Renal Disorders Flashcards
(67 cards)
1
Q
Acute Kidney Injury/Acute Renal Failure
A
- occurs suddenly/generally reversible
- abrupt loss of kidney function and glomerular filtration rate
2
Q
Glomerular Filtration Rate (GFR)
A
test used to check how well the kidney’s are working; estimates how much blood passes through the glomeruli each minute
3
Q
Glomeruli
A
cluster of capillaries around end of kidney’s where waste products are filtered from blood
4
Q
Causes of Acute Kidney Injury Prerenal
A
- diabetes
- fluid volume deficit; GI, hemorrhage, diuretics
- decreased cardiac output; MI, CHF
- prolonged hypovolemic status; sepsis, anaphylaxis, antihypertensive
5
Q
AKI Prerenal
A
blood flow INTO kidney is affected
6
Q
AKI Intrarenal
A
damage to the actual kidney
7
Q
AKI Intrarenal Causes
A
- rhabdomyolysis
- nephrotoxicity; mycin antibiotics, IV dye, ACE inhib, NSAIDS
- infections; pyelonephritis
8
Q
AKI Postrenal Causes
A
- bilateral kidney stones
- tumors
- BPH
- ureteral strictures
9
Q
AKI Postrenal
A
flow of urine OUT of kidney is affected
10
Q
How many phases of AKI are there?
A
4
11
Q
Phase 1 AKI (onset)
A
triggering event begins—start of kidney injury
12
Q
Phase 2 AKI (oliguric)
A
- urine output decreases and fluid volume overload develops
- serum waste begins to increase (BUN, Cr, K+, Mg+, Phosphorus)
13
Q
Phase 3 AKI (diuretic)
A
- triggering event is corrected
- urine output increases, sometimes in in large dilute amounts
14
Q
Phase 4 AKI (recovery)
A
- kidney function improves
- health status improves/energy increases
15
Q
S/S of AKI
A
- Oliguria
- Anuria
- low specific gravity
- hyperkalemia
- metabolic acidosis
- increased BUN/Creatinine
- hypocalcemia/hyperphosphatemia
16
Q
Oliguria
A
< 400 mL in 24 hrs
17
Q
Anuria
A
< 50 mL in 24 hrs
18
Q
Hyperkalemia w/ AKI
A
- cardiac arrhythmias w/ EKG changes
- tall peaked T-waves
- muscle weakness/paralysis
- nausea/diarrhea
- decreased or absent DTR’s
19
Q
Hypocalcemia w/ AKI
A
- tetany
- seizures
- prolonged QT interval on EKG
- trousseau sign
- Chvostek sign
20
Q
Trousseau Sign
A
carpal spasm that is the result of inflation of a BP cuff
21
Q
Chvostek Sign
A
twitching of facial muscles in response to tapping over the area of facial nerve
22
Q
Prevention of AKI
A
- prevent dehydration
- replace blood and fluids as appropriate
- strict I&O’s
- Assess BUN & Creatinine routinely on patients at risk
- Do NOT give IV contrast w/ elevated creatinine
- treat infections quickly
- eliminate use of catheters
- prompt perineal care
- assess use of nephrotoxic drugs
23
Q
Treatment for Prerenal AKI
A
IV fluids / blood transfusions
24
Q
Treatment for Intrarenal AKI
A
temporary dialysis
-prevent FVE, hyperkalemia, metabolic acidosis
25
Treatment for Postrenal AKI
remove obstruction
- prostatectomy
- stents
- indwelling catheter
26
Complications of Fluid Volume Excess
- hypertension
- congestive heart failure
- pericarditis
- pulmonary edema
27
CHF Symptoms
- dyspnea
- crackles
- tachycardia
- JVD
- dependent edema
28
What is pericarditis?
CP that worsens w/ lying down, fever, pericardial friction rub
29
Pulmonary Edema Symptoms
- bloody, frothy sputum
- orthopnea
- "air hunger"
- patient feels like they are drowning
30
Kayexalate
- oral, NG, edema
| - for hyperkalemia
31
IV Insulin w/ Dextrose and Diuretic
shifts K+ back into cells / dextrose to prevent hypoglycemia / diuretic to remove excess K+
32
IV Ca+ Gluconate
protect cardiac function from high K+ levels
33
Sodium Bicarbonate
neutralize acidosis
34
Phoslo
to absorb and lower phosphorus levels
| -give w/ food
35
What medications should you adjust the doses of to help excrete through the kidneys?
antibiotics
digoxin
ACE inhibitor
36
Nutrition Facts
- restrict foods high in K+
- restrict foods high in phosphorus
- moderately restricted protein intake
- avoid salt substitutes
37
Considerations of Elderly
- kidney weight and volume decreases
- blood flow to kidneys decrease
- number of nephrons decline
- reduced bladder tone
- enlarged prostate
- decreased muscle mass
38
Reduced bladder tone increases the risk of what?
UTI secondary to incomplete emptying
39
Chronic Kidney Disease
kidney damage or decreased kidney function for 3 or more months
-progresses more quickly in those w/ HTN
40
Uremia
build up of urea in the blood
41
Who is at an increased risk for Chronic Kidney Disease?
- HTN
- 65 and older
- African American
- men
42
Stage 1 CKD
- 90%+
| - kidney damage w/ normal function
43
Stage 2 CKD
- 60-89%
| - kidney damage w/ mild loss of function
44
Stage 3 CKD
- 30-59%
| - moderate to severe loss of function
45
Stage 4 CKD
- 15-29%
| - severe loss of function
46
Stage 5 CKD
- 15%
| - kidney failure and need treatment to live
47
Risks for CKD in Kidney Failure
- diabetes
- HTN
- proteinuria
- family history
- increasing age
48
Neuro S/S of CKD
- fatigue
- confusion/disorientation
- tremors/seizures
- restless leg
49
Cardiac S/S of CKD
- HTN
- pitting edema
- JVD
- tachycardia
- pericarditis
- anemia
- thrombocytopenia
50
Integumentary S/S of CKD
- dry/flaky/itchy skin
- ecchymosis
- thin brittle nails
- coarse thin hair
- dark bronze skin
51
Pulmonary S/S of CKD
- crackles
- thick, bloody frothy sputum
- pleuritic lung pain
- dyspnea/tachypnea
52
GI S/S of CKD
- ammonia breath
- metallic taste in mouth
- anorexia, N/V
- change in bowel habits
53
Reproductive S/S of CKD
- ED
- amenorrhea
- infertility
- decreased libido
54
Musculoskeletal S/S of CKD
- muscle cramps/spasms
- loss of muscle tone/strength
- bone pain/fractures
- foot drop
55
What to do for daily weights?
Same scale, same time, everyday
56
Fluid Restriction
- amount based on patient condition
- provider will determine
- educate to pace amount of fluid through day
57
Methods to help with thirst/
- hard candy
- chew gum
- rinse mouth w/ water
- lip moisturizer
- sip don't gulp
- limit salt
- limit during day if have evening plans
58
What is dialysis?
mechanical method of removing bodily wastes when the kidney is unable to do so
59
Hemodialysis
- machine functions as artificial kidney
| - 3 x weekly / 3-5 hrs each
60
Peritoneal Dialysis
-uses the peritoneum and a cleaning solution called dialysate to clean the blood
61
Dialysate
absorbs waste and fluid from the blood using the peritoneum as a filter
62
Temporary Vascular Access
- double lumen large bore catheter
- temporary for quick emergency access
- flushed w/ heparin after use
- NEVER flush before using
- aspirate 5-10 mL before using
63
Arteriovenous Fistula
- usually placed in forearm
- artery and vein are connected
- 2 large bore catheters are inserted during dialysis
- exercises such as squeezing a ball
64
How long does an arteriovenous fistula take to heal?
4-6 weeks
65
Education for Fistula
- "feel the thrill and hear the bruit"
- no labs or BP
- no IV sticks
- no tight clothes, jewelry, purses, etc.
- do not tie or sleep on that arm
66
Nursing Care for Dialysis Patient
- make sure patient eats breakfast
- most meds will be held
- daily weights
- psychosocial support
- involve case management
67
Kidney Transplant
- treatment of choice w/ end-stage failure
- helps to avoid dialysis
- less expensive
- living/deceased donor
- blood relatives not required
