Unit 2 Renal Review

What is an appropriate nursing diagnosis for glomerulonephritis?

Activity intolerance, fluid volume deficit, fluid volume excess

To determine the effectiveness of fluid restriction on a client in renal failure, the nurse will assess for what findings?

Airway, lung crackles

What clients are/are not candidates for intermittent self-catherization training?

Anyone who can't follow instruction

What fruits are high in potassium?

Bananas and oranges

What fruits are low in potassium?

Berries, Apples, Peaches

What are some teachings for post TURP?

Clients are instructed to drink at least 12-14 glasses of water each day, unless contraindicated because of another medical condition, to keep the urine dilute and stimulate the micturition reflex mechanisms. it is appropriate for the client to practice stopping his urine stream, avoid caffeinated beverages and spicy foods, and avoid vigorous activity for the first 3 postoperative weeks.

What clients are at greatest risk for dehydration?

Confused elderly, less total body fluid

What kind of statement made by the older adult client will alert the nurse to the possibility of fluid and electrolyte imbalances?

Confusion, Lethargy, Unable to get fluids

What foods contain high amount of potassium?

Dairy products, fruits

The client is going home after outpatient surgery for a hydrocele. Which information will the nurse emphasize in teaching this client? Edema from residual inflammation can remain for several weeks. This problem is increased if the scrotum is not supported and can cause the client considerable discomfort.

Decrease edema, elevate scrotum, use scrotal support

What effects can OTC drugs, especially NSAIDS, have on the renal system? What lab values may elevated as a result of toxicity?

Decreased creatinine lvl

What is a Varicocele?

Dilated vein within the spermatic cord caused by pressure in the vein usually due to incompetent valves. Can be identified as a bulge on palpation during an exam.

What assessment findings obtained while taking the history of an older adult client will alert the nurse the the possibility of fluid or electrolyte imbalance?

Edema, Skin tenting, weight fluxation

The nurse monitors for which clinical manifestations in a client with renal impairment associated with polycystic kidney disease?

Enlarged kidney, abdominal distention

Which symptoms are expected in orchitis?

Enlarged testicles, scrotal pain

What foods are appropriate for a low sodium diet?

Fresh/Frozen fruits and vegetables

Calcium-Rich foods

Greens, spinach, tofu, turnip, broccoli

What is the indication when a direct light transmits a red glow when viewing the scrotal sac?

Hydrocele

What are some drugs that can cause renal toxicity and contribute to renal failure?

Ibuprofen (NSAIDS)

The client is going home after urography. Which instruction or precaution should the nurse teach this client?

Increase fluid intake to >3000mL

A mother asks the nurse what would be the first indication that acute glomerulonephritis is improving. What would be included in the nurses response?

Increased urinary output

Two hours after a closed percutaneous kidney biopsy, the client reports a dramatic increase in pain. What may be the cause of the pain? What assessments are needed to rule out the possibility of internal bleeding?

Internal hemorrhage, increased pulse, decreased blood pressure

The client is scheduled to have a renography. She is concerned about discomfort during the procedure. How should the nurse respond?

Main discomfort is starting your IV.

The client scheduled for a prostatectomy asks whether he will have to have a urinary catheter in place after surgery. How should the nurses respond?

Need a catheter for at least a day for all types of surgery

What is present in a normal UA?

No ketones,No WBCs, pH urine range 4.5-8

A client with dehydration needs oxygen therapy. What S/S may be present?

O2sat, dyspnea, labored breathing, decreased cardiac output, increased pulse, decreased blood pressure

What assessment data obtained by the home care nurse suggests that an older adult client may be dehydrated?

Orthostatic hypo tension, dizzy, syncope

How much fluid is needed to prevent dehydration?

Output + 500-600mL

What assessments need to be made to r/o or identify hypokalemia?

Respiration, BP, skeletal muscle strength

What are treatments for Varicocele?

Scrotal support or mild-inflammatory meds such as Ibuprofen or Naprosyn.

Clients with renal failure are particularly at risk for digoxin toxicity because the drug is excreted by the kidneys. When caring for clients with CKD who are receving digoxin, monitor for signs of toxicity, such as nausea and vomiting.

See dig level, hold med and call physician

The client is scheduled for an intravenous urography, what specific allergies should the nurse and physician express concern about?

Shellfish, seafood, iodine

What are clinical findings that indicates to the nurse that client's renal failure is getting worse?

Soft, less audible heart sounds can signal the accumulation of fluid within the pericardial sac. Fluid accumulation results from the accumulation of uremic toxins, which cause inflammation of the pericardium and subsequent fluid buildup. Excess amounts of fluid within the pericardial sac can result in cardiac tamponade, a medical-surgical emergency.

What are some Post Kidney transplant observation/assessments?

The client may have diuresis. Excessive diuresis might cause hypotension. Hypotension needs to be prevented because this can reduce blood flow and oxygen to the new kidney, threatening graft survival.

What change in renal or urinary functioning, as a result of the normal aging process, increases the older adult client's risk for infection?

Urinary Retention

What client statements indicate a correct understanding of prevention and clinical manifestations of dehydration?

Weigh daily, check oral mucous membranes, 1L=1kg of weight

What types of patients are at greatest risk for bacterial cystitis? Fungal urinary tract infection?

Women, older women with decreased estrogen, Diabetes, immunocompromised

Renal transplantation teaching topics

avoid contact sports, lifetime need for immunosuppressants

Potassium-Rich foods

bananas, dried fruits, grapefruit, kiwi, lima beans, mango, meats, milk

Sodium-Rich foods

barbecue sauce, buttermilk, canned chili, canned seafood, canned soups, canned spaghetti sauce, fast foods

Low-Sodium Foods

canned pumpkin, egg yolk, fresh vegetables, fruits, grits, honey, jams and jellies, lean meats, rice,

What alteration in psycho social functioning will alert the nurse to the possibility of hypokalemia?

confusion, decreased cognitive function

The nurse teaches which dietary modifications to the client with polycystic kidney disease?

decrease sodium

What are some examples of clinical manifestations that indicate to the nurse that the client with glomerulonephritis is responding as expected to the prescribed treatment?

decreased edema, decreased weight

What clinical manifestation in a client with a urinary tract infection alerts the nurse to the possibility of acute pyelonephritis?

fever/chills may not be present

The nurse completes what assessments in the client with acute glomerulonephritis and periorbital edema?

hx of strep, assess lungs for crackles in base

What nursing interventions prevent episodes of pyelonephritis in a patient who has DM?

increase fluid intake, empty bladder frequently

What dietary modifications will the nurse teach to the client with nephrotic syndrome and a normal GFR?

increase protein, but not if GFR is decreased

Severe hypotension from shock or dehydration reduces renal blood flow and lead to prerenal acute renal failure. Volume depletion leading to prerenal azotemia is the most common cause of ARF and is usually reversible with what prompt intervention?

rapid replacement of fluids, rapid intake of fluids, fluid bolus

What are S/S of glomerulonephritis in a child?

sodium/water retention, peripheral edema, lungs