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Renal

BC3 - Renal Diseases Adult 1 Mr justice (Wendy)(Andrea)(TOnya)

QuestionAnswer
Glomerulonephritis characterized by immunological responses (causes autoimmune destruction of glomerulus)- AFFECTS BOTH KIDNEYS EQUALLY!
Clinical manifestations of glomerulonephritis Hematuria, ^WBC, ^RBC, ^Casts, Proteinuria, ^BUN, ^Creatinine
Other precipitating factors of glomerular problems multisystem illness like lupus and scleroderma
Acute glomerulonephritis can be caused by a strep infection (primarily in children & young adults); follows a strep infection
Chronic glomerulonephritis is from end stage glomerular disease
Chronic glomerulonephritis progresses toward renal disease slowly
How is glomerulonephritis diagnosed CT, US, U/A and blood studies
Treatment of acute glomerulonephritis with antibiotics & treat what is initially triggering the infection
Tx of Chronic glomerulonephritis Supportive tx: control HTN & UTI's, Restrictive diet for protein & phosphate
Why can renal patients have cardiac issues because K is not being excreted in uring causing hyperkalemia - which leads to cardiac problems
Nephrosclerosis atherosclerotic changes associated with age; sclerosis of the small arteries & artrioles of the kidneys. Decreased blood flow.
Nephrosclerosis is r/t vascular changes including HTN, atherosclerotic process and benign nephrosclerosis
S/S of Benign Nephrosclerosis Possibly HTN is ony symptom
Pyelonephritis inflammation of the renal parenchyma and collecting system
Causes of pyelonephritis bacterial infection, but fungi, protozoa or viruses sometimes infect the kidney
S/S of acute pyelonephritis mild fatigue, chills, fever, vomiting, malaise, flank pain, bothersome lower urinary tract symptoms characteristic of cystitis
Dx of pyelonephritis U/A shows pyuria, bacteriuria and varying degrees of hematuria; WBC casts
Urosepsis systemic infection arising from a urologic source
Tx of acute pyelonephritis antibiotics
Chronic pyelonephritis a kidney that has become shrunken and has lost function owing to scarring or fibrosis from recurring infections
Dx of chronic pyelonephritis radiologic imagining-IVP, CT scan
Urethritis inflammation of the urethra
Causes of Urethritis bacterial or viral infection - sexually transmitted
Interstitial cystitis chronic, painful inflammatory disease of the bladder
Probable contributing factors of IC chronic inflammation with mast cell invasion of the bladder wall,
Clinical manifestations of IC painful and bothersome lower urinary tract symptoms
Dx of IC exclusion
Nephrotic syndrome a clinical course that can be associated with a number of disease conditions
Causes of nephrotic syndrome Primary Glomerular Disease; Multisystem Disease (Lupus, DM); Infections; Neoplasms; Allergens; Drugs
S/S of nephrotic syndrome peripheral edema, massive proteinuria, hyperlipidemia and hypoalbuminemia
Tx of nephrotic syndrome symptomatic; goal is to relieve edema and cure or control the primary disease
Dieit Mgmt of nephrotic syndrome maintain a low - moderate protein diet that is low in sodium
Two types of impaired renal perfusion Renal artery stenosis & Renal Vein Thrombosis
S/S of Renal Artery Stenosis Abrupt onset of HTN
Dx of Renal Artery Stenosis Renal arteriogram most definitive test
Tx of Renal Artery Stenosis Surgical intervention: Anastamosis (like bypass) vs nephrectomy
Causes of Renal Vein Thrombosis (can be uni- or bi-lateral) Trauma, Tumor, Aneurysm, CA, Pregnancy, Nephrotic Syndrome
Assessment factors of Thrombosis Hematuria, Flank Pain, Fever, Nephrotic Syndrome
Tx of Thrombosis Anticoagulant therapy, Thrombectomy
Renal Vein Thrombosis patients are at risk for PE, so monitor for rerspiratory distress - chest pain, change in LOCneuro, HA, CVA, MI,
nephrolithiasis kidney stone disease
S/S of renal calculi severe abd or flank pain, hematuria and dysuria
Dx of renal calculi KUB (Kidney, Ureter & Bladder study), Flat plate of abd, CT of abd & pelvis, US, IVP, U/A, urine culture
Tx of renal calculi Endourologic, Lithotripsy, Surgery
Nursing considerations r/t tx of renal calculi Monitor I&O and monitor fo hemorrhage
Therapeutic tx of calcium oxalate stones increaase hydration, monitor intake of calcium and oxalate
Therapeutic tx of calcium phosphate stones treat underlying causes and other stones
Therapeutic tx of struvite stones Antibiotics r/t infection, increase fluid, possible removal
Therapeutic tx of Uric acid stones Monitor dietary intake of purines, increase fluids
Therapeutic tx of cystine stones increase fluids
Foods high in Purines Sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads
Foods moderate in Purines chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham
Foods high in calcium milk, cheese, ice cream, yogurt, sauces containing milk, all beans (except green beans), lentils; fish with fine bones; dried fruits, nuts; chocolate, cocoa, Ovaltine
Foods high in Oxalate spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans; chocolate, cocoa, instant coffee, Ovaltine, tea; worchestershire sauce
Intravenous Pyelography (IVP) requires dye injection, iodine allergy, monitor urine output post procedure, Check BUN/Creatinine prior to test
Cystoscopic Lithotripsy removal from the bladder
Uretoscope removal from the ureter & renal pelvis
Lithotripsy Ultrasonic therapy to break up, crush or pulverize; may need to be suctioned after removal, may be irrigated, invasive & non-invasive
Ureteral Stricture usually surgical and adhesion related
Urethral Stricture caused by infection, congenital, trauma, and fibrosis
S/S of ureteral stricture pain; risk for kidney impairmnt
S/S of uretheral stricture spraying, incomplete emptying, decreased stream, nocturia, frequency
Hypospadius urethra opens on the underside of the penis
Epispadius Urethra open on the dorsal side of the penis
Hydronephrosis Dilitation of renal pelvis & calyces caused by chronic pyelonephritis & renal atrophy
Polycystic Kidney Disease Hereditary, affects both kidneys; kidney cortex & medulla are filled with thin-walled cysts
Urinary Incontinence an uncontrolled loss of urine that is of sufficient magnitude to be a problem
Urinary Retention the inability to empty the bladder despite micturition or the accumulation of urine in th bladder because of an inability to urinate.
Tx of urinary retention Bethanecol (Urecholine); catheterization
Tx of incontinence Kegel exercises
Tx of Neural control medication and surgical sphincterotomy
Overactive bladder urge incontinence
Tx of overactive bladder medications and voiding patterns
Stress Incontinence sudden increase in intraabdominal pressure causes involuntary passage of urine. It can occur during coughing, heavy lifting, straining or laughing
Causes of stress incontinence most common in women with relaxed pelvic musculature
Tx of stress incontinence Kegel exercises, wt loss,
Urge incontinence Condition occurs randomly when involuntary urination is preceded by warning of few seconds to few minutes; leakage is periodic but frequent; Nocturnal frequency & incontinence are common
Causes of urge incontinence uncontrolled contraction or overactivity of detrusor muscle
Tx of urge incontinence tx of underlying causes, have pt urinate more frequently or on time schedule, anticholinergic drugs
Overflow Incontinence (Retention) occurs when pressure of urin in overfull bladder overcomes sphincter control. Leakage of sm. amts of urine is frequent throughout the day & nighht
Tx of overflow incontinence urinary catherization and Urecholine
Reflex Incontinence occurs when no warning or stress precedes periodic involuntary urination.
Causes of reflex incontinence neural control
Tx of reflex incontinence meds and surgical sphincterotomy
Incontinence after trauma or surgery fistula formation, post-op complication
Functional incontinence loss of urine resulting from problems of patient mobility or environmental factors
Causes of functional incontinence Elderly often have problems that affect balance and mobility
Tx of functiional incontinence Modifications of environment
Assistive tools for incontinence Voiding diary, health history, PVR (bladder scan & straight cath), Bladder training program
What happens to a patient who has a neurogenic bladder and they cannot self cath they can go into hypertensive crisis and then cardiac arrest
Created by: okrecota