Renal Urinary A
The urinary system is considered clean of steril?
what is sterile
what is a minimum hourly urine output. (30ml/hr)
Why is this important when assessing urine output? (urine output ties to cardiac output. Urine output tells us how well the kidneys are working)
pyelonephritis is typically caused by a UTI that has migrated to the kidney, what are the typical signs/symptoms of this
what is flank pain (affected side) fever, chills, decreased urinary output, urgency, dysuria, hematuria
what other disease has very similar signs/symptoms (cystitis)
what is a post void residual
what is the urine left over in the bladder after a void.
What is a normal value? 50mls
What does it mean when the value is higher? urinary retention
what are the kidney labs
what is BUN, creatinine, and GRF
what are the normals and what does each one represent? BUN 8-20, Creat 0.8-1.2 and GFR >65
Common anti-infectives used to treat UTI's
what is Cipro, Bactrim, and Sulfa
What is the CVA in the renal assessment
what is costovertebral angel (CVA)
what is CVA? This is the angle from the spine and ribcage where the kidney can be palpated if the kidney is the inflammed.
Bladder distention will reveal what type of assessment data
what is distention pelvic region, discomfort upon palpation, and dull percussion over the bladder.
Your renal patient comes to clinic with possible infection symptoms, what chronic disease process is most important to assess for
what is diabetes
what class of diuretics should not be used with DM as it can increase sugar levels Thiazides
Renal Colic is seen in clients with what renal disease
what is renal stone (calculi)
what is renal colic pain associated when the renal stone is moving sudden sharp and severe, comes and goes
How do we treat this? narcotics like demerol and morphine
What must you assess when providing this treatment? respiratory depression
What medication is used to treat the clients dysuria with a UTI
what is pyridium
what do you teach your client about pyridium - dont take more than 2 days in a row, will change your urine orange, stain clothes, and stain contacts
Your newly admitted client has been diagnosed with acute glomerulonephritis, what should the nurse assess for related to the diagnosis
what is a recent strep infection
what would be revealed in the urinalysis and/or serum levels if acute glomerulonephritis is suspected (increased WBC, bacteria, mucus but #1 will be protein)
Classic voiding symptoms are seen in what urinary aliment?
what is BPH
What are the classic voiding symptoms of BPH ( intermitten stream, difficulty getting starting, weak stream)
How do we treat this? alpha blockers tamulosin (Flomax)
How does this treatment work? smooth muscle relaxation, urethral dilation and bladder neck relaxation).
Clients receiving dialysis can have an increase in what electrolyte
what is phosphate.
What class of medication would be given to help remove this from the client? Phosphate binders
Name of the drug? Aluminum Hydroxide (Amphegel)
What is a major risk associated with renal failure when patients require dialysis cardiac rhythm issues, increased risk of infection, fluid/electrolyte issues
How is PD vs HD performed
Renal diet consists of what
what is restricted protein, potassium, sodium, and fluids
If clients end up with hyperkalemia, what are some of the treatment options for these clients? Kayexelate, insulin and calcium gluconate
clients who are getting diuretic therapy should be closely monitored for what common side effects
what is orthostatic hypotension, hypokalemia, and dehydration
Assessments for when your client is on a diuretic - urine output and potassium
what diuretic can you give instead to help reduce this risk - spirolactone (aldosterone antagonist)
what would you teach your client when taking a diuretic - monitor for s/s of hyperkalemia (spirolactone) diuretics - urine output, kidney function labs, wieght, intake and output
Chronic diseases that directly relate renal failure include
what is diabetes HTN and MI
Clients with BPH may end up getting a TURP, what is this
what is transurethral resection of the prostate.
What maybe part of the treatment plan following a TURP (CBI continuous bladder irrigation)
Med for spasms/pain (belladonna suppository)
How do you manage this treatment? managing the CBI you will titrate for a pink tinged urine, if cherry red increase infusion, if water colored decreased infusion
Patient education (med interations) dont take cough and cold medicaiton
Why do CKD clients end up with anemia
what is due to decreased levels of erythropoietin
How do you treat this? give erythropoietin
How do you know its working? check CBC, RBC and Hgb and Hct levels.
Differentiate between Pre-renal, intra-renal and post-renal disease
what is pre-renal is blood flow to the kidney is interrupted or diminshed IVF can help fix the problem and improve renal labs and output (decreased cardiac output, nephrotoxic drugs, hypovolemia)
Intra-renal is an issue within the kidney such as infection, inflammation, or stones. Treatment would be associated with the issues
post-renal is associated with urine unable to leave the kidney due to obstruction, remove the obstruction
nurses caring for clients on nephrotoxic drugs such as gentamycin should be assessing for renal issues by revewing what
what is BUN creat, GRF, urine output and daily weights
Clients who end up with AKI are typically correlated with what issues
what is Renal Ischemia infection and Nephrotoxicity
Labs with AKI/ARF? BUN, Creatinine, GFR
Most common ARF symptom (decreased urine output, increased BUN, creat, GFR, edema, respiratory compromise)
How do you know the client is getting better (increased urinary output, BUN creat and GFR improving)
why is Amlodipine given to renal transplant clients to help reduce blood pressure
what is due to the fact that Amlodipine helps remove excess creatinine from the blood
what other class of BP drug can be used to protect the kidneys (as long as they have a decent GFR) ACE Inhibitors
ARF clients should be closely monitored for what possible side effect
what is pulmonary edema
teach your clinet how to do a clean catch to reduce contamination in urine sample collection
what is ask the patient to clean her and skin/skin folds then begin voiding into the toilet and finally then into the specimen cup to catch mid-stream
If you client ends up with hyperkalmia due to renal disease what major side effect or complicaiton are you assesing for
what is cardiac dysrythmia's
how would you assess for this? EKG or telemetry monitor