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Flashcards in Renal Deck (39):
1

glomerulonephritis

acute can lead to chronic
-inflammatory reaction in the glomerulus
-antibodies lodge in the glomerulus: get scarring and decrease filtering.
-main cause: STREP THROAT

2

s/s of glomerulonepritis

sore throat
malaise and HA
BUN and creatinine UP
sediment/protein/blood in urine
flank pain
bp UP
facial edema
UO DOWN
urine specific gravity UP
----client is going into fluid volume excess

3

tx for glomerulonepritis

get rid of strep
balance activity with rest
I&O / daily weight
monitor BP
dietary
dialysis
diuresis begins is 1 to 3 weeks after onset
blood and protein may stay in urine for months
teach s/s of renal failure

4

how is fluid replacement determined?

fluid replacement = 24 hr fluid loss + 500ml

5

dietary needs for glomerulonephritis:
protein? __NA?___ Carbs?___

protein DOWN
NA DOWN
Carbs UP

6

Nephrotic syndrome

Losing A TON of protein.
-inflammatory response in the glomerulus--big hole so protein leaks out into the urine..then to the tissues
-client is edematous

7

total body edema =

anasarca

8

problems associated with protein loss:

1. blood clot (thrombosis)
--they are losing proteins that normally prevent their blood from clotting. without these proteins, the blood can clot and put them at risk for thrombosis
2. cholesterol and triglycerides will be high.
---the liver compensates by making more albumin, causing an increased release of cholesterol and trig.

9

causes of nephrotic syndrome

idiopathic but has been related to :
bacterial or viral infection
NSAIDS
cancer and genetic predisposition
systemic diseases such as lupus or diabetes
strep

10

s/s of nephrotic syndrome

proteinuria
hypoalbuminemia
edema (anasarca)
hyperlipidemia

11

tx for nephrotic syndrome

diuretics
ace inhibitor to block aldosterone secretion
prednisone to decrease inflammation
lipid lowering drugs for hyperlipidemia
sodium DOWN
protein UP
anticoagulation therapy
dialysis

12

RULE: limit protein with kidney problems EXCEPT

with nephrotic syndrome

13

renal failure causes:

pre-renal failure:____

blood cant get to the kidneys

-hypotension
- decrease HR
-hypovolemic
-any form of shock

14

renal failure causes:

intra-renal failure:____

damage has occurred inside the kidneys

-glomerulonephritis
-nephrotic syndrome
-dyes used in test such as heart cath and CT scan
-drugs
-malignant htn
-DM

15

renal failure causes:

post-renal failure:____

urine cant get out of the kidneys

-enlarged prostate
-kidney stone
-tumors
-ureteral obstruction
-edematous stoma

16

s/s of renal failure

-creatinine and BUN UP
-specfic gravity (initially concentrated then may become fixed)
-anemia
-htn, hf
-anorexia,n/v --(retaining toxins)
-itching frost
-acid/base imbalances (hyperkalemia,metabolic acidosis, retaining phosphorus)

17

oliguric phase of renal failure:

UO DOWN
UO of 100 to 400 ml/24 hrs
this client is in a fluid volume excess***
potassium goes up! *** (hyperkalemia)
(last 1 to 3 weeks)

18

diuretic phase of renal failure:

sudden onset
UO UP
this client is in a fluid volume deficit
hypokalemia (decrease potassium)

19

what are the 3 types of dialysis?

hemodialysis
peritoneal dialysis
continuous renal replacement therapy (CRRT)

20

hemodialysis is done 3-4 times per week so the client has to watch what they ________ between treatments.

eat and drinks

21

hemodialysis ... the machine acts as ___.

glomerulus (filter)

22

hemodialysis.. what should you monitor constantly ?

BP and electrolytes

unstable cardiovascular system cant tolerate hemodialysis.

23

with hemodialysis, blood is being removed, cleansed and then returned at a rate of ____ml/min

300-800

24

what is a vascular access?

what are the types of vascular access?

a site where they have access to a large blood vessel because very rapid blood flow is essential for hemodialysis

AVF (arteriovenous fistula) in forearm with an anastomosis between an artery and vein

AVG (arteriovenous graft) a synthetic graft to join the vessels

both require surgery! takes weeks to mature and be ready for repeated venipuncutres.

25

important: care of access
-DO NOT USE _____.
NO ____,____,____/

do not use for iv access
NO blood pressures
NO needle sticks
NO constrictions (NO WATCH)

26

assessment of access:

to make sure patent
thrill- cat purring sensation (palpate)
bruit- turbulent blood flow (auscultate)
feel a thrill.. hear a bruit

27

peritoneal dialysis

use peritoneal membrane as a filter
---dialysate is warmed and infused into the peritoneal cavity by gravity via a tenckhoff catheter.
-- the fluid (2000-2500ml) fills the peritoneal cavity, takes about 10 mins, and remains in the cavity for a prescribed amount of time. this is called the dwell time!

28

What is the "exchange" consisted on with peritoneal dialysis?

what should the drainage look like?

when the bag is lowered and the fluid along with the toxins , etc, are drained.

clear, straw-colored. cloudy= infection

29

who gets peritoneal dialysis?

someone who cant tolerate hemodialysis or someone who chooses peritoneal.

30

what are the 2 types of peritoneal dialysis?

continuous ambulatory peritoneal dialysis (CAPD)
continuous cycle peritoneal dialysis (CCPD)

31

what is CAPD

continuous ambulatory peritoneal dialysis

must have a client that has the energy and the desire to be active in their treatment and that also has the ability to learn and follow instructions
-done 4x a day, 7 days a week (done during the day)
-if have disc disease, arthritis,colostomy do this? NO high risk for infection!

32

what is CCPD

continuous cycle peritoneal dialysis

connect their peritoneal dialysis catheter to a cycler at NIGHT and their exchange is done automatically while they sleep. disconnected in the AM . the client has more freedom

33

what are the complications of peritoneal dialysis?

major complication is peritonitis (cloudy effluent 1st sign)
constant sweet taste
may get a hernia
altered body image/sexuality
anorexia
low back pain

34

what should the peritoneal dialysis increase in their diet?

fiber (have decreased peristalsis due to abdominal fluid) and protein (big holes in the peritoneum and lose protein with each exchange)

35

what is CRRT

continuous renal replacement therapy

typically done in an ICU setting and is continuous so that the client doesn't have drastic fluid shifts.

never more than 80 ml of blood out of the body at one time being filtered and therefore does not stress the cardiavascular system as much.

36

CRRT is performed on a client with:

a fragile cardiovascular status and acute renal failure

37

kidney stones aka ___

urolithisasis, renal calculi

38

s/s of kidney stones

pain and n/v
wbcs in urine
HEMATURIA
anytime you suspect a kidney stone, get a urine specimen ASAP and have it checked for RBCs
if a kidney stone is present, the client will get pain medication immediately.

39

tx for kidney stones

ketorolac(tordol), ondansetron(zofron),hydromorphone (dilaudid)
maybe surgery
strain urine
extracorporeal shoch wave lithotripsy (ESWL)