Med Surg 2 Exam 2

• Creatine Cr


  (M) 0.6-1.2 mg/dl (F) 0.5-1.1 mg/dl
• Blood Urea Nitrogen BUN


  10-20 mg/dl
• Bun/Cr Ratio


  10:1 20:1
• Bicarbonate (HCO3)


  Regulated by kidney
• Vitamin D


  Kidney converts to active form
• Sodium


  Altered with Renal Failure
• Potassium K+


  Hyperkalemia with Renal Failure
• Phosphorus


  Kidney responsible for excretion, Hyperphosphatemia with renal failure
• Calcium


  Hypocalcemia with Renal Failure, Inversely related to PO4
• Urinalysis


  Yellow to amber
• Specific Gravity


  1.005-1.030, <1.005 dilute urine, >1.030 concentrated urine
• pH


  4.6-8
• RBC


  <2
• WBC


  0.4
• Leukocyte esterase


  Positive = UTI
• Nitrates


  Negative = Positive UTI
• Ketones


  Negative = Ketosis, Positive = DKA, Low carb diet
• Glucose


  Negative = Positive DM
• Protein


  0-8 mg/dl
• Dysuria


  Pain while urinating
• Nocturia


  Excessive urinating at night
• Hematuria


  Bloody urine
• Frequency


  More than every 3 hours
• Urgency


  Strong urge to urinate
• Incontinence


  Involuntary urination
• Enuresis


  Urinating in sleep
• Proteinuria


  Protein in urine
• Oliguria


  Urine output <400ml daily
• Anuria


  Urine output >100ml/day
• Micturition


  Voiding
• Glomerular Filtration Rate


  24hr urine collection
• Renal Imaging Studies

  • Post void residual (bladder scanner)
  • Renal ultrasound
  • KUB X-Ray (Kidney Ureter Bladder)
  • CT Scan
  • MRI
  • IV Pyelogram (dye injected with x-ray)
  • Cystoscopy (scope up bladder)
• Polycystic Kidney Disease


  • Fluid filled cysts due to repeated cell division, cysts become large and compress surrounding tissue, decrease renal circulation, 50% progress to ESRD and dialysis
• Manifestations of Polycystic Kidney Disease

  • HTN
  • Hematuria
  • Flank/Lumbar/Abdominal Pain
  • Fever/Chills
  • Repeat UTI
  • Headache
• Diagnostics for Polycystic Kidney Disease

  • Ultrasound Abdomen
  • CT, MRI or IV Pyelogram
• Medical Management of Polycystic Kidney Disease

  • Manage Symptoms
  • Anti-HTN ACE-I/ARBs
  • Pain Management
  • Percutaneous Drainage for Cyst
  • Nephrectomy
  • Hemodialysis or Peritoneal Dialysis
  • Kidney Transplant
• Nursing Care for Polycystic Kidney Disease


  • Monitor vital signs
  • Monitor labs (BUN/Cr, electrolytes)
  • Manage symptoms
  • Administer anti-HTN medications
  • Fluid restriction
  • Low K+, Phos, Protein, Na+ diet
  • Pain management
  • Antibiotics for UTI
• Pyelonephritis


  Upper UTI
• Risk Factors for Pyelonephritis

  • UTI
  • Sex (females)
  • Pregnancy
  • BPH
• Pyelonephritis Pathology


  Inflammation of renal tissue and collection system, usually bacterial (E.coli)