Study Guide Module 6 PDF

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NUR 1212C - Health Alterations Across the Lifespan I 5...

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Nur1212C Study Guide Module 6

Pyelonephritis Pyelonephritis is either the presence of active organisms in the kidney or the effects of kidney infection (kidney still functions). Acute pyelonephritis is the active bacterial infection, whereas chronic pyelonephritis results from repeated or continued upper urinary tract infections or the effects of such infections. Common cause: E. coli. Acute pyelonephritis is often caused by bacterial infection that started in the lower GU tract (I.e. cystitis) Chronic pyelonephritis occurs with structural deformities, urinary stasis, obstruction, or reflux.  Risk Factors: 65+ years for males, Diabetes, Pregnancy, Kidney stones  Signs/Symptoms: o ACUTE: Fever, Chills, Tachycardia and tachypnea, Flank, back, or loin pain, Tender costovertebral angle (CVA), Abdominal, often colicky, discomfort, Nausea and vomiting, General malaise or fatigue, Burning, urgency, or frequency of urination, Nocturia, Recent cystitis or treatment for urinary tract infection (UTI) o CHRONIC: Hypertension, Inability to conserve sodium, decreased urine-concentrating ability, resulting in nocturia, Tendency to develop hyperkalemia and acidosis  Diagnostics: U/A - tests for presence of WBCs & bacteria, send for culture, blood cultures are obtained for specific organisms, CRP & ESR- to determine the presence of inflammation, XRAY of KUB or CT- performed to visualize anatomy, inflammation, fluid accumulation, abscess formation, defects, identification of stones, tumors, or prostate, Other tests include examining antibody-coated bacteria in urine, testing for certain enzymes, and radionuclide renal scan  Interventions/Treatments: o Drug therapy: antibiotics. Take all meds until complete. o Nutrition therapy: 2L fluid a day. o Surgical therapy: pyelolithotomy is needed for removal of a large stone in the kidney pelvis that blocks urine flow and causes infection. Nephrectomy is a last resort when all other measures to clear the infection have failed. For patients with poor ureter valve closure or dilated ureters, ureteroplasty (ureter repair or revision) or ureteral reimplantation (through another site in the bladder wall) preserves kidney function and eliminates infections.  Education/Management: good handwashing, thorough peri-care, wipe front to back, monitor temp  Complications: Hypertension (kidneys help control BP), Inability to conserve sodium, decreased urineconcentrating ability, resulting in nocturia, Tendency to develop hyperkalemia and acidosis Glomerulonephritis-Acute  Risk Factors: Most causes of acute GN are infections or are related to other systemic diseases, secondary to group beta A (throat) strep infection. Most cases occur in patients aged 5-15 years; only 10% occur in patients older than 40 years. Causes: Group A beta-hemolytic Streptococcus, Staphylococcal or gram-negative bacteremia or sepsis. Typically get just after an infection.  Signs/Symptoms: The onset of manifestations is about 10 days from the time of infection. Circulatory congestion, edema, fluid overload, fluid and sodium retention, shortness of breath, crackles in the lung fields, S3 heart sound (gallop rhythm), neck vein distention, Microscopic blood in urine occurs, smoky, reddish brown, rusty, or cola colored urine, dysuria, oliguria, Mild to moderate hypertension, fatigue, lack of energy, anorexia, nausea, vomiting, uremia  Diagnostics: Urinalysis (Early Morning Specimen preferred) , a kidney biopsy, glomerular filtration rate (GFR), Other serum tests include antistreptolysin-O titers, C3 complement levels, cryoglobulins (immunoglobulin G [IgG]), antinuclear antibodies (ANAs), and circulating immune complexes  Interventions/Treatments: Penicillin, erythromycin, or azithromycin is prescribed for GN caused by streptococcal infection. Antihypertensives.  Education/Management: prevent infection spread, antibiotics for people in immediate close contact with the patient also may be prescribed (will be treated this way because it is strep), personal hygiene and basic infection control, complete entire course of antibiotic, notify health care provider of sudden increase in weight or blood pressure.

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Complications: kidney impairment (hypertension, oliguria, disturbed fluid and electrolyte balance, and uremic symptoms), fluid overload, hypertension, and edema, uremia - waste products in blood

Glomerulonephritis-Chronic  Risk Factors: hypertension, infection and inflammation, or poor blood flow to the kidneys. Causes: Immunological diseases, Autoimmune diseases, Antecedent group A β-hemolytic streptococcal infection of the pharynx or skin, History of pharyngitis or tonsillitis 2 to 3 weeks before symptoms. Repeat acute kidney issues.  Signs/Symptoms: Develops over 20 to 30 years or even longer. Mild proteinuria and hematuria, hypertension, fatigue, occasional edema, systemic circulatory overload, lung crackles, Neck vein engorgement, edema (feet, ankles, shins, sacrum), uremic manifestations, Slurred speech, Ataxia, Tremors, Asterixis  Diagnostics: Urine output decreases, and urinalysis shows protein, Red blood cells and casts may be in the urine, glomerular filtration rate (GFR) is low, serum creatinine level is elevated, BUN is increased  Interventions/Treatments: diet changes, fluid intake sufficient to prevent reduced blood flow to the kidneys, and drug therapy to control the problems from uremia. If GFR is low, decrease protein intake. Eventually the patient requires dialysis or transplantation to prevent death.  Education/Management: Stress the importance of completing the drug therapy as directed. Blood pressure control is needed to slow the progression of kidney dysfunction. Fluid intake is recommended at 2 L/day, Calories from all food groups for healing to occur. The need for a balance between rest and activity, including any limitations after surgery. temperature every 4 hours, empty bladder completely each time  Complications: Kidney Failure, Hypertensive encephalopathy, Pulmonary edema, Heart failure, Chronic glomerulonephritis always leads to ESKD, Loss of nephrons reduces glomerular filtration, Changes in memory and the ability to concentrate occur as waste products collect in the blood Nephrotic Syndrome Nephrotic syndrome (NS) is a condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine and then be excreted. This process causes massive loss of protein into the urine, edema formation, and decreased plasma albumin levels. Caused by damage to the clusters of tiny blood vessels (glomeruli) of your kidneys (an internal injury).  Risk Factors: Renal Vein Thrombosis, Immune or Inflammatory Process (Lupus), Diabetic Kidney Disease (leads to nephropathy of glomeruli), Genetic defects (Fabry disease), Altered liver activity (leads to hyperlipidemia)  Signs/Symptoms: Severe Proteinuria (>3.5 of protein in a 24hr urine sample), Low serum albumin (3.5g), Fat levels o Blood Test- Albumen levels decreased (...