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LSC Ch 70 Renal Prbm
Nusring
| Question | Answer |
|---|---|
| FLUID LOSS | PKD: (Early On) Decreased urine concentration ability, lose fluid thru urine; Pyelonephritis: decrease urine concentration ability needs fluids to prevent dehydration |
| FLUID RETENTION | Glomerulonephritis: damage of glomeruli; edema, HTN, fluid overload, Decreased GFR=decreased plasma going thru glomeruli Nephrotic Syndrome: Loss of protein thru glomeruli; Albumin levels decrease, fluids go interstitial w/signs of edema, decreased GFR |
| Polycystic Kidney Disease (PKD) | Kidney problems affect H20 balance, all nephrons have cysts from birth, cyst growth damage glomerular & tubular membranes, Kidney enlarges, displaces other organs, HTN from renin angiotensin system, cysts grow into other tissues/organs, 50% chance |
| Physical Signs & Symptoms of PKD | Abdominal Flank Pain (dull- increased kidney size; sharp- ruptured cyst or kidney stone), Infection, cloudy urine, Nocturia: eary decrease urine concentration, hematuria- cyst rupture, kidney stone, increasing abd girth, constipation |
| More Symptoms for PKD | Increase HTN, Icrease Edema, Possible aneurysm rupture, Uremia, Anorexia, N/V, Pruritis, Fatigue, Uremic Frost on skin esp. face |
| Nursing Dx for PKD | Acute Pain r/t cyst rupture/stone, Chronic Pain r/t enlarging kidneys, *Risk for infection r/t cysts, decreased renal flow |
| Acute/Chronic Pain Drug Therapy | AVOID NSAIDS (Reduce renal flow), ASA- Bleeding, For Discomfort: Trimethoprim/famthoxazole (Septra, Bactrim) Cipro, MONITOR Se Creatinine for neprotoxicity (antibiotics) |
| Nursing Interventions for Pain (PKD) | Dry heat, heating pads, Needle Aspiration & Drainage, CAT Comfort control: Relaxation, Deep breathing, Guided imagery |
| Nursing Interventions for Constipations (PKD) | incease fluid intake, increase dietary fiber intake, regular exercise, stool softners, laxatives *Cautious- develop chronic constipation if used every day |
| Nursing Interventions for HTN 7 Renal Failure (PKD) | Sodium & Fluid Control, Drug therapy to control HTN, 2L/day fluids prevent dehydration, restrict Na intake <2000mg/day (1tsp=2300mg) |
| BP Control | Monitor BP trend, check or knowledge deficit, drug therapy: ACE inhibitors, diuretics, others |
| Hydronephrosis, Hydroureter, & Urethral Stricture | Hx childhood urinary tract problems, pattern of urination, amount, odor, flank pain, check symmetry, abdominal tenderness, signs of UTIElevated serum K+, Ph, Ca+, metabolic acidosis, urography: ureteral or renal pelvis dilation; |
| Medical Intervention for hydronephrosis, hydroureter, or urethral strictures | cystoscopy: stone removal & stent placement, Nephrostomy: NPO, clotting studies, moderate sedation, prone position, drains urine from kidney, U/O ureteral catheter (tubes) nephrostomy cath, blad cath (seperate bags) |
| Post procedure Care Nephrostomy | monitor amount coming out, clearly # each collection bag for accurate readings, assess hourly for 1st 24hrs, urine may be blood tinged, if drainage decreases w/back pain-notify physician, tube may be clogged/dislodged, monitor for leaking urine/blood-Phys |
| Cystitis | Bladder, Superficial infection of the bladder, dysuria, frequency and urgency |
| Acute Pyelonephritis | Bacterial infection, fever, chills, tachycardia & tachypnea, flank/back pain, tender costal vertebral angle, abd-often colicky discomfort, N/V, malaise & fatigue, burning urgency, & frequency of urination, nocturia |
| Chronic Pyelonephritis | Hypertension, Inability to conserve sodium, decreased urine concentrating ability (nocturia), tendency to develop hyperkalemia & acidosis Repeated/continued infection, UT obstruction, or urine reflux |
| Assessment for Pyelonephritis | Hx: UTI's DM, Stone disease, others, repeated &/or low grade fevers, flank tenderness, check BP compare to client's norm, anxiety, embarassment, guilt, sexual practices delay seeking tx |
| Lab Tests for Pyelonephritis | UA+ leukocyte esterase, wbc's & bacteria +nitrate dipstick test, blood cultures, c-reactive protein & ESR(any inflammatory process) |
| Nursing Dx for Pyelonephritis | Primary: Acute Pain, Others: Infection, Knowledge deficit, Activity intolerance, fear, Collaborative: Potential for Renal Failure, Potential for Sepsis |
| Nursing Intervention: Acute Pain Pyelonephritis | Urinary Antibiotics & Antiseptics, Nutrition: adequate calories for healing; 2-3L/day, surgery |
| Interventions for Renal Failure | Antibiotics, BP Control, Drink 2+ L/day, urine pale or clear, Dietary protein may be restricted - 16%urine is urea, |
| Community Based Care for Renal Failure | Drug regimes, Role of nutrition & adequate fluid intake, balance between rest & activity, manifestations of disease reoccurance, report unusual symptoms to physician, refer to nutritionist |
| Acute Glomerulonephritis | Key symptoms of glomeruli damage: hematuria & proteinuria; other symptoms: decreased GFR, Edema, HTN; Causes: Streptococcus & other infectious diseases |
| Assessment Hx for acute glomerulonephritis | Recent Infections (UTI's or skin) tonsillitis, Recent Travel, Recent illnesses, surgery, invasive procedures, known systemc diseases (lupus) |
| Signs & Symptoms of Acute Glomerulonephritis | *Fluid Overload/Edema-esp. face, Circulatory Conestion: misdiagnosed as Heart Failure, Older Adults, Dyspnea, crackles, foam rust colored/dark urine, Dysuria/oliguria, Anorexia, N/V (uremia), Fatigue and wt gain |
| Labs & Dx tests for Acute Glomerulonephritis | UA: hematuria & Proteinuria, *early morning specimen, GFR(24hr Urine)for Creatinine Clearance DECREASED, BUN Increased, Total protein Increased, Se. Albumin, Cultures blood, skin, throat, Antistrepolysin-O: Increased after beta hemolytic Stre, Renal Bx |
| Interventions for Acute Glomerulonephritis | Manage Infections: Antibiotics (penicilliins, sulfa, bactrim, cipro), antibiotics for persons in close contact, handwashing!, Prevent complications-fluid overload: diuretics, Na+, K+ H2O & Protein Restrictions, Dialysis, plasmaphoresis & rest |
| Uremia | N/V or anorexia indicate that uremia is present. Dialysis is necessary if uremic symptoms or fluid volume excess cannot be controlled. Plasmaphoresis may be attempted as well |
| Client Education for Acute Glomerulonephritis | Effect of drug therapy, Handwashing!, Fluid & sodium restrictions, weight & BP daily- fluid retention, notify physician of sudden increase in wt or BP |
| Rapidly Progressive Glomerulonephritis | crescent shaped cells in bowman's capsule, become ill quickly, loss of renal function, Ends in ESKD, Nutrition Restrictions of K+, Proteins, and Fluids |
| Low K+ Diet Avoid | Dairy Products >2cups, Meats >6oz, Fruits: citrus&bananas, Vegies:baked potato w/skin, sweet potato, spinach-cooked, beets, chocoalte, molasses, salt, boil potatoes to reduce K+ |
| Low Potassium Foods | Candies, Carbonated beverages, lemonade, cranberry juice, popsicles, Hawaiian punch, unsweetened Beverages: diet sodas, |
| Low Sodium Foods | Diuretics, Fluid Restriction: 1000-2000ml, Sodium Restriction: between 1-3gm/d Count IV Fluids |
| Chronic Glomerulonephritis | Long term damage leading to loss of nephrons, Hx: renal/urologic/systemic disorders, recent exposure to infections, overall hlth status (fatigue, DOE, lethargy), cocacola color, foamy urine, impaired memory & concentrating ability |
| Signs of circulatory overload (chronic glomerulonephritis) | Lung Sounds, RR, BP, Wt |
| Uremic symptoms | Slurred speech, ataxia, tremors, asterixis (flapping hands), skin yellowish in color, dry, pruritis |
| Dx tests for Chronic Glomerulonephritis | decreasing U/O, Color Appears normal, Proteinuria, few RBC's and casts, GFR low, Se. Creatinine & BUN: HIGH, hyponatremia-dilutes excess amounts of urine, oliguria leads to K+ retention, Se Phosphorus HIGH Se Calcium LOW, Metabolic Acidosis |
| Other Diagnostics of Chronic Glomerulonephritis | Kidneys abnormally small on xray, Early stage disease, renal biopsy |
| Interventions for chronic glomerulonephritis | Nutrition: Restrict Salt, Fluids, Protein, PHosphorus, Dialysis or Renal Transplantation |
| Nephrotic Syndrome | Immune Response, SImilar symptoms to glomerulo, *proteinuria, |
| Interventions for Nephrotic Syndrome | Steroids, Chemo, Immunosuppressants, ACE Inhibitors-decrease proteinuria, Heparin-reduce urine protein, Dietary restrictions: if GFR is normal proteins needed, if GFR is low restriction of proteins is needed to be decreased |
| Renal TB | Urinary Tract most common site of TB out of lungs, Anti-tubular drug therapy (*RIFAMPIN, INH), Complications: Renal Failure, Stones, Obstructions, Bacterial super infections of the urinary tract |
| Nephrosclerosis | Thickened nephron vessels, *HTN-need to control, kidneys don't filter properly |
| Renovascular Disease | Atherosclerosi, thrombosis-renal arteries, SUDDEN onset HTN, Angioplasty, stents, Meds for HTN |
| Diabetic Nephropathy | *Main Cause of ESRD, proteinuria, Insulin not metabolized as quickly, low BG levels |
| Cysts & Benign Tumors | Enlargement damages renal tissues, hematuria, drain cysts |
| Renal cell Carcinoma (adenocarcinoma) | Flank Pain, Anemia or Erythrocytosis, Anemia or Erythrocytosis (increase or decrease production of erythropoietin), Hypercalcemia |
| Assessment for Renal CA | Hx: Risk Factors (smoking, chemical exposure) Abdominal/flank pain, Wt Loss, change in urine color, Physical: Describes pain as dull ache, Pallor: darkened nipples & male breast enlargement, muscle wasting, weak |
| Interventions for Renal CA | Radiofrequency Ablation, Chemo-minimal effect, *BRM's-Increase survival time, Surgical-Nephrectomy, U/O Large urine/water loss w/hyponatremia low w/low BP; Single Kidney: monitor U/O hrly first 24hrs, Nephrotic drain-empty, pain w/deep breathing atelect |
| Post Nephrectomy | Monior for hemorrhage and adrenal insufficiency (low BP first sign), Pain Mgmt: Large incision thru several muscle groups, Prevent complications, prophylactic antibiotics, Steroid replacement therapy w/adrenal insufficiency (to maintain BG) |
| Renal Trauma | Minor, Major, or Pedicle, Renal or urological Disease, DM or HTN, Pain Description, VS & Peripheral Pulses, Abd assessment, U/A hematuria, infection, Increased WBC's |
| Minor injuries | contusions, small lacerations, tearing of the parenchyma and calyx |
| Major Injuries | lacerations to the cortex, medulla or branches of the renal artery/vein |
| Pedicle Injuries | lacerations or breaks in the renal artery/vein |
| Preventions of renal trauma | Wear a seatbelt, practie safe walking habits, use caution when ridig bikes, wear appropriate protective clothing for sports, avoid contact sports if u have 1 kidney |
| Drug Therapy for Renal Trauma | Dopamine or Dobutamine to control BP, Vitamin K-control bleeding, Platlets-control bleeding |
| Fluid Therapy for Renal Trauma | Restore circulating volume with IV's, blood transfusions, plasma volume expanders, monitor VS & U/O |
| Surgical Mgmt for Renal Trauma | Surgical Mgmt: Partial or total Nephrectomy; may remove kidney, repair, or re-implant |
| Community Based Care for Renal Trauma | Monitor Urine bleeding, retention, Notify Physician of decreased urine, hematuria, signs of infections, change in color/odor, increasing lethargy, and N/V |
Created by:
ginabeana
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