RENAL Flashcards
(31 cards)
Main Cause of
GLOMERULONEPHRITIS
STREPTOCOCCAL INFECTION
Which attacks the kidneys and also the heart valves which control against backflow
Is GLOMERULONEPHRITIS Acute or Chronic?
Acute, but can lead to chronic
GLOMERULONEPHRITIS
S/S
CVA Tenderness, BP increase, Facial Edema, Sediment/Protein/Blood in Urine, Bun & Creatinine increase, Malaise & Headache, Urine Output decrease, Patient going into fluid volume excess
GLOMERULONEPHRITIS
TX:
I&O and daily weighs, Balance activity with rest, BP monitoring, Increase Carbs, Decrease Protein & Sodium, Dialysis, Teach S/S of Renal Failure
What is happening in:
NEPHROTIC SYNDROME
Due to inflammatory response in the glomerulus big holes form there and protein starts leaking out in the urine. Without albumin/protein the body cant hold fluid in the vascular space and the fluid goes In The Tissues.
Sensing this Decreased circulating blood volume Our renin angiotensin system kicks in and begins to retain sodium and water which ends up going into the Tissues due to lack of protein in the vascular space.
Total Body Edema=Anasarca
Problems associated with protein loss:
- ** Blood clots (thrombosis)
* ** Cholesterol & Triglycerides will be ELEVATED
NEPHROTIC SYNDROME
Causes:
- ** Bacteria or viral infection
- ** NSAIDS
- ** Cancer & Genetic Predisposition
- ** Systemic disease like lupus or diabetes
- ** Can be Idiopathic as well
NEPHROTIC SYNDROME
S/S:
- ** Proteinuria
- ** Hypoalbuminemia
- ** Edema(Anasarca)
- ** Hyperlipidemia
NEPHROTIC SYNDROME
TX:
- ** Increase Protein, This is ONLY kidney disease that requires more Protein
- ** Diuretics
- ** Ace Inhibitors- To block aldosterone secretion
- ** Lipid lowering drugs
- ** Decrease Na intake
- ** Prednisone to decrease inflammation
- ** Anticoagulation therapy for up to 6 months
- ** Dialysis
PRE-RENAL FAILURE
Causes:
- ** Blood can’t get to the kidney
- ** Hypotension
- ** Decreased heart rate. (arrhythmia)
- ** Hypovolemic
- ** Any form of Shock-Shock kills Kidneys!!!!
INTRA-RENAL FAILURE
Causes:
- ** Damage has occurred inside the kidney
- ** Glomerulonephritis
- ** Nephrotic Syndrome
- ** Dyes used in test such as heart cath and CT scan
- ** Drugs (Aminoglycosides, Mycins)
- ** Malignant hypertension (uncontrolled HTN)
- ** DM causes severe vascular damage
POST-RENAL FAILURE
Causes:
- ** Urine can’t get out of the kidney
- ** Kidney stone
- ** Tumors
- ** Ureter obstruction
- ** Edematous Stoma ( Illeal conduit)
RENAL FAILURE
S/S:
- ** Creatinine and BUN go up
- ** Specific Gravity-Initially concentrated, then becomes Fixed(may lose ability to concentrate and dilute urine, if this is suspected will do a Fluid Challenge)
- ** Anemia
- ** HTN & HF- Retaining fluids
- ** Anorexia, nausea, vomiting- Retaining toxins
- ** Itching frost(Uremic Frost)- Encourage good skin care
- ** Acid-base/fluid & electrolyte imbalances- Hyperkalemia, Metabolic acidosis, Retain phosphorous which decreases serum calcium
ACUTE RENAL FAILURE
Two phases?
OLIGURIC PHASE
DIURETIC PHASE
OLIGURIC PHASE
What’s happening in this phase?
- ** Urinary Output( UO ) is decreased
- ** UO of 100 to 400mL/24hrs- This is where you would see a fixed specific gravity
- ** This patient is in fluid volume excess
- ** Potassium goes Up
- ** Phase lasts 1 to 3 weeks
DIURETIC PHASE
What’s happening in this phase?
- ** Sudden onset
- ** UO is increasing
- ** Patient in fluid volume deficit (Shock
- ** Potassium goes Down
HEMODIALYSIS
General Info to know:
- ** The machine is the glomerulus-(filter)
- ** It’s done 3 to 4 times per week, patient must watch what they eat and drink before treatments
- ** To prevent blood clots from forming patient is given an anticoagulation during dialysis.—Usually heparin–Must implement bleeding precautions
- ** Watch for Depression— May lead to Suicide
- ** Electrolytes and BP are watched constantly
- ** Some patients Can’t tolerate hemodialysis because of unstable cardiovascular system
VASCULAR ACCESS
What is vascular access?
*** A site where they have access to a large blood vessel because very rapid blood flow is essential for hemodialysis
VASCULAR ACCESS
Types of access?
- ** In hemodialysis blood is being removed, cleansed, and then returned at a rate of 300-800mL/min
- ** 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 to be ready for repeated venipunctures
What happens during DIALYSIS?
- ** Two needles are inserted into the vascular access
- ** One needle will allow blood to be pulled from the circulation and sent to the hemo machine
- ** The other is used to return the filtered blood to the client’s circulation
- ** The arterial end of the access will remove the blood and the return is through the low pressure venous end
Temporary HEMODIALYSIS catheters
-where are they placed?
- ** The Internal Jugular & The Femoral Vein often are used
* ** No surgery is required
VASCULAR ACCESS
-Care of Access:
- ** Do Not use any Dialysis Access points for IV Access
* ** NO BP, NO NEEDLE STICKS, NO CONSTRICTION
Assessment of Access
Why?
How?
- **Ensure patency
* ** Palpate, Auscultate– Feel a thrill….Hear a bruit
PERITONEAL DIALYSIS
- ** Use peritoneal membrane as a filter
- ** Dialysate is warmed and infused into the peritoneal cavity by gravity via a Tenckoff catheter
- ** The fluid (2000-2500mL) fills the peritoneal cavity ( takes about 10 min) remains in peritoneal cavity for a prescribed amount of time. This is called the dwell time
- ** Then the bag is lowered and the fluid along with the toxins, etc.; are drained, that is called the Exchange
- ** We warm the fluid because this promotes vasodialation and more blood flow
- ** The drainage should look clear, straw colored
- ** A person who can’t tolerate hemodialysis or someone who chooses peritoneal dialysis
- ** If all the fluid doesn’t come out, turn them from side to side
