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Med Surg 2 > Quiz 6 > Flashcards

Quiz 6 Flashcards

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1
Q

What is glomerulonephritis? What can it lead to?

A

inflammation and scarring of the kidney

lead to end stage kidney disease

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2
Q

What are the risk factors of glomerulonephritis?

A

beta-hemolytic streptococcal infection
tonsillitis or pharyngitis
presence of systemic disease

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3
Q

What are the clinical manifestations of glomerulonephritis?

A

hematuria (blood in urine)
oliguria or anuria (decreased or no)
azotemia (increased BUN)
proteinuria (protein foamy)
dysuria (pain)
flank or abd pain
fatigue
HTN
weight gain
low grade fever

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4
Q

What are the diagnostic studies for glomerulonephritis?

A

increased BUN, CR, ESR, K, Phosphate
decreased GFR, albumin, CA
+ ANA, + ASO titer

urinalysis - hematuria, proteinuria, RBS, sediments, casts

kidney bx

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5
Q

What medications are given for glomerulonephritis?

A

PCN for strep infection
corticosteroids for inflammation
antihypertensives for increased BP

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6
Q

What are nursing interventions for glomerulonephritis?

A

bed rest
monitoring for F/E imbalance (potassium)
high-calorie, low-protein, low-sodium diet, restrict fluids

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7
Q

What is a priority for a patient with acute glomerulonephritis?

A

check the patient’s daily weight

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8
Q

What can be done to confirm a diagnosis of chronic glomerulonephritis?

A

bx of kidney to check for sclerosis

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9
Q

What lab value would decrease for a patient with chronic glomerulonephritis?

A

RBC

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10
Q

What do you expect for a male with chronic glomerulonephritis?

A

serum creatinine of 7mg/dl

over 1.3 is BAD

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11
Q

When does a pt with glomerulonephritis need further teaching about a sodium restricted diet?

A

when they say they can still drink 3-4 carbonated drinks daily

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12
Q

When can a patient with glomerulonephritis resume normal activities?

A

when HTN and hematuria are resolved

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13
Q

What is a ileal conduit?

A

ureters are implanted into part of ileum or colon that has been resected from intestinal tract

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14
Q

What is a cutaneous ureterostomy?

A

ureters are excised from bladder and brought through abdominal wall

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15
Q

What is a nephrostomy?

A

catheter is inserted into pelvis of kidney

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16
Q

What is acute kidney injury?

A

sudden short term loss of kidney function (curable)
can lead to chronic kidney disease

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17
Q

What are the classifications of acute kidney injury?

A

prerenal - blood not perfusing kidneys
intrarenal - damage inside
postrenal - obstruction in outflow of urine

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18
Q

What are the phases of acute kidney injury?

A

onset
oliguric phase
diuresis phase
recovery phase

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19
Q

What are the clinical manifestations of acute kidney injury during the oliguric phase?

A

LOW URINE OUTPUT

metabolic acidosis (below 7.35)
sodium HIGH
phosphorus HIGH
potassium HIGH
BUN/CR HIGH
fluid overload (edema)

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20
Q

What are the clinical manifestations of acute kidney injury during the diuretic phase?

A

up to 5L/day, electrolyte losses
decreased BUN, then normalizes
decreased specific gravity
normal kidney function back

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21
Q

What happens during the recovery phase of acute kidney injury?

A

return to baseline (30mL/kg/hr)
complete recovery may take 12 months
residual kidney dysfunction may be noted

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22
Q

What medications are given to decrease potassium as a result of acute kidney injury?

A

IV insulin (regular)
IV glucose
IV sodium bicarb (decrease acidity)
IV calcium gluconate
PO or PR sodium polystyrene sulfonate (used in less severe cases, BM = Rx working)

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23
Q

What medications are given to decrease phosphorus as a result of acute kidney injury?

A

phosphate binders

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24
Q

What medications are given for anemia as a result of acute kidney injury?

A

epoetin alfa

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25
What are the nursing interventions for acute kidney injury?
monitor I&O, weigh daily examine urine monitor electrolyte balance assess for HF or pulm. edema review nephrotoxic drugs
26
What is the diet for a patient with acute kidney injury?
high calorie fluid restriction low protein restrict potassium, phosphorus, sodium, magnesium
27
What is an expected blood gas for a patient with acute kidney injury?
pH below 7.35 HCO3 14 PaCO2 30
28
When does a pt with acute kidney injury need further teaching about potassium diet source?
when they say adding pecans will be a change that they can readily make
29
What indicates an increased risk of acute kidney injury?
creatinine over 1.3
30
What will indicate understanding for a patient with acute kidney injury about fluid restrictions?
i will make a list of my favorite beverages
31
What is chronic kidney disease?
irreversible damage to the kidneys no cure GFR <60mL/min for at least 3 months
32
What are the stages of chronic kidney disease?
GFR greater than or equal to 90 - normal stage 1: <90 stage 2: 60-80 stage 3: 30-59 stage 4: 15-29 stage 5 (end stage renal): <15
33
What are the causes of chronic renal disease?
uncontrolled diabetes uncontrolled HTN
34
What are the clinical manifestations of chronic kidney disease?
uremic frost similar to acute kidney disease
35
What are the diagnostic studies of chronic kidney disease?
urinalysis cystoscopy renal bx albumin to creatinine ratio
36
What are the therapeutic procedures for chronic kidney disease?
dialysis kidney transplant
37
What are the nursing interventions for chronic kidney disease?
strict I&O monitor BP monitor for s/s of FVO and hyperK do not administer antacids w/ Mg do no administer enemas w/ phosphorus Avoid loop diuretics
38
What is the diet for someone with chronic kidney disease?
high carb low protein low potassium low sodium low phosphate
39
When would you take the daily weight of a patient with chronic kidney disease?
After they void
40
What is the most reliable measurement of fluid retention for a patient with chronic kidney disease include volume increase?
Daily weight
41
What are the expected findings of end-stage renal disease?
Slurred speech Bone pain Pruitis
42
What should be taught for a patient with chronic kidney disease about low protein diet?
A low protein diet reduces risk of uremia
43
What would you expect the blood gas to be for a patient with chronic kidney disease?
pH 7.25 HCO3 19 PaCO2 30
44
Why would aluminum hydroxide be given for a patient with chronic kidney disease instead of Pepcid?
Phosphorus levels lower when taking aluminum hydroxide
45
What is an adverse reaction of aluminum hydroxide?
Constipation
46
A patient with chronic kidney disease should limit which nutrients?
Protein phosphorus sodium
47
For a patient taking epoetin alfa, what would should be increased in their diet?
Iron
48
What is a manifestation of hyperkalemia in a patient with chronic kidney disease?
Decreased deep tendon reflexes
49
What foods that are high in potassium will you tell a patient with chronic kidney disease to avoid?
Tomato Bananas Raisins
50
What are examples of renal replacement therapy?
Peritoneal dialysis Intermittent hemodialysis Continuous renal replacement therapy
51
Describe hemodialysis
Requires vascular access AV fistula or AV graft Lifespan: 20-40 years, die from CLABSI Duration: 3 to 4 hours
52
What are the nursing interventions for hemodialysis?
Before: assess fluid status, assess AVF/AVG, weigh the client, hold morning meds, report any symptoms during procedure During: monitor BP After: prevent infection, monitor, complications, weight, client, provide adequate nutrition, rest
53
Describe continuous renal replacement therapy
Alternative method for treating AKI Uremic toxins and fluids are removed Duration: 24 hours
54
Describe peritoneal dialysis
Catheter inserted through anterior abdominal wall - solution dwells for 4 hours - fluid comes out More than inserted should come out Once a day More stable patients Types: continuous ambulatory PD and automated PD
55
What does it mean if the dialysate is cloudy
Peritonitis
56
What are the phases of the peritoneal dialysis cycle?
Inflow (fill) Dwell (equilibration) Drain
57
What food is contraindicated for a patient who is taking bumetanide?
Ham sandwich
58
when do you administer phenytoin after a patient gets dialysis?
When they complain of headache and restlessness
59
When teaching a patient about continuous ambulatory peritoneal dialysis what should you tell the patient?
Require the patient to follow fewer dietary and fluid restrictions than hemodialysis
60
What should a nurse do prior to exchanging dialysate for peritoneal dialysis?
Warm the solution prior to insulation
61
What should be reported immediately for a patient who is undergoing peritoneal dialysis?
Purulent dialysis outflow
62
For a patient with a new AV fistula to the right arm, what would indicate venous insufficiency?
Cold and numbness distal to the fish site
63
What can low calcium in the blood cause?
Seizures
64
What are the discharge instructions for a patient who is going to do a peritoneal dialysis at home?
Anticipate pain the first week during the inflow of dialysate
65
What are the manifestations of peritonitis?
Nausea and vomiting

Med Surg 2 (7 decks)

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