Care of patients with renal disorders ch 70 Flashcards
key features for polycystic kidney disease
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
diagnostic test for polycystic kidney disease
urinalysis: proteinuria, hematuria, bacteria( indicates infection) Creatinine and BUN rise creatinine clearance decreases sodium loss or sodium retention renal sonography CT MRI
interventions for polycystic kidney disease
pain management prevent infection prevent constipation prevent HTN prevent CKD
managing pain in polycystic kidney disease
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
preventing constipation in polycystic kidney disease
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
controlling HTN in polycystic kidney disease
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
key features of acute pyelonephritis
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
key features of chronic pyelonephritis
pg 1524
HTN
inability to conserve sodium
decreased urine concentrating ability, resulting in nocturia
tendency to develop hyperkalemia and acidosis
laboratory assessment for pyelonephritis
1525
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)
____ often occurs before kidney manifestations of acute glomerulonephritis
an infection
onset of symptoms is about 10 days from time of infection
Hx assessment for patient with acute glomerulonephritis
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
kidney disorders that requires increase in sodium and water intake
polycystic kidney disease waste sodium rather than retain it
infectious causes of acute glomerulonephritis
strep staph pneumococcal syphilis infective endocarditis measles mumps rocky mountain spotted fever histoplasmosis varicella
aka chronic nephritic syndrome
chronic glomerulonephritis
chronic glomerulonephritis
- what is it
- some manifestations
aka chronic nephritic syndrome develops over 20-30 years exact cause unknown always leads to end stage kidney disease proteinuria, hematuria, HTN, fatigue, edema
physical assessment/clinical manifestations of chronic glomerulonephritis
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
diagnostic tests and what they show
for chronic glomerulonephritis
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
interventions for chronic glomerulonephritis
diet changes
fluid intake sufficient to prevent reduced blood flow
drug therapy to control uremia
eventually dialysis or transplantation
nephrotic syndrome
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
main feature of nephrotic syndrome
and other features
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
management of nephrotic syndrome
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
key features of nephrotic syndrome
sudden onset of these manifestations:
1530
massive proteinuria hypoalbuminemia edema (face, periorbital) lipiduria hyperlipidemia increased coagulation reduced kidney function
systemic effects that can occur with renal cell carcinoma
1532
anemia or erythrocytosis hypercalcemia liver dysfunction with elevated liver enzymes hormonal effects increased sedimentation rate HTN
why does anemia or erythrocytosis occur with renal cell carcinoma
1532
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
hormone changes with renal cell carcinoma
parathyroid hormone cause hypercalcemia
increased renin levels (causing HTN)
increased hCH, which decrease libido
risks that increase chance of getting renal cell carcinoma
exact cause is unknown
higher for people who use tobacco, exposed to lead, phosphate, cadmium
potential s/s of renal cell carcinoma
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
renal cell carcinoma
-labs values/Dx tests to confirm
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
nonsurgical management for renal cell carcinoma
radio frequency ablation can slow tumor growth chemotherapy has limited effectiveness biological response modifiers sorafenib (Nexavar) PO temsirolimus (Torisel) IV
post op monitoring following nephrectomy
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
