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NURS 2514 > Week 3 - Seminar > Flashcards

Week 3 - Seminar Flashcards

(114 cards)

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1
Q

what are the 3 primary functions of the urinary system

A
  1. filter waste from blood
  2. balance electrolytes & acid/base
  3. excrete metabolic wastes
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2
Q

what are 3 secondary functions of the urinary system

A
  1. regulate BP
  2. regulate bone density
  3. regulate erythropoiesis
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3
Q

define chronic kidney disease

A
  • a state in which the kidneys no longer function adequately to rid the body of wastes
  • unable to maintain homeostasis
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4
Q

CKD is an example of_____

A
  • altered elimination
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5
Q

list 7 risk factors of CKD

A
  • diabetes
  • HTN
  • smoking
  • heart disease
  • over 65
  • meds
  • ethnicity
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6
Q

which ethnicities are risk factors for CKD (7)

A
  • indigenous
  • asian
  • south asian
  • pacific island
  • african
  • caribbean
  • latin canadian
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7
Q

what 2 things are monitored for those at risk of CKD

A
  • blood work

- urine

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8
Q

diagnosis of CKD is made when…

A

GFR < 60 ml/min/1.73 m2 for 3 months or longer

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9
Q

what is the most common renal disease that leads to dialysis & transplantation

A
  • diabetic nephropathy
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10
Q

how long after the onset of diabetes does proteinuria appear?

A
  • 10 years
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11
Q

what is an important way to prevent renal disease in pts w diabetes

A
  • blood glucose control
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12
Q

how many clinical stages of CKD are there?

A
  • 5
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13
Q

describe symptoms & GFR in stage 1

A
  • GFR = >90

- likely asymptomatic bc kidneys can compensare well

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14
Q

descibre symptoms & GFR in stage 2 (2)

A
  • GFR = 60-89
  • may have decreased ability to conc urine
  • develop symptoms of anemia
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15
Q

describe symptoms in stage 3-4 of CKD (5)

A
  • electrolyte & fluid imbalances
  • oliguria
  • more severe anemia
  • metabolic acidosis
  • azotemia
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16
Q

what is stage 5 of CKD? describe symptoms instage 5 of CKD (3)

A
  • end stage renal disease needing dialysis/transplant
  • anuria
  • severe electrolyte & fluid imbalance
  • uremia
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17
Q

is CKD progressive or sudden?

A
  • progressive deterioration
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18
Q

what 3 functions of the kidenys are lost during CKD

A
  • excretory
  • regulatory
  • endocrine
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19
Q

list 6 substances the kidneys retain during CKD

A
  • urea
  • creatinine
  • phenols
  • hormones
  • electrolytes
  • water
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20
Q

what is uremia

A
  • constellation of symptoms r/t to buildup of waste products & excess fluid
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21
Q

at what stage(s) do we see uremia in CKD

A
  • 4/5
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22
Q

what should we consider during health history for CKD (8)

A
  • current health (OPQRSTU)
  • PMHx (diseases that are risk factors)
  • PSHx
  • famHx
  • meds
  • allergies
  • social
  • occupation/enviro
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23
Q

why is it important to ask about meds for health history of CKD

A
  • some meds are nephrotoxic
  • consider compliance for drugs that help reduce risk factors ex. diabetes meds –> glucose regulaion is important for preventing kidney disease
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24
Q

list 5 electrolyte that will be effected by CKD

A
  • potassium –> hyperkalemia
  • sodium –> normal or low –> dilutional (from retaining so much water)
  • calcium
  • phosphate
  • magnesia –> hypermagnesia
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25
what causes hypermagnesia in CKD
- will only occur if ingesting Mg
26
what are 2 examples of sources of magnesium
- supplements | - milk of Mg
27
list 2 symptoms r/t to hypermagnesia
- decrease in mental status | - dysarrthymia
28
what acid-base imbalance may occur due to CKD
- metabolic acidosis
29
what are symptoms of hyperkalemia
Muscle weakness Urine output little or none Resp failure (due to muscle weakness) Decreased cardiac contractility (weak pulse, low HR again due to muscle weakness) Early: muscle cramps/twitches Rhythm changes (tall T waves, prolonged PR interval)
30
what are symptoms of hyponatremia
Stupor/coma Abdominal cramping, NV Lethargy Trouble concentrating Loss of urine & appetite, overactive bowel sounds Orthostatic hypotension Seizures, spasms of muscles Shallow resp
31
what are 2 possible diagnostic test for electrolyte/acid-base imbalances r/t CKD
- electrolytes (for imbalances) | - ABGs (for metabolic acidosis)
32
list 3 hematological symptoms r/t to CKD
1. anemia 2. bleeding tendencies 3. infection
33
list 3 causes of anemia r/t to CKD
- decreased erythropoitin - dialysis --> causes damaged RBC - frequent blood draws
34
what kind of anemia is seen in CKD
- normocytic (normal size) | - normochromic (conc of hgb is normal)
35
what causes bleeding tendencies r/t to CKD
- defect in platelet function r/t uremia
36
what causes infection r/t to CKD
- change in leukocyte function & altered immune response r/t aztoemia
37
describe physical assessment for hematological symptoms of CKD (4)
- observe for SOB, pale skin (for anemia) - auscultate for tachy - assess for unusual bleeding - assess for infection
38
how can we assess for unusual bleeding
- easy bruising - bleeding nose - bleeding gums - abdominal exam - blood in stool - signs of strok
39
how can we assess for infection (4)
- vital signs (temp) - increased pain - redness - purulence
40
what are potential diagnostics for hematological signs of CKD (5)
CBC: - low hgb - increased WBC (infection) - normal plt (defect, not thrombocytopenia**) - normal pt/ptt - ferritin/iron low
41
what are CNS symptoms of CKD (3)
- CNS depression - seizures, coma (uncommon) - peripheral neuropathy
42
what signs of CNS depression are seen in CKD (4)? what causes this?
due to uremia - fatigue - decreased loc - irritability - decreased conc
43
what are 4 signs of peripheral neuropathy
- restless legs - paresthesia in feet/legs - muscle weakness - muscle twitch, asterixis
44
what is asterixis
- uncontrolled movement in hands = hand flapping
45
describe physical assessment of CNS symptoms of CKD (2)
- observe/ inspect thru change in conciousness, behavior, convo - palpate extremities to assess for changes in sensation, unusual reflexes/tremors
46
what are 3 potential diagnostics for CNS symptoms of CKD
- increased BUN - electrolytes (decreased Na) - ABG --> acidosis
47
list 5 CVs symptoms of CKD
- HTN - accelerated artherosclerosis - HTN can lead to HF - cardiac dysrhythmias - uremic pericarditis
48
list 2 things that cause cardiac dysrythmias
- hyperkalemia | - hypocalcemia
49
describe physical assessment for CVS symptoms of CKD
- vital signs (BP, temp, HR, RR) - inspect for dyspnea, edema - auscultate lungs
50
why would you asculate lungs for CVS symptoms of CKD? What should you look for?
- to look for symptoms r/t to HF | - look for crackles, heart sounds
51
list 3 potential diagnostic tests for CVS symptoms of CKD
- EKG - electrolytes (increased K, decreased Ca, increased P) - BG
52
what are respiratory symptoms of CKD (3)
- dyspnea - secondary infections - kussmaul's breathing
53
what causes dyspnea r/t to CKD
- fluid overload - pulmonary edema - pleural effusion - uremic pleuritis
54
why would kussmaul's breathing occur with CKD
- due to metabolic acidosis
55
describe physical assessment of resp symptoms of CKD
- observe for SOB, dyspnea, cough (infection) | - ascultate for air entry & adventitious sounds
56
what is a diagnostic test for resp signs of CKD
- chest xray
57
what are 6 GI signs of CKD
- uremic fetor - stomatitis w ulterations - altered sense of taste (metallic) - NV, anemia - bleeding & ulceration - constipation
58
describe physical assessment of GI symptoms of CKD
- monitor I&O - monitor characteristics of emesis - observe/inspect mouth for ulceration, ammonia breath, abdomen - asucultate abdomen - palpate abdomen
59
what are GU symptoms of CKD (6)
- polyuria in early stages - with CKD progression: oligiura & anuria - proteinuria - casts - hematuria - pyuria
60
what urine volume is anuria
<40 mL/day
61
describe physical assessment for GU signs of CKD (3)
- assess vital signs (increased BP) - monitor I and O - monitor urine characteristics
62
what urine characteristics may occur in early CKD? late CKD?
- early = dilute | - late = conc
63
what is a diagnostic test for GU symptoms of CKD? what results will you see?
``` urinalysis: - proteinuria - casta - pyuria - hematuria (depends on cause) ```
64
list 2 integumentary symptoms of CKD
- pruritus | - uremic frost
65
what causes pruritis in CKD (3)
- dry skin - calcium-phosphate deposits - sensory neuropathy
66
what are risks associated w pruritis (2)
- bleeding - infection due to scratching
67
what causes uremic frost
- urea crystalizing on skin (rare)
68
describe physical assessment of the integ system for CKD
- inspect for rashes & scratches | - inspect for signs of infection
69
what are 3 possible diagnostic tests for the integ system
- BG - increase BUN - CBC for infection
70
what are 2 musculoskeletal symptoms of CKD
- renal osteodystrophy | - insoluble calcification in vascular walls & soft tissues
71
what is renal osteodystrophy
- skeletal disorder | - alteration of bone morphology
72
what is a risk of renal osteodystrophy
- increased risk of fractures
73
what causes calcifications in CKD
- phosphate binding w calcium
74
describe physical assessment for musculoskeletal signs of CKD
- often asymptomatic - assess for complains of weakness, muscle/bone pain - observe for abnormal gait
75
what are 4 potential diagnostic tests for musculoskeletal signs of CKD
- alk phosphotase increased - xrays --> fractures - BMD tests - Ca and phos levels
76
in general, what are 3 things you want to measure for physical assessment of CKD? why?
- vital signs (fluid overload, infection?) - I and Os (anuria, oliguria) - daily weight
77
in general, what are some things you want in observe/inspect for phys assessment of CKD
- gait - LOC - paleness - rash - bruising - edema - signs of infection - bleeding - uremic fetor - dyspnea - urine color
78
in general, what are 2 things you want to palpate during assessment of CKD
- extremities for sensation & edema | - abdomen for discomofrt
79
in general, what are 3 things you want to auscultate for assessment of CKD
- lungs (crackles, consolidation) - heart - abdomen (bowel sounds)
80
in general, what are 3 categories of diagnostics for CKD
- blood work - imaging - urine tests
81
what are 2 main types of blood work for CKD
- electrolytes | - CBC
82
what are 3 types of urine tests done for CKD
- urinalysis - albumin/creatinine urine test (ACR) - creatinine clearance (24 hr)
83
what is measured during urinalysis
- pH - protein - glucose - blood
84
what are 5 types of imaging test for CKD
- abdominal xray - renal US - renal CT (dye) - renal MRI - renal biopsy
85
what is a risk associated with getting a renal biopsy
- risk of bleeding
86
what is a risk of a renal CT (dye)?
- must be processed thru the kidney & can be harmful
87
what is dialysis
- movement of fluid & molecules across a semi-permeable membrane from one compartment to another
88
what is dialysis used for
- to correct fluid & electrolyte imbalances | - remove waste products
89
what stage of CKD is dialysis used for
- stage 5
90
what are 2 methods of dialysis
1. hemodialysis | 2. peritoneal dialysis
91
what are 5 possible indications for dialysis
Acidemia (metabolic acidosis) Electrolyte abnormalities with EKG changes (hyperkalemia) Intoxication from meds or Infection r/t uremia Overload of fluid (not responsible to diuretics) Uremia complications
92
how does dialysis help to treat infection
- enhances WBC function to fight infection
93
what uremia complications indicate use of dialysis (3)
- pericarditis - encephalopathy - GI bleeding
94
what is peritoneal dialysis? how does it work
- insertion of a catheter thru the anterior abdominal wall into the perionteal - dialysis inside the body that uses the peritoneal membrane - put fluid into the body, let it sit for awhile (dwell), and then you drain it out
95
list complications of PD (6)
- abdominal/back pain - outflow problems - hernias - protein loss - pulmonary complications - infection
96
what causes abdominal/back pain r/t PD (4)
- low pH of solution - peritonitis - intraperitoneal irritation - catheter placement
97
what is an outflow problem r/t PD
- normally, 80% of fluid should be returned that is instilled - outflow problem = not enough fluid returned
98
what can cause a hernia r/t PD
- due to increased intraabdominal pressure w infusion
99
what can cause protein loss during PD
- the peritoneal membrane is permeable to some
100
what can cause pulmonary complications during PD
- repeated upward displacement of the diaphragm due to extra fluid = decreased lung expansion
101
what two places coudl infection occur during PD
1. at the exit site | 2. peritonitis (inside the body)
102
what are signs of an infection at the exit site during PD (3)
- site redness, tenderness, drainage
103
what are signs of periotonitis due to PD (7)
- cloudy peritoneal effluent - diffuse abdominal pain - diarrhea - vomitting - abd distension - hyperactive bowel sounds - foul smell
104
what is hemodialysis? how does it work?
- dialysis outside the body - blood is brought out of the body & run thru a dialyzer which filters out toxins/waste products & clean blood is returned to body
105
what are 2 types of hemodialysis vascular access sites
1. fistula | 2. graft
106
what is a fistula?
- joining of an artery to a vein
107
how does a graft work for hemodialysis
- a synthetic looped graft is inserted between the arery & vein
108
list 2 nursing considerations for hemodialysis
- fistula must be protected from trauma & compression (ex. tight clothing, sleeping on that side, etc.) - no blood pressure, venipuncture (drawing of blood), IV
109
what are signs of good flow during hemodualysis
- palpate for thrill | - listen for bruit
110
list 5 complications of hemodialysis
- infection ---> sepsis - hypotension (bc fluid removed) - muscle cramps - loss of blood - disequilibrium syndrome
111
what is disequilibrium syndrome
- where rapid removal of urea leads to cerebral edema and increased intrcranial pressure - more common in people who are new to dialysis
112
what should you assess pre-dialysis (3)
- be aware of why they are having it - ensure vital signs are stable (bp esp) - review meds , some may be held
113
which meds might be held when giving dialysis
- any med that would be dialysed out
114
what should you monitor post-dialysis (5)
- monitor LOC, mental status - monitor vs - auscultate heart & lung sounds - observe vascular access - monitor urine & blood work

NURS 2514 (75 decks)

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