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Renal

Nykenya Corbin Renal/Urinary Final Englisch 47 Karten

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  1. 1UTI (causes)Some causes include not changing wet diapers or not wiping properly, holding in urine, frequent constipation or diarrhea, having some kind of urine blockage
  2. 2Managing a UTI• Give your child the prescribed medication for the full number of days your physician or nurse practitioner recommends. Some children need to continue on a lower dose of the antibiotic after the initial treatment is finished.
    • Take a follow-up urine culture to the laboratory if your physician or nurse practitioner has requested one. Use a sterile container to collect the urine. If the laboratory has not given you a sterile plastic container, you can use a glass container and a cover that have been sterilized. Make sure the urine stays refrigerated or in a cooler while you take it to the laboratory.
    • Keep the appointment for follow-up studies of your child's urinary system, if ordered by the physician or nurse practitioner. These studies can help diagnose a structural problem with your child's urinary system or monitor the kidneys for any problems.
    • Call your physician or nurse practitioner if your child has a fever or symptoms that make you think the infection has returned.
  3. 3UTI Prevention• Wipe babies and teach young girls to wipe from front to back after going to the bathroom. This takes any germs away from the opening that leads into the urinary system. Be sure to keep the foreskin on uncircumcised baby boys as clean as possible without forcible retraction.
    • Encourage your toilet-trained child to avoid "holding" urine and to urinate at least four times per day, emptying the bladder completely.
    • Give your child lots of fluids throughout the day to help flush out the bladder.
    • Avoid dressing your child in tight clothing or diapers. Use cotton underwear rather than synthetic fabric.
    • Avoid bubble baths, which can irritate your child's urinary system.
    • Emphasize proper hygiene if your daughter is sexually active and encourage her to urinate immediately after having sexual intercourse.
  4. 4Nursing Interventions ofor UTI- Adherence to drug therapies (take all antibiotics)
    - Fluid intake/adequate hydration
    - Prevention of future UTIs
    - Recognition of risk factors/complications - Prevention of recurrent UTIs
    - Patient Teaching
  5. 5UTI Treatment• 3-5 days of an oral antibiotic, Usually Bactrim (CHECK FOR SULFA ALLERGIES)
  6. 6S/SX of Upper UTIFever, Chills, Nausea, vomiting, Malaise, and flank pain
  7. 7S/SX of Lower UTIHesitancy or difficulty initiating urine stream, Low back pain, Nocturia, Incontinence, Hematuria, Pyuria,
    Bacteriuria, Retention, Suprapubic tenderness or fullness, Feeling of incomplete bladder emptying
  8. 8S/SX of UTI in Pediatric Pt- Infants may develop a Fever or hypothermia in neonate, Irritability, Dysuria as evidenced by crying when voiding, Change in urine odor or color, Poor weight gain, Feeding difficulties
    -Older kids may have Abdominal or suprapubic pain, Voiding frequency, Voiding urgency, Dysuria, New or increased incidence of enuresis, Fever
    - General symptoms : foul smelling urine, cloudy urine, hematuria, cramping in groin or lower abdomen
  9. 9Pyelonephritis (PEdiatric)- This is a UTI that invades the kidneys
    - Children are generally toxic in appearance and have more systemic symptoms
    - S/S: back pain, fever, costovertebral angle tenderness, nausea/vomiting, plus lower UTI symptoms
    - Treatments: IM injection of ceftriaxone PLUS 10-14 days of an oral antibiotic, usually cephalosporin. 2-4 days of ceftriaxone and fluids for the ill appearing child or infant
  10. 10Aging of the Urinary System- loss of elasticity and muscle support
    -Prostate enlargement
  11. 11Complicated UTI- Complicated UTIs are associated with conditions that increase the risk for treatment failure (remember if the antibiotics do not work the first time or other issues make it complicated such as pregnancy, obstruction, kidney stones, diabetes, neurogenic bladder, renal insufficiency, and immunosuppression.
    - Pt is at risk for pyelonephritis, urosepsis, and renal damage.
  12. 12Uncomplicated UTI- Occurs in otherwise normal urinary tract
    Usually involves only the bladder
    - is usually cystitis or pyelonephritis in premenopausal, non pregnant, otherwise healthy women. There is no anomaly or functional abnormality of the urinary tract
  13. 13Who's most at risk for a UTI?People who are immunocompromised such as diabetics, people on diabetic medications such as Jardiance that release sugar into the urine, obstructions, issues with constipation, Older people who are more likely to be dehydrated and have periods of incontinence are more likely to acquire UTIs. Women are more likely to develop UTIs because they have a shorter urethra from a man
  14. 14Cystitis-This is an inflammation of the bladder
    -causes without infection include: Irritants such as drugs, chemicals, feminine hygiene sprays, spermicidal jellies, or long-term use of catheters
    -Usually a complication of gynecologic cancers, pelvic inflammatory disorders, endometriosis, Crohn's disease, diverticulitis, lupus, or tuberculosis
  15. 15Drugs of choice for Uncomplicated UTI- trimethoprim/sulfamethoxazole (TMP/SMX) (Bactrim, Septra), nitrofurantoin (Macrodantin), cephalexin, and fosfomycin (Monurol).
    - TMP/SMX has the advantages of being inexpensive and taken twice daily
    - Nitrofurantoin is taken 3 or 4 times daily, but a twice-daily formulation is available. Long-acting preparation (Macrobid) is taken twice daily
  16. 16Pyelonephritis- Infection and inflammation of the kidney pelvis, calyces, and medulla.
    - Diagnostic: CT scans are the preferred imaging studies. They can assess for signs of infection in the kidney and complications of pyelonephritis, such as impaired renal function, scarring, chronic pyelonephritis, or abscesses
    - Gallium scan can use injectable dye to visualize organs, glands, bones, and blood vessels that have infection and inflammation
    IVP can demonstrate calculi, structural, and or vascular abnormalities
  17. 17Interventions for Pyelonephritis- can be treated at home for 14 days with the following antibiotics: trimethorpin, sulfamethaxazole, or ciprofloaxin or levofloxacin
    - Severe pyelonephrtitis treated in the hospital with 24 to 48 hours with IV medication Ciprofloszcin, Cephalosporin antibiotic ceftriaxone, ceftazidime, ampicillin, or gentamicin and tobramycin.
    - Remember some of these drugs such as gentamicin are nephrotoxic and levels must be assessed, such as peak and trough.
  18. 18Fluoroquinolones(eg., levofloxacin, ciprofloxacin)_________________ are given to treat complicated UTIs. Complicated UTIs require Long-term treatment (7 to 14 days or more)
    - Causes sun sensitivity
  19. 19Fluconazole (Diflucan)In patients with UTIs from fungi, ________________ is the preferred therapy
  20. 20Obstructive Uropathy-anatomic or functional condition that blocks or impedes the flow of urine
    - Damage occurs above level of obstruction
    - May affect only one kidney and the other kidney may compensate
    - When bladder outlet obstruction is present, pressure increases during bladder filling or storage. This pressure can be transmitted to the ureters. Pressure can lead to reflux (backflow, or backward movement, of urine), hydroureter (ureteral dilation and distention), vesicoureteral reflux (backflow of urine from the lower to upper urinary tract), and hydronephrosis (dilation or enlargement of the renal pelvises and calyces)
  21. 21Nephrolithiasis (Kidney Stones)•Crystals, when in a supersaturated concentration, can precipitate and unite to form a stone.
    - Keeping urine dilute and free flowing reduces the risk of recurrent stone formation in many individuals
    -What factors can cause a stone?: •Urinary pH (alkaline)
    •Solute load
    •Inhibitors in urine
    •Other factors:
    •Obstruction with urinary stasis
    •UTI
    Genetic
  22. 22Kidney Stones cont.•The first symptom of a kidney stone is usually severe pain in the flank area, back, or lower abdomen that begins suddenly.
    •Renal colic is the term used for the sharp, severe pain, which results from the stretching, dilation, and spasm of the ureter in response to the obstructing stone.
  23. 23Phenazopyridine (Pyridium)A urinary analgesic, such as oral __________________________________, may relieve discomfort caused by severe dysuria. ____________________________ is an azo dye excreted in urine. There it exerts a topical analgesic effect on the urinary tract mucosa. It is taken up to 2 concurrent days. Teach patients that this drug causes the urine to turn orange or red.
  24. 24Pyelolithotomyremoval of large stone form the kidney that causes infections and blocks the flow of urine from the kidney—remember these people were at risk for developing the disorder to begin with
  25. 25NephrectomyThe removal of the kidney when all procedures to clear the client of infection were unsuccessful.. This would be a last resort.
  26. 26UrethroplastyDone to repair or revise the ureter and can involve reimplantation of the ureter in the bladder wall to preserve the function of the kidney and eliminate infection
  27. 27Septic shockDone to repair or revise the ureter and can involve reimplantation of the ureter in the bladder wall to preserve the function of the kidney and eliminate infection
  28. 28Chronic Kidney Disease (CKD)(Elevated Creatinine, BUN, alterations in electrolytes) from the inflammation and infection that causes fibrosis of the kidneys, scarring and changes in the blood vessels and the glomerular and tubular filtration system
  29. 29HypertensionRelated to fluid and sodium retention, indicating chronic kidney disease caused by destruction of the filtration system of the kidney due to infection
  30. 30Urethritis- inflammation of the urethra
    -Treatments: antimicrobials, sitz baths
    - Males—sexually transmitted; see: discharge, dysuria, urgency, and frequency
    -Females—diagnosis difficult; see LUTS
    - Patient teaching: avoid vaginal sprays, perineal hygiene, no sex for 7 days, and contact partners
  31. 31Polycystic Kidney Disease (PKD)- This is a genetic disorder there are two types of Polycystic kidney disease (PKD), Autosomal or Recessive. The most common is Dominant ADPKD-1, which is what we see the most common and most severe. ADPKD-2 has a slower rate of cyst formation, so symptoms occur later in life and progression to end stage kidney disease and other complications is delayed
  32. 32Management of PKD- Prevention-No way to prevent people who have genetic mutation, however, we as nurses may:
    1.EARLY management of hypertension and detection may slow the progression of kidney damage.
    2.Genetic counseling may be useful for adults who have a parent with PKD.
    3. For Nursing Assessment; Family history of renal disorders would prove EXTREMELY useful for PKD to determine early testing to prevent complications.
  33. 33S/SX of PKD- NUMBER 1 S/S FOR PKD IS PAIN
    - Flank pain may be descrbied as a dull ache or sharp and intermittent discomfort. Dull, aching pain caused by increased kidney size with distention or by infection in a cyst. If they describe sharp pain, it may be because a cyst has ruptured and they can have bright red or cola colored urine.
  34. 34Diagnosing PKD•Imaging
    •Renal Ultrasound
    •CT
    •MRI
    •Labs
    •Creatinine (Rising)
    •BUN (Rising)
    •Creatinine Clearance (Decreasing)
    •Sodium (Fluctuating depending on kidney function
    •Urinalysis
    •Proteinuria (Glomeruli are involved)
    •Hematuria (Gross or Microscopic)
    •Bacteria (Indicate Infection)
    •Urinary Culture and Sensitivity Obtained
  35. 35REMEMBER- NSAIDS are used cautiously because they can reduce kidney blood flow. Aspirins are avoided to reduce the risk of bleeding
    -Make sure to prevent constipation
  36. 36REMEBER-24 Hour urine composite-Patient discards first sample and begins collecting, save all in container and will have to be refrigerated or add solution for preservatives
  37. 37BUN testThis measures the amount of urea nitrogen in your blood. Urea nitrogen is a waste product that your kidneys remove from your blood. Higher than normal _______ levels may be a sign that your kidneys aren't working well.
  38. 38Nursing Quality Alert (Infant/Child with a febrile UTI)• For infants and children 2 to 24 months of age, ultrasonography is recommended after the first febrile UTI. Ultrasonography can assess renal scarring and the extent of hydronephrosis but is not accurate for VUR.
    • Voiding cystourethrogram (VCUG) if the ultrasound is abnormal.
    • VCUG after a second febrile UTI.
  39. 39Glomerulonephritis- inflammation of the glomeruli of the kidney
    - Also see: tubular and interstitial changes, vascular scarring and hardening (glomerulosclerosis); affects both kidneys.
    -Associated conditions kidney infections, nephrotoxic drugs, immune disorders, systemic diseases
  40. 40Cryptorchidism- Undescended testes (usually 1 but can be both)
    -Higher risk in premies
    -Testes will usually drop within the first 6 months of life, if not, surgery is done before 1 year.
    - Pt has a increase risk for testicular cancer, testicular torsion and infertility later in life
  41. 41Nursing Quality Alert (Assessing Cryptorchidism)• Examine the infant in a warm environment. Be sure the infant is calm before the examination.
    • Warm your hands before touching the infant.
    • Milk each testis downward from the groin and document its distal point.
    • Examine the older child in both a sitting and a frog-leg position (Closes the inguinal canal)
    • Most testes descend by the time the infant is 6 months old.
  42. 42Hypospadias- abnormal congenital opening of the male urethra on the undersurface of the penis
    - Children should not be circumcised because the foreskin, is a source of tissue that surgeons use to rebuild the missing part of the urethra
    -Surgical correction is between 6 months and a year
    - Usually done before potty training
  43. 43Epispadias- congenital defect in which the urinary meatus is located on the upper surface of the penis
    - Children should not be circumcised because the foreskin, is a source of tissue that surgeons use to rebuild the missing part of the urethra
    -Surgical correction is between 6 months and a year
    - Usually done before potty training
  44. 44Common GU tests- Nitrites: Produced by select bacteria, may be present when bacteria are in urine, In infant and child, bacteria may not be present in the bladder long enough to produce sufficient nitrites to yield positive results.
    - WBC: may also be present in the urine with infections.
  45. 45Serum Creatininie- Your__________________ level is based on a blood test that measures the amount of creatinine in your blood. It tells how well your kidneys are working. When your kidneys are not working well, your _____________________ level goes up.
    - MOST RELIABLE INDICATOR OF RENAL FUNCTION. IS a by product of protein and muscle metabolism because it is released at a CONSTANT RATE
  46. 46Renal Pt Diet- Potassium-Kidneys excrete your postassium-When someone has renal failure or renal involvement, you will see the potassium elevate. For this potassium to elevate, it bad because it involves heart muscle and arrythmias may occur. This is a life threatening abnormal and dialysis or medications such as kaexalate must be given to bind to the potassium to help the body excrete it.
    -Sodium- Values are in range until the later part of kidney end stage.
    - Uric Acid-Can indicate kidney disease or purine metabolism. This causes gout and inflammation, so a low purine diet must be adhered to to regulate the level of urice acid or a patient must take daily medication called Allopurinol for gout and to maintain normal uric acid levels. Uric acid can also form stones which cause disruption of urine flow.
  47. 47Nitrofurantoin• Avoid use if the creatinine clearance <30 mL/min.
    • Notify HCP at once if fever, chills, cough, chest pain, dyspnea, rash, or numbness or tingling of fingers or toes develops.

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Final Renal/Urinary Karteikarten am Renal , erstellt von Nykenya Corbin am 04/12/2023.
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