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NURS 313R > Exam 3: Urinary/Renal Diseases And Chronic Renal Disease Dialysis > Flashcards

Exam 3: Urinary/Renal Diseases And Chronic Renal Disease Dialysis Flashcards

(74 cards)

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1
Q

Chronic Kidney Disease

A

Involves the progressive, irreversible destruction of the nephrons of both kidneys.

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2
Q

End Stage Renal Disease

A

occurs when GFR is less than 15 mL/min

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3
Q

Clinical Manifestations of Chronic Kidney Disease

A

-Uremia
-Metabolic Disturbances
-Electrolytes/Acid Base Imbalances
Other symptoms listed on other cards.

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4
Q

Uremia

A

Syndrome that incorporates all s/s in CKD

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5
Q

Clinical Manifestations of Chronic Kidney Disease: Urinary System

A

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6
Q

Clinical Manifestations of Chronic Kidney Disease: Hematologic

A

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7
Q

Clinical Manifestations of Chronic Kidney Disease: Cardiovascular System

A

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8
Q

Clinical Manifestations of Chronic Kidney Disease: Respiratory System

A

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9
Q

Clinical Manifestations of Chronic Kidney Disease: GI System

A

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10
Q

Clinical Manifestations of Chronic Kidney Disease: Neurologic System

A

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11
Q

Clinical Manifestations of Chronic Kidney Disease: Musculoskeletal System

A
  • Renal osteodystrophy
  • Osteomalacia
  • Ostietis fibrosa
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12
Q

Renal Osteodystrophy

A

..

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13
Q

Osteomalacia

A

Lack of minerals.

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14
Q

Ostietis Fibrosa

A

Calcium reabsorption

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15
Q

Clinical Manifestations of Chronic Kidney Disease: Integumentary

A

Uremic frost

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16
Q

Clinical Manifestations of Chronic Kidney Disease: Reproductive System

A

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17
Q

Clinical Manifestations of Chronic Kidney Disease: Endocrine System

A

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18
Q

Clinical Manifestations of Chronic Kidney Disease: Psychologic System

A

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19
Q

Diagnostic Studies for Chronic Kidney Disease

A
  • History and Physical
  • Renal ultrasound
  • Renal scan
  • CT scan
  • Renal biopsy
  • BUN,Srum Creatinine
  • Serum electrolytes
  • U/A, C/S
  • Hemoglobin and Hematocrit
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20
Q

Collaborative Care Goals for Chronic Kidney Disease

A
  • Preserve existing renal function
  • Treat clinical manifestation
  • Prevent complication
  • Provide for patient’s comfort
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21
Q

Collaborative Care for Chronic Kidney Disease

A
  • Drug Therapy

- Nutritional Therapy

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22
Q

What nutritional therapy should be implemented in patients with chronic kidney disease?

A
  • Protein Restriction
  • Sufficient calories from carbs and fat
  • Water restriction
  • Sodium and Potassium Restriction
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23
Q

Nursing Therapeutics for Chronic Kidney Disease: Identify

A
  • Identify risk factors
  • Identify s/s of fluid overload
  • Identify s/s of electrolyte imbalance
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24
Q

Nursing Therapeutics for Chronic Kidney Disease: Assess/Monitor

A
  • Monitor Renal Function
  • Daily weight and BP
  • Hemodialysis or peritoneal dialysis
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25
What should you teach a patient about chronic kidney disease?
Teach patient and family about diet and drugs.
26
Dialysis
- Is the movement of fluid and molecules across a semipermeable membrane from one compartment to another. - A technique in which substances move from the blood through a semipermeable membrane and into a dialysis solution (dialysate).
27
Dialysis is initiated when
GFR (Creatine clearance) is < 15 mL/min
28
What are 2 methods of dialysis?
- Peritoneal Dialysis | - Hemodialysis
29
What processes are involved in dialysis ?
- Diffusion - Osmosis - Ultrafiltration
30
Peritoneal Dialysis
- Obtained by inserting a catheter through the anterior of the abdomen. - Tip fo the catheter rests on the peritoneal cavity.
31
What are 3 Phases of the Peritoneal Dialysis Cycle?
1. Inflow 2. Dwell Phase 3. Drain
32
Complications of Peritoneal Dialysis includes
* exit site infection * peritonitis * abdominal pain * outflow problem * hernia * lower back problem * bleeding * pulmonary complication * protein loss * carbohydrate and lipid abnormalities
33
Hemodialysis: Needs
* a very rapid blood flow | * access to large blood vessel
34
Vascular Access for Hemodialysis
- Shunts | - Arteriovenous Fistula/Graft
35
Shunts
U shape silastic tube divided at the mid-point and each of the two ends is palced in an artery and a vein.
36
Arteriovenous Fistula/Graft includes
AVF and AVG
37
AVF
Anastomoses between an artery and vein
38
AVG
Synthetic graft is used. | Forms a bridge between arterial and venous blood supplies.
39
Hemodialysis Procedure
* 2 needles are inserted into the fistula or graft (1 to pull blood to the machine , 2nd to return blood back to the circulation) * Bruit / thrill created by arterial blood rushing into the vein * Do not take BP / IV insertion and venipuncture on the affected access.
40
Complications of Hemodialysis includes
* Hypotension * Muscle cramps * Loss of blood * Hepatitis * Sepsis
41
Urinalysis
General examination of urine to establish baseline information or provide data to establish a tentative diagnosis and determine whether further studies are to be ordered ASEPTIC TECHNIQUE
42
Nursing Responsibilities for Urinalysis
- Obtain specimen first urinated in morning- will be more concentrated - Ensure specimen is examined WITHIN 1 HOUR OF URINATING - Be sure to wash perineal area if soiled with menses or fecal material
43
Creatinine Clearance
Measures waste product of protein breakdown.
44
Nursing Responsibility for Creatinine Clearance
- Discard first urination when test is started - Save urine from all subsequent urinations for 24 hr - Instruct patient to urinate at end of 24 hr and add specimen to collection - Ensure that serum creatinine is determined during 24-hr period
45
Urine Culture
Must be clean-midstream catch | Done to confirm suspected UTI and identify causative organisms.
46
Nursing Responsibility for Urine Cultures
- Use sterile container for collection of urine - Touch only outside of container - For women, separate labia with one hand and clean meatus with other hand, using at least three sponges (saturated with cleansing solution) in a front-to-back motion - For men, retract foreskin (if present) and cleanse glans with at least three cleansing sponges - After cleaning, instruct patient to start urinating and then continue voiding in sterile container - The initial voided urine flushes out most contaminants in the urethra and perineal area - Catheterization may be needed if patient is unable to cooperate with procedure
47
BUN
Measures concentration of urea in the blood. | Used to identify presence of renal problems.
48
BUN: normal interval
6-20 mg/dL (2.1-7.1 mmol/L)
49
High urea in the urine can indicate
Decreased kidney function.
50
Blood Chemistries: Creatinine
-More reliable than BUN as a determinant of renal function.
51
Creatinine is an end product of
Muscle and protein metabolism and is liberated at a constant rate.
52
Creatine Clearance: normal range
0.6-1.3 mg/dL (53-115 mmol/L)
53
BUN/Creatine Ratio
10:1 Reference interval: 12:1 to 20:1 (from the book) If it is not balanced, then one or other is unbalanced.
54
Elevated levels of potassium can lead to
Muscle weakness and cardiac dysrhythmias
55
Calcium
Main mineral in bone and aids in muscle contraction, neurotransmission and clotting.
56
In renal diseases, decreased reabsorption of Ca leads to
Renal osteodystrophy
57
Calcium is associated with
Low levels of calcitrol which is essential to absorb Ca in the GI tract
58
Normal Calcium Range
9-11 mg/dL
59
Phosphorus
Balance is inversely related to Ca balance
60
In renal disease, phosphorus levels are
Elevated because the kidney is the primary excretory organ
61
Normal phosphorus levels
2.8-4.5 mg/dL
62
Bicarbonate
Most patients in renal failure have metabolic acidosis and low serum bicarb levels.
63
Normal Bicarbonate Levels
22-26
64
Why should patients with significantly decreased renal function NOT have IVP?
Because contrast media can be nephrotoxic and worsen renal function.
65
Intravenous Pyelogram
Visualizes urinary tract after IV injection of contrast media.
66
Nursing Responsibility for IVP
Evening before procedure, cathartic or enema is given to empty colon of feces and gas NPO 8 hours prior to procedure. Warmth, flushed face and salty taste may occur after injection of contrast media.
67
Renal Arteriogram
Visualizes renal blood vessels. | Must watch for bleeding in the groin.**
68
Nursing Responsibilities for Renal Arteriogram after procedure
MAINTAIN BED REST WITH AFFECTED LEG STRAIGHT Place pressure dressing over femoral artery injection site. Observe for complications.
69
Renal Biopsy
Done to obtain renal tissue to determine type of renal disease or to follow progress of renal disease.
70
Osteomalacia: Demineralization that results from
Slow bone turnover | Defective mineralization of newly formed bone
71
Osteomalacia results form
Parathyroid hormone suppression R/T: Increased calcium intake Increase vitamin D dosage Presence of DM
72
Ostietis Fibrosa: Decalcification of
Bone | Replacement of bone tissue with fibrous tissue (very fragile and easily broken)
73
Ostietis Fibrosa: Results from
Elevated PTH that causes bone resorption and softening.
74
Uremic “red eye”
Caused by irritation of calcium deposits.

NURS 313R (18 decks)

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