Anatomy and Physiology
Trace the path of urine from start (beginning) to end (exit from body)
What is ... urine formation in nephrons (kidneys) --> ureters --> bladder --> urethra --> urinary meatus.
How will labs change with kidney disorders?
What is - elevated BUN, creatinine. elevated electrolytes (ex: K+, PO4++). Perhaps decreased H&H.
List one urinary analgesic. What are 2 important nursing considerations?
What is phenazopyridine hydrochloride (pyridium). Only treats pain, not the infection (can mask worsening infection). May discolor urine orange or stain contacts.
List signs & symptoms associated with acute cystitis
What is ... dysuria, pyuria (foul smelling, cloudy urine), urgency and frequency, suprapubic discomfort. confusion in the elderly
What is pyelonephritis and what is the most common cause?
What is ... an infection in the kidney. The most common cause is gram negative bacteria commonly E. coli. Other gram - organisms Proteus, Klebsiella, and Enterobacter.
Describe polyuria, oliguria, and anuria
What is ... polyuria - increased urination, oliguria - decreased urination, anuria - absence of urination.
List nursing 4 nursing considerations for the pt undergoing a renal biopsy
What is ...informed consent. NPO 4-6 hrs pre-biopsy. Coagulation studies. Monitor for bleeding (VS, urine output, H&H, flank pain). Monitor for hematuria. Pt in supine position with back roll.
What is the class and purpose of the medications sevelamer hydrochloride (Renagel) or calcium acetate (PhosLo)?
What is ... phosphate binder. Binds to phosphate in the body so that the electrolyte can be eliminated via the GI tract. To manage hyperphosphatemia in CKD (ESRD)
Hydronephrosis is often the result of which renal disorder?
What is... renal calculi
What is the priority nursing care for the pt with urolithiasis.
What is pain management with meds such as ketorolac (Toradol) and making sure there is no obstruction of urine output
List 3 hormones that acts on your renal system or comes from the renal system and what they do.
What is Renin (from the kidney)= activates the RAAS to increase the BP. Erythropoeitin (from the kidney)= stimulates bones to make RBCs. Aldosterone (from the adrenal gland)= Increases Na+ absorption and H20 to increase BP. ADH (from the posterior pituitary gland) = Increases salt, and therefore, H20 reabsorption in the kidney tubules
List 3 nursing considerations regarding procedures using radiopaque contrast dye
What is ... instruct the pt to increase fluids to flush renal system. Assess for allergies (shellfish, iodine). NPO after midnight. Assess for SOB, rash, pruritus. Etc.
What is the medication tamsulosin (Flomax) class and use?
What is ... a peripherally acting antiadrenergic that decreases contraction in smooth muscle of the prostate. Decreases symptoms of BPH.
What is ... place one hand flat over the costo-vertebral angle and tap with the fist of the other hand.
List normal and abnormal components of urine
What is normal = nitrogenous wastes (urea, uric acid, creatinine), Electrolytes (K+, Na+, PO4-, etc), pigment. Abnormal = glucose, albumin, blood, ketones, WBCs, casts
What is the normal serum Phosphorus level and what are considerations for a patient with CKD? (chronic kidney disease)
What is - 2.5-4.5 mg/dL? What is limiting dietary intake and taking phosphate binders with food.
List side effects for anticholinergic medications
What is ... dry mouth, dry eyes, urinary retention, blurred vision, constipation, drowsiness
What are signs and symptoms of the patient with renal failure
What is ... HTN, edema, s/s of fluid excess, pruritis, uremic frost and halitosis. Labs (GFR down, BUN/serum creatinine up, Potassium K+ up)
FINAL JEOPARDY: Which illness is glomerulonephritis usually tied with. How might they test for it?
What is ... group A beta hemolytic streptococcus (strep throat. They will take a throat culture or an ASO titer (Antistreptolysin O)
Daily Double: Describe the RAAS process.
What is ... increased blood osmolality triggers the kidney (Juxtaglomerular apparatus) to release renin. Renin then acts on the enzyme angiotensinogen (from the liver) to make it Angiotensin 1. Then ACE from the lungs turns Angiotensin 1 into Angiotensin 2. Angiotensin causes vasoconstriction and increased thirst. It also tells the adrenal glands to secrete aldosterone and the pituitary gland to secrete ADH which tells your kidneys to retain salt and H20. --> increased BP
What is the TURP procedure indicated for. List important nursing considerations.
What is ...Continuous bladder irrigation. Expected bloody urine that becomes pink tinged within 24-48 hours. Priority monitoring for hemorrhage. Monitor VS and UO. Post incontinence.
Trimethoprim/sulfamethoxazole (Bactrim) is prescribed for UTI. What will you ask the patient? What teaching will you reinforce?
What is ... do you have any medication allergies? Reinforce importance of completing the entire course of the antibiotic. Take as prescribed. Report rash, diarrhea, worsening of symptoms.
List foods high in K+ and PO4-
What is ... K+ = fruits. PO4-= dairy, nuts, whole grain bread, poultry, etc.