Renal part 2 Flashcards
(79 cards)
1
Q
what is the most common renal disease
A
pyelonephritis
2
Q
is pyelonephritis more common in men or women
A
young women
3
Q
what is pyelonephritis
A
Infection and inflammation of the kidney pelvis, calyces, and medulla.
4
Q
where does pyelonephritis infection begin
A
usually begins in lower urinary tract
5
Q
what is the most common virus that cause the infection in pyelonephritis
A
Escherichia coli
6
Q
Repeated infections in pyelonephritis can create _____ that alters _____ ____ to kidney, glomerulus, and tubular structure
A
scarring
blood flow
7
Q
what can pyelonephritis can also cause
A
tubular cell necrosis and a possible abscess.
8
Q
what are the risk factors for pyelonephritis
A
- Frequent UTIs
- Conditions that lead to urinary stasis
- Males over 65 with prostatitis
- Spinal cord injury
- Congenital malformations
- Bladder tumors
- Chronic illness (DM, Hypertension, Chronic Cystitis)
9
Q
what are the s/s of pyelonephritis
A
- S/S of infection
- Back of flank pain
- CVA tenderness
- S/S of UTI
- Hematuria
- Suprapubic pain
10
Q
how do you diagnose pyelonephritis
A
- History and Physical
- Urinalysis
- Urine Culture
- Blood Cultures
- Complete Blood Count
- Basic Metabolic Panel
- Imaging Studies
11
Q
what lab values will you tested for pyelonephritis
A
UA and Urine Culture
Trend WBC
Blood Cultures
12
Q
what are some antibiotics used to treat pyelonephritis
A
Trimethoprim-sulfamethoxazole (Bactrim DS)
Ciprofloxacin (Cipro)
13
Q
what interventions are used for pyelonephritis
A
- Administer prescribed antibiotics as ordered
- Administer pain medications as ordered
- Provide adequate hydration
- Educate client regarding disease condition
- Instruct how to avoid UTIs
14
Q
what is glomerulonephritis
A
Inflammation of the glomeruli of the kidney
15
Q
what is the cause of acute glomerulonephritis
A
complications from an infection
16
Q
what is the cause of chronic glomerulonephritis
A
some of the same causes of acute or can be genetic (autoimmune)
17
Q
what are the risk factors of glomerulonephritis
A
- Recent infection particularly of the skin or respiratory tract.
- Recent travel or other possible exposure to bacteria, viruses, fungi or parasites.
- Presence of systemic diseases (Lupus or Goodpasture’s syndrome)
- Recent surgery or illness
18
Q
what are the ss of acute glomerulonephritis
A
Protein in urine Blood in urine Edema Decreased urine output Hypertension Elevated BUN/Creatinine
19
Q
what is the assessment involved for acute glomerulonephritis
A
- VS
- Daily weights
- Intake and Output
- Measure abdominal girth or extremity size
- Skin condition
- Dietary intake monitoring
- Trend Laboratory data
20
Q
what are some diuretics prescribed for acute glomerulonephritis
A
Furosemide (Lasix)
Spironolactone (Aldactone)
Hydrochlorothiazide (HCTZ)
21
Q
what are some corticosteroid’s prescribed for acute glomerulonephritis
A
Prednisone
Methylprednisolone
Dexamethasone
22
Q
what are the diet and fluid modification for acute glomerulonephritis
A
Maintain low-to-moderate protein diet
Dietary sodium and fluid restriction
23
Q
what is Polycystic Kidney Disease
A
- Appears as large, thin-walled, fluid-filled cysts ranging from millimeters to centimeters in diameter.
- Repeated cell-division within the renal tubules
- Cysts become so enlarged they compress surrounding tissue, destroying the underlying renal tissue.
- Suppresses the blood flow to underlying tissues, cutting off nutrient supply
24
Q
what are the ss of Polycystic Kidney Disease
A
- No signs or symptoms in early stage
- As cysts enlarge, symptoms appear
- Hypertension often the first symptom
- Hematuria
- Pain or heaviness in the back, abdomen, or flank area
- Headaches
- UTIs
- Urinary calculi
- Palpable, bilaterally enlarged kidneys
25
how do you diagnose polycystic kidney disease
- based on clinical manifestations
- patient and family history
- urinalysis
- abdominal ultrasound
- MRI
- IV pyelogram
- CT scan
26
what is the treatment for polycystic kidney disease
- PKD frequently progress to ESRD
- Impaired renal circulation s/t compression by cysts causes renal failure
- Failure results in decreased clearance of wastes and inadequate fluid, electrolyte, and acid-base balance.
- Clients who progress to severe PDK will require treatment of ESRD: hemodialysis or peritoneal dialysis.
- Manage UTIs and pain
- Manage hypertension
- Antibiotics to control spread of infection up to the kidney
27
what are the complications of polycystic kidney disease
- Severe hypertension
- Renal calculi
- Recurrent UTIs
- Hematuria
- Heart-valve abnormalities
- High-risk for developing aneurysms in the aorta or cerebral circulation
- Development of cysts in the liver or GI tract.
- Renal failure
28
what is the assessment for polycystic kidney disease
- VS
- Oxygenation
- Daily Weight
- Lab values
- Hemoglobin/Hematocrit
- Plasma creatinine/BUN
- Sodium level
- Potassium level
- Calcium level
- Phosphorus level
- Urinalysis/Urine cultures
29
what are some antihypertensives used for polycystic kidney disease
Lisinopril (Prinivil)
Captopril (Capoten)
Valsartan (Diovan)
Olmesartan (Benicar)
30
what are the interventions for polycystic kidney disease
- Diet modification
- Fluid restriction
- Administer antihypertensive agents as ordered
- Administer antibiotics as ordered
- Administer pain medication as ordered
31
what is the education of polycystic kidney disease
- Immediately report clinical manifestations of infections.
- Follow prescribed dietary restrictions.
- Follow prescribed antihypertensive therapy
- Follow prescribed antibiotics for UTI
32
what can cause renal trauma
Includes any falls, sports activities, gunshot wounds, stabbings, or significant traumatic injuries, especially if they involve the abdomen, flank, or back.
A sharp blow can cause a contusions, tearing, or rupture of the kidney.
33
what are the ss of renal trauma
- Decreased urinary output
- Absent urinary output
- Hematuria
- If bleeding is extensive, signs of shock may be present.
- Back or flank pain
- Hypotension and tachycardia w/ severe blood loss
34
how do you diagnose renal trauma
```
Ultrasound
CT scan
Intravenous Pyelogram
MRI
Renal arteriography
Urinalysis
CBC
Serum Chemistry
```
35
what is the treatment for renal trauma
- Based on extent of the injury
- Focus on stabilization
- Surgical repair of any perforations or lacerations
- Controlling bleeding
- Preventing shock
- Promoting urinary drainage
36
what is the assessment involved for renal trauma
- Vital Signs
- Pain
- Urine output and color
- Laboratory values
- UA
- Renal Function
- H/H
- Knowledge
37
what are the interventions of renal trauma
- pain meds as needed
- give fluids, promote fluid intake
- provide incision care as needed
- encourage rest
38
what is the education for renal trauma
- Teach client and family about the condition and any procedures or diagnostic tests.
- Teach the client and family regarding medication.
39
what is renal failure
- The partial or complete inability of the kidneys to filter waste products and water from the blood through glomerular and tubular filtration.
- If the kidneys fail to function properly, the remainder of the organ systems will be affected, and multisystem organ failure will occur.
40
is acute kidney injury reversible
Acute kidney injury is a rapid, acute disease process, that is reversible in most cases.
41
if acute kidney injury is not addressed what is inevitable which results in the need for
Chronic Kidney Disease
| results in the need for long-term dialysis or renal transplant.
42
what is acute kidney injury
Characterized by acute, rapid loss of renal function
43
what are some of the cause of acute kindey injury
Causes include cardiovascular disease and diabetes mellitus
44
what are the risk factors of acute kidney injury
include sepsis, contrast media, and exposure to nephrotoxins.
45
what is prerenal acute kidney injury
- S/T reduced renal blood flow resulting in decreased glomerular perfusion and filtration.
- Hypovolemia, decreased cardiac output, decreased peripheral vascular resistance, and vascular obstruction van affect circulation.
- RAAS is activated s/t presence of decreased perfusion
- Low urine output with an increase in BUN and creatinine and an inability of the kidneys to conserve sodium.
- If not resolved, intrarenal damage to the renal tissue may occur.
46
what is intrarenal acute kidney injury
- Involve direct damage to the renal parenchymal tissues, resulting in impaired nephron functioning.
- Damage s/t prolonged ischemia, exposure to nephrotoxins, contrast dye, hemoglobin released from hemolyzed RBCs, or myoglobin released from necrotic muscle cells.
- Acute tubular necrosis occurs
47
what is postrenal acute kidney injury
- Causes involve mechanical obstruction of the lower urinary tract.
- Urine flow is obstructed, causing reflux into the renal pelvis, impairing kidney function.
- Causes include BPH, prostate cancer, calculi, trauma and tumors.
48
what are the ss of acute kidney injury
- Signs of volume overload s/t decreased urine output
- Edema
- Pulmonary edema
- Shortness of breath
- Heart failure
- Jugular Vein Distention
- Hypertension
- Dysthymias
- Chest pain
- Pressure
- Confusion
- Lethargy
- Severe fluid & electrolyte imbalances
- May suffer seizures or coma
49
what is the assessment for acute kidney injury
Assessment includes blood pressure monitoring, heart rate, urine output, and clinical signs such as pulses, skin color, temperature, and respiratory status. Fluid intake and output should be carefully monitored also.
50
what is the supportive care for acute kidney injury
Supportive care which involves ensuring adequate circulating volume, correcting fluid overload, and correcting biochemical abnormalities.
51
what is the medical management involved for acute kidney injury
- Goals are to eliminate the cause, prevent complications, and assist the client in recovery.
- Assessment of adequate hydration is essential for maintaining appropriate intravascular volume and cardiac output.
52
what are the meds for acute kidney injury
- Administration of diuretics
- Forsemide (Lasix)
- Bumetanide (Bumex)
- Avoid nephrotoxic medications
- Treatment of hyperkalemia
53
what are the indications for dialysis
- Severe volume overload resulting in heart failure or severe respiratory distress
- Elevated potassium levels with ECG changes
- Severe metabolic acidosis
- Altered mental status
- Pericarditis, pericardial effusion, and cardiac tamponade.
54
what are the abnormal lab values you would expect in acute kidney injury
```
Elevated BUN & Creatinine
Normal or below-normal levels of serum sodium
Calcium deficit
Elevated potassium level
Anemia
Metabolic acidosis
```
55
what is chronic kidney disease
- Progressive, irreversible loss of kidney function.
| - Characterized by slow increases in BUN and creatinine.
56
how is chronic kidney disease different then acute kideny injury
- Different from AKI, it has a longer, more insidious onset and is typically caused by a long-term disease or medical comorbidities such as hypertension, diabetes, lupus, PKD, and pyelonephritis.
- Also, can result from poorly managed AKI.
57
what are the ss of chronic kidney disease
```
Hypertension
Heart failure
Pulmonary edema
Arrhythmias
Uremia
N/V
Anorexia
Headache
Lethargy
Fatigue
Confusion
Seizures and coma without treatment
Bone breakdown
Defective bone development
Metabolic alkalosis
Infertility
Hyperparathyroidism
Anemia
```
58
what is the diagnosis of chronic kidney disease
- Consistently elevated serum creatinine levels and decreased creatinine -clearance.
- Persistent presence of protein/albumin in urine.
- RBCs, WBCs, Protein and Glucose in UA
- Renal ultrasound
- CT scans
- Renal biopsy
59
what is the treatment for chronic kidney disease
- Renal replacement therapies to remove waste products.
- Support remaining function of the kidneys
- Management and control of hyperkalemia, hypertension, anemia, dyslipidemia, and renal osteodystrophies
- Medication and nutrition management
60
what is the treatment for hyperkalemia
- Restricting foods high in potassium
- Administration of IV calcium gluconate to stabilize the cardiac membrane
- Administration of IV glucose and insulin, albuterol, or bicarbonate to move potassium into the cell.
- Administration of furosemide (Lasix) improve clearance
- Administration of sodium polystyrene sulfonate (Kayexalate
61
what meds are used for hypertension
```
Diuretics
Beta-adrenergic blockers
Calcium channel blockers
ACE inhibitors
Angiotensin-receptor blocker agents
```
62
what is the treatment for anemia
- administration of erythropoietin
- oral iron supplements
- blood transfusion only if client is actively bleeding
63
what does renal transplant eliminate the need for
dialysis; dietary and fluid restrictions are reduced not eliminated.
64
what is the assessment involved for chronic kidney disease
- VS
- focused pulmonary, cardiac, and peripheral vascular assessments
- monitoring lab values: potassium, sodium, calcium, serum phosphate, hemoglobin, hematocrit, arterial pH
65
what are the interventions for chronic kidney disease
- Maintain cardiac monitor
- Daily weight, especially morning before dialysis
- Restrict fluids and sodium
- Skin care
- Proper positioning
- Renal diet; adequate protein levels
66
what is the education involved for chronic kidney disease
- Do not miss dialysis appointments
- Dietary restrictions
- Clinical manifestations of CKD and complications
- Avoid nephrotoxic substances such as NSAIDS, contrast media, nephrotoxic antibiotics, and alcohol.
- Daily weight
67
Dialysis is indicated for AKI or ESRD by the following:
```
Severe F/E imbalances
Elevated serum creatinine and potassium levels
Acidosis
Presence of uremic manifestations
Patients with GFR less than 10mL/min
```
68
what are the complications of hemodialysis
- Hypotension s/t rapid removal of fluid.
- Muscle cramps, headache, nausea, dizziness, fatigue.
- Bleeding
- Systemic infection
- Dialysis disequilibrium syndrome.
- Localized AV fistula and grafts complications can occur.
69
what is peritoneal dialysis
- Offers increased patient control and flexibility with the option of home treatment.
- Shorter period for the patient and can be performed independently.
- Involves fewer dietary restrictions and greater mobility for clients.
- Clearance of metabolic wastes is slower but more continuous.
- Avoids rapid fluctuations
- Vascular membrane of the peritoneal cavity is used as the dialyzing agent.
- Fluid and solute removal occurs via diffusion and filtration
- Involves instillation of hypertonic dialysate solution into peritoneal cavity and subsequent dwell times. Drain the dialysate solution that includes the waste products.
- Intact peritoneal membranes without adhesions or infection or multiple surgeries is required.
70
what are the complications of peritoneal dialysis
- Peritonitis and Cather Infection
- Abdominal pain
- Hyperglycemia and Increased Triglyceride Levels
- Outflow problems
- Respiratory compromise
- Protein Loss
71
what is the assessment for dialysis
- VS
- Oxygenation/Respiratory Status
- Temperature
- Daily weight
- Filtrate appearance
- Lab values
- Nutritional Intake
72
what labs will you test for dialysis
- Coag studies/H&H
- WBC Count
- Electrolytes and Renal studies
73
what are the specific assessment for HD dialysis
Bruit presence in fistula
Neuro assessment
Systems assessment post-dialysis
74
what are the specific assessment for PD dialysis
Abdominal girth
| Monitor outflow
75
what are the interventions for dialysis
- Dialysis nurses typically perform HD
- Avoid any procedures, blood draws, IV insertion, or blood pressure reading in the arm with HD access
- Hold medications that may be dialyzed out during session.
- Perform instill, dwell, and drain functions (PD)
- Warm dialysate to body temperature
76
what are the ss of renal cancer
- most clients are asymptomatic
- flank mass
- flank pain
- weight loss
- hematuria
- fatigue
- hypertension
- fever
- anemia
77
how is renal cancer diagnosed
- Ultrasound to differentiate between mass, cyst, or tumor.
- Renal angiography
- Percutaneous needle aspiration
- CT Scan
- MRI
- Urine cytology
- Renal biopsy
78
what is the surgical management for renal cancer
- radical nephrectomy
- removal of the affected kidney, adrenal gland, and surrounding tissue
- with ealry detection is still only shows 5 year survival rate
- if tumor is small, partial nephrectomy may occur
79
what is the post op care after surgical management of renal cancer
- Administer pain medication as ordered
- Administer IV hydration as ordered/encourage PO hydration
- Encourage respiratory exercises
- Appropriate care of catheters, stents, nephrostomy tubes, or drains
- Perform wound care as ordered
