Renal (test 10)

What does renin do?

Regulates blood pressure

Where is the glomerulus

In the nephron

• first step in urine formation

Normal GFR

125 mL/min

Older adult kidney points

• GFR and renal blood flow decrease

• Lowered vitamin D

• Lowered aldosterone and renin

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

True or false? Kidneys and heart are closely related?

True.

• Htn and kidney disease tend of be related.

Nitrofurantoin

• May color urine brown

Aminoglycosides

May cause nephrotoxicity

Substances that may be nephrotoxic

• Anti-infectives

• ACE inhibitors (prill)

• antineoplastic agents

• NSAIDS

• Tylenol

• Furosemide

What sound does a full bladder make

Dull sound

Normal Urine output

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

Normal urine specific gravity

1.003-1.029

Normal urine PH

4.5-8.0

Oliguria is defined as

less 30 mL/hr

urinary frequency

urinating more than every 2 hours

How quickly does a urinalysis need to be examined after collection

within one hour

Normal result of a urinalysis

-no protein

• no glucose

• no RBC

• no WBC

Clean catch

wipe front to back

• void 20-40 mL than collect rest midstream

Can you take a urine culture from a foley?

Yes, from the port or a brand new bag

24 hour urine collection

• Keep on ice or in fridge for 24 h

• first void disgaurded

• if any is spilled or lost, start over

Normal BUN

7-24 mg/dL

Normal creatinine

0.6-1.2 mg/dL

High BUN but normal creatinine?

Dehydration, HF, shock, high protein diet

KUB

X ray of kidneys, ureters, bladder

• can see stones

IV pyelogram

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

Retrograde pyelogram

-More intense than IV

• dye directly into ureters

• high risk of infection

Nsg care of patients post retrograde pyelogram

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

• increase fluids after

• antibiotics to prevent infection

Angiography

• catheter into femoral artery into the renal artery

• injects contrast dye

• shows arterial supply to kidneys.

Nsg care post angiography

• increase fluids

• check pedal pulses

• bed rest 4-12 h

True or false: metformin is bad before contrast dye

True

Nitrates or nitrites normal in urine?

nitrites abnormal

Medications for incontinence

• Oxybutynin (anticholinergic) to lower bladder spasms

• finasteride (androgen inhibitor) lower BPH

Nsg education for before measuring of residual urine

Instruct patient to empty bladder first

First sign of a UTI in the elderly

confusion

What is present in urine with a UTI

-Leukocytes

• nitrites

What is the most common bacteria that causes a UTI

E-coli

treatment for UTI

• Bactrim (trimethoprim-sulfisoxazole)

• Cipro

Why does cranberry products help prevent UTIs

increases acidity of urine

Pyelonephritis

• infection of the kidneys

• untreated UTI can cause

• repeated infections can cause scarring

• effects overall kidney function

Symptoms of pyelonephritis (kidney infection)

flank pain that radiates to genitalia, fever, chills

Treatment of pyelonephritis

• Bactrim -Cipro

What can bactrim cause?

Urinary crystals

• increase fluids to 3,000-4,000 mL

Glomerulonephritis

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

• acute and chronic versions

Acute glomerulonephritis

• commonly related to strep infection

• can lead to end stage kidney disease

• kidney scarring

Chronic glomerulonephritis

• irreversible destruction of nephrons

• kidneys atrophy

• scar tissue replaces nephrons

S/S of glomerulonephritis

• fever

• flank pain

• edema

• visual problems

• smoky urine

Nsg management of glomerulonephritis

• Decrease sodium

• decrease protein

• overall lower work of kidney

Most common age group for bladder cancer

men 60-80

S/s of bladder cancer

• Painless hematuria

• dysuria

• urinary retention

Hydronephrosis

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

• renal pelvis gets distended

• increases pressure, damaging BV

• kidneys stop working

Renal stones (lithiasis)

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

S/s of renal stones (lithiasis)

• sharp severe pain traveling from flank to suberpubic region

• fever

Size of renal stones that can be passed

Less than 5mm

Lithotripsy

Uses laser and shock waves to break kidney stone apart

Continent urinary diversion

-Indiana/kock pouch

• bladder created from ilium and ascending colon

• emptied by inserting cath

Diabetic nephropathy

Hyperglycemia damages small BV in kidneys

• most common cause of CKD

• takes years to develop

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

True

S/S of diabetic nephropathy

Oliguria (less than 30mL/hr)

Controlling diabetic nephropathy

• Strict control of CBGs

• ACE or ARBS to slow progression

• Dialysis if severe

Anasarca

widespread edema all over body

Acute renal failure

• Very sudden (hours to days)

• Rapid accumulation of toxic waste (azotemia)

• May be reversible

• Kidney tissue is damaged, GFR decreases

What happens when GFR is decreased?

Less absorption and secretion in kidneys

• holding onto waste

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.

Nsg management for patients with acute renal failure

• Edema monitoring

• I and Os

• Daily weights

• monitor for anemia

• D/C nephrotoxic drugs

Three causes of acute renal failure

• Pre-renal -Intrarenal

• Postrenal

Pre-renal acute kidney failure

Caused by low blood flow and oxygen to kidneys

• r/t: shock

• CHF

• Sepsis

• Anaphalxis

• PE

Intrarenal acute kidney failure

Caused by direct tissue damage in the kidneys

• r/t: nephritis

• nephrotoxins

• glomerulonephritis

• DM

Postrenal acute kidney failure

Caused by obstruction in bladder, urethra, ureters

• r/t: urethral obstruction

• BPH

• urethral stricture

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

Because of electrolyte imbalances

Chronic renal failure

-Progressive and irreversible damage

• nephrons destroyed

• body cannot maintain electrolyte and fluid balance

What can CRF lead to

• Fluid overload

• HTN

• dysarrythmias

• anemia

• dry itchy skin (with ammonia odor)

AV fistula

• Joining of artery and vein to make bigger

• 6-8 weeks before usable

AV graft

Using synthetic tube to connect artery and vein

• useable within 24 h

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

Nursing care for dialysis

• daily weights

• intake and output

• VS especially BP

• assess site often

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)

Are anti hypertensive meds given day of dialysis?

No!

• dialysis already causes pressure drop

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

no!

• dialysis already causes pressure drop

Do you hold anticoagulants before dialysis?

Yes.

• anticoagulants already given while getting dialysis.

What three meds are held before dialysis

• antihypertenives

• vasodialtors

• anticoagulants

Nursing care after fistula or graft placement

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

Check the fistula or graft for a __

bruit (whooshing sound)

The kidneys metabolize what vitamin into active form

Vitamin D

recommended daily water intake

2000-2500 mL

Urge incontinence

loss of urine when there is a strong urge

Stress incontinence

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

Functional incontinence

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

Neurological incontinence

Spinal cord injury, ect. causes loss of urinary control

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

Should inability to urinate 4-8 hours after cath removal

Report to provider

what is considered a normal amount of residual urine

100mL

Cystis

inflammation of the bladder

BCG treatments

solution is instilled into bladder

• tx for bladder cancer

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

Urinary stoma pouch cleaning

• One part vinegar one part water