Ch. 62 Patients w/ Kidney Disease

Question 1

Pyelonephritis

Answer 1

Starts in the bladder and moves upward to infect the kidneys

Bacterial infection = acute tissue inflammation, local edema, tubular cell necrosis, possible abscess formation

Question 2

Acute Pyelonephritis Clinical Manifestations

Answer 2

Tachycardia and tachypnea

Flank, back, or loin pain

Tenderness at CVA

N/V

Burning, urgency, or frequency

Nocturia

Recent cystitis or treatment of UTI

Question 3

Pyelonephritis Interventions

Answer 3

Manage Pain

Drug Therapy (ABX)

Nutrition

Fluid Therapy

Prevent CKD

Question 4

Acute Glomerulonephritis

Answer 4

Group of diseases that injure and inflame the glomerulus

Allows the passage of protein and blood in the urine

Question 5

Acute Glomerulonephritis Clinical Manifestations

Answer 5

Edema, especially face, eyelids, and hands

Hypotension

Dysuria or oliguria

Uremic s/s

Question 6

Acute Glomerulonephritis Interventions

Answer 6

Manage infection

Drug therapy - ABX, corticosteroids, cytotoxic drugs

Prevent complications by managing fluid and electrolyte balance and s/s

Question 7

When is dialysis necessary in Acute Glomerulonephritis?

Answer 7

If uremic symptoms or FVO cannot be controlled with nutrition or fluid management

Question 8

Uremia

Answer 8

Clinical syndrome marked by elevated concentrations of urea in the blood

Develops w/ deterioration of kidney function

Question 9

Uremia Clinical Manifestations

Answer 9

Anorexia

N/V

Itching

Yellowish skin, bruises, rashes

Loss of concentration and lethargy

Seizures

Slurred speech

Ataxia

Tremors

Asterixis

Question 10

Ataxia

Answer 10

Poor muscle control that causes clumsy, voluntary movements

Question 11

Asterixis

Answer 11

Inability to maintain sustained posture w/ subsequent brief shock-like involuntary movements

Question 12

Nephrotic Syndrome

Answer 12

Massive loss or protein in urine

Edema formation and decreased plasma albumin levels

Immunologic kidney disorder

Increases glomerular permeability

Question 13

Nephrotic Syndrome Treatment

Answer 13

ACE inhibitors

Cholesterol lowering drugs

Heparin

Dietary changes

Mild diuretics

Sodium restriction

Question 14

Nephrosclerosis

Answer 14

Degenerative disorder resulting from changes in kidney blood vessels which hardens the nephrons

Can lead to End-Stage Kidney Disease

Question 15

Nephrosclerosis Risk Factors

Answer 15

HTN

Atherosclerosis

DM

Genetics

Question 16

Polycystic Kidney Disease (PKD)

Answer 16

Genetic disorder where fluid-filled cysts develop in nephrons

Cysts look like clusters of grapes

Question 17

PKD Clinical Manifestations

Answer 17

HTN

Edema

Uremic symptoms

Dysuria, nocturia

Abdominal fullness and pain

Cyst bleeding/ruptures - bright red or cola-colored urine

Hematuria

Hyponatremia

HA

Question 18

PKD Interventions

Answer 18

Drug therapy to prevent malignant cyst formation

Manage BP

<2 g of sodium/day

Pain and infection management

Prevent constipation

Question 19

Hydronephrosis & Hydroureter Clinical Manifestations

Answer 19

Pain

Constipation

HTN

HA

Dysuria, nocturia

Question 20

Hydronephrosis & Hydroureter Interventions

Answer 20

Stent placement in ureter

Nephrostomy

Monitor for nephrostomy complications (decreased or absent drainage, cloudy or could smelling drainage, leakage of blood or urine, back pain)

Question 21

Diabetic Nephropahty

Answer 21

Vascular complication of type 1 or 2 DM

Leading cause of CKD

Severity is r/t hyperglycemia the pt generally experiences

Question 22

Renal Cell Carcinoma

Answer 22

Adenocarcinoma of kidney

Usually metastasizes to adrenal gland, liver, long bones, or other kidney

Systemic effects are anemia or erythrocytosis

Question 23

Renal Cell Carcinoma Clinical Manifestations

Answer 23

Pallor

Darkening of nipples

Breast enlargement

Muscle wasting

Weakness

Wt loss

Flank pain

Blood in urine