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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

A

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

A

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

A

Diet, NS or hypertonic saline solutions

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9
Q

Clinical Manifestations of Hypernatremia

A

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

A
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12
Q

General Management Strategies for Hyperkalemia

A
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13
Q

Clinical Manifestations of Hypocalcemia

A
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14
Q

General Management Strategies for Hypocalcemia

A
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15
Q

Clinical Manifestations of Hypercalcemia

A
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16
Q

General Management Strategies for Hypercalcemia

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17
Q

Clinical Manifestations of Metabolic Acidosis

A
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18
Q

General Management Strategies for Metabolic Acidosis

A
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19
Q

Clinical Manifestations of Metabolic Alkalosis

A
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20
Q

General Management Strategies for Metabolic Alkalosis

A
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21
Q

Clinical Manifestations of Hypoalbuminemia

A
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22
Q

General Management Strategies for Hypoalbuminemia

A
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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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25
Q

1 kg weight gain is = ?

A

1-kg wt gain = 1 L (1000mL) retained fluid

26
Q

Gerontological Considerations for Patients w/ Kidney Disorders

A

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
Q

Chronic Kidney Disease (CKD)

A

Umbrella term that describes kidney damage or decrease in glomerular filtration rate (GFR) lasting for 3 or more months

28
Q

End-Stage Kidney Disease (ESKD)

A

Final stage of CKD

Results in retention of uremic waste products & need for renal replacement therapy

29
Q

Risk Factors for CKD

A

Cardiovascular disease, diabetes, HTN, & obesity

30
Q

Acute Kidney Injury

A

Damage to the kidney’s cause a rapid loss of renal function
- Inability to filter waste or perform regulatory functions

31
Q

Pre-Renal Acute Kidney Injury

A

Interrupted blood flow, poor blood flow, or absent blood flow to the kidneys (acute/chronic)

32
Q

Causes of Prerenal AKI

A

Severe Life-Threatening Dehydration
Hypotension
Sepsis
Shock
Massive hemorrhagic event
Over diuresis (volume depletion)
Heart failure
Cirrhosis
Bilateral renal artery stenosis
Nephrosclerosis

33
Q

Nephrosclerosis

A

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
Q

Renal Artery Stenosis (RAS)

A

Narrowing of the renal arteries
- Usually the result of atherosclerosis

35
Q
A
36
Q

Tubulointerstitial Nephritis (TIN)

A

Inflammation that affects the tubules of the kidneys and the tissues that surround them

37
Q

Postrenal AKI

A

Severe, sudden obstruction of urine to the ureters

38
Q

Causes of Postrenal AKI

A

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
Q

Obstructive Disorders

A

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
Q

Nephrolitiasis

A

Characterized by an acute, sudden pain in the back or side that radiates to the lower abdomen and groin

41
Q

Stage 1 of Chronic Kidney Disease (CKD)

A

GFR equal to or >90 mL/min

Kidney damage w/ normal or increased GFR

42
Q

Stage 2 of Chronic Kidney Disease (CKD)

A

GFR= 60–89 mL/min

Mild decrease in GFR

43
Q

Stage 3 of Chronic Kidney Disease (CKD)

A

GFR= 30–59 mL/min

Moderate decrease in GFR

44
Q

Stage 4 of Chronic Kidney Disease (CKD)

A

GFR= 15–29 mL/min

Severe decrease in GFR

45
Q

Stage 5 of Chronic Kidney Disease (CKD)

A

GFR <15 mL/min

End-stage kidney disease or CKD

46
Q

Clinical Manifestations of CKD

A

Anemia (decreased erthyropoeitin)

Metabolic acidosis

Abnormal calcium & phosphorous balance

Fluid retention
- Edema & congestive HF can develop

HTN

47
Q

Glomerular filtration rate (GFR)

A

Amount of plasma filtered through the glomeruli per unit of time

48
Q

Diagnosis Criteria for Acute Kidney Injury

A

50% or greater increase in baseline serum creatinine

49
Q

Medical Management of CKD

A

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
Q

Nephrosclerosis

A

Hardening of renal arteries

51
Q

Pathophysiology of Nephrosclerosis

A

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
Q

Glomerulonephritis

A

Inflammation of the glomerular capillaries that can occur in acute & chronic forms

53
Q

The importance in early Diagnosis of Acute Kidney Injury

A

Mortality rate is 10-80%

Can progress to ESKD if not treated quickly

54
Q

Clinical Aspects of Acute Kidney Injury

A

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
Q

Initiation Phase of Acute Kidney Injury

A

Begins at initial insult to kidney function & ends when the oliguria phase starts

56
Q

Oliguria Phase of Acute Kidney Injury

A

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
Q

Diuresis Phase of Acute Kidney Injury

A

Gradual increase in GFR and UO, stabilization of labs with possible decrease
-Continue to monitor for uremic symptoms and for possible dehydration

58
Q

Recovery Phase of Acute Kidney Injury

A

Labs return close to patient baseline; permanently decreased
- GFR will be present (1-3%)

59
Q

Acute Kidney Injury Causes

A

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
Q

Acute Kidney Injury Treatment

A

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
Q

Nursing Actions for Acute Kidney Injury

A

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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