Chapter 39 terms
Erythropoietin: A hormone produced by the kidneys that stimulates the production of red blood cells in
bone marrow.
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Interventions/Significance:
o Monitor RBC Indices (RBC, MCV, MCH, MCHC, and RDW) for any changes in
erythropoietin levels in the body.
o Erythropoietin-stimuating medications are used to treat anemia that result from chronic
kidney disease, inflammatory bowel disease, or cancer treatment.
Staghorn Calculus: a calculus or stone that remains in the renal pelvis and becomes so large that it fills
more than one calyx, blocking the flow of urine
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S/S: severe pain at first, then becomes a constant dull pain. N/V and dysuria can occur
Test: ultra sound, CT, urinalysis, KUB (kidney/ureter/bladder radiography)
Treatment: pain control. Vigorous hydration to pass stone, shock wave therapy, surgical
intervention if too big to pass (uerteroscope, cyotocscope)
Nursing: determine the composition of the stone, strain urine to catch stone, encourage
fluids & walking, give pain meds
Oliguria: decreased output of urine. <400mL in 24 hours. S/S of Acute Glomerulonephritis
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Indications/significance:
o Monitor patients I&O
o Determine cause of decreased urine output
o Administer diuretics as ordered
o Assess for inflammation and/or infection of the kidneys or urinary tract.
o Monitor Chem 7 Panel for any fluid and electrolyte imbalances due reduced excretion of
wastes.
Azotemia: increased blood urea nitrogen caused when kidneys are unable to excrete normally. S/S of
Acute Glomerulonephritis
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Incidence/significance:
o Azotemia is suggestive of the kidney’s inability to excrete metabolic waste products.
o Monitor Chem 7 Panel for any fluid & electrolyte imbalances due to kidney’s inability to
excrete waste products.
o Monitor for s/s of azotemia:
 Confusion, decreased alertness, decreased or no urine production, dry mouth,
tachycardia, fatigue, pallor, swelling, and thirst.
Hematuria: the presence of blood in the urine. S/S of Acute Glomerulonephritis
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Interventions/ significance:
o Monitor I/O of patient and document presence of blood in urine and the characteristics
(pink-tinge, presence of clots, etc. )
o Assess the patient treat the underlying cause of the bleeding. (UTI, AKI, Cancer, Enlarged
prostate, etc.)
Anuria: total loss of urine production. S/S of Acute renal failure
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Interventions/ significance:
o Treat underlying cause (kidney failure, kidney stones, tumors)
o Monitor Chem 7 Panel for fluid & electrolyte imbalances due to inability to excrete
waste products.
 S/s of waste product toxicity: lack of appetite, weakness, n/v.
o Treatment with urinary catheter for obstruction, treatment with Mannitol to increase
removal of water from blood (contraindicated in renal disease)
Anasarca: total body edema. S/S of Acute renal failure
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Treat underlying cause of anasarca (liver failure, renal failure, right-sded heart failure,
malnutrition)
Follow fluid restriction orders on client.
Monitor Chem 7 Panel, specifically sodium which causes increased water retention.
Monitor I/O
Kussmaul’s Respirations: deep, sighing respirations that result from acidosis. S/S of Autre renal failure
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Interventions/ significance:
o Assess patient’s respiration rate, rhythm, and depth. (Should be deep and rapid
respirations)
o Monitor ABG’s and blood pH for presence of metabolic acidosis.
o Monitor Chem 7 panel for fluid & electrolyte imbalances due to reduced ability to
excrete waste products through kidneys.
End Stage Renal Disease (ESRD): when pt reaches the stage of total kidney failure
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S/S: GFR <15, on dialysis
Nursing: Slow progression of disease. Teach about dialysis and renal transplant.