2/16 Flashcards
Left untreated what will happen to almost all renal disorders?
A. polycystic kidney disease
B. chronic kidney disease
C. acute kidney injury
D. glomerulonephritis
Answer: B
Rationale: PKD - cannot stop it; can slow it down; depending on how long live will develop into CKD; “only curative treatment” = renal transplant - still have PKD - not want develop on other kidneys - long enough life expectancy not affect them after the transplant
Glomerulonephritis - easily treatment
AKI - very treatable; reversible
CKD - irreversible
The nurse should recognize that the production of lactic acid would place the client at risk for which of the following?
A. pre-renal injury
B. intra-renal injury
C. post-renal injury
D. occlusive-renal injury
Answer: B
Rationale: lactic acid produced outside kidney - damage done inside the kidney/destruction within the kidney; sepsis - high lactic acid, fluid volume deficit - two diff ways injuring kidneys - lack fluid/hypovolemia (pre-renal) and production lactic acid (intra-renal)
Pre-renal condition: dehydration, hyperglycemia/DM (vessels), HF, sepsis, bleeding, blood clots
Intra-renal condition: hyperglycemia/DM (vessels), sepsis, blood clots, nephrotoxic drugs (ibuprofen, street drugs, NSAIDs, toxins - lactic acidosis from sepsis goes in and inflamed glomeruli and causes glomerulinephritis, infections - acute pyelonephritis)
Post-renal condition: blood clots, renal calculi, prostate - benign and cancerous - bladder cannot empty urine and backs up into kidneys and causes hydronephrosis - urine-filled kidney and stops it from functioning
What is the hallmark manifestation of nephrotic syndrome?
A. loss of 3.5 grams of protein/day
B. massive edema
C. pulmonary edema
D. hyperlipidemia
Answer: A
Rationale: hallmark - shining star of what explains disease process/syndrome
Massive edema - does happen - happens in nephrotic syndrome and many other kidney issues when filtration not allowed
Pulmonary edema - easy place for lungs to fill up - happens lot diff kidney diseases
Hyperlipidemia - does happen in nephrotic syndrome but not shining star of what is happening; body losing protein - liver not happy about losing protein - can produce protein and albumin (oncotic pressure - pull fluids back into intravascular space); not specific organ - send both protein and lipids out - peeing out protein - left over is lipids - blood with large clumps of lipids in it - NEED BE ON A STATIN
Protect kidneys if was spilling protein into them: ACE-I/ARBS - start with ACE-I unless think have rxn or have rxn - control BP and provide kidney protection from protein spillage
Not put on diuretic - fluids in third space - are extravascular not intravascular - need albumin
Inside blood vessel: dry; albumin gone away - peed it out; fluid gone out into third space; intravascularly dry but extravascularly/third space wet; have to reverse nephrotic syndrome in order for it to get kidneys working again; edematous: face, eyes, anasarca - edema upon edema
Low BP: sludge - work harder to push through; RAAS - no fluid - tighten things up - up squirting factor - causes HTN
how med community defines diagnosis of nephrotic syndrome
Have fix main issue first
What is the hallmark concept of chronic kidney disease?
A. it can be reversed
B. it always requires dialysis
C. two or more contributing factors are a bad sign
D. kidney transplant is the only treatment
Answer: C
Rationale: cannot be reversed; is irreversible
Kidney transplant is not the only treatment - can do dialysis, do BP meds to bring down BP or protect kidneys; is at certain point - ESRD - conceptualized: GFR: 15 or less
Why want start dialysis: cannot control electrolytes - want control fluid volume, ability to regulate electrolytes; electrolyte: K - not want mess around with electrolyte that is really imp for generating electrical activity in the heart; see high K - need to get person on tele - tall peaked T waves - see that - good reason check K levels; really high K - causes muscle weakness and at times paralysis
Diet depends on filtration
Have adjust kidney diet - nutritionist level - to what happening to kidneys - kidney damage - cutting out Na, K, no salt substitutes, need to limit protein - protein causes damage, do need carbs for building
Always require dialysis - can have chronic kidney failure and never need dialysis; longer live and more damage done
2+ contributing factors are a bad sign - worse cause chronic renal failure
What type of dialysis requires an abdominal catheter?
A. continuous renal replacement therapy (CRRT)
B. hemodialysis
C. sustained low-efficiency dialysis (SLED)
D. peritoneal dialysis
Answer: D
Rationale: peritoneal dialysis: can only have peritonitis twice before switched to hemodialysis - on for years - sterile technique; little catheter, instill fluid, must be sterile; fluid and drains off; do it at home; machines do it for you
Start hemodialysis - always on it - stay with it forever; no going back
SLED, CRRT - hemodialysis - overarching for blood-related dialysis
CRRT - septic people; load taken off kidney while recover so not destroy it; runs 24/7; good for people when having trouble with fluid volume status and BP
SLED - not seen as much; esp since using CRRT; extended 6-8 hrs instead of 4
Know limitations dialysis grafts
Can monitor site
Make sure dressing in-tact
Should assess catheters and grafts - look at for infective processes, dressing
AV grafts - feel vibration; listen for bruit; look for infection
Cannot do:
Hook up to IV and use as an infusion unless specifically trained
Cannot access graft
Cannot access catheter
Safety issues involved with accessing it including catheters (Tessiyo) - two ports sticking out pts out neck/subclavian - packed with lots of units of heparin to keep it open - can over anti-coag pts
Speciality dialysis pts
Know limitations dialysis grafts
BUN/Cr - one can be elevated and other be norm
BUN elevated and normal Cr - dehydration
Renal labs:
Daily weight best ways do fluid volume changes and status
PKD
48 hours - if CT emergency - something to protect kidneys: fluids, bicarbonate, acetylecysteine
CT scans and use of metformin -
Furosemide
Peritoneal dialysis
Lactic acid - in kidney and burning it up
Do what is in scope and if have order
Intrarenal on sepsis pat
Can give albumin
Removal of K that cannot filer - Kayexalate (sodium polystyrene) - quick protective mechanism - decreases K+; insulin, dextrose 50 - drives K intracellular making cardio protective - not stay there forever; follows glucose
Nephrotic syndrome
Normal - Measure urine - 30 mL/hr or greater; 0.5 mL/kg/hr (more specific); less than 30 mL/hr is bad
Scheduled for nephrectomy
