Care of patients with renal disorders ch 70

Question 1

key features for polycystic kidney disease

Answer 1

abd or flank pain
HTN
nocturia
increased abd girth
constipation
bloody or cloudy urine
kidney stones
headaches (with or without vision changes)

as kidney function decreases: edema, anorexia, n/v, pruritus, fatigue

Question 2

diagnostic test for polycystic kidney disease

Answer 2

urinalysis: proteinuria, hematuria, bacteria( indicates infection)
Creatinine and BUN rise
creatinine clearance decreases
sodium loss or sodium retention
renal sonography
CT
MRI

Question 3

interventions for polycystic kidney disease

Answer 3

pain management
prevent infection
prevent constipation
prevent HTN
prevent CKD

Question 4

managing pain in polycystic kidney disease

Answer 4

antibiotics if cyst is infected and causing discomfort (Bactrim, Cipro, Septra, Trimpex)
Heat application
cysts can b reduce by needle aspiration and drainage
relaxation and comfort, imagery

NSAIDs are used cautiously (reduce kidney blood flow)
aspirin is avoided to reduce risk for bleeding

Question 5

preventing constipation in polycystic kidney disease

Answer 5

maintain adequate fluid intake
increase dietary fiber when fluid intake is more than 2500mL/24 hr
exercise regularly
stoll softeners, bulk agents, careful use of laxatives

Question 6

controlling HTN in polycystic kidney disease

Answer 6

drink at least 2 L daily
restrict sodium
calcium channel blockers
beta blockers
vasodilators
ACEIs (can help control cell growth of PDK and reduce microalbuminuria)
protein intake may be limited to slow end stage KD

Question 7

key features of acute pyelonephritis

Answer 7

fever 
chills
increased HR, RR
flank, back, or loin pain
tender costovertebral angle
abd, often colicky, discomfort
n/v
general malaise, fatigue
burning, urgency, frequency of urination
nocturia
recent cystitis or treatment for UTI

Question 8

key features of chronic pyelonephritis

pg 1524

Answer 8

HTN
inability to conserve sodium
decreased urine concentrating ability, resulting in nocturia
tendency to develop hyperkalemia and acidosis

Question 9

laboratory assessment for pyelonephritis

1525

Answer 9

positive leukocyte esterase, nitrite dipstick test, presence of WBC, bacteria
occasional RBCs, WBC casts, protein
blood cultures for specific organisms
C-reactive protein
erythrocyte sedimentation rate (to determine presence of inflammation)

Question 10

____ often occurs before kidney manifestations of acute glomerulonephritis

Answer 10

an infection

onset of symptoms is about 10 days from time of infection

Question 11

Hx assessment for patient with acute glomerulonephritis

Answer 11

recent infections (particularly skin or upper respiratory tract)
recent travel
exposure to viruses, bacteria, fungi, parasites
recent illnesses, surgery, invasive procedures
any known systemic diseases, like systemic lupus

Question 12

kidney disorders that requires increase in sodium and water intake

Answer 12

polycystic kidney disease waste sodium rather than retain it

Question 13

infectious causes of acute glomerulonephritis

Answer 13

strep 
staph
pneumococcal 
syphilis
infective endocarditis
measles
mumps
rocky mountain spotted fever
histoplasmosis
varicella

Question 14

aka chronic nephritic syndrome

Answer 14

chronic glomerulonephritis

Question 15

chronic glomerulonephritis

• what is it
• some manifestations

Answer 15

aka chronic nephritic syndrome
develops over 20-30 years
exact cause unknown
always leads to end stage kidney disease
proteinuria, hematuria, HTN, fatigue, edema

Question 16

physical assessment/clinical manifestations of chronic glomerulonephritis

Answer 16

assess for:
systemic circulatory overload
listen for presence of S3
edema
asess for uremic symptoms: slurred speech, ataxia, tremors, asterixis
yellowish color skin, bruises
itching, dryness

Question 17

diagnostic tests and what they show

for chronic glomerulonephritis

Answer 17

URINALYSIS: urine output decreases, protein, diluted, RBCs, casts
GFR is low
serum creatinine elevated (usually greater than 6)
BUN increased (often as high as 100-200)
sodium retention common
hyperkalemia can occur when oliguria develops
hyperphosphatemia
calcium lower than normal
acidosis develops from hydrogen ion retention and loss of bicarbonate
kidneys abnormally small on x-ray
kidney biopsy important

Question 18

interventions for chronic glomerulonephritis

Answer 18

diet changes
fluid intake sufficient to prevent reduced blood flow
drug therapy to control uremia
eventually dialysis or transplantation

Question 19

nephrotic syndrome

Answer 19

condition of increased glomerular permeability that allows larger molecules to pass through the membrane into the urine, and then excreted
causes massive loss of protein, edema, decreased plasma albumin levels

Question 20

main feature of nephrotic syndrome

and other features

Answer 20

severe proteinuria (more than 3.5 g in 24 hrs)

low serum album levels of less than 3g
high serum lipid levels
fats in urine
edema
HTN

renal vein thrombosis often occurs at the same time

Question 21

management of nephrotic syndrome

Answer 21

varies depending on what process is causing disorder (identified by kidney biopsy)

suppressive therapy using steroids, cytoxic, immunosuppressive agents
ACEIs (can decrease protein loss in urine)
cholesterol lowering drugs
Heparin (may reduce urine protein loss and improve kidney function)
dietary protein increased if GFR is normal
dietary protein decreased if GFR is decreased
diuretics
sodium restriction

Question 22

key features of nephrotic syndrome
sudden onset of these manifestations:

1530

Answer 22

massive proteinuria
hypoalbuminemia 
edema (face, periorbital)
lipiduria 
hyperlipidemia
increased coagulation
reduced kidney function

Question 23

systemic effects that can occur with renal cell carcinoma

1532

Answer 23

anemia or erythrocytosis
hypercalcemia
liver dysfunction with elevated liver enzymes
hormonal effects
increased sedimentation rate
HTN

Question 24

why does anemia or erythrocytosis occur with renal cell carcinoma

1532

Answer 24

most pos either have one or the other, not both at same time

at times, tumor cells produce large amounts of erythropoietin, causing erythrocytosis

other times, tumor cells destroy the erythropoietin producing kidney cells and anemia occurs

Question 25

hormone changes with renal cell carcinoma

Answer 25

parathyroid hormone cause hypercalcemia
increased renin levels (causing HTN)
increased hCH, which decrease libido

Question 26

risks that increase chance of getting renal cell carcinoma

Answer 26

exact cause is unknown

higher for people who use tobacco, exposed to lead, phosphate, cadmium

Question 27

potential s/s of renal cell carcinoma

Answer 27

flank pain (dull, aching)
blood in urine (late common sign)
kidney mass
renal bruit
pallor
darkening of nipples
gynecomastia
muscle wasting
weakness
poor nutritional status
weight loss

Question 28

renal cell carcinoma

-labs values/Dx tests to confirm

Answer 28

RBCs in urine
decreased hemoglobin/hematocrit
hypercalcemia
increased ESR
increased adrenocorticotropic hormone
increased hCG, cortisol, renin, parathyroid hormone

IV urogram, sonography, CT, MRI
complete Dx requires a biopsy

Question 29

nonsurgical management for renal cell carcinoma

Answer 29

radio frequency ablation can slow tumor growth
chemotherapy has limited effectiveness
biological response modifiers
sorafenib (Nexavar) PO
temsirolimus (Torisel) IV

Question 30

post op monitoring following nephrectomy

Answer 30

asess for hemorrhage, adrenal insufficiency
abd distention
hypotension (early sign of hemorrhage, adrenal insufficiency)
decreased urine output
altered LOC
monitor temp, HR, RR at least q4hrs
measure I&O
weight pt daily