kidney conditions and diseases

med/surge exam 3

what is the primary function of the nephron?

functional unit of the kidney that filters blood via the glomerulus → removes waste, regulates electrolytes, and forms urine

when damaged, GFR is decreased and toxins buildup

why is GFR the most important indicator of kidney function?

reflects filtration ability

decreased GFR = kidney failure progression → leading to increased BUN/Cr levels and fluid/electrolyte imbalances

what happens when renal perfusion (blood flow) decreases?

decreased blood flow → decreased GFR → RAAS activation → fluid retention → hypertension → worsens kidney damage

what do the kidneys produce?

erythropoietin (RBCs)

renin (BP regulator)

vitamin D conversion into calcitrol

primary function of the glomerulus?

filter waste, water, and solutes from the blood, producing filtrate that is processed into urine while keeping essential proteins and blood cells in the bloodstream

the filter

what is the pathophysiology of a UTI?

ascending bacterial infection → bladder (cystitis) or kidneys (pyelonephritis)

key clinical manifestations of a UTI?

dysuria

frequency

urgency

cloudy urine

fever

what is the biggest ABC concern with UTI?

circulation → risk of sepsis if untreated

nursing priority for suspected UTI?

obtain urine culture BEFORE antibiotics

key side effects of UTI antibiotics?

GI upset, diarrhea, allergic reaction

Trimethoprim/sulfamethoxazole, Nitrofurantoin

what is an uncomplicated UTI?

causes active, painful symptoms with no associated disease in healthy individuals causing need for antibiotics

what is a asymptomatic bacteriuria UTI?

presence of bacteria in the urine, through cultures, without symptoms. Usually not treated

what is a health care-associated UTI?

infections related to catheterization or recent medical care involving resistant bacteria

patient teaching for UTI antibiotics?

finish full course of antibiotics, increase fluids, and report any signs of rash or diarrhea

what is the pathophysiology of urge incontinence?

overactive detrusor muscle causing a sudden urge to void

what is the pathophysiology of overflow incontinence?

bladder overdistension leading to leakage due to retention

what is the main nursing priority with incontinence?

prevent skin breakdown and infection

what is the pathophysiology of stress incontinence?

weakness of pelvic floor muscles and urethral sphincter causing pt not to be able to maintain urethral closure

urine will leak involuntarily with coughing or sneezing

what is the pathophysiology of urinary retention?

obstruction (such as BPH), infection, or neuro dysfunction causing an inability to empty bladder

key clinical manifestations of urinary retention?

bladder distension

hesitancy

decreased urine output

what is the ABC risk for urinary retention?

circulation → kidney damage from backflow of fluid (hydronephrosis)

what is the pathophysiology of benign prostatic hyperplasia (BPH)?

enlarged prostate compresses the urethra causing a urinary obstruction

clinical manifestations of BPH?

weak stream

hesitancy

nocturia (waking up at night to urinate)

retention

what complication is most concerning with BPH?

acute urinary retention → requires immediate intervention (immediate catheterization!)

treatment methods for BPH?

continuous bladder irrigation

transurethral resection of prostate (TURP)

transurethral needle ablation (TUNA)

prostatectomy

life-style modifications for BPH?

decrease fluid intake before bed

avoid caffeine/ alcohol

timed voiding

what is the pathophysiology of pyelonephritis?

bacterial infection that spreads to the kidneys causing inflammation and damage

clinical manifestation of pyelonephritis?

fever

flank pain (uncomfortable, sharp, aching abd pain)

n/v

CVA tenderness

what is the pathophysiology of glomerulonephritis?

immune-mediated inflammation of glomeruli leading to decreased filtration and protein leakage

key clinical manifestations of glomerulonephritis?

hematuria

proteinuria

edema (periorbital!)

hypertension

why is airway a concern for glomerulonephritis?

severe periorbital edema occurs → causing facial swelling → leading to airway compromise

what is the pathophysiology of polycystic kidney disease?

a congenital disorder that involves the formation of multiple fluid-filled cysts in the kidneys (nephrons). As cysts enlarge they compress normal nephrons leading to decreased kidney function and progressive kidney failure

what are the key clinical manifestations of polycystic kidney disease?

flank pain

polyuria, nocturia, hematuria

palpable enlarged kidneys

hypertension

proteinuria

what are the nursing priorities for polycystic kidney disease?

circulation is priority → must control hypertension to slow kidney damage

what causes PKD and what are the risk factors?

genetics (autosomal dominant: cysts begin to develop at 30 + autosomal recessive: multiple cysts are present at birth)

comorbidities → hypertension, chronic kidney disease

what are the treatment methods for polycystic kidney disease?

no cure → manage progresson

control BP (ACEs/ARBs)

pain management

dialysis in ate stage

normal GFR rate?

90-120 mL/min

how does tamulosin, nifedipin, and alfucosin help renal calculi?

relaxes smooth muscle to help pass stone

what is the pathophysiology of renal calculi?

crystal formation in urine causing stone formation that obstruct the uriniary tract

clinical manifestations of renal calculi?

severe flank pain

hematuria

n/v

systemic infection

what is the biggest complication with renal calculi?

obstruction → leading to infection → leading to sepsis

what is important to note with diagnostic testing for kidneys?

NO DYE

patient teaching for renal calculi?

increase fluids

avoid foods high in calcium

movement

treatment order for renal calculi?

pain medication + hydration

ultrasound/x-ray

remove obstruction first (tamsulosen, nifedipin, or lithrotripsy (surgical))

adequate flow and relief

educate

what is the pathophysiology of acute renal failure?

sudden decrease in kidney function that occurs when blood flow to the kidneys is significantly compromised leading to decreased GFR and toxin accumulation

what are the types of acute kidney injury?

prerenal → decreased perfusion to kidneys (occurs before damage to kidneys)

intrarenal → direct damage to kidneys from lack of oxygen causing nephrotoxins (acute tubular necrosis occurs in this type)

postrenal → result of bilateral obstruction of the structures that leave the kidneys

clinical manifestations of acute kidney injury?

oliguria

increased BUN/Cr

fluid overload

hyperkalemia

what is the most life threatening issue for acute renal injury?

hyperkalemia → which can lead to arrhythmias (circulation)

how do loop diuretics, furosemide, help with treatment for acute kidney injury?

increase urine output which will help to remove excess fluids

key side effects of loop diuretics (furosemide)?

hypokalemia

dehydration

patient education when on loop diuretics (furosemide)?

monitor weight

monitor electrolytes

and report weakness

what can cause damage to kidneys?

trauma, steroids, ARBs/ACEs, dyes, tubular necrosis

what does inadequate blood flow to kidneys cause?

decreased urine output

sodium (Na+) retention

waste/toxins in the blood

what GFR value indicates need for dialysis intervention?

below 15

treatment methods for acute kidney injury?

monitor I+O (fluid challenge → give pt bolus fluids and see how they manage)

eliminate nephrotoxic medications (ex: vancomysin, tetracycline, NSAIDs)

treatment of electrolyte imbalances (hyperkalemia or hypokalemia)

how are electrolyte imbalances treated with acute kidney injury?

loop diuretics (furosemide)

K+ sparing diuretics (spironolactone)

kayexalate (used to treat HYPERkalemia)

labs and diagnostics used to assess kidney function include?

BUN/Cr (increased)

GFR (decreased)

ABG (acidic)

what is the pathophysiology of chronic kidney disease?

progressive nephron damage leading to irreversible decreased kidney function over time

main causes of chronic kidney disease?

diabetes and hypertension

clinical manifestations of chronic kidney disease?

fatigue

hypertension

dark frothy urine

edema

electrolyte imbalance

NEURO CHANGES (toxins building up)

what is the biggest risk for chronic kidney disease?

fluid overflow leading to pulmonary edema (breathing issue)

why is it bad to find protein in urine?

albumin passes through urine with kidney damage

what is the purpose of dialysis?

takes over the role of the kidneys by removing waste and excess fluid and cleaning to the blood, then returning the blood to the patient

key nursing priorities for hemodialysis?

check for bruits/thrills

NO IV/BP in accessed arm for dialysis

monitor for hypotension

daily weights (before and after dialysis)

assess for muscle cramps (electrolyte changes)

medications used for patients undergoing dialysis treatment?

erythropoietin, iron, vit D + phosphorus + folic acid, topicals for itching

what is ALWAYS a priority with renal patients?

fluid balance (I+Os and weights)

electrolytes

blood pressure

what are the risk factors for a UTI?

female

urinary retention

catheters

poor hygiene

what labs/diagnostics confirm UTI?

urine dipstick

urine culture

what are risk factors for urinary incontinence?

aging

weak pelvic floor

neurological disorders

obesity

treatment methods for urinary incontinence?

pelvic floor training (kegels)

bladder training

catheters

antispasmotics

what are risk factors for urinary retention?

obstruction (BPH)

infection

medications

diagnostics for urinary retention?

bladder scan

post-void residual

treatment for urinary retention?

catheterization!

treat underlying causes

risk factors for BPH?

aging!

male sex

hormonal changes

side effects of tamsulosin (BPH and renal calculi med)?

orthostatic hypotension

dizziness

risk factors for pyelonephritis?

untreated UTI

female

urinary obstruction

treatment for pyelonephritis?

IV antibiotics

fluids

diagnostics done to diagnose PKD?

ultrasound (for cysts)

increased BUN/Cr

decreased GFR

risk factors for glomerulonephritis?

immune response post-infection

hepatitis B and hepatitis C

diagnostics/labs done for glomerulonephritis?

proteinuria!!!

CBC, BMP

increased BUN/Cr

treatment for glomerulonephritis?

steroids (to decrease inflammation)

Rituximab (immunosuppresant)

BP control

risk factors for renal calculi?

dehydration

obesity

sedentary lifestyle

what are the different way s hemodialysis can be accessed?

fistula → surgically combines an artery and a vein (preferred longterm)

graft → tubing inserted in arm to join artery and vein via the tube

catheter → central line is inserted into a long big vein

what is peritoneal dialysis?

catheter is inserted into abdomen lining and connected to a dialysate bag, dialysate absorbs waste product.

dialysate goes into the abdomen through the catheter where it will stay for a couple hours and waste products cross into peritoneal space and are drained

what food groups should be closly monitored/restricted for kidney conditions?

sodium, potassium, phosphorus

what are protein needs for patients with CKD?

not on dialysis → moderate protein

dialysis → increase protein