Renal

Question 1

define anasrca.

Answer 1

generalized severe edema

Question 2

define anuria

Answer 2

no urine output

Question 3

define ascites

Answer 3

fluid volume overload and build-up, concentrated in the abdomen

Question 4

where does edema typically form?

Answer 4

the lowest part of the body

Question 5

define extracellular/intracellular fluid

Answer 5

fluid outside of the cell, inside the cell

Question 6

what are the parts of the renal system?

Answer 6

kidney, ureters, bladder, urethra

Question 7

list the primary functions of the kidneys

Answer 7

regulate volume: through urine production
composition of urine: electrolytes concentration
regulation of pH: through hydrogen ions
eliminating waste: meds, diet, muscle metabolism
BP regulation: RAAS, increase blood and oxygen flow
RBC production: stimulates erythropoietin
vitamin d conversion

Question 8

how much of the body’s CO goes to the kidneys

Answer 8

25%

Question 9

what is the general anatomy of the renal capsule

Answer 9

outer cortex: nephrons
inner medulla: the loop of Henle and collecting ducts
renal pelvis: transfers urine to bladder
afferent and efferent arteriole

Question 11

What does the glomerulus do?

Answer 11

Filter. (Fluid and blood)
IN: sodium,potassium, and maybe protein
OUT: extra electrolytes, meds, etc

Question 12

What are the three nephron functions

Answer 12

Glomerulus filtration, tubular secretions, tubular reabsorption

Question 13

The glomerulus is under high pressure, 70mg, what is a healthy GFR

Answer 13

125 ml/min, if it is lower it shows damage

Question 14

What is the passage of nephron

Answer 14

Glomerulus
Bowman’s
Tubules
Loop of henle/medulla
Renal pelvis

Question 15

Where is the loop of henle found

Answer 15

The nephron

Question 16

What conditions require diuretics

Answer 16

Cardiovascular (HTN and HF)
Renal — GFR effects
Hepatic
Burns
Trauma
Allergies
Inflammatory reaction
Fluid overload— increased hydrostatic pressure
Low plasma: decreased ontonic pressure

Question 17

What is dependent, pulmonary and anasarca edema?

Answer 17

D: sets in lowest point
P: fluid overload in lungs
A: massive, generalized

Question 18

True or false, edema occurs only when the heart no longer functions efficiently?

Answer 18

False

Question 19

What is the main function of diuretics

Answer 19

Increases secretion of water, sodium, and other electrolytes

Question 20

What are the main drug classes of diuretics

Answer 20

Loop diuretics - furosemide
Thiazide - HCTZ/metolazone
Potassium sparing- spironolactone
Osmotic - mannitol
Carbonic anhydrase inhibitor: acetazolamide

Question 21

What diuretic does not work in renal tubules

Answer 21

Osmotics

Question 22

What is used when a rapid diuretic is needed? Hint: it is also used for renal impairment

Answer 22

Loop diuretics

Question 23

What is the main loop diuretics, how it is given, its MOA and when it is used?

Answer 23

Furosemide (bumetanide, toresemide)
Given: PO, IV, IM
MOA: inhibits Na and Cl reabsorption in ascending LOH
USE: pulmonary edema, CHF, hepatic, renal, HTN, critically ill, and for chronic conditions

Question 24

What are the adverse reaction, contraindications and drug interactions for loop diuretics?

Answer 24

A: fluid/electrolyte imbalance, hyponatremia, hypokalemia, fluid deficit, ototoxicity (low plasma, hearing loss is main symptom)
C: Anuria, allergy to sulfonamides
D: Aminoglycosides, cephalosporins,(increased effect) corticosteroids, digoxin (hypokalemia)

Question 25

What are the nursing implications and patient teaching for loop diuretics

Answer 25

N: slow IV push (20mg/min), checking labs, daily weight and I&O, vital monitoring (hypotension), give PO in AM P: low sodium diet, high k diet, daily weight, orthostatic, take in AM

Question 26

What is the main thiazide and thiazide like diuretic, how it is given, MOA and use?

Answer 26

Hydrochlorothiazide HCTZ) and metolazone (like) Given: PO MOA: decreases reabsorption of Na, H2O, Cl and HCO3 in distal convoluted tubule Use: first line for HTN, edema for CHF, nephrotic syndrome, renal impairment

Question 27

What are the adverse effects and contraindications for thiazide and thiazide like diuretics?

Answer 27

A: hypotension, weakness, dizziness, diarrhea/constipation, hypokalemia, hyperglycemia C: allergy to sulfonamides, renal failure/anuria

Question 28

What are the nursing implications and patient teaching for thiazide and thiazide like diuretics

Answer 28

N: check labs, weight and I&O, vitals, give in AM, monitor dizziness P: low sodium, high k diet, daily weight, orthostatic, take in AM

Question 29

What is hypokalemia, and the prevention and management of it?

Answer 29

K lower than 3.5 Signs: conduction, weakness, palpitations, GI upset low dose diuretics — combo with potassium sparing/wasting Supplements Increase foods in potassium Restrict sodium

Question 30

What assessment finding in a patient with heart failure recovering furosemide would indicate an improvement in fluid volume status?

Answer 30

Absence of crackles in lungs

Question 31

What is the main potassium sparing diuretic, how it works, MOA, and use

Answer 31

Spironolactone -slow onset and peak (24-48 hrs) -6 weeks for full effects MOA: blocks aldosterone (RAAS) Use: HF, ascites, hypokalemia, HTN, hyperaldosteronism

Question 32

What are the adverse effects, contraindications, and drug interactions for potassium sparing diuretics

Answer 32

A: dizziness, diarrhea, androgen like (breast growth, irregular periods), increased GI bleed, BB: tumorigenic with chronic toxicity C: renal insufficiency and hyperkalemia D: ACE, ARB, K containing drugs (hyperkalemia)

Question 33

What are the nursing implications and patient teaching for potassium sparing diuretics?

Answer 33

N: check labs, weight and I&O, dizziness P: avoid salt subs, low k diet (no oranges, banana, spinach), weight, acites, orthostatic, take in morning WITH food

Question 34

What is hyperkalemia and the prevention and management of it?

Answer 34

K greater than 5 Signs: muscle cramps, EKG changes, hypotension, arrhythmias, death -potassium sparing and wasting meds -no supplements -no salt substitutes -maintain urine output

Question 35

What is the main osmotic diuretic, how it is given, MOA and use?

Answer 35

Mannitol Given: IV (glass) in critical care MOA: increases pressure of glomerular filtrate, pulls from extra vascular into blood (goes to kidneys), decreases reabsorption of H2O and electrolytes USE: intracranial pressure, intraocular pressure, decreased renal circulation and GFR (Not used in the loop)

Question 36

What are the adverse effects, contraindications, and nursing implications of osmotic diuretics?

Answer 36

A: hyperosmolar non ketotic coma, confusion, headache, syncope, dysrhythmias, dehydration C: dehydration, abdomen pain, appendicitis, pulmonary edema, cardiac decompensation (HF), older adults N: physical and neuro exam, I&Os, vitals INFILTRATION=hyaluronidase

Question 37

What is the main carbonic anhydrase inhibitor, how its given, MOA, use and adverse effects?

Answer 37

Acetazolmide GIVEN: IV or eye drops MOA: inhibits CA to reduce formation of aqueous humor and lower IOP USE: open angle glaucoma and secondary glaucoma A: metabolic acidosis IV ONLY: Steven Johnson’s, flaccid paralysis, blood dycrasias

Question 38

What are the contraindications and nursing implications of carbonic anhydrase inhibitors?

Answer 38

C: renal/hepatic, Addisons disease, electrolyte imbalance, chronic non congestive angle closure glaucoma N: vision exam, teach to give eye drops

Question 39

Should a patient taking spironolactone use salt substitutes?

Answer 39

No, it will increase K levels