Exam 1- urinary/renal Flashcards
(270 cards)
1
Q
Raas
long term what
A
long term bp regulator
2
Q
When what drops-what is formed
that converts what to what
then converts into what by what
RAAS
A
When bp drops- renin is formed
Renin converts angiotensinogen into angiontenin 1
Which is then converted into angiontesion 2 by ACE
3
Q
what does angiotensin 2 do
promotes
releases
stimulates
A
promote vasocontriction,
releases ADH and aldosterone(, sodium/ water retention),
stimulates thirst
4
Q
kidneys are what
process what
A
Human Body Regulator
Process waste products, drugs, and toxins and nutrients
5
Q
responsibilities of kidneys
filters through what
regulates
regulates
helps
helps
produces
A
Filtrate through nephrons
Regulate electrolyte (salt) concentrations
Regulate amount of fluid within the body
Help regulate blood pressure
Help maintain acid-base balance
Produce hormones that affect blood and bones
6
Q
What GFR
What urine output
kidneys
A
Must have a GFR between 120-125 mL/min
Urine output at least 30 ml/hour, if able to drink 8 glasses of water a day = urine output could be increased!
7
Q
In order for filtration to occur- need 3 things-
functioning
permeability
proper
A
functioning nephron,
permeability of membrane
proper net filtration
8
Q
if increase in bp
if decrease in bp
what do renal vessels do
A
If increase in blood pressure- renal vessels tend to contrict
If low blood pressure, renal vessels dialate
9
Q
Erthyropietin can be reduced if patient is
h
has
low
A
is hypoxic,
has poor kindey function,
low red blood cells count,
10
Q
what are regulated in small intestine
what vitamin
c
p
A
Vit d
, calcium
phosphate
11
Q
where does kidneys regulate eelctrlyes
what is also released
A
Regulares electrolytes through loop of henle,
antidiaratic hormone (ADH) is also releases,
12
Q
BNP-
released from where/ why
forces what/ increases
stops what hormone
A
releases from right atrium
When there is too much volume -
forcing the system to diuresis, which is increasing urine output
Stops adh hormone so tubes can excrete urine
13
Q
Starlings law-
which is why what
A
the heart can only stretch so much- heart is like rubber band,
which is why you don’t want too much fluid
14
Q
what do kidneys need to make urine
A
Without a functioning nephron, the kindeys are unable to make
urine
15
Q
Renal problems means-
problems with-
eliminating
balanacing
A
eliminating waste products
, balance fluid, electrolytes, acids & bases
16
Q
Renal problems affect other organs and can life-threatening situations
what organs systems
n
c
h
r
A
Neurologic
Cardiac
Hepatobiliary
Respiratory
17
Q
Renal disorders can be caused by:
c
o
I
t
t
n d
A
congenital,
obstructive,
infections,
trauma,
tumors,
neurologic disorders
18
Q
Urinalysis
A
Ph –
Specific gravity –
Protein –
Creatinine (urine) –
19
Q
Serum
A
GFR –
BUN-
Creatinine (serum) –
Creatinine clearance –
20
Q
Urinary Tract Infections Risk factors:
what age
what gender
impaired what
bowel __
d
what active
p
b
c
A
Old Age
Female – short ureter
Obstructions (tumor, calculi, strictures)
Impaired bladder innervation
Bowel incontinence- e coli can get into urethra
Diabetes mellitus
Sexually active-unprotected
Pregnancy
BPH
CAUTI- most often e coli
21
Q
how to prevent uti
what wiping
how much antibiotics
what activity
when follow up
frequent what
voiding when
increase what
decrease what
A
wiping front to back
full course of antibiotics
increase activity
follow up 2 weeks after
frequent bladder emptying
voiding before/after sex
increase fluids
decrease sugar
22
Q
Cystitis- most common uti
what is it
A
Inflammation of the urinary bladder
Bladder mucosa becomes red & inflamed from a bacteria and pus will form
23
Q
Cystitis
what happens
what forms
A
Bladder mucosa becomes red & inflamed from a bacteria
pus will form
24
Q
normal manifestations of cystitis
d
u
n
what type of urine
A
Dysuria,
urgency,
nocturia,
hematuria or cloudy
25
older adults manifestations of cystitis
L
i
changes
lethargy
incontinent
and behavior changes
26
what do you want to get when dealing with cystitis
and why
Obrain a urine analysis and find out what bacteria is sensitive to,
so we can get right antibiotic
27
what type of meds do you start with before culture
after culture then what
broad spectrum antibiotics- ceftriaxone
after culture you get specific antibiotic
28
Cystitis meds
what med
what if pregnant x2
3 day oral quinolone (Flaxacins)
except if pregnant, then ampicillin or cephalosporin (ceft-)
29
Cranberry effectiveness:-in cystitis
might
be careful why
might help w uti because high in vitamin c-
be careful because juice is high in sugar and bacteria feeds on sugar
30
Pyelonephritis- what is it
Inflammation of renal pelvis and parenchyma (functional kidney tissue)
31
Pyelonephritis- why does it happen
results from
usually
Results from an infection that travels to the kidney.
(Usually E.coli
32
Pyelonephritis manifestations
f w/ c
m
what pain
c t
potential
Fever w/ chills,
malaise,
flank pain,
costovertebral tenderness (tender on kidney area),
potential n/v
33
Pyelonephritis
what iv antibiotics
a/g
c
Treatment
ampicillin/gentamicin
ceftriaxone
34
Pyelonephritis
what oral antibiotics
t
s
c
trimethoprim-
sulfamethoxazole
ciprofloxacin
35
Pyelonephritis treatment
iv fluids-
put what
what if possible
want to be
dont want
put multiple lines in-
18 gauge if possible-
want to hyperperfused-
don’t want dehydration
36
pyleonehritis
This is a very serious infection…
may need what
and place what for what
why treat asap- what does that look like
many times including hospitalization
the placement of a PICC line for long term antibiotic therapy
-Treat asap- risk of sepsis( decreased map/bp)
37
One way to differentiate between uti and pyelonephtiritis-
pylo will have extremely high wbc counts
pylo will also have kidney pain
38
Renal / Urinary Calculi-
majority caused by what
why might need hospitalization
what do they get if sent home
Majority of stones caused by calcium stones- painful
May need hospitalization if they have urinary obstruction
If sent home- w strainer and specimen cup(help prevent future stones)
39
foods to avoid in renal/urianry calculi
p
c
b t
w
b
s
potatoes
chohcolate
black tea
wheat
beans
spinach
40
what happens if urinary calculi is not fixed
how do you fix
inc or dec fluid
hydronephrosis
fix w/ receiving symptoms and removing stone
need to increase fluid
41
Renal surgery-Lithotripsy
what does it do
place what after/why
Indicated with: calculi, structural abnormalities, strictures
-sound waves that will bust up calculi that turns it into gravel so you can pass the stone-
also will place a uretral stent
42
why a stent after lithotripsy
does what
prevent what
dilate ureter and make it easier on way out
and prevent backflow urine
43
Renal surgery-Ureteroplasty-
what is it
pt return w x2
Indicated with: calculi, structural abnormalities, strictures
surgical repair of a ureter-
pt will return w a stent and a cathater
44
Renal surgery-
Ureteral Stent.-
how does it work
dont want kidneys to get what
and so you dont get what
Indicated with: calculi, structural abnormalities, strictures
dialates ureter used so urine doesn’t get occluded,
kindey doesn't hydronephrosis
and you don’t get pylonephritis
45
uretral stent teaching
cant do what
give
increase
monitor
what feels like
cannot drive until stent is out,
give pain meds- non nsaids
increase fluids,
monitor i/o,
feels like burning and constant having to pee
46
ureteral stent meds x2
might be on anti inflammatorys ,
might be on phenazopyridine,
47
uretral stent
try to do what
give what
collect what
try to pass sentiment at home
- give cup
collect any sentiment that comes out
48
Renal surgery-
Cystoscopy
what is it
Indicated with: calculi, structural abnormalities, strictures
- camera that is inserted into meatus
49
Uti nursing actions- Releive acute pain-
assess
teach
encourage
assess pain,
teach comfort measures like warm baths, warm packs,
encourage fluids intake,
50
Uti-Restore normal urinary elimation
monitor what
avoid what
use what
use
provide
nursing actions
-monitor urine,
avoid all caffeinated drinks,
use aseptic technique,
use straight cath when possible,
provide peri care,
51
Uti nursing actions-Promote self management-
teach
develop what plan
schedule
teach ways
teach midstream clean catch ,
plan to take meds,
schedule appointemtns,
teach ways to prevent uti,
52
urinary tract tumor
factors-
what in bladder
chronic what
carcinogens in bladder
chronic inflammation
53
urinary tract tumor
difference between papillary lesions and carcinoma in situ
Papillary lesions (papillomas)-polylp like structure, bleed easily, prognosis is good
Carcinoma in situ- flat spots in bladder, poor prognosis, can become invasive
54
urinary tract tumor
manifestation
Intermittent painless hematuria (bleeding in urine) (cancer)
55
urinary tract tumor diagnosis
: UA,
urine cytology,
ultrasound,
IVP,
cystoscopy,
CT/MRI
56
urinary tract tumor- risk factors
what's biggest one
exposure to
exposure to
Smoking,
exposure to checmicals/dye(plant workers and stuff)
exposure to agent orange are huge risks
57
urinary tract tumor- treatments
chemo-mitomycin
what type of chemo
do what w Cath
sent home w
have what
direct contact chemo
lock catheter so it stays contacted-
sent home w 3 way cath
have multiple rounds of chemo) ,
58
urinary tract tumor -another treatment
radiation,
59
urinary tract tumor surgery- TURBT
does what
resection of bladder tumor,
partial cystectomy,
It's an operation to remove an early cancer in your bladder
60
radical cystectomy/urinary diversion- urinary tract tumor
does what
will have what
removal of bladder
and have chronic urinary diversion neph tubes in back)
61
Urinary tract tumor-Promote normal urinary elimination-
monitor what for how long
label what
secure w
encourage
monitor output closely for 24 hrs,
label all caths,
secure urethral caths w tape,
encourage activity
62
Urinary tract tumor- Reduce risk for impaired skin integrity-
assess for
ensure
change
assess for redness,
ensure gravity drainage,
change urine collection appliance
63
Urinary tract tumor-Reduce risk for infection-
maintain what
monitor s/s of infection-t/ what urine/ m/p
maintain separate closed drainage system,
monitor s.s of infection- high temp, cloudy urine, malaise, pain
64
Signs and symptom’s and risks for: infants
L
poor
Child with Genitourinary function disorders- Read maternal child book
lethargic,
or having poor feeds,
65
Signs and symptom’s and risks for: Toddlers-
verbalize
I
i
Child with Genitourinary function disorders- Read maternal child book
verbalize pain,
itching,
incontinence,
66
Signs and symptom’s and risks for:Young children
what bp means renal disease
Child with Genitourinary function disorders-
hypertension
67
Health Promotions for each age group- infants
frequent
how to
Child with Genitourinary function disorders- Read maternal child book
frequent diaper changes
how to provide peri care
68
Health Promotions for each age group- toddlers
dont want
wear
Child with Genitourinary function disorders- Read maternal child book
dont want super tight clothing
wear cotton underwear
69
why might little girls get multiple utis
also check for
Child with Genitourinary function disorders- Read maternal child book
Sometimes multiple utis in little girsl can be because medias is close to rectum before growth spurt so they can get infections there
If frequent look for potential abuse
70
teach kids what
avoid what
Child with Genitourinary function disorders- Read maternal child book
Teach kids how to wipe,
avoid bubble baths
71
loss of glomerulus tissue = what
Age-related changes in the renal system
decreased gfr
1/2 of what it used to be at age 30
72
loss of concentration ability=
inc risk of what
also at risk for what- like what
Age-related changes in the renal system
inc risk of dehydration
fluid/electrlytes imbalances like hyperkalemia
73
decreased drug clearance = what
Age-related changes in the renal system
increased drug toxicity
74
why inc risk for renal failure
Age-related changes in the renal system
nephrotoxic drugs
75
kidney damage stage
1- gfr number
2-gfr number
3-gfr number
4-gfr number
5-gfr number
Age-related changes in the renal system
1-90+
2- 60-89
3-30-59
4-15-29
5->15
76
Polycystic Kidney Disease - hereditary disease
characterized by what
and what else
Characterized by cyst formation
& kidney enlargement
77
how does polycystic kidney disease cause HTN
– cysts all around in/out of kindeys-
will block blood flow and cause vasocontriction(HTN)
78
2 types od polycystis kidney disease
: autosomal dominant
autosomal recessive
79
Manifestations of polycystic kidney disease
what bp
what pain
h
p
u
r c
poly
: HTN
flank pain,
hematuria,
proteinuria,
UTI,
renal calculi
polyuria
80
Treatment of polycystic kidney disease
increase
a
a
d
t
Increase fluids
ACE inhibitors
ARBs
Dialysis
transplant
81
Glomerular Disorders- leading cause of CKD
primary does what
secondary does what
Primary involving mainly the kidney
Secondary to a multisystem disease or hereditary condition
82
Glomerular Disorders
Glomerulus has increased permeability which causes classic manifestations:
h
p
what bp
a
hematuria,
proteinuria,
HTN,
azotenia
83
Primary: what
-why does that happen
Glomerular Disorders
poststreptococcal glomerulonephritis
– strep that is not fully treated, goes to kidneys and will attack kindeys
84
Glomerular Disorders-Secondary
d
untreated
l
: DM,
untreated HTN,
Lupus
85
Glomerular Disorders assessments
watch for
do they have
a
what urine
- watch for imbalanced electrolytes-
do they have edema/ angiodeme(on eyes),
azotemia,
brown concentrated urine,
86
Antiglomerular basement membrane glomerulonephritis-
leads to what
manifestations-(w/n/v/what bp/e/h)
what med
Glomerular Disorders-Acute postinfectious glomerulonephritis-
leads to rapid decline in renal function-
weak, n/v, hypertension, edema, hematuria-
prednisone
87
Goodpasture syndrome (lung involvement)-
seen in what 2 age groups
causes what-s/s
what med
Glomerular Disorders-Acute postinfectious glomerulonephritis-
seen in men under 30 and adults in 60-70-
causes pulmonary hemorrhage, cough sob and bloody sputum are early s/s-
prednisone
88
Nephrotic syndrome-
massive :
p
hypo
hyper
e
t
what med
Glomerular Disorders-Acute postinfectious glomerulonephritis-
massive proteinuria,
hypoalbuminemia,
hyperlipidemia,
edema,
thrombolemboli-
prednisone
89
Chronic glomerulonephritis-
what s/s
Glomerular Disorders-Acute postinfectious glomerulonephritis-
all s.s found at once, usually will see hypertension w impaired renal function
90
Diabetic nephropathy-
seen when
will see what and what
Glomerular Disorders-Acute postinfectious glomerulonephritis-
seen 5-10 yrs within diagnosis of diabetes,
will see artieriosclerosis and pyelonephritis
91
Lupus Nephritis-
ranges from
need to do what
may need
what med
Glomerular Disorders-Acute postinfectious glomerulonephritis-
ranges from microscopic hematuria to massive proteinuria-
need to manage underyling disease,
and may need dialsysis-
prednisone
92
Primary glomerular disorder: Acute post infectious Glomerulonephritis
Patho:
pathogen does what
leads to what
cap membrane does what
a pathogen destroys the structure & function of the glomerulus
leading to problems with filtration.
Capillary membrane becomes more permeable to plasma, proteins, & blood cells.
93
Primary glomerular disorder: Acute post infectious Glomerulonephritis
manifestations
h
p
edema where
a
what bp
hypo
how bad of oliguria
what color urine
Hematuria,
proteinuria,
edema- in face(around eyes-periorbital),
azotemia
HTN,
hypoalbuminemia,
oliguria (less than 400ml in 24 hrs),
, urine that is brown/cola colored,
94
Primary glomerular disorder: Acute post infectious Glomerulonephritis
Watch for s/s that things are getting worse,
c
d
a
problems w
l
changes in
this is when kidneys are giving up
confusion,
disorientation,
angioedema,
problems breathing,
lethargic,
loc changes
95
Urinalysis-what see in
Glomerular Disorders-labs
RBCs, proteins
96
BUN
what = azetonia
what = severe renal disorder
Glomerular Disorders-labs
over 50 mg/dL = azotemia / over 100 mg/dL = severe renal
97
Serum creatinine
Glomerular Disorders-labs
over 4 mg/dL
98
Urine creatinine-what expect
Glomerular Disorders-labs
decreased
99
GFR
what is goal
when does it decrease
Glomerular Disorders-labs
healthy adult the goal is over 60 ml/min /
decreased w/ decreased renal function
100
Creatinine clearance- what is it
Glomerular Disorders-labs
amt. of blood cleared in 1 minute.
Normal is 85-135 mL/min
101
Electrolytes
what k
what calcium
what magnesium
what sodium
Glomerular Disorders-labs
Hyperkalemia,
hypercalcium,
high magnesium,
low sodium
102
what are some meds->
avoid nephrotoxic ones-
x2 (a/c)
Glomerular Disorders-Medical Treatments:
antibiotics (depending on cause)
Avoid any nephrotoxic ones (
aminoglycoside -mycins,
cephalosporins-ceft)
103
Immunosuppressive therapy
Glomerular Disorders-Medical Treatments:
: prednisone (not for poststreptococcal)-
104
oral what
what bp meds
Glomerular Disorders-Medical Treatments:
Oral glucocorticoids- predn"isone"s-inflammation
ACE or ARBs
105
what activity level
how much sodium in diet
how much protein in diet
Glomerular Disorders-Medical Treatments:
Decreased activity (initially )
NA restricted to 1-2 g/day (also fluid restriction)
Decreased dietary protein
106
Nephrotic syndrome puts you at risk for what
Glomerular Disorders-Medical Treatments:
risk of thromboembolism
107
Plasmapheresis-what does it do
used w what
Glomerular Disorders-Medical Treatments:
removes antibodies from plasma-
used w immunosuppressant therapy
treats anti gbm,and goodpastrure syndrome
108
what is final -if all else fails treatment
Glomerular Disorders-Medical Treatments:
Dialysis
109
excess fluid volume
assess-(v/l/m)
monitor what (h/b/c)
restrict
daily
Glomerular Disorders Nursing Care
assess vs/lungs/med effect
monitor electrolytes-h/h,bun, creatinine)
restrict fluids
daily wt
110
Glomerular Disorders Nursing Care-Fatigue
provide what
assist w
teaching about
what meals
Provide adequate rest,
assist with ADL’s,
teaching about fatigue associated with disease,
small frequent meals- rice, pasta
111
Glomerular Disorders Nursing Care-Risk for infection
assess for
monitor what lab
provide what
what procedures
teaching what
Assess for S/Sx of infection,
monitor CBC
Provide good nutrition,
sterile procedures,
teaching to minimize risk of infection
112
Glomerular Disorders Nursing Care- Ineffective Role Performance
support
therapeutic
teaching about
Support coping skills,
therapeutic communication,
teaching about the disease & effects, support services
113
vascular kidney disorder- HTN
damages
accelerates
decreases what
damages walls of arterioles
accelerates athleroscoris
decreased gfr and tubular function
114
renal artery occlusion-vascular kidney disorder-
commonly from what
s/s- what pain, /, f, what bp
commonly from a blood clot
s.s of flank pain, n/v, fever, hypertension
115
vascular kidney disorder- renal artery occlusion- how treat
s
a meds
b meds
surgery
anticoagulant meds
and bp meds like ace/arbs
116
renal artery stenosis-vascular kidney disorder-
why narrowing
leads to what
will need what
what 3 meds are needed
narrowing due to atherosclerosis
leads to HTN
will need dilation/graft
need ace inhibors/arbs and statins and aspirin
117
renal vein occlusion-vascular kidney disorder-
occlusion from what
from what
will need what x2
occlusion from blood clot
from nephrotic syndrome
will need thrombotic and anticoagulant
118
renal vein occlusion-vascular kidney disorder- meds
cant give what
what thrombolytics
Cannot give aspirin
Thrombolytic like tpa, or streptokinase
119
what is priority w vascular kidney disorder -do what w bp
allows what
diuretics need what to work
decrease bp
allows gfr to go up
diuretics need a functioning kidney/gfr to work
120
Kidney Trauma
what causes trauma
kidneys may have what
Blunt/Penetrating injury causes trauma
Kidney may have a contusion -> potential shatter
121
manifestations of kidney trauma
what is turners sign
what s/s of shock(bp/hr/loc)
o
h
what pain
monitor for what
turners sign(may not be initial)- start as slight bruising that is growing
( shock- low bp high hr, low loc)
,oliguria,
hematuria,
flank pain,
monitor for perfusion
122
Diagnosis of kidney trauma
what h/h
what ast
what scan
- low h/h,
high ast,
ct scan
123
Treatment of kidney trauma
what do if bleeding is low
what do if bleeding is severe
what do if shattered
-typically monitor bleeding if low,
if severe attempt to control hemorrahe and prevent shock,
if shattered, only treatment is removal of kindey
124
Renal Tumors
b/m
p/m
Benign or malignant
Primary or metastatic?
125
Renal Tumors-manifestations
h
what pain
what in abdomen
potential
wt
hematuria…always contact your primary provider!- may be in morning only at first/////
flank pain,
abdominal mass,
potential fever,
wt loss
126
Renal Tumors Diagnosis-Smoking is high risk for renal cancer
: ultrasound,
CT scan
, CXR,
bone scan,
MRI
127
Renal Tumors- what inhibit new blood cell formation
what type of drugs
nib' drugs
128
Renal Tumors- main treatment
main is removal of kidney(nephrectomy)
129
Nursing care following nephrectomy(removal of kidney)
Frequent assessments of what
monitor what lab
Frequent assessments of function of remaining kidney including hourly output
monitor cbc
130
monitoring for ( h/ a i)
what are early signs x2
Nursing care following nephrectomy(removal of kidney)
Monitoring for hemorrhage & adrenal insufficiency:
early sign is hypotension and oliguria
131
Nursing care following nephrectomy(removal of kidney)
care of what
no more what
Care of drains
No contact sports
132
Nursing care following nephrectomy(removal of kidney)
what fluid intake
are all fluids the same
Fluid intake -2000-2500 mL/day
Are all fluids the same?- want water, not soda/alcohol
133
nephrectomy- Releive surgical pain-
assess for
assess I
use measures like -p/ g I/ r
assess for pain,
assess incision,
use pain measures such as positioning, guided imagery, relaxation
134
nephrectomy-Reduce risk of breathing pattern that increases risk for postoperatice respiratory complications-
what positions
what frequently
a
frequent what
semi fowlers,
changing positions frequently,
ambulation,
frequent deep breathing,
135
nephrectomy-Maintain fluid balance-
assess what
maintain what
use what
assess dressings,
maintain fluid intake,
use aseptic technique,
136
Acute Kidney Injury (AKI)
rapid what
causes what
Rapid ↓ in renal function
causes metabolic wastes accumulating in the body( like creatnin and BUN)
137
Acute Kidney Injury (AKI)-These are further categorized as:
p
I
p
Pre renal injury
Intrinsic renal injury
Post renal injury
138
how prevent Aki
may need to do what if Aki is present
To prevent aki’s- give lots of Iv fluids
May need to decrease fluids if there is a disease or injury present to kidneys
139
Prerenal aki
what causes pre renal Aki
then causes what to kidney
will result in what
when is pre renal reversed
decrease in vascular volume or resistance, cardiac output
causes a decrease in renal blood flow
drop in GFR and possible necrosis & damage (with continued ischemia)-
will be reversed when blood flow is restored
140
what can cause prerenal aki
what type of volume
what 2 organ failures
meds:
n
a
a
hypovolemia
CHF and liver failure
meds:
nsaids
arbs
ace inhibitors
141
Intrarenal
what causes intrarenal Aki
affects what
: acute damage to different parts of the kidney due to disease or necrosis (problem may originate prerenal such as HTN, or problem may be dt nephrotoxic drugs)
, affecting: glomerular filtration, tubular reabsorption, and/or tubular secretion
142
intrinsic aki causes
I
s
n
what bp
Ischemia
Sepsis
Nephrotoxins
hypertension
143
post renal aki
what causes this
such as
obstruction to urine flow
such as BPH, kidney stone
144
how to fix
pre renal
instrisic
post renal
pre- admisnter fluids
instric- removing cause and potential dialysis
post renal- bypass obstruction
145
initiation phase
when does it happen
what are manifestations
what is treatment/prognosis
AKI phases/ characteristics
From event to tubular injury (hours to days)
Usually no manifestations or very slight (slight dehydration etc)
Treatment good prognosis- likely to reverse and go into recovery
146
maintenance phase AKI
decrease in what
inability to do what
what is suppressed
decrease in GFR & tubular necrosis
inability to eliminate metabolic wastes, water, electrolytes, and acids
Erythropeoiten secretion is suppresed
147
recovery phase of aki
what repair
what happens to renal function
what makes for best outcome
tubule cell repair & regeneration = normal GFR
Renal function improves rapidly (5-25 days) but continues for up to 1 year
Diagnose early for best pt outcome
148
AKI-
who can it happen to
can happen to anybody
watch for in all patients
149
manifestations of Initiation phase of aki
do not do what
Initiation: Few symptoms (catch it here!)-
do not negate slight changes in things
150
Maintenance phase aki manifestations
what gfr
o
a
m a
e
what k
fluid retention causing what
Decreased GFR,
oliguria,
azotemia,
metabolic acidosis,
edema,
high potassium
fluid retention causing CHF, pulmonary edema , electrolyte imbalances,
151
recovery of aki manifestations
what gfr
d
what electrolytes
Return of GFR,
diuresis,
all electrolytes improved
152
Intravenous fluids- why
AKi meds
gives fluids to kidneys
153
Inotropic (dopamine)-why
direct
increases
AKi meds
direct vasoconstrictor - (increase bp)
increasing cardiac output
154
when do you give dopamine
(what down x2)
need what map for urine
need to give what w dopamine
when bp and urine output are down- give dopamine to raise bp and urine output
need a map over 70 to make urine (dopamine will fix map)
need to give fluids w dopamine
155
Norepinephrine (vasopressor)-
what bp
helps what
AKi meds
raises bp and
can help perfuse tissue
156
Fenoldopam-why
AKi meds
(vasodilator to increase kidney blood flow)
157
Loop diuretic (Lasix)
Osmotic diuretic (Mannitol)-
why
AKi meds
- to keep kidneys working and get rid of fluid/potassium
158
ACE, ARBs or other anti-HTN meds-
how help
AKi meds
reduce bp by vasodialating
159
Antacids H2 antagonists or PPI- pantoprozole- do what
AKi meds
protects gi tract from any gi bleeds
160
increased potassium
put what on
check what lab
check what
assess what
frequent what
Put a tele monitor on,
check mg level,
check loc,
assess pain,
frequent assessments- needs eyes on pt a lot
161
Calcium chloride (unless dig toxic)
reduces what
Increased K+ meds
calcium carb reduces the chance of V.fib(defib),
162
Bicarb
how does this help-increases
Increased K+ meds
increases ph causing the K+ to shift intracellular
163
Insulin 10 units (Remember ONLY regular is given IV!)
insulin does what
Increased K+ meds
Insulin will push the glucose into the cells along with k+ which will decrease the extracellular K
164
Glucose (50% dextrose given IV)
stimulates what
Increased K+ meds
stimulates insulin secretion
165
Nebulized albuterol
promotes what
Increased K+ meds
Albuterol promotes cell reuptake of K+,
166
Sodium polystyrene sulfonate (kayexalate) orally or enema
how does this work
Increased K+ meds
Kayexalate binds to stool and allows K+ excretion.
167
what is important w hyperkalemia
IMPORTANT SAFETY: This is done at an urgent time which increases the chance of a medical error.
STOP and do your checks!
DO NOT TAKE SHORT CUTS! Or trust some else to check
168
Fluid restriction until when
how do you know
Acute Kidney Injury (AKI) Medical and Nursing treatments:
Fluid restriction until perfusion restored
(skin color, pulse ox, cap refil, bp, pulses)
169
Diet-
low in
high in
Acute Kidney Injury (AKI)Medical and Nursing treatments:
low protein,
higher carbs- white bread, rice, no potato, pasta (not a lor of sauces)
170
Fluid management:- how to calculate fluid intake
Acute Kidney Injury (AKI)Medical and Nursing treatments:
daily fluid intake is calculated by allowing 500-800 ml for insensible losses & then adding excreted as urine during the previous 24 hours.
If a patient with AKI excretes 500 ml of urine in 24 hours, the patient is allowed a fluid intake of 1000-1300 ml for the next 24 hours.
171
when dialysis
what care
Acute Kidney Injury (AKI)Medical and Nursing treatments:
Dialysis- if things progress
Skin care
172
monitor for what
Acute Kidney Injury (AKI)Medical and Nursing treatments:
Monitor for infection risk
173
what are you avoiding in aki
Acute Kidney Injury (AKI)Medical and Nursing treatments:
Avoid anything nephrotoxic- myocin antibiotics, nsaids
174
antibiotics that are nephrotoxic
a
t
f
p
v
s
aminoglycosides
tetracyclines
fluroquinolones
penicccilin
vancomyicun
sulfonamides
175
chemo that is nephrotoxic
b
m
c
bisphosphanates
methotrexate
doxorucin
176
immunosuppressants that are nephrotoxic
a
c
azathioparine
cyclosporine
177
other meds that are nephrotoxic
n
a
a
m
s
nsaids-
allopurinol
ace inhibitors
mannitol
streopokinase
178
what main meds need to know are nephrotoxic
what antibiotics
what nsaids
what other drug
mycin- antibiotic
nsaid- ibuprofen, ketololac, aspirin
chemo drugs
179
Renal replacement therapy- dialysis
3 types
Hemodialysis (HD) via multiple lumen central line
Peritoneal dialysis (PD)
Continuous renal replacement therapies (CRRTs)
180
Hemodialysis
what do prior
what do pre/post
assess also for what
what do if that happens
prior- austutate bruit over site
assess vitals pre/post
assess for dialysis disequilibrium syndrome- neurological symptoms
stop transfusion
181
How to know if dialysis is “working”
what's lowered
whats balanced
?
what bp
how often do you do this
Lowered creatinine
Balanced electrolytes
? Urine output
Normal or low b/p
Often chronic…3 days a week
182
what are you watching for in dialysis
h
b
I
hypotension,
bleeding,
infection
183
vascular access
what is short term
what is long term
Double-lumen catheter (short-term)- central line
Arteriovenous (AV) fistula (long-term)
184
vascular access
cant do what
takes what
creates what
No BP or venipuncture on that arm
Takes time to mature
Creates a lumpy appearance
185
vascular access
risk for
I
c
t
infection,
clotting,
thrombosis
186
how do you know vascular access is functioning
what feel
what hear
palpable pulsation - "thrill"
and bruit (buzzing sound due to differences in pressure from artery to vein) on auscultation
187
Prior to dialyisis- vascular access
might have :
what electrolytes
what bp
what urinr output
make sure what
make sure get what
might have high electrolytes,
some hypotension
Little to no urine output,
make sure they eat breakfast
, make sure they
Get insulin,
188
when they return vascular access dialysis
get what
watch for what
s
v
get vitals,
watch for symptomatic hypotension
Sycope
vertigo
189
Peritoneal dialysis-Predialysis care-
document what
what to pt
measure
what bladder
do what to solution
document vitals,
weight pt,
measure abdominal girth,
empty bladder,
warm solution
190
Intradialysis care-
what technique
watch for
record what
Peritoneal dialysis
aspectic technique,
watch for repsitoartory distress,
record amount of dialystate used
191
Peritoneal dialysis-Post dialysis care-
assess
time
assess vitals,
time meals w outflow
192
how does it work
what is used to drain container
where can it be done
Renal Replacement Therapy: peritoneal Dialysis
Warmed sterile dialysate is instilled into peritoneal cavity through abd catheter
Gravity drains to drainage container
More gradual process, takes longer, can be done at home
193
peritoneal dialysis Complications related to
what complication
what do you exactly need
what to do if volume in =/= volume out
complications such as peritonitis- lethal
exactly need I/o
change position if i doesn't equal o
194
peritonitis-
s/s-when pain/ what abdomen
how treat what meds/ what other
pain on rebound//. board like abdomen
need to get correct antibiotic and may need surgery
195
Watch incision- for what in peritoneal dialysis
what imbalance
f
increased
for infection
electroyte imbalance
fever,
increased lethargy
196
what type of dialysis is used for kids
risk for what
periotoneal dialysis
risk for peritonitis
197
-aki - Restore fluid and electrolye balance
/
daily
place where
watch for (what k,na,phosphate)
what w fluids
what candies
what frequently
- i/o,
weight daily,
place in semi fowlers,
watch for hyperkalemia, hyponatremia, hyperphosphatemia,
restrict fluids,
hard candies decrease thirst,
turn frequently
198
Maintain adequate nutrition-
daily
meet
provide
what prior to meals
aki
weight daily,
meet w dietician,
provide frequent meals,
antiemetics and mouth care prior to meals
199
Chronic Kidney Disease (CRD)
what is CRD
what is ESRD
GFR is maintained until when
Progressive, irreversible kidney injury
End-stage renal disease (ESRD): kidney function is inadequate to sustain life
GFR is maintained at normal rate until 70-80% of renal function is lost
200
signs of Chronic Kidney Disease (CRD)
u f
what gain
o
a
legs
what syndrome
what w meds
what changes
uremic frost
weight gain
oliguria
anuria
restless legs
psychotic syndrome
meds toxicity
electrolyte changes
201
Watch for Chronic Kidney Disease (CRD)
decreased
p
increased
watch for
watch for
decreased loc,
psychosis,
increased restlenses,
watch for med toxicity,
watch for fluid overload
202
Id dialysis is no longer an option-
hospice/comfort care
203
Chronic Kidney Disease (CRD): complications- Fluid & Electrolytes:
risk of
d
what k
what calcium
Risk of dehydration, hyperkalemia, hypocalcemia
204
Chronic Kidney Disease (CRD): complications-
Cardiovascular
what bp
p e
p
c t
: HTN,
pulmonary edema,
pericarditis,
cardiac tamponade
205
Hematologic
a
decreased
Chronic Kidney Disease (CRD): complications
: Anemia,
decreased platelets
206
how does anemia happen in CKD
how do you treat anemia in CKD
decrease in renal function= decrease in erythopeitan = decreased rbc
treatment- give blood
207
administration of blood
hand
open
all
spike/and
prime w
prepare/invert
spike
close
prime/ attach
regulate
monitor for
hand hygiene,
open y tubing,
all clamps in off,
spike ns bag and put on iv pole,
prime with ns,
prepare blood-invert2-3 times,
spike blood,
close ns,
prime with blood, attach to vad,
regulate blood flow- initial 15 minutes (rate 60-120 ml/hr)
montor for reaction
208
what do you do if you suspect a transfusion reaction
stop
get
adminster
remain
stop the tranfusion
get new tubing
adminster normal saline
remain w paiteitn
209
allergic rx to blood-i
febrile rx to blood-f
circulatory overload rx to blood-d/c
hemolytic rx to blood-b/b
infection rx to blood-bp/ /
allergic - itching
febrile- fever
circulatory overload -dyspnea/cough
hemolytic - burning/back pain
infection - hypotension, n/v
210
Chronic Kidney Disease (CRD): complications- Immune system:
risk of
what decline
what's impaired
whats suppressed
Risk of infection,
WBC decline
, immunity impaired,
fever suppressed
211
Chronic Kidney Disease (CRD): complications-Gastrointestinal:
u-> leads to /
g
p
u f
Uremia leads to N/V,
gastroenteritis,
PUD,
uremic fetor (urine breath)
212
Neurologic
Chronic Kidney Disease (CRD): complications
: CNS alterations,
fatigue,
psychotic symptoms,
uremic encephalopathy
, peripheral neuropathy,
motor impairment,
restless leg syndrome
213
Chronic Kidney Disease (CRD): complications- Musculoskeletal
what phosphate
what calcium
what vit d
leads to what
: Hyperphosphatemia
& hypocalcemia,
decreased vit D
leading to renal rickets
214
Chronic Kidney Disease (CRD): complications- Endocrine & metabolic:
risk of
increased
what's affected
im
Risk of gout,
increase cholesterol,
reproductive function affected,
impotence
215
Chronic Kidney Disease (CRD): complications- Dermatologic
what color skin
what skin
what turgor
what on skin
: Pallor & yellowish skin,
dry skin
, poor skin turgor,
uremic frost on the skin causing pruritus
216
3 p's and s restriction
Chronic Kidney Disease (CRD): Interventions
Protein Restriction
Sodium 3g then 2g
Potassium Restriction
Phosphorus Restriction
217
what can people eat in CKD
yes eat
no eat
WHITE foods
yes eat- complex carbs- vegetables, pasta
no eat- tofu and eggs
218
Vitamins
c
f
extra what
Chronic Kidney Disease (CRD): Interventions
- calcium,
folic acid,
extra vitamin d
219
Chronic Kidney Disease (CRD): Interventions-Watch for pulmonary edema!-
what in lungs
what 02
what manifestation
requires what
what hr/bp
fluid in lungs-
decreased o2,
wheezing,
pink frothy sputum-
, requires intubation,
rapid hr, high bp then drop,
220
watch for what
dialysis how often
Chronic Kidney Disease (CRD): Interventions
Watch for weight gain
Dialysis – 3 x week
221
potential what
watch for what stages
Chronic Kidney Disease (CRD): Interventions
Potential kidney transplant
Watch for stages and development of ESRD (Stage 5)
222
what do you need to worry about mentally for pt with ckd
Chronic Kidney Disease (CRD): Interventions
Anticipatory grieving & major life changes (financial concerns)-
whole life has to change because of this- no vacations/ job
223
Kidney Transplant Preop
start what
fix what
Start immunosuppression
Fix any hyperkalemia or other electrolyte disturbances
224
post op kidney transplant
adminster what
remove Cath when
monitor what
Adminster dierutics
Remove cath 2-3 days after
Monitor electrolytes
225
post op kidney transplant
Watch UO -> how to give fluid replacement
fluid replacement to be given equal to the previous 30-60 minutes of output
226
Watch for s/s hemorrhage-
s
increased
what are s/s of shock( changes in what x2)
post op kidney transplant
swelling,
increased abdominal girth,
shock-changes in vitals/loc
227
post op kidney transplant- Watch for renal thrombosis
abrupt
reduced
-abrupt hypertension,
reduced gfr
228
post op kidney transplant- Watch for infection –
what changes
what urine
what drainage
loc changes,
cloudy urine,
purulent drainage
229
transplant rejection- s/s
what over site
f
gain
what urine output
post op kidney transplant
sweeling/tenderness over graft site
, fever,
wt gain,
decreased urine output
230
Monitor and support kindey function-
monitor what
report what
maintains blood glucose where
adminster what meds
allow what
monitor i/o,
report electrolyte imbalances,
maintain blood glucose 90-130,
administer antihypertensive,
allow rest periods
231
Maintain adequate nutritional intake-
weigh when
when give antiemetics
what before meals/bedtime
small
CKD
weigh daily before breakfast,
administer antiemetics 30-60 minutes before eating,
assist w mouth care prior to meals and bedtime,
small meals and snacks,
232
Reduce risk of infection-
what precautions
temp how often
monitor what lab
get what as needed
what changes
___ excercises
restrict who
CKD
standard precautions and good hygiene techniques,
temp every4 hrs,
monitor wbc,
get cultures as needed,
poisitonal changes,
cough and deep breathing,
restrict ill people
233
what happens when vit d is low
what 2 things in low calcium
CKD
vit d- immune support- become sick and fatigued
calcium- tetany, osteoporosis
234
what are you worried about in CKD
how do you prevent it
worried about clots, dvt, pe
prevent with activity and moving
235
what happens in rhabdo
what build up
what type of aki is rhabdo
How does rhabdomyolysis affect kidneys
breakdown of muscle = myoglobin buildup
myoglobin buildup = kidneys are affected
rhabdo= intrinsic aki
236
what fluids
what pain meds
what stomach protector
avoid what
tx of rhabdo
isotonic fluids
nonnsaid pain meds
ppi(pantoprozole) and h2(famotidone)- protect go system
avoid nephrotoxic drugs
237
what diet
what type of labs in
rhabdomyolysis
low protein diet
check heart labs- troponin, echo, egg
238
what does proteinuria look like
beer- foamy
239
if pt is on iron in aki
causes what
need to get what
causes constipatipon
need to be active
240
what teaching w pylonephritis
watch for what
treat that w what
keep what
low what w antibiotics
watch for c diff
treat that w metronidazole
keep clean w keeping dry
low sugar w antibiotics
241
What ECG looks like on A flutter
what rhythm
what p qrs t
what in between
regular rhythm
regular p qrs t
just has a lot of waves/ lots of p’s in between the qrs
242
What A fib looks like on ECG
what rhythm
what qrs
main idefitfies
cant get
irregular rythm
has a normal qrs
but time in between looks scribbly
cant get a proper p pr t
243
What does SVT looks like on ECG
very
will not
Very narrow- high on tachycardia
will have a barely visible p or t wave
very pointy
244
what does v tach look like on ECG
Big M’s
a lot of big m’s
245
v fib on ecg
tiny m's
246
When can you defibrillate x3
pulseless pt
pulsless vtach
vfib
247
when can you synchronized cardioverison x4
afib
a flutter
vtach w pulse
svt
248
when do you external pacing
severe bradycardia w pulse
249
Renal arteriogram
visualizes what
detects
visualize renal blood vessels
detect renal artery stenosis, renal thrombosis or embolism, tumors, cysts,
250
Renal arteriogram
pre- assess
what allergies
discontinue what
npc how long
Allergies to iodine
Discontinue anticoags
Npo 8-12 hrs
251
Renal arteriogram
restrict what
monitor what
Restrict activity
Monitor urine output
252
Renal scan
evaluates what
assess what
evaluate kidney blood flow
assess kidney perfusion and urine production
253
Renal scan
pre
do what
obtain what
Drink water prior to test
Obatin wt
254
Renal scan
post
increase what
fluids
255
Intravenous pyelogram (IVP)
visualize what
diagnose what
visualize the entire urinary tract
diagnose kidney disorders or to detect calculi (stones),
256
Intravenous pyelogram (IVP)
pre
what allergy
npo how long
allergy to seafood
npc for 8-12 hrs
257
Uroflowmetry
volume of urine voided per second.
258
Uroflowmetry
pre
increase what
remain free
Increase fluid intake
Remain free from voifing to make sure full bladder
259
Cystoscopy
visualisation of what
visualization of the bladder wall
260
Cystoscopy
pre
take
take vs
261
Cystoscopy
post
report
apply
what baths
increase
Report hematuria
Apply heat to lower abdomen
Sitz baths
Increase fluids
262
Renal biopsy
determines what
Determines the cause of renal disease
263
Renal biopsy
pre
npo how long
8-12 hrs
264
Renal biopsy
post
pressure for how long
assess
Pressure for 20 mins
Assess bowels
265
causes of kidney disease
what bp
d
L
what cells
chronic
repeated
what meds
what disease
HTN
diabetes
lupus
sickle cell
chronic glomerulonephritis
repeated pyelo
nephrotoxins
polycystic kidney disease
266
how does sodium bicarbonate correct metabolic acidosis
is what
is alkaline so will raise ph
267
how does regular insulin correct metabolic acidosis
does what
brings potassium into cell and will lower k
268
how does IVF correct metabolic acidosis
increases what
increases fluid to help excrete waste
269
how does dialysis correct metabolic acidosis
articifal what
artificial blood filtering which will get rid of waste and electrolytes
270
renal impairment from meds (nsaids/ mycins)
what bun/ creatnine
what HCT
what electrolytes
f
e
I
what care
promote what
high bun and creatinine
low HCT
altered electrolytes
fatigue
edema
irritability
skin care
promote rest
