Chronic Non-Complex Genitourinary, Renal & Male Repro PPT

what are the key jobs of the urinary tract and kidneys?

• urine formation and the excretion of wastes

• regulatory fxn: regulation of fluid and electrolyte balance & acid-base balance

• hormonal fxns: renin production (helps regulated BP), secretion goe erythropoietin for RBC production, & release of bradykinin and prostalglandins

what should the fluid intake be kept at to maintain good urinary fxn?

at LEAST 2L/day

what should you make sure happens with regards to voiding to maintain good urinary fxn?

• void when you need to

• should be at LEAST 3-4 hours

• urinate before and after sex

what should you ensure with regards to hygiene to maintain good urinary fxn?

wipe front to back (females)

what should you ensure happens with regards to mobility to maintain good urinary fxn?

stay active — immobility is associated with urinary stasis & nephrolithiasis

what should your urine output be to maintain good urinary fxn?

at LEAST 0.5 mL/kg/hr

why is promoting fluid intake for the elderly so important?

because they often won’t do it themselves

what will healthy urine look like?

light yellow, straw colored, and clear

what will abnormal urine look like?

cloudy, dark yellow, orange, dark brown, bloody (hematuria)

what’re you looking for in a renal assessment?

• last time they urinated (what it looked like)

• describe urinating (hard, easy, abnormal)

• assess intake

• assess void frequency

• assess CVA tenderness or flank pain

• ask about meds (diuretics, HTN meds,

what labs indicate kidney function?

Cr & BUN

what’s the expected range for Cr (MENTAL)?

0.6-1.3 mg/dl

what’s the expected range for BUN (MENTAL)?

6-20 mg/dl

what’s the expected range for K (MENTAL)?

3.5-5.0 mEq/L

what’s the expected range for Na (MENTAL)?

136-145 mEq/L

what’s the expected range for Ca (MENTAL)?

9-10.5 mg/dL

what’s the expected range for P (MENTAL)?

2.5-4.5 mg/dL

what’s the expected range for Mg (MENTAL)?

1.3-2.1 mg/dL

what’re some urine tests that can be performed as diagnostic studies?

bedside urine dipsticks & urinalysis

what is a composite urine collection?

• a 24 hour collection

• starts AFTER the first void (that void is dumped)

what is creatinine and what is it measuring?

a byproduct of muscle brkdown — will end up in the blood if the kidneys aren’t working (so it measuring kidney fxn)

what is BUN indicating/measuing?

it can be elevated and just indicate dehydration (HIGH =DRY)

what does HIGH BUN and serum gravity mean?

DRY — they need water (high is dry)

how is creatinine CLEARANCE found and what is this?

• it shows how much Cr they’re voiding

• will be INVERSE to Cr in blood (so if there’s kidney damage, the serum Cr will be HIGH and the clearance will be low — not reaching the urine)

what’s the best way to collect a urinalysis?

clean-catch midstream

what is retrograde pyelogram?

is a type of imaging study where contrast is instilled during cystoscopy (camera in bladder and urethra) that allows the identification of structural differences, fistulas, diverticula, or tumors in the bladder and urethra

what are the important notes of a urinalysis?

you discard the first void, you put every void in one jug, keep the job on ice

how would you collect a urinalysis on a foley pt?

you would keep the bag on ice

what is a KUB?

an abdominal Xray (of kidney, ureters, and bladder) — used to look at foley placement

with CT scans, what do you want to look at with regards to kidney fxn before?

for fxn!! the dye can be hard to pass — make sure they are hydrated

your pt has hematuria/bladder pain and you don’t know why. they take them for a cystoscopy. what’s this?

a camera that’s inserted into the bladder (can biopsy) that

what causes UTI?

bacteria that enters the sterile bladder causing inflammation

your pt comes in and complains of painful urination (dysuria) and bladder irritability, dysuria, urinary frequency (increase need to go) , urgency, urination in small volumes as well as gross hematuria or microhematuria, and suprapubic pain, cloudy urine, and malodorous urine. what is going on?

UTI

how to you manage a UTI?

• urinalysis and urine culture

• an antibiotic based on the urine culture — bladder analgesics for pain

• increase fluids

• teach pt

what do you need to teach a UTI pt?

how to take their meds, to hydrate, proper hygiene, and voiding patterns

what’re the different types of incontinence?

stress, urge, mixed, overflow, or functional

what is the goal of tx for incontinence?

prevent or stop the leakage as well as strengthen the pelvic floor (i.e. kegel exercises)

what’re some complications of incontinence?

anything related to exposure to that moist environment

what is the following describing:

urine leakage associated with increase abd pressure from laughing, sneezing, coughing, climbing stairs, or other physical stressors on the abd cavity, and this the bladder (largely women)

stress incontinence

what’s the tx for stress incontinence?

pelvic floor physiotherapy, surgery, and anti-incontinent devices

what is the following describing:

involunatry leakage accompanied or immediately preceded by urgency; characterized by involvuntary detrusor contractions; affects men and women

urge incontnence

what’s the tx for urge incontinence?

changes in diet, behavior medifications, pelvic-floor exercises, meds, and new forms of surgery

what’s pyelonephritis?

infection and inflammation of the kidney pelvis, calyces, and medulla

where does pyelonephritis start and go to?

th elower tract and ascends to the kidneys

what’s the tx for pyelonephriits>

• increase fluids

• antibiotics

• then s/sx support

what’s your BIG concern with pyelonephritis?

SEPSIS

what’re the s/sx of sepsis?

• BP will be LOW (hypotensive)

• HR will be HIGH (tachy)

your pt presents with what looks to be a lower UTI, but they also have a fever, chills, flank pain, N/V, costovertebral (CVA) tenderness, as well as leukocytosis, increases BUN/Cr, and UA is + for pyuria, bacteria=uria, WBC, and RBC. what’s going on?

pyelonephritis

what is glomerulonephritis?

an immunoligic kidney disorder that can start in the kidneys or be the result of other issues like lupus, or diabetic nephropathy

what is something that can cause glomerulonephritis that aren’t preexisting conditions?

infection like strep that causes damage to the glomerular basement membrane

you assess in your pt coffee colored urine, HTN, edema, and elevated BUN. what’s going on?

glomerulonephritis

how would you tx glomerulonephritis>

• VS, daily weights, and STRICT I&Os

• restrict their Na and fluid intake

• RESTRICT PROTEIN

• take meds (antiHTN, steroids)

• treat the underlying infx

• asses their renal fx and electrolytes (their K will be high)

what do you restrict protein intake in glomerulonephritis?

because their kidneys have a hard time filtering and thus won’t be able to filter this out

what labs should you expect with glomerulonephritis?

increased K

your pt presents with anorexia, N/D, and constipation AND you notice that they are confused and have been experiencing seizures (maybe even coma), ALSO: oliguria & uremia . what’s going on?

acute renal failute

what is going on in chronic renal failure?

this is the progressive, irreversible loss of kidney fxn and are characterized by the 5 stages delineated by GFR

what’re the most common causes of chronic renal failure?

DB & HTN

how to you treat acute renal failure?

• eliminate the cause → prevent complications → assist recovery

• diuretic & nutritional therapy

• possible dialysis

what population are more vulnerable to acute renal failure?

the elderly

you do you treat chronic renal failure?

• renal replacement therapies

• renal transplantation

what is going on with acute renal failure?

caused by trauma, obstruction, infection, nephrotoxic meds, contrast media — happens suddenly

how do you measure therapeutic med troughs?

take 30 min before then an hour in or something

what type of kidney injury is a result of volume depletion and prolonged reduction of blood flow to the kidneys that causes ischemia to nephrons?

prerenal

what are some things that could cause PRErenal injury?

dehydration (i.e. stomach virus) causing decreased perfusion, renal artery stenosis, HYPOtension

what type of kidney injury is the direct damage to the renal system and results in impaired nephron funcitoning?

intrarenal

what causes intrarenal injury?

NSAIDS, antibiotics, trauma, and glomerulonephritis

what type of kidney injury is a mechanical obstruction of the lower urinary tract (the urethers and bladder)?

postrenal injury

what causes postrenal injury?

stones, BPH

what’re the phases of acute renal failure?

initiating phase → oliguria phase → diuretic phase → recovery

what phase of acute renal failure is being described:

the beginning phase of the insult resulting in decreased blood flow to kidneys — usually don’t see the s/sx

initiating phase

what phase of acute renal failure is being described:

urine output is <400 mL/day for 8-14 days and their labs show an INCREASE in serum concentration of wastes: s/sx of fluid overload are present

oliguria

what phase of acute renal failure is being described:

occurs when the cause of AKI has been corrected and is characterized by SIGNIFICANT urine output up to 5L/day — watch for dehydration/labs

diuretic

what phase of acute renal failure is being described:

starts as the kidneys begin to return to its regular excretory fxn (imporved lab values reflecting fxn of kidneys) — may take 6-12 months

recovery phase

what is the urine output of the oliguria phase?

LESS than 400mL/day

what will you see in the labs of a pt who has acute renal failure (urea, Cr, K, P, Ca, and vitals)?

• HIGH: urea (azotemia), Cr, Protein in urine, P,

• LOW: Ca

• vitals: edema, pulmon. edema, SOB, JVD, HTN, N/V/D, lethargy, altered mental state

how would you TREAT acute renal failure (DRILL THIS)?

• sodium/fluid restrictions

• VS, strict I&O

• labs

• restrict K, P, Protein, and H/H

• meds: diuretics, antiHTN

• positioning: DB & C

• maybe insert an temp dialysis cath

what does a GFR that’s greater than/= 90 indicate?

normal function OR stage 1 kidney damage

what does a GFR of 60-80 indicate?

stage 2 chronic kidney disease (GFR is reduced and the damage is mild)

what does a GFR of 30-59 indicate?

stage 3 — moderate damage

what does a GFR of 15-29 indicate?

stage 4 — SEVERE damage

what does a GFR of less than 15 indicate?

stage 5 — end stage

what does CKD mean for RBCs?

erythropoietin isn’t being produced (hormone for RBC production)

what should your diet be for a CKD pt?

lowered K/ low K diet

what should you hear on a fistula?

bruit and rushing — thrill