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HURST > Renal > Flashcards

Renal Flashcards

1
Q

glomerulonephritis patho

A

acute can lead to chronic

  • inflammatory reaction in glomerulus (filter of the kidney)
  • antibodies lodge in glomerulus causing scarring and decreased filtering
  • main cause is strep group A
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2
Q

S/sx of glomerulonephritis

A

flank pain (costovertebral angle / CVA tenderness)
decreased UOP (oliguria)
hematuria (rusty or coke colored urine)
proteinuria
periorbital edema
increased BP
FVE
urine specific gravity increases (concentrated)
azotemia (abnormally high BUN and creatinine)
malaise and headache due to toxins

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3
Q

glomerulonephritis treatment

A 
get rid of cause (usually strep)
I&O / daily wts
diuretics
monitor BP
restrict fluids
balance activity with rest
dietary needs (increase carbs and decrease sodium and protein)
dialysis
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4
Q

How do you determine fluid replacement?

A

24 hr fluid loss + 500 mL

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5
Q

Client Teaching for glomerulonephritis

A

diuresis begins 1 to 3 wks after onset

blood and protein may stay in urine for months

teach s/sx of renal failure

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6
Q

S/sx of renal failure

A

mailaise, headache, anorexia, N/V, decreased output and wt gain

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7
Q

Nephrotic Syndrome patho

A

inflammatory response in glomerulus (big holes form so protein leaks out)

hypoalbuminemic (low albumin in blood due to loss of protein)

albumin helps you retain fluid in the vascular space so now that we don’t have it, it leaks into interstitial space (EDEMA)

decreased blood volume due to edema so kidneys activate the renin-angiotensin system to produce ALDOSTERONE

aldosterone retains sodium and water, but since there’s no albumin, it all leaks into tissues and interstitial space

ANASARCA = total body edema

problems: anasarca, no albumin, FVD, blood clots, increased cholesterol and triglycerides

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8
Q

Nephrotic Syndrome Causes

A

idiopathic, but related to:

bacterial or viral infections

NSAIDS

cancer / genetic

systemic dzs such as lupus or diabetes

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9
Q

Nephrotic Syndrome S/sx

A

massive proteinuria

hypoalbuminemia

edema (anasarca)

hyperlipidemia

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10
Q

Nephrotic Syndrome Treatment

A

diuretics

ace inhibitors to block aldosterone secretion

prednisone to decrease inflammation

cyclophosphamide (decreases immune response)

 - shrinks holes so protein can't get out
 - immunosuppressed
 - infection is major complication of nephrotic syndrome

diet - client can become malnourished fast

 - decreased sodium 
 - moderate protein (1-2 g/kg/day) / not limiting protein!

lipid lowering drugs

anticoagulation therapy for up to 6 mo

dialysis

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11
Q

Acute Kidney Injury (AKI) Causes

A

Pre-Renal Failure - blood can’t get to kidneys

 - hypotension
 - bradycardia (arrhythmia)
 - hypovolemic
 - shock

Intra-Renal Failure - damage in the kidney

 - glomerulonephritis or nephrotic syndrome
 - malignant HTN and diabetes
 - acute tubular nephrosis (damage to the filter) 
       - hypotension, sepsis, drugs
 - dyes used in heart cath and CT scan
 - drugs (aminoglycosides and NSAIDs

Post-Renal Failure - urine can’t leave kidney

 - enlarged prostate
 - kidney stone
 - tumors
 - ureteral obstruction
 - edematous stoma (ileal conduit)

*goal - reverse it to prevent chronic renal failure

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12
Q

Four Phases of AKI

A

initiation phase (injury occurs)

oliguric phase (output may be <100 mL / 24 hr)

diuretic phase (kidney recovering)

recovery phase (3-12 months)

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13
Q

S/sx of Acute Kidney Injury

A

Creatinine and BUN increase

specific gravity increase (may lose ability to concentrate and dilute urine)

HTN - retaining fluids

HF - retaining fluids

Anorexia, N/V - retaining toxins

itching frost (uremic frost) (ensure good skin care)

retain phosphorus –> serum Ca is decreased –> calcium is pulled from bone

anemia (not enough erythropoietin)

Hyperkalemia (fatal arrhythmias)

metabolic acidosis (unable to filter or retain hydrogen or bicarb)

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14
Q

Treatment of Acute Kidney Injury

A

Nursing Measures:

 - bedrest to decrease metabolism and caloric needs
 - TCDB
 - monitor I&Os / daily wts
       - 1 kg = 1 L
 - VS

Meds:

 - loop diuretics or osmotic diuretics
 - IV glucose and insulin to treat hyperkalemia
 - IV calcium gluconate for dysrhythmias
 - polystyrene sulfonate to decrease potassium
 - phosphate binding drugs to prevent hypocalcemia
 - give any IV meds in the smallest volume allowed

Nutrition:

 - increase carbs and fats
 - low sodium
 - avoid food / fluids high in phosphate
 - avoid foods high in potassium like bananas, citrus, and coffee

Prevent infection (mouth care / no catheters)

Renal Replacement Therapy

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15
Q

oliguric phase

A

10-14 days

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16
Q

diuretic phase

A

begin when output increases

fluid and electrolyte replacement

17
Q

recovery phase

A

client placed on increased protein and increased calories

resume activity as tolerated

18
Q

Renal Replacement Therapy

A

replace kidney function (hemodialysis, continuous renal replacement therapy, peritoneal dialysis)

started when BUN and creatinine levels can’t be decreased
FVE is compromising heart and lungs
Hyperkalemia and metabolic acidosis can’t be treated successfully

19
Q

problems associated with protein loss

A

blood clots (the proteins that prevent clotting are gone)

increased cholesterol and triglycerides (liver tries to compensate by releasing more albumin which increases cholesterol and tris)

20
Q

Hemodialysis

A

done 3-4 x a week

watch what you eat or drink between treatments

anticoagulants during to prevent blood clots (heparin)

depression (suicide / watch for drastic and dangerous diet changes)

before dialysis, assess fluid status (wt, BP, edema)

electrolytes and BP monitored constantly (30-60 min)

need access to large vein (300 to 800 mL/min)

 - AVF and AVG (surgery required)
 - temporary (internal jugular or femoral / no surgery required)

** unstable cardiovascular system can’t tolerate hemodialysis

21
Q

arteriovenous fistula

A

AVF

anastomosis between an artery and vein

need weeks to mature before ready for venipuncture

22
Q

arteriovenous graft

A

AVG

synthetic graft to join vessels

need weeks to mature before ready for venipuncture

23
Q

Care of dialysis access

A

do not use for IV access (meds, drawing blood, etc.)

no BP, needle sticks, or constriction on that extremity

  • ensure patency by palpating for thrill and auscultate for bruit
    • thrill (cat purr / palpate)
    • bruit (turbulent blood flow / auscultate)
24
Q

Continuous Renal Replacement Therapy (CRRT)

A

ICU setting / continuous so no drastic fluid shifts

never more than 80 mL of blood out of body at one time to not stress CV system

used when client has fragile cardiovascular system and acute kidney injury

25
Q

Peritoneal Dialysis

A

peritoneal membrane is used as filter

dialysate is infused into peritoneal cavity by gravity via Tenchkhoff catheter

takes about 10 min and remains in cavity for prescribed time (dwell time) before drained

warm fluid to promote vasodilation

if drainage is cloudy = infection / should look like urine

if all fluid doesn’t come out, turn patient / reposition.

clients can choose this option or they get it if they can’t tolerate hemodialysis

2 types: Continuous Ambulatory Peritoneal Dialysis & Automated Peritoneal Dialysis

26
Q

Continuous Ambulatory Peritoneal Dialysis (CAPD)

A

client must have energy and desire to be active in their treatment

must be able to learn and follow instructions

done 4 times a day 7 days a week

  • clients with disc dz or arthritis can’t do it bc you have to ly down
  • colostomy pts can’t due to infection risk
27
Q

Automated Peritoneal Dialysis (APD)

A

connect to cycler at night and its done while they sleep.

more freedom

28
Q

Complications of Peritoneal Dialysis

A

exit site infection

peritonitis

29
Q

Peritonitis S/sx

A

abdominal pain

cloudy effluent

30
Q

Dietary Needs of the Peritoneal Dialysis Client

A

increase fiber and protein

 - fiber for decreased peristalsis due to abdominal fluid
 - big holes in peritoneum and lose protein with each exchange
31
Q

Nephrolithiasis S/sx

A

Kidney stones / urolithiasis

ureterolithiasis - stone in ureter

pain, N/V
WBCs in urine
Hematuria **

  • anytime you suspect a kidney stone, get urine sample ASAP and check it for RBCs
  • if kidney stone is present, pain medication immediately
32
Q

Nephrolithiasis Treatment

A

Ondansetron
NSAIDS or opioid narcotics
Alpha adrenergic blockers (relax smooth muscles of ureter)
Increase fluids (forever)
Surgery to remove stone if needed
extracorporeal shock wave lithotripsy (ESWL) to crush stone
strain urine and send stones for analysis

33
Q

Limit protein with kidney patients except for …

A

nephrotic syndrome and peritoneal dialysis

HURST (15 decks)

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