NUR2228 > Week 5 - Prerequisite knowledge > Flashcards

Week 5 - Prerequisite knowledge Flashcards

(49 cards)

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1
Q

What are the functions of the kidneys?

A
  • Excretion (urea, creatinine, uric acid, bilirubin, drugs)
  • Fluid/BP control (RAAS)
  • Electrolyte and acid–base regulation
  • Hormone secretion (renin, EPO)
  • Vitamin D activation
  • Gluconeogenesis in starvation/acidosis

Understanding kidney functions helps predict labs/ABGs and link symptoms to physiology.

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2
Q

What is the primary function of the glomerulus in the nephron?

A

Filtration

The filtrate includes water, NaCl, K⁺, HCO₃⁻, glucose, and AAs; no RBCs or large proteins.

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3
Q

What is reabsorbed in the proximal tubule of the nephron?

A
  • ~65% NaCl & water
  • ~100% glucose/AAs
  • ~90% HCO₃⁻

The proximal tubule also secretes uric/organic acids, including many antibiotics.

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4
Q

What happens in the Loop of Henle?

A
  • Descending: water out
  • Ascending: ~25% NaCl out

This process concentrates urine.

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5
Q

What is the role of the distal tubule in the nephron?

A
  • Fine-tunes NaCl (~5%)
  • Secretes K⁺/H⁺

The distal tubule plays a crucial role in electrolyte balance.

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6
Q

What occurs in the collecting duct?

A

Final H₂O/urea handling; ADH & aldosterone act here

This is the last site for water reabsorption before urine is excreted.

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7
Q

Where do carbonic anhydrase inhibitors act in the nephron?

A

Proximal tubule

These diuretics affect bicarbonate reabsorption.

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8
Q

Where do loop diuretics primarily work?

A

Ascending loop

Loop diuretics inhibit NaCl reabsorption in this segment.

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9
Q

Where do thiazides act in the nephron?

A

Distal tubule

Thiazides are used to manage hypertension and fluid retention.

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10
Q

Where do K⁺-sparing diuretics like spironolactone work?

A

Late distal/collecting duct

These diuretics act as aldosterone antagonists.

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11
Q

What are the six core functions of the kidney?

A
  • Excretion
  • Fluid/BP control (RAAS)
  • Electrolyte balance
  • Acid–base regulation
  • Hormone secretion (renin/EPO)
  • Vitamin D activation
  • Gluconeogenesis (starvation/acidosis)

These functions are essential for maintaining homeostasis in the body.

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12
Q

What is the typical GFR in healthy adults?

A

~125 mL/min

Creatinine tracks GFR because it’s filtered and not reabsorbed/secreted.

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13
Q

Define filtration, reabsorption, secretion, and excretion.

A
  • Filtration: blood→nephron at glomerulus
  • Reabsorption: nephron→blood
  • Secretion: blood→nephron
  • Excretion: out as urine

These processes are crucial for kidney function and waste management.

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14
Q

What are the jobs of the nephron segments: PCT, Loop, DCT, and CD?

A
  • PCT: bulk reabsorption
  • Loop: desc H2O/asc NaCl
  • DCT: fine-tunes NaCl, secretes K+/H+
  • CD: final H2O/urea (ADH/aldosterone)

Each segment plays a specific role in urine formation and electrolyte balance.

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15
Q

Urinalysis: nitrites and leukocyte esterase indicate what?

A
  • Gram-negative bacteriuria (nitrites)
  • Inflammation/WBCs (LE) → supports UTI

These findings are common indicators of urinary tract infections.

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16
Q

What do high and low specific gravity patterns in urinalysis indicate?

A
  • High: dehydration
  • Low: dilute states or impaired concentrating ability

Specific gravity trends correlate with intake and output.

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17
Q

List the three host urinary defenses.

A
  • Complete emptying
  • Competent UV junction & antegrade peristalsis
  • Antibacterial urine (acidic pH, high urea, inhibitory glycoproteins)

These defenses help prevent urinary tract infections.

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18
Q

What are common disruptions of urinary defenses?

A
  • Obstruction/retention
  • VUR
  • Pregnancy
  • High intravesical pressures
  • Alkalinising organisms
  • Dehydration
  • Catheter presence

These factors can increase the risk of urinary tract infections.

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19
Q

Differentiate cystitis vs pyelonephritis pain.

A
  • Cystitis: suprapubic dysuria/frequency = lower tract
  • Pyelonephritis: unilateral flank pain + CVA tenderness ± fever/chills = upper tract

Understanding the pain location can help in diagnosing the condition.

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20
Q

What is the most common organism causing pyelonephritis?

Study These Flashcards
A

E. coli

Other organisms include Proteus, Enterobacter; Pseudomonas in CAUTI/complicated cases.

21
Q

What are the first-line investigations for pyelonephritis?

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A
  • MSU urinalysis + MCS
  • Consider renal ultrasound (obstruction) ± CT urogram if complicated

These investigations help confirm the diagnosis and assess for complications.

22
Q

What are the core management principles for pyelonephritis?

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A
  • Prompt antibiotics (culture-guided)
  • Hydration
  • Analgesia
  • IV (e.g., gentamicin) if septic/complicated
  • Review devices

Timely management is crucial to prevent complications.

23
Q

What are the hallmark urine findings in glomerulonephritis (GN)?

Study These Flashcards
A
  • Haematuria
  • Proteinuria (often with hypertension, oedema, oliguria)

These findings are indicative of kidney inflammation and damage.

24
Q

List common immune aetiologies of GN.

Study These Flashcards
A
  • Post-strep
  • SLE
  • Goodpasture’s
  • Granulomatosis with polyangiitis
  • PAN

These conditions can lead to glomerular inflammation and damage.

25
What are the **management principles** for GN?
* Treat cause (abx/antivirals/immunosuppression) * Control BP/oedema * Consider RRT for ESRF ## Footnote Management focuses on addressing the underlying cause and complications.
26
What are the **three categories** of AKI?
* Pre-renal (perfusion) * Intra-renal (parenchymal injury) * Post-renal (obstruction) ## Footnote Understanding the category helps guide treatment.
27
What are typical causes of **pre-renal AKI**?
* Dehydration/haemorrhage/diuresis * Sepsis/↓SVR * ↓CO (HF/MI/arrhythmia) * Renal artery/vein issues ## Footnote These causes are related to reduced blood flow to the kidneys.
28
What are typical causes of **intra-renal AKI**?
* ATN (ischaemic/nephrotoxic) * AIN (drug allergy) * Acute GN * Contrast injury * Toxins (ethylene glycol) * Sepsis ## Footnote These causes involve direct damage to kidney tissue.
29
What are typical causes of **post-renal AKI**?
* BPH/prostate Ca * Stones * Tumours * Neurogenic bladder * Pelvic/perineal trauma (bilateral or solitary kidney risk) ## Footnote These causes are related to obstruction of urine flow.
30
What is included in the **initial AKI workup** bundle?
* UEC/Cr/eGFR * FBC/CRP * Urinalysis + MCS * Renal ultrasound * Med review for nephrotoxins * Strict I&O + daily weights ## Footnote A thorough workup is essential for diagnosis and management.
31
What are **valid indications** for an IDC? (name 3)
* Acute retention relief * Pre/post-op decompression (pelvic/lower abdo) * Strict UO in critical illness * Urethral repair * Trauma ## Footnote These indications guide the use of indwelling catheters.
32
When is IDC **not appropriate**?
* Staff convenience * Routine urine collection in place of MSU ## Footnote IDC should be used judiciously to avoid complications.
33
What are the **top three prevention steps** for CAUTI?
* Maintain closed system (don’t disconnect) * Bag below bladder with no kinks * Aseptic insertion/access + sample via port ## Footnote These steps help reduce the risk of catheter-associated urinary tract infections.
34
How to collect urine for culture with a catheter?
* From sampling port only: disinfect, use sterile syringe * Avoid drainage bag for culture ## Footnote Proper technique is crucial for accurate culture results.
35
What are the **key indications** for SPC?
* Post bladder/prostate/urethral surgery * Urethral trauma * Chronic urinary management (e.g., BPH/prostate cancer, neurogenic bladder) ## Footnote SPC is used for specific clinical situations requiring urinary management.
36
What are common **complications** of SPC?
* Poor drainage (tip on wall/sediment/clots) * Site infection * UTIs * Bladder spasms ## Footnote Awareness of complications is important for monitoring and management.
37
What is essential **nursing care** for SPC?
* Daily sterile site clean/inspect * Secure to abdomen * Keep bag below bladder * Coil tubing * Position change if poor flow * Irrigate only with order ## Footnote Proper care helps prevent complications and ensures effective drainage.
38
What is the site and prime use of **thiazide diuretics**?
* Site: Distal tubule (Na+/Cl− cotransporter) * Prime use: hypertension and mild oedema ## Footnote Thiazides are commonly used for managing blood pressure.
39
What is the site and prime use of **loop diuretics**?
* Site: Thick ascending limb (NKCC2) * Prime use: acute pulmonary oedema, CHF oedema, CKD fluid overload ## Footnote Loop diuretics are effective in managing fluid overload.
40
What is the site and caution for **K+-sparing diuretics (spironolactone)**?
* Site: Late DCT/collecting duct (aldosterone antagonist) * Caution: watch for hyperkalaemia, endocrine AEs; avoid in significant renal failure ## Footnote Monitoring is essential to prevent complications.
41
What is the hallmark effect of **carbonic anhydrase inhibitors**?
* Proximal tubule HCO3− loss → metabolic acidosis ## Footnote These inhibitors have niche uses, such as in glaucoma and altitude sickness.
42
When should **osmotic diuretics (mannitol)** not be used?
* Decompensated CHF/pulmonary oedema (can worsen) * Active intracranial bleed (relative) ## Footnote Caution is necessary to avoid exacerbating conditions.
43
What is the diuretic of choice for **hypertension** vs **acute pulmonary oedema (APO)**?
* Hypertension: thiazide(-like) * APO: loop IV (plus venodilatory preload reduction) ## Footnote Different conditions require specific diuretic choices for optimal management.
44
What is a key caution for **gentamicin** in renal infection?
Aminoglycoside nephro/ototoxicity risk; dose by weight/renal function; monitor levels where protocolled ## Footnote Careful dosing and monitoring are essential to prevent toxicity.
45
What class is **oxybutynin** and what are its big AEs?
* Class: Anticholinergic antispasmodic * AEs: dry mouth/constipation/blurred vision/confusion—caution in frail/elderly ## Footnote Awareness of side effects is important for patient safety.
46
What must be documented for **hydration**?
* Hourly UO (if at risk) * Total I&O * Daily weight trends * Note fluid restrictions/orders ## Footnote Accurate documentation is essential for monitoring fluid status.
47
What are **sepsis red flags** in UTI/pyelonephritis?
* Hypotension * Rigors * Tachycardia * New confusion (older adults) * Lactic acidosis → activate sepsis pathway ## Footnote Recognizing these signs is critical for timely intervention.
48
What is the role of a **dietitian** in renal patients?
* Guide fluid/salt/potassium/protein targets (AKI/CKD) * Support malnutrition risk * Coordinate with medical plan ## Footnote Dietitians play a vital role in managing dietary needs for renal patients.
49
What is the role of a **pharmacist** in renal impairment?
* Renal dose adjustments * Nephrotoxin review * Interaction checks (e.g., NSAIDs + diuretics) * TDM where relevant ## Footnote Pharmacists are essential in ensuring safe medication management in renal patients.
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