Renal Flashcards Preview

Illness and Patho 1 > Renal > Flashcards

Flashcards in Renal Deck (174):
0

A patient's creatinine clearance is 5 mL/min. What does this value signify?

Renal Dysfunction

1

Acute renal failure is potentially reversible in which phase?

Initiation phase

2

Hyponatremia in renal dysfunction is the result of what?

Water overload

3

Signs and symptoms of acute renal failure include what?

Tachypnea, low pH, and low serum bicarbonate

4

What is a common complication of hemodialysis?

Hypotension

5

Name a medication that has the dual effect of creating a solute diuresis and augmenting renal blood flow

Furosemide

6

In general, maintenance of cardiovascular function and what are the two key goals in the prevention of acute tubular necrosis?

Adequate intravascular volume

7

One of the most useful noninvasive diagnostic tools available for clinicians to monitor fluid volume status is what?

Monitoring daily weights

8

A study that delineates the size, shape, and position of the kidneys and also demonstrates abnormalities, such as calculi, hydronephrosis, cysts, or tumors is what?

KUB x-ray

9

While undergoing his first ever hemodialysis treatment, the patient suddenly becomes confused, complains of a headache, begins to twitch, and proceeds to have a seizure. The nurse realizes that this is most likely due to what?

Cerebral edema

10

Name the indications for hemodialysis.

Acid-base imbalances, electrolyte imbalances, and fluid overload

11

Name the principles that are the basis for dialysis.

Diffusion and ultrafiltration

12

After a patient has an arteriovenous fistula placed, what differences will occur in that arm?

The vein will dilate and the pulse distal to the fistula will need to be evaluated

13

Name the common complications of hemodialysis.

Dysrhythmias, hypotension, infection, and muscle cramps

14

In a patient undergoing peritoneal dialysis, what signs and symptoms should a nurse be looking for?

Abdominal pain and fever, cloudy return fluid, and poor drainage from the abdominal cavity

15

What might exposure to aminoglycoside antibiotics result in?

Acute tubular necrosis

16

What medications should be withheld for 4-6 hours before hemodialysis?

Antihypertensives

17

What is the most common intrarenal condition resulting from prolonged ischemia?

Acute tubular necrosis

18

How long after an aminoglycoside is administered is a peak level taken?

1-2 hours

19

What contributes to prerenal failure?

Hypovolemia and cardiogenic shock

20

Urine output of less than 400 mL in 24 hours

Oliguria

21

The sudden deterioration of renal function, resulting in retention of nitrogenous waste products

Acute renal failure

22

Conditions that produce acute renal failure by interfering with renal perfusion

Prerenal

23

Acute renal failure resulting from obstruction of the flow of urine

Postrenal

24

Conditions that produce produce acute renal by directly acting on functioning kidney tissues

Intrarenal

25

Particularly useful for patients in the critical care unit whose cardiovascular status is too unstable to tolerate rapid fluid removal

Continuous renal replacement therapy

26

Manifested by abdominal pain, cloudy peritoneal fluid, fever and chills, nausea and vomiting, and difficulty in draining fluid from the peritoneal cavity

Peritonitis

27

Commonly used to treat the anemia of chronic renal failure

Epogen

28

Controversial treatment of acute renal failure

Dopamine

29

Primarily used for controlling fluid volume

Ultrafiltration

30

Separation of solute by differential diffusion

Dialysis

31

The normal BUN/Creatinine ratio

10:1 to 20:1

32

What should normal urine production be?

1 mL/kg/hr

33

What is the absolute minimum amount of urine production to sustain life?

30 mL/hr

34

Normal specific gravity or urine values

1.005-1.030

35

What does a urine specific gravity of greater than 1.030 indicate?

Dehydration

36

What do RBCs in the urine indicate?

Infection, damage, or a break in a membrane

37

What do WBCs in urine indicate?

Infection

38

Lack of control of voiding

Incotinence

39

Voiding at frequent intervals

Frequency

40

Difficulty in initiating voiding

Hesitancy

41

Need to void immediately

Urgency

42

Urine output <100 mL/day

Anuria

43

Urine remaining in the bladder post voiding

Residual urine

44

What is the normal residual volume of urine?

50 mL or less

45

Awakening at night to void

Nocturia

46

Painful urination

Dysuria

47

Presence of blood in the urine

Hematuria

48

Urine output of more that 2500 mL/day

Polyuria

49

What disease is polyuria indicative of?

Diabetes

50

What is the normal creatinine level?

0.5-1.2 mg/dL

51

Specifically indicates renal function, this value increases when glomerular filtration is impaired

Creatinine

52

How man nephrons must be lost before there is a change in creatinine levels?

25%

53

What is a normal BUN level?

5-25 mg/dL

54

Increases with excessive protein intake or trauma, but may be falsely elevated in many cases

BUN

55

What can falsely elevate BUN levels?

Lots of protein, blood, diet, and poor liver function

56

Direct visualization of the inner lining of the bladder

Cystoscopy

57

Abdominal x-ray of the kidney, ureters,and bladder

KUB x-ray

58

Visualizes the urinary tract

Intravenous pyelogram

59

What is important to evaluate before administering an IVP?

Normal creatinine levels in order to clear dye

60

What is the most common nosocomial infection?

UTI

61

What is done to diagnose a UTI?

Symptoms, urinalysis, urine culture and sensitivity, IVP, and an abdominal ultrasound

62

Why is a urine culture and sensitivity done on suspected UTIs?

It is necessary for definitive identification of the infecting organism and the most effective antibiotic

63

Which drug is prescribe for palliative reasons in a UTI patient?

Pyridium

64

Why is an anticholinergic prescribed to a UTI patient?

To decrease the spasms of the bladder

65

If a patient has a UTI, how much fluid should the take in?

An extra 2000-3000 mL/day

66

How can urine be acidified?

Intake of cranberry juice

67

Presence of stones in the urinary tract

Urolithiasis

68

Stones formed in renal parenchyma

Nephrolithiasis

69

Formation of stones in the ureter

Ureterolithiasis

70

What are predisposing factors for renal calculi?

Heredity, UTI, foley, IMMOBILITY, dehydration, pH of urine, hyperparathyroidism, GOUT, excess vitamin D

71

Who is most susceptible for renal calculi?

Young males

72

What are the types of renal calculi?

Calcium oxalate, calcium phosphate, uric acid, struvite, and cystine

73

Which type of renal calculi is the biggest and has sharp edges?

Struvite

74

Which type of renal calculi is influenced by heredity?

Cystine

75

What are the emergency treatments for renal calculi?

IV Dilaudid or Morphine, IV Fluid, Torodol, and Ditropan

76

Why is Torodol given to renal calculi patients?

To decrease inflammation

77

Why is Ditropan given to renal calculi patients?

To depress the smooth muscle of the ureter

78

What are the signs and symptoms of renal calculi?

Pain, hematuria, changes in urine output, urgency and frequency, and pyuria

79

How are renal calculi diagnosed?

Lab findings, x-rays, KUB, IVP, renal ultrasounds, spiral CT scan

80

What nursing interventions can be taken for a patient with renal calculi?

Strain all urine, force fluids, walk, narcotics, spasmolytic agents, check vitals, back rubs, PIV dye

81

Rapid deterioration of renal function associated with an accumulation of nitrogenous wastes of the body that is not due to extrarenal factors

Acute Renal Failure

82

Accumulation of nitrogenous wastes of the body

Azotemia

83

Renal failure caused by poor blood flow to the kidneys

Prerenal azotemia

84

Trauma causes what kind of renal failure?

Prerenal

85

What is the most common and most curable type of renal failure?

Prerenal

86

Acute renal failure resulting from damage to the kidney itself

Intrarenal failure

87

What are the causes of intrarenal failure?

Inflammation, Immunologic, and ATN

88

What can cause ATN?

Damage to the nephrons, antibiotics, and rhybdomylosis

89

Obstruction of the urinary collecting system

Postrenal Acute Renal Failure

90

What are the phases of ARF?

Onset, Oliguric, Diuretic, and Recovery

91

What signs and symptoms will a patient in ARF exhibit?

SOB, lots of backed up fluid, and increased BUN and Creatinine

92

What nursing interventions should be done for a patient in ARF?

Decrease fluid intake, give Lasix, assess for pulmonary edema, and daily weights

93

Why should patients in ARF be on a low protein, high CHO and calorie diet?

Because they can't break proteins down and they are in a high metabolic state

94

What happens to the urine of a patient in ARF?

The specific gravity decreases because they lose the ability to concentrate it

95

What are the signs of Dig Toxicity?

Halo vision and bradycardia

96

Why is low does dopamine used in ARF patients?

To restore renal perfusion and help increase blood pressure

97

What does Vitamin K combat in ARF patients?

Increased BUN that interferes with platelet aggregation

98

What should the diet of a patient in ARF look like?

High CHO, high calorie, low protein, low sodium, low fluid, low magnesium, low phosphorous, and low potassium

99

How is fluid replaced in a ARF patient?

With output from previous 24 hours + 400 mL for insensible loss

100

A standard treatment with dialysate solution that uses vascular access for continuous arteriovenous and venovenous hemofiltrations

Continuous Renal Replacement Therapy

101

Remove plasma water and dissolved contents from the clients' blood across a membrane

Dialysis

102

What is the pH problem of all patients in ARF?

Metabolic Acidosis

103

How does dialysis decrease the BUN and Creatinine levels?

By removing water and waste

104

Progressive, irreversible kidney injury where kidney function does not recover

Chronic Kidney Disease

105

How do patients with CRF survive?

By using artificial means of replacing kidney function

106

Inflammatory process involving both kidneys' immune response of glomerular membrane to the protein beta hemolytic streptococcus

Chronic Glomerulonephritis

107

Inherited disorder in which nephrons form cysts and are non-functional

Polycystic Kidney Disease

108

Which antibiotics are nephrotoxic?

Mycins

109

What is the leading cause of CRF?

Diabetes Mellitus

110

What is the second leading cause of CRF?

Hypertension

111

Why does hypertension cause CRF?

Shrinks and scars the kidneys

112

What are the stages of CRF?

Reduced renal reserve, renal insufficiency, renal failure, end-stage renal disease

113

In which stage does the healthier kidney compensate for the more diseased kidney?

Reduced Renal Reserve

114

In which phase of CRF does metabolic waste being to accumulate?

Renal Insufficiency

115

In which stage of CRF does anemia occur?

Renal Insufficiency

116

Condition in which nephrons cannot reabsorb Bicarb and are unable to excrete hydrogen ions

Acidosis

117

How does the body attempt to compensate for acidosis?

Increased respirations to blow off CO2

118

Why are patients in CRF anemic?

Because of decrease in Erythropoietin

119

In which phase of CRF do patients become acidotic?

Renal Failure

120

In which phase of CRF are there excessive amounts of nitrogenous wastes accumulating in the blood to an extent that the patient is unable to maintain homeostasis?

End Stage Renal Disease

121

Why are patients in End Stage Renal Disease hard to resuscitate after a cardiac event?

Because they are acidotic

122

What symptom to only patients in ENRD exhibit?

Paroxysmal Nocturnal Dyspnea

123

What is the classic indicator of renal failure?

Azotemia

124

What are the signs and symptoms of CRF?

Nausea, vomiting, anorexia, diarrhea, constipation, increased nitrogenous wastes, restlessness, muscle spasms, peaked T waves, arrhythmias, AMS, halitosis, pale, uremic frost, RLS

125

Rate at which the kidneys remove creatinine from plasm

Creatinine Clearance

126

Why does sodium-hyponatremia occur in early renal failure?

Increase in urine output and less nephrons to reabsorb the sodium

127

What symptoms of CRF are caused by a increase in potassium levels?

Peaked T waves, arrhythmias, bradycardia, and cardiac arrest

128

What will be increased in the urine of a CRF patient?

Protein

129

Why is the calcium of a patient with CRF decreased?

Because the kidneys cannot excrete phosphorus and when phosphorous increase, calcium decreases

130

Besides the kidneys, what other organ hypertrophies in a patient with CRF?

The parathyroid

131

What is the end result of the kidneys' inability to excrete phosphorous?

Brittle bones

132

What is the sign of severe CRF?

Anemia

133

What are the side effects of Epogen?

Pain and hypertension

134

Why do patients with CRF also have hypertension?

The renin-angiotensin aldosterone system fails to recognize the increased renal blood flow so it increases renin production, which increases blood pressure

135

Why do CRF patients have pericarditis?

From the uremic toxins

136

How much does 1 liter of excess fluid weigh?

2.2 lb

137

What cardiac conditions will a CRF patient exhibit?

Hypertension, hyperlipidemia, heart failure, and pericarditis

138

What will the urine of a patient in ESRF look like?

Dilute and clear

139

What laboratory assessments should be done to diagnose CRF?

BUN, Creatinine, Electrolyte, CBC, ABG

140

What is the test of choice to diagnosis CRF?

MRI

141

When should the nurse administer vitamin and mineral supplements to a patient in CRF?

After dialysis

142

What drugs are used to treat CRF?

Digoxin, Antacids, Amphojel, Stool Softeners, Narcotics, Antihypertensives, Diuretics, Insulin, and Erythropoietin

143

What tests are used to diagnose CRF?

KUB, IVP, Aortorenal angiography, Ultrasounds, MRI, Renal Biopsy

144

How can a CRF patient decrease their risk for infections?

Meticulous skin care, preventive skin care, inspection of vascular access site for dialysis, and monitoring of vital signs

145

How can a nurse prevent a patient with CRF from feeling fatigued?

Give vitamin and mineral supplements, give epogen, and give iron

146

What types of vascular access devices are used to administer hemodialysis?

Arteriovenous fistula or graft long term or catheter or shunt for short term

147

What complications can arise from the vascular access devices used for hemodialysis?

Thrombosis or stenosis, infection, aneurysm formation, ischemia, heart failure

148

What causes post dialysis disequilibrium syndrome?

Lots of fluid taken up quickly

149

Procedure involves siliconized rubber catheter placed into the abdominal cavity for infusion of dialysate

Peritoneal dialysis

150

Why is the peritoneum used for dialysis?

Because it is a semipermeable membrane

151

What is the nurse's responsibility when administering peritoneal dialysis?

Observe the outflow amount and pattern of the fluid

152

If a kidney is going to be transplanted, what needs to be matched between the donor and recipient?

Blood type and HLA

153

How is a kidney transplanted?

The old kidney is left in and the new kidney is placed in front of it

154

What does the nurse look for after a kidney transplant?

Golden Nectar

155

What is the nurse's responsibility in a patient that just had a kidney transplant?

Keep the kidney very hydrated

156

Inflammation of the bladder caused by irritation or, more commonly, by infectioin

Cystitis

157

An inflammation of the urethra that causes symptoms similar to UTIs

Urethritis

158

For a patient with renal calculi, what do nursing interventions focus on?

Pain management and prevention of infection and urinary obstruction

159

The use of sound, laser or dry shock waves to break the renal calculi into small fragments

Lithotripsy

160

How much fluid should a normal person drink?

1.5-2.5 L/day

161

What exercises can women with incontinence do to reverse the condition?

Pelvic floor strengthening exercises

162

What is the kidney's role in the human body?

Filtering wastes and balancing fluids, electrolytes, acids and bases

163

Involves an active bacterial infection and tissue inflammation, tubular cell necrosis, and possible abscess formation anywhere in the kidney

Acute pyelonephritis

164

Occurs with a lower urinary tract defect, obstruction, kidney stones, or, most commonly, when urine reflexes from the bladder back into the ureters

Chronic pyelonephritis

165

Why do ARF patients need a high calorie diet?

Because there is a high rate of catabolism

166

What types of dialysis are used in emergency situations?

Continuous renal replacement therapy, continuous arteriovenous hemofiltration, continuous arteriovenous hemodialysis and filtration

167

Which systemic diseases put patients at higher risk for CRF?

Diabetes Mellitus, hypertension, lupus, and sickle cell disease

168

What is urea the end product of?

Protein metabolism

169

What type of dialysis is the least disruptive to a normal lifestyle?

Continuous Ambulatory Peritoneal Dialysis

170

What does protein in a urinalysis indicate?

Kidney injury and muscle wasting

171

What would cause a BUN to be elevated?

Excessive protein intake or trauma

172

What is the most common cause of renal calculi?

Dehydration

173

Why does Diabetes Mellitus cause CRF?

The fluctuations between high and low sugars does constant damage