Renal Flashcards by Julie Hodgman

What is the function of the the glomerulus int he kidneys?

It filters

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What happens during glomerulonephritis?

When is it developed?

The patient has a systemic infection and about 2-3 weeks later, they develop it.

Antibodies are produced in response to the infection and they lodge within the glomerulus causing scarring and decreased ability to filter properly

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What is the main cause of glomerulonephritis?

Make sure we tell these patients what? Why?

Strep

Make sure to tell them to take all of their antibiotics or they are at risk for heart and kidney damage

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How does strep affect the heart?

The bacteria attack the valves that essentially prevent back flow

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NCLEX

Anytime there is is some sort of valvular disease, think what?

Heart failure d/t backflow!

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In general, what is happening with the glomerulonephritis patient?

They are retaining fluid and toxins

Kidneys are not working correctly

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S/S of retaining toxins

Malaise and headache

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S/S glomerulonephritis

How will it start?
Build up of toxins causes what?
BUN and Creatinine \_\_\_\_
What will the urine contain?
Why does the urine have this?

GLOMERULONEPHRITIS

Sore throat
Malaise and headache
^BUN, ^Creatinine - can't excrete
PROTEIN, blood, sediment
There is damage / holes to the glomerulus so protein are able to leak out

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S/S GLOMERULONEPHRITIS

Where is pain?
Where is edema?
Urine output \_\_\_\_
BP \_\_\_\_
Urine specific gravity \_\_\_\_
Fluid volume \_\_\_\_\_\_\_

GLOMERULONEPHRITIS

Flank pain - costavertebral angle tenderness
Facial edema
Decreased urine output
^BP
Urine SG increased (dilute blood d/t fluid retention)
Fluid volume excess

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What does tapping over the kidneys tell the doctor?

If there is infection within them

May do if a patient has a UTI to see if is traveled to the kidneys

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How do we treat glomerulonephritis?

What are we going to monitor?

How should their diet be?

Antibiotics
Dialysis
Balance activity and rest to conserve energy and avoid breaking down protein for energy

MONITOR
I/O, daily weight
Blood pressure

DIET
Decreased Protein
Decreased Sodium
INCREASE Carbs - for energy

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How is fluid replacement calculated in glumerulonephritis?

Replacement = 24 hours fluid loss + 500 mL

*500 is for sensible fluid loss

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In glomerulonephritis, when does diuresis begin?

What will stay in their urine for months?

What do we need to teach them?

1-3 weeks after onset

Blood and protein

S/S Renal Failure (HA, malaise, N/V/anorexia, decreased UO, weight gain)

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When people have kidney problems, what it the general diet we want to follow? What is the only exception?

Low protein

Nephrite syndrome is the only exception!

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What does protein do to the BUN?

Increases it

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Major differences between Glomerulonephritis and Nephritic syndrome

G: lose protein, facial edema

NS: Lose LOADS of protein, total body edema, can be caused by more than just bacteria or strep

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How does albumin work?

It holds onto fluid in the vascular space

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How does the body develop Nephrotic Syndrome?

Ending result?

Inflammation in glomerulus
Protein leaks out A LOT
Lose albumin in the blood
Fluid fills up into the tissues
3rd spacing causes a decrease in circulating volume
Kidneys sense this and RAAS signals aldosterone tot produce
Aldosterone causes retention of Na and Water
More fluid in the tissues occurs because there is no albumins to keep the Na and water in the vascular space
Anasarca (generalized edema)

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What are the complications associated with protein loss?

Blood clotting - They are losing proteins that usually keep the blood from clotting

Increased release of cholesterol and triglycerides due to the increase in albumin

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What are causes of Nephrotic Syndrome?

Do we usually know the cause?

Usually idiopathic - don’t know the cause

Bacterial OR VIRAL infections
NSAIDS
Cancer and genes
About 1/3 have a systemic disease (Ex: Lupus, DM)
Strep

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Basic S/S of Nephrotic Syndrome

Proteinuria
Low albumin in the blood
Anasarca
Hyperlipidemia - produced t replenish protein loss

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How do we treat Nephrotic Syndrome—

Meds?
Diet?

Diuretics
Prednisone - shrink holes so protein doesn't leak out
ACE I - block aldosterone secretion 
Statins
Anticoagulation for 6 months

Low Na, INCREASED PROTEIN

Dialysis too pull off excess fluids

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How does giving Lasix and Albumin help the Nephrotic Syndrome patient?

Decrease fluid retention and keep the fluid in the vascular space and out of the tissue

*Risk for fluid volume excess when giving the albumin, so give Furosemide with it

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What is Pre-Renal failure?

What are some causes?

Blood can’t get to the kidneys

Hypotension
Bradycardia - rhythm change
Hypovolemic
ANY form of shock!

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What is Intrarenal failure? Some causes?

Damage has occur INSIDE the kidneys ``` Glomerulonephritis, Nephritic Syndrome Dyes (heart cath, CT) Medication (Mycin drugs, Metformin) Uncontrolled HTN (malignant) DM - vascular damage ```

What is Post-renal failure? Some causes?

Urine can't get out of the kidneys ( ``` Enlarged prostate Kidney Stone Tumors Ureter obstruction Edematous stoma ``` *There is back flow occurring

S/S Renal Failure BUN and creatinine ___ RBC ___ Specific gravity ____ How can we check this?

BUN and Creatinine ^ RBC decreases --> Anemia SG initially increased but it make become fixed and lose the ability to concentrate/dilute urine Do a fluid challenge - bolus with 250mL NS and see if urine becomes diluted *SG depends on UO!

What does renal failure fluid retention cause?

HTN and HF

Because we are retaining toxins in renal failure, what will be the S/S?

Anorexia, N/V

Renal failure skin Make sure to do what?

``` Itching frost (Uremic frost) D/t a lot of urea that makes it to the skin ``` Good skin care

What Acid/Base and E imbalances are there in Renal Failure?

Increased K --> arrhythmias Retain phosphorus causing decreased serum Ca leading to osteoporosis Metabolic acidosis

What are the 2 phases of ACUTE Renal failure?

Oliguric phase | Diuretic phase

What happens during the OLIGURIC phase of Acute Renal Failure? ``` UO ____ How much output in 24/hr? Fluid volume _____ K _____ How long does this last? ```

``` Decreased UO 100-400 ml/hr --> Fixed SG Fluid volume excess*** Increased potassium*** 1-3 weeks THEN diuretic phase ```

Any time urine output has decreased or stopped, what is going to be retained?

POTASSIUM - aren't getting rid of it and retaining

What happens in the DIURETIC phase of Acute Renal Failure? ``` Onset? UO _____ How much in 24 hours? Fluid volume _____ K _____ ```

UO increases Could excrete as much as 10L Fluid volume deficit --> Shock K DECREASE - d/t excretion

When educating a patient on acute renal failure recovery, what do you tell them? What to monitor?

Recovery may take as long as 12 months Keep their appointments Monitor their BP and labs Prevent chronic renal failure!

Hemodialysis - the machine acts as our what?

Glomerulus

How often if HD done? | What to tell the patient between treatments?

3-4 times a week | Watch what they eat and drink

What is given during HD? What is watched constantly?

Anticoagulant - Usually Heparin Electrolytes and BP

How long does Heparin stay in the body?

4-6 hours so we need to watch invasive procedures after dialysis and bleeding signs

What is the lifestyle like of HD patient? | What are they at risk for?

Confining, tedious Risk for depression/suicide

What patients cannot tolerate HD?

Patients with unstable CV systems These patients can't handle the volume changes

What medications need to be held for a patient going to dialysis?

ACE I - don't want VD NTG - don't want VD Water soluble vitamines - just filtered out Ampicillin - filtered out * Kidneys don't filter out Pepcid

What must a HD patient have? | What is this?

Vascular access - A site where they have access to a large blood vessel because very rapid flow is essential

How fast is the fluid removed, filtered, and returned back to the body?

300-800 ml/min

What are the 2 types of HD access? How are these inserted? When can they be used?

AVF (arteriovenous fistula) - anastomosis between artery and vein AVG (arteriovenous graft) - synthetic graft to join the vessels Both require surgery Site takes weeks to mature and be ready for vent puncture

How are the HD sites accessed? Which end does what?

2 needles are inserted (1 pulls fluid out, 1 puts it back in) The ARTERIAL end removes the blood and the VENOUS end will return it through low pressure

What access sites are often used for temporary HD? | Need surgery for these?

IJ or femoral vein | No

Caution to the HD arm?

LIMB ALERT! No pokes, BP, constriction, so purse, no watch

What to assess in a HD access site?

Patency Thrill - feel Bruit - hear

What is the filter during peritoneal dialysis?

Peritoneal membrane

How is the dialysate used in PD?

It's warmed and infused into the peritoneal cavity by gravity via a Tenckhoff catheter

How much fluid is dialyzes in PD in a given amount of time? What is the term for how long the fluid is in the peritoneal cavity?

2000-2500 mL fills the cavity (takes about 10 minutes) and stays in the cavity for a prescribed amount of time (dwell time)

How si the PD fluid drained? How long does this take? What is this called?

The bag is lowered along with the filtered out substances 15-30 minutes Exchange

Why is PD fluid warmed?

Promotes VD and more blood flow

What should PD drainage look like?

CLEAR or straw colored! | Cloudy = INFECTION

What type of patient gets PD?

Someone who can't tolerate HD or just choses this way

What do you if all of the fluid that went in, doesn't come out in PD?

Turn side to side | Reposition

How much fluid do we want to come out in PD?

More than what we put in

What are the 2 types of PD?

CAPD (Continuous ambulatory PD) | CCPD (Continuous Cycle PD)

How and how often is CAPD done?

Done manually 4x a day, 7 days/week

Who can't do CAPD?

Someone who doesn't have the energy or desire to be so involved in treatment Has disc disease or arthritis - too much pressure on the back and too much pain Patient with a colostomy - high risk for infection because of sterile access 4x a day next to a dirty stoma

How does CCPD work?

PD catheter is connected at night and the filtration is done while they sleep *More freedom

Complications of PD ``` Most common? Taste? Might get what? Weight? Pain? ```

``` Peritonitis! - cloudy Constant sweet taste d/t dialysate Might get a hernia Anorexia Back Pain Altered body image/sexuality ```

Diet of PD patient

Increased FIBER - they have decreased peristalsis d/t abdominal fluid Increased PROTIN - holes in peritoneum cause protein loss with each exchange

Where is CRRT usually done? | For what patients?

ICU performed on a patient with a fragile CV status and Acute Renal failure

Why is CRRT not stressful to the heart?

Never more than 80mL are being filtered at one time

Another name for kidney stones

Urolithiasis (ureter), renal calculi

S/S kidney stones | What's in the urine?

Pain --> N/V | WBC, BLOOD!

Anytime you suspect kidney stones, what do you do?

UA asap and have it checked for RBC

Treatment of kidney stones May do what to the urine? What kind of surgery could be done?

Pain meds!! Anti-emetic Increase fluids FOREVER! prevent future stones! Strain it Extracorpeal shock wave lithotripsy

Renal Flashcards

(71 cards)