Urinary Smurinary
Oh So Renal
Renals, Dysfunctional Renals
No Failures Here
Renal 101
100
Age related changes of the urinary system.
What are... *INCREASED frequency, urgency, overflow incontinence, stress incontinence, nocturia, decreased ability to concentrate urine (due to loss of reg diurnal excretory patterns, weakened urinary sphincter, decreased muscle tone, decreased bladder capacity)..... *altered drug excretion......*decrease in functioning nephrons & renal vessels......... *LABS: decrease creatinine clearance, increased serum creatinine, low specific gravity, increased BUN,
100
A patient presents with severe decrease in urinary output what diagnostics would the nurse expect to be ordered for this patient ................................................................ Bonus(50pts): What electrolyte imbalance would this patient be most at risk for & what treatment would the nurse anticipate?
What are...U/A, H&H, CT scan w/out contrast, renal ultrasound, metabolic panel (BUN, creatinine)............ BONUS: Hyperkalemia ............. TREATMENT: 50% dextrose and regular insulin, usually in conjunction with sodium bicarbonate or calcium gluconate given intravenously to correct the acidosis
100
Name the most common form of hereditary renal disease AND management of this disease.
What is polycystic kidney disease (PKD); prevent UTIs, may need dialysis, transplant, dietary modifications, fluid restrictions, and assistance with family coping
100
Which kind of acute kidney failure is caused by severe dehydration or heart failure?
prerenal
100
An older male patient experiencing dysuria was prescribed phenazopyridine (Pyridium). The nurse should teach this client that his medication will....
What is turn sclera & urine red or orange and stain contacts & undergarments.
200
General and specific s&s of urinary system disorders
What are... GENERAL: fatigue, HA, blurred vision, elevated BP, excessive thirst, change in body weight, cognitive changes................ SPECIFIC: edema, lower back pain, pelvic pain, painful urination, frequency, urgency, changes in stream, retention, decreased or increased urine output, urine that is(has) concentrated / diluted /drainage present / blood present
200
A diabetic patient presents with increased BUN, increased creatinine, high specific gravity, low H&H, decreased urine output. What is this patient likely experiencing? ............
What is acute kidney injury (AKI)
200
What lab values will indicate hemodialysis was effective for an AKI patient? SELECT ALL THAT APPLY ................. (A.)Serum potassium level decreases from 5.9 to 4.7 mEq/L ................................................................... (B.) Serum creatinine level decreases from 1.8 to 0.9 mg/dL .................................................................. (C.)Hemoglobin increases from 9 to 11 g/dL .............................................................. (D.)White blood cells increase from 4000 to 9000/mm3 .............................................................. (E.) BUN decreases from 120 to 70 mg/dL
What are A., B., & E.
200
Which kind of acute kidney failure is can be caused by aminoglycoside use, blood transfusion reactions, or sepsis?
intrarenal
200
The nurse recognizes patients at the highest risk for Chronic Kidney Disease are
The aging population, obese patients, diabetics, patients with hypertension, African Americans & Native Americans.
300
Appropriate physical assessment of urinary system
What is......... INSPECT/OBSERVE: lower abdomen, urinary meatus for inflammation, discharge.................. PALPATE: lower abdomen for bladder distention, masses, or tenderness......................................................... PERCUSS: costovertebral angle (CVA) for tenderness / pain.................................... AUSCULTATE: (posteriorly) renal arteries for bruits
300
A CKD patient presents with muscle spasms, weakness, positive Chvostek's & Trousseau's, confusion, and diarrhea. What electrolyte imbalances might this patient be experiencing? ................................................. BONUS: What treatment should the nurse anticipate being ordered for this patient?
What are hypocalcemia & hyperphosphatemia ................ BONUS: Treatment--> calcium-based phosphate binders, such as calcium acetate (Phoslo) or calcium carbonate (Caltrate) to improve excretion of phosphorus
300
A older adult female patient diagnosed with Systemic Lupus Erythematous (SLE) is having a routine urinalysis at the doctor's office. The nurse finds the patient has proteinuria, with fatty casts. Upon further assessment the nurse finds the patient has edema, ascites, hyperlipidemia, hypoalbuminemia, and hypercoagulability. The nurse suspects this patient to have what health alteration?
What is nephrotic syndrome.
300
Which kind of acute kidney failure is caused by benign prostatic hyperplasia, calculi obstruction, prostate cancer, or spinal cord disease?
postrenal
300
The most definitive diagnostic for Chronic Kidney Disease (CKD) is ____________ and the nursing interventions are___________________; ____________________.
What is a renal biopsy; PRE: verify order, informed consent, allergies ; POST: keep patient laying on affected side for 30-60mins, then 24hr bedrest; watch for bleeding / infection.
400
Urinary / Renal Diagnostics
What are KUB (kidney, ureter, bladder) scan= size, shape, & position of kidneys........... Creatinine Clearance= 24hr urine w/serum creatinine................ Residual Urination= straight cath after pt voids.............. Urine Analysis= specific gravity, WBC, RBC, glucose, ketones.......... Serum= RBCs, WBCs, platelets, creatinine, BUN
400
The nurse's most important role in prevention of acute poststreptococcal glomerulonephritis
What is....promoting early diagnosis and treatment of sore throats and skin lesions.
400
A young male presents to the clinic with flu-like symptoms, coughing, and reports some shortness of breath. Upon assessment, the nurse auscultates crackles in both lobes. The patient states, "my coughing is so bad it interrupts my smoking and there is blood sometimes". Blood tests show that the patient is anemic, and is positive for glomerular & alveolar antibodies. The nurse suspects what health alteration in this patient?
What is goodpasture syndrome.
400
What acronym is used to classify stages of acute kidney injury?
R-risk; I-injury; F- failure; L- loss; E- end stage kidney disease
400
To percuss for CVA tenderness the nurse should _______________________________________. If present, this is an indication of ________________ or ______________________.
Place one hand on the patient along the posterior costovertebral angle (CVA) margin, then strike the fist of the opposite hand against the dorsal surface of the hand on the patient; kidney infection or polycystic kidney disease
500
An elderly patient presents with sudden confusion and agitation what possible complications might the patient be experiencing? SELECT ALL THAT APPLY: A.) UTI B.) DVT C.) urinary retention D.) micturition
(A.)urinary tract infection (UTI) & (C.)urinary retention
500
A male patient is experiencing sudden, severe pain that radiates towards the testicles along with nausea and vomiting, pallor, and diaphoresis . The nurse suspects this patient may be suffering from what complication?
What is renal colic
500
The most common causes of chronic kidney disease.
What are chronic uncontrolled hypertension and diabetes.
500
Name the most common cause, the diagnostic criteria, & primary cause of death in Acute Kidney Injury (AKI) vs Chronic Kidney Disease (CKD).
AKI COMMON CAUSE- Acute Tubular Necrosis (ATN); DIAGNOSTIC- sudden reduction in urine output (UO) and/or elevated serum creatinine; CAUSE OF DEATH- infection ............................................................... CKD COMMON CAUSE- diabetic nephropathy; DIAGNOSTIC- GFR<60 for >3mo and/or kidney damage >3mo
500
The nurse is obtaining an admission history from a patient with acute glomerulonephritis. What additional information should the nurse ask for pertaining to this condition?
Recent upper respiratory tract infections (strep throat), skin infections (impetigo), scarlet fever, and any other infections related to streptococcus and or previous episodes of glomerulonephritis.
M
e
n
u