BC3 - Renal Diseases Adult 1 Mr justice (Wendy)(Andrea)(TOnya)
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| Glomerulonephritis | characterized by immunological responses (causes autoimmune destruction of glomerulus)- AFFECTS BOTH KIDNEYS EQUALLY!
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| Clinical manifestations of glomerulonephritis | Hematuria, ^WBC, ^RBC, ^Casts, Proteinuria, ^BUN, ^Creatinine
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| Other precipitating factors of glomerular problems | multisystem illness like lupus and scleroderma
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| Acute glomerulonephritis can be caused by | a strep infection (primarily in children & young adults); follows a strep infection
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| Chronic glomerulonephritis is from | end stage glomerular disease
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| Chronic glomerulonephritis progresses toward | renal disease slowly
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| How is glomerulonephritis diagnosed | CT, US, U/A and blood studies
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| Treatment of acute glomerulonephritis | with antibiotics & treat what is initially triggering the infection
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| Tx of Chronic glomerulonephritis | Supportive tx: control HTN & UTI's, Restrictive diet for protein & phosphate
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| Why can renal patients have cardiac issues | because K is not being excreted in uring causing hyperkalemia - which leads to cardiac problems
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| Nephrosclerosis | atherosclerotic changes associated with age; sclerosis of the small arteries & artrioles of the kidneys. Decreased blood flow.
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| Nephrosclerosis is r/t | vascular changes including HTN, atherosclerotic process and benign nephrosclerosis
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| S/S of Benign Nephrosclerosis | Possibly HTN is ony symptom
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| Pyelonephritis | inflammation of the renal parenchyma and collecting system
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| Causes of pyelonephritis | bacterial infection, but fungi, protozoa or viruses sometimes infect the kidney
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| S/S of acute pyelonephritis | mild fatigue, chills, fever, vomiting, malaise, flank pain, bothersome lower urinary tract symptoms characteristic of cystitis
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| Dx of pyelonephritis | U/A shows pyuria, bacteriuria and varying degrees of hematuria; WBC casts
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| Urosepsis | systemic infection arising from a urologic source
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| Tx of acute pyelonephritis | antibiotics
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| Chronic pyelonephritis | a kidney that has become shrunken and has lost function owing to scarring or fibrosis from recurring infections
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| Dx of chronic pyelonephritis | radiologic imagining-IVP, CT scan
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| Urethritis | inflammation of the urethra
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| Causes of Urethritis | bacterial or viral infection - sexually transmitted
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| Interstitial cystitis | chronic, painful inflammatory disease of the bladder
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| Probable contributing factors of IC | chronic inflammation with mast cell invasion of the bladder wall,
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| Clinical manifestations of IC | painful and bothersome lower urinary tract symptoms
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| Dx of IC | exclusion
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| Nephrotic syndrome | a clinical course that can be associated with a number of disease conditions
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| Causes of nephrotic syndrome | Primary Glomerular Disease; Multisystem Disease (Lupus, DM); Infections; Neoplasms; Allergens; Drugs
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| S/S of nephrotic syndrome | peripheral edema, massive proteinuria, hyperlipidemia and hypoalbuminemia
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| Tx of nephrotic syndrome | symptomatic; goal is to relieve edema and cure or control the primary disease
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| Dieit Mgmt of nephrotic syndrome | maintain a low - moderate protein diet that is low in sodium
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| Two types of impaired renal perfusion | Renal artery stenosis & Renal Vein Thrombosis
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| S/S of Renal Artery Stenosis | Abrupt onset of HTN
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| Dx of Renal Artery Stenosis | Renal arteriogram most definitive test
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| Tx of Renal Artery Stenosis | Surgical intervention: Anastamosis (like bypass) vs nephrectomy
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| Causes of Renal Vein Thrombosis | (can be uni- or bi-lateral) Trauma, Tumor, Aneurysm, CA, Pregnancy, Nephrotic Syndrome
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| Assessment factors of Thrombosis | Hematuria, Flank Pain, Fever, Nephrotic Syndrome
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| Tx of Thrombosis | Anticoagulant therapy, Thrombectomy
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| Renal Vein Thrombosis patients are at risk for | PE, so monitor for rerspiratory distress - chest pain, change in LOCneuro, HA, CVA, MI,
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| nephrolithiasis | kidney stone disease
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| S/S of renal calculi | severe abd or flank pain, hematuria and dysuria
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| Dx of renal calculi | KUB (Kidney, Ureter & Bladder study), Flat plate of abd, CT of abd & pelvis, US, IVP, U/A, urine culture
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| Tx of renal calculi | Endourologic, Lithotripsy, Surgery
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| Nursing considerations r/t tx of renal calculi | Monitor I&O and monitor fo hemorrhage
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| Therapeutic tx of calcium oxalate stones | increaase hydration, monitor intake of calcium and oxalate
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| Therapeutic tx of calcium phosphate stones | treat underlying causes and other stones
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| Therapeutic tx of struvite stones | Antibiotics r/t infection, increase fluid, possible removal
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| Therapeutic tx of Uric acid stones | Monitor dietary intake of purines, increase fluids
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| Therapeutic tx of cystine stones | increase fluids
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| Foods high in Purines | Sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads
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| Foods moderate in Purines | chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham
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| 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
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| Foods high in Oxalate | spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans; chocolate, cocoa, instant coffee, Ovaltine, tea; worchestershire sauce
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| Intravenous Pyelography (IVP) | requires dye injection, iodine allergy, monitor urine output post procedure, Check BUN/Creatinine prior to test
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| Cystoscopic Lithotripsy | removal from the bladder
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| Uretoscope | removal from the ureter & renal pelvis
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| Lithotripsy | Ultrasonic therapy to break up, crush or pulverize; may need to be suctioned after removal, may be irrigated, invasive & non-invasive
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| Ureteral Stricture | usually surgical and adhesion related
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| Urethral Stricture | caused by infection, congenital, trauma, and fibrosis
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| S/S of ureteral stricture | pain; risk for kidney impairmnt
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| S/S of uretheral stricture | spraying, incomplete emptying, decreased stream, nocturia, frequency
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| Hypospadius | urethra opens on the underside of the penis
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| Epispadius | Urethra open on the dorsal side of the penis
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| Hydronephrosis | Dilitation of renal pelvis & calyces caused by chronic pyelonephritis & renal atrophy
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| Polycystic Kidney Disease | Hereditary, affects both kidneys; kidney cortex & medulla are filled with thin-walled cysts
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| Urinary Incontinence | an uncontrolled loss of urine that is of sufficient magnitude to be a problem
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| Urinary Retention | the inability to empty the bladder despite micturition or the accumulation of urine in th bladder because of an inability to urinate.
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| Tx of urinary retention | Bethanecol (Urecholine); catheterization
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| Tx of incontinence | Kegel exercises
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| Tx of Neural control | medication and surgical sphincterotomy
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| Overactive bladder | urge incontinence
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| Tx of overactive bladder | medications and voiding patterns
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| Stress Incontinence | sudden increase in intraabdominal pressure causes involuntary passage of urine. It can occur during coughing, heavy lifting, straining or laughing
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| Causes of stress incontinence | most common in women with relaxed pelvic musculature
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| Tx of stress incontinence | Kegel exercises, wt loss,
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| 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
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| Causes of urge incontinence | uncontrolled contraction or overactivity of detrusor muscle
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| Tx of urge incontinence | tx of underlying causes, have pt urinate more frequently or on time schedule, anticholinergic drugs
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| 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
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| Tx of overflow incontinence | urinary catherization and Urecholine
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| Reflex Incontinence | occurs when no warning or stress precedes periodic involuntary urination.
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| Causes of reflex incontinence | neural control
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| Tx of reflex incontinence | meds and surgical sphincterotomy
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| Incontinence after trauma or surgery | fistula formation, post-op complication
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| Functional incontinence | loss of urine resulting from problems of patient mobility or environmental factors
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| Causes of functional incontinence | Elderly often have problems that affect balance and mobility
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| Tx of functiional incontinence | Modifications of environment
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| Assistive tools for incontinence | Voiding diary, health history, PVR (bladder scan & straight cath), Bladder training program
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| 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
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