renal/ab studyguide
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| • Urinalysis |
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| Urinalysis purposes | 1. Screen pt’s urine for renal or urinary tract disease; 2. Helps detect metabolic or systemic disease unrelated to renal disorders; 3. _detect presence of drugs_
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| o Color/Clarity of urine | straw yellow to dark yellow and clear_
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| o Odor | Slightly aromatic
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| o pH | 4.5—8.0
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| o Specific Gravity | density of a solution compared to density of water 1.010 – 1.025
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| o RBCs | 0 – 2 / high-power field
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| o WBCs | 0 – 5 / high-power field
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| o Casts | 0, except 1 or 2 hyaline casts / low-power field
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| o Crystals | Present
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| o Abnormal Substances | _protein, glucose, ketones and bacteria _
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| • Specific Gravity | Density of a solution compared to density of water; 1.010—1.025; Altered by having blood, protein, and cast in urine
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| • Blood Urea Nitrogen – BUN |
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| BUN measures | Serum Test; Evaluates kidney function; Aids in diagnosis of renal disease; Assessment of hydration
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| BUNReference Levels | 8—20 mg/dL_
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| o BUN Measures | nitrogen factor of urea = chief end product of protein metabolism; formed in liver from _ammonia; excreted by _the kidneys_
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| o Elevated BUN levels may indicate | renal disease, reduced renal blood flow, urinary track obstruction
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| o Decreased BUN levels may indicate | Severe hepatic damage, malnutrition, over hydration
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| • Client preparation for lower urinary tract ultrasound | Requires Full Bladder, Privacy
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| • For MRI prep | no alcohol, caffeine, or smokes 2hr before or food 1hr before &no iron supplements)
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| • Complications & interventions post percutaneous kidney biopsy (needle biopsy) | Infection, Bleeding, VS
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| • Expected & unexpected findings post cystoscopy |
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| o Expected findings post-cystoscopy | Some burning on voiding, Blood tinged urine, Urinary frequency, Contrast agent is injected into the bladder may leak through a small bladder perforation
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| o Unexpected findings post-cystoscopy | Large amounts leak out of the bladder, Blockages, UTI
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| • Complications post renal angiography | Hematoma formation, Arterial thrombosis or dissection, False aneurysm formation, Altered renal function
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| • Nursing interventions post percutaneous lithotripsy | Infection, Hemorrhage, Urosepsis, Watch for bleeding, Leaking, Obstruction of urinary tract by a stone or edema with subsequent acute renal failure. Relieve Pain, monitor & manage potential complications, increase fluid intake, I&O
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| • Teach post-percutaneous lithotripsy | instruct pt to report decreased urine volume, bloody or cloudy urine, fever & pain, all urine is strained through gauze, notify dr if temp is above 101 degrees F, hematuria may occur for 4-5 days(this is normal),
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| teaching post-percutaneous lithotripsy continued | bruise may be observed on the tx side of back, urine pH monitoring, recommend ways to prevent stone recurrence, urine cultures may be done every 1 to 2 months for first year, then periodically after
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| • Expected findings post op TURP with continuous bladder irrigation | What goes in must come out, Avoid over distention of the bladder, CACO, Look up irrigationl; monitor irrigant output closely, monitor for electrolyte imbalance, requires overnight stay, irrigate as ordered to prevent obstruction
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| preventing renal calculi reoccurence | Avoid excessive sweating & dehydrations ; Call physician with first sign of UTI
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| o Preventing renal calculi reoccurrence continued | Restricted protein intake,Decreased sodium intake 3-4g/day, Low-calcium diets aren’t recommended, Avoid oxalate-containing foods, Drink fluids q 1—2 hr, 2 glasses at bedtime and sips upon wakening;
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| Oxalate-containing foods | spinach, strawberries, rhubarb, tea, peanuts, Wheat bran
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| Risk factors of UTI | Inability or failure to empty bladder completely, Bath instead of shower, Obstructed urinary flow (Urethral strictures, Congenital abnormalities, Bladder tumors, Calculi in bladder or kidneys,
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| Risk factors of UTI continued | Compression of the ureters, Contracture of bladder neck), Decreased natural defenses or immunosupression, Instrumentation (catheter), Urethrovesical—urine flow from urethra back into bladder,
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| Risk factors of UTI continued again. | Ureterovesical or vesicoureteral—urine flow from bladder into ureters , Inflammation or abrasion of urethral mucosa, Contributing condition(Diabetes mellitus,Pregnancy, Neuro disorders, Gout, Incomplete emptying of the bladder and urinary stasis)
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| o S/Sx of UTI | About half of patients are asymptomatic (don’t show symptoms), Pain & burning upon urination &/or frequency, nocturia, Incontinence, Suprapubic, pelvic, or back pain, Hematuria or change in urine or urinary pattern
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| o Prevention of UTI | Increase water intake, Void after sex, Avoid pop, Proper hygiene (Clean from front to back), Clean catheter, Take meds as prescribed, Don’t hold the urine
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| • Urinary retention assessment | Time & amt of last void? Voiding small amts frequently? Dribbling, Pain or discomfort? S/Sx of UTI burning, frequency, pain, Any other indicators, Restlessness, Agitation
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| o Possible causes of urinary retention | Pregnancy, Diabetes, Enlarged prostate Meds, Age, post-op
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| • S/S of urinary retention | Pt verbalize full bladder or incomplete bladder emptying, Bladder distention
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| o Some S/S of UTI | Hematuria, Urgency, Frequency, Nocturia, fever
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| • Nursing interventions / teaching for incontinence | Fluid management, Voiding schedule, Pelvic muscle exercise, Avoid diuretics after 4pm, Avoid caffeine, alcohol and aspartame (nutrasweet), Stop smoking, Teach pt to use a log or diary , Explain medications, Teach pt it is treatable and not inevitable
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| • Medications that promote bladder emptying | Bethanechol (Urecholine)—may help increase the contracture of the detruser muscle
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| • Discharge teaching post urinary diversion with Indiana Pouch | Drain at regular intervals (never wait longer than 2-3hr;S/S of UTI (fever, flank pain, urgency, frequency); Increase liquids to thin mucus, Irrigate cecostomy tube 2-3 times daily post-op to prevent occlusion from mucus
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| • Stoma complications | Signs of irritation/bleeding, Infection, Stoma refraction – serperation(need to protect it by supplying karaya power, adhesive paste, and a properly fitting skin barrier and pouch), Monitor all additional drains for patency & drainage
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| • Antispasmodic medications | Urispas, Ditropan
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| o Discharge teaching post-Prostatectomy | Prune juice and stool softners, Analgesics as prescribed, Notify dr if pain not relieved
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| o Post-Hysterectomy teaching | Relieve anxiety-Encourage pt to verbalize concerns, Improve body image-Talk about fertility & sexuality,
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| Post-Hysterectomy teaching continued | Pain relief - Analgesics as prescribed, May limit intake for 1-2 days, May require rectal tube or heating pad to abdomen, Permit additional fluids & soft diet when BS peristalsis return, Encourage early ambulation (helps with peristalsis),
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| post-hysterectomy teaching continued again | Encourage voiding,Know limitations/restrictions, assess incisions daily, AVOID-Straining, lifting, do not sit for long periods of time, showers over baths;intercourse, and driving until permitted by DR., Report s/sx of complications immediately
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| o Interventions for vascular access device | Protect vascular access, Assess for patency and signs of potential infection, Don’t use affect arm for BP or Blood Draws, Palpate for thrill, auscultate for bruit, check color,
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| Interventions for vascular access device continued | Report abnormalities; Instruct client(Routine ROM is encouraged, No activity that would occlude or compress extremity)
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| Need to monitor with vascular access device | fluid balance indicators and monitor IV therapy carefully (Accurate I & O records); Assess for uremia & electrolyte imbalance (Regulary and check lab date); Monitor cardiac and resp status carefully (Assess distal pulses);
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| • Continuous Ambulatory Peritoneal Dialysis (CAPD) is done to... | remove wastes, chemicals, and extra fluid from your body. The peritoneum is a thin lining on the inside of your abdomen (stomach), and some other organs. During CAPD, a liquid called dialysate is put into your abdomen.
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| o Continuous ambulatory peritoneal dialysis (CAPD) is done to...continued | It is put in through a CAPD catheter.The catheter is a tube that goes from the outside, to the inside of your abdomen. The dialysate pulls wastes and substances from your blood and lymph fluid through the peritoneum.
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| Continuous ambulatory peritoneal dialysis (CAPD) is done to...continued | The wastes mix with the dialysate. The peritoneum works like a filter as the wastes are pulled through it.
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| o Dialysate | dialysate is left in your abd for 3 to 5 hours(dwell time). After that, the dialysate is drained out through the catheter. Filling and emptying your abd with dialysate is an exchange.
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| dialysate continued | Exchanges may be done 3 to 5 times during the day & once during the night. CAPD exchanges can decrease or take away problems such as swelling, itching, fatigue, and weakness. CAPD can help decrease high blood pressure, and make them feel better
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| o PT Teaching with CAPD | Maintain sterile technique with cath, fluid, and tubing, Always wear a mask to protect against airborn bacteria. (includes anyone within 6 ft of tubing), Care for cath entry site
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| Nutritional teaching for renal calculi | Restrict protein intake to 60 g/day, Reduce table salt & high sodium foods to 3 to 4 g/day, Avoid oxalate containing foods(Spinach, strawberries, rhubarb, tea, peanuts, wheat bran), Drink water every 1 to 2 hrs during day, Sips at night time awakening
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| o Sodium bicarbonate Buffer | Most important buffer system, Buffers up to 90 % of H+ in ECF
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| o Normal ECF bicarbonate – carbonic acid ratio | Normal ECF is a 20 bicarbonate
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| Lungs role in acid-base balance | Respiratory control of H+; 1.Primary controller of body’s carbonic acid supply;
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| Lungs role in acid-base balance continued | 2.Blood CO2 increases -- Resp. rate & depth ↑ to eliminate CO2 ; 3.Blood CO2 decreases -- Resp. rate & depth ↓ to retain CO2 to form carbonic acid (CO2 + H2O H2CO3); 4.Rapid acting for compensation
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| Kidneys role in acid-base balance | Renal control of H+; 1.Primary regulator of concentration of ECF bicarbonate;
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| Kidneys role in acid-base continued | 2.Regenerates & reabsorbs bicarbonate ions; 3.Excretes H+ ions & retains bicarbonate ions or -; Retains H+ ions & excretes bicarbonate ions; 4.Slower than lungs for compensation - hours –days
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| • CO2 retention & pH | Rapid breathing CO2 goes down and pH goes up; Slow breathing CO2 goes up and pH goes down
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| o Normal pH | 7.35—7.45
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| o Normal PaCO2 | 35—45
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| o Normal HCO3 | 22—26
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| o Normal PaO2 | 80—100
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| o Normal O2 Sat | 95—100%
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| o Noncompensating | either PaCO2 or HCO3 will be in normal ranges with noncompensation
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| o partial compensation | all measurements are abnormal with partial compensation; both systems trying to balance pH
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| o complete compensation | returns to normal ranges while PaCO2 & HCO3 remain abnormal
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| • Compensatory mechanisms for respiratory acidosis | Co2 levels rise in the blood->CO2 combines with water to form carbonic acid (H2CO3)->Carbonic acid dissociated to form bicarb ion (HCO3) and H+ (continued next card)
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| • Compensatory mechanisms for respiratory acidosis continued | ->pH sensory detect a drop in pH due to an increase in H+ concentration in the blood and send a signal to the brain, forcing the person to breath
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| Kidneys | produce & retain bicarbonate & excrete hydrogen ions in the urine
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| • Effects of complete compensation | pH is normal but both systems are abnormal to keep the pH in balance
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| How lungs compensate | Co2 levels rise in the blood, CO2 combines with water to form carbonic acid (H2CO3),
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| o How Lungs compensate continued | Carbonic acid dissociated to form bicarb ion (HCO3) and H+, pH sensory detect a drop in pH due to an increase in H+ concentration in the blood and send a signal to the brain, forcing the person to breath
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| o How Kidneys compensate | produce & retain bicarbonate & excrete hydrogen ions in the urine
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| o Metabolic acidosis |
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| Etiology of metabolic acidosis | Excess acid production in body; Rapid excretion of bicarbonate from body
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| things that can cause metabolic acidosis | Diabetic ketoacidosis, Lactic acidosis (shock, resp or cardiac arrest), Renal failure, Liver failure, Severe diarrhea, Vomiting, Salicylate toxicity, Starvation, GI fistulas
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| S/S of metabolic acidosis | Kussmaul respirations (deep and rapid), Confusion, disorientation progressing to coma, HA, Lethargy, Hypotension, Arrhythmias, Warm to hot, flushed skin pg 294, Abd pain
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| Interventions for metabolic acidosis | Identify & treat cause, ex anti-emetics, anti-diarrheals, fluid replacement (0.9% or 0.45% NaCl or Bicarb); Assess serial lab results; BUN & creatine for renal function; AST & ALT for liver function; Serum electrolytes; Blood sugar levels;
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| Interventions for metabolic acidosis continued | Monitor ABGs; Assess VS (including T), Wt, skin turgor, & urine
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| o Metabolic alkalosis |
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| Etiology of metabolic alkalosis | Bicarbonate excess; Excess alkali intake(Antacids,Carbonated drinks); Retention of bicarbonate (Hypokalemia (accompanied by ↓ of chloride & ↑ in bicarbonate);
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| Etiology of metabolic alkalosis continued | Diuretic therapy; Adrenal disease (accompanied by decrease of chloride and increase in bicarbonate); Loss of stomach acid(Vomiting, gastric suctioning (most common reason));GI fistulas
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| S/S of metabolic alkalosis | nervousness, Dizziness, cardiac irritability, N/V, Paresthesias, Tetany or muscle cramps – late signs, S/S of dehydration
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| o Respiratory acidosis |
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| Etiology of respiratory acidosis | carbonic acid excess, Lungs retain CO2 – hypoventilation, loss of lung surface for ventilation, Weakness of respiratory muscles d/t Polio, Guillain-Barre, chest injuries, MD, Myasthenia Gravis; Mechanical ventilation – increased retention of CO2
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| Causes of hypoventilation | Damage to respiratory center in medulla, Head injury, Depression of respiratory center by drugs, Narcotics, Anesthetics, Barbiturates, Obstruction of respiratory passages, Pneumonia, Pulmonary edema, Aspiration of foreign object,Asthma
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| o Causes of Loss of lung surface for ventilation | Atelectasis, Pneumothorax, COPD
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| S/S of respiratory acidosis | Dyspnea, Hypoxia, restlessness, progressing to lethargy, Drowsiness, confusion, & coma, tachycardia, confusion, and coma,Dysrhythmias, Seizures, diaphoresis
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| Interventions for respiratory acidosis | Semi-Fowler’s to facilitate ventilation, suction prn, Artificial airway, Assess patency of airway, RR, breath sounds, HRR, encourage TCDB, IS, Encourage ambulation, bronchodialaters, Maintain a calm reassuring attitude
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| o Respiratory alkalosis |
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| Etiology for respiratory alkalosis | carbonic acid deficit, Lungs - eliminate CO2 – hyperventilation, Hyperventilation - Excessive blowing off of CO2 results in hypocapnia (decreased partial pressure of CO2 in blood),
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| Etiology for respiratory alkalosis continued | Overstimulation of respiratory center in the medulla results in hyperventilation.
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| Causes of hyperventilation | Pain, Fever, Brain tumors, meningitis, & encephalitis, Early salicylate poisoning, Excess assisted mechanical ventilation, Hyperthyroidism, Pregnancy (increased progesterone, increase respiratory center sensitivity to CO2)
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| S/S for respiratory alkalosis | hyperventilation, C/O light-headedness, Arrhythmias – tachycardia, anxiety, hysteria, Epigastric pain, nausea, tetany, seizures, Paresthesias in toes & fingers
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| Interventions for respiratory alkalosis | Identify & correct cause, monitor ABG’s, Monitor for hypokalemia & dysrhythmias, Treat pain or fever if present, Encourage patient to slow down breathing = ↑ CO2 retention, Encourage relaxation, Reduce environmental noise or stimuli, Anti-anxiety med
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| acidic pH | <7.35
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| alkalotic pH | >7.45
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| acidic PaCO2 | >45
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| alkalotic PaCO2 | <35
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| acidic HCO3 | <22
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| alkalotic HCO3 | >26
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| pH 7.25 PaCO2 51 HCO3 23 this is an example of... | noncompensating respiratory acidosis
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| pH 7.50 paCO2 31 HCO3 24 this is an example of... | noncompensating respiratory alkalosis
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| pH 7.50 paCO2 36 HCO3 28 this is an example of... | noncompensating metabolic alkalosis
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| pH 7.25 paCO2 36 HCO3 18 this is an example of... | noncompensating metabolic acidosis
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| pH 7.25 paCO2 50 HCO3 28 this is an example of... | partial compensating respiratory acidosis
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| pH 7.55 paCO2 32 HCO3 18 this is an example of... | partial compensating respiratory alkalosis
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| pH 7.25 paCO2 30 HCO3 18 this is an example of... | partial compensating metabolic acidosis
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| pH 7.55 paCO2 50 HCO3 30 this is an example of... | partial compensating metabolic acidosis
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| pH 7.35 paCO2 50 HCO3=28 | complete compensating respiratory acidosis
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| pH 7.43 paCO2 32 HCO3 20 this is an example of... | complete compensating repiratory alkalosis
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| pH 7.36 paCO2 31 HCO3 18 this is an example of... | complete compensating metabolic acidosis
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| pH 7.44 paCO2 48 HCO3 28 this is an example of... | complete compensating metabolic alkalosis
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