Nephrology

Study Notes

Kidneys are unable to filter waste from the blood, potentially reversible
Symptoms include high creatinine levels, reduced urine output, fluid retention (edema, hypertension), changes in level of consciousness (LOC) and uremia.
Nursing interventions include monitoring intake and output (I&O), daily weight, blood pressure (BP), and hyperkalemia. Restrict sodium and fluid intake. Dialysis may be needed.

Irreversible kidney damage causing uremia
Dialysis is typically required.
Patients are at risk for hyperkalemia and fluid overload.
Nursing interventions include restricting protein, monitoring for fluid overload (jugular vein distension (JVD)), daily weights, and monitoring I&O.

Upper UTI (pyelonephritis) can be life-threatening, potentially leading to urosepsis.
- Symptoms include flank and back pain, fever, nausea, and vomiting (N/V).
Lower UTI (urethritis and cystitis) is commonly caused by E. coli.
- Risk factors include pregnancy, diabetes, and prostatic hypertrophy in older men.
Nursing interventions include antibiotic therapy (complete course), increased fluid intake, monitoring I&O, encouraging voiding every 2-3 hours, and avoiding catheterization (especially for older adults).

Blockage in one or both ureters, preventing urine drainage from kidneys to the bladder.
Causes include kidney stones (calculi), strictures, or tumors.
Location of pain can help identify the location of the stone.
Nursing interventions include pain management, increasing fluid intake, intravenous antibiotics (as needed), assessing urine for stones, and monitoring I&O.

Loss of bladder control due to central nervous system (CNS) issues (e.g., Parkinson's, Multiple Sclerosis, spinal bifida).
Symptoms include urinary tract infections (UTIs), urinary incontinence, and kidney stones.
Nursing interventions include creating a voiding schedule, double voiding, pelvic floor exercises, intermittent catheterization, or an indwelling catheter (if needed).

Enlargement of the prostate gland in older men.
Symptoms include increased urinary frequency, urgency, nocturia, and difficulty initiating urination.
Nursing interventions include encouraging frequent voiding, increased fluid intake, monitoring vital signs, and medications (antispasmodics, alpha-adrenergic antagonists).

Surgical procedure to remove prostate tissue.
Post-operative continuous bladder irrigation is needed to remove blood clots until the urine is light pink.

Condition leading to proteinuria (protein in urine), hypoalbuminemia (low protein in blood), and fluid shifts resulting in edema.

Normal urine output is approximately 1 mL/kg/hour for adults and ranges from 1500-2000 mL per day.
Monitoring body weight is an indicator of renal status and fluid retention. Weigh patients at the same time daily and using the same scale for accurate assessment.
Dialysis patients should be closely monitored for signs of shock due to potential blood loss.
GFR (glomerular filtration rate) is used as an indicator for protein consumption. Restrict protein intake in patients with Chronic Kidney Disease (CRF).