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NURS 2360 Med/Surg > EXAM 3 > Flashcards

EXAM 3 Flashcards

(49 cards)

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1
Q

What is the normal GFR

A

90-120

it will DECREASE with kidney disease

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2
Q

osmotic diuretic

A

mannitol

causes osmotic diuresis

mostly for NEURO

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3
Q

loop diuretics

A

reduces the reabsorption of Na+, Cl-, and K+

decreases blood volume

water leaves body

monitor electrolytes especially K+

monitor BP

monitor for lightheadedness, dizziness

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4
Q

thaizaide diuretics

A

hydrochlorothiazide

inhibits soidum transport

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5
Q

spironolactone

A

do NOT use in reanl disease b/c kidney already strugglng to get rid of K+

potassium sparing diuretic

monitor Na and K+

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6
Q

carbonic anhydrase inhibitors

A

acetozalamide, brinzolamide

for glaucoma

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7
Q

nursing implications diuretics

A

monitor I & O

monitor electrolytes especially K+ and Na+

monitor V/S

if taking potassium sparing diuretics do not ue salt substitutes

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8
Q

urinary calculi risk factors

A

family or personal hx

immobility or sedentary life

gout

hyperparathyroidism

repeated UTI

dehydration

diet high in proteins and sodium

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9
Q

Urinary Calculi - Calcium

A

can detect on xray

oxalate most common

diet or phosphate

bone disease, hyperparathyroidism, dehydration,

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10
Q

struvite/magnesium ammonia phosphate stone

A

most commonly from bacterial UTI

gram negative bacteria

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11
Q

Uric Acid Stones

A

gout

diet high in purines: organ meats, anchovies, sardines, liver, beef, game meats, beer, legumes

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12
Q

cystine stones

A

genetic metabolic disorder

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13
Q

clinical manifestations urinary calculi

A

pain

blockage of urine flow

tissue trauma

N/V

pallor

hematuria

fever/chills

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14
Q

diagnostic tests kidney stones

A

Urinalysis - hematuria, bactiera, crystal fragments

24 hour urine - calcium, uric acid, oxalate

chemical analysis of of passsed stone

serum blood tests - calcium, phosphorus, uric acid, BUN, creatinine

xray, u/s, CT scan

may need IVP or cystoscopy

clinical picutre

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15
Q

kidney stone treatment

A

hydration, increase activity

morphine sulfate

NSAID: ibuprofen, acetaminophen, indomethacin

tamsulosin (Flomax) relax muscles in ureter

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16
Q

lithotripsy

A

1.5-2.0 sized stones

uses waves or sound waves to crush stones

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17
Q

prevent future stones

A

adequte fluid intake

calcium stones: reduce sodium intake, maintain normal blood calcium, reduce foods high in oxlate (spinach, nuts, wheat bran)

uric acid stones: limit animal protein, low purine

medications: thazide diuretics, allopurinol, antibiotics (stuvite)

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18
Q

glomerulonephritis

A

inflammation/infection of the glomular apillary membranes: acute or chronic

acute: immune response d/t infection. streptococcus most common

chronic: d/t vascular damage of nephrons d/t diabetes, HTN, systemic lupus erythematous

allows passage of protein from blood to urine, decrease in blood volume tirgers R-A-A-S causing retention of Na+ and h2o. Adds to amount of total body fluid - visous cycle

can lead to nephrotic syndrome

leaking into kidney is less than leaking out.

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19
Q

clinical manifestations of glomerulonephritis

A

may be asymptomatic or have abrupt onset

flank, mid-abdominal pain

malaise

fever

N/V

edema (periorbital, feet, ankles)

plueral effusion - crackles, cough, dyspnea

acute HTN

hematuria

nephrotic syndrome

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20
Q

nephrotic syndrome

Study These Flashcards
A

problem w/ glomerular fuction “leak” glomerulous

result of increased glomerular capillary membrane permeability (glomeruli are kidneys filters)

protein can pass from blood through the glomerular capillary into urine so pt. has HYPOproteinemia

21
Q

S/S of nephrotic syndrome

Study These Flashcards
A

hypoalbuinemia & hypoporteinemia

proteinuria, albuminuria

progressive edema

hematuria

hypertension

severe headache

22
Q

nephrotic syndrome diagnostic

Study These Flashcards
A

clinical picture

cultures to identify infection

labs- BUN, creatinine, electrolytes, protein, albumin, ESR

urinalysis

kidney scan or biopsy

23
Q

nonpharmacological treatment of glomerularnephritis/nephrotic syndrome

Study These Flashcards
A

identify underlying cause

bedrest during acute glomerulonephritis

fluid/electrolyte balance - monitor I&O, daily weights, BP, electrolytes

diet: low sodium, potassium, protein and pohphorus

24
Q

pharmacological treatment of glomerulonephritis and nephrotic syndrome

Study These Flashcards
A

diuretics to reduce edema

antihypertensives (Hydralazine)

antibioitcs - KEY

ACE inhibitors cause a decrease in intraglomerular capillar pressure

steroids

25
Acute Pyelonephritis
inflammation and infection of the renal pelvis and tissue usually from UTI small abcess form on surface of kidney may lead to chronic pyelonephritis, perminant kidney damage, chronic kidney disease could lead to sepsis
26
Clinical manifestations of acute pyelonephritis
look very ill fever, chills, N/V, flank pain, CVA tenderness, H/A, muscle pain, malaise hematuria, pyuria, fould smelling urine
27
pyelonephritis diagnostics
U/A, urine C&S intervenous pyelogram, renal U/S, CT scan WBC, blood cultures
28
treatment pyelonephritis
antibioitcs increase fluids follow up UA and C&S
29
Acute kidney injury
abrupt decline in GFR inability to excrete wastes maintain fluid/electrolyte balance maintain hormone production, RBC production
30
Cuase of AKI
ischemia and exposure to nephrotoxins also major sx, sepsis, and severe pneumonia
31
Causes of AKI
prerenal - hypoperfusion leads to AKI, does not directly effect kidney tissue intrarenal - direct damage to kidney postrenal - usually from obstruction
32
prerenal AKI causes
anything that decreases vascular volume, cardiac output, systemic vascular resistence ex. dehydration, hemorrhage, hypovolemia, renal artery stenosis/occlusion, hypotension, sepsis, medications decreased perfusion leads to decersaed GFR reverses rapidly when blood flow restored and renal parenchyma undamaged
33
causes of intrarenal AKI
direct damage to kidney nephrotoxins - aminoglycoside antibiotics: gentamycin, vancomycin, neomycin, tobramycin NSAIDS contrast dye glomerulonephritis rhabdomylosis lupus Acute tubular necrosis
34
postrenal causes of AKI
obstruction of urinary tract stones, fibrosis
35
anuria
<100 mL in 24 hours
36
oliguria
100-400 mL in 24 hours
37
polyuria
excessie urine in 24 hours
38
initiation phase of AKI
from insult to injury begins w/ initiating event and ends with tubular injury if intervene now can stop progress often asymptomatic
39
maintance phase AKI
unstable period, severe drop in GFR urine output usually less than expected oliguria, non-oliguria salt/water retention causes: edema, hyperkalemia, imparied potassium excretion, metabolic acidosis, anemia, confusion
40
recovery phase AKI
process of tubular cell repair return of GFR to normal intially abnormally large amounts of urine exceted (polyuria) tubular function begins to recover increased diuresis may cause low BP, low fluid volume, cloesly monitor continues up to 1 year
41
detecting AKI
always watch out for small changes in creatinine, urine output
42
AKI treatment
fluid electrolyte balance - replace electrolytes if needed, fluid restrictions, treat eleveated electrolyte levels monitor EKG related to hypokalemia: sodium polystyrene sulfonate, k cocktail diuretics carefully fluid management maintain glycemic control dialysis or CRRT
43
chronic kidney disease
progressive reduction of functioning nephrons irreversable results in uremia and inability to remove nitrogenous wastes
44
CKD causes
diabetes HTN chronic glomerulonephritis chronic pyelonephritis polycystic kidney disease systemic lupus
45
CKD patho
GFR falls BUN/creatinine rises in blood urine creatinine decreases
46
stage 5 CKD
highest stage azotemia - nitrogen in blood uremia - urea in blood
47
clinical manifestations of CKD
fluid/electrolyte/acid-base balance cardiovascular effects hematologic effects immune effects pruitits
48
CKD collarboative care
control underlying disease BP control - ACE or ARB (ACE kidney protective) diet: low protein, low salt, low potassium avoid nephrotoxins keep hbA1C ~ 7 continue activity
49
CKD medications
calcium preopations and phosphours binders - to precent renal osteodystrophy sevelamer & calcium acetate - biind to and exrete phosphorus supplemental calcium - vitamin D nephrocaps sodium bicarb erythropeoietin for anemia sodium ploystrene sulfonate antihypertensives - ACE diuretics - lasix

NURS 2360 Med/Surg (6 decks)

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