renal Flashcards Preview

NCLEX > renal > Flashcards

Flashcards in renal Deck (29)
Loading flashcards...
1

glomerulonephritis patho

acute can lead to chronic

inflamed glomerulus
antibodies lodge in the glomerulus causing scarring and decreased filtering

main cause: strep

2

glomerulonephritis s/s

flank pain (CVA tenderness)
low urine output (oliguria)
hematuria
proteinuria
periorbital edema
high BP
FVE
high urine specific gravity
azotemia (high BUN and Cr)
malaise
headache

3

glomerulonephritis treatment

treat cause
i and o
weights daily
diuretics
monitor BP
restrict fluids (fluid replacement = 24 hour fluid loss + 500)
balance activity w/ rest
high carbs
high Na
low protein
dialysis

4

glomerulonephritis teaching

diuresis begins in 1-3 weeks after onset
blood and protein may stay in urine for months
teach s/s of renal failure:
malaise
headache
anorexia
n/v
low output
weight gain

5

nephrotic syndrome patho

inflamed glomerulus
big holes form (protein leaks out in urine)
hypoalbuminemic (low albumin in blood)
without albumin cannot hold on to fluid in vascular space
fluid goes to tissues
edematous
blood in tissues so circulating blood volume goes down
kidney wants to replace the lost fluid
renin angiotensin system kicks in
aldosterone produced
retention of Na and H2O
anasarca

6

problems associated with protein loss

blood clots (thombosis)
high cholesterol
high triglycerides

7

nephrotic syndrome causes

bacterial/viral infections
NSAIDs
cancer/genetic predisposition
systemic diseases (lupus, diabetes)

8

nephrotic syndrome s/s

proteinuria
hypoalbuminemia
edema (anasarca)
hyperlipidemia

9

nephrotic syndrome treatment

diuretics
ACE (blocks aldosterone secretion)
prednisone (decrease inflammation)

cyclophosphamide (decrease body's immune response):
shrink holes so protein cannot get out
immunosuppressed
infection

****diet
moderate protein 1-2g/kg/day
malnourished fast
low Na
**** limit protein with kidney issues except with nephrotic syndrome

lipid lowering drugs for hyperlipidemia
anticoagulation for up to 6months
dialysis

10

nephrotic syndrome considerations

daily weights
intake and output
measure abdominal girth or extremity size
good skin care

11

acute kidney injury

sudden renal damage
want to reverse chronic renal failure

12

causes of AKI

pre renal failure:
blood cannot get into kidneys
hypotension
low heart rate
hypovolemic
shock

intra renal failure:
damage inside the kidney
glomerulonephritis
nephrotic syndrome
malignant hypertension (uncontrolled HTN)
diabetes
acute tubular necrosis (damage to the filtering bodies of the kidneys) caused by hypotension, sepsis, drugs
dyes used in tests
drugs (aminoglycosides are nephrotoxic)
NSAIDs

post-renal failure:
urine cant get out of kidneys
enlarged prostate
kidney stone
tumors
ureteral obstruction
edematous stoma (ileal conduit)

13

four phases of AKI

initiation (injury occurs)
oliguric (output less than 100ml/24 hours
diuretic (kidney recovering)
recovery (3-12months)

14

s/s of AKI

high BUN/Cr
high specific gravity
HTN (retaining fluid)
HF (retaining fluid)
anorexia
n/v (retaining toxins)
itching frost (uremic frost)
retain phosphorous (low serum Ca--pulled from the bone)
anemia (not enough erythropoietin)
hyperkalemia
metabolic acidosis (cannot filter or retain hydrogen or bicarb)

15

treatment of AKI

bedrest (decrease metabolism and cal needs)
TCDB
monitor i and o
daily weights
monitor VS
1kg = 1000ml of fluid
renal replacement therapy
support
oliguric phase ends 10-14days
diuretic phase (when output increases and fluid and electrolyte replacement)
recovery phase (based on increased protein and increased cals)

16

AKI meds

loop or osmotic diuretics
IV glucose and insulin (hyperkalemia)
IV calcium gluconate
polystyrene sulfonate (decrease K)
phosphate binding (prevent low Ca)

17

AKI nutrition

high carbs
high fat
low protein
avoid high phosphate
avoid high K (bananas, citrus, coffee)

18

renal replacement therapy

take over or replace kidney function

started when:
BUN/Cr cannot be decreased
FVE compromising heart and lungs
hyperkalemia and metabolic acidosis cannot be treated

19

hemodialysis

machine is the glomerulus (filter)
3-4x/week
anticoags during treatment to prevent clots (bleeding precautions)
assess fluid status before
electrolytes and BP watched constantly

20

vascular access to heodialysis

blood is being removed, cleansed, returned at a rate of 300-800ml/min

access to large blood vessel because rapid blood flow is needed

AVF:
arteriovenous fistula in the forearm with an anastomosis between an artery and vein

AVG:
arteriovenous graft synthetic graft to join vessels

both require surgery

two needles inserted (one allows fluid to be pulled and one is to the machine)

arterial end of the access will remove the blood and return it through the low pressure venous end

for temporary access the internal jugular or femoral vein can be used

21

care of access

***** do not use IV access (drawing blood, administering meds, etc)
no BP
no needle sticks
no constriction (watch, purse, blouse)

22

assessment of access

ensure patency

thrill (cat purring sensation--palpate)
bruit (turbulent blood flow--auscultate)
feel the thrill
hear the bruit

23

continuous renal replacement therapy

done in ICU
continuous
never more than 80ml of blood out of the body at one time
used for AKI

24

peritoneal dialysis

peritoneal membrane as a filter
dialysate infused into the peritoneal cavity
takes about 10 minutes and remains for an amount of time
lower bag and fluid which are drained (exchanged)
warm fluid to promote vasodilation
drainage should be clear, straw colored
turn side to side if fluid does not come out

25

two types of peritoneal dialysis

CAPD:
done 4x/day 7 days a week
not for those with disc disease or arthritis (causes pressure on back)
not for those with colostomy (infection)

APD:
connect at night
exchange done while sleeping
disconnected in AM

26

complications of peritoneal dialysis

exit site infection
peritonitis

s/s
abdominal pain
cloudy effluent

27

dietary needs for peritoneal dialysis client

increase fiber
increase protein

28

kidney stones (nephrolithiasis) s/s

sharp pain
n/v
WBC in urine
****hematuria:
get a urine asap and checked for RBC

29

kidney stone treatment

Ondansetron
NSAIDs
opioids
alpha adrenergic blockers (relax smooth muscle of ureter)
increase fibers (forever)
surgery to remove stone
extracorporeal shock wave lithotripsy (ESWL) to crush stone
strain urine (send stone for analysis)