1
Q
What is Hydronephrosis
A
swelling of a kidney due to a buildup of urine
2
Q
Hydronephrosis Causes
A
Obstruction in Urinary Tract
Can be secondary to prostate enlargement
3
Q
Signs and symptoms of Hydronephrosis
A
- Frequency
- Urgency
- Dysuria
- Flank and Back pain
- Renal failure
4
Q
Interventions for Hydronephrosis
A
- Treat cause
- Urinary catheter
- Stents (runs from kidney pelvis to bladder)
- Nephrostomy Tube
- intake and output
- no clamping
5
Q
What is Polycystic kidney disease
A
- multiple cysts in the kidney
- inherited disease
6
Q
Signs and symptoms of Polycystic kidney disease
A
- Dull Heaviness in Flank/Back
- Hematuria
- Hypertension
- UTI (prone)
- Kidney would become enlarged (palpation possible)
7
Q
Interventions for Polycystic kidney disease
A
- Progressive
- No treatment
8
Q
What is Glomerulonephritis
A
- acute inflammation of the kidney, typically caused by an immune response
- causes glomerulus to become more porous
- tends to be a post-strep infection
- can be caused by drugs or toxins
9
Q
Signs and symptoms of Glomerulonephritis
A
- Oliguria
- Hypertension
- Electrolyte Imbalances
- Edema
- Electrical imbalances
- Flank Pain
- Proteins, WBCs, RBC’s in urine
10
Q
Dx for Glomerulonephritis
A
- urinalysis
- ultrasound
- x-ray
- biopsy
11
Q
Interventions for Glomerulonephritis
A
- Interventions
- managing hypertension
- quick treatment for strep
- Renal Failure Treatment
- renal dialysis
- fluid, sodium, protein restrictions
- Monitor Vital signs
- Symptom support
- rest
- education
12
Q
Acute Renal Failure
A
-Sudden loss of kidney function
13
Q
Acute renal failure causes
A
types
- prerenal failure
- intrarenal failure
- nephrotoxins
- postrenal failure
14
Q
Cause of prerenal failure
A
- Decreased blood supply to kidneys
- blood loss
- heart failure
- blockage
15
Q
Cause of intrarenal failure
A
- damage to nephrons
- nephrotoxins
- diagnostic contrast media (dyes)
- medications (IV Aminoglycosides, Tobramycin, Amikacin, Cisplatin), Chemicals
- damaging immune response
- nephrotoxins
16
Q
Causes for postrenal failure
A
-Obstruction (below kidney) causing backflow
17
Q
Dx of acute renal failure
A
- History
- Prevention
- check serum BUN and creatinine prior to dyes or meds
- Hydrate before/after contrast media
- Monitor peak/trough levels of nephrotoxic drugs per policy
18
Q
Oliguric phase of acute renal failure
A
- low output
- Monitor labs
- Restrict fluid, Na & poss. Protein
- 24hrs-week
- Fluid, electrolytes imbalance
19
Q
Diuretic phase of acute renal failure
A
- high output
- Fluid electrolytes balance out of wack
- dehydration – on high IV fluids
20
Q
Recovery phase of acute renal failure
A
-takes up to 1 year
21
Q
interventions for acute renal failure
A
- treat cause
- supportive treatment (fluid electrolytes, HbG, Hct,etc)
- dialysis
- continuous renal replacement
22
Q
Chronic Renal Failure
A
- Gradual decrease in kidney fx
- irreversible
23
Q
Causes of chronic renal failure
A
- Diabetes
- Hypertension
- Chronic exposure to toxins
- Hyperlipidemia
- Diabetic Nephropathy
- Nephrosclerosis
- Glomerulonephritis
- Autoimmune Diseases
24
Q
S/S of chronic renal failure
A
- Large Proportion of Nephrons Damaged
- Progressive
- Renal Insufficiency: 75% of Nephrons Lost
- End-stage: 90% of Nephrons Lost
- Uremia: Urea in the Blood
- Affects All Body Systems
25
Interventions for chronic renal failure
```
Treat causation
-Hypertension
-Diabetes
-Cholesterol
Fluid Restriction
Treat anemia (w/erythropoietin)
Treat Ca+/hyperparathyroidism
Treat metabolic acidosis
Diet
Medications
Dialysis
```
26
Diet interventions for chronic renal failure
- High Calorie
- Low Protein (Unless Dialysis)
- b/c of the byproducts that kidneys must filter
- [controversial b/c lack of ability to repair tissue]
- Low Sodium, Potassium, Phosphorus
- Increased Calcium
- Vitamins
27
Medication interventions for chronic renal failure
- Diuretics
- Antihypertensives
- Phosphate Binders
- Calcium/Vitamin D Supplements
- Kayexalate prn
28
Dialysis intervention for chronic renal failure - occurs with specific symptoms
- Symptoms of Fluid Overload
- High Potassium
- Neurological Signs
- Uremia
29
Vascular access care for acute renal failure
- listen for thrill, bruit over access site
- don’t take BP on arm with access
- instruct pt to be careful with arm with access
- keep watch for infection
- take radial pulse, size, T etc of each arm to monitor for circulatory compromise
- postop - NV checks, pain, elevate extremity
30
Dialysis done by pt
- Peritoneal Membrane Is Semipermeable Membrane, Across which Excess Wastes/ Fluids Move from Blood
- Peritoneal Catheter
- Exchange Process: Fill, Dwell Time, Drain
- Takes about 8 hrs
- must have frequent labs to determine solution concentrations
31
Kidney transplant interventions
- Living-Related Donor or Cadaver Donor
- Antirejection Drugs
- Donate kidney typically lasts ~10 yrs
32
Nursing care for excess fluid volume
- Monitor Weight
- Intake and Output
- Fluid Restriction
- Monitor for Fluid Retention
33
Nursing care for electrolyte imbalance
- Monitor Levels
- Dietary Restrictions
- Monitor Dysrhythmias
34
Nursing care for waste products
- Oral Care
- Skin Care
- Lotion
- Protect from Injury
35
Nursing care for impaired hematological fx
-Protect from Injury/Infection
36
Cancer of the Kidney
- Rare
- Exact cause unknown
- Risk Factors
- Smoking – lifetime risk
- Obesity
- Hypertension
- Exposure to asbestos, lead, cadmium and phosphates
37
S/S of cancer of the Kidney
- Palpable abdominal mass found during routine exam.
- Hematuria
- dull pain in flank area
- mass
38
Dx for cancer of the kidney
- IVP (intravenous pyelogram- x-ray examination of the kidneys)
- Cystoscopy and Pyelogram
- Ultrasound
- CT Scan
- MRI
- Renal Biopsy
39
Cancer of the Bladder
```
Most Common Urinary Tract Cancer
Men > Women
Ages 50-60 Years
Etiology
Smoking
Industrial Pollution – aniline dyes, asbestos, and aromatic amines
```
40
S/S of cancer of the bladder
```
Early
-Painless
-Hematuria
Late
-Pelvic pain
-lower back pain
-dysuria, frequency, urgency
-inability to void
```
41
Dx for bladder cancer
- Urinalysis
- Urine for Cytology, Culture
- Cystoscopy and Transurethral Biopsy
- IVP (Intravenous pyelogram)
42
Urological obstructions
Obstruction of Urine Flow Is Always Significant
Backup of Urine Destroys Kidney
-urethral strictures (lumen narrowing due to scar tissue)
-renal calculi
-hard, generally stones
-kidney stones (nephrolithiasis) - formed primarily in kidney
43
Types of kidney stones
- Calcium – found in 90% of stones
- Uric acid
- Oxalate
- Struvite
- Cystine
- Xanthine
44
Causes of kidney Calculi (stones)
- Heredity
- Chronic Dehydration
- Infection
- Immobility
- Men >Women
45
S/S of Renal Calculi (stones)
- Flank Pain
- Renal Colic
- Dysuria
- Costovertebral Tenderness
- Hematuria
- Frequency
- Urgency
- Enuresis
- GI Upset
46
Dx of Renal Calculi
- Kidney-Ureter-Bladder X-ray
- IVP - intravenous pyelogram
- renal ultrasound
- urinalysis (RBC, WBC)
47
Complications of Renal calculi
- UTIs
- Hydronephrosis
- Pain, spasm, or colic from peristalsis movement of ureter contracting on the stone
- tissue trauma
48
Tx for renal calculi
-Using pain medicine: Nonprescription medicine, such as NSAIDs, Narcotics
-Drinking enough fluids: drinking water and other fluids may help passing a calculi.
-Lithotripsy
-Surgery
-(Uric Acid)
Allopurinol
49
Urinary Incontinence/ Urinary retention Types
Stress Incontinence
-Involuntary Urine Loss from Increasing Abdominal Pressure
Urge Incontinence
-Involuntary Urine Loss with Abrupt/Strong Desire to Void
Overflow Incontinence
-Incontinence for distension of bladder
-Commonly assoc. with obstruction of outlet or BPH (benign
prostate hypertrophy)
Functional Incontinence
-Incontinence from Impairment of Physical/Mental Function
Total Incontinence
-Continuous, Unpredictable Loss of Urine
50
Urinary Retention
Acute
-Anesthesia, Medications, Local Trauma to Urinary Structures
Chronic
-Enlarged Prostate, Medications, Strictures, Tumors
51
Urinary retention Dx
-Monitor Urine Output, Bladder distention
-Bladder Scan
-Residual Volume of more than100 ml Urine
-Indicates Need for Treatment
Nursing diagnosis – Risk for impaired tissue/tissue damage
Indwelling Catheters
Urinary Catheters Result in Infection
52
Types of Urinary Catheters
```
Intermittent Catheterization
-Best
-Reduces Risk of Infection
-Patients May Self-cath
Suprapubic Catheter
-Indwelling Catheter Inserted Through Incision in Lower
Abdomen into Bladder
```
53
Nursing Dx for Urinary Incontinence
Risk for
- Stress incontinence
- Urgency incontinence
- Total incontinence
- Functional incontinence
- Overflow incontinence
- Skin impairment
- Self-care deficit r/t toileting
- Situational low self esteem
- Social anxiety
- Disturbed body image
54
Justifiable reasons for catheterization
- Close monitoring of output
- Urinary Tract Obstruction
- Neurogenic Bladder
- Treatment Related Immobility
