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MedSurg Renal17

MedSurg Renal Goodcare

Blood filtered by a semi-permeable membrane in the glomerulus Glomerular filtration
Amount of blood filtered by glomeruli in a minute is about 120-125 mL per minute Normal GFR
Most accurate indicator of renal function GFR
Most accurate method of GFR estimate and is based on 24 hr urine collection and blood creatinine Creatinine Clearance
Hormone that maintains Water balance and causes reabsorption of water (makes distal tubules /collecting ducts permeable to water) ADH
causes reabsorption of Na+ and water; K+ excretion in distal tubules secretion affected by circulating blood volume & plasma K+/Na+ Aldosterone
Secreted by cells in right atrium in response to atrial distention due to increase in plasma volume. Atrial natriuretic peptide (ANP)
Clears blood plasma of unnecessary substances Nephrons
Acts on kidneys to increase Na+ excretion; Inhibits renin, ADH, and action of angiotensin II on adrenal glands, thus suppressing aldosterone large volume of dilute urine results. ANP
Released in response to low serum calcium levels Maintains serum Ca²+ by causing increased tubular reabsorption of Ca²+ ions and decreased tubular absorption of phosphate ions Parathormone or Parathyroid hormone (PTH)
Erythropoetin and Vit D Renal Hormones
Stimulates bone marrow to produce red blood cells Erythropoetin
Propel urine by peristaltic one way flow Ureters
Reservoir for urine Bladder
Average volume of urine that causes bladder distention and the urge to urinate 200-250 mL
Normal urinary output for an adult 1500mL/day
Residual bladder volume 50 ml
Tube that serves as a conduit for urine from the bladder neck to outside of the body through the urinary meatus during voiding Urethra
The aging nephron decreases as a unit: ↓GFR (glomerulus function) ↓ability to conserve urine (tubular function) T or F True
Some medications affect ability of bladder or sphincter to contract or relax normally (antidepressants, calcium channel blockers, antihistamines, neurologic and musculoskeletal disorder meds). T or F True
Anticoagulants cause hematuria. True or False True
Nephrotoxic antibiotic gentamicin
Change the color of unrine Pyridium and Macrodantin
Specific nephrotoxic drugs, i.e. garamycin; OTC preparations (NSAIDS) Meds that can impair kidney function
Areas of residence in U.S.- Great Lakes, Southwest, Southeast with higher risk factors stone belt area
1-2 inches Female urethra
8-10 inches Male urethra
exposure to industrial chemicals such as carbon tetrachloride, phenol, ethylene glycol, smoking Environmental factors
Consider : Loss of elasticity & muscle tone of the bladder Weakening of the urinary sphincter Decreased bladder capacity Prostatic enlargement and loss of _____________ mass with aging Renal Mass
Blood/urine tests includes: Creatinine, Creatinine Clearance BUN, GFR, Residual urine and 2 other tests Urinalysis (UA) & Urine Culture and Sensitivity
Portable ultrasonic bladder scan IVP Renal ultrasound Renal biopsy Radiology/Imaging studies
Can show the size, shape, and position of the urinary tract, and it can evaluate the collecting system inside the kidneys IVP
An X-ray test that provides pictures of the kidneys, the bladder, the ureters, and the urethra (urinary tract ) IVP
A test used to check how well the kidneys are working Glomerular filtration rate
Symphysis pubis is a Landmark for Physical Assessment of the Urinary System; what is another? Costovertebral angle tenderness (+)
Hard rock-like deposits formed in urinary tract -also known as calculi Kidney stones
Stone formation Lithiasis
Dietary issues that may increase incidence of stones: Excessive intake of certain proteins & amino acids Excessive intake of certain vegetables, fruits and tea Excessive intake of calcium (controversial) Low fluid intake EEELs
form in kidney -urinary tract in general: Urolithiasis Nephro-lithiasis
Most common cause of upper urinary tract obstruction Urinary calculi
Incidence and Risk Factors occur regionally, highest incidence in southern and Midwestern states (stone belt). True or False True
Abnormalities that result in increased urine levels of calcium, oxalate, and uric acid are Metabolic Problems for stones. T or F True
Males > Females and Blacks < Caucasians True
■ dehydration ■ immobility/calcium loss from bone ■ excess calcium, oxalate, protein intake ■ gout, hyperparathyroidism, ■ urinary stasis/recurrent UTIs Predisposing Factors to stones
Formation of stones occurs with: Nucleation Lack of inhibitory substances Super-saturation (…such as in dehydration) NuLS
Calculus formation affected by: Acidity or alkalinity of urine presence/absence of inhibiting compounds T or F True
An endocrine disorder characterized by high levels of calcium in the blood and excessive calcium excretion in the urine Hyperparathyroidism
The most common stones Calcium stones
calcium oxalate calcium phosphate struvite uric acid cystine 5 types of stones
Relieve pain Treat infection or obstruction Eliminate the stone Determine cause of stone formation Prevent recurrence Medical goals
urinary concentration of uric acid Strong association with gout Thrives in an acidic environment Seen mostly in men Uric acid stones
Obstruction -->Hydronephrosis -->Acute Renal Failure Complications
Genetic autosomal recessive defect Rare Thrives in a acidic environment Cystine Stones
Diagnosis includes UA Urine test for: calcium, uric acid, oxalate, urates, phosphates KUB, Renal Ultrasound IVP & Retrograde Pyelogram Labs, Renal function &Urine Culture Renal Calculi Diagnosis
Stones formed from accumulation of magnesium-ammonium-phosphate agents Common in women Likes an alkaline environment Struvite
Mostly associated with UTIs Urease -producing bacteria: (Proteus Mirabilis, Klebsiella, Pseudomonas, species of staphylococci) Make urine alkaline appearance: staghorn Struvite
dull, achy flank pain or silent Kidney stone
Cause SEVERE PAIN due to obstruction; f/chills & hematuria Ureteral stones
Percentage (%) that pass on their own 90%
Force fluids (2-3 liters/day) Encourage ambulation or frequent changes in position Strain all urine Analgesics for pain Antibiotics if infection present Watchful waiting Treatment
Nephrolithotomy Pyelolithotomy Ureterolithotomy Cystotomy **Stents or drainage tubes may be placed Surgical incision
Size of stones unlikely to pass the ureters >4mm
Vital signs Strict I&O Force fluids IV/PO Strain all urine Monitor pain level May have minimal bruising over shock site Ureteral stent may be left in place Lithotripsy Post Care
Percutaneous nephrolithotomy (laser/ultrasound) Incisional lithotomy Cystoscope/ureteroscope- laser/extraction PIC - invasive treatment
blood in the urine bruising on back or abdomen bleeding around organs discomfort as stone fragments pass through urinary tract if stone doesn't shatter completely, a second round of ESWL or ureteroscopic stone removal may be needed. ESWL Complications
Non-invasive:/external shock waves Stents may be placed before or after lithotripsy No incision, less pain extracorporeal shock-wave lithotripsy (ESWL)
Use of sound waves to crush stones Lithotripsy
NPO determine that consent obtained anesthesia – conscious procedural sedation ECG no anti-coagulants ESWL - Pre-Procedure Nursing responsibilities
Monitor vital signs closely for s/sx of shock due to bleeding Assess incision site Strict I&O Some hematuria during post-op expected Force fluids Urinary Calculi Surgical Treatment Post Care
Once stones retrieved or passed - prevention is the focus Force fluids 2-3 liters/day Water, cranberry juice Once composition of stone is known - further education may be necessary to alter the pH of the urine thus reducing instances of recurrence Urinary Calculi- Patient Education
Encourage patient to finish all antibiotics given for UTIs Force fluids Acidify urine with foods that increase acidity (prunes, cranberries, asparagus, tomatoes, corn) Struvite stones (Pt. Ed)
May be needed if urine can no longer pass from the kidneys through the bladder and out the urethra urostomy tube
Reduce foods high in oxalate Force fluids Thiazide diuretics (Hctz) Phosphates to prevent GI absorption Patient Education Calcium oxalate stones
Predisposing factor: Hyperparathyroidism Treat the underlying cause and the presence of other stones Low sodium diet Patient Education Calcium phosphate stones
Reduction of food high in purines such as small bone fishes, organ meats, sweet breads May require K citrate to make urine more alkaline Allopurinol given to reduce uric acid Uric acid stones (Pt Ed)
Indicated when bladder removed d/t cancer, neurogenic bladder, obstruction,(calculi, tumor, stricture), urinary retention, etc. Urinary diversion
All diversions ‘divert’ urine away from bladder/kidney with use of tubes or similar devices. True or False True
Required when bladder requires removal or for long term chronic conditions; (stoma formed from ileum) Ileal Conduit
Continent ileal urinary reservoir Indiana/Koch pouch
Post op - assess for bleeding at the site, Assure unobstructed drainage. If dislodged, CALL M.D. IMMEDIATELY NEVER CLAMP – why???? may have order to irrigate accurate I&O, If right or left--record each tube output separately keep urine acidic Nursing Care r/t stents/tubes
required when bladder requires removal or for long term chronic conditions Neobladder
Assessment: assess frequently, assess stoma, slight bleeding OK,access stoma - not sensitive, surrounding skin – why?? ;assess urine by stoma/tube NOT bag, foul smell? concentrated? avoid asparagus, cheese, eggs; mucous in urine, on stoma Care of stoma and ileal conduit
Pink--red--dark purple--dusky--cyanosis--want it moist and red Care of stoma and ileal conduit
Interventions ileal conduit: increase fluid intake urine pH < 6.5 because of alkaline encrustation, skin irritation Appliance – Ostomy Care/Patient Education similar to colostomy/ileostomy Nursing care of ileal conduit
1-2 pc appliances; empty 1/3 to 1/2 full; watch for leakage; don’t ‘patch’ with tape, change appliance in AM; Use gauze/tampon to contain/absorb urine when cleaning; use soap and water; ensure skin dry; use skin prep/protectant; use foley bag at night Ostomy Care/Patient Education
Kock or Indiana Pouch; a continent ileal conduit urinary reservoir ascending colon/part of ileum made into ‘bladder’ reservoir exits thru abd. wall to make a stoma with a valve present (ureters implanted into ”new bladder” ) Continent Urinary Diversion
catheter inserted into ‘valve’ to drain reservoir at intervals no appliance needed—could catheterize at night Continent Urinary Diversion
Altered Urinary Elimination (risks?) Potential for Sexual Dysfunction; Ineffective Coping Risk for Ineffective Management of Therapeutic Regime Knowledge Deficit;High Risk for Altered Skin Integrity & High Risk for Body Image Disturbance Urinary Diversion Nursing Diagnoses
Created by: TutorDavis17