kidney function is too poor to sustain life

Chronic kidney disease

Infuses four 2-L exchanges ; Each dwell is 4-8 hours; Exchanges occur 7 days a week Continuous connect system or disconnect & reconnect at a later time Can complete exchanges overnight with an automated cycler (automatic peritoneal dialysis [APD])

Continuous ambulatory peritoneal dialysis (CAPD)

If a patient has acute glomerulonephritis that is not caused by an acute infection, what medication would you expect to be prescribed

Corticosteroids & cytotoxic drugs (to suppress immunity responses & help with inflammation)

product of muscle & protein decomposition "no common pathologic condition other than kidney disease increases the serum ___________ level; at least 50% of kidney function must be lost before you see the increased level

Creatinine

May have pink tinged urine but not grossly red, may have orders to irrigate foley catheter if clots expected

Cystoscopy addi. info

What do nephrologist do with pd exchanges?

Nephrologist prescribes number & frequency of PD exchanges, dialysate

Dialysis catheter

DO NOT USE for med administration, blood draws, or CVPs (ICU)

Ensure accurate weight before & after dialysis Monitor for clotting, stenosis, infection, tunnel or exit-site infection Monitor post-dialysis for bleeding, hypotension, fluid shifts, electrolyte imbalances, fever Monitor for peritonitis

Dialysis care

PD - sterile technique when caring for PD catheter & hooking up or clamping off dialysate bags Instruct patient not to carry heavy/compressing/constricting objects on extremity in which vascular access is placed Instruct patient not to sleep with body weight on top of extremity in which vascular access is placed Instruct PD patient DO NOT use microwave for warming dialysate Ensure drainage bag is lower than patient's abdomen Accurate inflow & outflow ; retained dialysate is counted as fluid intake

Site care to avoid CABSI/CRBSI

small tube placed in ureter by ureteroscopy It dilates ureter, enlarges passageway for stone or stone fragments

Stenting

Which instruction from the primary health care provider would the nurse anticipate reinforcing with a client who is on metformin therapy and is scheduled to undergo renal computed tomography (CT) with contrast dye?

Stop metformin 1 day before the procedure (Metformin can react with the iodinated contrast dye that is given for a renal CT and cause lactic acidosis. The nurse anticipates an instruction that the client should discontinue the metformin 1 day before the procedure. The client is advised to discontinue the metformin for at least 48 hours after the procedure.)

For which potential complication would the nurse monitor a client receiving continuous ambulatory peritoneal dialysis for end-stage kidney disease?

Tachycardia, Cloudy outflow, Abdominal pain

Organisms from the external urethra ascend the urinary tract, infection spread through the blood & lymph, and irritation/trauma/ instrumentation of linings/mucosa Bacteria finds a susceptible place along the urinary tract to colonize, then multiply, surmounting our normal host protective flora resistance

UTI what's going on

scope passed through urethra & bladder into ureter Stone visualized & removed using grasping baskets, forceps, or loops

Ureteroscopy

Lithiasis emergency

Urinary tract obstruction is an emergency! Treated immediately to preserve kidney function Much depends on stone location, size, composition

Which instruction would the nurse provide to the client who has been diagnosed with a urinary tract infection?

Urinate after intercourse (Voiding promptly after intercourse can help decrease the ascent of bacteria up the urethra to the bladder.)

Which instruction would the nurse include in a health practices teaching plan for a female client with a history of recurrent urinary tract infections?

Wear cotton underwear or lingerie.

Which action would the nurse take before a client's scheduled hemodialysis treatment?

Weigh the client to establish a baseline for later comparison (A baseline weight must be obtained to be able to determine the net fluid loss from dialysis.)

Same causative factors as AKI Progressive loss of kidney function

What can cause chronic kidney disease?

Possibly explained by excess crystalization Imbalance of urine pH Calcium complexes Genetic implications, family history Previous incidences of stone formation Gout

What can cause lithiasis?

Oliguria: UOP < 400 mL per 24h in adults • Diuretic phase may reveal polyuria Azotemia: retention & buildup of nitrogenous wastes in blood s/sx of fluid overload

What does AKI look like?

Functioning nephrons are overworked Blood vessel constriction, RAAS activation

What's going on in AKI

Skin and mucous membrane changes from a lack of estrogen appear to...

account for increased risk of UTI in older women together with overall decreased immunity.

For which complications would the nurse monitor a client hospitalized with end-stage kidney disease?

anemia and dyspnea

Provider is responsible for explaining the procedure to the patient, RN may need to ensure completion of signature on informed consent

any procedure requiring informed consent

presence of bacteria in urine

bacteriuria

Stores urine, provides continence, and enables micturition; a muscular sac (for women it is in front of the vagina)

bladder

measures effectiveness of kidneys to excrete urea nitrogen (protein decomp waste product); _________ can be increased by other factors so not necessarily best indicator of kidney function but is a tool for assessing kidney dysfunction

blood urea nitrogen (BUN)

where are control centers for voiding located; injury to these areas may result in involuntarily loss of bladder control & emptying

cerebral cortex, brainstem, lower spinal cord

Cystoscopy

cystoscope through urethra into bladder

What leads to urgency

decreased bladder capacity and decreased ability to concentrate urine

Decreased blood flow, decreased kidney mass and decreased GFR leads to

decreased drug clearance, increased risk for drug reaction, nephrotoxicites & damage from drugs & contrast dyes

How to assess circulation in fistula or graft

feel the thrills, hear the bruits

Fungal (candida) UTI drug of choice (DOC)

fluconazole

hallmark symptoms of UTI in younger clients

frequency, dysuria, and urgency