Renal Urinary A
The urinary system is considered clean of sterile? what is a minimum hourly urine output? Why is this important when assessing urine output?
what is sterile
(30ml/hr)
(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 other disease has very similar signs/symptoms
what is flank pain (affected side) fever, chills, decreased urinary output, urgency, dysuria, hematuria
(cystitis)
what is a post void residual and what is the normal value, what does the PVR indicate?
what is the urine left over in the bladder after a void.
50mls
urinary retention
what are the kidney labs and what are the normals and what does each one represent?
what is BUN, creatinine, and GRF
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 and what is CVA?
what is costovertebral angel (CVA)
This is the angle from the spine and ribcage where the kidney can be palpated if the kidney is the inflamed.
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 class of drugs would be contraindicated with this client?
what is diabetes
Thiazides
Renal Colic is seen in clients with what renal disease, what is renal colic pain and How do we treat this? What must you assess when providing this treatment?
what is renal stone (calculi)
associated when the renal stone is moving sudden sharp and severe, comes and goes
narcotics like demerol and morphine
respiratory depression
What medication is used to treat the clients dysuria with a UTI and what do you teach your client about pyridium
what is 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 would be revealed in the urinalysis and/or serum levels if acute glomerulonephritis is suspected
what is a recent strep infection
(increased WBC, bacteria, mucus but #1 will be protein)
Classic voiding symptoms are seen in what urinary aliment? What are the classic voiding symptoms consistent with? How is this treated (medicine and action)
what is BPH
( intermitten stream, difficulty getting starting, weak stream)
alpha blockers tamulosin (Flomax)
smooth muscle relaxation, urethral dilation and bladder neck relaxation)
Clients receiving dialysis can have an increase in what electrolyte, what medication helps with this electrolyte imbalance?
What is a major risk associated with renal failure when patients require dialysis
How is PD vs HD performed
what is phosphate. Phosphate binders Aluminum Hydroxide (Amphegel)
cardiac rhythm issues, increased risk of infection, fluid/electrolyte issues
Abdominal cavity (not blood) with a shunt done independently at home vs HD with an AV graft/shunt and done at a clinic.
Renal diet consists of and what If clients end up with hyperkalemia, what are some of the treatment options for these clients?
what is restricted protein, potassium, sodium, and fluids
Kayexelate, insulin and calcium gluconate
clients who are getting diuretic therapy should be closely monitored for what common side effects,
what diuretic can you give instead to help reduce this risk and what would you teach your client when taking a diuretic
what is orthostatic hypotension, hypokalemia, and dehydration
urine output and potassium
- spirolactone (aldosterone antagonist)
- 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 and what is the post-operative treatment and nursing responsibility with it? What med is used post-op? What class of med is contraindicated with BPH?
what is transurethral resection of the prostate.
(CBI continuous bladder irrigation)
(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 and what Labs with AKI/ARF? What are the symptoms and how do you know the client is getting better?
what is Renal Ischemia infection and Nephrotoxicity
BUN, Creatinine, GFR
(decreased urine output, increased BUN, creat, GFR, edema, respiratory compromise)
(increased urinary output, BUN creat and GFR improving)
why is Amlodipine given to renal transplant clients to help reduce blood pressure and what other class of BP drug can be used to protect the kidneys
what is due to the fact that Amlodipine helps remove excess creatinine from the blood
(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 and how would you assess for this?
what is cardiac dysrythmia's
EKG or telemetry monitor