10.1 Renal Flashcards

Question

BPH Management

Answer 1

- Lifestyle changes such as limiting beverages at night and avoiding caffeine, alcohol, decongestants, or antihistamines. Void when the urge to is first felt

Answer 2

- Alpha Adrenergic Blockers - Tamsulosin, Alfuzosin, Terazosin. Used to relax prostate muscles but does not effect prostate size. Relieves urinary obstruction. Can cause headaches, fatigue, problem ejaculating, or lightheadedness - 5-alpha reductase inhibitors - blocks conversion of testosterone to DHT. DHT is what causes prostate enlargement. Can cause reduction in size of prostate. (Finasteride, Dutasteride) - Combination of the 2 can be used together

Answer 3

- Transurethral Resection of Prostate - Instrument is put into urethra through the penis to shave away parts of the inner prostate - Lasers can also be used to remove prostate tissue and causes less bleeding - Microwaves can be used to kill prostate cells causing it to shrink

Answer 4

PREOP - Antibiotics for existing UTI, teaching of catheters, teaching of continuous bladder irrigation in post-op POSTOP - Continuous bladder irrigation (monitor for bleeding or clots) clots are expected in the first 24-36 hours. Manually irrigate to relieve clots or blockage of the catheter - Bladder irrigation is done through 3 way foley catheter with normal saline. Flow rate should maintain a rose color of the fluid and done for 24-48 hours. Monitor for infection, catheter care, frequent urination and erectile dysfunction.

Answer 5

- Impotence - Inability to sustain erection - Can be caused by age, prostate surgery, chronic illness

Answer 6

- Originally used for pulmonary hypertension - Can be dangerous if used with other vasodilators (alpha adrenergic blockers and nitrates) - Absorption is slowed by high fat meals - Can cause Hypotension, dyspepsia, flushing, priapism, nasal congestion, obstructive sleep apnea. Can also rarely cause optic neuropathy, and hearing loss. INTERACTIONS Nitrates - cause life threatening hypotension Alpha Blockers - Postural Hypotension SILDENAFIL SHOULD NOT BE TAKEN BY PATIENTS TAKING NITROGLYCERIN OR OTHER NITRATES - DO NOT TAKE IF HF, HYPO/HYPERTENSION, OR UNSTABLE ANGINA

Answer 7

PDE5 Inhibitor 2 - Vardenafil and Tadalafil Alprostadil - Injected directly into penis

Answer 8

- Acute Renal Failure - Rapid loss of kidney function with rise in serum creatinine and reduction in urine output - Accumulation of nitrogenous waste, BUN and Creatinine in blood (azotemia). Reversible but mortality rate is high.

Answer 9

- Caused by AKI | - Accumulation of nitrogenous waste, BUN, and creatinine in blood

Answer 10

- Hypovolemia/Hypotension - Reduced Cardiac Output - HF - Obstruction of kidneys/lower urinary tract - Obstruction of renal arteries/veins

Answer 11

- External causes that reduce blood flow to kidneys - Dehydration/Hypovolemia/Hemorrhage/Decreased Perfusion/HF/Reduced Cardiac Output - These cause decrease in GFR and cause oliguria (less than 400 mL urine per day) - Reversal may be possible with fluid replacement

Answer 12

- Direct damage to Kidney Tissue - Prolonged ischemia, nephrotoxic drugs, trauma (crush injuries) which cause hemolyzed RBC's and myoglobin to circulate and damage renal tissue.

Answer 13

- Death of tubular epithelial cells from renal tubules - Most common cause of AKI - Caused by ischemia (kills basement membranes) and nephrotoxic drugs (kills tubular epithelial cells) - Reversible if ischemia does not kill basement membranes

Answer 14

- Inflammation of glomeruli caused by immunologic processes - Can develop after strep (APSGN - Acute Poststreptococcal GlomeruloNephritis) - Can also be caused by pyelonephritis (inflammation of renal parenchyma and collecting system)

Answer 15

- Repeated acute glomerulonephritis, hypertensive nephrosclerosis or hyperlipidemia - Results in renal insufficiency and go asymptomatic for years - Labs include fixed specific gravity, casts, proteinuria, electrolyte imbalances, hypoalbuminemia

Answer 16

- Results from post-infectious glomerulonephritis - INFLAMMATION - Hematuria, edema, azotemia, proteinuria, hypertension - Treated with diet modification, antibiotics, corticosteroids, and immunosuppressants

Answer 17

- Anything that damages glomerular membrane leading to increased permeability of plasma proteins - Results in hypoalbuminemia and edema - Managed through drug and diet therapy - PROTEIN IN URINE

Answer 18

- Caused by obstruction from bladder cancer, prostate cancer, BPH (benign prostatic hypertrophy), calculi, trauma, extrarenal tumors.

Answer 19

- Occurs 1-7 days after injury and lasts 7-14 days - Urine output less than 400 mL a day - Urinalysis may show cast, RBC's, and WBC's - Fluid overload can cause HF, pulmonary edema, pericardial/pleural effusion - Can cause metabolic acidosis with decreased bicarbonate and kussmaul respirations - Increased excretion of sodium which leads to hyponatremia and cerebral edema - Potassium excess can go unnoticed but can cause ECG changes - Can cause leukocytosis - Elevated BUN and Serum Creatinine - Can cause fatigue/difficulty concentrating/seizure/stupor/coma

Answer 20

- Monitor I&O - Determine dietary adjustment (low potassium if they are high in potassium, and determine if protein should be limited) - Determine need for hemodialysis (acute) or peritoneal dialysis (chronic)

Answer 21

- Occurs when AKI is corrected - Daily urine output is 1-3 liters a day and may reach 5L or more MONITOR FOR - Hyponatremia - Hypokalemia - Dehydration

Answer 22

- May take 12 months to recover but BUN and Serum Creatinine should decrease

Answer 23

- Assessing cause of dehydration - Serum Creatinine (not evident until 50%+ loss of kidney function) - Urinalysis (osmolarity, sodium, specific gravity, urine sediment, hematuria, pyuria (pus in urine), crystals - Kidney Ultrasonography IS THE FIRST TEST DONE - Renal scan to check abnormal blood flow, tubular function and collecting system - CT scan to identify any lesions or masses - BIOPSY IS THE BEST WAY TO DETERMINE INTRARENAL CAUSES - Contrast Induced Nephropathy (CIN) is when the contrast used causes kidney damage. PREVENT THIS

Answer 24

- Reversible - Adequate fluid intake and output managed with diuretics - Monitor fluids during oliguria phase and check for lung crackles, or fluid overload - Hyperkalemia is the most serious electrolyte disorder in AKI (Administer insulin and sodium bicarbonate to push potassium back into cell) - Calcium gluconate can be given to prevent heart damage - Sodium Polystyrene can be given to eliminate potassium from the body

Answer 25

- Leading cause of End Stage Kidney Disease (ESKD) - Associated with hypertension and diabetes - Irreversible loss of kidney function - GFR less than 60 mL/min for longer than 3 months

Answer 26

- Poor function of kidneys due to poor blood flow to kidneys

Answer 27

BUN - Concentration of urea (product of protein metabolism) in the blood. Not specific for renal function. Normal value is 10-20. Increase can also be caused by increased protein intake, fever, corticosteroids, and catabolic states. Creatinine - End product of muscle and protein metabolism. Normal level is 0.6-1.1. Elevated in renal disease. GFR - Amount of blood filtered by glomeruli each minute. Creatinine and GFR is the best way to calculate kidney function. Serum Creatinine - Calculated GFR is more accurate than creatinine for kidney function. When adults age, there is a natural decline in GFR so creatinine is more preferred in these cases.

Answer 28

``` Stage 1 - Normal between 90-120 Stage 2 - Normal between 60-90 Stage 3 - Between 30-60 Stage 4 - Between 15-30 ESKD (Stage 5) - Between 0-15 ```

Answer 29

- History of diabetes/hypertension - Risk for contrast-associated nephrotic injury - Assess hydration and hyperkalemia (most serious imbalance for CKD)

Answer 30

- Uremia (elevated urea in the blood) | - Incorporates all signs and symptoms seen in various body systems

Answer 31

- Polyuria due to kidneys not being able to concentrate urine. - Occurs at night - Urine specific gravity is fixed at 1.010 - Oliguria (less than 400 mL) happens when CKD becomes worse - Anuria urine output less than 40 mL in a day

Answer 32

- Altered Carbohydrate Metabolism - Impaired glucose metabolism can cause insulin resistance. - Can cause hyperglycemia and hyperinsulinemia - Dialysis can help but will not return glucose or insulin to normal values - Diabetes patients with CKD may require less insulin because the kidneys cannot excrete it as well, meaning it stays in circulation for longer - Patients who need insulin before dialysis may not need it when they start dialysis - Hyperinsulinemia causes higher triglyceride levels - Lipid metabolism is altered due to less lipoprotein lipase (used to breakdown lipoprotein)

Answer 33

- Hyperkalemia is the most dangerous causing dysrhythmias - Hypernatremia due to impaired excretion causing edema, HTN, HF - Metabolic Acidosis due to inability to excrete acid and retain bicarbonate

Answer 34

- Kussmaul Respirations from acidosis - Dyspnea from fluid overload - Pulmonary edema from fluid overload - Respiratory Infection - Uremic Pleuritis

Answer 35

- Excess urea affects all areas of GI - Mucosal Ulceration - Stomatitis - Uremic Fetor (odor of urine in breath) - GI Bleed - Anorexia/Nausea/Vomiting/Constipation

Answer 36

- Altered Mental Status - Seizure - Coma - Dialysis Encephalopathy

Answer 37

Skin - Pruritis, Uremic Frost (metabolic waste through skin) Musculoskeletal - CKD Mineral and Bone Disorder (CKD-MBD) Bone Remodeling that causes softening of bones (osteomalacia) and vascular calcification

Answer 38

- Substances/toxins removed from body through semi-permeable membrane into dialysis solution (dialysate) - Used in ESKD to correct fluid/electrolytes and remove waste products - Used when uremia can no longer be managed or when GFR falls below 15 mL/min

Answer 39

- Diffusion (solutes move from greater concentration to lower concentration - Osmosis (Water moves from lower concentration to greater concentration solutes) - Ultrafiltration (water and fluid removal due to osmotic gradient over membrane)

Answer 40

- Catheter is inserted through the abdominal wall - Preparation for catheter placement includes emptying bowels and bladder, weighing patient, and obtaining consent form - Wait 7-14 days after catheter insertion before using it - Site should be healed in 2-4 weeks where patients can shower and pat the insertion site dry - Showering is preferred over baths because catheter cannot be submersed in water. - Check insertion site daily for redness, swelling, drainage or tenderness

Answer 41

Inflow - Solution (dialysate) is infused into catheter over 10 minutes then inflow clamp is closed to prevent air from entering the tube Dwell (equilibration) - Diffusion and osmosis occur between blood and peritoneal cavity which can last anywhere between 20 minutes to 8 hours Drain - 15-30 minutes where fluid is drained out of peritoneal cavity via gravity. Massaging the abdomen or position change can make this step quicker PERITONITIS - Cloudy drainage which should be reported

Answer 42

- Allows patient to do dialysis while they sleep so it is preferred - Machine can do 4+ cycles a night taking 1-2 hours per exchange

Answer 43

- Manually done 4 times a day

Answer 44

- Exit Site Infection (nurses should assess clients understanding that this needs to be a sterile technique. The most common bacteria for infection is strep and staph) - Peritonitis - Cloudy drainage. Obtain specimen for culture/sensitivity. Most often happens due to improper technique - Hernia - Due to intraabdominal pressure during dialysate infusion. More common in obese or multiparous women and older men. - Lower back problems - due to intraabdominal pressure from dialysate - Bleeding - Pulmonary complications such as atelectasis, pneumonia, bronchitis due to repeated displacement of diaphragm - Protein loss - Advantages include only taking 3-7 days to learn, increased patient independence, improved ease of traveling, greater mobilization, fewer dietary restrictions

Answer 45

- Artificial membrane made of cellulose - Blood is removed from a surgically created fistula via a catheter and pushed into a dialyzer - Dialysate is pumped in and flows opposite way of blood - Heparin is infused either as a pre-dialysis bolus or via heparin pump to prevent blood clotting in the machine - Blood is then returned to body and dialysate is drained/discarded

Answer 46

- Most difficult issue is gaining vascular access - Types of access include arteriovenous fistulas/grafts, temporary catheters, or percutaneous cannulation of internal femoral and jugular vein for immediate access - AV fistulas have best patency and least complications - AV fistulas create a connection between an artery and a vein usually in the forearm - Takes 3 weeks for fistula to heal and be used - Patency is assessed via palpable thrill or auscultated bruit

Answer 47

- 2 needles, 1 to take blood out and 1 to put blood back in | - Dialyzer and blood lines need to be primed with saline to eliminate air

Answer 48

- Protect vascular access (patency, infection, do not check BP on that arm or draw blood) - Monitor fluid balance, IV therapy, I&O - Monitor signs of uremia, electrolyte imbalance - Monitor cardiac/respiratory status carefully - Cardiovascular medications must be held prior to dialysis

Answer 49

- In CKD it is used to treat edema, lower BP, and lower potassium in hyperkalemia patients

Answer 50

- Loop Diuretic - Blocks reabsorption of sodium and chloride which prevents reabsorption of water in the loop of Henle. - Used for BP management and mobilization of fluids for pulmonary edema NURSING INTERVENTIONS - Monitor BP, potassium (note decrease in potassium) especially for digoxin toxicity - Can cause ototoxicity after rapid IV infusion (monitor tinnitus and balance disturbances) - Can cause hypomagnesemia (Monitor weakness, muscle twitching, tremors) - Monitor weight - Educate patient on foods high in potassium and risk of orthostatic hypotension

Answer 51

- Thiazide Diuretic - Block sodium and chloride reabsorption thereby preventing water reabsorption in the early distal convoluted tubules. - First drug of choice for HTN, also used for moderate HF NURSING INTERVENTIONS - Assess signs of dehydration and electrolyte imbalance - Monitor for increased blood glucose - 2 doses a day, 2nd dose should be before 2pm to prevent nocturia - Educate patient on monitoring BP and weight - Does not cause ototoxicity x

Answer 52

- Potassium Sparing Diuretic - Blocks aldosterone which in turn eliminates sodium and water and retains potassium - Can be used with loop or thiazide diuretics - ACE inhibitors, Angiotensin Receptor Blockers, and Direct Renin Inhibitors can cause elevated potassium - If used with potassium supplements, hyperkalemia is at risk

Answer 53

- Osmotic Diuretic - Given via IV to raise serum osmolarity which draws fluid back into vascular and extravascular spaces. Pulls water into the tubules along with electrolytes to be excreted - Reduces Intracranial Pressure and Intraocular Pressure RISKS - Contraindicated in head bleed, severe pulmonary edema, severe dehydration, and renal failure - Increased risk of hypokalemia with digoxin (cardiac glycoside) - Monitor lithium levels because it is excreted in urine

10.1 Renal Flashcards

(78 cards)