Diuretics
-enhances urinary output used to decrease BP and edema
-decrease reabsorption of NaCl by kidney thus increasing amt of salt and water excreted in urine
-given to HF and HTN pts
*All diuretics increase the excretion of water from bodies
1. Thiazide Diureti
Thiazide Diuretics
act on "Distal convoluted tubule" to reduce Na and Cl reabsorption leading to excretion of electrolytes and water. 2nd choice after Lasix
1. Chlorothiazide (Diuril)-"water pill" causes hypokalemia, hyponatremia, and hypercalcemia.
Precautions-allergy to s
Loop Diuretics (high ceiling)
-act on "Ascending loop of Henle" to inhibit tubular reabsorption of Na and Cl.
-Most potent!
-may cause electrolyte depletion
1. furosemide (lasix)-1st choice. Patent, HTN, Orthostatic hypotension, need K suppl. possible code! cause hypokalemia, hypochlo
Potassium Sparing Diuretics
-acts on "Distal convoluted tubule"
-inhibit Na reabsorption and K secretion
-used with other diuretics due to its weak axn
2 Types:
Aldosterone-antaonists & Non-Aldosterone antagonists
1. spironolactone (Aldactone)-"aldosterone" antagonist. blocks aldost
Osmotic Diuretics
-act at "Proximal convoluted tubule" to increase plasma osmotic pressure, causing redistribution of fluid toward circulatory vessels
-increase excretion of water, Cl, Na and K
-Used for edema, decrease intra ocular pressure, decrease intracranial pressure
Carbonic Anhydrase Inhibitor Diuretics-
-promotes reabsorption of Na and bicarbonate and "Proximal tubule."
-promotes excretion of H20, Na, and K
1. Diamox (most common)-lowers intra ocular pressure. take in a.m. prev. nocturia
nsg. consid-monitor for sign of fluid overload-change in pulse, res
PCA pump assessment and care after renal surgery
5 mg/20 min. (drug fix! hehe)
Hypotension
-1st s/e of renal disorders or tx
1. elevate the legs with pillows below the feet or trendelenburg position
2. promote client's safety
3. monitor v/s
4. promote client's comfort
5. administer meds as ordered by MD
Therapeutic Communication
I think we all know this (I hope??!!)
Urine analysis
1. Cloudiness
2. Odor
3. Specific Gravity
4. pH
5. Blood and tissue cells
6. casts
7. crystals
8. protein
9. sugars
10. ketones
11. bilirubin
12. bacteria
cloudiness
turbid. contains red or WBC, bacteria, fat, mucus, digestive fluid (chyle), or pus from a bladder or kidney infection
odor
foul-smelling urine is a common symptom of UTI
specific gravity
can be affected by a range of diseases and disorders.
Low (below 1.005)-nephrogenic diabetes insipidus, acute tubular necrosis, and inflam of the upper urinary tract.
Fixed (remains at 1.010)-remains no matter how much fluid pt drinks. pts who have chroni
pH
greater than 7 (more alkaline)-may result from UTI or metabolic
below 7 (more acidic)-may be due to PKU, the secretion of homogentisic acid in the urine (alkaptonuria), and acidosis
Blood and tissue cells
-RBC in the urine can be due to vigorous or exposure to toxic chemicals.
-Bloody urine can be sign of bleeding in the GI tract as a result of systemic bleeding disorders, various kidney disease, bacterial infections.
-High WBC in urine usually a UTI infec
Casts
-sml fibrous obj that are formed when protein and other materials settle in the kidney tubules and collecting ducts.
-are dislodged by normal urine flow
-lg # of them in a urine specimen is a sign of kidney disease
Crystals
-sev diff. chemicals in body fluids can form crystals
-some in normal urine (calcium oxalate or uric acid crystals)
-lg # of calcium oxalate crystals may be a sign of abnormally high levels of calcium in the blood
Protein
-in urine can be a symptom of inflam of the kidneys, degenerative kidney disease, or multiple tumors
Sugars
high levels of glucose and other sugars in urine (glycosuria) often symptom of DM
Ketones
presence of abnormally high #'s in urine (ketonuria) usually results from uncontrolled DM
Bilirubin
-orange-yellow pigment found in bile (a fluid secreted by the liver)
-may be a symptom of liver disease caused by formation of fibrous tissue
Bacteria
in the urine may be a sign of severe infection, liver damage, or diseases that destroy RBCs
Where reabsorption of Sodium and Chloride ions occurs? Which part of the nephron?
Henle's Loop
Glomerulus
-Water and solutes (Na and other ions, nitrogen wastes, urea, uric acid, creatinine, glucose, and other nutirents) filter through the glomeruli into Bowman's capsule
-Filtration
Proximal convoluted tubule
-water and solutes
-Reabsorption
Distal convoluted and collecting tubules
-water, sodium, and other chloride ions
-Ammonia, K ions, urea, uric acid, creatinine, H ions, and some drugs
-Reabsorption/Secretion
Post void residual urine volume significance
less than 50 ml
otherwise can be sign of renal bladder problem
Glomerulonephritis
-cause: unknown; 3rd leading cause of renal failure
-grp of disease in which kidneys are damaged and partly destroyed by inflam of glomeruli
-RBC's and protein excreted in urine may be immune
-occurs more in kids and young adults
*most common disease of t
Post-streptococcal glomerulonephritis
may develop after a strep infection in your throat or, rarely on your skin (impetigo)
Bacterial endocarditis
bacteria can occasionally spread through bloodstream and lodge in heart causing an infection of one or more heart valves
Viral infections
may trigger glomerulonephritis-HIV (causes AIDS), Hep B, Hep C
Best diet for chronic kidney disease
-1-2 gm of low Na and K (soda, bananas, citrus)
-avoid salt subst (contain K)
-low Protein diet-can eat dairy products: eggs, meat. fish in sml portions only!
-high calories from CHO and fats frm polyunsaturate sources (to maintain weight and spare protei
appropriate tx for client with ESRD
-fluid restriction
-1-2 gm of low Na diet, low K diet, avoid salt subst contain K
-low protein diet
-Epogen or Procrit SQ to increase erythropoetin
Low/High Sodium Diet
processed and convenience foods, frozen meals and deli meats, such as salami, pastrami, corned beef, bacon and hot dogs. Condiments-soy sauce, mustard and prepared salad dressings are high in sodium. Canned foods,ready-to-serve foods and soups, pickles, c
Low/High Potassium Diet
Fruit: Apples, Berries, Fruit Cocktail, Grapes, Lemon,Peaches, Pineapple, Plums, Watermelon
Vegetables: Carrots, Cabbage, Cauliflower, Cucumber
Eggplant, Green beans, Lettuce, Onion, Summer squash, Sweet peppers
Dairy substitutes: Nondairy creamers, Rice
TURP
Transurethral Resection of the Prostate"
-approaching the gland through the penis and bladder using a resectoscope, a surgical instrument with an electric cutting wire for resection and cautery to resect the lobes away from the capsule.
1. Monitor v/s an
A nitrogenous waste product from the metabolism of protein (which made of amino acid)?
Urea
Midstream Urine Specimen
Clear Catch
Nsg Dx of excess fluid volume?
Hypervolemia
-Excess fluid volume r/t acute renal failure
-risk for impaired skin integrity r/t fluid retention and edema
-risk for impaired gas exchange r/t fluid volume excess, fatigue, and weakness
Expected Outcomes for Hypervolemia
-regain fluid balance as e/b weight loss, decreasing edema, and normal v/s
-experience decreased dyspnea
-maintain intact skin and mucous membranes
-increase activity levels as prescribed
Planning and implementation of Hypervolemia
-Daily Weigh at 0600-1800 daily (assess v/s and breath sounds Q4h
-Measure I & O Q 4h
-Obtain urine specific gravity Q8h
-Restrict fluids as follows:
350 ml from 0700-1500
300 ml from 1500-2300
100 ml from 2300-0700.
=750 ml
prefers water or apple juice
-
Kock pouch
-a continent pouch formed by the terminal ileum after colectomy (colon).
-pouch volume of 500-1000ml for feces/urine
-pt doesn't need to carry stoma bag
indicated for: pts who are unfit for ileal pouch anal anastomosis, pts develop severe incontinence or
Nephrostomy tube Post-Procedure Mngmt
-inspect tube secured no kinks
-administer analgesia
-bed rest for 4 h
-must be connected to a sterile closed drainage syst. and drainage bag below level of kidney always
-v.s monitored Q30min for 2 h, hourly for next 2h, then four hourly for 24 h
-I&O fo
Nalidixic acid (NegGram)
anti-bacterial
tx: UTI
Contraindications: don't take aluminum, calcium, sucralfate, iron, or zinc within 2-3 h of taking. EXTREME caution in children under 18 not recommended under 9 yrs old
s/e: drowsiness, dizziness, blurred vision, photosensitive, d/v,
Immediate Nursing Interventions wound dehisces
-pt no higher than 20degrees
-bend knees reduce abdm pressure
-sterile gauze or towels soaked in saline should be placed over the wound or any exposed bowel. don't push any viscera back into abdm. tissue color assessed and exposed bowel
-assess v/s and O2
Acute renal failure Phases
1. Oliguria-output less than 400 ml/24h, decreased Na, elevated BUN and Creatinine, extensive catabolism, tissue destruction.may last up to 6 wks. Hemodialysis used to reduce acidosis, correct uremia and lower the rapidly increasing blood potassium levels
spastic neurogenic bladder results of
-spinal cord injury, neural tube defects-spina bifida, brain tumors, or other diseases of the brain.
-may produce involuntary or frequent scanty urination without a feeling of bladder fullness and possibly spontaneous spasms of the arms and legs.
Acid-ash foods
pH below 7, cause urine to be acidic
-protect against calcium and magnesium stones, which only for in alkaline urine
-meat, whole grains, eggs, cheese, cranberries, prunes, and plums
Oxalic Acid stones-limit broccoli, asparagus, chocolate, tea, rhubarb, s
Alkaline-ash foods
ph above 7, cause urine to be alkaline
milk, vegetables, fruits (except cranberries, prunes, and plums
-prevents uric acid stones, which only form in acidic urine
-2/3 of kidney stones contain calcium
-If stones contain uric acid-purine rich foods restric
Bladder training
-strengthening and coordinating muscles of the bladder and urethra and may help control urination.
-determine bladder capacity-stretching the bladder (delaying urinating) Kegels/pubococcygeal exercises!
-drinking less fluid before sleep
-develop routines
What are indicative of the early stages of renal failure?
1. prerenal-include systemic causes, such as low blood volume, low BP, and HF
2. Intra-renal/Intrinsic-sources of damage to kidney itself are dubbed intrinsic. Common causes glomerulonephritis, and acute interstitial nephritis (AIN)
3. Post-renal-AKI is a
Nephrostomy procedure
-incision created btwn the kidney and the skin to drain urine directly from the renal pelvis
-performed when occlusion keeps urine from passing from the kidney, thru ureter, and into bladder without way for urine to drain and pressure rises within damagin
Pronounced itching
potential skin problem found in client with renal failure
Arteriovenous fistula
-abnormal connection or passageway between an artery and a vein
-may be congenital, surgically created for hemodialysis tx, or acquired due to pathologic process such as trauma or erosion of an arterial aneurysm
which finding indicates that peritoneal dialysis is achieving a therapeutic effect?
-provides only a fraction of plasma clearance that hemodialysis does can be done at home
-takes 36-48 h to achieve what HD accomplishes in 6-8 h if pt needs dialysis for more than 2-3 days HD is begun
nsg-I/O, v/s, wt, LOC, pain in left shoulder due to ir
client dehydrated, HTN, oliguria
IV NS and balance homeostasis of the client
Liquid diet
clear liquid diet-water, broth, clear juices such as apple or grape, popsicles and gelatin.
full liquid diet
allow all the liquids in a clear liquid diet plus thicker fluids such as milk, pudding and vegetable juices.
soft diet
cooked fruits and vegetables, bananas, soft eggs and tender meats.
A mechanical soft diet-allows most foods as long as they can be chopped, ground, mashed or pureed to a soft texture.
regular diet
uhhhh a regular diet! Calorie needs are based on age, gender, size and health goals.
what is the main cause of polycystic kidneys?
PKD" genetic disorder characterized by the growth of numerous fluid-filled cysts, which can slowly replace much of the kidney.
-longstanding renal insufficiency
-dialysis pt
Kidney fx compromised by pressure of cysts on renal structures, secondary infect
Test
Acid Ash Diet-meat
Na restriction-chees
Lasix-give K
prevent hyperkalemia-potatoes tomoatoes OJ
Not Liquid diet-milk
Paxil-serotonin syndrome
all oligura v/s-start IV fluid of normal NS sol bolus followed by maint. dose
surgery-elevate leges with pillows