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Nursing of Adults Renal
Renal
139
Nursing
Undergraduate 1
05/01/2015

Additional Nursing Flashcards

 


 

Cards

Term

What changes in the kidney occur due to aging?

Definition

Older people have a reduced number of nephrons.

Kidney mass is reduced.

GFR(glomerular filtration rate) is reduced.

Term
What is the normal specific gravity range?
Definition
1.005-1.030
Term
What does urine specific gravity determine?
Definition

The concentration of urine. 

Higher specific gravity = higher concentration.

 

It can measure for dehydration.

Term
What are the laboratory studies used for evaluation renal function?
Definition

-Urinalysis

 

-Culture and sensitivity

 

-24 hour urine

Term
What is the purpse of a urinalysis?
Definition

-Urinalysis identifies cells or crystals in the urine.

 

-USE MIDSTREAM CLEAN-CATCH TECHNIQUE.

Term
What does a urine culture and sensitivity check for?
Definition
Bacteria in the urine
Term
What does the 24 hour urine test evaluate?
Definition

-Creatinine and protein in urine are used to help identify kidney disease.

 

-Increased levels indicate kidney disease, UTI, or other serious conditions

Term
What is a midstream clean-catch?
Definition
-Have patient start urinating, stop, then catch amount in sterile conatiner.
Term
Where do you store urine for the 24hour test?
Definition
It may need to be kept refrigerated or on ice.
Term
Name the important implications for the 24 hour urine test.
Definition

-May need to be kept refrigerated or on ice.

-Note diet or med changes during collection period.

-Post notices that all urine is to be saved.

-Discard first urine, save ALL including the last specimen.

-If any urine is missed you must RESTART.

Term

What is the normal result for a Urinalysis?

-color

-specific gravity

-PH

Definition

Color: Light straw to dark amber color with no foul odor

Specific Gravity: 1.005-1.030

PH: 4.5-8.0

Term
What is the normal finding in a culture and sensitivity test?
Definition
-No bacteria
Term

Normal findings in the 24 hour urine test.

-Protein?

-Creatinine?

Definition

Protein:  150mg/24 hour period

Creatinine:  0.9 to 1.9 g/ 24 hour period

Term

What does the IVP diagnostic study evaluate and how?

 

Definition

-Evaluates the urinary tract and renal function

-Contrast medium and xrays are used to evaluate

Term
What must you ask BEFORE IVP procedure?
Definition

OBTAIN INFORMED CONSENT.

-Ask about ALLERGIES to iodine, seafood and xray contrast dye.

-Laxatives as ordered before procedure

-CLEAR LIQUIDS ONLY 8 HOURS BEFORE TEST

Term
What should the nurse monitor for after IVP procedure?
Definition

-Monitor VS

-Urinary Output

-Check injection site for redness, pain, warmth

-Apply warm packs to site if indicated

-Increase fluids

 

Term

List sypmtoms of an allergic reaction to the dye in the IVP procedure.

 

Definition

-Dyspnea

-Tachycardia

-Itching

-Hives

-Flushing

REPORT THESE IF PRESENT AFTER IVP

Term
What is a cytoscopy?
Definition
Procedure that allows direct visualization of the urethra and bladder using an endoscope.
Term
As a nurse what is important for us to teach a patient undergoing a cytoscopy?
Definition

NEED INFORMED CONSENT.

-Teach/assist with bowel preparation as ordered.

-NPO 8 HOURS BEFORE PROCEDURE

-Administer sedation and other meds as ordered

-Warm sitz baths and meds help relieve discomfort

-Increase fluids

-Laxatives may be ordered to prevent constipation or straining

Term
What causes urinary incontinence?
Definition

Any condition that increases bladdre pressures or reduces resistance with in the urethra.

-Pelvic muscle relaxation

-Imparied nerual control

-Bladder problems

Term
What can be used to treat urinary incontinence?
Definition

1-May be treated with drugs to inhibit detrusor muscle contractions and increase capacity.

-Detrol/ Ditropan

2-Estrogen therapy may be used.

3-Surgery may be performed.

-Bladder neck suspension

-Prostatectomy

Term
What would make stress a type of urinary incontinence?
Definition

Multiple pregnancies, decreased estrogen, prostate surgery.

 

-Loss of small amt of urine when pressure increases as in sneezing, laughing, etc.

Term
What causes urgency incontinence?
Definition

Decreased bladder capacity, bladder irriation, CNS disorders.

 

-Involuntary urine loss associated with a strong need to void RIGHT NOW.

Term
What causes overflow incontinence?
Definition

Neurologic disorders or trauma, enlarged prostate, fecal impaction, anticholinergic drug effects.

 

-Urinary retention with bladder overdistention and frequent loss of small amounts of urine.

Term
What causes reflex incontinence?
Definition

Neurologic disorders or trauma.

 

-Involuntary loss of moderate amt of urine occuring with out warning.

Term
What causes functional incontinence?
Definition

Physical disability, impaired mobility, neurologic disorders, diuretic therapy or sedation, lack of facilities, privacy or caregiver assistance.

 

-Inability to get tot toilet facilities to urinate.

Term
What is urinary retention?
Definition
When normal bladder emptying is impaired.
Term
What are some possible causes of urinary retention?
Definition

-Benign Prostatic Hypertrophy

-Acute inflammation

-Surgery

-Medications

-Neurologic Diseases

-Voluntary urinary retention

Term

What can cause a UTI in females?

(urinary tract infection)

Definition

-Short urethra

-Proximity to vagina and anus

-Tissue trauma/contamination during intercourse

-Personal hygiene practices

-Voluntary urinary retention

-Diaphragm use for birth control

Term

What can cause a UTI in males?

 

 

Definition
-Enlarged prostate
Term
What can cause a UTI in OLDER adults?
Definition

-More alkaline urine (less acidic)

-Incomplete bladder empyting

-Urinary retention

-Changes in vaginal PH(women)

-Decreased prostatic secretions(MEN)

-Higher incidence of diabetes and glucosuria

Term
How does glucose in the urine cause a UTI?
Definition

Glucose in the urine promotes bacterial growth.

SUGAR LIKES BACTERIA!

Term
What are common symptoms of a UTI?
Definition

-Dysuria

-Frequency

-Urgency

-Nocturia

-Pyuria(pus)

-Hematuria(blood)

-Flank Pain

-Costovertebral tenderness

-Vomitting

-Diarrhea

-Fever

-Shaking

-Chills

-Malaise

Term
How is a UTI treated?
Definition

-ANTIBIOTICS!

-  3, 7, or 10 day course of antibiotics.

(sulfonamides)

-Anti-Infectives(for chronic infections)

-Analgesics(to relieve pain)

Term
What is acute pyelonephritis?
Definition

It is considered an upper UTI.

-Inflammation of the renal pelvis and parenchyma (functional portion of the kidney)

Term
How is pyelonephritis treated?
Definition

SAME AS A UTI!

Antibiotics, Anti-Infectives and Analgesics can be used.

Term
What is a sulfonamide and what can it be used for?
Definition

Sulfonamide = ANTIBIOTIC!

 

USED FOR UTI'S

Term
What are Anti-Infectives used for?
Definition
Used to prevent chronic UTI's
Term
What is phenazopyridine?
Definition
Urinary analgesic (pain reliever)
Term
What is acute glomerulonephritis?
Definition

An inflammatory condition that primarly affects the glomerulus.

 

-Usually follows an infection of strep.

-Immune complexes become trapped in the glomerular membrane which causes an imflammatory response and draws WBC's to the area.

Term
What is done for Acute glomerulonephritis?
Definition
Acute glomerulonephritis usually RESOLVES ITSELF.
Term
What are the signs and symptoms of glomerulonephritis?
Definition

-Hemturia

-Proteinuria

-Edema

-Hypertension

-Fatigue

-Anorexia

-Nausea

-Vomitting

-Headache

-Elevated BUN and creatinine

Term
What are the goals of treatment for glomerulonephritis?
Definition

Identify and treat underlying cause!

Dietary management.

Term
What are important dietary principles for a patient with glomerulonephritis and nephrotic syndrome?
Definition

-Possible Na restriction

-Proteins may be increased when they are being lost in the urine

-If azotemia is present -Protein is restriced!

(azotemia = elevated BUN levels)

NEPHROTIC SYNDROME:

Low Na diet with moderate protein restriction

Term
What lab tests may be done in those with glomerulonephritis and nephrotic syndrome?
Definition

-Throat/Skin cultures

-ASO titer

-Erythrocyte sedimentation rate(ESR)

-BUN/Serum Creatinine

-GFR/Creatinine clearance

-Serum electrolytes

-Urinalysis

-KUB xray

-

Term
What does a throat or skin culture show?
Definition
Idenitifes possible strep infection
Term
What does the ASO titer test show?
Definition
Identifies antibodies
Term
What does the Erythrocyte sedimentation rate (ESR) lab test show?
Definition
Indicates inflammation and may be elevated in acute glomerulonpehritis
Term
What does the BUN and serum creatinine lab test show?
Definition
Increased if there is kidney disease
Term
What does the GFR and creatinine clearance lab test show?
Definition
Specific indicators of renal function
Term
What will serum electrolytes show in a lab test?
Definition
Show effect of the impaired kidney function on fluid and electrolyte balance.
Term
What will a urinalysis show?
Definition
Identifies blood cells and protein in the urine.
Term
What does a KUB xray show?
Definition
Evaluates and shows actual kidney size.
Term
What are the MOST common symptoms of cancers of the urinary tract?
Definition

-Painless Hematuria (blood in urine)

-Frequency to urinate

-Urgency (gotta go right now!)

-Dysuria (painful urination)

 

Term
What is the most common complication that the nurse must watch for following a kidney surgery?
Definition
Hemorrhage
Term
What are the 4 main functions of the urinary system?
Definition

1. Excretes metabolic wastes

2. Excretes or conserves water and solutes

3. Regulates acid-base balance

4. Regulates blood pressure

Term

What is the purpose of the ureters?

 

Definition
To carry urine from kidney to the bladder
Term
How long are the ureters?
Definition
10-12 inches
Term
What is the job of the urinary bladder?
Definition

Hollow, muscular organ that holds urine.

 

It controls the release or urine.

Term
What is glomerular filtration?
Definition
Blood filtered and ends up with glomerular filtrate---water, salt, nutrients and waste
Term
What is tubular reabsorption?
Definition
Nutrients and sals reabsorbed and transported to preitubular cap network.
Term
What is tubular secretion?
Definition
Excess potassium and waste eliminated
Term
What are the 3 endocrine functions of the kidneys?
Definition

1. Renin-Angiotensin-Aldosterone system

2. Production of erythropoietin

3. Activation of vitamin D (important for calcium regulation)

Term
What is erythropoietin?
Definition
Stimulates bone marrow to produce red blood cells
Term
Define cystitis
Definition
Inflammation of the urinary bladder
Term
What are some manifestations of cystits?
Definition
Dysuria, Frequency, Urgency, Nocturia, Pyuria, Hematuria, Suprapubic discomfort
Term
Define pyleonephritis
Definition

Inflammation of the renal pelvis and parenchyma.

 

Term
What are some things you would teach the patient with a UTI?
Definition

1. Empty bladder every 2-4 hours while awake

2. Maintain intake of 8-10 glasses/day

3. Cleanse front to back after voiding

4. Void before and after sexual intercourse

5. Avoid bubble baths, feminie hygiene, sprays, douches

6. Wear cotton undergarments

Term
How does one get acute glomerulonephritis?
Definition
Glomerulonephritis follows a strep infection
Term
What is nephrotic syndrome?
Definition
A group of symptoms that results from damage to glomerular membranes and protein loss
Term
Manifestations of a patient with Nephrotic syndrome?
Definition

-Proteinuria

-Low serum albumin levels

-High blood lipid levels

-Edema

 

Term
What is a common complication of nephrotic syndrome?
Definition
Thromboemboli!
Term

A client is complaining of pain in the right flank region. Which of the follow-up question would be most important for the nurse to ask?

1. Have you noticed any changes in your urine?

2. Do you have diabetes?

3. Has your appetite or weight changed recently?

4. Does the pain wake you from sleep?

Definition
1. Have you noticed any changes in your urine.
Term

Digoxin 0.25 mg daily has been prescribed for an 80 y.o. client. The nurse observes closely for:

1. evidence of drug excretion without the desire effect.

2. excretion of the drug unchanged in the urine.

3. impaired urinatio due to effects of the drug.

4. manifestations of drug toxicity due to impaired excretion.

Definition

4. manifestations of drug toxicity due to impaired excretion.

--Renal function declines with aging as nephron units are lost. This affects drug excretion, increasing the risk of toxicity. Doses of drugs such as digoxin often need to be lower for older adults

Term

The nurse, preparing a client who is scheduled for a creatinine clearance test, includes which of the following in the instructions? Select all that apply

1. note time of the first saved urin sample as the start of the 24 hour collection

2. save a portion of each voiding for 24 hours.

3. empty the bladder at the start time and discard this urine.

4. avoid puting any toilet paper in the saved urine.

5. prevent feces from contaminating the saved urine.                   Review page 734 box 28-3

Definition
3, 4, 5
Term

The nurse reviewing a urinalysis (UA) results for a client notes that there is 2+ protein in the urine. The most appropriate response by the nurse is to:

1. do nothing, as this is within normal limits for the UA

2. limit the clients protien intake.

3. report the result to the physician

4. request a repeat urinalysis to verify

Definition
3- report to physcian. No more than a trace of protein should be found in the urine.
Term

Define renal calculi.

 

Definition

Kidney stones

-Masses of crystals formed from materials normally excreted in the urine.

Term
What are the manifestations seen with renal calculi?
Definition

-Kidney/Pelvis- dull achy flank pain

-Ureter- renal colic, pain radiating to suprapubic area, nausea, vomitting, pallor, cool clammy skin, hematuria.

-Bladder- Dull suprapubic pain, hematuria

 

Term
What is the medical treatment for renal calculi?
Definition

-Medications: narcotic analgesics & thiazide diuretic

-Dietary Management: Increae fluids (2.5-3L)  Review table 29-3 page 757

-Surgery: Lithotripsy, cytoscopy, nephrolithotomy, nephrectomy.

Term
What is a lithrotripsy?
Definition
Crushing of calculi using sound or shock waves.
Term
What is the nursing management for a patient with renal calculi?
Definition

- #1 IS PAIN MANAGEMENT

-Increase fluids

-Monitor output

-Strain ALL urine

-Patient teaching

Term
Why do we strain ALL urine when a patient has a kidney stone?
Definition

-Straining for urine allows us to save recovered stones for lab analysis.

-Lab analysis can help direct treatment to prevent further stone formation.

Term

How would you explain the ESWL procedure to a client?

(Extracorporeal shock-wave lithrotripsy)

Definition
In an ESWL shock waves generated outside the body are directed at the stone.  These waves travel harmlessly through soft tissue, but then break the stone into fragments that are small enough to be eliminated through the urine.
Term
Define Hydronephrosis
Definition
Abnormal dilation of the renal pelvis and calyces.
Term
What can cause hydronephrosis?
Definition

An obstruction causes urine back up from bladder into ureters and kidney.

 

Term
What diagnostics are used to find Hydronephrosis?
Definition

-CT scan

-Ultrasound

-Cytoscopy

Term
Why is hydronephrosis such a serious condition that needs treatment immediately?
Definition
To preserve kidney function.
Term
What are the manifestations of hydronephrosis?
Definition

-Flank pain

-Hematuria, pyuria (pus in urine)

-Fever, Nausea, Vomitting, Abdominal Pain

-Decreased urine output

Term
What is the treatment for hydronephrosis?
Definition
To reestablish urine outflow
Term
What is the nursing care for a patient with hydronephrosis?
Definition
Focuses on prevention and ensuring proper drainage.
Term
Define Polycystic Kidney Disease.
Definition
Hereditary condition characterized by cyst formation on massive kidney enlargment.
Term
Explain what happens with polycystic Kidney disease
Definition
Cysts replace normal functioning tissue, eventually leading to renal failure.
Term
What are some treatments for polycystic kidney disease?
Definition

-Increase fluid and sodium

-Cyst puncture/ abscess drainage

-Antihypertensives

-Dialysis

-Kidney transplant

-Genetic counseling

Term
What may cause trauma to the kidneys?
Definition

Blunt or penetrating injuries.

-Contusions

-Hematomas

-Lacerations

 

Term
What are the primary manifestations of kidney trauma?
Definition

-Pain

-Hematuria

-Anuria

-Grey Turner's sign

-May have signs of shock

Term
What is Grey Turner's sign?
Definition
Brusing over the flank and lower back. (occurs with retroperitoneal bleeding)
Term
What is renal failure?
Definition
Kidneys are unable to remove waste products from the blood causing waste accumulation.
Term
Define acute renal failure
Definition
Abrupt onset of rapidly declining renal function.
Term
What are the 3 classifications of renal failure?
Definition

1. Prerenal - Decreased blood flow to glomeruli (ischemia-hemmorhage, heart failure, shock)

2.Intrarenal - Trauma, surgery, infections, nephrotoxins drugs & contrast dyes.

3. Postrenal - obstruction below kidneys causing urine to back up.

Term
What are the 3 stages in Acute renal failure?
Definition

1. Initiation Phase

2. Maintenance Phase

3. Recovery Stage

Term
What happens during the initiaion phase of acute renal failure?
Definition

-Short (1-3 days)

-Increased BUN, creatinine

-Normal to decreased urine output

Term
What happens during the maintenance phase of acute renal failure?
Definition

-Follows onset stage and ocntinues for up to 14 days. Urine output decreased < 400mL/day

-Increased BUN, creatinine, potassium, phosphorus

-Decreased bicarbonate and calcium

-Anemia

Term
What happens duing the recovery stage of acute renal failure?
Definition

-Urine output > 400mL/day; may rise above 4 Liters/ day

-Lasts 1 to 12 months

-As renal tissue recovers, serum electrolytes, BUN and creatinine retrun to normal

Term
What are the medical treatments for acute renal failure?
Definition

-Treat underlying cause

-Fluid and dietary restrictions

-Restoration of electrolyte balance

-Drug therapy

-Diet

-Temporary hemodialysis

Term
What is hemodialysis?
Definition

-Given through AV fistula (connection between artery/vein)

-Electrolytes, waste products and excess water are removed from the body by diffusion and filtration.

Term
Define Chronic Renal Failure
Definition
Slow process of kidney destruction.
Term
What are the manifestations of chronic renal failure?
Definition

-Uremia (urine in blood)

-Nausea, Vomitting

-Weakness, Fatigue

-Lethargy, Confusion

Term
What lab diagnostics are used for chronic renal failure?
Definition

-BUN

-Creatinine

-Urinalysis

-Electrolytes

-Kidney biopsy

Term
How many stages are in Chronic Renal Failure?
Definition
4
Term
What would a patient with chronic renal failure show in stage 1 and 2?
Definition
They will be symptom free as unaffected nephrons compensate.
Term
What would you find in a patient with stage 3 chronic renal failure?
Definition
Decreased GFR. (glomerular filtration rate- time in minutes for blood to be filtered in the glomerulus)
Term
What would you see in a patient in stage 4 chronic renal failure?
Definition

-Multisystem effect (uremia)

-Azotemia (nitrogen metabolites - urea, creatinine, and uric acid)

-Dialysis or kidney transplant is necessary!

Term
What are nursing teaching and care responsibilities in a patient with chronic renal failure?
Definition

-Maintain intake/ output

-Daily weights

-Vitals q 4 hours

-Assess lung sounds, heart sounds

-Edema, neck vein distention

-Fluid / dietary restrictions

-Emotional support

-Eductaion regarding dialysis

Term

What does the nursing evaluation and care of a patient with a dialysis shunt entail?


Definition

-DO NOT use affected arm for BP

-DO NOT use affected arm for labs

-Auscultate to hear bruit

Term
What type of diet restrictions would you see in a patient with acute renal failure?
Definition

RESTRICT FLUID

RESTRICT PROTEIN

RESTRICT SODIUM

RESTRICT POTASSIUM

Term
What type of dietary restrictions would you see in a patient with chronic renal failure?
Definition

RESTRICT FLUID

RESTRICT PROTEIN

RESTRICT SODIUM

RESTRICT POTSSSIUM

(Once pt is to dialysis , increase protein, calories, calcium)

Term
What is ESRD?
Definition
End Stage Renal Disease
Term
What are the Integumentary effects related to ESRD?
Definition

-Pallor

-Uremic skin color (yellow/green)

-Dry skin

-Pruritis

-Ecchymoses

Term
What are the hematologic effects related to ESRD?
Definition

-Anemia

-Impaired clotting

-Increased risk of infection

Term
What are the metabolic effects related to ESRD?
Definition

-Hyperkalemia

-Acidosis

-Hyperlipidemia

-Hyperuricemia

-Malnutrition

Term
What specific teachin will you give a pt with polycystic kidney disease regarding fluid and sodium?
Definition

INCREASE fluids

DECREASE sodium

Term
What is required for lifetime after a patient has a kidney transplant?
Definition
-Antirejection medications
Term

A 79 year old client with benign prostatic hypertrophy has not voided in the past 8 hours. The FIRST actionby the LPN would be to:

1. provide 500 mL fluids orally

2. perform a catheterization with a 14 Fr. straight cath.

3. Palpate lower abdomen

4. notify the physician

Definition
3. palpate the lower abdomen.
Term

A 50 year old woman experiences stress incontinence.  Which of the following assessment findings indicates a risk factor for this condition?

1. total abdominal hysterectomy 9 years ago.

2. smokes one pack of cigarettes per day

3. exercises four times a week

4. history of two pregnancies


Definition
1. total abdominal hysterectomy 9 years ago
Term

An LPN evaluates for residual urin on a client; 30 mL of clear yellow urin is returned.  The appropriate action by the nurse would be to:

1. notify the physician

2. document the finding in the medical record

3. implement measures to assist the client void

4. increase the client's fluid intake


Definition

2. document the finding 

-50ml or less is normal

Term

THe nurse establishes a nursing diagnosis of Urinary Incontinence related to weak pelvic floor muscles for a 69 year old client.  Which of the following would be appropriate nursing intervention?

1. encourage client to drink orange juice and tea at each meal.

2. schedule furosemide (Lasix) 40mg at 8pm daily

3. teach to perform kegel exercises every 2 hours while awake

4. restrict fluid intake to 500 mL/ day

Definition

3. teach to perform kegal exercises every 2 hours while awake.

 

Term

The nurse teaching a client to help prevent urinary tract infections includes which of the following instructions? select all that apply

1. drink at least one 8 ounce glass of orange juice daily

2. increase your water intake to 6 or more glasses per day

3. after voiding or defecating, wipe from back to front

4. wear cotton briefs under clothing

5. void before and after sexual intercourse

Definition
2, 4, 5
Term

A 19 year old is admitted with acute glomerulonpehritis. The nurse expects to obtain which of the following assesment findings?

1. "strep throat" 2 weeks ago

2. pneumonia 1 week ago

3. gastroenteritis

4. infulenza 3 weeks ago

Definition

1. strep throat 2 weeks ago

-glomerulonephritis is known to follow a strep infection

Term

For a client with a uretral calculus, a priority nursing action is to

1. wash hands

2. restrict fluids

3. strain all urine

4. collect a sterile urine specimen

Definition
3. strain all urine
Term

A female client is discharged after a right nephrotomy to remove a urinary calculus.  Discharge teaching should include:

1. maintaining oral fluid intake of 1500mL/day

2. avoiding all sources of calcium

3. signs and symptoms of urinary tract infection

4. maintaining alkaline urine

Definition

3. signs/ symptoms of UTI

-this patient would be at risk for a UTI following this procedure

Term

A client is diagnosed with chronic kidney disease.  The nurse explains that dietary management of a client with chronic kidney disease includes:

1. a high protein, low carb diet

2. a low protein, high carb diet

3. a high fat, moderate-sodium diet

4. a low fat, high sodium diet

Definition
2. low protein, high carb diet
Term

A client has arteriovenous (AV) fistula in his left arm for hemodialysis access.  THe nurse recognizes the need for further teaching if the client states:
1. "My wife gets the best blood pressure in my left arm."

2. "I check my fistula for pulsations."

3. "I remind the lab personnel to take blood from my right arm."

4. "I sleep on my left side with my left arm extended." 

Definition

1. "My wife gets the best blood pressure in my left arm."

-Patients on hemodialysis SHOULD NOT have BP or labs drawn from the affected arm!

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