CCAH unit 3 chap 57

priority concept: renal/urinary system 3

elimination, fluid and electrolyte balance, acid base balance

renal system functions: 6

regulate fluid volume/composition, filters waste, regulate bp, acid base balance, produce erythropoietin, convert vit D to active form

what does renin do?

assist in bp regulation/blood flow

what does prostaglandin do?

helps regulate GFR/blood flow to kidneys

what does bradykinin do?

increase blood flow

what does erythropoietin do?

stimulate bone marrow for RBC production

what does vit D do?

promotes calcium absorption in GI tract

RAAS system funtion pathway:

renin released from renal artery, angiotensin i, converting enzyme, angiotensin ii triggers aldosterone release, aldosterone increases Na/H2O, retention with high blood pressure

changes with aging renal/urinary: 5

decreased GFR, nocturia, decreased bladder capacity, weak urinary sphincters/short urethras in women, tendency to retain urine

decreased thirst can cause the risk of what?

dehydration

low GFR can cause:

kidney failure

over time, kidneys ________

shrink

less muscle =

less creatinine

what is creatine?

natural component that supplies energy to muscles

what is creatinine?

waste product of creatine metabolism

creatinine is a marker for what?

kidney filtration efficiency

overtime, the kidneys have a harder time concentrating urine, causing:

urine frequency

overtime bladder muscles weaken, leading to: 2

urine retention, incomplete emptying

women’s shorter urethra causes a higher risk of:

UTI

nursing considerations with older adults with renal/urinary changes: 3

monitor hydration, watch nephrotoxic meds, fall precautions

nursing interventions for older adults with renal/urinary changes: 3

BSC nearby, reduce fluids 2-4hr before bed, time diuretics

what drugs can worsen urinary retention?

anticholinergics

how to use cautions when administering nephrotoxic drugs?

check kidney function labs, identify high risk drug classes, Evaluate necessity/alternatives

what to remember when giving nephrotoxic drugs? 3

Use the drug only when clinically essential, for the shortest duration possible, consider safer alternatives

recognizing cues: health hx questions 6

family hx, chronic health issues, chemical exposure, diet, prescriptions/otc, changes in urine appearance/pattern/ability to void

recognizing cues: past medical hx indicators 5

kidney stones, infection, tumor, diabetes, htn

recognizing cues: exposure risks 5

metals, chemicals, travel, sexual risk, contrast/dye

recognizing cues: diet 3

recent changes, fluid intake, high protein

what should happen to proteins in the kidneys?

glomerulus blocks larger molecules like proteins/albumin and keeps proteins in bloodstream

what does proteinuria mean physiologically? 3

damage to glomerulus permeability, tubule damage reduces reabsorption, excess proteins overwhelm kidneys reabsorption capacity

what can cognitive function indicate renally?

waste build up

renal skin assessment: 3

yellow, rashes/swelling, uremic frost

what are renal rashes caused by?

uremia/toxin buildup in blood causing itching/rash

abdomen palpation is contraindicated if what is present? 2

tumor, aneurysm

what does a distended bladder sound like when percussed?

dull

male creatinine levels:

0.6-1.2mg/dL

female creatinine levels:

0.5-1.1mg/dL

BUN levels:

10-20mg/dL

BUN to creatinine ratio:

6-25

blood osmolarity levels:

280-300 mosm/kg

_____ only rises when about 50% of kidney function is lost

creatinine

bun acronym for:

blood urea nitrogen

BUN breakdown order: liver converts…

liver converts nitrogen from protein to urea which travels through blood to kidneys and leaves by urine

what is BUN?

waste product from protein breakdown that kidneys filter

what does BUN test for?

how well kidneys are removing waste

high ____ does NOT always indicate kidney disease

BUN

high ______ indicates kidney disease

creatinine

how to calculate BUN/creatinine ratio:

BUN divided by creatinine

BUN/creatinine ratio: high levels indicate 4

dehydration, reduced blood flow to kidneys, gi bleed, high protein intake

how does dehydration cause BUN/creatinine ratio to change?

BUN rises faster than creatinine

BUN/creatinine ratio: low levels indicate

liver disease, low protein intake/malnutrition, overhydration, muscle injury/kidney impairment

high blood osmolarity can indicate:

dehydration

low blood osmolarity can indicate:

blood is diluted, too much fluid

how does the body regulate high blood osmolarity?

ADH is released, causing kidneys to retain water/concentrate urine

how does the body regulate low blood osmolarity?

ADH secretion drops, kidneys excrete diluted urine

low BUN indicates:

chronic liver disease

if the nurse notices pt’s BUN is elevated, what should they look at next?

creatinine

if a pt’s BUN and creatinine is elevated, the pt may be dealing with: 2

chronic kidney disease, AKI/med toxicity

if a pt with high BUN/creatinine and have CKD, what should the nurse look at?

GFR to stage disease

stage 1 kidney disease GFR rate:

90+ mL/min

stage 5 kidney disease GFR rate:

<15 mL/min

if a pt’s BUN high/creatinine low, the pt is most likely:

dehydrated

common causes of AKI: CAKEMAN acronym

cyclosporine, ACEI, keppra, erythromycin/gentamycin, metformin, amphotericin, NSAIDs

normal urine specific gravity levels:

1.005-1.030

urine specific gravity ___________ in older adults

decreases

what does urine specific gravity measure?

density of urine to water

pH range of urine:

4.6-8

possible causes of orange urine: 4

chemo meds, dehydration, liver/bile duct condition, laxatives

possible causes of green/blue urine: 3

UTI/pseudomonas, propofol/methylene blue, food dyes

possible causes of red/pink urine: 3

hematuria, beets/rhubarb/berries, menstruation

possible causes of purple urine: 4

CAUTI/purple urine bag syndrome, gram negative bacteria

possible causes of dark brown urine: 4

liver disease, old blood, muscle breakdown, severe dehydration

what can indicate DKA in urine? 2

ketones, glucose

nursing safety priority: report the presence of ______/______- in urine of patient undergoing a screening exam to PCP

glucose, proteins

rules of 24fr urine collection:

first void discard, process starts over if one sample is missed, place foley in bath basin of water for 24rs

normal male GFR:

107-139 mL/min

normal female GFR:

87-107 mL/min

what is bedside sonography?

bladder scan

if a female with a hysterectomy needs a bladder scan, what mode should it be placed on?

male

KUB xray meaning:

kidneys, ureters, bladder

what to check for with pt undergoing CTA: 2

NPO status, dye/contrast allergies

diabetic pt’s on metformin going for contrast/dye procedure are at risk for:

lactic acidosis

how long does metformin be held before/after procedure?

48hr

why is metformin held during contrast/dye procedure?

metformin is cleared by kidneys can contrast can cause AKI, causing metformin to accumulate and cause lactic acidosis

what to check before pt goes for procedure with dye/contrast:

kidney function

who else checks kidney function before giving dye/contrast?

radiology

how soon can AKF occur after administering contrast?

48 hrs

who is more at risk for contrast induced nephropathy? 6

older, dehydrated, CKD, DM, CHF, current hypotension

when should metformin be administered after contrast/dye procedure?

kidney function

for renal US, bladder has to be ____

full

cystoscopy/cystourethroscopy preop checklist: 4

gen/local anesthesia with sedation, NPO at midnight, bowel prep, lithotomy position

cystography/cystourethrography checklist:

gen/local anesthesia with sedation, foley to instill contrast, void during xrays

why is contrast instilled through foley catheter during cystography/cystourethrography?

less damage to kidneys

what labs to check before kidney biopsy:

PT, PTT, INR, platelets

how long should pt lay flat after kidney biopsy?

4hrs

postop PRIORITY: kidney biopsy

internal bleeding

normal platelet levels

150-400

what does MAP measure?

organ perfusion

how to calculate MAP:

sys + 2 x dia / 3

normal map:

>65