Renal!!!

Nursing 356 with Fenske at University of Michigan - Ann Arbor

About this deck

By: Petrina Stamatopoulos
Textbook:

Saunders Comprehensive Review for the NCLEX-RN� Examination (Saunders Comprehensive Review for Nclex-Rn)
Created: 2010-11-30
Size: 30 flashcards
Views: 40

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Determination of serum creatinine level

Test that measures the amount of creatinine in the serum. Creatinine is an end product of protein and muscle metabolism.

Function and analysis of creatinine

Levels reflect glomerular filtration rate.

Renal dz is the only pathological condition that increases the serum creatinine level.

Serum creatinine level increases only when at least 50% of renal func. is lost.

Normal lab values- 0.6-1.3mg/dL

Determination of BUN Level

BUN is a byproduct of protein metabolism in the liver.

BUN levels indicate the extent of renal clearance of urea nitrogenous waste products.

An elevation does not alway mean that renal disease is present.

When BUN and Creatinine levels inc at the same rate + ration and remains constant, then renal dysfunction is the cause.

Normal BUN values- 8 to 25mg/dL

Urinalysis

A urine test for evaluation of renal system and for determining renal disease

Nurses must- wash perineal area and use a clean container for collection, obtain 10-15mL of first morning voiding

Menstruating is fine- just put a note on bag.

Specific gravity determination

Can be measured by a multiple test dipstick methods( refractor)

Cold specimens- false reading

Normal value- 1.016-1.022

Inc specific gravity- occurs w/ insufficient fluid intake, dec renal perfusion, or inc. ADH

Urine culture sensitivity testing

A urine test that identifies the presence of microorganisms and determines the specific antibiotics to treat to treat those critters.

Nurses must- clean the perineal area and urinary meatus with a bacteriostatic solution.

Collect midstream sample in a sterile container- sample must be sent immediately.

Identify any sources of potential contamination- hands, hair, clothing, vaginal or rectal secretions.

Urine to dilute- too much drinking H20- too dilute to produce a + culture

Cystocopy and biospy

The bladder mucosa is a examined for inflammation, calculi, or tumors by means of cystoscope, a sample for biopsy may be contained.

Nurses must- obtain informed consent, if biopsy is planned- w/hold food and fluids after midnight at the night before the test.

If a cystoscopy alone is planned, no special preparation is necessary and the procedure may be performed in the physician's office. Pt may have inc. fluid intake

Post Op interventions for Cystocopy

Nurses must-

Monitor VS, inc fluid intake, Monitor I/Os, encourage deep-breathing to relieve bladder spasms, administer analgesics as prescribed, sitz or tub baths for back+ abdominal pain, Leg cramps are common bc of litotomy position in procedure, assess urine/color, burning pink=tinged or tea colored urine, and frequency are common. BRIGHT RED URINE OR CLOTS- notify physician.

Renal Biopsy

Insertion of a needle into the kidney to obtain a sample of tissue for examination usually done percutaneously.

Asses VS, Baseline coagulation studies, informed consent, w/hold foods/fluids after midnight.

During- position in prone w/ pillow under abdomen

Post- VS-hypotension, tachy=bleeding, HcT, HgB, encourage fluid intake, urine for bleeding, no heavy lifting and strenuous activity for 2 wks.

Acute Renal Failure- definition

is the rapid loss of kidney func. from renal cell damage.

ARF- FACTs

Occurs abruptly, and can be reversible, S +S causes by the retention and wastes, the retention of liquids and inability of the kidneys to regulate E+.

ARF can lead to hypoperfusion, cell death, and decompensations of renal function. Prognosis depends on the causes and condition of pt. Near normal- normal returns gradually

ARF Causes

Prerenal- outside the kidney caused by intravascular volume depletion, dehydration, dec. cardiac output, dec. peripheral vascular resistance, dec renovascualar blood flow, and prerenal infection or obstruction.

Intrarenal intrarenal: W/in the parenchyma of the kidney, caused by tubular necrosis, prolonged prerenal ischemia, infection or obstruction, and nephrotoxicity,

Postrenal- b/w kidney and urethral meatus bladder neck obstruction, bladder cancer, calculi,+ infection

Phases of ARF

1. Onset- precipitating event

2. Oliguric phase- Duration- 8-15 days the longer the duration the less chance of recovery

3. Diuretic phase- Urine output rises slowly

4. Recovery phase(convalescent)

Oliguric phase

Sudden dec in Output less then 400mL a day

signs of excessive fluid- HTN, edema, pleural and pericardial effusions, dysrhythmias CHF, pulmonary edema.

Signs of uremia- Anorexia, nausea, vomiting, and prutitis.

Signs of neurological changes- tingling of extremities, drowsiness progressing to disorientation, then coma.

Metabolic acidosis- Kussmaul respirations-

Pericardition- friction rub, chest pain on inspiration, low grade fever

Lab analysis

restrict fluid intake-400mL- 1000mL

Lasix

Diuretic Phase

Use of diuresis- 4L- 5L a day

Excessive urine output indicates that damaged nephrons are recovering their ability to excrete wastes but not to concentrate urine,

Dehydration- hypovolemia, hypotension, + tachy occur.

Level of consciousness improves

Lab analysis

administer IV fludis as prscribed, which may contain E= to replace losses.

Recovery phase

Slow process- 1 to 2 yrs

Urine volume returns to normal

Memory improves

strength increases

the older adult is less likely than a younger adult to regain full function

Acute can progress to chronic

Nursing interventions for ARF

Monitor VS, HTN, tachycardiam tachypnea, and irregular heart rate

I/Os hourly- urine color, character

monitor wt- same time, same scale q. day- noting inc 1/2 to 1lb a day- indicates fluid retention

monitor for changes in BUN, serum creatinine, and serum E+ levels

Monitor for acidosis- Tx with sodium bicarbonate

monitor for urinalysis for protein level, hematuria, + specific gravity

Uremia- dec in consciousness

Infections- inc WBC or fever may not be present

Lungs- wheezes + rhonchi and monitor for ede

Nursing interventions cont. for ARF

Uremia- dec in consciousness

Infections- inc WBC or fever may not be present

Lungs- wheezes + rhonchi and monitor for edema- fluid overload

diet- moderate protein- to dec workload on the kidneys, and high carbs

restrict K+ and Na+ intake

medications prescribed- mechanism for metabolism and excretion of all prescribed medication

Be alert to nephrotoxic medication.

dosage- renal failure

Prepare client for dialysis

emotional support

Lab values inc in ARF phases

Oliguric phase: hyperkalemia, hypocalcemia, hyperphosphatemia, dec urine specific gravity, dec glomerular filtration rate. elevated BUN + creatinine

Diuretic phase: gradual decline in BUN and creatinine- still elevated, low creatinine clearance, hypokalemia, hyponatremia, hypovolemia

Recovery phase: inc. glomerular filtration rate, stabilized BUN/Creatinine,

Chronic Renal failure-definition

Is a slow, progressive, irreversible loss in kidney function. It occurs in stages and resultsin uremia or endstage renal dz.

Facts about CRF

Affects all major body systems and requires dialysis or kidney transplantation to maintain life.

Hypervolemia can occure bc of the kidneys' inability to excrete Na+ + H2O, hypovolemia can ocure bc of kidneys' inability to conserve Na+ + H2O

Primary causes of CRF

1. Diabetes

2. May follow ARF

3. HTN

4. Chronic urinary obstruction

5. Recurrent infections

6. Renal artery occlusion

7. Autoimmune disorders

Nursing Assessment

Assess all body systems

Assess psychological changes, which could include emotional lability, withdrawal, depression, anxiety, suicidal behavior, denial, dependence-independence conflict, and changes in body images.

Things to watch for w/ pt CRF + nursing diagnosis

Activity intolerance and insomnia- fatigue results from anemia buildup of wastes from the diseased kidneys. Provide adequate rest periods.

Anemia- decreased secretion of erythropoietin + dec production of RBC, Dec HcT + HgBs-

GI bleeding- urea is broken down by the intestinal bacteria to ammonia, ammonia irritates teh GI mucosa, causing ulceration + bleeding.

Hyperkalemia- HTN + hypotension, and apical HR, irregular- kidneys can't break up potassium

Anemia w/ CRF interventions

Administer epoetin alfa or darbepotin alfa, hematopoietics- to stimulate RBC production

Folic acid B12

Fe orally daily- w/ phosphate binders

Administer stool softners- bc of constipation affects of iron

Blood transfusion

GI bleed w/ CRF interventions

Monitor HgBs + HcTs

monitor stools for occult blood

instruct pt to use a soft tooth brush

Do not take acetylsalicylic acid(asiprin) bc it is excreted by kidneys- aspirin toxicity can prolong bleeding time

Hyperkalemia W CRF interventions

Monitor K+ levels anything about 6.0

can cause tall peaked T waves, flat P waves, a widened QRS complex, and prolonged PR interval, dec Cardiac output, heart blocks.

Place pt in continuos cardiac monitor- dysrhythmias

low potassium diet

administer polystyrene sulfonate= to lower potassium

Loop diuretics no potassium sparing diuretics

Hypermagnesemia w/ CRF interventions

Results from dec. renal excretion of MAG

Monitor cardiac status- bradycardia, peripheral vasodilation, hypotension

Monitor CNS- dec nerve impulse transmission,- drowniess, lethargy

Monitor neuromuscular- reduced or absent deep tendon reflexes or weka or absent voluntary skeletal muscle contractions

Loop diurectics

Give Ca+ for cardiac

no meds w/ MAG- antacids, laxitives, or enemas

severe elevations- avoid foods- that inc mag levels

Hyperphosphatemia w/ CRF interventions

In CRF kidneys cannot excrete phosphorus- too big

As the phosphorus level rises, the calcium level drops, this lead to the stimulation of parathyroid hormone, causing bone demineralization.

Tx is aimed at lowering Phs. levels

Administer phosphate binders- calcium carbonate(TUMS)., calcium acetate(PhosLo), or Renagel w/ meals to lower PHS levels.

Administer stool softners bc meds cause constipation

Limit foods high in PHS

Hypervolemia

HTN- monitor

I/Os + daily wt. for fluid retention

Monitor for periorbital, sacral, + perpheral edema, monitor serum electrolyte levels

monitor for HTN

S/SES: CHF, pulmonary edema- restlessness, heightened anxiety, tachy, dyspnea, basilar lunch crackles,blood tingued sputum- notify physician

Diuretics- furosemide

Low sodium diet

no antacids or cold remedies contain sodium bicarbonate

About this deck

By: Petrina Stamatopoulos
Textbook:

Saunders Comprehensive Review for the NCLEX-RN� Examination (Saunders Comprehensive Review for Nclex-Rn)
Created: 2010-11-30
Size: 30 flashcards
Views: 40

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis