Unit 11: Kidneys/Urinary
Failure in RIFLE Class for AKI
-Increased serum creatinine 3x baseline -OR- -GFR decreased >75% or equal to -OR- -Serum creatinine >354mmol/L w/acute rise of 44mmol Criteria: -<0.3mL/kg/h for 24hrs OR Anuria for 12hrs
Most common gastro s/sx r/t kidney/urinary problems are:
-N&V -diarrhea -abd. discomfort/distention
Pt's are at high risk for ________ when they have a decreased GFR, oliguria/anuria.
hyperkalemia
Prerenal azotemia is caused by:
hypoperfusion of the kidneys due to a nonrenal cause.
Decreased acid secretion in ESKD results from
inability of kidney tubules to excrete ammonia and reabsorb sodium bicarb -also decreased excretion of phosphorus
Blood phosphorus levels may _______ while calcium levels _______ in a pt with kidney disease.
increase decrease
The nurse recognizes that test results that most likely indicate a urinary tract infection include:
increased WBCs
yellow/milky white urine may indicate:
infection, pyuria, or use of vaginal creams
Retrograde Pyelography
instill a catheter thru ureters into renal pelvis by a cystoscope -contrast injected
ADH is also known as
vasopressin -plays a key role in the regulation of ECF by excreting or retaining water
Kidneys convert inactive ________ to its active form.
vitamin D
urinary frequency
voiding more frequently than every 3 hours
Glomerulus
where filtration occurs -blood leaves here thru the efferent arteriole and flows back to the inferior vena cava
When does specific gravity levels go down?
with high intake
KUB test
xray of abdomen to analyze kidneys, ureters, and bladder -checks size, shape, and position of renal/urinary system -no prep needed
What illnesses are associated with acute glomerulonephritis?
-Group A Strep -Varicella zoster virus -hep B -epstein Barr virus
Nursing Diagnoses r/t ESKD
-Hypervolemia -Impaired nutritional intake -Lack of Knowledge -Activity Intolerance -Risk for situational low self esteem
If the pt is experiencing ECG changes r/t hyperkalemia, the RN may administer what?
-IV dextrose 50% -IV insulin -IV calcium replacement This will shift potassium back into the cells
What are characteristics of the intrarenal category of acute kidney injury (AKI)?
-Increased BUN -Increased creatinine -low-normal specific gravity of urine -increased sodium in urine
Risk in RIFLE Classification for AKI
-Increased serum creatinine 1.5x baseline -OR- -GFR decreased by >25% or equal to Criteria: -0.5mL/kg/h for 6 hrs
Injury in RIFLE Class for AKI
-Increased serum creatinine 2x baseline -OR- -GFR decreased >50% or equal to Criteria: -0.5mL/kg/h for 12hrs
What is a prostaglandin?
-hormone-like substance made from essential fats used for things like blood clotting, body temperature and contraction of the uterus
Dialysis may be initiated to prevent complications of AKI. What types of complications may lead to dialysis?
-hyperkalemia -metabolic acidosis -pericarditis -pulm edema
Olders adults are more prone to develop:
-hypernatremia -fluid volume deficit (decreased stimulation of thirst)
Prerenal AKI causes
-hypoperfusion r/t decreased blood flow to kidneys -burns -hemorrhage -GI losses -hypotension -sepsis/shock -obstruction of renal vessels
Renal Replacement Therapy (RRT)
a treatment that replaces kidney function; the treatment may be some type of dialysis or it may be kidney transplantation
Prerenal causes of acute renal failure include:
-hypovolemic shock -cardiogenic shock secondary to CHF -septic shock -anaphylaxis -dehydration -renal artery thrombosis or stenosis -MI -lethal dysrhythmias
Anticholinergic effects on incontinence
-improve bladder retention -improve bladder emptying -improve bladder control
What foods should be avoided in a low-purine diet?
anchovies, animal organs and sardines.
ADH (vasopressin)
antidiuretic hormone secreted by posterior pituitary gland. -causes kidneys to reabsorb more water
Treatment w/nephrosclerosis
antihypertensives like ace inhibitors
Which of the following causes should the nurse suspect in a client diagnosed with intrarenal failure?
glomerulonephritis
Glycosuria
glucose in urine
Erythropoietin
glycoprotein from kidney that stimulates bone marrow to produce RBCs
erthropoietin
glycoprotein produced by kidneys -stimulates bone marrow to make RBCs
Nursing Interventions for Kidney Biopsy
-Ensure no bleeding risks -Urine sample before and after -After, check incision site for bleeding and within urine -Have pt hold breath is kidney needle biopsy -Watch VS -Watch for infection -give IV fluids -May have small amt of hematuria for up to 24hr
A client is diagnosed with polycystic kidney disease and requires teaching on the management of the disorder. Which statement made by the client indicates a need for further teaching?
"As long as I have one normal kidney, I should be fine." Explanation: Polycystic kidney disease is characterized by the formation of multiple cysts on both kidneys. Polycystic kidney disease is inherited as an autosomal dominant trait. The fluid-filled cysts can cause great enlargement of the kidneys and interfere with kidney function, which can eventually lead to renal failure.
The client with polycystic kidney disease asks the nurse, "Will my kidneys ever function normally again?" The best response by the nurse is:
"As the disease progresses, you will most likely require renal replacement therapy." Explanation: There is no cure for polycystic kidney disease. Medical management includes therapies to control blood pressure, urinary tract infections, and pain. Renal replacement therapy is indicated as the kidneys fail.
The nurse is caring for a client scheduled for urodynamic testing. Following the procedure, which information does the nurse provide to the client?
"Contact the primary provider if you experience fever, chills, or lower back pain." Explanation: The client must be made aware of the signs of a urinary tract infection after the procedure.The client will have catheters placed during the procedure but will not be sent home with one. The client should be told to avoid caffeinated, carbonated, and alcoholic beverages after the procedure because these can further irritate the bladder. These symptoms usually decrease or subside by the day after the procedure. If the client received an antibiotic medication before the procedure, they should be told to continue taking the complete course of medication after the procedure. This is a measure to prevent infection.
A client undergoes extracorporeal shock wave lithotripsy. Before discharge, the nurse should provide which instruction?
"Increase your fluid intake to 2 to 3 L per day." Explanation: The nurse should instruct the client to increase his fluid intake. Increasing fluid intake flushes the renal calculi fragments through — and prevents obstruction of — the urinary system.
A client with newly diagnosed renal cancer is questioning why detection was delayed. Which is the best response by the nurse?
"Very few symptoms are associated with renal cancer." Explanation: Renal cancers rarely cause symptoms in the early stage. Tumors can become quite large before causing symptoms. Painless, gross hematuria is often the first symptom in renal cancer and does not present until later stages of the disease.
azotemia
(excessive) urea and nitrogenous substances in the blood
AKI is marked by:
*abrupt loss of kidney function defined as: --sudden increase of serum creatinine of 0.3 mg/dL within 48 hours OR --1.5 times baseline serum creatinine over 1 week. *decrease in glomerular filtration rate (GFR) *abrupt decline in urine output (<0.5 mL/kg/hr for 6 to 12 hours)
Risk Factors for Kidney or Urologic Disorders
-Advanced Age -BPH -Diabetes -Gout -hyperparathyroidism -Crohn's/ileostomy -Htn -Consistent catheterization -immobilization -MS -tumors -Parkinson's -pregnancy -radiation to pelvis -sickle cell -spinal cord injury -strep/impetigo/nephrotic syndrome -lupus
Who is at risk for developing nephrosclerosis?
-African American -pts w/uncontrolled htn -pts w/diabetic nephropathy -pts w/underlying CKD
What potential complications of ESKD require collaborative approach to care?
-Anemia -Bone disease -Hyperkalemia -Htn -Pericarditis
The nurse is caring for a patient with a medical history of untreated CKD that has progressed to ESKD. Which of the following serum values and associated signs and symptoms will the nurse expect the patient to exhibit?
-Calcium 7.5 mg/dL; hypotension and irritability -Potassium 6.4 mEq/L; dysrhythmias and abdominal distention -Phosphate 5.0 mg/dL; tachycardia and nausea and emesis
Functions of the Kidney
-Control BP -Control Water balance -excrete waste products -regulate electrolytes -regulate acid-base balance -regulate RBC production -renal clearance -secrete prostaglandins -synthesis of Vit. D to its active form -urine formation
Which nursing diagnosis is appropriate for the client with a new ileal conduit?
-Deficient knowledge: management of urinary diversion -Disturbed body image -Risk for impaired skin integrity
UTI Education
-Notify physician of any urgency, burning, frequency, and difficulty urinating -drink 2-3L per day to dilute urine and reduce irritation to bladder -take full course of antibiotics even after s/sx subside to avoid a recurrence uti -women to avoid scented toilet tissue and bubble baths -wear cotton underwear, not nylon
The nurse is providing an education program for the nursing assistants in a long-term care facility in order to decrease the number of UTIs in the female population. What interventions should the nurse introduce in the program?
-Perform hand hygiene prior to patient care. -Assist the patients with frequent toileting. -Provide careful perineal care.
Loss in RIFLE Class for AKI
-Persistent AKI= complete loss of kidney function >4wks
What are some age-related changes associated with the renal system?
-Renal arteries thicken -decrease in weight of kidney -decreased blood flow -decreased bladder capacity
postinfections that can cause acute nephritic syndrome
-Strep A -HIV -Epstein Barr Virus -varicella -impetigo -upper resp infection -viral infection -mumps -hep b
Clinical manifestations of Peritonitis
-abdominal pain/distention -absence of bowel sounds -nausea and vomiting -fever -changes in vital signs.
Intrarenal AKI causes
-actual damage to glomeruli or kidney tubes -acute tubular necrosis (most common)
What conditions can develop with chronic glomerulonephritis?
-anemia -hyperkalemia -metabolic acidosis -hyperphosphatemia
Tx of acute nephritic syndrome
-antibiotics (penicillin) -limit protein and sodium -steroids -monitor I/Os and daily wt -steroids -increase carb intake for energy -diuretics if edema present -immunosuppressants
Preventing AKI
-assess output/labs -observe for any wounds/burns/precursors for sepsis -prevent/treat infections promptly -prevent/treat hypotension/shock w/blood or fluid replacement -provide proper hydration -if foley present, meticulous peri-care and remove cath ASAP -prevent nephrotoxicity by closely monitoring drug doses and blood levels pertaining to them
In autosomal recessive polycystic kidney disease, it begins affecting them ________ or even before. Also, both parents carry the gene, but neither are affected. It is ______common than autosomal dominant PKD.
-at birth -less
Dialysis can correct:
-biochemical abnormalities -allow liberalization of fluids/protein/sodium intake -diminish bleeding tendencies -promote wound healing
CT scan of kidney can show:
-calculi build up -congenital abnormalities -obstructions -infections -polycystic diseases
Clinical manifestations of acute glomerulonephritis
-cola-colored urine -hematuria -edema -azotemia -proteinuria
Elderly s/sx assoc w/acute nephritic syndrome
-confusion -dyspnea r/t circulatory overload -enlarged neck veins -pulm edema
What are some conditions that can cause a high specific gravity?
-diabetes -nephritis -fluid deficit
What are some conditions that can cause a low specific gravity?
-diabetes insipidus -glomerulonephritis -severe renal damage
What are some medications that can trigger incontinence?
-diuretics -hypnotics -sedatives -antihypertensives
Overdistended bladder and interstitial cystitis s/sx
-dull, continuous pain at the suprapubic area that's intense with voiding -urine urgency -straining to void
Clinical findings of fluid excess
-dyspnea -generalized edema -tachycardia -distended neck veins -crackles in lungs (pulm edema)
S/Sx of a lower UTI
-dysuria -burning when voiding -frequency of voiding -nocturia -suprapubic/pelvic pain -incontinence -urine pH elevated -positive nitrates in urine -positive leukocytes in urine =WBCs in urine -Glucose in urine (can be indicative of diabetes, but also means the urinary tract is infection prone)
Potential causes of calcium renal stones:
-excessive intake of vitamin D -hypercalcemia -hyperparathyroidism -excessive intake of milk and alkali -renal tubular acidosis.
IV Urography test types
-excretory urography -IV Pyelography
Fluid deficits in elderly can lead to:
-falls -med toxicity -constipation -UTI -Resp infection -delirium -seizures -lytes imbalances -hyperthermia(fever) -delayed wound healing
Acute prostatitis s/sx
-feeling of fullness in perineum -vague back pain -frequency/urgency urination -dysuria
Risk factors for developing a lower UTI
-female -holding urine for long periods of time -decreased fluid intake -diabetes -pregnancy -neurologic disorders -gout
ureteral stricture s/sx
-flank pain -tenderness at costovertebral angle and back -abdominal discomfort.
Glomerulonephritis can occur as a result from the following infections:
-group A strep -bacterial endocarditis -hep B or C -HIV
s/sx of acute nephritic syndrome
-hematuria -edema -pus/casts in urine -htn -proteinuria -decreased GFR -azotemia -cola colored urine f/RBCs -headache -malaise -poss anemia -flank pain -increased BUN/creatinine r/t decreased output -decreased albumin -hyperlipidemia
Possible complications of retrograde pyelography
-hematuria -infection -perforating of ureter
Nutrition for renal patients
-high carbs -low protein -restrict sodium, potassium, and phosphorus (bananas, citrus, dairy)
Hyperkalemia S/SX
-high serum levels >5 -ECG changes in T-waves (tall/tented/peaked) -irritability -abdominal cramping -diarrhea -paresthesia (abn sensation) -gen. muscle weakness
Aldosterone
-hormone synthesized/released by adrenal cortex -causes kidneys to reabsorb sodium
If there is a decreased amount of water intake, blood osmolality will begin to _______ which then stimulates the release of _______ hormone which then acts on the kidney to ________ reabsorption of _______ which returns osmolality of blood to normal.
-increase -antidiuretic -increase -water
CKD S/SX
-increased serum creatinine levels -anemia r/t decreased erythropoietin production -metabolic acidosis -abnorm calcium and phosphorus -fluid retention (edema and CHF) -abnorm lytes -htn
Structures within the kidney/urinary system:
-kidneys -urethra -ureters -bladder
What are some restrictions a nurse would teach a pt w/CKD?
-limit potassium (fresh fruits/veg); hyperkalemia can be life threatening -limit sodium; prevention of fluid accumulation -taking iron/folic acid supplements or epogen; aids in RBC production -limit protein to only complete proteins
Clinical Manifestations of Polycystic Kidney Disease
-loss of renal function -increasing size of kidneys as cysts grow -hematuria -htn -renal calculi developing -UTI's -proteinuria -abdominal fullness/flank pain as cysts enlarge
acute glomerulonephritis s/sx
-may be asymptomatic -fever -nausea -malaise -headache -edema (generalized or periorbital) -pain -mild/mod htn
Tx for uremic frost
-moisturize -avoid hot water -use cold or warm water
Postrenal AKI causes
-obstruction distal from kidneys -renal calculi -strictures -blood clots -BPH -malignancies -pregnancy
Dysfunction of the kidney S/SX
-pain -changes in voiding -GI disturbances
Commonly prescribed medication for CKD
-phosphate binding agents -calcium (carbonate or acetate); given with food -vit D -antihypertensives/cardiac meds -human erythropoietin
s/sx of nephrotic syndrome
-proteinuria -hypoalbuminemia -diffuse edema -high cholesterol -hyperlipidemia -increased risk for DVT, renal vein clot, PE -headache/malaise
renal cell carcinoma s/sx
-rarely exhibits symptoms early on -painless hematuria -persistent back pain in later stages.
Chronic Glomerulonephritis Causes
-recurrent acute glomerulonephritis -htn nephrosclerosis -glomerulus sclerosis -diabetes -lupus
Cystography is used if the pt is experiencing ______ or if they have a ________ injury.
-reflex/backflow of urine -bladder
Why are elderly more susceptible to AKI and CKD as well as increased risk for adverse drug effects?
-sclerosis of glomerulus/renal vasculature -decreased blood flow -decreased GFR -altered tubular function -acid-base imbalance -multi-use of meds where metabolites are cleared by kidneys
Functions of Kidney
-secretion of prostaglandins -regulation of blood pressure -synthesis of aldosterone and vitamin D.
chronic glomerulonephritis s/s
-shrinking kidneys -scar tissue build up -leads to stage 5 GFR -htn -increased BUN/creatinine -proteinuria -wt loss/strength -nocturia -headache -dizzy -GI upset -edema -anemia -distended neck veins -crackles in bases -hyperkalemia -increased phosphorus levels (decreased calcium) -metabolic acidosis -confused -hypoalbuminemia
Tests to measure renal concentration
-specific gravity -urine osmolality
What waste products must be eliminated in urine by the kidneys?
-urea (protein metabolism) -creatinine -phosphates -sulfates -uric acid (purine metabolism)
How to collect a urine sample for UTI
-urinate a small amount into toilet to rid urethra of contaminates -clean genitalia with sterile wipes prior to giving sample (labia on women and tip of penis on men) -give sample of at least 1-2oz -catch urine mid-stream and then finish voiding in toilet
urinary calculi (kidney stones) s/sx
-vary with size, location, and cause. -Small stones may pass unnoticed -sudden, sharp, severe flank pain that travels to the suprapubic region and external genitalia -pain is accompanied by renal or ureteral colic (painful spasms that attempt to move the stone) -pain comes in waves that radiate to the inguinal ring, the inner aspect of the thigh, and to the testicle or tip of the penis in men, or the urinary meatus or labia in women.
The nurse is creating a plan of care for a client with nephrotic syndrome. Which assessment findings will dictate necessary nursing actions?
-wt gain -periorbital edema -SOB -anorexia
What educational information should the nurse provide to a patient to do peritoneal dialysis at home?
1). Use aseptic technique during the procedure 2). wear a mask when performing exchanges 3). Clean insertion site daily with antiseptic solution such as iodine; not soap 4). Stabilize the catheter to the abdomen above the belt line to avoid rubbing 5). Dialysis supplies should be kept in a clean area away from pets and children
Glycosuria can occur _________ or in ___________; which is the most common condition that causes blood glucose level to exceed the kidney's reabsorption capacity.
1). as a benign condition 2). poorly controlled diabetes
Tricyclic antidepressants can help the bladder by decreasing _______ and increasing ______.
1). bladder contractions 2). bladder neck resistance.
A history of _____ or _____ would place a person at risk for developing renal calculi.
1). hyperparathyroidism 2). osteoporosis
Urine Specific Gravity normal range
1.005-1.035
Specific gravity normal range
1.010-1.025
What is the normal blood flow through the kidneys per minute?
1000-1300ml
1kg of weight gained is equal to
1000ml
1kg of wt gain is = to?
1000ml retained fluid
Normal GFR
125 mL/min
Where is the costovertebral angle?
12th rib. Angle made from inferior vertebrae to floating rib.
Bladder fullness is transmitted to CNS when it has reached:
150-200mL -initial desire to void occurs -fullness/discomfort w/strong desire to void occurs when bladder is at capacity (400-500ml)
How long does it take for erythropoietin to start increasing a CKD pt's Hct levels?
2-6weeks
The kidneys receive approximately how much percentage of cardiac output?
20-25%
Test that checks creatinine clearance
24hr urine
GFR starts decreasing at the age of:
35-40yrs -yearly decline of 1ml/min
Functional capacity amount of bladder:
400-500ml
1lb gained weight is equal to
500ml
A patient has stage 3 chronic kidney failure. What would the nurse expect the patient's glomerular filtration rate (GFR) to be?
A GFR of 30-59 mL/min/1.73 m2
Increased blood osmolality indicates:
ADH stimulation Explanation: Antidiuretic hormone (ADH), also known as vasopressin, is a hormone that is secreted by the posterior portion of the pituitary gland in response to changes in osmolality of the blood. With decreased water intake, blood osmolality tends to increase, stimulating ADH release.
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which disorder?
Acute glomerulonephritis
A client comes to the emergency department complaining of severe pain in the right flank, nausea, and vomiting. The physician tentatively diagnoses right ureterolithiasis (renal calculi). When planning this client's care, the nurse should assign the highest priority to which nursing diagnosis?
Acute pain Explanation: Ureterolithiasis typically causes such acute, severe pain that the client can't rest and becomes increasingly anxious. Therefore, the nursing diagnosis of Acute pain takes highest priority. Diagnoses of Risk for infection and Impaired urinary elimination are appropriate when the client's pain is controlled.
Which hormone causes the kidneys to reabsorb sodium?
Aldosterone Explanation: Aldosterone is a hormone synthesized and released by the adrenal cortex.
The nurse is employed in a urologist's office. Which classification of medication is anticipated for clients having difficulty with urinary incontinence?
Anticholinergic -such as Detrol, Ditropan, and Urecholine.
Which type of medication may be used to inhibit bladder contraction in a client with incontinence?
Anticholinergic agent
A patient who has nephrotic syndrome develops flank pain. Which treatment will the nurse plan to explain to this patient?
Anticoagulants Rationale Flank pain in a patient with nephrotic syndrome suggests a renal vein thrombosis and anticoagulation is needed
Nephrotic Syndrome
Any condition that seriously damages the glomerular membrane and results in increased permeability to plasma proteins
An ileal conduit is created for a client after a radical cystectomy. Which of the following would the nurse expect to include in the client's plan of care?
Application of an ostomy pouch Explanation: An ileal conduit involves care of a urinary stoma, much like that of a fecal stoma, including the application of an ostomy pouch, skin protection, and stoma care.
Which nursing action is essential for a patient immediately after a renal biopsy?
Apply a pressure dressing and position the patient on the affected side Rationale A pressure dressing is applied, and the patient is kept on the affected side for 30 to 60 minutes to put pressure on the biopsy side and decrease the risk for bleeding.
Following a renal biopsy, a client reports severe pain in the back, the arms, and the shoulders. Which intervention should be offered by the nurse?
Assess the patient's back and shoulder areas for signs of internal bleeding. Explanation: After a renal biopsy, the client should be on bed rest. The nurse observes the urine for signs of hematuria. It is important to assess the dressing frequently for signs of bleeding, monitor vital signs, and evaluate the type and severity of pain. Severe pain in the back, shoulder, or abdomen may indicate bleeding. In such a case, the nurse should notify the physician about these signs and symptoms. The nurse should also assess the client for difficulty voiding and encourage adequate fluid intake.
A nurse is conducting a health history on a patient who is seeing her health care provider for symptoms consistent with a UTI. The nurse understands that the most common route of infection is which of the following?
By ascending infection (transurethral) Explanation: The most common route of infection is transurethral, in which bacteria colonize the periurethral area and enter the bladder by means of the urethra.
A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures?
Hyperphosphatemia Explanation: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia.
A client is diagnosed with polycystic kidney disease. Which of the following would the nurse most likely assess?
Hypertension Explanation: Hypertension is present in approximately 75% of clients with polycystic kidney disease at the time of diagnosis. Pain from retroperitoneal bleeding, lumbar discomfort, and abdominal pain also may be noted based on the size and effects of the cysts.
The nurse is caring for a client with a history of sickle cell anemia. The nurse understands that this predisposes the client to which renal or urologic disorder?
CKD
As one increases, the other decreased. What 2 serums have this relationship in renal disease?
Calcium and phosphorus -usually high phosph and low calcium r/t poor filtration thru glomerulus
Which objective symptom of a UTI is most common in older adults, especially those with dementia?
Change in cognitive functioning
A 24-year-old patient was admitted to the emergency room after a water skiing accident. The X-rays revealed two fractured vertebrae, T-12 and L1. Based on this information, the nurse would know to perform which of the following actions?
Check the patient's urine for hematuria. Explanation: The kidneys are located from the 12th thoracic vertebrae to the third lumbar vertebrae. Therefore, the accident may have caused blunt force trauma damage to the kidneys. Ice is always applied for the first 24 hours, then heat, if not contraindicated. Activity will be restricted but bed rest is not necessary.
When caring for the patient with acute glomerulonephritis, which of the following assessment findings should the nurse anticipate?
Cola-colored urine
Which finding by the nurse will be most helpful in determining whether a 67-yr-old patient with benign prostatic hyperplasia has an upper urinary tract infection (UTI)?
Costovertebral tenderness Rationale Costovertebral tenderness is characteristic of pyelonephritis. Bladder distention, foul-smelling urine, and suprapubic discomfort are characteristic of a lower UTI and are likely to be present if the patient also has an upper UTI.
Which of the following vitamin is necessary for maintenance of normal calcium levels?
D
What is one reason why an older adult will experience nocturia?
Decreased bladder compliance and decreased vasopressin levels
After teaching a group of students about the types of urinary incontinence and possible causes, the instructor determines that the students have understood the material when they identify which of the following as a cause of stress incontinence?
Decreased pelvic muscle tone due to multiple pregnancies Explanation: Stress incontinence is due to decreased pelvic muscle tone, which is associated with multiple pregnancies, obstetric injuries, obesity, menopause, or pelvic disease.
The wall of the bladder is comprised of four layers. Which of the following is the layer responsible for micturition?
Detrusor muscle Explanation: The bladder wall contains four layers. The smooth muscle layer beneath the adventitia is known as the detrusor layer. When this muscle contracts, urine is released from the bladder. When the bladder is relaxed, the muscle fibers are closed and act as a sphincter.
What 2 conditions make up 60-70% of CKD development?
Diabetes and HTN
A nurse who works in a clinic sees many patients with a variety of medical conditions. The nurse understands that a risk factor for UTIs is which of the following?
Diabetes mellitus
ESKD in RIFLE Class for AKI
ESKD >3mos
An appropriate nursing intervention for the client following a nuclear scan of the kidney is to:
Encourage high fluid intake. Explanation: A nuclear scan of the kidney involves the IV administration of a radioisotope. Fluid intake is encouraged to flush the urinary tract to promote excretion of the isotope.
Which of the following is a cause of a calcium renal stone?
Excessive intake of vitamin D
When caring for a patient after cystoscopy, which instruction would the nurse provide?
Expect blood-tinged urine Rationale Pink-tinged urine and urinary frequency are expected after cystoscopy. Burning on urination is common, but pain that requires opioids for relief is not expected. A good fluid intake is encouraged after this procedure. Bed rest is not required after cystoscopy
True or False: Polycystic Kidney Disease has a cure
False -only cure is a transplant
A patient who has increased blood urea nitrogen (BUN) and serum creatinine levels is scheduled for a renal arteriogram. Which bowel preparation order would the nurse question for this patient?
Fleet enema Rationale High-phosphate enemas, such as Fleet enemas, should be avoided in patients with elevated BUN and creatinine because phosphate cannot be excreted by patients with renal failure.
Stage 4 CKD
GFR 15-29ml/min
Stage 3 CKD
GFR 30-59ml/min
Stage 2 CKD
GFR 60-89mL/min
Stage 5 CKD
GFR <15ml/min
Stage 1 CKD
GFR >90 or equal to 90 -Normal is 125ml/min
Complications of acute glomerulonephritis
HTN encephalopathy, heart failure, pulmonary edema
nephrosclerosis
Hardening of blood vessels (arteries) in the kidney -to avoid from occurring, antihypertensives should be taken to manage blood pressure
An athlete is thought to have sustained an injury to a kidney. The ER nurse caring for the client reviews the initial orders written by the primary health care provider and notes an order to collect all voided urine and send it to the laboratory for analysis. The nurse understands that this nursing intervention is important for what reason?
Hematuria is the most common manifestation of renal trauma and blood losses may be microscopic, so laboratory analysis is essential. Explanation: Hematuria is the most common manifestation of renal trauma; its presence after trauma suggests renal injury. Hematuria may not occur, or it may be detectable only on microscopic examination. All urine should be saved and sent to the laboratory for analysis to detect RBCs and to evaluate the course of bleeding.
Which type of voiding dysfunction is seen in clients diagnosed with Parkinson disease?
Incontinence
A client has end-stage renal failure. Which of the following should the nurse include when teaching the client about nutrition to limit the effects of azotemia?
Increase carbohydrates and limit protein intake. Explanation: Calories are supplied by carbohydrates and fat to prevent wasting. Protein is restricted because the breakdown products of dietary and tissue protein (urea, uric acid, and organic acids) accumulate quickly in the blood.
The nurse advises the patient with chronic pyelonephritis that he should:
Increase fluids to 3 to 4 L/24 hours to dilute the urine. Explanation: Unless contraindicated, fluids should be increased to dilute the urine, decrease burning on urination, and prevent dehydration
A nurse is reviewing the laboratory test results of a client with renal disease. Which of the following would the nurse expect to find?
Increased serum creatinine Explanation: In clients with renal disease, the serum creatinine level would be increased. The BUN also would be increased, serum albumin would be decreased, and potassium would likely be increased.
4 phases of AKI
Initiation- initial insult to kidney Oliguria-serums increase, output 400ml/24hrs, uremic s/sx begin Diuresis-gradual increase in urine; lab values begin to normalize Recovery- improved renal function over 3-12mos
Which action would the nurse take first when a patient's urine dipstick test indicates a small amount of protein?
Inquire about which medications the patient is currently taking. Rationale: Normally the urinalysis will show zero to trace amounts of protein, but some medications may give false-positive readings.
A continent urinary diversion pouch such as a Kock or Indiana pouch require:
Intermittent catheterizations and irrigations
A client comes to the emergency department complaining of sudden onset of sharp, severe pain in the lumbar region that radiates around the side and toward the bladder. The client also reports nausea and vomiting and appears pale, diaphoretic, and anxious. The physician tentatively diagnoses renal calculi and orders flat-plate abdominal X-rays. Renal calculi can form anywhere in the urinary tract. What is their most common formation site?
Kidney
When is kidney disease considered chronic?
Kidney damage or decrease in GFR for >3mos
A 78-yr-old patient has been admitted with benign prostatic hyperplasia. Which action would the nurse include in the plan of care?
Leave a light on in the bathroom during the night. Rationale The patient's age and diagnosis indicate a likelihood of nocturia, so leaving the light on in the bathroom is appropriate. Fluids should be encouraged because dehydration is more common in older patients. The information in the question does not indicate that measurement of the patient's output is necessary or that the patient has overflow incontinence.
What is a common antibiotic given to treat a UTI?
Levofloxacin (Levaquin) -fluoroquinolone class
The nurse performs a physical examination on a client diagnosed with acute pyelonephritis to assist in determining which of the following?
Location of discomfort Explanation: The physical examination of a client with pyelonephritis helps the nurse determine the location of discomfort and signs of fluid retention, such as peripheral edema or shortness of breath.
A nurse who is taking care of a patient with a spinal cord injury documents the frequency of reflex incontinence. The nurse understands that this is most likely due to:
Loss of motor control of the detrusor muscle. Explanation: Spinal cord injury patients commonly experience reflex incontinence because they lack neurologically mediated motor control of the detrusor and the sensory awareness of the urge to void. These patients also experience hyperreflexia in the absence of normal sensations associated with voiding.
Examination of a client's bladder stones reveals that they are primarily composed of uric acid. The nurse would expect to provide the client with which type of diet?
Low purine
The nurse is caring for a hospitalized patient with a decreased glomerular filtration rate who is scheduled for an intravenous pyelogram (IVP). Which action will the nurse include in the plan of care?
Monitor the urine output after the procedure. Rationale Patients with impaired renal function are at risk for decreased renal function after IVP because the contrast medium used is nephrotoxic, so the nurse should monitor the patient's urine output.
Which is an effect of aging on upper and lower urinary tract function?
More prone to develop hypernatremia
Urine specific gravity is a measurement of the kidney's ability to concentrate and excrete urine. Specific gravity compares the density of urine to the density of distilled water. Which is an example of how urine concentration is affected?
On a hot day, a person who is perspiring profusely and taking little fluid has low urine output with a high specific gravity.
A 64-year-old man is seeing his urologist for an annual check-up, post prostatectomy. The health care provider is concerned with the symptom he finds because it is considered diagnostic for bladder cancer. Which of the following signs/symptoms is diagnostic for bladder cancer?
Painless, gross hematuria Explanation: Although flank pain may occur, the painless, gross hematuria is characteristic of bladder cancer.
If an indwelling catheter is necessary, which nursing intervention should be implemented to prevent infection?
Perform meticulous perineal care daily with soap and water
The nurse is caring for a postoperative client who has a Kock pouch. Nursing assessment findings reveal abdominal pain, absence of bowel sounds, fever, tachycardia, and tachypnea. The nurse suspects which of the following?
Peritonitis
The following catheterization procedures are used to treat clients with urinary retention. Which procedure would the nurse identify as carrying the greatest risk to the client?
Permanent drainage with a urethral catheter Explanation: Permanent drainage with a urethral catheter carries the greatest risk. It may also increase the risk for bladder stones, renal diseases, bladder infections, and urosepsis, a severe systemic infection by microorganisms in the urinary tract invading the bloodstream
Urine that is orange may be caused by:
Phenytoin or other medications.
A client in moderate pain is admitted for possible kidney stones. The client appears diaphoretic and has frequent periods of nausea and vomiting. The client reports sudden oliguria and initial portable bladder ultrasound shows 300 mL in the bladder after the client voided 50 mL. Which action should the nurse anticipate performing first for this client?
Place a urinary catheter. Explanation: Increased urinary urgency and frequency coupled with decreasing urine volume strongly suggest urinary retention depending on the acuity of the onset of the symptoms, immediate bladder emptying via catheterization and evaluation may be necessary to prevent kidney dysfunction. The combination of pain, sudden oliguria, nausea, vomiting and post-residual results are suggestive of an acute condition. The pain, nausea, and vomiting may be the result of urinary retention and a full bladder. Placement of a urinary catheter may alleviate those conditions. After placing the urinary catheter, a reassessment and treatment of those conditions can occur.
acute nephritic syndrome
Postinfectious glomerulonephritis, rapidly progressive glomerulonephritis, and membranous glomerulonephritis
3 categories of AKI
Prerenal-hypoperfusion of kidney Intrarenal-actual damage to kidney Postrenal-obstruction to urine flow
A patient with a UTI is having burning and pain when urinating. What urinary analgesic is prescribed for relief of these symptoms?
Pyridium Explanation: The urinary analgesic agent phenazopyridine (Pyridium) is used specifically for relief of burning, pain, and other symptoms associated with UTI.
AKI
RAPID loss of renal function r/t damage to kidneys -50% or more increase in serum creatinine above baseline
A client is concerned after noticing the color of their urine is dark brown. The nurse is aware that the client is prescribed senna, methyldopa, and acetaminophen. Which action is an appropriate response by the nurse?
Reassure the client the urine color is related to the medication methylopa and no further action is needed at this time. Explanation: Some medications cause a change in the color of the urine. Methyldopa can cause urine to appear dark brown to black in color and is a normal findings. Senna products can cause the urine. to appear pink or red.
Which information in the patient history would indicate a possible cause of acute glomerulonephritis?
Recent sore throat and fever
An adult patient is admitted to the hospital with new-onset nephrotic syndrome. Which assessment data will the nurse expect?
Recent weight gain Rationale The patient with a nephrotic syndrome will have weight gain associated with edema
Sympathomimetics have which of the following effects on the body?
Relaxation of bladder wall Explanation: Sympathomimetics mimic the sympathetic nervous system, causing increased heart rate and contractility, dilation of bronchioles and pupils, and bladder wall relaxation.
A woman comes to her health care provider's office with signs and symptoms of kidney stones. Which of the following should be the primary medical management goal?
Relieve the pain
RIFLE
Risk Injury Failure Loss ESKD
A client with renal failure is undergoing continuous ambulatory peritoneal dialysis. Which nursing diagnosis is the most appropriate for this client?
Risk for infection Explanation: The peritoneal dialysis catheter and regular exchanges of the dialysis bag provide a direct portal for bacteria to enter the body.
Following percutaneous nephrolithotomy, the client is at greatest risk for which nursing diagnosis?
Risk for infection Explanation: Percutaneous nephrolithotomy is an invasive procedure for the removal of renal calculi.
A patient has had recurrent uric acid kidney stones. Which diet items would the nurse recommend that the patient avoid or limit?
Sardines and liver Rationale Organ meats and fish such as sardines increase purine levels and uric acid
What is a possible complication of a UTI?
Sepsis -pt may be experiencing fever, tachycardia, chills, N&V, headache, malaise, elevated WBCs, pain
Based on her knowledge of the primary cause of end-stage renal disease, the nurse knows to assess the most important indicator. What is that indicator?
Serum glucose Explanation: The nurse would evaluate serum and urine levels of glucose because diabetes is the primary cause of renal failure.
What is used to decrease potassium level seen in acute renal failure?
Sodium polystyrene sulfonate Explanation: The elevated potassium levels may be reduced by administering cation-exchange resins (sodium polystyrene sulfonate [Kayexalate]) orally or by retention enema. Kayexalate works by exchanging sodium ions for potassium ions in the intestinal tract.
The nurse is caring for a client who has undergone a nephrectomy. Which assessment finding is most important in determining nursing care for the client?
SpO2 at 90% with fine crackles in the lung bases Explanation: Altered Breathing Pattern and Ineffective Airway Clearance Risk are often challenges in caring for clients postnephrectomy due to location of incision. Nursing interventions should be directed to improve and maintain SpO2 levels at 90% or greater and keep lungs clear of adventitious sounds. Intake and output is monitored to maintain a urine output of greater than 30 mL/hour. Pain control is important and should allow for movement, deep breathing, and rest. Blood-tinged drainage from the JP tube is expected in the initial postoperative period.
What is urine specific gravity?
Specific gravity evaluates the kidney's ability to regulate fluid balance & evaluate the hydration status of the body.
Urinary retention is associated with:
Spinal cord injury
A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?
Start IV fluids with a normal saline solution bolus followed by a maintenance dose . Explanation: The client is in prerenal failure caused by hypovolemia. I.V. fluids should be given with a bolus of normal saline solution followed by maintenance I.V. therapy. This treatment should rehydrate the client, causing his blood pressure to rise, his urine output to increase, and the BUN and creatinine levels to normalize.
A client who has recently undergone ESWL for the treatment of renal calculi has phoned the urology unit where he was treated, telling the nurse that he has a temperature of 101.1ºF (38.4ºC). How should the nurse best respond to the client?
Tell the client to report to the ED for further assessment. Explanation: Following ESWL, the development of a fever is abnormal and is suggestive of a UTI; prompt medical assessment and treatment are warranted. It would be inappropriate to delay further treatment.
The nurse is providing supportive care to a client receiving hemodialysis in the management of acute kidney injury. Which statement from the nurse best reflects the ability of the kidneys to recover from acute kidney injury?
The kidneys can improve over a period of months. Explanation: The kidneys have a remarkable ability to recover from serious insult. Recovery may take 3 to 12 months. As long as recovery is continuing, there is no need to consider transplant or permanent hemodialysis.
Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective?
The periorbital and peripheral edema have resolved. Rationale Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative, and the patient will not experience dysuria because the patient does not have a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal infection.
A client with bladder cancer had his bladder removed and an ileal conduit created for urine diversion. While changing this client's pouch, the nurse observes that the area around the stoma is red, weeping, and painful. What should the nurse conclude?
The pouch faceplate doesn't fit the stoma. Explanation: If the pouch faceplate doesn't fit the stoma properly, the skin around the stoma will be exposed to continuous urine flow from the stoma, causing excoriation and red, weeping, and painful skin.
A client asks the nurse why cystitis is more common in women than in men. Which of the following body parts will the nurse include in the answer?
The urethra Explanation: Because the urethra is short in women, ascending infections or microorganisms carried from the vagina or rectum are common.
The nurse performs acute intermittent peritoneal dialysis (PD) on a client who is experiencing uremic signs and symptoms. The peritoneal fluid is not draining as expected. What is the best response by the nurse?
Turn the client from side to side. Explanation: If the peritoneal fluid does not drain properly, the nurse can facilitate drainage by turning the client from side to side or raising the head of the bed. Other measures to promote drainage include checking the patency of the catheter by inspecting for kinks, closed clamps, or an air lock.
A client comes to the clinic for a follow-up visit. During the interview, the client states, "Sometimes when I have to urinate I can't control it, and do not reach the bathroom in time." The nurse suspects that the client is experiencing which type of incontinence?
Urge incontinence
The nurse advises a patient with renal stones to avoid eating shellfish, asparagus, and organ meats. She emphasizes these foods because she knows that his renal stones are composed of which of the following substances?
Uric acid Explanation: Uric acid stones are found in patients with gout and myeloproliferative disorders. Therefore, a diet low in purines is recommended.
A client comes to the emergency department complaining of a sudden onset of sharp, severe flank pain. During the physical examination, the client indicates that the pain, which comes in waves, travels to the suprapubic region. He states, "I can even feel the pain at the tip of my penis." Which of the following would the nurse suspect?
Urinary calculi
Which statement describing urinary incontinence in an older adult client is true?
Urinary incontinence isn't a disease. Explanation: Urinary incontinence isn't a normal part of aging nor is it a disease. It may be caused by confusion, dehydration, fecal impaction, restricted mobility, or other causes.
anuria
Urine output less than 50 ml in 24 hours
A nurse assesses a client shortly after living donor kidney transplant surgery. Which postoperative finding must the nurse report to the physician immediately?
Urine output of 20 ml/hour Explanation: Because kidney transplantation carries the risk of transplant rejection, infection, and other serious complications, the nurse should monitor the client's urinary function closely. A decrease from the normal urine output of 30 ml/hour is significant and warrants immediate physician notification.
oliguria
Urine output of less than 400 ml in 24 hours
What is pyridium and what are some side effects?
Used to decrease burning during urination -urinary analgesic -can change color of urine to red/orange -can cause GI upset if not taken after meals
Which of the following is a strategy to promote urinary continence?
Void regularly 5-8x/day
pyuria
WBCs in urine -pus
A patient passing bloody urine has scheduled a cystoscopy with cystogram. Which description of the procedure by the nurse is accurate?
Your doctor will insert a lighted tube in the bladder through your urethra, inspect the bladder, and instill dye to outline your bladder on x-ray.
polycystic kidney disease
a genetic disorder characterized by the growth of numerous fluid-filled cysts in the kidneys -cysts enlarge the kidney -autosomal dominant (more common) and recessive genes
Renin function
a hormone that's directly involved in the control of arterial blood pressure; it is essential for proper functioning of the glomerulus
A 76-yr-old with benign prostatic hyperplasia (BPH) is agitated and confused, with a markedly distended bladder. Which intervention prescribed by the health care provider would the nurse implement first?
a. Insert an indwelling urinary catheter. b. Draw blood for a serum creatinine level. c. Schedule an intravenous pyelogram (IVP). d. Administer lorazepam (Ativan) 0.5 mg PO. ANS: A The patient's history and clinical manifestations are consistent with acute urinary retention, and the priority action is to relieve the retention by catheterization. The BUN and creatinine measurements can be obtained after the catheter is inserted. The patient's agitation may resolve after the bladder distention is corrected, and sedative drugs would be used cautiously in older patients. The IVP may be done as a diagnostic test but does not need to be done urgently
Which assessment data reported by a patient is consistent with a lower urinary tract infection (UTI)?
a. Low urine output b. Bilateral flank pain c. Nausea and vomiting d. Burning on urination ANS: D Pain with urination is a common symptom of a lower UTI. Urine output does not decrease, but frequency may occur. Flank pain and nausea are associated with an upper UTI
After change-of-shift report, which patient would the nurse assess first?
a. Patient who has cloudy urine after bladder reconstruction b. Patient with a urethral stricture who has not voided for 12 hours c. Patient who voided bright red urine after returning from lithotripsy d. Patient with polycystic kidney disease whose blood pressure is 186/98 mm Hg ANS: B Not voiding for 12 hours suggests acute urinary retention, which is a medical emergency. The nurse will need to assess the patient and consider whether to insert a retention catheter. The other patients will be assessed, but their findings are consistent with their diagnoses and do not require immediate assessment or intervention.
renal clearance
ability of kidneys to clear solutes from plasma -24hr urine collection is primary test used to evaluate clearance.
Metabolic _________ occurs in kidney disease.
acidosis -Pts cannot eliminate daily acid-type substances properly
If AKI is caused by hypovolemia secondary to hypoproteinemia, what infusion may be prescribed?
albumin
Regulation of sodium volume excreted is dependent on:
aldosterone -increased aldosterone in blood= less sodium excreted in urine
Nephrotoxic meds
aminoglycosides -gentamicin, tobramycin, polymyxin B, amphotericin B, vanco, amikacin, cyclosporine, tacrolimus NSAIDs -aspirin, ibuprofen, motrin, advil, etc. Contrast Agents -careful use in those with kidney damage
Glomerular Filtration Rate (GFR)
amount of plasma filtered through the glomeruli per unit of time
Urgency is associated with:
an overactive bladder
A client is admitted to the hospital with a prerenal disorder, a nonurologic condition that disrupts renal blood flow to the nephrons, affecting their filtering ability. One cause of prerenal acute kidney injury is:
anaphylaxis
Where is the ADH secreted?
by the posterior pituitary gland
A client is scheduled to undergo surgical creation of an ileal conduit. The primary nurse educates the client about surgery and the postoperative period. The nurse informs the client that many members of the health care team (including a mental health practitioner) will see him. A mental health practitioner should be involved in the client's care to:
help the client cope with the anxiety associated with changes in body image.
The nurse is obtaining a health history from a client describing urinary complications. Which assessment finding is most suggestive of a malignant tumor of the bladder?
hematuria
What metabolism does calcitonin regulate?
calcium and phosphorus
Phosphorus levels increase which in return causes
calcium to decrease -calcium binds to phosphorus
Hyperkalemia can lead to:
cardiac arrhythmias -v-tachycardia -arrest
cylindruria
casts in urine
Cystography
catheter inserted into bladder and contrast is instilled to outline the bladder wall -may leak thru a small bladder perforation, but harmless
Functional incontinence
client has function of the lower urinary tract but cannot identify the need to void or ambulate to the toilet
An older adult's most recent laboratory findings indicate a decrease in creatinine clearance. When performing an assessment related to potential causes, the nurse should:
confirm all of the medications and supplements normally taken. Explanation: Adverse effects of medications are a common cause of decreased renal function in older adults
The detrusor muscle is responsible for:
contracting the bladder
A creatinine clearance test is ordered for a client with possible renal insufficiency. The nurse must collect which serum concentration midway through the 24-hour urine collection?
creatinine
To obtain a brush biopsy, a ________ and ______ is used
cystoscope catheter
Maintaining fluid balance in kidney pts is based upon
daily weight
Increased specific gravity =
decreased fluid intake
Anuria
decreased urine output of less than 50 mL in 24 hours
Orange/amber urine may indicate:
dehydration or fever
Daily weight measurements are a reliable means of:
determining overall fluid status (loss or overload)
Incomplete bladder emptying is associated with:
diabetes mellitus
A client has a full bladder. Which sound would the nurse expect to hear on percussion?
dullness
creatinine
endogenous waste product of muscle energy metabolism
Renin
enzyme that is released from kidneys
Renal Angiography
evaluates blood flow of renal arteries -checks for stenosis or blockages that may cause decreased blood flow
polyuria
excessive urination
ultrasonography requires a
full bladder -fluid intake encouraged before procedure
nephrons
functional units of kidney responsible for urine formation
specific gravity is based upon:
hydration status
Bladder retraining following removal of an indwelling catheter begins with
instructing the client to follow a 2- to 3-hour timed voiding schedule. Explanation: Immediately after the removal of the indwelling catheter, the client is placed on a timed voiding schedule, usually 2 to 3 hours, not 6 hours. At the given time interval, the client is instructed to void. Immediate voiding is not usually encouraged. If bladder ultrasound shows 100 mL or more of urine remaining in the bladder after voiding, straight catheterization may be performed to ensure complete bladder emptying.
Overflow incontinence
involuntary loss of urine associated with overdistention of the bladder.
reflex incontinence
involuntary loss of urine due to hyperreflexia in the absence of normal sensations usually associated with voiding
enuresis
involuntary urination while sleeping
When dehydration occurs, a pt will have:
low urine output and a high specific gravity of urine
Pink to red urine may indicate
lower urinary tract bleeding
Vit D is necessary for?
maintaining normal calcium balance in body
creatinine clearance
measure of amt of creatinine the kidneys are able to clear in a 24hr period
NSAIDS are
nephrotoxic
Incomplete emptying of the bladder is common in people with:
neurological disorders like -diabetic neuropathy -MS -Parkinson's
Glomerulonephritis is an inflammatory response in the glomerular capillary membrane, and causes disruption of the renal filtration system. Although diagnostic urinalysis can reveal glomerulonephritis, many clients with glomerulonephritis exhibit:
no symptoms. Explanation: Many clients with glomerulonephritis have no symptoms. Early symptoms may be so slight that the client does not seek medical attention.
A nurse is providing postprocedure care for a client who underwent percutaneous lithotripsy. In this procedure, an ultrasonic probe inserted through a nephrostomy tube into the renal pelvis generates ultra-high-frequency sound waves to shatter renal calculi. The nurse should instruct the client to:
notify the physician about cloudy or foul-smelling urine.
A KUB Xray (kidney/ureter/bladder) is used to reveal:
obstructions such as calculi, cysts, or tumors.
RBCs carry _______ throughout the body
oxygen
Kidneys are often unable to be
palpated. -If palpated it usually indicates inflammation
Kidney biopsy can be either _______ or _______ biopsy
percutaneous needle
nuclear scans of the kidneys are checking
perfusion and uses a radioisotope injection -encourage fluids after to flush isotopes out of system
GFR is the amount of ______ filtered thru glomeruli per unit of time.
plasma
__________ is the most common category of AKI with 60-70% of cases.
prerenal
How can specific gravity be altered?
presences of blood, protein, or casts in urine
A client has been diagnosed with acute glomerulonephritis. This condition causes:
proteinuria
Angiography on kidney
provides the details of the arterial supply to the kidneys, specifically the number and location of renal arteries
If a bruit is heard in the abdomen, it may indicate:
renal artery stenosis -or- aortic aneurysm
A client presents to the emergency department complaining of a dull, constant ache along the right costovertebral angle along with nausea and vomiting. The most likely cause of the client's symptoms is:
renal calculi
A client is undergoing diagnostics due to a significant drop in renal output. The physician has scheduled an angiography. This test will reveal details about:
renal circulation
24 hr urine collection is the primary test of ________
renal clearance
Creatinine clearance is the best approximation of:
renal function
The nurse is aware, when caring for patients with renal disease, that which substance made in the glomeruli directly controls blood pressure?
renin
Which of the following hormones is secreted by the juxtaglomerular apparatus?
renin
IVP (intravenous pyelogram)
shows kidneys, ureters, and bladder via xray as dye moves through upper and lower urinary systems
Radiography of kidney shows:
size and position of kidneys, ureters, and bladder (KUB)
Aldosterone is responsible for the regulation of
sodium -it stimulates the kidneys to reabsorb sodium
Urinary retention is common in people who have suffered from:
spinal cord injury -detrusor muscle not strong enough to contract and expel urine
hematuria and proteinuria can have no:
symptoms, but may be detected in a UA
latrogenic incontinence
the involuntary loss of urine due to extrinsic medical factors, predominantly medications
Osmolality measures
the kidney's ability to dilute or concentrate urine
micturition
urination
Renal Artery Embolization
used for renal cancer patients -renal artery occluded to stop blood flow to tumor=kills tumor cells
