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Med Surg 2 > Renal > Flashcards

Renal Flashcards

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1
Q

What do the kidneys do?

A

Maintain body fluid volume and composition and create urine for waste
filter in order to balance fluids & electrolytes
help make RBCs
help regulate BP

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2
Q

What do the kidneys help regulate?

A

Blood pressure, acid-base balance (produce erythropoietin for RBCs synthesis and convert Vitamin D to an active form)

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3
Q

What does aldosterone do?

A

Increases kidney reabsorption of sodium and water which restore BP, blood volume and blood sodium levels.
-Promotes excretion of potassium
-promoted the reabsorption of sodium in the DCT

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4
Q

What does vasopressin do?

A

increases tubular permeability to water, allowing water to leave the tube & be reabsorbed by the capillaries
-increases arteriole constriction

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5
Q

What happens to the kidney with age?

A

Loses cortical tissue and nephrons and gets smaller with age
-reduces ability to filter blood and excrete wastes

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6
Q

What can suggest kidney disease in patient’s older than 50?

A

Sudden onset of hypertension

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7
Q

What do you ask when assessing the function of the kidney?

A

-Changes in appearance (odor, color, clarity)
-ability to initiate or control
-changes in pattern
-changes in amount
-pain (flank, lower aBd, pelvic region, perineal area)

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8
Q

Symptoms of uremia

A

Anorexia, N/V, muscle cramps, pruritus, fatigue and lethargy

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9
Q

60.1- When obtaining a health history and physical assessment from a 68 year old male client who has a history of an enlarged prostate, which finding does the nurse consider?
A. distended bladder
B. absence of bruit
C. frequency of urination
D. dribbling urine after voiding
E. chemical exposure in the workplace

A
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10
Q

What pathologic conditions increase serum creatinine levels?

A

Just kidney disease!!!

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11
Q

What does it mean when serum creatinine levels double?

A

50% reduction of GFR

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12
Q

What happens with liver and kidney dysfunction

A

BUN is decreased
-this is due to the liver failure limiting urea production

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13
Q

What does it mean when both serum creatinine & BUN increase?

A

Kidney dysfunction
-not related to poor perfusion or dehydration

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14
Q

What happens when glomerulus filtration decreases?

A

Cystatin-C increases
(predictor of CKD)

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15
Q

High specific gravity indicates

A

-dehydration, decreased kidney blood flow, excess vasopressin: SIADH, stress, surgery, anesthetic agents, certain drugs

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16
Q

Low specific gravity indicates

A

high fluid intake, diuretic drugs or DI

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17
Q

Normal specific gravity

A

1.005 - 1.030

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18
Q

Normal microalbumin levels

A

less than 2.0 mg/dL

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19
Q

What indicates microalbuminuria

A

levels greater than 80mcg/24hr

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20
Q

CKD

A

gradual decline of kidney function

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21
Q

AKI

A

sudden onset of kidney function
(higher mortality rate)

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22
Q

Problems related to kidney function loss

A

waste elimination, fluid & electrolyte balance, disturbances in acid-base balance, build up of nitrogen-based wastes and loss of kidney hormone function

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23
Q

What lab value defines an AKI?

A

Increased serum creatinine by 0.3mg/dL or 1.5 times the baseline
or
urine volume less than 0.5mL/kg/hr for 6 hours
-creatinine can be used but too slow

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24
Q

Causes of AKI

A

reduced perfusion
damage to kidney tissues
obstruction of urine outflow

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25
Risk factors for AKI
shock, cardiac surgery, hypotension, prolonged mechanical ventilation and sepsis
26
RF for AKI if hospitalized
older adults, DM, HTN, PVD, liver disease and CKD
27
Prerenal AKI
Source outside the kidneys creating conditions that impair renal perfusion
28
Intrinsic AKI
Inside of the kidney by disorders that directly effect the renal cortex or medulla
29
Causes of prerenal AKI
shock, dehydration, burns and sepsis
30
Causes of intrinsic AKI
allergic disorders, embolism or thrombosis of the renal vessels & nephrotoxic agents
31
Postrenal AKI
A urine flow obstruction
32
Causes of postrenal AKI
tumors, kidney stones or strictures
33
Pre & Postrenal compensations and what it does to the kidneys?
constricts kidney blood vessels, activating renin-angiotensin-aldosterone pathway and release of ADH -increases blood volume and improves kidney perfusion but reduce urine elimination (oliguria and azotemia)
34
What to do with AKI?
ACT EARLY! keep track of Is & Os over 2 hours DW
35
What labs to monitor for kidney function?
**creatinine**, BUN, serum potassium, sodium, osmolarity, urine specific gravity, albumin-creatinine ratio, electrolytes
36
Immunity mediated AKI
Flu, colds, gastroenteritis & sore throats
37
What is prerenal?
Reduced perfusion
38
What happens during prerenal?
Shock, hypotension, anything that blocks blood flow to the kidney
39
What is intrarenal?
kidney damage
40
What happens during intrarenal?
glomerulonephritis, lupus, drugs that damage kidney, toxins, ischemia
41
What is postrenal?
obstruction
42
What happens with postrenal?
bladder cancer, kidney stones, prostate cancer or BPH
43
How do kidneys compensate in prerenal and postrenal?
-Activating the RAAS manifests in high BP -constricting kidney blood vessels -releasing ADH- holds onto fluid, holds onto more water so less urine
44
What happens to blood volume and kidney perfusion in prerenal and postrenal?
both increase
45
What do prerenal and postrenal cause?
oliguria and azotemia (build up of nitrogenous wastes)
46
What is included in a history assessment for AKI
drugs/toxins, DM, HTN, lupus, infection, dehydration, IV contrast, current condition
47
Assessment findings for AKI
history oliguria fluid overload pulmonary crackles increased oxygen demand/ RR/ dyspnea edema N/V confusion
48
Diagnostics of AKI
increased serum creatinine increased BUN levels abnormal electrolytes urine Na levels **metabolic acidosis** urine specific gravity ultrasound CT scans (no IV contrast) MRI xray/KUB
49
What are interventions for AKI
Intervene early (low UOP, edema, rising creatinine) maintain MAP above 65 monitor Is& Os fluid replacement or restriction medications central venous pressure CCB Nutrition Renal replacement therapy
50
What are the nutrition interventions for AKI?
metabolic support 40g/day of protein (more if on dialysis) potassium restrictions fluid restrictions
51
Stages of CKD
Stage 1-5
52
Stage 1 of CKD
normal GFR/ increased
53
Stage 2 of CKD
mild disease/ decrease in kidney function/ mild decrease in GFR (60-80)
54
Stage 3 of CKD
moderate disease/ azotemia present/restriction of fluids/ GFR 30-59
55
Stage 4 of CKD
severe disease/ cannot maintain A-B & F-E balance/ dialysis may be needed/ GFR 15-29
56
Stage 5 of CKD
GFR < 15/ dialysis or death/ transplant
57
Diagnosing AKI (4)
elevated BUN elevated creatinine elevated potassium decreased UOP
58
Assessment for CKD
fluid volume overload= breathing difficulty elevated potassium = cardiac arrest
59
What happens in CKD when 75% of kidney function is gone?
kidneys are unable to -maintain urine production -maintain homeostasis -BUN rises -urine production decreases
60
What happens metabolically in CKD
-rise in BUN & creatinine -increase phosphorus= decreases calcium so weak bones Kussmaul breathing renal osteodystrophy metastic calcifications vascular calcium deposits itchy skin
61
What happens with the heart in CKD
HTN malfunction of RAAS hyperlipidemia HF pericarditis cardiomyopathies
62
What are the hematologic impact of CKD
anemia damaged platelets
63
What happens to the GI system with CKD
PUD uremia leads to stomatitis colitis BUN/ creatinine -anorexia N/V hiccups
64
What are the skin changes with CKD
pruritis bronzed skin uremic frost bruises
65
Assessment for CKD
urinary changes alterations in taste weight loss uremic halitosis weight loss -> anorexia N/V fatigue drowsiness confusion-> seizures & coma neuropathies -> due to uric acid fluid overload HTN dysrhythmias Kussmaul breathing signs of anemia
66
What are the signs of fluid overload?
crackles, JVD, edema
67
CKD patients should not lose or gain
2lbs overnight 5lbs in a week
68
CKD patients on dialysis should not gain
3lbs in between dialysis
69
Pharm therapy for CKD
lasix & antihypertensives
70
Interventions for CKD
DW lasix & antihypertensives fluid restrictions nutrition dialysis
71
When would diuretics be given to CKD
mild to severe (up until stage 3) **no diuretics if on dialysis**
72
What do diuretics do?
increase UOP decrease fluid overload decrease BP *monitor electrolytes & ototoxicity (lasix)
73
CKD medications
diuretics antihypertensives CCB angiotensin BB
74
Amount of protein a CKD patient should have
Less protein until on dialysis
75
How much potassium for CKD patient
60-70 mEq/dialy (restriction) ** because potassium is typically high in these patients
76
How much sodium for CKD
restriction -b/c HTN, edema, HF (1-3 g/day) = early stages -2-4g after starting dialysis
77
What is done with phosphorus for CKD
phosphorus binder is given with meals
78
Interventions/ teaching with CKD
infection prevention (avoid crowds) injury prevention be aware of meds processed by kidneys high risk of fatigue -rest/activity balance
79
How long does is take AV fistula to mature?
6 months
80
Rules of fistulas
NO BP NO venipuncture feel thrill & listen to bruit Q4 assess distal pulses assess for signs of infection avoid pressure on fistula -when accessed used sterile procedure makes signs above bed so everyone knows there is a fistula
81
What is the most common fistula complications
thrombosis
82
What are the 4 fistula complications?
thrombosis strictures infection ischemia
83
What are the long term vascular accesses for CKD?
AV fistula AV graft
84
What are the short-term vascular accesses for CKD?
Vas cath perm cath
85
What is a vas cath?
non-tunneled = higher risk for infection large bore central line intended for short-term use *big risk for clot
86
What is a perm cath?
tunneled large bore central line intended for short term use less risk for infection cap with anticoagulants
87
What is peritoneal dialysis?
utilizes peritoneal cavity for exchange of fluids, wastes and electrolytes
88
What is lost in peritoneal dialysis?
protein
89
When is peritoneal dialysis not an option?
extensive abdominal surgery/adhesions
90
What are the complications of PD
infection peritonitis discomfort bowel perforation
91
How to avoid peritonitis
sterile technique ensure the catheter is not leaking monitor for cloudy outflow/ effluent check for abdominal tenderness fever
92
What is the most commonly prescribed renal replacement therapy?
hemodialysis
93
What are the signs someone needs dialysis?
no response to diuretics symptomatic hyperkalemia calciphylaxis (vascular calcification & skin necrosis)
94
What are patients at risk for when receiving hemodialysis?
cardiac arrest and seizures - do to large volume shifts
95
What are patients at risk for when receiving hemodialysis?
cardiac arrest and seizures - do to large volume shifts
96
What is the care involved in hemodialysis?
warming monitoring often
97
What can happen as a result of hemodialysis?
fatigue changes in LOC
98
What is used for unstable patients?
continuous renal replacement therapy
99
What is continuous renal replacement therapy?
hemofiltration- uses a filter with fine pores -avoids large volume shifts with HD but provides -runs continuously for 24 hours a day 1:1 nursing ICU setting

Med Surg 2 (10 decks)

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