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488 > Class 7: Renal > Flashcards

Class 7: Renal Flashcards

1
Q

Diagnostic testing for the renal system

A

-Urinalysis & culture
-CrCL, kidney, ureter & bladder studies
-Ultrasound, CT, MRI, nuclear scan, & renal angiography

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2
Q

Diagnostic tests cont’d + Renal

A

-Urologic endoscopic procedures
-Renal & ureteral brush biopsy
-Kidney biopsy, urodynamic test

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3
Q

CrCl

A

-Creatinine clearance estimates the GFR (volume of filtrate made by the kidneys per minute)
-Urine and Cr levels are measured along with a 24hr urine
-Clearance can then be calculated using a CrCl blood spec & 24hr urine

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4
Q

With kidney failure CrCl is…

A

Chronically low

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5
Q

CrCl normal ranges

A

-Patrick Kane & Mcdavid, difference of 40mL/min
-Female: 88-128mL/min
-Male: 97-137mL/min

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6
Q

Adult voiding dysfunction + nursing management of UI

A

-Behavioural therapy, pt teaching
-Pharmacological or surgical management

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7
Q

Nursing management of urinary retention

A

-Promote normal elimination, pt teaching
-Foley
-Pharmacological or surgical management

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8
Q

Nursing care of a UTI

A

-Colony counts (bacterial content)
-Frequency & urgency
-Fluid balance, hygiene
-Risk for ARF or urosepsis
-Pharmacological therapy & pain management

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9
Q

Prevention of UTIs

A

-Avoid unnecessary catheterization and early removal of catheters.
-Cranberry juice or cranberry essence may help decrease risk.

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10
Q

Acute intervention of UTIs

A

-Adequate fluid intake:
-Dilutes urine, decreasing irritablity
-Flushes out bacteria before they can colonize

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11
Q

What to avoid in UTIs + acute intervention

A

Avoid caffeine, alcohol, citrus juices, chocolate, and highly spiced foods as they are potential bladder irritants

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12
Q

Relief/recovery from UTIs

A

-Application of local heat to suprapubic or lower back may relieve discomfort
-Emphasize taking full course of antibiotics despite disappearance of symptoms
-Second or reduced drug may be ordered after initial course in susceptible patients
-Instruct patient to watch urine for changes in colour and consistency and decrease in cessation of symptoms
-Counsel on persistence of lower tract symptoms beyond treatment; onset of flank pain or fever should be reported immediately

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13
Q

Pyelonephritis

A

Kidney infection, type of UTI

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14
Q

Pyelonephritis + Nursing care of an infection

A

-Pharmacological therapy
-Urine spec, blood Work
-Ins & outs, VS monitoring & pt teaching

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15
Q

Nursing care of an infection cont’d

A

-Relapses may be treated with 6-week course of antibiotics
-Follow-up urine culture and imaging studies
-Re-infection treated as individual episodes or managed with long-term therapy; prophylaxis tx may be used for recurrent infection.

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16
Q

Nursing & collaborative management: Acute glomerulonephritis

A

-Focused on symptom management:
-Rest until signs of glomerular inflammation (proteinuria, hematuria) and HTN subside
-Edema is treated by restricting sodium and fluid intake and by administrating diuretics
-Severe HTN is treated with antihypertensive drugs
-Dietary protein intake may be restricted

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17
Q

Glomerular disease

A

Difficult to maintain balance of substances in the bloodstream

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18
Q

Nursing care of glomerular disease

A

-Ins & outs
-Hematuria & symptom management
-Pharmacological therapy
-Dietary protein & Na+ Restriction
-R&R, follow-up

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19
Q

Nephrotic syndrome

A

Causes the body to pass to much protein in the urine

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20
Q

Nephrotic syndrome + nursing care of primary glomerular disease

A

-Urine & blood spec
-Complications: Clots, elevated cholesterol, poor nutrition, HTN, AKI & CKD
-Pharmacological therapy
-Dietary restrictions, pt teaching

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21
Q

Acute renal failure/acute kidney disease + those at risk include

A

-Major surgery or trauma
-Receiving nephrotoxic medications or are elderly

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22
Q

Stages of acute renal failure

A

-Onset – 1-3 days with ^ BUN & Cr, possible decreased urine output
-Oliguric – urine output < 400mL/d, ^BUN, Cr, Phos, & K+ may last up to 14 d
-Diuretic – urine output ^ to as much as 4000 mL/d but no waste products, at end of this stage may begin to see improvement
-Recovery – things go back to normal or may remain insufficient and become chronic

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23
Q

Acute renal failure + diagnostic tests

A

-BUN, Cr, Na+ & K+. pH; bicarb. Hgb and Hct
-Urine studies
-Abdominal and renal CT/MRI
-Retrograde pyelogram

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24
Q

Acute renal failure medical tx

A

-Fluid & dietary restrictions
-Maintain lytes
-Dialysis to jump start renal function
-Stimulate production of urine with IV fluids, dopamine or diuretics

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25
Q

Acute renal failure + medical tx cont’d

A

-Hemodialysis, peritoneal dialysis
-Continuous renal replacement therapy (CRRT); does not require dialysate

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26
Q

Acute renal failure + Nursing intervention

A

-Monitor I/O & lab results
-Watch for symptoms of hyperkalemia: malaise, anorexia, paresthesia, muscle weakness & EKG changes
-Watch for hyperglycemia or hypoglycemia if receiving TPN or insulin infusions
-Maintain nutrition, daily weights
-Assess for signs of HF, GCS

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27
Q

AKI tx

A

-Nutritional therapy
-Renal Replacement Therapy (Hemo or peritoneal dialysis)
-Kidney transplant

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28
Q

Goals of tx of AKI

A

-Eliminate cause, manage S&S
-Prevent complications during recovery

29
Q

Nursing interventions of AKI

A

Health promotion, acute intervention, ambulatory and home care

30
Q

Age-related considerations: AKI

A

-Less able to compensate for changes in volume, solute load, and CO
-Older adults are more susceptible because they have fewer functioning nephrons
-Causes of AKI in older adults include aminoglycosides, dehydration, diuretics, hypotension, infection, obstructive disorders, radiocontrast agents & surgery

31
Q

Impaired function of other organ systems can..

A

Increase the risk of developing AKI

32
Q

Diuretics

A

-First line antihypertensive
-Decrease plasma and ECF volumes which decreased preload, CO, and PVR = Decreased workload of the heart

33
Q

Types of diuretics

A

-Potassium sparing, thiazide and loop diuretics
-Thiazide diuretics are the most commonly used diuretics for HTN

34
Q

Classes of diuretics

A

-Carbonic anhydrase inhibitors
-Loop, osmotic, potassium-sparing, and thiazide & thiazide-like diuretics

35
Q

1st line tx of HTN

A

Thiazide & thiazide-like diuretics

36
Q

Rapid diuresis diuretics

A

Loop diuretics

37
Q

Tx of CV conditions (MI) + Diuretics

A

Potassium-sparing diuretics

38
Q

Carbonic anhydrase inhibitors

A

-Acetazolamide & methazolamide

39
Q

Loop diuretics

A

Bumetanide, ethacrynic acid & furosemide

40
Q

Osmotic diuretics

A

Mannitol

41
Q

Potassium-sparing diuretics

A

Amiloride, eplerenone, spironolactone & triamterene

42
Q

Thiazide and thiazide-like diuretics

A

Chlorothiazide, hydrochlorothiazide, indapamide & metolazone

43
Q

Slide 39 & 40

A
44
Q

Thiazide diuretics

A

-First-line defense of HTN

45
Q

Thiazide diuretic MOAs

A

-Inhibits reabsorption of Na+, K+ & Cl- resulting in osmotic water loss
-Relax arterioles (reduces afterload)
-Precipitate hypokalemia and hypercalcemia, hyperglycemia, hyperlipidemia, hyperuricemia

46
Q

Indication of thiazide diuretics

A

-HTN
-Edematous state d/t HF, liver cirrhosis, corticosteroid or estrogen therapy

47
Q

Contraindications for thiazide diuretics

A

Hepatic coma (metalozone), anuria and severe kidney failure

48
Q

Adverse effects of thiazide diuretics

A

-Electrolyte disturbances
-Dizziness (plasma shifts)
-GI disturbances, thrombocytopenia
-Pancreatitis, cholecystitis
-Headache, impotence

49
Q

Electrolyte disturbances in thiazide diuretics

A

-Reduced K
-Elevated Ca+, lipids, glucose, and uric acid

50
Q

Loop diuretic MOA

A

Reduces BP, PVR, SVR (afterload), CVP (preload), & LV end-diastolic pressure

51
Q

Indications of loop diuretics

A

-Edema (r/t sided HF), HTN
-Fluid accumulation d/t liver and kidney disease
-Improve respiratory function d/t pulmonary edema (left sided HF)

52
Q

Contraindications of loop diuretics

A

-Drug allergy or allergic to sulfa abx
-Hepatic coma
-Severe electrolyte loss (Na and K)

53
Q

Adverse effects of loop diuretics

A

-Severe electrolyte loss and dehydration
-Each medication has specific AE such as furosemide; ototoxicity, photosensitivity

54
Q

Potassium sparing diuretic

A

-AKA aldosterone inhibiting diuretic
-Spironolactone is the most commonly used medication

55
Q

MOA potassium sparing diuretic

A

Blocks reabsorption of Na+ and water which are excreted, and K+ retained

56
Q

Potassium sparing diuretic indications

A

HF

57
Q

Contraindications of potassium sparing diuretics

A

Hyperkalemia, anuria & severe kidney failure

58
Q

Adverse effects of potassium sparing diuretics

A

-Spironolactone: Gynecomastia, amenorrhea, irregular menses, and postmenopausal bleeding
-Triamterene: Causes kidney stones by reducing folic acid levels

59
Q

Special considerations in pediatrics + calculations

A

-Calculate carefully because pediatrics are at greater risk for adverse effects (excess fluid volume, electrolyte loss, hypotension, and shock) and toxicity

60
Q

Furosemide considerations in pediatrics

A

Increased half-life

61
Q

Pediatric considerations when taking diuretics

A

-Avoid lengthy exposure to either heat or sun; increased risk of heat stroke, exhaustion, and fluid volume loss

62
Q

Thiazide diuretics in pregnant women

A

-Cross the placenta and pass through to the fetus
-Breastfeeding is not advised for mothers who are taking these drugs

63
Q

Lab results + diuretics

A

-Ca+, glucose & uric acid
-BUN, Cl-, Mg+, K+, & Na+ (loop diuretics)

64
Q

Mannitol works in the…

A

Proximal tubule & descending loop of Henle

65
Q

Acetazolamide works in the…

A

Proximal tubule

66
Q

Loop diuretics work in the…

A

Ascending loop of Henle

67
Q

Thiazide diuretics work in the…

A

Distal tubule

68
Q

Potassium-sparing diuretics work in the…

A

Distal tubule & collecting duct

488 (16 decks)

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