Renal

Question 1

Acute glomerulonephritis patho

Answer 1

Occurs after exposure to strep infx
SLE

Question 2

S+S of acute glomerulonephritis

Answer 2

Oliguria
Dark, rust-colored urine
Hematuria, proteinuria
Edema
HTN
Weight gain
Anorexia, malaise, weakness

Question 3

UA and lab studies of acute glomerulonephritis

Answer 3

UA: RBCs, protein
Elevated: BUN, creatinine, evidence of recent strep infx
Positive throat culture

Question 4

Tx of acute glomerulonephritis

Answer 4

Supportive care
Antihypertensive agents, diuretics, temporary dialysis, abx
Sodium-restricted diet
Report HA to HCP
Seizure precautions

Question 5

CKD causes

Answer 5

DM and HTN

Question 6

S+S of CKD

Answer 6

Volume overload: edema, pleural effusions, HTN
Accumulation of urea and waste products: pruritis, lethargy, sleep changes, peripheral neuropathy
Low EPO -> anemia
Vitamin D and metabolism -> bone dz

Question 7

Lab values of CKD

Answer 7

High potassium, phosphorous
Low calcium, GFR
Metabolic acidosis

Question 8

Pharm of CKD

Answer 8

HTN: ACE inhibitors, ARBs
Anemia: EPO injections, iron
Edema: diuretics
Protect bones: calcium and vitamin D
Hyperkalemia: oral intestinal K binders (sodium zirconium, patiromer)
Hyperphosphatemia: oral phosphate binders (calcium acetate/carbonate)
Metabolic acidosis: sodium bicarbonate

Question 9

Diet of CKD

Answer 9

Low potassium
Low phosphorous
Sodium and fluid restriction
Modest protein restriction

Question 10

Hemodialysis dialysis solution

Answer 10

Electrolytes and dextrose can be added

Question 11

Procedure of hemodialysis

Answer 11

Access pt’s circulation
Administer heparin to pt
Heparinized blood flows through semipermeable membrane in one direction
Dialysis solution flows in opposite direction
Wastes are removed and electrolytes are corrected via diffusion
Ultrafiltration removes excess water from blood
Blood returns to pt via the access line after it has been cleansed

Question 12

Interventions of hemodialysis

Answer 12

Administer anticoagulants (heparin)
Withhold antihypertensives prior to hemodialysis
Obtain BP on arm opposite of fistula/graft
Provide appropriate nutrition
Weigh before and after

Question 13

If air embolism occurs during hemodialysis, what tx

Answer 13

Clamp access tubing
Reposition to Trendelenburg on left side
Administer oxygen (high-flow)
Notify HCP

Question 14

Disequilibrium syndrome def and S+S

Answer 14

Solutes are removed from blood faster than CSF and brain
N+V, restlessness, agitation, confusion -> seizures -> death

Question 15

Disequilibrium syndrome during hemodialysis tx

Answer 15

Slow/stop dialysis
Notify HCP
Reduce environmental stimuli
Prepare to administer IV hypertonic saline and mannitol
Prepare to dialyze for shorter periods at reduced flow rates to prevent recurrence

Question 16

When accessing dialysis cath (peritoneal dialysis), what precautions are there to follow?

Answer 16

Wear a mask
Use aseptic technique
Cleanse around insertion site

Question 17

Troubleshooting peritoneal dialysis

Answer 17

Keep drainage bag below abdomen
Check for kinks in tubing
Change the position by turning the pt to a side-lying position or by asking the pt to walk
Assess for constipation and provide options for relief such as stool softener

Question 18

Peritonitis S+S during peritoneal dialysis

Answer 18

Tachycardia
Fever
Abdominal pain
Cloudy effluent

Send cloudy fluid to lab for C+S and prepare to administer abx

Question 19

Abnormal outflow characteristics of peritoneal dialysis

Answer 19

Cloudy: infx
Bloody: expected during first exchanges; later = problem
Fecal/brown: intestinal perforation

Question 20

Lower urinary tract infx AKA

Answer 20

Cystitis

Question 21

Upper urinary tract infx AKA

Answer 21

Pyelonephritis

Question 22

S+S of cystitis

Answer 22

Dysuria
Urinary frequency and urgency
Hematuria
Lower abdominal pain

Question 23

Pyelonephritis S+S

Answer 23

N+V
Fever
Flank pain (costovertebral angle tenderness)

Question 24

Meds of UTI

Answer 24

Abx
Antipyretics/analgesics
Antispasmodics

Question 25

Pt teaching of UTI

Answer 25

Avoid bladder-irritating foods: caffeine, spicy foods, alcohol Perineal hygiene Avoid synthetic fabrics that seal in moisture Empty bladder before and after sex

Question 26

Acute nephrolithiasis tx

Answer 26

Administer pain meds Strain pt's urine Administer antiemetics if needed Encourage pt to move around

Question 27

For CKD, what meds to avoid?

Answer 27

NSAIDs

Question 28

On bladder scan, when is urinary retention indicated?

Answer 28

Amt > 100 mL

Question 29

Arteriovenous fistula education

Answer 29

Avoid sleeping on arm w/ AVF or use creams/lotions on site Avoid lifting heavy objects on side of AVF Check fx of vascular access several times per day by feeling for thrill to access AVF patency Avoid restrictive clothing/jewelry Report S+S of infx and bleeding after dialysis

Question 30

How is creatinine tested?

Answer 30

24 hr urine collection

Question 31

Kidney disease is at risk for what 2 electrolytes?

Answer 31

Hyperkalemia Hyperphosphatemia

Question 32

Nephrotic syndrome

Answer 32

Increased glomerular basement membrane permeability leading to protein loss

Question 33

S+S of nephrotic syndrome

Answer 33

Weight gain Periorbital edema when walking -> edema Ascites Pallor Decreased urine output Fatigue Irritability Anorexia Extreme proteinuria and albuminuria

Question 34

Labs of nephrotic syndrome

Answer 34

Extreme proteinuria and albuminuria Hyperlipidemia

Question 35

Tx of nephrotic syndrome

Answer 35

Promote diuresis Corticosteroids Albumin Diuretics Nutrition: decreased salt in edema pts, protein-rich snacks