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Macrodantin—
should not be used in patients with GFR’s of less than 50ml/min or Renal pt’s it is not effective at low GFR’s in reducing the infection.
Acute;__________ usually starts in medulla and spreads to cortex
pyelonephritis
What are the signs and symptoms of pyelonephritis
S/Sx:--acute illness—fever, chills, flank pain, CVA (Costovertebral angle tenderness)
Assessment and labs for acute pyelonephritis
Assessment:  Clinical sx, u/a C+S for effective tx. WBC’s in urine (Prevent urosepsis). CBC, may need IVP or CT scan,
symptoms of urosepsis
symptoms of sepsis such as high fever (higher than 101 degrees Fahrenheit), rapid breathing, fast heart rate, weak pulse, profuse sweating, unusual anxiety, changes in mental status or level of consciousness, or decreased or absent urinary output.
what is urosepsis
Urosepsis is caused by a bacterial infection of the urinary tract or prostate that spreads into the bloodstream.
Chronic Pyelonephritis-
decreased kidney function, level varies, one or both kidneys, can lead to end stage renal disease
Uretheritis
Uretheritis—inflammation of urethra secondary to bacteria or  gonococcus infection—may be ASX in 10% of people affected—epididimytis in males, pelvic dz in females—all partners of person should be check for STD’s and f/u completed.
usual cause of uretheritis in men
Usually sexually transmitted in men
s/s of uretheritis
Discharge, Dysuria, frequency
Interstitial Cystitis:
chronic, painful inflammatory disease of the bladder
a patient with interstitial cystitis is referred to as painful bladder, may have to go to the bathroom_____
60x/day
tx for interstitial cystitis
TCA’s to dec. bladder spascity & anticholinergic Meds—to relax smooth muscle,  Tx—instill drugs to bladder to tx symptoms (desensitize pain receptors)—dimethyl sulfate has a + 50% response rate to tx//prn pt’s may self-cath Pyridium as a bladder protectant May use laser destruction & cauterization of ulcers
s/s of interstitial cystitis
Pain (mod to severe), may worsen with bladder filling, physical exertion, certain foods, emotional stress UTI symptoms
foods to avoid to prevent irritation of the bladder as with interstitial cystitis
may have been tx’d in the past by practitioners who have had little success with dx or tx,, bladder log, low acid foods avoiding coffee, tea, carbonated and ETOH. Depression & anxiety are common problems, antidepressants
Glomerulonephritis
Inflammation of the glomerulus Affects both kidneys equally
Acute post strep Glomerulonephritis:
Acute Glomerulonephritis: Inflammation of the capillaries of glomerulus-usually in children greater than 2 yrs and young adults —but can occur at any age, alters gfr, increases Na water retention Grp A Beta-hemolytic strep—and occurs 2-3 weeks past the sore throat—may be caused by many other viruses including Hep B And HIV Antigen antibody  complex that forms are deposited in glomeruli- causes inflammatory reaction
s/s of glomerulonephritis
Clinical SX: Edema- generalized, starts in lo pressure tissues, (peri orbital) Hematuria —may appear to have cola colored urine –Generalized edema •Starts in lo pressure tissues- peri orbital •Profound edema = Anasarca –Hypertension –Oliguria, hematuria, proteinuria –May have abdominal or flank pain Proteinurias—primarily high levels of Albumin Also h/a, general malaise, inc. BUN & Creat as u/o drops
complications of glomerulonephritis
Hypertensive encephalopathy CHF Pulmonary Edema Fail to tx will result in Kidney Failure and ESRD in weeks to months
nursing care for glomerulonephritis
Focus on symptomatic relief, pt. education & Safety—How to recognize sx, when to see MD, control diet, (NA and fluid restriction),(possible protein restrict) take meds as prescribed, etc.. f/u with nephrologist
s/s of acute glomerulonephritis
–Generalized edema •Starts in lo pressure tissues- peri orbital •Profound edema = Anasarca –Hypertension –Oliguria, hematuria, proteinuria –May have abdominal or flank pain
tx for acute glomerulonephritis
Tx: antibiotics, steroids, anti-immune drugs, dec. dietary protein, loop diuretics and anti-hypertensives—no value in prolonged bed rest for these patients.
s/s of chronic glomerulonephritis
Sx: Htn, inc. BUN May be found as 2ndary to retinal hemorrhage (HTN), or abnormal urine test CVA, severe nose bleed, inc. Nocturia Peri-cardial friction rub and Pulsus Pardoxis! Labs & Dx: Hyper K+ Metabolic Acidosis Anemias—2ndary to dec. erythropoietic activity Hypo albuminemia Inc. PO4 & dec Ca++ (remember relationship) Hyper Mg++ Abnormal Nervous Conduction CXR-pulmonary edema— EKG—may show peaked T waves because of Hyper K+ TX: supportive and symptomatic Treat HTN, dec protein in diet, Dialysis as needed, Nursing: Fld & e-lyte changes Watch for dec. renal fct—dec u/o, puffy, swollen pt Educate family how they can best help pt.
s/s of nephrotic syndrome
–MASSIVE PROTEINURIA –HYPOALBUMINEMIA –HYPERLIDIDEMIA –PERIPHERAL EDEMA
describe the nephrotic syndrome cycle

•A vicious cycle…….
•Nephrotic syndrome •POSSIBLY IMMUNE, FLUID SHIFT FROM PLASMA TO INTERSTITIAL, CAUSES HYPOVOLEMIA STIMULATES RENIN-ANGIO AND ALDOSTERONE. NA+ AND WATER RETAINED, K+ EXCRETED, STARTS AGAIN • NORMAL 1-14/ PROTEIN >3500MG/DL  24HOURS •GOALS OF TREATMENT/ *REOCCURS
goal of nephrotic syndrome treatment
reduce edema
tx for nephrotic syndrome
Treatment is symptomatic- goal is to relieve edema and treat underlying cause if known
•cautiously use diuretics, anti-inflammatory drugs
•lo sodium diet
•additional protein in diet if loss is excessive
•Severe cases may be treated with steroids and cytoxan
nursing interventions for nephrotic syndrome
Major intervention is dealing with the edema: assess edema frequently, visual and measure abd girth,or extremity size, daily weight, I&O-compare daily  monitor foods eaten, pt. may become malnourished, may be anorexic Supportive care, altered body image
t/f the normal urinary tract is sterile above the urethra
true
how are UTI's generally classified
upper or lower.. and uncomplicated or complicated
Types of Lower UTI
Bacterial cystitis-inflammation of the urinary bladder bacterial prostatitis-inflammation of the prostate gland bacterial urethritis-inflammation of the urethra  
t/f lower UTI are more common than upper UTI
true
types of upper UTI
acute or phronic pyelonephritis-inflammation of the renal pelvis, interstitial nephritis- inflammation of the kidney, and renal abscesses
complicated UTI
occur in people with catheterization and urologic abnormalities and often time need hospitalized.
uncomplicated UTI
community acquired
what is the most common site for nosocomial infections
urinary tract
What are the mechanisms that maintain the sterility of the bladder
1. the physical barrier of the urethra 2. urine flow 3. ureterovesical junction competence 4. variaous antibacterial enzymes and antibodies 5. antiadherent effects mediated by the mucosal cells of the bladder
pathophysiology of UTI
for infection to occur.. 1. bacteria must gain access to the bladder 2. attach to and colonize the epithelium of the urinary tract 3. avoid being washed out with voiding 4. evade host defense mechanism 5. initiate inflammation
how does the bladder fight of bacteria
by increasing the normal slow shedding of bladder epithelial cells resulting in bacteria removal. glycosaminoglycan (GAG)-exterts a nonadherent protective effect against bacteria  
what factors effect glycosaminoglycan
saccarin, cyclamate, aspartme and tryptophan metabolites
what is the first laboratory indicator of renal disease
increased creatinine
what does increased creatinine mean
concentrated urine.. dehydration
what are abnormal findings in urine
GLUCOSE

PROTEIN

BLOOD

KETONES AND BILIRUBIN

BACTERIAL ORGANISMS
what does BUN measure
conc. of urea in blood/ HF dehydration
what is the normal BUN range and what does it identify?
RANGE 10-30 MG/DL
IDENTIFY RENAL PROBLEMS. UREA IN BLOOD REGULATED BY KIDNEY UREA EXCRETION
what is the normal creatinine range and what does it measure
RANGE .5-1.5 MG/DL.
    MORE RELIABLE THAN BUN., END PRODUCT OF PROTEIN METABOLISM, specific to kidney function
The best estimate of functioning renal tissue is:
GFR
Blood urea nitrogen (BUN) levels _____ as glomerular filtration decreases
increase
Casts take the shape of:
renal tubules
The specific gravity of urine in older adults is normally:
low normal
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