Nursing Care for Kidney Conditions

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Questions and Answers

Which of the following is considered a secondary glomerular disease?

  • Minimal change disease
  • Focal segmental glomerulosclerosis (FSGS)
  • Membranous nephropathy
  • Systemic lupus erythematosus (SLE) (correct)

Why is an early morning urine specimen preferred for urinalysis when evaluating glomerulonephritis?

  • It contains fewer red blood cells, reducing interference with protein detection.
  • It is more dilute, making formed elements easier to identify.
  • It has a lower pH, which preserves cellular components.
  • It is more concentrated, acidic, and contains more intact formed elements. (correct)

Which finding would be expected in a urinalysis of a patient with glomerulonephritis?

  • Hematuria and proteinuria (correct)
  • Glycosuria and ketonuria
  • Bacteriuria and increased nitrites
  • Decreased specific gravity and alkaline pH

Which condition increases the risk of death from glomerulonephritis in older adults, as mentioned in the provided content?

<p>Immunocompromised background (D)</p> Signup and view all the answers

What condition, other than kidney-related issues, might exacerbate the symptoms of glomerulonephritis in older adults?

<p>Heart failure (A)</p> Signup and view all the answers

Which of the following is a viral infection that may lead to secondary glomerular disease?

<p>Human immunodeficiency virus (HIV) (C)</p> Signup and view all the answers

Which of the following secondary glomerular diseases is associated with liver dysfunction?

<p>Sustained hepatitis B (C)</p> Signup and view all the answers

Which of the following organisms is the MOST common cause of pyelonephritis in community-dwelling adults?

<p>Escherichia coli (C)</p> Signup and view all the answers

Which of the following conditions falls under the classification of vasculitis that can lead to secondary glomerular disease?

<p>Wegener granulomatosis (A)</p> Signup and view all the answers

A patient with pyelonephritis is being assessed. Tenderness during palpation of the costovertebral angle (CVA) may indicate:

<p>Infection or inflammation (A)</p> Signup and view all the answers

Which of the following assessment findings might indicate inflammation during the inspection of the costovertebral angles (CVAs)?

<p>Enlargement, asymmetry, edema, or redness/hyperpigmentation (D)</p> Signup and view all the answers

Besides bacteria, what other immunological responses can lead to kidney scarring and increase the risk for pyelonephritis?

<p>Inflammatory responses from immunity excesses and autoimmune reactions (C)</p> Signup and view all the answers

Which of the following medications, when used in high doses or for prolonged periods, can lead to papillary necrosis and reflux, potentially increasing the risk of pyelonephritis?

<p>Nonsteroidal anti-inflammatory drugs (NSAIDs) (D)</p> Signup and view all the answers

Which population is MOST commonly affected by acute pyelonephritis?

<p>Young females who are sexually active (D)</p> Signup and view all the answers

In hospitalized patients, pyelonephritis can be caused by various organisms. Besides Escherichia coli, which of the following organisms is a common culprit in this setting?

<p>Klebsiella species (D)</p> Signup and view all the answers

What psychosocial consideration is important to assess in an older adult presenting with a urinary or renal infection?

<p>New-onset confusion (C)</p> Signup and view all the answers

What is the typical protein level found in the urine of a patient with chronic glomerulonephritis (GN) during a 24-hour collection?

<p>Less than 2 g (C)</p> Signup and view all the answers

Which of the following is the most common treatment for renal cell carcinoma (RCC)?

<p>Nephrectomy (A)</p> Signup and view all the answers

A constant specific gravity level of around 1.010 in a patient with chronic glomerulonephritis indicates what?

<p>A fixed level of dilution despite variable fluid intake (C)</p> Signup and view all the answers

Elevated serum creatinine levels in chronic glomerulonephritis are indicative of what?

<p>Poor waste elimination by the kidneys (B)</p> Signup and view all the answers

What is the average age at diagnosis for kidney cancer?

<p>64 years (A)</p> Signup and view all the answers

Which of the following is a potential cause of anemia in patients with renal cell carcinoma?

<p>Destruction of erythropoietin-producing kidney cells by tumor cells (D)</p> Signup and view all the answers

Which of the following serum sodium levels would be expected in a patient with chronic glomerulonephritis experiencing dilution of the plasma from excess fluid?

<p>Between 135 and 145 mEq/L (falsely normal) (C)</p> Signup and view all the answers

What causes hyperkalemia in patients with chronic glomerulonephritis?

<p>Oliguria which leads to decreased potassium excretion (C)</p> Signup and view all the answers

Which of the following hormonal effects is associated with renal cell carcinoma?

<p>Increased human chorionic gonadotropin (hCG) levels (B)</p> Signup and view all the answers

In the late stages of chronic glomerulonephritis, a kidney biopsy is most likely to reveal?

<p>Glomerular changes, cell loss, protein and collagen deposits, and fibrosis (B)</p> Signup and view all the answers

Why might a patient with renal cell carcinoma experience erythrocytosis?

<p>Tumor cells producing large amounts of erythropoietin (A)</p> Signup and view all the answers

Which of the following factors should be included when assessing a patient for renal cell carcinoma?

<p>History of smoking (C)</p> Signup and view all the answers

Besides physical symptoms, what emotional states should healthcare providers be attentive to when taking the history of a patient with chronic glomerulonephritis?

<p>Feelings of anger, resentment, sadness, or anxiety (C)</p> Signup and view all the answers

What is the primary reason patients with renal cell carcinoma are at risk for chronic kidney disease (CKD) and cardiovascular complications?

<p>The effect of nephrectomy and potential metastasis (A)</p> Signup and view all the answers

What is the primary mechanism leading to hypertension in chronic glomerulonephritis?

<p>The Loss of nephrons reduces glomerular filtration (B)</p> Signup and view all the answers

Which of the following is considered the primary diagnostic method for Polycystic Kidney Disease (PKD)?

<p>Ultrasound (C)</p> Signup and view all the answers

Which is the following cell types is a recognized type of renal cell carcinoma?

<p>Papillary cell (C)</p> Signup and view all the answers

What is the primary benefit of early detection and management of hypertension in individuals with Polycystic Kidney Disease (PKD)?

<p>Slowing the progression of kidney damage (C)</p> Signup and view all the answers

A patient with suspected Polycystic Kidney Disease (PKD) reports increased abdominal girth, constipation and bloody urine. Which of the following assessment findings does this information correlate with?

<p>Hematuria (B)</p> Signup and view all the answers

What information should the nurse obtain when exploring a patient's family history for Polycystic Kidney Disease?

<p>Age at which the parent was diagnosed and any related complications (C)</p> Signup and view all the answers

Which diagnostic tool provides quantitative data regarding tissue oxygenation, fibrosis, edema, inflammation and perfusion in Polycystic Kidney Disease (PKD)?

<p>MRI or CT (B)</p> Signup and view all the answers

In the early stages of Polycystic Kidney Disease, what urinary-related issue is commonly observed?

<p>Inability to concentrate urine (B)</p> Signup and view all the answers

What emotional or psychological factors can complicate the care of patients with Polycystic Kidney Disease (PKD)?

<p>Feelings of guilt and concern for the patient's children (C)</p> Signup and view all the answers

When kidney function is significantly compromised in a patient with Polycystic Kidney Disease (PKD), the care becomes similar to what other condition?

<p>End-stage kidney disease (B)</p> Signup and view all the answers

What is the purpose of placing the patient on the nonoperative side during surgery?

<p>To facilitate easier access to the kidney area (B)</p> Signup and view all the answers

Why might the eleventh or twelfth rib need to be removed during a nephrectomy?

<p>To allow for better access to the kidney and tumor (A)</p> Signup and view all the answers

What is a major concern after the removal of a kidney and adrenal gland?

<p>Infection in the surgical site (A)</p> Signup and view all the answers

What may be required if the remaining adrenal gland cannot secrete sufficient glucocorticoids after surgery?

<p>Steroid replacements (B)</p> Signup and view all the answers

How often should the patient be assessed for signs of systemic or local infection post-operation?

<p>Every 8 hours (A)</p> Signup and view all the answers

Flashcards

Pyelonephritis

A kidney infection usually caused by bacteria, often E. coli.

Common bacteria in pyelonephritis

The most common cause is Escherichia coli; Enterococcus faecalis is common in hospitals.

Symptoms of kidney scarring

Chronic kidney damage may result in ongoing infection and discomfort.

CVA tenderness

Costovertebral angle tenderness indicates kidney infection or inflammation.

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Non-bacterial causes of pyelonephritis

Includes inflammatory responses, autoimmune reactions, and immune excess.

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Psychosocial assessment for older adults

New confusion in elderly patients may indicate urinary or renal infections.

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Symptoms of bacteriuria

Changes in urine color or odor can indicate bacterial infection.

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Risk factors for acute pyelonephritis

Sexually active young females and hormone-related changes increase risk.

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Glomerulonephritis

A kidney condition that can lead to chronic kidney disease (CKD).

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Chronic Kidney Disease (CKD)

Progressive loss of kidney function over time.

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Systemic Lupus Erythematosus (SLE)

An autoimmune disease that can cause glomerulonephritis.

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Urinalysis

Test that examines urine for abnormalities like hematuria and proteinuria.

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Hematuria

Presence of red blood cells in urine, indicating potential kidney issues.

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Proteinuria

Presence of abnormal levels of protein in urine, a sign of kidney dysfunction.

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Alport Syndrome

Genetic condition causing kidney disease and hearing loss.

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IgA Nephropathy

A kidney disease caused by the accumulation of IgA protein in kidneys.

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Polycystic Kidney Disease (PKD)

A genetic disorder characterized by the growth of numerous cysts in the kidneys.

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Primary diagnosis method for PKD

Ultrasound is primarily used to diagnose PKD by measuring kidney size and detecting cysts.

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Role of family history in PKD

Family history analysis helps identify individuals at risk for PKD, especially if a parent is affected.

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Management of PKD

Management primarily occurs in the community and includes care for hypertension and frequent UTIs.

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Key symptoms of PKD

Symptoms include abdominal pain, hypertension, nocturia, hematuria, and increased abdominal girth.

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Effects of PKD on urine

In early stages, PKD causes sodium wasting and an inability to concentrate urine.

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Urinalysis findings in PKD

Urinalysis may reveal proteinuria, indicating kidney damage.

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Progression of PKD

PKD can progress to kidney failure with anuria, which is a lack of urine production.

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Kidney Cancer Statistics

About 13,920 people die annually from kidney cancer in the United States, one of the top 10 cancers.

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Common Age for Diagnosis

The average age at diagnosis of kidney cancer is 64 years; rarely in those under 45.

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Paraneoplastic Syndromes

Effects like anemia, hypercalcemia, and liver dysfunction are paraneoplastic syndromes related to kidney cancer.

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Erythropoietin's Role

Tumor cells can produce erythropoietin, causing erythrocytosis or anemia in kidney cancer patients.

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Nephrectomy Treatment

Nephrectomy, or kidney removal, is the most common treatment for localized renal cell carcinoma (RCC).

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Metastatic Kidney Cancer Treatment

If cancer has spread, nephrectomy is followed by targeted chemotherapy and cytokine treatment.

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Risk Factors to Assess

Ask about smoking, chemical exposure, weight loss, urine changes, flank pain, and fever as risk factors.

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Five Kidney Cancer Carcinomas

RCC has five types: clear cell, papillary, chromophobe, collecting duct, and unclassified.

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Chronic Glomerulonephritis

A long-term kidney disease causing damage to glomeruli over years to decades, leading to reduced kidney function.

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Symptoms of Chronic GN

Common symptoms include mild proteinuria, hematuria, hypertension, fatigue, and occasional edema.

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Glomerular Filtration Rate (GFR)

A measure of kidney function that declines in chronic glomerulonephritis, indicating kidney damage.

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Urine Specific Gravity

In chronic GN, the specific gravity is fixed around 1.010, indicating kidney's inability to concentrate urine despite fluid changes.

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Serum Creatinine Level

Elevated serum creatinine in chronic GN indicates poor waste elimination; levels often exceed 6 mg/dL.

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Potassium Retention

In chronic GN, oliguria leads to potassium not being excreted, resulting in hyperkalemia when levels exceed 5.4 mEq/L.

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Hypertension in Chronic GN

Hypertension often accompanies chronic glomerulonephritis due to reduced nephron number and renal arteriole sclerosis.

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Incision site

The area where the surgeon makes an incision to access the kidney.

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Kidney removal position

Patient is positioned with the kidney to be removed uppermost.

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Adrenal insufficiency

A potential complication where adrenal glands can't secrete enough glucocorticoids post-surgery.

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Post-operative infection prevention

Administering antibiotics during and after surgery to prevent infection.

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Drain placement

A drain may be placed in the wound to remove fluids before closure.

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Study Notes

Learning Outcomes

  • Plan collaborative care with the interprofessional team to promote urinary elimination in patients with kidney conditions.
  • Teach adults how to decrease the risk for kidney conditions.
  • Teach patients and caregivers about common drugs and management strategies for kidney conditions.
  • Plan patient- and family-centered interventions to decrease the psychosocial impact of kidney conditions.
  • Apply knowledge of anatomy, physiology, and pathophysiology to provide evidence-based care for patients.
  • Analyze assessment and diagnostic findings to generate solutions and prioritize nursing care.
  • Organize care coordination and transition management for patients with kidney conditions.
  • Use clinical judgment to plan evidence-based nursing care to promote urinary elimination and prevent complications.
  • Incorporate factors that affect health equity into the plan of care.

Key Terms

  • Abscess: A localized collection of pus.
  • Acute glomerulonephritis: Inflammation of the glomerulus developing suddenly.
  • Dysuria: Painful urination.
  • Hydronephrosis: Abnormal enlargement of the kidney.
  • Hydroureter: Abnormal distention of the ureter.
  • Nephrectomy: Surgical removal of the kidney.
  • Nephrosclerosis: Degenerative kidney disorder from changes in kidney blood vessels.
  • Nephrostomy: Surgical creation of an opening directly into the kidney.
  • Nephrotic syndrome: Immunologic kidney disorder causing increased glomerular permeability.
  • Polycystic kidney disease: Genetic disorder with fluid-filled cysts in the kidneys.
  • Pyelolithotomy: Surgical removal of a kidney stone.
  • Pyelonephritis: Bacterial infection of the kidney and renal pelvis.
  • Stricture: Narrowing of the urinary tract.
  • Ureteroplasty: Surgical repair of the ureter.

Priority and Interrelated Concepts

  • Elimination (pyelonephritis is the concept exemplar)
  • Fluid and Electrolyte Balance
  • Acid-Base Balance
  • Immunity
  • Pain

Other Key Information

  • Healthy kidneys regulate urinary elimination, fluid and electrolyte balance, and acid-base balance.
  • Kidney problems can disrupt homeostasis and affect urinary elimination.
  • Chronic kidney disease and acute kidney injury (AKI) are discussed in another chapter.

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Kidney Conditions Chapter 59 PDF

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