Renal

Question 1

Patho of glomerulonephritis

Answer 1

Inflammatory reaction in the glomerulus

Antibodies lodge in the glomerulus leading to scarring and decreased filtering

Question 2

Main cause of glomerulonephritis

Answer 2

Strep

Question 3

S/S of glomerulonephritis

Answer 3

Sore throat
Malaise and HA-retaining toxins
Increased BUN and Creatinine
Protein and blood in urine (tea/rust colored)
Protein leaks out due to holes in glomerulus
Flank pain (CVA tenderness)
Increased BP
Facial edema
Decreased UOP
Increased urine specific gravity
Client will go into fluid volume excess

Question 4

Treatment of glomerulonephritis

Answer 4

Decreased protein and Na, increased carbs to prevent breaking down protein for energy
Dialysis

Question 5

How long will blood and protein stay in the urine with glomerulonephritis?

Answer 5

Months

Question 6

When does diuresis begin after onset of glomerulonephritis?

Answer 6

1-3 weeks

Question 7

How is fluid replacement determined?

Answer 7

24 hour fluid loss + 500cc = total replacement

Question 8

Protein makes BUN do what?

Answer 8

Increase

Question 9

Patho of nephrotic syndrome

Answer 9

Inflammatory response in the glomerulus, big holes form so protein starts leaking in urine, leads to hypoalbuminemia. Without albumin you can’t hold onto fluid in vascular space, so fluid goes into tissues. (edema) Since all fluid is in tissues, blood volume is decreased. Aldosterone is produced to try to replace blood volume, so Na and water are retained, but there is no albumin to hold it, so more fluid goes to tissues.

Question 10

Total body edema

Answer 10

Anasarca, occurs with nephrotic syndrome

Question 11

Problems associated with protein loss

Answer 11

Blood clots, protein keeps blood from clotting
Cholesterol and triglycerides are released from the liver compensation by making more albumin, causing an increased release of cholesterol and triglycerides.

Question 12

Causes of nephrotic syndrome

Answer 12

Bacterial and viral infections
NSAIDs
Cancer, genetics
Systemic dz like lupus/diabetes
Strep

Question 13

S/S of nephrotic syndrome

Answer 13

Proteinuria
Hypoalbuminemia
Edema (anasarca)
Hyperlipidemia

Question 14

Tx of nephrotic syndrome

Answer 14

Diuretics
ACE inhibitors to block aldosterone
Prednisone to decrease inflammation and shrink holes in glomerulus-causes immunosuppression
Lipid lowering drugs
Decrease Na
Increase protein-give lasix, could go into fluid excess
Dialysis
Anticoagulation therapy for 6 months

Question 15

One kidney dz when you have to have more protein in diet

Answer 15

Nephrotic syndrome

Question 16

Renal failure requires what?

Answer 16

Bilateral failure

Question 17

Causes of renal failure

Answer 17

Pre renal
Intra renal
Post renal

Question 18

Pre renal failure

Answer 18

Blood can’t get to the kidneys

• Hypotension
• Decreased HR, arrhythmias
• Hypovolemia
• Shock

Question 19

Intra renal failure

Answer 19

Damage has occurred inside kidney

• Glomerulonephritis
• Nephrotic syndrome
• Dyes with heart cath and CT scans
• Drugs (mycins, nephrotoxicity)
• Malignant HTN (uncontrolled)
• DM causes vascular damage

Question 20

Post renal failure

Answer 20

Urine can’t get out of kidneys

• Enlarged prostate
• Kidney stone
• Tumors
• Ureteral obstruction
• Edematous stoma (ileal conduit)

Question 21

S/S of renal failure

Answer 21

Increased creatinine and BUN
Anemia
Initially: increased specific gravity
Fixed specific gravity: lose ability to concentrate and dilute urine, fluid challenge: bolus with 250 mL NS
HTN & HF, retaining fluids
Anorexia, n/v, retaining toxins
Itching frost (uremic frost)-take good skin care
Hyperkalemia
Metabolic acidosis
Retain phos leading to decreased serum Ca and Ca is pulled from bones

Question 22

Why is there anemia with renal failure?

Answer 22

Not enough erythropoietin-stimulates RBC production

Question 23

Two phases of acute renal failure

Answer 23

Oliguric

Diuretic

Question 24

Acute renal failure

Answer 24

Kidneys have been damaged by one of the causes: this damage leads to the oliguric phase

Question 25

Oliguric phase of acute renal failure

Answer 25

Decreased UOP 100-400 mL in 24 hours Fluid volume excess Increased K *Good time do do the fluid challenge

Question 26

Diuretic phase of acute renal failure

Answer 26

Sudden onset Increased UOP Fluid volume deficit Decreased K

Question 27

For hemodialysis, the machine does the work of what?

Answer 27

The glomerulus

Question 28

How often is hemodialysis done

Answer 28

3-4 x per week, so client has to watch what they eat and drink between treatments

Question 29

What med will clients get during hemodialysis?

Answer 29

An anticoagulant to prevent clots from forming. Usually heparin, so implement bleeding precautions

Question 30

Do you worry about suicide with hemodialysis pts?

Answer 30

Yes, they depressed. They may use methods like not going to their appointments or eating the wrong diet

Question 31

Why can't all clients handle hemodialysis?

Answer 31

Decreased blood volume can lead to chock. Unstable cardiovascular system clients can't handle it

Question 32

What meds do you hold before hemodialysis?

Answer 32

Lisinopril (already have decreased BP during) Nitro Water soluble vitamins Antibiotics (won't do any good if it's filtered out)

Question 33

What med CAN you give before hemodialysis?

Answer 33

Famotidine, not filtered by kidneys

Question 34

Types of vascular access with hemodialysis (must have access)

Answer 34

Arteriovenous fistula Arteriovenous graft Both require sx, the site takes weeks to mature and be ready for repeated venipunctures

Question 35

What rate is blood removed, cleansed, then returned with hemodialysis?

Answer 35

300-800mL/min

Question 36

What is vascular access?

Answer 36

Site for access to a large blood vessel, very rapid flow is essential for hemodialysis

Question 37

Arteriovenous fistula

Answer 37

In forearm, anastomosis between an artery and a vein

Question 38

Arteriovenous graft

Answer 38

Synthetic graft to join artery and vein vessels

Question 39

How many needles are inserted into the vascular access during hemodialysis?

Answer 39

Two, one allows blood to be pulled form he circulation and set to machine, other is used to retune the filtered blood to client's circulation

Question 40

Which end of access removes blood?

Answer 40

Arterial end

Question 41

Which end of access replaces blood?

Answer 41

Low pressure venous end

Question 42

Temporary hemodialysis access

Answer 42

The internal jugular or femoral veins are often used for catheter placement. Sx is not required

Question 43

Care of hemodialysis access

Answer 43

Do not use for IV access to draw blood, admin meds | No BPs, needle sticks, constriction, purse, jewelry

Question 44

Assessment of hemodialysis access

Answer 44

Ensure potency by palpating for a thrill-cat purring sensation Auscultate for a bruit-turbulent blood flow Feel the thrill, hear the bruit

Question 45

Peritoneal dialysis filter is what

Answer 45

Peritoneal membrane

Question 46

How to prepare dialysate for peritoneal dialysis

Answer 46

Warm to body temp and infuse into peritoneal cavity by gravity via a tenckhoff catheter

Question 47

How does the fluid for peritoneal dialysis work

Answer 47

2000-2500 mL fills peritoneal cavity (takes 10 min) and remains for a prescribed amount of time, called the dwell time

Question 48

Exchange during peritoneal dialysis

Answer 48

After fluid fills peritoneal cavity, the bag is lowered and the fluid, along with he toxins, are drained

Question 49

Why do we warm the fluid for peritoneal dialysis

Answer 49

Cold promotes vasoconstriction which limits blood flow. We want it warm to vasodilate for more blood flow

Question 50

What should the drainage look like with peritoneal dialysis?

Answer 50

Clear, straw-colored. Cloudy means infection | Should be able to read a newspaper through the drainage/effluent

Question 51

What type of clients get peritoneal dialysis?

Answer 51

Someone who can't tolerate hemodialysis or someone who chooses it

Question 52

What happens if all the fluid doesn't come out with peritoneal dialysis?

Answer 52

Reposition

Question 53

Two types of peritoneal dialysis

Answer 53

Continuous ambulatory | Continuous cycle

Question 54

Continuous ambulatory peritoneal dialysis

Answer 54

Client has to have energy and a desire to be active Done 4 x per day, every day Fluid causes pressure on back, so pt with disc dz or arthritis shouldn't do this Clients with colostomy can't do this, infection risk

Question 55

Continuous cycle peritoneal dialysis

Answer 55

Connect their peritoneal dialysis cath to a cycler at night and their exchange is done automatically while the sleep. DC in AM. Client has more freedom

Question 56

Complications of peritoneal dialysis

Answer 56

``` Peritonitis (cloudy effluent 1st sign) Constant sweet taste Hernia Altered body image Anorexia Low back pain ```

Question 57

Dietary needs of the peritoneal client

Answer 57

Increase fiber and protein They have decreased peristalsis due to abdominal fluid Big holes in peritoneum and lose protein with each exchange

Question 58

Continuous renal replace ment therapy

Answer 58

Done in an ICU and is continuous so the client doesn't have drastic fluid shifts Never more than 80 mL or blood out of body at once so it doesn't stress the heart as much Performed on a client with a fragile cardiovascular status and acute renal failure

Question 59

S/S of kidney stones/urolithiasis/renal calculi

Answer 59

Pain, N/V WBC in urine Hematuria**

Question 60

Anytime you suspect a kidney stone, do what?

Answer 60

Get a urine specimen ASAP and have it checked for RBS

Question 61

If a kidney stone is present on specimen, do what?

Answer 61

Give pain meds immediately

Question 62

Tx for kidney stones

Answer 62

``` Ketorolac Ondansetron Hydromorphone Increase fluids Maybe need s Strain urine Extracoporeal shock wave lithotripsy ```