Renal week 3

Question 1

What do the kidneys do

Answer 1

Make urine 
Regulate Na
Regulate fluid balance
Acid base - bicarb excretion and reabsorption
BP regulation
RBC production
Converts inactive vitamin D to active form
Prostaglandin secretion

Question 2

Prostaglandin

Answer 2

vasodilate blood vessels ?

Question 3

What is released by kidneys for RBC production

Answer 3

Erythropoetin

Question 4

What is healthy UOP

Answer 4

1. 5L Q24 hours
   - - 30ml/hour

edema build up after 2.5-3L of fluid retained

Question 5

how much K excreted by kidneys

Answer 5

90%

Question 6

Gero: kidney

Answer 6

decreased ability to adjust to the changes in H2O / electrolyte

Question 7

Gero: blood flow

Answer 7

Increased for for failure r/t polypharm., comorbidities, decreased renal function

Question 8

Gero: tubule system

Answer 8

Loss of ability to conserve / excrete Na and hydrogen

• • decline ability to concentrate
• • increased risk for dehydration

Question 9

Gero: nephrons

Answer 9

altered drug excretion and drug-drug interaction

Question 10

Glomerulernephritis

Answer 10

infection/inflammation of glomerulers

Question 11

Polycystic kidneys

Answer 11

patient develops cysts which alters form of nephrons

Question 12

nephrotic syndrome

Answer 12

common in younger patients

high lipids, high amount of edema

Question 13

Rhabdomylosis

Answer 13

results in muscle damage

clogged nephrons

Question 14

Pre-renal disease: impaired perfusion (cause)

Answer 14

• cardiac failure
• sepsis
• blood loss
• dehydration
• vascular occlusion

Question 15

Renal disease: Glomerularnephritis, small vessel vasculitis, acute tubular necrosis (cause?)

Answer 15

• drugs, toxins, prolonged hypotension, interstitial

Question 16

Renal disease: interstitial nephritis (cause)

Answer 16

drugs, toxins, inflammatory disease, infection

Question 17

Post renal disease (cause)?

Answer 17

urinary calculi
retroperitoneal fibrosis
benign prostatic enlargement
prostate cancer
cervical cancer
urethral stricture/valves
meatal stenosis/phimosis

Question 18

kidneys want MAP to be what?

Answer 18

above 65

Question 19

Acute kindey injury: Oliguric phase (signs and symptoms)

Answer 19

Oliguria (<40mL/day within 1-7 days of kidney injury)
Urinalysis (casts, RBC, WBC, sp gr fixated at 1.010)
Metabolic acidosis
hyperkalemia and hyponatremia
elevated BUN and creatinine
Fatgue / malaise

Question 20

Acute kidney injury: diuretic phase (s/s)

Answer 20

gradual increase UOP –> 1-3L/day; may reach 3-5
hypovolemia, dehydration
hypotension
BUN and creatinine levels begin to normalize

Question 21

Acute kidney injury: recovery phase (s/s)

Answer 21

begins with GFR increases

BUN and creatinine levels plateaus then decreases

Question 22

Who is at higher risk for developing kidney disease and why

Answer 22

AA and asians – difference levels for GFR

Question 23

CKD: neuro s/s

Answer 23

weakness, fatigue, confusion, tremors, sz.

Question 24

CKD: integumentary s/s

Answer 24

gray, bronze skin
dry
flakey
pruritus
thin nails

Question 25

CKD: cardio s/s

Answer 25

``` HTN edema JVD hyperkalemia hyperlipidemia ```

Question 26

CKD: pulmonary s/s

Answer 26

crackles, pleurisy, SOB, tachypnea, kussimuals

Question 27

CKD: GI

Answer 27

ammonia breath anorexia NV constipation

Question 28

CKD: heme s/s

Answer 28

anemia | thrombocytopenia

Question 29

CKD: reproductive

Answer 29

``` ED amenorrhea testicular atrophy infertility decrease libido ```

Question 30

CKD: musculoskeletal s/s

Answer 30

cramps loss of strength bone pain fractures

Question 31

Chronic renal failure s/s

Answer 31

``` sallow, yellow discoloration pruritus and uremic frost CNS depression peripheral neuro anorexia NV GI bleed peptic ulcer disease constipation hyperglycemia hyperlipidemia psychological changes (withdrawal, depression, psychosis) anemia (bleeding) hyperparathyroid loss of period infertility impotence gout decrease GFR by 10% renal osteodystrophy ```

Question 32

Hemodialysis: notes to remember

Answer 32

Evaluate access site for: a. patency and signs of infection b. do NOT take BP or obtain blood from extremity that has access site

Question 33

CKD: priority assessments

Answer 33

--Fluid Status – Edema HTN Pulmonary Edema Heart Failure Urine Output I/O Weights May Have Hyperglycemia K+ Levels EKG Changes Metabolic Acidosis Cardiovascular Assessments Respiratory – May Have Kussmaul –Depleted Sodium Bicarb Infections- Coagulopathy

Question 34

CKD s/s

Answer 34

Anorexia, N/V, lethargy, fatigue, high to very high bun creatinine neurological impairment- confusion, HA, drowsiness, encephalopathy peripheral neuropathy asterixis fractures – from calcium imbalances prescription and OTC medications emotional status

Question 35

CKD priority labs/diagnostics

Answer 35

urine for proteinuria urine- elevated albumin wbc protein casts glucose GFR- 120-130 mL/min/1.73 m2 K+ BUN 10-20 mg/dL Creatinine 0.6-1.2 mg/dL Ultrasound kidneys CT scans – masses vascular abnormalities Renal scan renal biopsy

Question 36

CKD priority interventions

Answer 36

Diuretics for fluid overload- based on urine output Weigh daily 0.5-1 pound increase daily is fluid retention diet restrictions, low protein, fluid, K+, Na, phosphorous Dialysis- hypotension N/V chest pain muscle cramps evaluate fistula (thrill bruit) insertion site for bleeding hematoma infection Peritoneal- catheter for infection peritonitis hernia backvpain respiratory complications Hyperkalemia treatment- dialysis calcium gluconate sodium bicarb loop diuretic IV insulin D50 kayexylate

Question 37

CKD complications

Answer 37

``` Cardiovascular Dyslipidemia Bone disease ESRD with dialysis or Peritoneal dialysis Renal transplant ```

Question 38

CKD priority meds

Answer 38

``` calcium acetate – bind phosphate calcitrol erythropoietin statins gemfibrozil ```

Question 39

CKD education

Answer 39

``` Diet restrictions dialysis method how to take medications Track weight Blood pressure Follow up appointments ``` ``` K = low phos = low fluids = 1500mL/day ```

Question 40

when can AV fistula start to be used

Answer 40

3-6 months after inserted

Question 41

describe the red and blue parts and av fistula

Answer 41

blue venous part | red arterial part

Question 42

Hemodialysis description

Answer 42

s

Question 43

Hemodialysis: vascular access

Answer 43

Temporary AV fistula AV graft

Question 44

Hemodialysis: medical and nursing management

Answer 44

``` pharm therapy nutritional and fluid therapy psychosocial care self care home hemodialysis ```

Question 45

Who may need dialysis?

Answer 45

people with... ``` Acid-base issues Electrolyte problems intoxications overload of fluids uremic symptoms ```

Question 46

What are additional renal replacement therapies if your patient is not hemodynamically stable enough to develop hemodialysis

Answer 46

Continuous Hemofiltration Continuous veno-venous hemofiltration Continuous veno-venous Hemodiafiltration Continuous veno-venous hemofiltration with dialysis

Question 47

Peritoneal dialysis: procedure

Answer 47

Preparing the patient Preparing the equipment Performing the exchange

Question 48

Peritoneal dialysis: complications

Answer 48

Peritonitis Leakage Bleeding Incomplete recovery of fluid

Question 49

Peritoneal dialysis: nursing management

Answer 49

Caring for the catheter site Meeting psychosocial needs Teaching patients self care Continuing care

Question 50

Kidney transplant: preop management

Answer 50

workup and listing

Question 51

kidney transplant: postop management

Answer 51

``` Antirejection medication Assessing for transplant rejection Preventing infection Monitoring urinary function Addressing psychological concerns Monitoring and managing potential complications Teaching self care Continuing care ```

Question 52

Renal trauma: manifestations

Answer 52

grey turner sign | cullen sign