Test # 4 Chapter 70 CARE OF PATIENTS WITH RENAL DISORDERS Flashcards Preview

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Flashcards in Test # 4 Chapter 70 CARE OF PATIENTS WITH RENAL DISORDERS Deck (58):
1

Pathophysiology of Polycystic Kidney Disease

***Genetic Disorders- a child of a parent with PKD has a 50% chance of inheriting the disease and passing it on to the next generation. There is a huge genetic link.

***Cyst damage glomerular and tubular membranes. So causes decreased GFR.

***Kidney tissue is replaced by non-functioning cysts which look like clusters of grapes. 2-3 times bigger. Can weigh up to 10 pounds. The cysts can also transfer to other organs such as the liver.

2

What is the Etiology of Polycystic Kidney Disease

Genetic:

Autosomal Dominant Trait

Autosomal Recessive Trait- starts at birth and older. Will be worse if starts earlier.

3

What are the key features of Polycystic Kidney Disease

Could be Multiple

Key Features: HTN, Constipation, Flank pain, Enlarged Abdomen as a whole.

4

Nursing Interventions for PKD

Goal is to help with early detection and to slow the progression of the disease.


Pain Management-
Treatment of Infection-
Prevention of Constipation-
Treat HTN-
CKD turns to ESKD-
Nutrition-

5

***Pain Management for PKD

These pts are in a lot of pain.

Need to avoid NSAID’s because reduce kidney blood flow.

Anything that contains aspirin over the counter such as Alka Seltzer.

Avoid Morphine, Demerol and Codeine. (With Kidney problems as a whole)

They can have Oxycontin and Dilaudid.

Very Safe are Fentynal and Methadones.

6

*** Treatment of Infection in PKD Patients

will be on a lot of antibiotics (which are hard on the kidneys)

need to look at there creatinine while they are on it to make sure that it does not get to high (greater than 2)

7

**Prevention of Constipation in PKD patients

drink water (2-3 liters a day), increase fiber, exercise, can take a stool softener but not on a daily basis

8

**Drugs to treat HTN in PKD patients

ace inhibitors, CCB, BB, and diuretics. Teach low sodium diet, and how to take BP at home (and that they really need to take it), checking weight daily.

9

**CKD - ESKD-

will progress from chronic to end stage kidney disease.

10

**Nutrition-

could be multiple

ow sodium, drink water (2-3 liters a day), increase fiber, exercise,

11

On assessment of a client with PKD, which findings is of greatest concern to the nurse?

a) flank pain
b) periorbital edema
c) bloody and cloudy urine
d) enlarged abdomen

b) periorbital edema




ACD are all expected, and B is odd man out

12

What is the Pathophysiology of Obstructive Disorders?

Pressure builds up directly on kidney tissue. The nephrons get damaged so they do not produce urine like they are supposed to GFR goes down. Waste products build up. Acid base is out of balance. Perm damage can occur in a few days or a few weeks depending on the patient (diabetic or not).

Tubular filtrate pressure also increases in the nephron and drainage is impaired

Nitrogen waste products and electrolytes are retained.

13

What are the three different types of obstructive disorders?

Hydronephrosis,
Hydroureter
and Urethral Stricture-

14

Hydronephrosis-

having an issue close to the kidneys. This is the worst of the three. The urine backs up to the kidney very fast because it has no where to go.

15

Hydroureter-

Obstruction in the ureter. Backs up to the kidney.

16

Urethral Stricture-

narrowing of the urethra that causes back up to the bladder, then to the kidney.

17

Etiology of obstructive disorders

Hydronephrosis and Hydroureter- typically a stone lodged and wont let urine through, can be a tumor, or trauma as well.


Urethral Strictures- typically related to STD or trauma

18

Complications of obstructive disorders

Asymmetric (one side and not the other), tender flank pain, urine will look bloody and cloudy.

PH will go up because things are not working properly, normal is 4.6 - 8,

UTI, will have bacteria in the urine as well

19

Nursing Interventions for obstructive disorders

Urinary retention and infection are common problems.

Stone Removal/Stent Placement

Nephrostomy:

20

***Nephrostomy:

Surgery-Procedure diverts urine externally and prevents further damage to the kidney

Typically conscious sedation.

NPO 6-8 hours before. When they put it inside it immediately relieves the pressure and it stays until the obstruction is fixed.

21

*** Nephrostomy: Post-op.

I&O’s,

monitor urine will have red tinge for first 24 hours then will go back to normal,

monitor the insertion site,

monitor CVA tenderness (is sign of infection),

monitor temperature and vitals,..

***If cloudy urine and lower back CVA tenderness, gather cultures, get vitals, call the doctor. if no urine output, check to see if kinked or come out.

22

A patient is 6 hours post-op from a nephrostomy procedure. The collection bag has cloudy urine and the patient is reporting back pain. What is your priority nursing intervention?

a) Irrigate the drainage bag so the urine will no longer be cloudy.

b) Administer the ordered pain medication to help with the back pain.

c) Assess vital signs then call the doctor.

d) Educate your patient about post-op care.

c) Assess vital signs then call the doctor.

23

Which laboratory test result for a patient who is about to have a nephrostomy for hydronephrosis does the nurse report immediately to the physician?

a) Sodium 137mEq/L
b) Potassium 4.8mEq/L
c) BUN 23mg/dL
d) INR 4.6

d) INR 4.6

24

What is the Pathophysiology of Pyelonephritis?

Bacteria moves up from urinary tract into the kidney tissue causing an inflammatory response and local edema results.

We break them up into 2 groups - Acute & Chronic.

25

What is the Etiology of Pyelonephritis?

Acute- Is an active infection. This can lead to abscesses. Typically Related to pregnancy. Ecoli is the culpret.

Chronic- Repeated or continual infection.

Chronic is more difficult because it leads to scarring and reduced kidney Function.

Related to structural Defect within the patient that makes them more prone or patients that have kidney stones or take NSAIDS.

26

Diabetics-

have reduced bladder tone (don’t have the sensation that they need to urinate)
overall just as they age and because of diabetes,


They have more sugar on board in their bladder which is a better environment for bacterial growth.

Education piece for a diabetic-

Teach to urinate every 2 -3 hours. Drink 2-3 liters of water, avoid caffeine and alcohol.

27

Does an acidic pH or alkaline pH promote bacterial growth within the bladder?

When someone has an infection, they will be alkalinic when it shows up. Increases pH. Before they get it, acidity promotes the bacterial growth.

28

Clinical Manifestations of Pyelonephritis?

Acute: S/S dysturia, polyuria (increased Urine Production) (UTI S/S)

Chronic: over time have kidney damage, will have hyperkalemia and be acidotic.

29

Nursing Interventions for Pyelonephritis?

Drug Therapy- antibiotics and pain medication

Nutrition Therapy- 2-3 liters of water a day. empty bladder every 2-3 hours, avoid caffeine and alcohol

Surgical Management- fix the underlying cause. If they have a stone, they will take it out. If they have a stricture they can fix it. They will not take the kidney out unless they have to. it is a last resort.

30

Which of the following symptoms would most likely indicate that the patient has pyelonephritis?

a) Ascites
b) Costovertebral Angle Tenderness
c) Polyuria
d) Nausea and Vomiting

b) Costovertebral Angle Tenderness

31

What is the Pathophysiology of Acute Glomerulonephritis?

Glomerulus is damaged, typically they have an infection

Symptoms 10 days from time of infection

Recovery is usually quick and complete

32

What is the Etiology of Acute Glomerulonephritis?

Infection, e.g Streptococcus or cold sores in the mouth. They get an infection and don’t get it treated fast enough and it causes kidney issues

33

****What are the Clinical Manifestations of Acute Glomerulonephritis?

GFR low (normal is 125) when they get to 50 or less, you will start to see fluid overload issues.

Fluid Retention & Na Retention causes high BP and pulmonary edema.

Weight Gain

SOB/Crackles

Heart- will hear S3 Gallop from extra fluid in the ventricles. Will have JVD.

Fatigue

34

*** What are the Nursing Interventions for Acute Glomerulonephritis?

Manage Infection with antibiotics and figure out the cause

**Prevent Complications- give diuretics, reduce sodium intake. restrict fluid intake (fluid that they can have in a day is equal to their 24 hour urine output plus 500-600ml) , strict I&O’s, weight loss or gain is equal to fluid loss or gain, weight loss indicates that the interventions are working.

***Weight gain/loss- weigh every day (we want them to lose about a pound a day)

35

What is the Pathophysiology of Chronic Glomerulonephritis?

Develops over 20-30 years or longer

36

What is the Etiology of Chronic Glomerulonephritis?

Etiology unknown, but possible related to HTN (causes poor blood flow to the kidneys), infections, inflammation, poor blood flow to kidneys


Always leads to ESRD- kidney tissue will atrophy, nephrons will decrease in number, protein will increase in the urine and GFR will decrease (the sicker they are, the more their GFR will decrease)

37

***What are the Clinical Manifestations of Chronic Glomerulonephritis?

Systemic Overload- crackles in the lungs, respirations increased, S3 gallop, weight increases, pulmonary edema.

Uremic Symptoms- kidneys remove waste so when not working properly, waste will build up.

This causes them to have uremic symptoms such as ataxia (uncontrolled movements), slurred speech, skin will change (texture, dryness, scratching, bruise easily)

38

***What are the Nursing Interventions for Chronic Glomerulonephritis?

BP- Give Medications

Nutrition- Low sodium, appropriate fluid intake,

Dialysis- most people end up here sooner than expected. Need to get rid of waste. Urine output is decreased.

39

The patient has been diagnosed with chronic glomerulonephritis. The nurse should teach the patient that the disease may progress to:

a) thromboemboli
b) systemic lupus erythematosus
c) diabetes mellitus
d) end stage renal disease

d) end stage renal disease

40

What is the Pathophysiology of Nephrotic Syndrome?

Increased glomerular permeability that allows large molecules (albumin and protein) to pass through the membrane into the urine

***Main feature is severe proteinuria and low albumin

41


*****What are the Nursing Interventions for Nephrotic Syndrome?

Lab Values- <.8 protein in the urine, normal albumin is 3.5 - 5 (they will have hypo), they will have high lipids.

Medications- steroids (decreases inflammation), ace inhibitors (great for kidney patients, helps decrease the protein loss in the urine), if high lipids will have cholesterol meds, and diuretics to help with edema.

Nutrition- depending on GFR is what we are going to teach them. If their GFR is ok, they can have normal intake of protein. If GFR is decreased, then we will decrease their protein intake, low sodium diet (helps will edema issues), fluid intake will be lower side of normal such as 2L,

42

Which lab value would the nurse expect to see in a patient with nephrotic syndrome?

a) Proteinuria
b) Albumin 4g/dL
c) pH 5
d) Potassium 4mEq/L

a) Proteinuria

43

What is the Pathophysiology of Diabetic Nephropathy?

Kidneys disease- damage related to diabetes and control of hyperglycemia

Albumin are first detected in the urine. This is a large particle that is normally filtered out.

Once progressive kidney damage occurs, protein can be detected in urine

44

What is the Etiology of Diabetic Nephropathy?

Diabetes- type 1 or 2, but mainly type 1. If type 2 if picked up in their 30’s.

45

What are the S&S of Diabetic Nephropathy?

Early many have none, albumin in the urine is what normally cues them in, then protein will be picked up.

Stages, albumin is first then protein will be picked up.

46

***What are the Nursing Interventions for Diabetic Nephropathy?

Avoid Dehydration-

Keep glucose in normal range

Avoid nephrotoxic agents- medications or CT dye... things that are hard on the kidneys.

If we do not try to fix the problem, or patient does not comply, they will progress to end stage kidney disease.

47


A patient is newly diagnosed with diabetic nephropathy. Which statement by the patient demonstrates understanding of the disease?

a) I will limit my intake of fluids to protect my kidneys.

b) I will keep my blood glucose levels in the target range.

c) It is okay for me to have CT contrast as long as I tell my doctor afterwards.

d) I should wear protective gear around my lower back when I play tennis.

b) I will keep my blood glucose levels in the target range.

48

Pathophysiology of Renal Cell Carcinoma

Health kidney tissue is damaged and replaced by cancer cells.

****Most often between age 55-60, smoking puts you at greater risk.

49

Renal Cell Carcinoma:

Paraneoplastic Syndrome-

people with this type of cancer can develop Anemia and Erythrocytosis, hypercalcemia, HTN, and liver dysfunction.

50

Renal Cell Carcinoma:

Anemia and Erythrocytosis-

kidneys overproduce erythropoietin and red blood cells are increased (Erythrocytosis), then it turns off. It turns back on an destroys them causing anemia. Cannot have Anemia and Erythrocytosis at one time.

51

Renal Cell Carcinoma:

HTN-

due to overactive renin system.

52

Renal Cell Carcinoma:

-Hypercalcemic-

because tumor cells cause parathyroid to increase, causing to much calcium.

53

Renal Cell Carcinoma Nursing Interventions

Clinical Manifestations- fatigue, pale skin, lose weight, flank pain, blood in the urine. Diagnosis is usually later which causes the survival rate to not be great. HH is low due to anemia,

Non-Surgical- chemo is not real effective, can do eblasions and modifiers that can help immune response, but not a lot they can do.

Surgical- nephrectomy, Post op- focus attention to blood loss. Hypovolemia SS are low BP and increased HR, decreased urine output, If BP is down and urine output is down, assess their vital signs (Increase in HR) first and then hang fluids, check IV to make sure it is patent.

54

The nurse caring for a patient who is experiencing renal cancer would include which priority nursing intervention after a radical nephrectomy?

a) Assess for signs of infection.
b) Assess for signs of pain.
c) Assess for respiratory complications.
d) Assess for coping strategies.

c) Assess for respiratory complications.

55

What is the Pathophysiology of Kidney Trauma?

what matters is where the trauma took place in the kidney. could be stabbed, fell off the roof, car wrecks ect


Minor- parenchyna and caylx are considered minor

Major- cortex, veins, arteries are considered more serious.

56

What is the Etiology of Kidney Trauma?

Trauma

Duh lol

57

What are the S&S of Kidney Trauma?

Ecchymosis to abdomen or flank

Pain, CVA Tenderness

UA, hematuria

58

****What are the Nursing Interventions for Kidney Trauma?

Drug Therapy- bleeding- you hang blood, BP down- you hang fluid

Fluid Therapy (bolus)

**Urinary Catheter- if there is any kind of bleeding, you do not stick a catheter in. Always let the doctor know.

Surgery- remove the kidney, partially or total. depends on injury. (Bench surgery, take the kidney out, set it on the abdomen, fix the arteries, put it back in)

**Prevention- teach avoid contact sports, don’t get on the roof, wear seatbelt. Dont drive fast.

**Post-op Care- once it has been partially removed, removed or bench surgery. Post op care is, Monitor I &O, infection, bleeding, pain management, social and emotional things. Football players that have kidney removed can no longer play football.