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488 > Class 7: Renal > Flashcards

Class 7: Renal Flashcards

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1
Q

Diagnostic testing for the renal system

A

-Urinalysis & culture
-CrCL, kidney, ureter & bladder studies
-Ultrasound, CT, MRI, nuclear scan, & renal angiography

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2
Q

Diagnostic tests cont’d + Renal

A

-Urologic endoscopic procedures
-Renal & ureteral brush biopsy
-Kidney biopsy, urodynamic test

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3
Q

CrCl

A

-Creatinine clearance estimates the GFR (volume of filtrate made by the kidneys per minute)
-Urine and Cr levels are measured along with a 24hr urine
-Clearance can then be calculated using a CrCl blood spec & 24hr urine

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4
Q

With kidney failure CrCl is…

A

Chronically low

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5
Q

CrCl normal ranges

A

-Patrick Kane & Mcdavid, difference of 40mL/min
-Female: 88-128mL/min
-Male: 97-137mL/min

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6
Q

Adult voiding dysfunction + nursing management of UI

A

-Behavioural therapy, pt teaching
-Pharmacological or surgical management

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7
Q

Nursing management of urinary retention

A

-Promote normal elimination, pt teaching
-Foley
-Pharmacological or surgical management

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8
Q

Nursing care of a UTI

A

-Colony counts (bacterial content)
-Frequency & urgency
-Fluid balance, hygiene
-Risk for ARF or urosepsis
-Pharmacological therapy & pain management

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9
Q

Prevention of UTIs

A

-Avoid unnecessary catheterization and early removal of catheters.
-Cranberry juice or cranberry essence may help decrease risk.

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10
Q

Acute intervention of UTIs

A

-Adequate fluid intake:
-Dilutes urine, decreasing irritablity
-Flushes out bacteria before they can colonize

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11
Q

What to avoid in UTIs + acute intervention

A

Avoid caffeine, alcohol, citrus juices, chocolate, and highly spiced foods as they are potential bladder irritants

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12
Q

Relief/recovery from UTIs

A

-Application of local heat to suprapubic or lower back may relieve discomfort
-Emphasize taking full course of antibiotics despite disappearance of symptoms
-Second or reduced drug may be ordered after initial course in susceptible patients
-Instruct patient to watch urine for changes in colour and consistency and decrease in cessation of symptoms
-Counsel on persistence of lower tract symptoms beyond treatment; onset of flank pain or fever should be reported immediately

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13
Q

Pyelonephritis

A

Kidney infection, type of UTI

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14
Q

Pyelonephritis + Nursing care of an infection

A

-Pharmacological therapy
-Urine spec, blood Work
-Ins & outs, VS monitoring & pt teaching

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15
Q

Nursing care of an infection cont’d

A

-Relapses may be treated with 6-week course of antibiotics
-Follow-up urine culture and imaging studies
-Re-infection treated as individual episodes or managed with long-term therapy; prophylaxis tx may be used for recurrent infection.

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16
Q

Nursing & collaborative management: Acute glomerulonephritis

A

-Focused on symptom management:
-Rest until signs of glomerular inflammation (proteinuria, hematuria) and HTN subside
-Edema is treated by restricting sodium and fluid intake and by administrating diuretics
-Severe HTN is treated with antihypertensive drugs
-Dietary protein intake may be restricted

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17
Q

Glomerular disease

A

Difficult to maintain balance of substances in the bloodstream

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18
Q

Nursing care of glomerular disease

A

-Ins & outs
-Hematuria & symptom management
-Pharmacological therapy
-Dietary protein & Na+ Restriction
-R&R, follow-up

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19
Q

Nephrotic syndrome

A

Causes the body to pass to much protein in the urine

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20
Q

Nephrotic syndrome + nursing care of primary glomerular disease

A

-Urine & blood spec
-Complications: Clots, elevated cholesterol, poor nutrition, HTN, AKI & CKD
-Pharmacological therapy
-Dietary restrictions, pt teaching

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21
Q

Acute renal failure/acute kidney disease + those at risk include

A

-Major surgery or trauma
-Receiving nephrotoxic medications or are elderly

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22
Q

Stages of acute renal failure

A

-Onset – 1-3 days with ^ BUN & Cr, possible decreased urine output
-Oliguric – urine output < 400mL/d, ^BUN, Cr, Phos, & K+ may last up to 14 d
-Diuretic – urine output ^ to as much as 4000 mL/d but no waste products, at end of this stage may begin to see improvement
-Recovery – things go back to normal or may remain insufficient and become chronic

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23
Q

Acute renal failure + diagnostic tests

A

-BUN, Cr, Na+ & K+. pH; bicarb. Hgb and Hct
-Urine studies
-Abdominal and renal CT/MRI
-Retrograde pyelogram

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24
Q

Acute renal failure medical tx

A

-Fluid & dietary restrictions
-Maintain lytes
-Dialysis to jump start renal function
-Stimulate production of urine with IV fluids, dopamine or diuretics

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25
Acute renal failure + medical tx cont'd
-Hemodialysis, peritoneal dialysis -Continuous renal replacement therapy (CRRT); does not require dialysate
26
Acute renal failure + Nursing intervention
-Monitor I/O & lab results -Watch for symptoms of hyperkalemia: malaise, anorexia, paresthesia, muscle weakness & EKG changes -Watch for hyperglycemia or hypoglycemia if receiving TPN or insulin infusions -Maintain nutrition, daily weights -Assess for signs of HF, GCS
27
AKI tx
-Nutritional therapy -Renal Replacement Therapy (Hemo or peritoneal dialysis) -Kidney transplant
28
Goals of tx of AKI
-Eliminate cause, manage S&S -Prevent complications during recovery
29
Nursing interventions of AKI
Health promotion, acute intervention, ambulatory and home care
30
Age-related considerations: AKI
-Less able to compensate for changes in volume, solute load, and CO -Older adults are more susceptible because they have fewer functioning nephrons -Causes of AKI in older adults include aminoglycosides, dehydration, diuretics, hypotension, infection, obstructive disorders, radiocontrast agents & surgery
31
Impaired function of other organ systems can..
Increase the risk of developing AKI
32
Diuretics
-First line antihypertensive -Decrease plasma and ECF volumes which decreased preload, CO, and PVR = Decreased workload of the heart
33
Types of diuretics
-Potassium sparing, thiazide and loop diuretics -Thiazide diuretics are the most commonly used diuretics for HTN
34
Classes of diuretics
-Carbonic anhydrase inhibitors -Loop, osmotic, potassium-sparing, and thiazide & thiazide-like diuretics
35
1st line tx of HTN
Thiazide & thiazide-like diuretics
36
Rapid diuresis diuretics
Loop diuretics
37
Tx of CV conditions (MI) + Diuretics
Potassium-sparing diuretics
38
Carbonic anhydrase inhibitors
-Acetazolamide & methazolamide
39
Loop diuretics
Bumetanide, ethacrynic acid & furosemide
40
Osmotic diuretics
Mannitol
41
Potassium-sparing diuretics
Amiloride, eplerenone, spironolactone & triamterene
42
Thiazide and thiazide-like diuretics
Chlorothiazide, hydrochlorothiazide, indapamide & metolazone
43
Slide 39 & 40
44
Thiazide diuretics
-First-line defense of HTN
45
Thiazide diuretic MOAs
-Inhibits reabsorption of Na+, K+ & Cl- resulting in osmotic water loss -Relax arterioles (reduces afterload) -Precipitate hypokalemia and hypercalcemia, hyperglycemia, hyperlipidemia, hyperuricemia
46
Indication of thiazide diuretics
-HTN -Edematous state d/t HF, liver cirrhosis, corticosteroid or estrogen therapy
47
Contraindications for thiazide diuretics
Hepatic coma (metalozone), anuria and severe kidney failure
48
Adverse effects of thiazide diuretics
-Electrolyte disturbances -Dizziness (plasma shifts) -GI disturbances, thrombocytopenia -Pancreatitis, cholecystitis -Headache, impotence
49
Electrolyte disturbances in thiazide diuretics
-Reduced K -Elevated Ca+, lipids, glucose, and uric acid
50
Loop diuretic MOA
Reduces BP, PVR, SVR (afterload), CVP (preload), & LV end-diastolic pressure
51
Indications of loop diuretics
-Edema (r/t sided HF), HTN -Fluid accumulation d/t liver and kidney disease -Improve respiratory function d/t pulmonary edema (left sided HF)
52
Contraindications of loop diuretics
-Drug allergy or allergic to sulfa abx -Hepatic coma -Severe electrolyte loss (Na and K)
53
Adverse effects of loop diuretics
-Severe electrolyte loss and dehydration -Each medication has specific AE such as furosemide; ototoxicity, photosensitivity
54
Potassium sparing diuretic
-AKA aldosterone inhibiting diuretic -Spironolactone is the most commonly used medication
55
MOA potassium sparing diuretic
Blocks reabsorption of Na+ and water which are excreted, and K+ retained
56
Potassium sparing diuretic indications
HF
57
Contraindications of potassium sparing diuretics
Hyperkalemia, anuria & severe kidney failure
58
Adverse effects of potassium sparing diuretics
-Spironolactone: Gynecomastia, amenorrhea, irregular menses, and postmenopausal bleeding -Triamterene: Causes kidney stones by reducing folic acid levels
59
Special considerations in pediatrics + calculations
-Calculate carefully because pediatrics are at greater risk for adverse effects (excess fluid volume, electrolyte loss, hypotension, and shock) and toxicity
60
Furosemide considerations in pediatrics
Increased half-life
61
Pediatric considerations when taking diuretics
-Avoid lengthy exposure to either heat or sun; increased risk of heat stroke, exhaustion, and fluid volume loss
62
Thiazide diuretics in pregnant women
-Cross the placenta and pass through to the fetus -Breastfeeding is not advised for mothers who are taking these drugs
63
Lab results + diuretics
-Ca+, glucose & uric acid -BUN, Cl-, Mg+, K+, & Na+ (loop diuretics)
64
Mannitol works in the...
Proximal tubule & descending loop of Henle
65
Acetazolamide works in the...
Proximal tubule
66
Loop diuretics work in the...
Ascending loop of Henle
67
Thiazide diuretics work in the...
Distal tubule
68
Potassium-sparing diuretics work in the...
Distal tubule & collecting duct

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