renal interventions 4 exam 2
normal potassium levels
3.5-5.0 mEq/L
Phosphate binders
-Aluminum Hydroxide (Amphojel) Lowers elevated phosphate levels by binding to phosphate present in blood and excreting it via the gut. -Increased amount of phosphate in the blood is one of the first signs of kidney disease. Important for CKD because phosphate retention + insufficient vitamin D → osteodystrophy. teach patient to take drug with meals and do not take within 2 hours of any other drugs. Monitor serum phosphorus and serum calcium. Monitor for constipation
read over enuresis on page 25 of student notes
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read over renal transplantation on page 20 in the student notes maybe ???
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Normal creatinine levels
0.6-1.2 mg/dL men 0.5-1.1 mg/dL women
normal urine specific gravity
1.005-1.030
Normal BUN levels
10-20 mg/dL
how much blood does the kidney receive per minute
1200ml of blood/min (20-25% of cardiac output)
Normal GFR
125 mL/min
Normal sodium levels
135-145 mEq/L
Normal urine pH
4.6-8
Normal blood pH
7.35-7.45
normal calcium levels
9-10.5 mg/dL*** or 8.5-10 depends where u look
what is pyelonephritis
A bacterial infection of the kidneys and the renal pelvis, involves the upper urinary tract.
what is acute glomerulonephritis
An inflammatory immunologic response resulting in glomerular damage caused by Infectious and noninfectious causes. the onset is very sudden and patients usually recover quickly with treatment.
treatment of hypospadias/epispadias
Delay circumcision, use foreskin to repair, surgery before 18 months, or before school starts
what is the most common cause of cystitis?
E. coli
sodium in chronic renal failure
Early in chronic renal failure the client will be susceptible to hyponatremia due to large levels lost in the urine due to polyuria. In late stages of chronic renal failure sodium retention will occur due to the kidneys losing the the ability to excrete sodium. This will manifest with hypertension and edema.
diurnal
Happening or active during the day
What is BUN?
Measures the amount of urea nitrogen in the blood; urea is formed in the liver as the end product of protein metabolism; it is directly related to the excretory function of the kidneys and liver. it can be affected by diet and will increase with high protein intake. Any bleeding will cause an increase as well.
Phases of AKI
Onset. Oliguric. Diuretic. Recovery / convalescence
define nephrolithiasis
The formation of renal calculi, or kidney stones, in the parenchyma (external part of kidney)
What is prerenal AKI
a DECREASED BLOOD flow to the kidneys leading to ischemia in the nephrons, prolonged hypoperfusion can lead to acute tubular necrosis and acute renal failure.
what is chronic renal failure AKA chronic kidney disease (CKD)
a clinical syndrome of progressive IRREVERSIBLE kidney injury. as kidney function decreases BUN rises dramatically , output decreases, and the client becomes at risk for fluid overload.
epispadias
a congenital abnormality in males in which the urethra is on the upper surface of the penis
what is polycystic kidney disease or PKD
a disease it affects the renal paraenchyma and occurs bilaterally. overtime paraenchymal tissue is replaced by non-functioning cysts and each kidney may enlarge 2-3 times its normal size. Fluid-filled cysts are prone to infection. Control of hypertension is essential because it can affect the renal function
what is lithotripsy. describe pre and post-op care
a procedure that uses sound waves to break up renal calculi. patient receives moderate sedation and lies flat on a table with the lithotripter and at the stone. A local anesthetic cream is applied to the skin over the stone 45 minutes prior to the procedure. Monitor cardiac rhythm during the procedure. After the surgery strain the urine to monitor the passage of stone fragments. Bruising may occur on the flank of the affected side. drink 2-3 L/day your and maybe blood-tinged for several days instruct to take all antibiotics Occasionally a stent is placed to ease the passage of stone fragments
what is peritoneal dialysis
a type of dialysis that removes toxins by using the peritoneal membrane. A hypertonic solution called dialysate is instilled into the peritoneum and is used to remove electrolytes and toxins by diffusion, and removes water by osmosis.
what is dialysate
a warmed, dextrose solution with Heparin to prevent clots, you can add medications to it. It is used in peritoneal dialysis. Check to make sure it is clear and colorless before using
hypospadias
abnormal congenital opening of the male urethra on the undersurface of the penis
what is intrarenal AKI
actual TISSUE DAMAGE to the kidney caused by inflammation or immunologic processes or from prolonged hypoperfusion.
what are examples of drugs that are dialyzable
aminoglycosides. Anti-tuberculosis agents. Antiviral and antifungal agents. Cephalosporins. Anticonvulsant. Penicillins.
what is post renal AKI
an obstruction BELOW THE KIDNEY; of the urinary collecting system anywhere from the calyces to the urethral meatus, or obstruction of the bladder-(must be bilateral to cause post renal failure unless only one kidney is functional)
anemia in association with chronic renal failure
anemia results from decreased production of erythropoietin to make red blood cells. This is due to a short lifespan of red blood cells, the increase in waste products, iron deficiency, and bleeding. Treatment includes blood transfusion, epogen, increase in dietary iron, increase in carbohydrates to increase energy and rest.
list of nephrotoxic substances
antibiotics- amphotericin B, methicillin. Rifampin. Sulfonamides. Tetracycline. Vancomycin. Gentamicin. Tobramycin chemotherapy- cisplatin, cyclophosphamide, methotrexate NSAIDs- celecoxib, ibuprofen, Naproxen. acetaminophen, captopril, cyclosporine non-drug agent- contrast dye, pesticides heavy metal- arsenic, lead
potassium in chronic renal failure
any increase in potassium low during the late stages of renal disease can lead to hyperkalemia. This could be from a non compliant diet, blood transfusion, Hemorrhage, or acidosis. Severe cardiac complications can occur due to arrhythmias.
what do you need to assess for when assessing acute glomerulonephritis
ask about history such as recent skin or upper respiratory infections (pt usually has previous infection) Ask about recent travel. ask about recent invasive procedures or surgeries. Assess for edema of the face, eyelids, hands. Assess for hypertension. Assess urine color, urine may be reddish brown, or Cola colored. Assess for dysuria. Assess for flank pain, will not be as painful as pyelonephritis. assess for malaise, fever, headache, sore throat.
assessment with urinary incontinence
assess history-voiding patterns contributing factors or other health problems. Assess for bladder distention or tenderness Inspect external genitalia for signs of urethral or uterine prolapse
bladder training
assess patients awareness of bladder fullness. Assess 24-hour voiding pattern for 2-3 consecutive days. base the initial interval of toileting on the voiding pattern. Teach patient to void every 45 minutes on the first day and to ignore or suppress the urge to urinate in between. Take patient to the toilet and remind them to urinate on their 45 minute intervals. Provide privacy and run water in the sink. If patient is not consistently able to resist the urge to urinate reduce the intervals by 15 minutes. Continue this regimen for at least 24 hours or however many days it takes for the patient to become comfortable with their schedule. When patient remains continent between intervals increase intervals by 15 minutes daily until 3-4 hour intervals are comfortable for the patient. Praise success
dietary considerations for a calcium oxalate kidney stone
avoid oxalate sources such as spinach, black tea, and rhubarb.
what is vesicoureteral reflux
backward projection of urine from bladder to the ureters and kidneys caused by insufficient tunneling of the ureters into submucosal bladder tissue, leading to ineffective restriction of urine backflow during bladder contraction.
nocturnal enuresis in a child
bedwetting that occurs past Age 5 - 7
describe the onset phase of AKI
begins with precipitating event and continues until oliguria develops. May last for hours or several days. There's a gradual accumulation of waste such as creatinine and BUN
hypocalcemia and chronic renal failure
calcium is lost from the bones do to the decreased production of active vitamin D. Treatment is aluminum hydroxide to bind with phosphorus and a low phosphate diet. avoid liver, tuna, meat, Dairy, almonds, and peanuts. A calcium supplement is recommended. increase phosphorus equals decrease calcium. This causes an increase in parathyroid hormone which causes calcium to be pulled out of the bone in the blood resulting in weak bones.
what causes intrarenal AKI
can be caused by: acute interstitial nephritis, exposure to nephrotoxins, acute glomerulonephritis, vasculitis, hepatorenal syndrome, acute tubular necrosis (ATN), renal artery or vein thrombosis, trauma, cancer, diabetes, hypertension.
considerations with hypospadias/epispadias
cannot circumcise
what is the etiology of renal stones caused by cystinuria
caused by an autosomal recessive defective amino acid metabolism that precipitates in soluble cystine crystals in the urine
what is the etiology of renal stones caused by hyperoxaluria
caused by an autosomal recessive trait resulting High oxalate production. Also caused by excess oxalate from foods.
what is the etiology of renal stones caused by hypercalcemia
caused by increased intestinal calcium absorption or decreased kidney tubular excretion of calcium.
describe the oliguric phase of AKI (phase 2)
characterized by urinary output of 100-400 ml/24 hours. Body does not respond to fluid challenges or diuretics. This typically lasts 8-15 days. urine output my fall to less than 50ml/24 hours. The longer the stage last the higher risk of irreversible damage. labs show: increased creatinine and bun. Hyperkalemia. Bicarbonate deficit. Hyperphosphatemia. Hypocalcemia. Hypermagnesemia. decreased glomerular filtration rate may be present.
Labs with cystitis
check urine for bacteria and white blood cells in a clean catch UA. Culture and sensitivity as helpful. Serum white blood count will be elevated
what are you looking for in a urinalysis
color. Odor. Turbidity. Specific gravity. PH. Presence of glucose. Presence of ketones. Presence of protein. Presence of bilirubin. Presence of red blood cells. Presence of white blood cells. Presence of crystals. Presence of bacteria. Presence of parasites. Leukoesterase. Presence of nitrates.
what is isosthenuria in relation to chronic renal failure?
decreased ability to dilute urine resulting in a fixed osmolarity. This occurs as the disease progresses
dietary considerations for a uric acid Stone
decreased intake appearing sources such as organ meat, poultry, fish, gravy, red wine, and sardines.
what is hemodialysis
dialysis to remove toxins by filtering blood through a dialysis machine by diffusion. it is a nursing specialty. Continuous dialysis that is individual as per patient but generally last 3-4 hours.
nursing interventions with vesicoureteral reflux
did France administer prescribe low-dose antibiotics such as nitrofurantoin or trimethoprim-sulfamethoxazole teach child and parents to force fluids and have child void at least every 3 hours. administer analgesics and anti-spasmodics for bladder spasms
dietary considerations with a patient who has chronic renal failure
dietary restrictions include: protein restrictions fluid restriction potassium restriction sodium restriction phosphorus restriction magnesium restriction +administration of appropriate vitamin and mineral supplements, and provision of adequate calories.
how to prevent urinary tract infections
drink 2-3 L fluid daily if not contraindicated. Get enough sleep and maintain good nutrition. Do not use spermicides if possible. Clean front to back for women. Avoid douches, scented Lube, bubble bath, tight fitting underwear, scented toilet tissue for women. Empty your bladder before and after intercourse for women. Gently wash the perineal area before and after intercourse. Do not delay urination when the need is felt. If you feel you are experiencing symptoms of an early UTI seek care immediately. Take cranberry juice substances. take apple cider vinegar 2 tablespoons three times daily in juice. Apply topical estrogen to perineal area if postmenopausal.
nursing interventions with an antibiotic given for UTI such as nitrofurantoin
drink a full glass of water with each dose. Overall fluid intake should be at least 3 daily. Complete drug regimen even if symptoms improve watch for fever. Monitor white blood count
interventions/teaching for people with cystitis
drug therapy: antibiotics, anticholinergic, phenaxopyridine fluid intake increased to 2-3L. Warm sitz bath without bubbles. Cotton underwear. No tampons. Wipe front to back. Empty bladder before and after intercourse. Clean perineum before and after intercourse.
signs and symptoms of vesicoureteral reflux
dysuria. Urinary frequency. urgency. Hesitancy. Urine retention. Cloudy, dark, or blood-tinged urine
patient education with PKD. ***SAA
educate patient regarding: importance of fluid balance Diet therapy. Teach to watch for urine changes such as cloudiness, blood, dark, or foul-smelling urine. Teach to record blood pressure daily and take temperature fever suspected. Weigh at the same time daily. Limit salt. Notify if headache or visual disturbances occur because they may be due to Berry aneurysm. Monitor bm's to prevent constipation.
assessment findings with pyelonephritis
excruciating pain. flank or abdominal discomfort. Frequency. Urgency. Burning with urination. Lower back pain. Swelling and asymmetry in the costrovertebral area. High fever and chills patients are sicker than those with cystitis risk for sepsis.
assessment findings with renal stones
excruciating pain. Nausea and vomiting. Chills. Change in urination pattern. Urine may be Rusty. Assess urine for turbidity and odor. Access output. assess for bladder distention.
what is the main risk factor associated with renal calculi?
family history
rule of thumb with fluid restrictions and chronic renal failure
fluid restriction is limited to 500 - 700 mL + the amount of urine output. with fever you may need to increase fluids.
symptoms of cystitis ***SAA
frequency. Dysuria. Urgency. Hesitancy. difficulty initiating stream. bladder pain. Voiding in small amounts. Acute confusion in the elderly. hematuria
non surgical management of PKD
get analgesics such as Tylenol because aspirin increases bleeding. Give antibiotics for infection but watch for nephrotoxicity. Apply heat to flank area. Encourage deep breathing and relaxation.
interventions for fluid volume excess associated with PKD
give antihypertensives and diuretics. Encourage low sodium diet unless they are experiencing salt wasting. Limit protein as kidney disease progresses. Prevent constipation.
what is an important part of Psychosocial patient education when it comes to PKD
give genetic counseling because if one parent has PKD there's a 50% chance the child will inherit PKD. Half of patients who develop PKD will develop renal failure by age 50.
treatment for hyperkalemia in late-stage renal failure
give- bicarb, glucose + insulin, or kayexalate by mouth or in enema
what is the etiology of renal stones caused by struvite
he sounds are made of magnesium ammonium phosphate and carbonate apatite formed by urea splitting by bacteria, most commonly proteus mirabilis (needs alkaline urine to form.)
lab findings with PKD
hematuria proteinuria increased creatinine increased BUN decrease creatinine clearance
advantages of hemodialysis versus peritoneal dialysis
hemodialysis is more efficient and clearing wastes and there is a shorter time needed for treatment. peritoneal dialysis has a flexible schedule for exchanges. Few hemodynamic changes during and following exchanges. Less dietary and fluid restrictions
procedure with hemodialysis versus peritoneal dialysis
hemodialysis- complex and requires a second person trained in the technique weather completed at home or at a unit. Special training for personnel and in-home use. Required at least two people to manage the process. peritoneal dialysis- simple and easier to complete at home compared with hemodialysis. Less complex training, typically managed by the patient or by one person.
complications with hemodialysis versus peritoneal dialysis
hemodialysis- disequilibrium syndrome. Muscle cramps and back pain. Headache. Itching. Hemodynamic and cardiac Adverse Events. Infection. Increased risk for subdural and intracranial hemorrhage from anticoagulation and changes in blood pressure during dialysis peritoneal dialysis- protein loss. peritonitis. Hyperglycemia from dialysate. Respiratory distress. Bowel perforation. Infection. Weight gain and discomfort from the dwelling solution. Potential for back pain and development of hernia
contraindications with hemodialysis versus peritoneal dialysis
hemodialysis- hemodynamic instability or severe cardiac disease. Severe vascular disease that prevents vascular access. Serious bleeding disorders. Uncontrolled diabetes. peritoneal dialysis- extensive peritoneal adhesions, fibrosis, active inflammatory GI disease. Ascites or massive central obesity. Recent abdominal surgery
access with hemodialysis versus peritoneal dialysis
hemodialysis- vascular access route peritoneal dialysis- intra-abdominal catheter
what are the different causes of kidney stones?
hypercalcemia. Hyperoxaluria. Hyperuricemia. Struvite. Cystinuria
hypertension in association with chronic renal failure
hypertension occurs in approximately 80 - 90% of clients with chronic kidney disease. The elevation of blood pressure results from fluid and sodium overload and the malfunction of the renin-angiotensin-aldosterone system which fails to recognize increase blood flow and cannot produce renin which leads to an increase in blood pressure. Treatment is sodium restriction, fluid restriction, weight reduction and medications. Start on ACE inhibitors or PRILS IMMEDIATELY.
what results when less than 20% of kidney function is lost?
hyposthenuria- loss of ability to concentrate urine and polyuria both of these are early signs of kidney failure and can result in severe dehydration if left untreated
General causes of AKI (listed under etiology in notes, but I found several of these fall on the different descriptions under the "types" of AKI)
hypotension from excess blood or water loss resulting in hypoperfusion to the kidney may lead to prerenal AKI MAP decreased to 60-70 for greater than 30 mins (book says keep at 65 or above to promote kidney perfusion) dehydration causes decreased intravascular volume and decreased blood supply to kidneys DIC, obstruction, acute hemolytic transfusion reaction, severe hypertension, diabetes, infection/sepsis, heart failure, nephrotoxins, drugs, dyes acute tubular necrosis which is a type of intrarenal failure secondary to ischemia or nephrotoxicity. anything causing decreased perfusion to the kidneys.
problems associated with peritoneal dialysis
hypotension/hypovolemia. Hyperglycemia infection- peritonitis. Clots/catheter obstruction. Removal- loss of outflow, check tubing for Kinks or reposition client.
symptoms of intrarenal AKI
if caused by nefer toxic substances - oliguria, proteinuria, progressively increasing BUN and creatinine. it's caused by an inflammatory condition - costovertebral pain, fever, dysuria, Peoria, urinary urgency, urinary frequency.
interventions for acute glomerulonephritis
if patient is oliguric they may need protein and potassium restriction. If hypertensive and oliguric they may need sodium restriction. May need high carbs. Promote rest. Weigh daily at the same time. Teach signs and symptoms of renal failure such as malaise, headache, anorexia, nausea and vomiting, weight gain, and decrease in urine output if kidney failure results patient will need dialysis
describe the recovery / convalescent phase of AKI (phase 4)
in this phase the patient begins to return to normal levels of activity. Elevated BUN starts to fall. Normal tubular function is reestablished. May last months - 1 year. Patient will need close follow-up monitoring during this time.
what is the leading cause of death in acute renal failure?
infection is the leading cause of death in acute renal failure and occurs in 30 - 70% of patients. Patient will need antibiotic treatment before dental care.
what is cystitis
inflammation of the bladder, most commonly caused by bacteria moving up the urinary tract from the external urethral to the bladder.
enuresis in a child
involuntary urination during the day of children younger than 3-4 ? not sure what age she wanted on this.
how can you reverse prerenal AKI
it can be reversed by establishing normal intravascular volume, blood pressure, and cardiac output.
what is creatinine
it is a waste product of muscle metabolism, it is excreted in the urine, and is used as a measurement of kidney function. decrease in renal function leads to a buildup of serum creatinine. This is not happen until function decreases by at least 50%. Increase protein in the diet can increase creatinine. This is one reason protein is restricted or limited with kidney failure.
client teaching after transplant
kidney failure often leads to temporary infertility but is reversed after transplant. It is recommended to delay pregnancy for at least a year after transplant and pregnancy should be planned and discussed with transplant surgeons and Physicians. instruct patients about drug regiments, signs and symptoms of rejection, signs and symptoms of infection, and other complications.
dietary considerations for a struvite stone
limit High phosphate foods such as dairy, organ meat, and whole grain
dietary considerations for a cystine Stone
limit animal protein. Encourage oral fluids, 500 mL every 4 hours while awake and 750ml at night.
dietary considerations for a calcium phosphate Stone
limit foods high in animal protein. some patients benefit from a reduce calcium diet. Decrease sodium intake.
minimizing catheter-related infection
maintain good hand hygiene. only insert urinary catheters when appropriate assess patients with catheters daily to determine the need for one, the strongest predictor of CAUTIs is the length of time the catheter is placed. Consider alternatives to catheters. Use sterile technique when inserting catheters. Do not allow the tip of the outflow to touch the collection container when emptying. Do not overfill the balloon and select the smallest size catheter possible. Maintain a closed system. Maintain unobstructed urine flow. Secure catheter to the thigh or lower abdomen. Perform daily cath care. Consider the use of coated catheters for patients requiring catheters longer than 3-5 days.
what are the different methods of peritoneal dialysis
manual- hangs from an IV pole, infused, dwell, outflow automated - machine, infused, dwell, outflow 10 minutes; continues overnight. intermittent - 4 days a week for up to 10 hours daily may be automated or manual. continuous - automated overnight, last exchange stays in peritoneal cavity and drains out the next night. CAPD (continuous ambulatory peritoneal dialysis)- 4-8 hours dwell time and is done daily
what are the causes of post renal AKI
may be caused by: urethral or bladder cancer, tumors, renal calculi, atony of the bladder, prostatic hyperplasia, urethral stricture.
what are some causes of prerenal AKI
may be caused by: shock Congestive heart failure. Pulmonary embolism. Anaphylaxis. Pericardial tamponade. Sepsis/infection
what is creatinine clearance
measures glomerular filtration rate and is an indicator for renal disease progression. As clearance decreases, serum levels increase: levels will correspond to the degree of renal failure. levels of creatinine in the urine will DECREASE but serum levels will INCREASE. it is measured using a 24 HOUR URINE COLLECTION. the test must be started again if all urine in the 24 hours period is not collected when the test begins.
overall what gender has a higher prevalence of renal Stones?
men
assessment with hemodialysis
monitor for bleeding bc you give Heparin during dialysis to prevent clots. monitor weight and I&Os monitor electrolytes monitor for disequilibrium syndrome monitor vital signs- may have a slight temperature do to the warming of dialysate
prevention of AKI
monitor those at risk for signs. intervene early.
risk factors for urinary incontinence
more prevalent in females. age. Being post-menopausal. Neurologic diseases such as Parkinson's. Diabetes. Childbirth. urilogic procedures. Over the counter drugs. Bowel patterns. Stress and Anxiety
what is a tenkoff
name of a catheter that is placed into the peritoneal cavity. Through this catheter dialysate is infused and dwells within the cavity for at least one hour depending on the patient and the type of peritoneal dialysis used.
assessment findings with polycystic kidney disease ***SAA
nurse should assess for: distended abdomen / increase girth. Flank pain. high blood pressure. Nocturia. Bloody or cloudy urine. Kidney stones. Sodium wasting. constipation. Decreased ability to concentrate urine and signs of uremia as the disease progresses. progresses to kidney failure with anuria
factors contributing to urinary tract infections
obstruction of the urinary tract calculi diabetes mellitus vesicoureteral reflux - bacteria Laden urine is forced backward from the bladder up into the ureters and kidneys alkaline urine which promotes bacterial growth or concentrated urine gauge Dash urinary stasis or other conditions that may cause incomplete bladder emptying. certain drugs that cause delayed bladder emptying (anticholinergics) sexual intercourse. antibiotic use that changes the normal protective Flora
interventions for pyelonephritis
patient will be in extreme pain so give analgesics. Antibiotics. Force fluids. Empty bladder at least every 2 hours. Perform urine cultures. Bed rest if necessary.
pericarditis in association with chronic renal disease (+signs and symptoms)
pericarditis may occur in 30 - 50% of patients with chronic renal failure. It is caused by irritation to the pericardial Sac from uremic toxins. Signs and symptoms include localized severe chest pain, increased pulse, low grade fever, and pericardial friction rub which can be heard upon auscultation.
what is the most common type of acute renal failure AKA acute kidney injury
prerenal
uremia
presence of urinary waste in the blood
what do you need to know for a person with a arteriovenous fistula
protect the arm with the fistula- no blood pressures, no blood draws, no IVs. Assess for thrill and bruit each shift. Watch for infection.
24-hour urine collection nursing interventions
provide written materials to assist in instruction. Place signs appropriately. Inform all personnel and family of test in progress. on initiation of the collection ask the patient to void and discard the urine, and note the time. If a Foley catheter is in use empty the tubing and drainage bag at the start of the time and discard the urine. Collect all urine over the next 24 hours. 24 hours after initiation ask the patient to empty the bladder and add that urine into the Container. Do not remove the urine from The Collection container or other specimens. if any urine is mist you must start the 24-hour collection completely over
interventions with peritoneal dialysis ***Q
record I&Os monitor electrolytes especially potassium and phosphate. Monitor diet - fluid restricted if oliguric. High-carb, monitor protein watch for infection. Turn side to side if dialysate does not flow well. High-fiber and stool softeners to prevent constipation
pH in relation to chronic renal failure
respiratory compensation will maintain pH but eventually the patient will require an Alkali replacement to counteract acidosis and may develop Kussmaul breathing patterns
what are the glomerular filtration rates associated with the stages of chronic kidney disease
stage 1-at risk. GFR >90 ml/min stage 2-mild CKD. GFR 60-90 ml/min stage 3-moderate CKD. 30-58 ml/min stage 4-severe CKD. 15-29 ml/min stage 5-end stage kidney disease (ESKD). <15 ml/min
Define urolithiasis
stones in the urinary tract
what is stress incontinence and what is teaching associated with preventing/ managing stress incontinence
stress incontinence is weak pelvic muscles as a result of childbirth. assess for history of losing small amounts of urine when coughing, sneezing, laughing, or physical exertion. Give medications to increase the resistance of the urethra. Encourage diet reduction if obese. Avoid alcohol and caffeine. Teach to perform Kegel exercises to strengthen the pelvic floor. If severe surgery may be necessary.
what is acute renal failure or ARF also known as acute kidney injury or AKI
sudden, rapid, potentially reversible deterioration of renal function. there is progressive elevation of BUN and creatinine. The problem is usually related to protein metabolism or volume depletion. It will eventually result in renal failure if not treated
treatment of vesicoureteral reflux
surgery involving reimplantation of the ureters
what are the symptoms of prerenal AKI
symptoms are shock like and include: decreased output, urine sodium less than 10mEq/L, increased BUN no protein is present in urine.
nursing interventions with spasmolytics or anti-spasmodics given to relieve bladder spasms with a UTI
teach patient to notify prescriber if blurred vision, eye problems, confusion, dizziness, fainting, tachycardia, or difficulty passing urine. Teach patients to wear dark sunglasses in sunlight or bright areas because drugs May dilate the pupils
Kegel exercise teaching
teach patient to practice identifying the correct muscles by sitting on the toilet with their feet flat on the floor 12 inches apart. Tell them to begin to urinate and then attempt to stop their urine flow. Lift bottom off the seat or squeeze legs together. When they stop the urine stream they're using the correct pelvic muscles for kegels. teach patient to perform exercises by tightening pelvic muscles for a slow count of 10 and then relaxing for a slow count of 10. Do exercises 15 times while lying down, sitting up, then standing, a total of 45 exercises. Repeat 10 times. This should take no more than 10 to 12 minutes for all three positions, or 3 to 4 minutes for each set of 15 exercises. begin with 45 exercises a day in 3 sets of 15 exercises each. Pt will notice Improvement faster if theycan do this twice daily for a total of 20 minutes each day. Remember to exercise in all three positions so muscles learn to squeeze effectively despite positioning. People usually report Improvement in several weeks although it may take as long as 3 months.
nursing interventions with bladder analgesics such as phenazopyridine (pyridium) given for relief of pain and burning due to UTI
teach patients that this drug will not treat the infection only help with the symptoms. Teach to take drug with or immediately after a meal. Warn that will turn the urine red or orange.
different types of access points for hemodialysis
temporary access - subclavian catheter which is used only for dialysis. Arteriovenous fistula or AV fistula
metabolic acidosis with chronic renal failure
the kidneys become unable to excrete excessive hydrogen ions with which leads the impairment of the kidney to produce ammonia. Normal reabsorption of bicarbonate is also impaired which leads to a buildup of hydrogen ions which leads to acidosis.
how is the skin affected in chronic renal failure
the skin is dry, flaky, and itchy. Encourage use of mild soap and moisturizers. And antihistamine may be used if severe.
what is the treatment for someone in the oliguric phase of AKI
the treatment is to correct fluid and electrolyte imbalances, monitor Vitals, weight, and I&Os, and dialysis for anuria
why is the workload of the heart increased with chronic renal failure?
this is due to anemia, hypertension, and fluid overload. Left ventricular hypertrophy and congestive heart failure are common. Cardiac disease is the leading cause of death in patients with end-stage renal disease.
describe the diuretic phase of AKI (phase 3)
this is the high output phase. Often has a prompt onset with urine flow increasing rapidly over a period of several days. Diuresis can result in an output of up to 10 liters per day of diluted urine. Renal function may continue to improve for up to 12 months after oliguric acute renal failure begins. The client is particularly vulnerable to additional renal injury during this time. This stage is not often seen because dialysis is started in the oliguric stage.
contraindications for renal transplantation
uncorrectable cardiac disease. Malignant neoplasms. Active infections. IV drug abuse. Severe obesity. Acute vasculitis. Severe psychosocial problems. Long-standing pulmonary disease. Heart, lung, liver disease.
how long can the kidneys maintain an effect of glomerular filtration rate
until 80% of function is lost
GI distress with chronic renal failure
uremia can affect all levels of the GI system. The normal flora of the oral cavity is altered in uremia. The mouth usually contains an enzyme that will hydrolyze urea. Since it doesn't halitosis and stomatitis are common. Anorexia, nausea, vomiting, and hiccups are also common. Patients may have pelvic ulcers, diarrhea, or constipation.
lab findings with acute glomerulonephritis
urine will be concentrated with a high specific gravity. May have red blood cells, white blood cells, and protein present. Glomerular filtration rate may be decreased. BUN will be elevated. Do a culture and sensitivity.
what is the etiology of renal stones caused by hyperuricemia
usually caused by gout- an inherited disorder of purine metabolism. or the increase production or decrease clearance of purine from myeloproliferative disorders, thiazide diuretics, or carcinoma.
what is urge incontinence
when a patient cannot suppress contraction signals to urinate. They may lose large amounts of urine. You may give medications to control a hypertonic bladder such a smooth muscle relaxants and calcium channel blockers. You may perform bladder training.
