More flashcards for NRS 317 GU

Prerenal

reduced blood flow (dehydration, hypotension, heart failure)

Intrarenal

kidney tissue damage (ATN, infection, nephrotoxins).

Postrenal

blocked urine flow (BPH, stones).

What urine output threshold is concerning for AKI?

< 0.5 mL/kg/hr

Which finding is an ESCALATE trigger in AKI?

Falling UOP, rising K+, ECG changes, respiratory distress

What is acute tubular necrosis (ATN)?

Injury/death of renal tubular cells, usually from ischemia or nephrotoxins

ATN is an intrarenal cause of AKI. Causes include prolonged hypotension/shock, nephrotoxic meds or contrast, sepsis, rhabdomyolysis, and hemolysis.

Which urinalysis finding is classic for ATN?

Muddy brown granular casts

Normal BUN and serum creatinine ranges (per the slides)?

BUN 7–20 mg/dL; creatinine about 0.6–1.3 mg/dL

What is the typical range for urine specific gravity?

1.005–1.030

Higher SG = more concentrated urine (e.g., dehydration).

Lower SG = more dilute urine or reduced concentrating ability.

In hypovolemia, how does urine specific gravity differ between a normal kidney and an injured kidney?

Normal kidney conserves water and SG rises; injured kidney may not concentrate, so SG stays low or near 1.010

A fixed SG near 1.010 suggests intrinsic kidney injury impairing concentration.

Which dipstick findings support a possible UTI?

Positive leukocyte esterase and nitrites

They support a possible UTI, but a dipstick alone does not establish a diagnosis. Interpret with symptoms, I&O, and culture if ordered.

What is the classic presentation of a kidney stone?

Sudden severe flank pain that comes in waves and may radiate to the groin, with hematuria

Renal/ureteral colic often comes with hematuria, urgency or frequency, N/V, pallor, and diaphoresis. Fever or chills suggest infection.

What should the nurse do for a patient with a suspected kidney stone?

Assess pain, track I&O, monitor temp/VS, strain urine and send any passed stone for analysis

Also review UA for blood, WBCs, or bacteria, and review imaging.

What risk factors contribute to kidney stones?

Dehydration/urinary stasis, high calcium/vitamin D/protein/oxalate/purines, hypercalcemia, gout, family history, UTIs, immobility

Also prolonged catheterization and diuretic-related volume loss.

What is hydronephrosis, and what are common causes?

Dilation of the renal pelvis and calyces from urine backup, often due to BPH, stones, or tumors

Persistent blockage can lead to infection or kidney injury. Early on there may be no symptoms.

Case 1: A 72yo with BPH had a catheter inserted that drained 1,500 mL, then UOP rose to 350 mL/hr with dizziness and BP 96/58. What complication should the nurse suspect?

Post-obstructive diuresis

Monitor UOP, VS/orthostatics, daily weight, I&O, and electrolytes (K+, Na+, Mg2+). Anticipate IV fluid replacement. Watch for hypovolemia, hypotension, and electrolyte loss.

Case 2: A 68yo with 2 days of vomiting and diarrhea has BP 88/54, HR 116, UOP 20 mL/hr, and creatinine up from 0.9 to 1.8. What is the most likely cause of the low UOP?

Prerenal AKI from hypovolemia

Reduced renal perfusion from fluid loss. Anticipate IV fluids, notify provider, and monitor strict I&O, daily weights, BUN/creatinine, and K+. Avoid nephrotoxins. If it worsens, watch for ATN, hyperkalemia, acidosis, and fluid overload.

Case 3: A 45yo with dysuria and frequency has positive leukocyte esterase, nitrites, and blood, then develops T 38.8°C, chills, and right flank pain. What is the concern?

Lower UTI progressing to pyelonephritis (kidney infection)

Anticipate urine culture and sensitivity, CBC, and possibly blood cultures and imaging, plus antibiotics, fluids, and antipyretics. Watch for sepsis (hypotension, tachycardia, confusion, falling UOP).

Case 4: A 59yo in septic shock has BP 78/42, HR 128, confusion, and UOP 10 mL/hr. Why does shock cause decreased UOP and AKI?

Low blood pressure reduces renal perfusion, causing ischemia that can progress to ATN

Priorities: airway/breathing/circulation, IV fluids, vasopressors as ordered, antibiotics, cultures, lactate, and hourly UOP. Watch for AKI/ATN, hyperkalemia, acidosis, fluid overload, and multi-organ failure.

Case 5: A 19yo with 3 weeks of polyuria, polydipsia, weight loss, deep rapid respirations, CBG 386, and positive urine glucose and ketones. What is most likely, and what is the priority concern?

Type 1 diabetes with diabetic ketoacidosis (DKA)

Deep respirations (Kussmaul) with ketones suggest metabolic acidosis. Anticipate IV fluids, IV insulin, and electrolyte (especially K+) replacement. Obtain ABG/BMP. Monitor glucose, K+, and neuro status, and watch for cerebral edema and hypokalemia.

Case 6: A 58yo with obesity, family history, gradual polyuria/polydipsia, blurred vision, A1C 9.1%, CBG 248, and foot numbness/tingling. What is most likely, and what should be assessed?

Type 2 diabetes; assess feet, eyes, kidney function, BP/lipids, and neuropathy

Gradual onset, obesity, family history, high A1C, and no ketosis point to type 2. Anticipate lifestyle changes and metformin/other meds with education on glucose monitoring and foot care. Long-term complications: neuropathy, retinopathy, nephropathy, CVD, and infection.

Case 7: A 42yo after pituitary surgery has extreme thirst, UOP 450 mL/hr, very pale urine, SG 1.002, Na+ 153, high serum osmolality, and low urine osmolality. What condition is this, and how does it differ from diabetes mellitus?

Diabetes insipidus (ADH deficiency); urine is dilute and there is no hyperglycemia or glucosuria

Priority concern: dehydration, hypovolemia, and hypernatremia. Anticipate desmopressin (DDAVP) and fluid replacement. Monitor UOP, Na+, serum/urine osmolality, SG, daily weights, VS, and neuro status.