Pyelonephritis
A nurse is assessing a client who may have acute pyelonephritis. What findings strongly support this diagnosis?
Fever, chills, flank pain, and costovertebral angle tenderness
A client develops dark, tea-colored urine, facial edema, and hypertension following a recent streptococcal infection. What kidney disorder should the nurse suspect?
Acute glomerulonephritis
A client reports painless hematuria, flank discomfort, and unexplained weight loss. What type of kidney cancer should the nurse suspect?
Renal cell carcinoma
A client has a family history of kidney disease, hypertension, flank discomfort, and multiple fluid-filled cysts in both kidneys. What condition should the nurse suspect?
Polycystic kidney disease
A client has persistently elevated blood pressure despite taking multiple antihypertensive medications. Imaging reveals narrowing of a renal artery. What condition does the nurse suspect?
Renovascular hypertension due to renal artery stenosis
A client with pyelonephritis develops hypotension, tachycardia, and confusion. What life-threatening complication should the nurse suspect?
Sepsis with possible septic shock.
A client with acute glomerulonephritis has worsening edema, elevated blood pressure, and decreasing urine output. What complication is the nurse most concerned about?
Acute kidney injury (AKI) with fluid overload
A client who smokes and has a history of hypertension is diagnosed with renal cell carcinoma. Name one additional established risk factor for this cancer.
Obesity, chronic kidney disease (especially with long-term dialysis), or certain hereditary syndromes.
What happens to the kidneys as polycystic kidney disease progresses, eventually causing decreased kidney function?
Cysts enlarge and progressively damage normal kidney tissue
How does narrowing of the renal artery cause blood pressure to increase?
Reduced renal perfusion activates the renin-angiotensin-aldosterone system (RAAS)
Before administering the first dose of antibiotics, which specimen should the nurse obtain when feasible, and why?
Obtain a urine specimen for culture and sensitivity to identify the causative organism and guide antibiotic therapy.
A client with acute glomerulonephritis develops severe hypertension, a sudden headache, and blurred vision. What is the nurse's priority action?
Immediately assess and escalate care
Imaging reveals a suspicious renal mass. Which diagnostic imaging study is commonly used to evaluate the mass and determine the extent of the tumor?
Contrast-enhanced CT of the abdomen, when appropriate
A client with polycystic kidney disease reports a sudden, severe headache unlike any previous headache. What serious complication must the nurse consider?
Intracranial aneurysm with possible rupture and hemorrhage
A client with renal artery stenosis suddenly develops severe shortness of breath, crackles, and hypoxemia. What serious complication should the nurse suspect?
Acute pulmonary edema
Name two findings that indicate a client with pyelonephritis is responding to antibiotic treatment.
Decreased temperature, reduced flank pain, improved vital signs, or improving laboratory findings such as a decreasing white blood cell count.
A client with chronic glomerulonephritis has persistent proteinuria, increasing creatinine, and a declining GFR. What long-term complication is the client at risk of developing?
End-stage kidney disease
A client recovering from a nephrectomy has decreasing blood pressure, increasing heart rate, and a rapidly increasing amount of bloody drainage. What complication should the nurse suspect?
Postoperative hemorrhage
A client with polycystic kidney disease has persistently elevated blood pressure. Why is controlling hypertension especially important for this client?
Hypertension accelerates kidney damage and increases cardiovascular risk
A client with bilateral renal artery stenosis is prescribed an ACE inhibitor. What important risk should the nurse monitor for after the medication is started?
Acute kidney injury and a rise in serum creatinine
What are two important discharge instructions for a client recovering from pyelonephritis?
Complete the prescribed antibiotic course, maintain adequate hydration unless contraindicated, report recurrent fever or worsening flank pain, and attend follow-up appointments.
A client with chronic glomerulonephritis is prescribed a low-sodium diet and blood pressure medication. Name two additional nursing interventions or monitoring priorities that help slow kidney damage.
Monitor blood pressure and administer prescribed medications.
Track intake and output, daily weights, and edema.
Monitor creatinine, GFR, potassium, and other electrolytes.
Monitor urine findings and proteinuria.
Reinforce prescribed dietary modifications, including individualized sodium, protein, and potassium recommendations.
Support follow-up with nephrology and adherence to the treatment plan.
A client has undergone a radical nephrectomy for renal cell carcinoma. Name two important nursing assessments or teaching priorities during recovery.
Monitor vital signs, incision and drain output, and signs of bleeding.
Monitor urine output, creatinine, and estimated GFR to assess remaining kidney function.
Assess pain and respiratory status; encourage appropriate mobility and pulmonary hygiene.
Teach the client to attend oncology and urology follow-up appointments.
Reinforce avoiding nephrotoxic medications unless specifically directed and checking with the care team before using NSAIDs.
Discuss follow-up imaging and surveillance for recurrence as prescribed.
Name two important teaching points for a client with polycystic kidney disease to help preserve kidney function and recognize complications.
Take prescribed medications and monitor blood pressure regularly.
Maintain appropriate fluid intake as directed by the healthcare team.
Avoid smoking and discuss NSAIDs and other potentially nephrotoxic medications with the provider.
Keep appointments for kidney function testing and follow-up.
Report fever, painful urination, or worsening flank pain, which may indicate infection or another complication.
Seek emergency care for a sudden, severe headache or new neurologic symptoms.
Name two interventions or monitoring priorities for a client with renovascular disease to control blood pressure and protect kidney function.
Monitor blood pressure and response to prescribed antihypertensive medications.
Monitor serum creatinine, estimated GFR, and potassium.
Assess intake and output, daily weights, and signs of fluid overload.
Administer prescribed medications and monitor for adverse effects.
Reinforce smoking cessation, lipid management, and other cardiovascular risk-reduction measures.
Prepare the client for ordered diagnostic imaging or possible renal artery intervention when indicated.