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Kidney Failure (Slides 1-19)

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cdunbar4's version from 2016-11-06 19:18

Functions of kidneys

Question Answer
Regulate _________ and __________ of ECFvolume; composition
Produces hormone that ↑'s RBC productionerythtropoetin
Activates which vitamin?Vitamin D
Helps regulate ______ ___________ via _______.Blood pressure; RAAS
Nephron is the functional unit of kidney, each kidney has how many?1 million nephrons
Glomerulus functionselective filtration
proximal tubule function (what does it reabsorb and excrete?)reabsorption of 80% of electrolytes & water; reabsorption of ALL C6 & A.A.; reabsoprtion of HCO3-; secretion of H+ & creatinine.
Loop of Henle function (reabsorbs what electrolytes/fluids and location of reabsorption)reabsorbs Na & Cl in ascending limb; reabsorbs water in descending loop; concentrates filtrate
Distal tubule excretes ___, ___, and _________. How does ADH play a role here?K, H & ammonia; ADH regulates reabsorption of water
Distal tubule regulates Ca+ and Phosphate via what hormone?PTH
Distal tubule regulates ___ and ____ by aldosteroneNa; K
Collecting duct functionreabsorption of water (ADH required for this function)
Components of Kidney in the cortexglomeruli, Bowman's capsule, proximal and distal tubules
Components in the MedullaLoop of Henle, collecting ducts
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Gerontologic Changes

Question Answer
Affects on size and filtration (%)20-30% smaller; 30-50% less filtration
↓ nephrons & renal blood vessels; thickened basement membrane of capsule & glomeruli do what to creatinine clearance; BUN & serum creatinine?Creatinine clearance ↓; BUN ↑; serum creatinine ↑
↓ function of Loop of Henle & tubules can cause what alterations in assessment findings?drug excretion is altered; nocturia; loss of normal diurnal excretory pattern d/t ↓ ability to concentrate urine; ↓ concentrated urine
↓ elasticity & muscle tone esp.in females due to less estrogen = more infx, irritations & incontinence
Male prostate enlargement hesitancy, retention, slow, infections, dribbling
↑ prevalence of unstable bladder contractionsstress or overactie bladder, dysuria
↓ bladder capacity and sensory receptorsstress incontinence (esp. during Valsalva maneuver)
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Assessment

Question Answer
past health history questions HTN, DM, gout, connective tissue disorders (lupus, scleroderma), skin or URIs of strep origin, TB, viral hepatitis, congenital disorders,neurologic disorders or trauma.
Medications (nephrotoxins)Antibiotics (bacitracin, cephalosporins, streptomycin); others (cocaine, captopril, cimetidine, NSAIDs, rifampin)
Surgeries or other txanything urologic or renal
Example of a health perception-health management question to ask:Have you ever smoked? If yes, how many ppd?
Ex of Nut'l-Metab ?How much and what kinds of fluids to you drink daily?
Ex of an Elimination ?Are you able to sit through a 2 hr meeting or ride in a care for 2 hrs w/o urinating?
Ex of Activity-Exercise ?Do certain activities aggravate your urinary problem?
Ex of Sleep-Rest ?Do you awaken at night from an urge to urinate?
Ex of a Cognitive-Perceptual ?Do you ever have pain when you urinate? If so, where is the pain?
Ex of Self-Perception-Self-Concept ?How does your urinary problem make you feel about yourself?
Ex of a Role-Relationship ?Does your urinary problem affect your relationships with family or friends?
Ex of a Sexuality-Reproductive ?Do you have hygiene problems r/t sexual activites that cause you concern?
Ex of a Coping-Stress Tolerance ?What strategies are you using to cope with your urinary problem?
Ex of a Values-Belief ?Has your present illness affected your belief system?
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Diagnostics (Urine and Blood TBL 45-8)

Question Answer
Urinalysisget a baseline (try to get first urinated morning specimen and examine within 1 hour of collection)
Creatinine Clearance waste product of protein breakdown (usually muscle); approximates GFR
creatinine clearance formulaurine creatinine x urine volume/serum creatinine
Nursing responsibility when getting sample for creatinine clearance void 1st urine, then collect all pee afterwards for 24hrs (may need to wash perianal area first so fecal matter doesn't get in)
Composite urine collectionmeasures specific components like: electrolytes, glucose, protein, minerals (discard first urine; sample can be refrigerated)
urine culture "clean catch midstream"confirms suspect UTI & ID's causative organisms: use sterile container, spread labia of women and clean urethra front to back; men retract foreskin
concentration testmeasures specific gravity (1.001-1.033)
residual urinedetermines amount of urine left in bladder after urinating 50mL or less (increases with age)
protein determinationdipstick-should be no albumin in urine
urine cytologyvoiding, catheterization or irrigation; ID's abnormal cellular structures that occur with bladder cancer & to follow the progress of bladder cancer (do NOT use first voiding)
BUN blood urea nitrogen used to ID presence of renal problems. Concentration of urea in blood is regulated by rate at which kidney excretes urea. Normal = 6-20mg/dL
What nonrenal factors can cause an increase in BUN?rapid cell destruction from infections, fever, GI bleeding, trauma, athletic activity & excessive muscle breakdown, corticosteroid therapy
Serum Creatinine normal range0.6-1.3 mg/dL *more reliable than BUN to determine renal function
BUN/creatinine ratio reference interval12:1 & 20:1
Uric Acidused as screening test primarily for disorders of purine metabolism, but can also indicate kidney disease.
Female and Male serum uric acid normalsF: 2.3-6.6 M: 4.4-7.6
Serum sodiummain extracellular electrolyte. Usually values stay w/in normal range until late stages of renal failure
Serum potassiumKidneys responsible for excreting majority of body's K. In renal disease, K levels are critical to determine d/t K being one of the 1st to be abnormal. ↑ levels = cardiac dysrhythmias & muscle weakness
Serum Calcium main mineral in bone and aids in muscle contraction, neurotransmission & clotting. In renal disease, ↓ reabsorption of Ca => renal osteodystrophy
Serum PhosphorusInversely r/t Ca. Renal disease, phosphorus levels are ↑ d/t kidney being the primary organ to excrete it
Serum BicarbonateMost pt.s in renal failure have metabolic acidosis and low serum HCO3- levels
EGFRestimated glomerular filtration rate = broad guess of GFR based on what is in your blood; NOT a definitive diagnosis
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UTI

Question Answer
complicated vs. uncomplicatedcomplicated = at risk for renal damage (coexisting obstruction, stone, calculi, DM, neurologic, or infx) and uncomplicated = otherwise normal urinary tract
Classification upper UTIfever, chills, flank pain (more systemic symptoms)
Classification lower UTInot usually systemic signs: cystitis, urethritis
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