HCC Acute Renal Disruptions
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| ARF | Acute Renal Failure. A clinical sydrome characterized by rapid loss of renal function with progressive azotemia. ARF is often assoc. c oliguria
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| Azotemia | An accumulation of nitrogenous waste products such as blood urea nitrogen(BUN) and increasing levels of serum creatinine.
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| Uremia | The condition in which renal function declines to the point that symptoms develop in multiple body systems.
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| Nephrotoxic Agent | A substance that is toxic to the kidney tissues.
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| ATN | Acute Tubular Necrosis. A type of intrarenal ARF caused by ischemia, nephrotoxins, or pigments.
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| Oliguria | <400 mL of urine in 24hrs. Usually occurs within 1-7 days of the causative event.
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| Fluid Volume Excess | When urinary output decreases, fluid retention occurs.
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| Metabolic Acidosis | When the kidneys cannot excrete acid products of metabolism. Bicarb level decreases. Client may develop Kussmaul respirations to increase the excretion of carbon dioxide.
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| Kussmaul Respirations | Rapid, deep respirations.
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| Nephron | The functional unit of the kidney. Each kidney contains 800,000 to 1.2 million nephrons. • A nephron is composed of a glomerulus, Bowman’s capsule, and a tubular system.
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| Kidneys | The kidneys receive 20-25% of the cardiac output. The primary function of the kidneys is to filter the blood and maintain the body’s internal homeostasis.
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| Glomerulus | Filters the blood. Hydrostatic pressure of the blood within the glomerular capillaries causes a portion of blood to be filtered across the semipermeable membrane into Bowman’s capsule.
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| GFR | The amount of blood filtered by the glomeruli in a given time is termed the glomerular filtration rate (GFR). The normal GFR is about 125 ml/min.
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| Tubular Function | The functions of the tubules and collecting ducts include reabsorption and secretion.
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| Loop of Henle | The loop of Henle is important in conserving water and thus concentrating the filtrate. In the loop of Henle, reabsorption continues.
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| Distal Convoluted Tubules | Two important functions of the distal convoluted tubules are final regulation of water balance and acid-base balance.
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| ADH | Antidiuretic hormone (ADH) is required for water reabsorption in the kidney.
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| Aldosterone | Aldosterone acts on the distal tubule to cause reabsorption of sodium ions (Na+) and water. In exchange for Na+, potassium ions (K+) are excreted.
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| Acid-Base Balance | Acid-base regulation involves reabsorbing and conserving most of the bicarbonate (HCO3) and secreting excess H+.
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| ANP | Atrial natriuretic peptide (ANP) acts on the kidneys to increase sodium excretion.
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| PTH | Parathyroid hormone (PTH) acts on renal tubules to increase reabsorption of calcium.
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| EPO | The kidneys produce erythropoietin in response to hypoxia and decreased renal blood flow. Erythropoietin stimulates the production of red blood cells (RBCs) in the bone marrow.
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| Vitamin D | Vitamin D is activated in kidneys. Vitamin D is important for calcium balance and bone health.
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| Renin | Renin, which is produced and secreted by juxtaglomerular cells, is important in the regulation of blood pressure.
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| PG | Prostaglandin (PG) synthesis (primarily PGE2 and PGI2) occurs in the kidney, primarily in the medulla. These PGs have a vasodilating action, thus increasing renal blood flow and promoting Na+ excretion.
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| Ureters | The ureters are tubes that carry urine from the renal pelvis to the bladder. Circular and longitudinal smooth muscle fibers, arranged in a meshlike outer layer, contract to promote the peristaltic one-way flow of urine.
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| Bladder | Primary functions are to serve as reservoir for urine, to help body eliminate waste products. Normal adult urine output is approx 1500 ml/day. On avg, 200 to 250 ml of urine in the bladder causes moderate distention and the urge to urinate.
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| Urethra | A small muscular tube that leads from the bladder neck to the external meatus. Primary function is a conduit for urine from the bladder neck to outside the body during voiding. The female urethra is significantly shorter than male.
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| Aging Renal System | By the seventh decade of life, 30% to 50% of glomeruli have lost their function. Atherosclerosis has been found to accelerate the decrease of renal size with age.
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| Urinalysis | This test may provide information about possible abnormalities, indicate what further studies need to be done, and supply information on the progression of a diagnosed disorder.
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| Creatinine Clearance | Because almost all creatinine in the blood is normally excreted by the kidneys, creatinine clearance is the most accurate indicator of renal function. The result of a creatinine clearance test closely approximates that of the GFR.
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| UTI | Urinary Tract Infection. The second most common bacterial disease, and the most common bacterial infection in women. UTIs include cystitis, pyelonephritis, and urethritis.
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| Risk Factors for UTI's | Pregnancy, menopause, instrumentation, and sexual intercourse. Escherichia coli (E. coli) is the most common pathogen causing a UTI.
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| UTI Symptoms | Dysuria, frequent urination (more than every 2 hours), urgency, and suprapubic discomfort or pressure. Flank pain, chills, and the presence of a fever indicate an infection involving the upper urinary tract (pyelonephritis).
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| UTI Interventions | Emptying the bladder regularly and completely, evacuating the bowel regularly, wiping the perineal area from front to back after urination and defecation, and drinking an adequate amount of liquid each day.
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| Pyelonephritis | An inflammation of the renal parenchyma and collecting system. The most common cause is bacterial infection. Recurring infection can result in chronic pyelonephritis.
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| Pyelonephritis Symptoms | Vary from mild fatigue to the sudden onset of chills, fever, vomiting, malaise, flank pain, and the lower UTI characteristics.
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| Pyelonephritis Interventions | Teaching the need to continue drugs as prescribed, the need for a follow-up urine culture to ensure proper management, and identification of risk for recurrence or relapse.
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| Nephrotic Syndrome | When the glomerulus is excessively permeable to plasma protein, causing proteinuria that leads to low plasma albumin and tissue edema. Associated with diabetes or systemic lupus erythematosus.
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| Nephrotic Syndrome Interventions | Edema is assessed by weighing the patient daily, accurately recording intake and output, and measuring abdominal girth or extremity size.
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| Lithiasis | The five major categories of stones (lithiasis) are calcium phosphate, calcium oxalate, uric acid, cystine, and struvite.
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| Lithotripsy | Used to eliminate calculi from the urinary tract. Outcome for lithotripsy is based on stone size, stone location, and stone composition.
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| Client Goals with Lithiasis | Will have (1) relief of pain, (2) no urinary tract obstruction, and (3) an understanding of measures to prevent further recurrence of stones.
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| Lithiasis Interventions | The patient should consume an adequate fluid intake to produce a urine output of approximately 2 L/day. Additional preventive measures focus on reducing metabolic or secondary risk factors.
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| Urethral Stricture | A narrowing of the lumen of the ureter or urethra. Ureteral strictures can affect the entire length of the ureter.
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| Causes of a Urethral Stricture | A urethral stricture is the result of fibrosis or inflammation of the urethral lumen. Causes of urethral strictures include trauma, urethritis, iatrogenic, or a congenital defect.
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| Urethral Stricture Symptoms | Clinical manifestations of a urethral stricture include a diminished force of the urinary stream, straining to void, sprayed stream, postvoid dribbling, or a split urine stream.
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| Renal Vascular Problems | Vascular problems involving the kidney include (1) nephrosclerosis, (2) renal artery stenosis, and (3) renal vein thrombosis.
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| Renal Artery Stenosis | a partial occlusion of one or both renal arteries and their major branches due to atherosclerotic narrowing. The goals of therapy are control of BP and restoration of perfusion to the kidney.
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| PKD | Polycystic kidney disease is the most common life-threatening genetic disease. Characterized by cysts that enlarge and destroy surrounding tissue by compression.Dx is based on symptoms, family history, IVP, ultrasound, or CT scan.
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| Diabetes and Renal Dysfunction | Diabetic nephropathy is the primary cause of end-stage renal failure in the United States. Diabetes mellitus affects the kidneys by causing microangiopathic changes.
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| HD | Hemodialysis is used when rapid changes are required in a short period of time.
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| PD | Peritoneal dialysis is simpler than HD, but it carries the risk of peritonitis, is less efficient in the catabolic patient, and requires longer treatment times.
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| CRRT | Continuous renal replacement therapy may also be used in the treatment of ARF, particularly in those who are hemodynamically unstable.
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| Urinary Incontinence | 6 major types: Stress, Urge, Overflow, Reflex, Functional, Total.
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| Stress Incontinence | Loss of small amounts of urine with sneezing, laughing, or lifting. R/t weak pelvic muscles, urethra, or surrounding tissues.
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| Urge Incontinence | Inability to stop urine flow long enough to reach the toilet. R/t an overactive detrusor muscle with increased bladder pressure.
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| Overflow Incontinence | Assoc with bladder overdistention and frequent loss of small amts of urine. R/t obstruction of the urinary outlet or an impaired detrusor muscle.
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| Reflex Incontinence | Involuntary loss of a moderate amt of urine usually with warning. R/t hyperreflexia of the detrusor muscle, usually from altered spinal cord activity.
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| Functional Incontinence | Inability to get to the toilet to urinate. R/t physical, cognitive, or social impairment.
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| Total Incontinence | Involuntary, unpredictable loss of urine that does not generally respond to treatment.
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| Urinary Incontinence Significance | Contributing factor to altered skin integrity and falls, especially in older adults.
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| 85% | 85% of clients with urinary incontinence are female.
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| Risk Factors for Urinary Incontinence | Hx of multi pregnancies and vaginal births, aging, renal disease, bladder spasm, chronic urinary retention, and chronic bladder infection(cystitis). Neuro d/o's, medications, obesity, confusion, dementia, immobility, depression.
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| Chronic Kidney Disease | CKD usually develops slowly over months to years and necessitates the initiation of dialysis or transplantation for long-term survival. The prognosis of CKD is variable depending on the etiology, patient’s condition and age, and adequacy of follow-up.
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| Postvoid Residual Urine | Rules out urinary retention(greater than 100 mL retained urine post voiding).
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| Urine Culture/Sensitivity | Rule out urinary tract infection(presence of RBC's, WBC's, and microorganisms).
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| Serum Creatinine and BUN | To assess renal function(elevated with renal dysfunction).
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| Voiding Cystourethrography(VCUG) | To assess the size, shape, support, and function of the urinary bladder; identify obstruction(prostate) and postvoid residual urine.
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| Assessments | Loss of urine when laughing, coughing, or sneezing, enuresis, spasms, retention, frequency, urgency, nocturia, I&O, Patterns, skin integrity, barriers to toileting, Sx of UTI, suprapubic fullness.
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| Enuresis | Bed-wetting
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| Interventions | Toileting schedule, bladder training-remind, gradually increase voiding intervals, consciously hold urine, intermittent catheter, decrease fluids b4 bedtime.
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| Interventions 2 | Remove barriers to toileting, electrical stim to pelvic floor, incontinence garments, condom catheter, avoid indwelling urinary catheters.
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| Teach the client | Incontinence diary, kegels, valsalva, avoid caffeine & alcohol, SE's of meds, vaginal cone therapy, proper med admin.
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| Skin Breakdown Prevention | Keep the skin clean & dry, apply protective barrier creams, implement bladder retraining program.
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| Social Isolation Prevention | Assis the client with measures to conceal urinary leaking, offer emotional support.
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| Aging | Incontinence is NOT a normal part of aging.
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| ATI | Review your med-surge ATI book!! Do the questions at the end of the chapters! Do the online ATI practice quiz!!
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