renal disorders

• pyelonephritis = kidney infection
• pyelonephritis: inflammation of renal parenchyma (functional tissue) and urinary collecting system
• risk factors for pyelonephritis (kidney infection): recurrent pre existing UTIs (the bacterium will crawl up into the kidneys), pregnancy
• clinical manifestations of pyelonephritis: fever, chills, nausea, vomiting, back/flank pain, costovertrebral tenderness, enlarged kidneys
• medical treatment pyelonephritis: hydration, antibiotics, emergency surgery if fever/pain longer than 48 hours (for abscess/renal calculi)
• complications for pyelonephritis: scarring, CKD (every infection causes damage to the nephrons), permanent damage, urosepsis
• early signs of urosepsis: changes in mental status, fever, tachycardia, tachypnea, hypotension, oliguria, and leukopenia
• physical assessment pyelonephritis: fever, chills, nausea and vomiting, anorexia, vital signs (temperature, pulse, BP - looking for signs of sepsis/SIRS), and pain level
• labs for pyelonephritis: UA and culture, CBC (infection), BC (infection in the blood stream - sepsis)
• interventions for pyelonephritis: antibiotics, pain management, provide adequate hydration (eight 8 ounce glasses of water to rinse out the kidneys)
• teaching interventions for pyelonephritis: explain the disease condition to the patient and family (how they got it and how to prevent it), instruct patient and family on how to avoid UTIs
• CKD: progressive, irreversible loss of kidney function
• risk factors for CKD: diabetes, HTN, hyperlipidemia, smoking, recreational drug use, NSAIDs (decreases renal perfusion), and obesity
• clinical manifestations of CKD: alterations in sodium and fluid balance (hypertension, heart failure, pulmonary edema; increased fluid volume is the first sign), altered potassium excretion (HIGH potassium = lethal arrhythmias), impaired metabolic waste elimination (nausea, vomiting, anorexia, and neurological symptoms = Cr and BUN really HIGH)
• clinical manifestations of CKD cont: altered calcium and phosphorus (bone breakdown, osteodystrophies, defective bone development), decreased acid clearance and bicarbonate production (metabolic acidosis), endocrine (infertility, amenorrhea, thyroid abnormalities), and chronic anemia
• medical treatment for CKD: renal replacement therapy (dialysis), support the remaining function of kidneys, treat clinical manifestations, prevent complications, renal transplant
• physical assessment for CKD: vitals (BP, O2), weight (dry weight), urinary output; assess pulmonary, cardiac, peripheral vascular
• labs for CKD: elevated serum creatinine, decreased creatinine clearance, protein/albumin in urine, uremia (lot of uric acid in bloodstream), renal ultrasound (looking for stones, blood flow to the kidneys, enlargement, tumors, strictures), CT scan, and renal biopsy
• the more dialysis has to take off the more sick itll make the patient so if they don't stick to the renal diet they are causing more pain to themselves
• nursing interventions for CKD: maintain cardiac monitoring (lethal arrhythmias), weight patient (DRY weight), restrict fluids and sodium, assessment of venous access or AV fistula, medications