renal

Question 1

functional unit of the kidney is the

Answer 1

nephron

Question 2

glomerulus

Answer 2

bundle of capillaries where filtration occurs in nephron

Question 3

Function of kidneys

Answer 3

remove toxins from blood, maintain electrolyte balance, regulate water balance

Question 4

Renin Angiotensin Aldosterone System

Answer 4

regulates water balance and controls blood pressure; renin released by kidneys -> angiotensinogen -> angiotensin I -> angiotensin II -> aldosterone

Question 5

renin is released when

Answer 5

decrease renal blood flow, sympathetic input, epi/norepi, early in day, when standing

Question 6

Inhibits renin:

Answer 6

adenosine, angiotensin II, Adrenalin. lockers, aldosterone, later in day, lying down

Question 7

Angiotensin II Receptor Blockers

Answer 7

Losartan; inhibits vasoconstrictor properties of angiotensin II

Question 8

ACE inhibitor

Answer 8

blocks concessions of angiotensin I to angiotensin II, increases renin levels and decrease aldosterone leading to vasodilation

Question 9

Loop diuretics

Answer 9

“ide”; act on loop of Henle to increase urine output by affecting sodium reabsorption within the nephron

Question 10

Loop diuretics uses and monitoring

Answer 10

increase UO, edema, CHF, bp management; monitor potassium levels (considered potassium wasting), most effective of all diuretics

Question 11

Thiazide diuretics

Answer 11

“thiazide”; decreases sodium reabsorption causing more
fluid loss in urine; htn, CHF; monitor electrolyte levels and bp

Question 12

potassium sparing diuretics

Answer 12

spares potassium; htn, edema, swelling, hypokalemia; monitor potassium; not as strong as other diuretics so are often combine with a different diuretic

Question 13

when kidneys have poor perfusion we will see

Answer 13

urine output go down

Question 14

normal urine output

Answer 14

30ml/hr

Question 15

UTI S&S

Answer 15

dark, cloudy urine, blood in urine, pain in pelvis, pain or burning while urinating (dysuria), strong or foul smelling, increase frequency or urgency

Question 16

pyelonephritis

Answer 16

UTI that has reached the kidneys

Question 17

UTI treatment

Answer 17

hydration (more fluids being filtered and put out bacteria will be flushed out), antibiotics

Question 18

glomerulonephritis

Answer 18

acute inflammation of kidneys at level of nephron; happens d/t inflammatory reaction, antibodies get lodged into glomerulus, #1 cause is strep

Question 19

glomerulonephritis S&S

Answer 19

sore throat, malaise, headache, flank pain, htn, edema, decreased UOP, increased BUN and Cr, increase specific gravity, dark, cloudy, sediment

Question 20

glomerulonephritis tx

Answer 20

abx for strep, struck I&Os, bp, decrease protein and sodium, increased carbs

Question 21

nephrotic syndrome

Answer 21

causes body to pass too much protein in urine; no protein in the blood = not being able to hold onto fluid which leads to third spacing - bp still low but RAAS activated due to low perfusion to kidneys water and sodium retained but not in cells = tons of edema

Question 22

causes of nephrotic syndrome

Answer 22

anything that causes inflammation; infection, cancer, NSAID overuse, diabetes, lupus, diabetes, strep throat

Question 23

Nephrotic Syndrome S&S

Answer 23

anasarca, blood clots, high cholesterol, proteinuria, hypoalbuminemia, edema, hyperlipidemia

Question 24

nephrotic syndrome tx

Answer 24

fix the cause, prednisone, diuretics, ACE inhibitors, statins, anti coagulation, dialysis, high protein low sodium diet

Question 25

pre renal failure

Answer 25

blood cannot get to the kidneys; hypotension, hypovolemia, shock

Question 26

intra renal failure

Answer 26

damage inside the kidney; golemerulonephritis, nephrotic syndrome, nephrotoxic drugs

Question 27

post renal failure

Answer 27

something is blocking urine from leaving the kidneys; kidney stone, tumor, urethral obstruction, enlarged prostate

Question 28

Acute kidney injury

Answer 28

sudden, happens over few hours to few days, causes build up of waste products in blood

Question 29

Phases of AKI

Answer 29

onset, oliguric, diuretic, recovery

Question 30

onset phase of AKI

Answer 30

Injury occurs and output decreases, hours to days

Question 31

oliguric phase

Answer 31

decreased output, becomes fluid volume overload, 10-14 days, oliguria, edema, SOB, increased BUN and Cr, metabolic acidosis, anemia, hyperkalemia, hyperphosphatemia, hypocalcemia, fatigue, confusion, nausea

Question 32

Diuretic phase AKI

Answer 32

diuresis, 1-3 weeks, 3-5 L dilute urine per day, hypotension and hypovolemia, hypokalemka, hyponatremia, BUN and Cr begin to normalize

Question 33

CKD

Answer 33

happens slowly over a long period of time, damage to kidneys accumulates over time, can no longer filter waste properly, and waste products build up

Question 34

HTN and CKD

Answer 34

high bp put pressure on renal artery causes thickening of opening from blood vessels to kidneys = less blood flow to kidneys = kidneys ask for more blood and activate RAAS = causes more htn = eventually causes glomerulosclerosis and loss of nephrons

Question 35

major causes or CKD

Answer 35

htn and uncontrolled diabetes

Question 36

diabetic nephropathy

Answer 36

chronic high blood sugars = production of pro inflammatory cytokines causes changes to kidneys -> thickening of tubular basement membrane, thickening of renal arterial wall, sclerosis of nephrons; major intra renal cause of CKD

Question 37

CKD is staged based off of the __________

Answer 37

GFR; as it decreases condition worsens

Question 38

in CKD stages 2 and 3 we want to

Answer 38

protect kidneys, try to reverse damage

Question 39

Stages 4 and 5 of CKD will require

Answer 39

dialysis

Question 40

S&S early stages of CKD

Answer 40

GFR goes up, diuresis

Question 41

S&S late stage CKD

Answer 41

htn, edema, hyperkalemia (muscle cramps, ECG changes, fibrillations), metabolic acidosis, osteodystrophy (not enough calcium = secondary hyperparathyroidism = causes osteoporosis), uremia, neuro changes, anorexia, vomiting, skin changes (uremic frost)

Question 42

Labs in CKD will look like

Answer 42

Increased BUN and Cr, high potassium and phosphorus, low calcium, metabolic acidosis

Question 43

renal diet

Answer 43

low sodium, low phosphorus, low protein, low potassium

Question 44

CKD treatment

Answer 44

restrict fluid intake, no K+ sparing diuretics or ACE inhibitors, regular lab work, dialysis

Question 45

hemodialysis

Answer 45

3-4 times/week, blood goes out IV in artery and gets filtered then goes back to body through IV in vein (has fistula), will cause rapid fluid shift, monitor bp and electrolytes

Question 46

fistula nursing considerations

Answer 46

no BPs or IVs in arm of fistula, palpate for a thrill, and musculature a bruit

Question 47

Peritoneal dialysis

Answer 47

not all can handle hemodialysis, peritoneal membrane is used to filter instead of machine; dialysate is infused into peritoneal cavity and dwells for 6hrs, fluid is drained taking toxins with it; drainage should be clear (cloudy indicates infection), need to drain all dialysate (everything that goes in needs to come out) might need to turn pt side to side