Transcript Renal System

Renal System
Joanna Shedd, MS, CNS, RN
Disorders of the Urinary Tract
Presented By: Joanna Shedd
Kidneys
• Left and right
• Adrenal on each
kidney
• Vascular organ
• Nephrons in cortex
Diagnostic Exams for Kidneys
• Routine UA
• Color significance p. 1506
• Creatinine Clearance
• 24-hr Cr. Clearance
Diagnostics: Urinalysis – “UA”
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Color – amber to yellow
Clarity - clear
pH – 4.6 – 8.0
Specific gravity – 1.010 – 1.030
Protein – 0 – 8 mg/dL
Diagnostics: Urinalysis Continued
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Sugar – no sugar normally
Ketones – none, normally
Red blood cells (RBC) – 0 – 4
White blood cells (WBC) – 0 – 5
Casts – none, normally
Diagnostics Continued
• Culture & Sensitivity
• Blood Tests
BUN (blood urea nitrogen)
Creatinine
CBC (complete blood count)
Diagnostics: Blood Urea Nitrogen (BUN)
• Passes through glomerular filtrate unchanged
• Reabsorbed during passage through nephron
• Range: 5 – 20 mg/dL
Processes that can affect BUN
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High-protein diet
GI bleeding
Hepatic disease
Dehydration
Medications
Catabolic state – starvation, injury,
infection
Diagnostics Continued
Radiology:
• KUB
(kidney, ureters, bladder)
• IVP (intravenous pyelogram)
• Prep with laxatives,
• NPO after MN
• Check for allergies,
• Baseline renal function
Diagnostic Continued
• Blood Urea Nitrogen (BUN) – ability of the kidney to
excrete nitrogenous wastes
• End product of protein metabolism
• Can be affected by many factors
• Creatinine (Cr) – ability of the kidney to excrete creatinine
• End product of creatine
• Muscle is more stable
• Better indicator of kidney function
Functions of the Kidney
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Remove waste products
Regulate fluid balance
Maintain electrolyte imbalance
Regulate BP
Activates growth hormone
Diagnostics Continued
Radiology:
• Renal angiography
• Arterial, more invasive
• Post care similar to
angio care
Diagnostics Continued
Other:
• Cystoscopy –
Direct visualization
of urinary tract
• Renal biopsy –
Examine tissue
under microscope
Intake and Output (I&O)
• Essential to determine fluid deficit
or excess
• Can affect patient outcomes
• Doctors will treat patient
accordingly, i.e., IV therapy
• Assess patient for accompanying
signs/ symptoms
Intake
• Orally – including ice chips
• Parenterally – IV fluids, blood
products
• Rectally
• Tubes, etc
• Semi-solid foods
Output
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Urine – color and amount
Gastric secretions
Vomitus
GI drainage
Wound drainage
Stools
Functions of the Kidney
• Ultra filtration
• Process by which urine
is formed
• Around 1-2L/day
excreted
• Filtration in Bowman’s
capsule
• Reabsorption and
secretion in tubules and
collecting duct
Functions of the Kidney
• Electrolyte balance
• Aldosterone
• Anti-diuretic hormone
(ADH)
• Acid-base balance
• Lungs – CO2
• Kidneys – HCO3
Functions of the Kidney
• Erythropoietin – red blood cell
production
• Calcium regulation
• Multiple processes
• Phosphorous regulation
• Component of all
intermediates of glucose
metabolism
Functions
• Blood pressure regulation
• ADH
• Renin-angiotensin-aldosterone
System (RAAS)
Functions
• Excretion of metabolic wastes
and toxins
• Excreted in glomerular filtrate
• Drugs either excreted directly
from kidneys
• OR metabolized in liver, then
excreted by kidneys
URINARY TRACT
INFECTION
• Infection anywhere in the urinary tract
• Cystitis
(Bladder Infection)
• Pyelonephritis
(kidney infection)
• Urosepsis
Urinary Tract Infection
Continued
Predisposing Factors:
• Women>Men
• Aging
• Certain disease processes
• Injury/trauma to mucosal lining
• Urinary stasis/ retention
• Poor hygiene/ clothing
• Allergens/ irritants
Cystitis: Signs and
Symptoms
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Burning/Dysuria
Frequency/Urgency
Void small amounts
Low back/ suprapubic pain
Bladder spasm
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Malaise
Chills/fever
Nausea/vomiting
Cloudy, possibly bloody urine
Pyelonephritis:
Signs/Symptoms
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High fever
Chills
Nausea
Pain on affected side
Headache
Malaise
Cloudy, bloody, foul-smelling urine
Dysuria
Interventions
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Bladder- usually po, 7-10 days
Pyelo – usually IV 3-5 days, then po 2-4 weeks
Increase fluid intake
Acidify urine
Comfort measures
Eliminate cause
Education on prevention
UROLITHIASIS
• Stones in urinary tract
• Most common: renal
Predisposing factors:
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Supersaturation of urine
Urine Stasis
Urinary PH
Presence of precipitate
UROLITHIASIS
Signs/Symptoms:
• Nausea/vomiting
• Pale, clammy skin
• Hematuria
• Can lead to hydro-nephrosis, obstruction
• Can lead to acute renal failure
• Intense, colicky pain on affected side
UROLITHIASIS: Interventions
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Push fluids
Encourage ambulation
Antispasmodics/ narcotics
Moist heat to flank
Anti-emetics for nausea
Strain all urine
UROLITHIASIS: Interventions
• Ureteral Catheters
• Extracorporeal shockwave
lithotripsy (ESWL)
• After procedure: drink
water and ambulate
• Watch for bleeding,
strain urine
• Surgical intervention
• Percutaneous nephroscopic removal
• Open surgical procedure
ACUTE RENAL
FAILURE
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Abrupt loss of kidney function
Can be over few hours to few days
Usually reversible
Can progress to Chronic renal failure
Acute Renal Failure
Acute Renal Failure
Causes: Prerenal
• Any condition that interferes with blood flow to
kidneys
• Most common:
hypovolemia & hypotension
• Decrease perfusion leads
to decrease urine
Causes: Intrarenal
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Damage to kidneys themselves
Kidney disease
Trauma/injury
Nephrotoxins
Acute tubular necrosis
Causes: Postrenal
• Obstruction in urinary tract
• Benign prostatic hypertrophy
(BPH)
• Tumors
• Calculi
• Secondary damage to kidneys
Clinical Phases
• Initiation phase
• Maintenance phase
• Oliguric period
• Diuretic period
• Recovery phase
Signs/Symptoms
Fluid imbalances
HTN
CHF
Pulmonary edema
Acidemia
Uremia
Electrolyte imbalances
K+
Ca2+
Na+
pre-renal (low Na+)
Intrarenal (high Na+)
Anemia
Interventions: Correct Cause
Electrolyte Balance
• K+ - kayexalate
• Phosphorous
• Calcium
• Correct acidosis
• NaHCO3
• Dialysis
Fluid Balance
• I&O
• BP
• Daily Weight – 1lb
= 500cc
• Breath sounds
• Na+ levels
Shock
• Inadequate blood flow to vital
organs
• Cells become unable to extract
and use oxygen
Blood flow
• Adequate amounts of blood for
heart to pump
• Effective pumping by heart
• Constriction and dilation of blood
vessels to maintain blood pressure
Hypovolemic Shock
• Most common
• Caused by loss of:
• Whole blood
• Plasma
• Interstitial fluid
• Loss is so great, body’s metabolic
needs are not met
Causes of Hypovolemic shock
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Trauma
GI bleeding
Burns
Severe vomiting/ diarrhea
Diuretic therapy
Renal failure
Hypovolemic Shock - Pathophysiology
• Loss of volume affects circulation
to organs and body
• Affects balance of release of
hormones to maintain
homeostasis
Hypovolemic shock - Patho
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Body preserves vital organs first
Decreased cardiac output
Vasoconstriction of kidneys
Decreased renal perfusion
Hypovolemic shock
• Ischemia stimulates release of
renin (activates RAAS)
• Release of Aldosterone reabsorbs
Na+ and H2O
• Reduced renal perfusion
Hypovolemic shock
• Oliguria – markedly
decreased urine
• Decrease cardiac output
• Cycle continues to spiral
downward
Interventions
• Return volume with either
fluid or plasma
• Watch electrolytes
• Strict intake and output
(I&O)
Creatinine
• Excreted unchanged in
urine
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Range: 0.6 – 1.5 mg/dL
Usual ratio to BUN 1:10
Creatinine clearance test
Levels tested in 12-24 hr
urine test
Nursing
• Understand importance of
I&Os
• Importance to maintain
>30cc/hr
• Other cues for hydration: skin
turgor, urine color, odor, etc.
• Good health history/
assessment
• Renal system important for
homeostasis
An abnormal finding on a urinalysis is?
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B.
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Color – pale yellow
Glucose – present 3+
RBC – 0
Specific gravity – 1.020
Oliguria is said to be present with urine
output is?
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B.
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D.
About 50mL/hr
Between 60-70 mL/hr
Greater than 100 mL/hr
Less than 30 mL/hr
A client in an auto accident has lost over
a liter of blood . What assessment
would the nurse note about the client?
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B.
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Face pale, pulse weak & thready
Pressures of 110/70 – 120/80
Respirations even, unlabored at 16
Urine yellow, output 200mL/4 hours
The nurse is doing I&Os at the end of the
shift and notes the following: Oral intake –
480 mls, IV intake – 900 mls; urine output
500 mls. What conclusion can be drawn
about the I&Os?
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B.
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Client is in homeostaisis balance
Client is experiencing fluid deficit of 880 mls
Client is experiencing fluid excess of 880mls
Client needs to have a foley catheter placed
Which of the following is not a function of
the kidneys?
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Filtration
Maintaining BP levels
Maintaining pH levels
Making WBCs