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NURS3313 Adult Health > Chapter 48: Management of Patients w/ Kidney Disorders > Flashcards

Chapter 48: Management of Patients w/ Kidney Disorders Flashcards

1
Q

Fluid Volume Overload

A

Fluid intake exceeds the ability of the kidneys to excrete fluid

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2
Q

Clinical Manifestations of Fluid Volume Overload

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Acute weight gain ≥5%
Edema
Crackles, SOB
Decreased BUN, decreased hematocrit
Distended neck veins

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3
Q

General Management Strategies of Fluid Volume Overload

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Fluid and sodium restriction, diuretic agents, & dialysis

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4
Q

Fluid Volume Deficit

A

If fluid intake is inadequate, the patient is said to be volume depleted

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5
Q

Clinical Manifestations of Fluid Volume Deficit

A

Acute weight loss ≥5%
Decreased skin turgor, dry mucous membranes
Oliguria or anuria
Increased hematocrit
BUN level increased out of proportion to creatinine level
Hypothermia

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6
Q

General Management Strategies for Fluid Volume Deficit

A

Fluid challenge, fluid replacement orally or parenterally

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7
Q

Clinical Manifestations of Hyponatremia

A

Nausea
Malaise, lethargy
Headache
Abdominal cramps
Apprehension, seizures

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8
Q

General Management Strategies for Hyponatremia

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Diet, NS or hypertonic saline solutions

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9
Q

Clinical Manifestations of Hypernatremia

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Dry, sticky mucous membranes, thirst, rough dry tongue, fever, restlessness, weakness, disorientation

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10
Q

General Management Strategies for Hypernatremia

A

Fluids, diuretic agents, dietary restriction

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11
Q

Clinical Manifestations of Hypokalemia

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12
Q

General Management Strategies for Hyperkalemia

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13
Q

Clinical Manifestations of Hypocalcemia

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14
Q

General Management Strategies for Hypocalcemia

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15
Q

Clinical Manifestations of Hypercalcemia

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16
Q

General Management Strategies for Hypercalcemia

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17
Q

Clinical Manifestations of Metabolic Acidosis

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18
Q

General Management Strategies for Metabolic Acidosis

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19
Q

Clinical Manifestations of Metabolic Alkalosis

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20
Q

General Management Strategies for Metabolic Alkalosis

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21
Q

Clinical Manifestations of Hypoalbuminemia

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22
Q

General Management Strategies for Hypoalbuminemia

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23
Q

Intake & Output (I & O) Record

A

Used to document important fluid parameters, including the amount of fluid taken in (orally or parenterally), the volume of urine excreted, and other fluid losses (diarrhea, vomiting, diaphoresis)

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24
Q

What is a more accurate depiction of a patient’s volume status: I & O record or daily weights?

A

Daily weights

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1 kg weight gain is = ?
1-kg wt gain = 1 L (1000mL) retained fluid
26
Gerontological Considerations for Patients w/ Kidney Disorders
With aging, kidney is less able to respond to acute fluid & electrolyte changes Fluid Balance Deficit in Older Adults Can Lead To: - Falls - Med toxicity - Constipation - UTI and respiratory tract infections - Delirium - Seizures - Electrolyte imbalances - Hyperthermia - Delayed wound healing
27
Chronic Kidney Disease (CKD)
Umbrella term that describes kidney damage or decrease in glomerular filtration rate (GFR) lasting for 3 or more months
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End-Stage Kidney Disease (ESKD)
Final stage of CKD Results in retention of uremic waste products & need for renal replacement therapy
29
Risk Factors for CKD
Cardiovascular disease, diabetes, HTN, & obesity
30
Acute Kidney Injury
Damage to the kidney's cause a rapid loss of renal function - Inability to filter waste or perform regulatory functions
31
Pre-Renal Acute Kidney Injury
Interrupted blood flow, poor blood flow, or absent blood flow to the kidneys (acute/chronic)
32
Causes of Prerenal AKI
Severe Life-Threatening Dehydration Hypotension Sepsis Shock Massive hemorrhagic event Over diuresis (volume depletion) Heart failure Cirrhosis Bilateral renal artery stenosis Nephrosclerosis
33
Nephrosclerosis
Hardening/narrowing of the renal arteries-> leads to slow, progressive kidney damage - Via long-standing, poorly controlled HTN DM can also cause this Asymptomatic early in disease course Uremia results in patients if dialysis is not initiated
34
Renal Artery Stenosis (RAS)
Narrowing of the renal arteries - Usually the result of atherosclerosis
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36
Tubulointerstitial Nephritis (TIN)
Inflammation that affects the tubules of the kidneys and the tissues that surround them
37
Postrenal AKI
Severe, sudden obstruction of urine to the ureters
38
Causes of Postrenal AKI
Benign prostatic hypertrophy or prostate cancer Cervical cancer Retroperitoneal disorders Intratubular obstruction (crystals or myeloma light chains) Pelvic mass or invasive pelvic malignancy Bladder masses (clot, tumor or fungus ball) Neurogenic bladder Urethral strictures Kidney stones
39
Obstructive Disorders
Stasis of urine, leading to infection or stone formation Progressive dilation of renal collecting ducts and tubular structures, causing destruction and scarring Can come from: any obstruction of urine (kidney stones, scar tissue, strictures, pregnancy, tumors, congenital defects, prostate)
40
Nephrolitiasis
Characterized by an acute, sudden pain in the back or side that radiates to the lower abdomen and groin
41
Stage 1 of Chronic Kidney Disease (CKD)
GFR equal to or >90 mL/min Kidney damage w/ normal or increased GFR
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Stage 2 of Chronic Kidney Disease (CKD)
GFR= 60--89 mL/min Mild decrease in GFR
43
Stage 3 of Chronic Kidney Disease (CKD)
GFR= 30--59 mL/min Moderate decrease in GFR
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Stage 4 of Chronic Kidney Disease (CKD)
GFR= 15--29 mL/min Severe decrease in GFR
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Stage 5 of Chronic Kidney Disease (CKD)
GFR <15 mL/min End-stage kidney disease or CKD
46
Clinical Manifestations of CKD
Anemia (decreased erthyropoeitin) Metabolic acidosis Abnormal calcium & phosphorous balance Fluid retention - Edema & congestive HF can develop HTN
47
Glomerular filtration rate (GFR)
Amount of plasma filtered through the glomeruli per unit of time
48
Diagnosis Criteria for Acute Kidney Injury
50% or greater increase in baseline serum creatinine
49
Medical Management of CKD
Treat underlying causes Keep BP below 125 to 130/80 mmHg Control cardiovascular risk factors Treat hyperglycemia Manage anemia Encourage smoking cessation Weight loss & exercise Reduce salt & alcohol intake
50
Nephrosclerosis
Hardening of renal arteries
51
Pathophysiology of Nephrosclerosis
Damage is caused by decreased blood flow to the kidneys-> patchy necrosis of the renal parenchyma - Over time, fibrosis occurs & glomeruli are destroyed - Can progress quickly over time if not treated - Acute: Associated w/significant & prolonged HTN
52
Glomerulonephritis
Inflammation of the glomerular capillaries that can occur in acute & chronic forms
53
The importance in early Diagnosis of Acute Kidney Injury
Mortality rate is 10-80% Can progress to ESKD if not treated quickly
54
Clinical Aspects of Acute Kidney Injury
Changes to BUN, Cr, and GFR Metabolic complications such as acidosis and fluid/electrolyte imbalances Urine output (UO) volume may or may not be affected Patient may appear critically ill showing signs of lethargy, drowsiness, headache, muscle twitching, seizures
55
Initiation Phase of Acute Kidney Injury
Begins at initial insult to kidney function & ends when the oliguria phase starts
56
Oliguria Phase of Acute Kidney Injury
Increase of serum concentration of substances usually excreted by kidneys (ex – creatinine, K+, phos, mag) UO drops to 400ml/day or less Watch for uremic symptoms, life threating electrolyte imbalances such as hyperkalemia may also develop
57
Diuresis Phase of Acute Kidney Injury
Gradual increase in GFR and UO, stabilization of labs with possible decrease -Continue to monitor for uremic symptoms and for possible dehydration
58
Recovery Phase of Acute Kidney Injury
Labs return close to patient baseline; permanently decreased - GFR will be present (1-3%)
59
Acute Kidney Injury Causes
Volume depletion Impaired cardiac function - LT sided HF (decreased perfusion to kidneys) - Low EF Urinary tract obstructions - Kidney stones Vasodilation Infections Increased diuresis (physiological or medication) Renal ischemia (transfusion reactions or hemolytic anemia; rhabdomyolysis, trauma/crushing injuries) Nephrotic agents (NSAIDS, ACE inhibitors, chemicals, contrasts, etc...) Comorbidities (Diabetes is present in ~40% of AKI cases) https://thekidneyexperts.com/kidneys-dont-work/
60
Acute Kidney Injury Treatment
Eliminate/treat the underlying cause Manage fluid balance and avoid fluid excess Provide renal replacement therapy (RRT) when indicated HD; PD; CRRT (will learn about these in Complex Health) Strict asepsis, infection prevention with all catheters and vascular access devices
61
Nursing Actions for Acute Kidney Injury
Assess/monitor daily weights, CVP, blood and urine labs, electrolyte levels – especially hyperkalemia I/O balance Total UO per 24 hrs BP and patient assessment Aseptic techniques Patient education and psychosocial support

NURS3313 Adult Health (27 decks)

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