Med Surg Session 11: Renal

Session 11

 

Renal disorders

 

Know why you are giving diuretics

Empty the foley bag before the diuretic is administered so you can track the output closely. 

Can have pre, intra, and post renal injuries

  • Post renal is an obstruction
  • Intrarenal is Structural damage to the kidney can be caused by radiocontrast dye
  • Prerenal is a reduction in blood flow
  • Structural damage to the kidney

 

Things that increase the chance for infection in urinary system

  • Urinary stasis
  • High levels of glucose in the urine

 

Pyelonephritis – infection of the kidneys,

  • Give lots of fluids
  • Treat pain, infection, and nausea

 

Glomerulonephritis –

  • Look for blood in the urine
  • Proteinuria, high BUN, periorbital edema, and hematuria

 

Renal calculi –

  • rf – high protein, dehydration, warm climates
  • Flank and abdominal pain
  • Use a NON radio contrast CT scan
  • Manage pain!

 

BPH – benign prostatic hyperplasia

  • Digital rectal exams are the prefered method
  • Increase chance of renal stones due to urine retention.
  • May need a catheter placed to urinate properly.
  • Can give Alfa blockers to relax smooth muscle
    • A side effect of these is orthostatic hypotension
  • Three way foley is use to continuously irrigate the bladder and catheter to prevent clots from stopping up urine flow.

 

Prostate cancer –

  • Mimics BPH symptoms
  • Screen with DRE and PSA

 

Chronic kidney disease –  long term decrease in kidney function

  • Can have chronically high BUN and Cre levels
  • polyuria in the beginning, it will progress to oliguria
  • Often need dialysis
  • On HTN meds, Na and fluid restrictions, calcium based phosphate binders
  • Indications for dialysis – we wait as long as possible  because being dialyzed is not optimum for the patient.  
  • Types – hemo, and peritoneal
    • Peritoneal has a high chance for infection, but the person can do it at home and does not need to be hooked up to the dialysis machine for 12 hours a week.  4x day for about 30 mins each time.
    • Hemodialysis – 12 hours a week at the center
      • Have an Arteriovenous fistula for better access commonly in the forearm
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