Renal (test 10)

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What does renin do?

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Health

95 Terms

1

What does renin do?

Regulates blood pressure

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2

Where is the glomerulus

In the nephron

  • first step in urine formation

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3

Normal GFR

125 mL/min

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4

Older adult kidney points

  • GFR and renal blood flow decrease

  • Lowered vitamin D

  • Lowered aldosterone and renin

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5

Functions of the kidneys

  • Excrete waste and water from body

  • maintain acid base balance and electrolyte balance

  • blood pressure regulation

  • erythropoietin (tells bone marrow to make RBC)

  • Synthesis of vitamin D

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6

True or false? Kidneys and heart are closely related?

True.

  • Htn and kidney disease tend of be related.

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7

Nitrofurantoin

  • May color urine brown

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8

Aminoglycosides

May cause nephrotoxicity

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9

Substances that may be nephrotoxic

  • Anti-infectives

  • ACE inhibitors (prill)

  • antineoplastic agents

  • NSAIDS

  • Tylenol

  • Furosemide

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10

What sound does a full bladder make

Dull sound

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11

Normal Urine output

1-2 L in 24 hours (1,000-2,000 mL)

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12

Normal urine specific gravity

1.003-1.029

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13

Normal urine PH

4.5-8.0

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14

Oliguria is defined as

less 30 mL/hr

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15

urinary frequency

urinating more than every 2 hours

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16

How quickly does a urinalysis need to be examined after collection

within one hour

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17

Normal result of a urinalysis

-no protein

  • no glucose

  • no RBC

  • no WBC

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18

Clean catch

wipe front to back

  • void 20-40 mL than collect rest midstream

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19

Can you take a urine culture from a foley?

Yes, from the port or a brand new bag

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20

24 hour urine collection

  • Keep on ice or in fridge for 24 h

  • first void disgaurded

  • if any is spilled or lost, start over

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21

Normal BUN

7-24 mg/dL

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22

Normal creatinine

0.6-1.2 mg/dL

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23

High BUN but normal creatinine?

Dehydration, HF, shock, high protein diet

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24

KUB

X ray of kidneys, ureters, bladder

  • can see stones

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25

IV pyelogram

IV dye given than x rays taken at different times after voiding

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26

Retrograde pyelogram

-More intense than IV

  • dye directly into ureters

  • high risk of infection

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27

Nsg care of patients post retrograde pyelogram

  • dye may cause burning , flushing, bad taste in mouth

  • increase fluids after

  • antibiotics to prevent infection

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28

Angiography

  • catheter into femoral artery into the renal artery

  • injects contrast dye

  • shows arterial supply to kidneys.

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29

Nsg care post angiography

  • increase fluids

  • check pedal pulses

  • bed rest 4-12 h

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30

True or false: metformin is bad before contrast dye

True

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31

Nitrates or nitrites normal in urine?

nitrites abnormal

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32

Medications for incontinence

  • Oxybutynin (anticholinergic) to lower bladder spasms

  • finasteride (androgen inhibitor) lower BPH

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33

Nsg education for before measuring of residual urine

Instruct patient to empty bladder first

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34

First sign of a UTI in the elderly

confusion

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35

What is present in urine with a UTI

-Leukocytes

  • nitrites

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36

What is the most common bacteria that causes a UTI

E-coli

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37

treatment for UTI

  • Bactrim (trimethoprim-sulfisoxazole)

  • Cipro

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38

Why does cranberry products help prevent UTIs

increases acidity of urine

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39

Pyelonephritis

  • infection of the kidneys

  • untreated UTI can cause

  • repeated infections can cause scarring

  • effects overall kidney function

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40

Symptoms of pyelonephritis (kidney infection)

flank pain that radiates to genitalia, fever, chills

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41

Treatment of pyelonephritis

  • Bactrim -Cipro

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42

What can bactrim cause?

Urinary crystals

  • increase fluids to 3,000-4,000 mL

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43

Glomerulonephritis

  • Infection of glomerulus (in nephron) -becomes porous causing proteins, WBC, RBC, leak into urine

  • acute and chronic versions

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44

Acute glomerulonephritis

  • commonly related to strep infection

  • can lead to end stage kidney disease

  • kidney scarring

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45

Chronic glomerulonephritis

  • irreversible destruction of nephrons

  • kidneys atrophy

  • scar tissue replaces nephrons

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46

S/S of glomerulonephritis

  • fever

  • flank pain

  • edema

  • visual problems

  • smoky urine

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47

Nsg management of glomerulonephritis

  • Decrease sodium

  • decrease protein

  • overall lower work of kidney

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48

Most common age group for bladder cancer

men 60-80

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49

S/s of bladder cancer

  • Painless hematuria

  • dysuria

  • urinary retention

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50

Hydronephrosis

  • Flow of urine is obstructed, urine backs into renal pelvis

  • renal pelvis gets distended

  • increases pressure, damaging BV

  • kidneys stop working

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51

Renal stones (lithiasis)

  • r/t dehydration, urinary stasis, UTIs, increased uric acid and calcium

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52

S/s of renal stones (lithiasis)

  • sharp severe pain traveling from flank to suberpubic region

  • fever

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53

Size of renal stones that can be passed

Less than 5mm

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54

Lithotripsy

Uses laser and shock waves to break kidney stone apart

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55

Continent urinary diversion

-Indiana/kock pouch

  • bladder created from ilium and ascending colon

  • emptied by inserting cath

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56

Diabetic nephropathy

Hyperglycemia damages small BV in kidneys

  • most common cause of CKD

  • takes years to develop

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57

True or false: patients with DM and kidney disease require less insulin

True

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58

S/S of diabetic nephropathy

Oliguria (less than 30mL/hr)

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59

Controlling diabetic nephropathy

  • Strict control of CBGs

  • ACE or ARBS to slow progression

  • Dialysis if severe

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60

Anasarca

widespread edema all over body

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61

Acute renal failure

  • Very sudden (hours to days)

  • Rapid accumulation of toxic waste (azotemia)

  • May be reversible

  • Kidney tissue is damaged, GFR decreases

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62

What happens when GFR is decreased?

Less absorption and secretion in kidneys

  • holding onto waste

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63

Why may a patient with kidney failure have low hemoglobin, RBC and other blood labs?

Because the kidneys secrete erythropoetin, which tells the bone marrow to produce RBC.

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64

Nsg management for patients with acute renal failure

  • Edema monitoring

  • I and Os

  • Daily weights

  • monitor for anemia

  • D/C nephrotoxic drugs

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65

Three causes of acute renal failure

  • Pre-renal -Intrarenal

  • Postrenal

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66

Pre-renal acute kidney failure

Caused by low blood flow and oxygen to kidneys

  • r/t: shock

  • CHF

  • Sepsis

  • Anaphalxis

  • PE

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67

Intrarenal acute kidney failure

Caused by direct tissue damage in the kidneys

  • r/t: nephritis

  • nephrotoxins

  • glomerulonephritis

  • DM

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68

Postrenal acute kidney failure

Caused by obstruction in bladder, urethra, ureters

  • r/t: urethral obstruction

  • BPH

  • urethral stricture

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69

Why are disarrythmias of the heart common in people with kidney problems?

Because of electrolyte imbalances

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70

Chronic renal failure

-Progressive and irreversible damage

  • nephrons destroyed

  • body cannot maintain electrolyte and fluid balance

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71

What can CRF lead to

  • Fluid overload

  • HTN

  • dysarrythmias

  • anemia

  • dry itchy skin (with ammonia odor)

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72

AV fistula

  • Joining of artery and vein to make bigger

  • 6-8 weeks before usable

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73

AV graft

Using synthetic tube to connect artery and vein

  • useable within 24 h

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74

Nursing education for patients with dialysis access on arm

  • Never sleep on arm

  • no watches on arm

  • no constrictive clothing

  • no severe bending

  • do not hang off bed

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75

Nursing care for dialysis

  • daily weights

  • intake and output

  • VS especially BP

  • assess site often

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76

Kidney transplant

-Sometimes used for patients with CRF

  • many times 1 can do work of 2 kidneys

  • usually family donor

  • protective isolation and anti rejection drugs (lowers immune system)

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77

Are anti hypertensive meds given day of dialysis?

No!

  • dialysis already causes pressure drop

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78

Are nitroglycerine and other vasodialators given on the day of dialysis?

no!

  • dialysis already causes pressure drop

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79

Do you hold anticoagulants before dialysis?

Yes.

  • anticoagulants already given while getting dialysis.

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80

What three meds are held before dialysis

  • antihypertenives

  • vasodialtors

  • anticoagulants

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81

Nursing care after fistula or graft placement

Elevate fistula or graft for 24-48 hr to help with flow

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82

Check the fistula or graft for a __

bruit (whooshing sound)

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83

The kidneys metabolize what vitamin into active form

Vitamin D

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84

recommended daily water intake

2000-2500 mL

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85

Urge incontinence

loss of urine when there is a strong urge

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86

Stress incontinence

Sneezing, laughing, coughing causes increased abd pressure and sphincter fails

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87

Functional incontinence

caused by inability to recognize need to urinate such as during extreme depression

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88

Neurological incontinence

Spinal cord injury, ect. causes loss of urinary control

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89

Kegals steps and instructions

-practice for several days each time you urinate, stop stream

  • tighten muscles while counting to three

  • repeat 15 times

  • do once a day

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90

Should inability to urinate 4-8 hours after cath removal

Report to provider

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91

what is considered a normal amount of residual urine

100mL

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92

Cystis

inflammation of the bladder

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93

BCG treatments

solution is instilled into bladder

  • tx for bladder cancer

  • pt position is changed every 15-30 min to coat bladder

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94

Urinary stoma pouch cleaning

  • One part vinegar one part water

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95
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