NRNP 6550 FINAL EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED

NRNP 6550 FINAL EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED Terms in this set (188) Stages of CKD o Stages - 5 stages 80 - 120 ml/min § 1: Kidney damage (protein in the urine) and Normal GFR 90 § 2: Mild decrease in GFR 60 - 89 § 3a: Mild-Mod. GFR 45 - 59 § 3b: Mod-severe GFR 30 - 44 § 4: Severe decrease GFR 15 - 29 § 5: ESRD GFR 15, uremia, cardiovascular disease. Prerenal renal failure Characterized by diminished renal perfusion resulting from a decrease in blood supply to the kidneys: NO NEPHRON damage - Decreased blood supply; intravascular volume depletion, vasodilatory states - Increased tubular sodium and water reabsorption, causing: oliguria, decreased urine sodium, high urine osmolality, increased urine specific gravity caused by: Intravascular Volume depletion: absolute decrease in blood volume: - Hemorrhage - GI losses (diarrhea, vomiting, large amt of NGT aspirate or pancreatitis) - Urinary losses (e.g DI & use of diuretics) - Skin losses (e.g., third spacing, large surface area burns, or wounds. Vasodilatory States: relative decrease in blood volume: - Sepsis - Anaphylaxis - Drugs a. ACE inhibitors b. NSAIDs c. Diuretics Decreased CO relative decrease in blood volume - Severe systolic heart failure - MI - Cardiogenic shock Arterial occlusion/vasoconstriction states (e.g., catcholamines) Liver disease: advanced hepatic disease with cirrhosis that may cause relative hypovolemia d/t splanchnic pooling or hepatorenal syndrome d/t vasoconstriction in the kidneys Result: - low urine volume - increased urine creatinine with normal serum creatinine - minimal proteinuria - serum K moderately increased - serum phos moderately increased - serum calcium normal - normal renal size on US 4. Low Na+ 5. Low H2O 6. High osmolality (500 and up) 7. High uric acid 8. Specific gravity: greater than 1,010 9. Urinary sodium: less than 20 10. Sediment*: 0 (hyaline casts) 11. BUN/ creat ratio: greater than 10/1 Urine culture with UTI 100.000 colonies in asymptomatic: bacteruria 10 - 10.000 colonies in symptomatic patients but also pyuria pyuria: more than 10 leukocytes elevated erythrocytes with pyelonephritis WBC in urine false positive with tumor, urethritis and poor collection technique Repeat in pregnant women Lower urinary tract UTI and upper urinary tract UTI bladder and urethra: cystitis/ urethritis/ prostatitis kidney and ureters: pyelonephritis/ renal abcess Uncomplicated and complicated uti Uncomplicated: in normal working urinary tract Complicated: defects in urinary tract or with other health problems Common pathogens for UTI E.coli (elderly women) Staphylococcus proteus mirabilis (elderly men) Klebsiella enterecoccus pseudomonas Providencia (institutionalized) Fungus: candida Risk factors for UTI Female critically ill elderly catheter (caused by biofilm) DM calculi, tumor, stricture neurogenic bladder Women: sexual intercourse or new sex partner pregnancy previous UTI Men: prostate enlargement prostatitis lack of circumcision gay HIV Findings UTI Lower: Dysuria/ urgency/ frequency/ incontinence suprapubic pain hematuria fever/ chills uncommon No flank pain Upper: flank pain fever and chills hematuria n/v ams (in elderly) malaise tachycardia/ tachypnea Testing and results for UTI Gold standard: urine culture and sensitivity: detection of bacteria. Start with POC: urine analysis. UA: pos for nitrite or leukocyte or blood CBC: leukocyte with left shift in pyelonephritis For recurrent UTI in women or UTI in men rule out obstruction, calculi, or necrosis with: xr voiding CT abdomen US pelvis MRI pelvis Management acute cystitis First line: - Single dose Fosfomycin (monurol) - 3 day: sulfa: trimethoprim/ sulfa (bactrim) (do not give near delivery of baby, give cephalexin instead) or sulfa - 5 days: nitrofurantoin, caution in elderly Second line: - qiunolones: ciprofloxain or levofloxacin for 3 days (not for pregnant women!) - B-lactams: amoxi-clav, cefdinir for 3 - 7 days Management uncomplicated upper UTI Outpt: quinolone: ciprofloxacin for 7 days or levofloxacin for 5 days Sulfa: trimethoprim/ sulfa (bactrim) for 14 days Inpt: Ceftriaxone or cefotaxime Ampicillin CAUTI: bacterial: treat with AB for 7 days Candiduria: fluconazole for 14 days Discomfort: Pyridium Management acute complicated bacterial pyelonephritis - Admit - Aminoglycosides: gentamicin/ tobramycin (not for monotherapy), based on renal function (trough less than 2 and peak level 5-10mg/L) and do not give for CKD - Ampicillin - Cefazolin - Cefotaxime and Ceftriaxon based on obesity and pulm disease