Adult Health Exam III: Kidneys

CKD

decreased renal function over long period of time that is irreversible

Stage I CKD

damage to kidney w normal function

GFR: > 90 w proteinuria

Stage II CKD

damage w mild loss of function

GFR: 60-89

Stage III CKD

mild-severe function loss

GFR: 30-59

Stage IV CKD

severe loss of functoin

GFR: 15-29

Stage V

end-stage

GFR: < 15

need dialysis and transplant

GFR:

rate glomerulus filters waste/ions/water in blood

decreased GFR leads to

increase urea

increased creatinine

increased urinary output

hypervolemia

increased K (therefore decreased phosphate)

decreased Ca

increased Mg

proteinuria and hematuria

CKD causes

DM

HTN

acute kidney disease

infection

polycystic kidney disease

nephrotoxic drugs

early CKD Tx

control HTN

glucose control

monitor GFR and BP

advanced CKD Tx

dialysis

kidney transplant

CKD nursing interventions

asses neuro

educate low protein diet

watch metabolic acidosis

watch anemia

monitor signs of hypervolemia

monitor hyperK+

monitor hyperphosphatemia and hypocalcemia

monitor hypermagnesemia

Hemodialysis

filter blood

monitor VS, cramping, N/V, bleeding

hemodialysis complications

dysequilibrium syndrome: neuro deterioration bc increased ICP

hypotention

peritoneal dialysis

hypertonic fluid draws excess fluid and drains in to bagpe

peritoneal dialysis complications

peritonitis

fever

cloudy outflow

abdominal pain w tenderness

N/Vinfection of the peritoneum, causing symptoms like fever, cloudy outflow, and abdominal pain.

Nursing care for kidney transplant

monitor output

bladder irrigation for clots

monitor for organ rejection

lower UTIs

urethritis

cystitis

upper UTI

ureteritis

pylenophritis

who do UTIs affect more?

women bc urethra is short

UTI causes

hormone changes

Abx

renal stones

DM

toiletries

obstructive prostatic hypertrophy

vesicoureteral reflux (congenital defect)

overextended bladder

indwelling catheter, intercourse

decreased immune system

UTI Dx

UA (WBCs and bacteria

urine culture

cystoscopy

UTI S&S

burning w pee

needing to pee with only drops coming out

odor

dark and cloudy

pain w costovertebral angle (CVA tenderness)

spasms/cramping

fever and WBC

sudden confusion (geriatrics)

UTI nursing interventions

I/O

control pain

education

collect and monitor labs

encourage 2.5-3L water

administer sulfonamides (Bactrim)

UTI pt edu

pee after sex

take all Abx

wipe front to back

Prostate CA

most common cancer in men (not related to skin)

Prostate CA late stage S&S

pain (pelvis/back)

dysuria

hematuria

fatigue

Prostate CA cause

loss of cancer suppressor gene

Prostate CA risk factors

age 50+

race

fam Hx

high animal fat low veggie diet

obesity

alc

Prostate CA Dx

digital rectal exam

MRI and ultrasounds

biopsy

blood test

Prostate CA Tx

surveillance

radiation therapy

radical prostatectomy

hormone therapy

anti-androgens and leutonizing hormone blockers (first line_

Bladder CA

common in geriatrics

associated w smoking

Bladder CA risk factors

smoking

exposure to chemicals

age 40+

Bladder CA S&S

hematuria w or w/o pain

renal colic

dysuria

frequency, urgency, retension

fever

night sweats

Bladder CA Dx

UA

blood count

urine cystology

creatinine

CRP

ultrasound

cystoscopy - gold standard

Chlamydia and Gonorrhea

bacterial

can lead to PID, infertility, pre-term labor complications

Chlamydia and Gonorrhea S&S

dysuria

discharge

PID symptoms

Chlamydia and Gonorrhea Dx

urine test

specimen testC

Chlamydia and Gonorrhea Tx

doxycycline - chlamydia

cephalosporin - gonorrhea

STI nursing interventions

complete disease reporting requirements

abstinence during Tx

safe sex

follow up

telling partners

PID

inflammation from vaginal, uterus, fallopian tubes, ovaries

can cause infertility, sepsis, death

PID S&S (if symptomatic)

lower abdominal pain

pelvic pain

menstrual irregularities

painful urination

fever

PID Tx

analgesics

Abx

Syphilis

can cause systemic complications and death w/o Tx

Syphilis primary stage

ulcer chancre

Syphilis secondary stage

flu-like symptoms

rash on hands and feet

Syphilis latent stage

no symptoms

Syphilis tertiary stage

severe neuro and cardio damage

Syphilis Dx

blood test

Syphilis Tx

Abx (doxy)

HPV

most common STI

some strains cause warts, others cancer

get vaxx

HPV warts

white/flesh colored

HPV Dx

pap test

wart biopsy

HPV Tx

no cure

wart removal

Renal Calculi

AKA kidney stones

Kidney stone risk factors

dehydration

meds

IBD

GOUT

frequent UTIs

Kidney stone S&S

stabbing flank pain

N/V

fever

increased HR and BP dysfunction

urinating issues (including hematuria)

kidney stone Dx

UA

imaging

extracorporeal shockwave lithotripsy

percutaneous nephrolithotomy

kidney stone nursing interventions

fluids

strain urine to catch stones

encourage ambulation

pain management

change diet

Kidney stone meds

NSAIDs and opioids

Abx

antiemetics

alpha blockers to dilate ureter

Kidney CA risk factors

exposure to toxins

obesity

HTN

unopposed estrogen use

age 45+

men

kidney CA S&S

back mass

unintentional weight loss

fever, malaise

hydroureter (buildup pee in ureter)

pain by flank

hematuria

Kidney CA Dx

Hx

CBC

CT pelvis or abdomen

renal ultrasound

XRAY kidney, bladder, ureter

biopsy

kidney CA Tx

partial or radical nephrectomy

chemo/radiation

microwave/cryoablation

targeted therapy

kidney CA nursing interventions

post-op care

support renal function

report HTN, hyperglycemia, hypercalcemia

kidney CA pt edu

health maintenance

avoid nephrotoxic drugs