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Med surg exam 2 > KIDNEYS > Flashcards

KIDNEYS Flashcards

(45 cards)

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1
Q

Emergent dialysis requirements

A

Elevated Potassium
Metabolic acidosis
Hypovolemia

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2
Q

Glomerulonephritis

A

Children, over 60
Chronic
atuoimmune, genetic, or drug use

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3
Q

Nephritic syndrome

A 
Inflammation of glomeruli
HTN
Hematuria
Oliguria
Berger's disease (most common cause)
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4
Q

Neprhotic syndrome

A

Hypoalbuminemia-> albumin excreted, reduction in oncotic pressure-> edema

Hyperlipidemia

Mega proteinuria

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5
Q

Nephrosclerosis

A

Benign: over 60, Vasc. changes w/ htn/atherosclerosis

Malignant: significant HTN, malignant HTN

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6
Q

Renal Artery Stenosis

A

Atherosclerosis of renal arteriies
Can be one or both branches

Cause of secondary HTN

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7
Q

Renal Vein Thrombosis:

A

Basically a DVT in kidneys

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8
Q

Polycystic Kidney Disease (PKD)

A

4th cause of ESRD
Genetic
Manifestations: Ruptured cysts, HTN, pain/heaviness

May need nephrectomy

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9
Q

Kidney Cancer

A

Renal cell carcinoma

Male
Smoker
Obese
Family Hx

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10
Q

AKI Acute Kidney Injury

A

Oliguric Phase
Diuretic Phase
Recovery phase

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11
Q

Oliguric phase (AKI)

A

Phase 1 of AKI

Oliguria- <400mL/day within 1-7 days of kidney injury
Urinalysis (specific gravity fixated at 1.010)
Metabolic acidosis
Hyperkalemia, Hyponatremia
Elevated BUN and Creatinine
Fatigue, malaise

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12
Q

Diuretic phase (AKI)

A

Phase 2 of AKI

Gradual inc. in urine output
Hypovolemia, dehydration
Hypotension
BUN and Creatinine normalizes

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13
Q

Recover phase (AKI)

A

Phase 3 of AKI

GFR increases
BUN and creatinine plateaus and then drops

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14
Q

Risk factors for AKI

A 
Pre-existing kidney disease
MODS/sepsis
Age
Trauma
Surgery
Burns
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15
Q

Rifle classification of AKI

A

R: RISK

I: INJURY

F: FAILURE

L: LOSS

E: ESKD

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16
Q

RIFLE (R)

A

Risk

Serum creatinine 1.5x baseline OR GFR decrease by 25%

Urinary output under .5mL/kg/hr for 6hr

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17
Q

RIFLE (I)

A

Injury

Creatinine 2x baseline
GFR decreases by 50%

Urinary output:

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18
Q

RIFLE (F)`

A

Failure

3x baseline serum creatinine
GFR decreases 75%

Or Creatinine aboce 354 umol/L with acute rise of 44umol/L

Urinary output >.3mL/kg/hr for 24hr
or Anuria for 12 hr

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19
Q

RIFLE (L)

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A

Loss

Persistent acute renal failure= complete loss of kidney function for more than 4 weeks

20
Q

RIFLE (E)

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A

End Stage Kidney Disease for more than 3 months

21
Q

Pre-renal issue causes

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A

Hypoperufsion: Volume depletion, vascular issues, shock

Decreased filtration (Hypotension): most common in Peds

Cardiac Output: MI, HF

22
Q

Intrinsic renal issue causes

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A

Glomerular: Acute glomerulonephritis

Vascular: Vasculitis, Atheroemboli, manipulation of aorta

Tubulointerstitial: Acute tubular necrosis

23
Q

MEDS that can cause pre-renal injury

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A

Ace inhibitors
ARB (Angiotensin II blockers)

NSAIDS

COX-2 inhibitors (celecoxib)

Loop diuretics, thiazide diuretics

Immunomodulators: Cyclosporine

24
Q

MEDS that can cause ATN (Acute Tubular Necrosis)

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A

Antibiotics

HIV meds

Statin (lovastatin): rhabdomyolysis

Biphosphonates

25
Post Renal issue causes
10% of renal issues ``` Obstructions: Prostate Intraperitoneal tumor Stones Trauma ```
26
AKI nursing considerations
Volume status: watch for excess urine and edema, look for osmolality Review labs: GFR, creatinine Flank pain, muscle pain Infection/sepsis Cardiac: BP/EKG Respiratory compensation
27
Nursing considerations for Phase 1 AKI (Oliguric)
``` Manage Fluid volume Sodium balance Acid/base balance Hyperkalemia Hematologic considerations (hypovolemia, hypoalbuminemia etc.) ``` Watch for waste accumulation Neurologic disorders
28
Nursing considerations for Phase 2 AKI (Diuretic)
High urine volume means watch volume management and electrolytes
29
Nursing considerations for Phase 3 AKI (Recovery)
Look for GFR increases Let them know it may take up to a year to heal fully
30
Differences between AKI and CKD
Acute can turn into chronic ``` Chronic: Better tolerates wide lab ranges Anemia, cachexia, gray skin Low calcium Stable (out of range) creatinine ``` Chronic normocytic anemia Renal Ultrasound: Scars/large kidneys Acute: Hypotension, fluid overload, metabolic acidosis Rapid increasing creatinine Normal calcium Renal ultrasound normal
31
End Stage Renal Disease
Under 15mL/min GFR ``` Inc BP Pitting edema HF Pulmonary Edema Ammonia odor to breath Anorexia Anemia ``` Yellow/gray skin Metabolic acidosis Inc. potassium
32
Chronic Renal failure stage 1 GFR
Kidney damage w/normal function | 90+
33
Chronic Renal failure stage 2GFR
Kidney damage w/mild loss function | 89-60
34
Chronic Renal failure stage 3A GFR
Mild to moderate loss of kidney function 59-44
35
Chronic Renal failure stage 3b GFR
Moderate to severe kidney function loss 44-30
36
Chronic Renal failure stage 4 GFR
Severe loss kidney function 29-15
37
Chronic Renal failure stage 5 GFR
Kidney failure under 15
38
Nursing considerations for CKD
Dietary restrictions: High fat, low protein, low sodium, low potassium, low phosphorus. Fluid restrictions Ostrosdystrophy: Give calcium/phosphorus balance-binders, PTH, Vit D Anemia: ESA (erythropoeitin stimiulating agents), Iron, blood
39
Pediatric considerations for CKD
Impeded physical growth/sexual maturation Developmental issues
40
Who needs dialysis (AEIOU)
``` Acid-base problems Electrolyte problems Intoxications Overload of fluids Uremic symptoms ```
41
Renal replacement therapies for ESRD
palliative care Transplant Hemodialysis Peritoneal dialysis
42
Peritoneal dialysis
CAPD 3-5 times/day 20-40 min at a time CCPD done overnight Catheter in abdomen STERILE TECHNIQUE Diffusion dependent on time, volume, speed of transport Osmotic gradient determined by dextrose solution % used Adequacy measured by KT/V Residual renal function lasts longer in PD
43
Hemodialysis considerations
Fluid, sodium, potassium, phosphorus restricted Encourage more protein (can be filtered now) Phosphorous binders Watch access management Assess for thrills/bruits NO BP, IV, NEEDLE STICKS on access limp DON'T USE DIALYSIS CATH FOR GENERAL USE- only EMERGENCY Take weights daily Watch fluid management, I&Os
44
Creatinine range
.8-1.2mg/dL
45
BUN range
7-20mg/dL

Med surg exam 2 (7 decks)

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