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Renal/Urinary
Week 5
| Term | Definition |
|---|---|
| Urinary Tract Infection patho | Most common bacterial infection. Often caused by E coli. Uncomplicated: female, not pregnant, no diabetes or fever. Complicated: diabetic, febrile, male |
| UTI risk factors | alkaline urine, urinary incontinence, indwelling catheters, stool incontinence, bladder distention, genetics, diabetes, female, age |
| symptoms of a UTI | lower back/abd comfort, N/V, urinary frequency and urgency, dysuria, feeling of incomplete bladder emptying, perineal itching, hematuria, pyuria, nocturia, cloudy/foul smelling urine |
| UTI diagnosis | Urinalysis (present leukocytes, nitrites, hemoglobin, RBCs). Urine culture with 100,000+ present bacteria. Cystoscopy/cystourethroscopy, CT/MRI |
| Treatment for UTI | abx: 3-10 days depending on if it is complicated or not. Bladder analgesics include phenazopyridine (TURNS URINE, SWEAT AND TEARS BRIGHT ORANGE). |
| Nursing interventions for UTI | meds, fluids, warm sitz bath 2-3xday, avoid use of catheters, pregnant patients require immediate treatment to prevent pyelonephritis (causes early labor). Teach pt to increase fluid intake, report s/s and take meds |
| Acute kidney injury patho | acute, rapid loss of renal function or azotemia (accumulation of waste products and progressive increase in potassium). |
| Uremia (AKI) | azotemia and clinical signs of decreased renal function |
| Oliguria | decreased urine output less than 400 mL/day (non oliguria AKI heals quicker) |
| AKI stages | Stage 1: creatine 1.5-1.9x baseline, urine output less than 0.5mL/kg/hr for 6+hrs. Stage 2: creatinine is 2-2.9x baseline, urine output less than 0.5mL/kg/hr for 12+hrs. Stage 3: creatinine is 3x baseline, urine output less than 0.3mL/kg/hr for 12 hrs+ |
| Prerenal AKI | Most common cause; not related to anatomy of urinary system. Damage can resolve quick if assessment/treatment is done quickly. Ex: shock, decreased CO/renal perfusion, sepsis, liver failure |
| Intrarenal AKI | Direct damage to the parenchymal tissues resulting impaired nephron function. Ex: injury (physical/hypoxic), chemical injury, immunologic, etc. Acute tubular necrosis (due to nephrotoxic agents: can be reversed). |
| Postrenal AKI | Mechanical obstruction in ureters, bladder or urethra such as tumor, stones, BPH or strictures. |
| S/S of AKI | decreased urine volume, fluid overload, anorexia, increased potassium/phosphorus, nausea, decreased sodium/calcium, constipation, confusion/lethargy, metabolic acidosis, anemia, increased BUN/creatinine, seizures, coma |
| AKI diagnosis | Kidneys/ureter/bladder xray (KUB), US, CT/MRI, nuclear medicine tests (cystography) |
| AKI treatment | Eliminate cause, prevent complications. Avoid nephrotoxic agents, diuretics (sodium and potassium regulated), may need dialysis in severe cases |
| AKI complications | hyperkalemia (leads to cardiac arrest, will see peaked T waves and may need emergent hemodialysis) |
| AKI meds | IV calcium (gluconate or chloride), IV glucose first then IV insulin, albuterol, bicarb, sodium polystyrene sulfonate, IV furosemide |
| Pyelonephritis patho | Most common renal disease, inflammation of the renal parenchyma and urinary collecting systems. E coli is most common cause in females, young people with a major risk factor of pre-existing UTIs. |
| s/s pyelonephritis | fever, flank/back pain, chills, N/V, UTI symptoms (patient looks sick) |
| pyelonephritis diagnostics | Labs (urinalysis, urine culture), CT/US (can see hydronephrosis or edema in kidney) |
| pyelonephritis treatment | IV abx in patient with pain control and Pyridium; outpatient with mild/moderate and can be stabilized with PO Bactrim, fluroquinolones, cephalosporins. Hydrate and discharged under close supervision |
| Complications of pyelonephritis | Chronic kidney disease, kidney scarring due to inflammation, urosepsis (change in mental status, fever, tachycardia, tachypnea, hypotension, oliguria, leukopenia) |
| Acute glomerulonephritis patho | inflammation of the glomeruli of the kidney. Can be caused by infection (strep), autoimmune or vasculitis. Acute or chronic and prognosis depends on extent and cause |
| symptoms of glomerulonephritis | protein / blood/WBC in the urine, edema, decreased urine output, hypertension, increased BUN/creatinine, cola-colored urine, anorexia, nausea |
| Diagnosis of glomerulonephritis | History/physical exam, labs (UA - RBC and protein), BUN/Creatinine, decreased albumin, cultures, chemistry (hyperkalemia, hypocalcemia), kidney biopsy |
| Treatment of glomerulonephritis | Abx if infectious cause, diuretics, antihypertensives, restriction of fluids/sodium, protein restriction, rest. Plasmapheresis: filter out plasma with immune complex and discarded (RBCs and donor plasma returned to pt) |
| Urolithiasis patho and diagnostics | Stones in kidneys (nephrolithiasis ) / ureters (ureterolithiasis). History/physical exam, labs, CT, KUB, MRI, US |
| Urolithiasis risk factors | male, genetics, damage to urinary tract lining, decreased urine flow, concentrated urine, metabolic defects, high or low urine pH, urinary retention and stasis, dehydration |
| symptoms of urolithiasis | Severe pain/renal colic, urinary frequency/dysuria, diaphoresis, pallor, N/V, oliguria, anuria (obstruction = emergency), hematuria |
| Treatment of urolithiasis | less than 5 mm usually pass on their own, pain meds given. Alpha adrenergic blockers are given to relax musculature or lower ureter (Flomax), oxybutynin, abx. Surgery if it does not pass after 4-6 weeks, larger than 10mm or severe obstruction/pain |
| Urolithiasis complications | pyelonephritis, urosepsis, obstruction, irreversible kidney damage, hydronephrosis (can burst) |
| Renal trauma | Can be sustained many ways (mainly blunt force trauma). Contusions, lacerations, hematomas, shattered kidneys. Graded from 1-5 (5 is worst) |
| Clinical manifestations of renal trauma | Reduced or absent urinary output, hematuria, extensive bleeding, back/flank pain, bruising |
| Diagnostics renal trauma | history/physical exam, labs (UA), US, CT/MRI, intravenous pyelogram, renal arteriography |
| Renal trauma complications / treatment | Treatment: based on extent (stabilize / surgery), prevent shock. Complications: damage to kidney function or bleeding |
| Renal cancer | Renal carcinoma is most common type. 60-70% 5 year survival rate with nephrectomy. Can metastasis to lungs/long bone and malignant tumors are more common |
| Risk factors of renal cancer | male, age 50-70, african american or american indian / Alaskan native, smoking, chewing tobacco, genetics, obesity, HTN, environmental exposure |
| symptoms of renal cancer | asymptomatic initially: flank pain, flank mass, hematuria, weight loss, fatigue, HTN, fever (not related to infection), anemia |
| Renal cancer diagnostics | US, biopsy (6 hrs bedrest after), CT/MRI/PET, labs (UA) |
| Renal cancer treatment | Meds include biological immunotherapy (cytokines, interleukin 2, interferon). Renal cancer is resistant to chemo. Ablation therapy can be cryo or microwave to decrease growth of tumor. Radical nephrectomy removes the kidney, adrenal gland, ureter, lymph |
| Bladder cancer patho | Can be invasive (grows outside of transitional epithelium) or noninvasive (remains in transitional epithelium). Risk factors include job exposure, tobacco use, 55+, male, chronic UTI |
| Bladder cancer symptoms / diagnosis | hematuria, dysuria, frequency, and urgency. Diagnostics: MRI, biopsy, bladder wash (saline is instilled into bladder and then retrieved), PET, US, labs (UA) |
| Bladder cancer treatment | Topical/intravesical chemo or immunotherapy. Bacillus Calmette-Guerin (BCG; live virus infused in bladder for 2 hrs. do not share toilet for 24 hrs after voiding), radiation, surgeries (partial or radical) |
| Complications of bladder cancer | can be from disease or treatment, bleeding from tumors, pain, hydronephrosis |
| Nursing interventions for bladder cancer | meds, continuous bladder irrigation, I ad O, teaching |
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