disorders of the kidney Flashcards
describe AKI
- sudden onset/reversible
- causes can be pre-renal, intra renal, post renal, or nephrotoxins
- symptoms may vary
- goal to keep patients alive until renal lesion heals
- 40-60% mortality
what are some pre renal causes of AKI
low BP
what are some intra renal causes of AKI
kidney infection or dye damage
what are some post renal causes of AKI
kindey stone or tumor blocking urine leaving the kidney
describe CKD
- slow progression/irreversible
- causes include diabetes and hypertension (both cause repetitive damage to glomerulus
- symptoms vary
- goal to slow or prevent progression with dialysis or transplant
- 100% mortality wihtout treatment
define CKD
kidney damage or decrease in GFR > 3months
insidious, progressive loss of renal function
what are soem risk factors for CKD
- diabetes (primary cause)
- hypertension (second leading cause)
- glomerulonephritis/pyelonephritis
- polycystic kidney
- heredity/congenital
- renal cancers
what are some signs and symptoms of CKD
- elevated serum Cr and BUN
- electrolyte abnormalities
- anemia
- metabolic acidosis
- fluid retention
- heart failure
can vary from mild to severe, most arent noticed until severe
what is the initial goal of CKD
prevent or slow progression of failure
treat underlying causes
what are some interventions for CKD
- renal diet
- control HTN
- control glucose levels
- assess meds
what is the goal of the renal diet
to decrease production of metabolic watses and regulate electrolytes
whats included in the renal diet
- low protein
- low potassium
- low sodium
- low phosphorus
- fluid restriction (late stages) may be 1000-1500ml/day
what are some food sources that are high in potassium
- salt substitutes
- potatoes (unless dialyzed)
- oranges and OJ
- bananas
- prune juice
- tomato
- dried beans and lentils
- nuts, chocolate, coconut
what are some food sources that are high in phosphorus
- milk
- milk products
- fish
- chicken and beef liver
- legumes
- whole grain breads and cereal
- peanut butter
- colas
what are some nephrotoxic meds
- diuretics
- ace inhibitors
- aminoglycosides
- metformin
- nsaids
describe the first stage of CKD
- kidney damage with normal or increased GFR
- treatment of underlying condition and comorbidities
- no symptoms
describe the second stage of CKD
- mild
- estimate the rate of progression
- no symptoms
describe the third stage of CKD
- moderate
- evaluate and treat complications
describe the fourth stage of CKD
- severe
- prepare for renal replacment therapy
describe the fifth stage of CKD
- kindey failure, end stage
- dialysis or transplantation
what are the multisystem effects of ESKD
- neurologic: toxins and electrolytes buiding up -> concern for seizures and confusion
- inetgumentary: easy bleeding or bruising, thin hair, uremic frost, pruritis
- CV: fatal K+ levels, edema
- pulmonary: SOB, crackles
- GI: metallic taste in mouth, anorexia
- hematologic: anemia
- MSK: increased risk for bone fractures, osteoporosis, bone pain (decreased Ca)
what are some fluid/electrolyte imbalances that occur with ESKD
- sodium retention
- potassium retention
- acidosis
- increased phosphorus and decreased calcium
what is uremic frost
when the body tries to sweat urea out, causes salty coating on skin
true or false
intrarenal failure may be caused by meds such as metoprolol
false
metprolol is not nephrotoxic
which food is included in a renal diet?
1) fish
2) tomato
3) pasta
4) milk
pasta
what are some interventions for ESKD
- peritoneal dialysis
- hemodialysis
- renal transplant
what are some indications for dialysis
- acute renal failure
- chronic renal failure
- prepare for transplant
- removal of drugs/poisons in event of overdose
- severe fluid overload
can be used short or long term
what does hemodialysis do?
- removes excess fluid
- corrects acidosis
- removes waste products
- maintains safe electrolytes
how does hemodialysis work?
- “false” kidney
- osmosis
- diffusion
- ultrafiltration
describe hemodialysis access
AV fistula or synthetic graft
what should you do when assessing hemodialysis access
- bruit and thrill
- distal pulse
- cap refill
whats used for temporary hemodialysis access
hemodialysis catheter (dual lumen)
what are some important points to remember about hemodialysis catheters
- not very plaible
- should not be used for more than 14 days
- must be sutured in place (high risk for bleeding)
- if femoral, patient should not be up in chair d/t possiblilty of rupture of vessel
usually all you have to do is inspect, do not remove the dressing
what are some complications of hemodialysis
- hypotension
- nausea and vomiting
- hemmorhage
- muscle cramps
- infection
- cardia dysrhythmias
- disequilibrium syndrome (all of these symptoms)
- high risk for seizures
- clotted access
most of these are r/t dramatic fluid shifts
what are some nursing considerations for hemodialysis
- monitor dry weight
- assess vital signs
- assess access site
- monitor diet/fluid intake
- pre diaysis meds
- patient/family education
what is dry weight
weight taken after dialysis, this is the goal weight
describe pre dialysis meds
- most will get cleared out during dialysis
- can give insulin or nausea meds
- dont give anything that will lower BP
describe patient/family education for hemodialysis
- big time commitment
- exhausted afterwards
- not a permanent fix - can only survive about 10-15 years on it
what are some common meds given to people receiving hemodialysis
- erythropoietin
- vitamin D analog
- renal vitamins
- calcium and phosphate binders
- iron replacement
- electrolyte modifiers (kayexalate)
- antihypertensives (just not before)
- anticonvulsants
what meds should be avoided with hemodialysis
magnesium-based antacids
describe peritoneal dialysis
dialyzing fluid is instilled into the peritoneal cavity via a catheter placed in the abdomen using the peritoneum as the dialyzing membrane
better for younger people
what are the two primary type of peritoneal dialysis
- continuous ambulatory peritoneal dialysis (CAPD) - can get up and go about your day
- continuous cyclic peritoneal dialysis (CCPD) - plug into machine while youre sleeping
what are some advantages to peritoneal dialysis
- steady state blood chemistries
- convenience
- patient/family can be taught process
- fewer dietary restrictions
- more control over daily life
- can be used for hemodynamically unstable patients
- circulatory system remains intact
what are some acute complications for peritoneal dialysis
- peritonitis
- bleeding
- leaking
describe peritonitis
- inflammation of peritonium
- results from poor technique, bacteria is introduced
- can tell from cloudy stuff being drained, fever, and tender abd
what are some long term complications of peritoneal dialysis
- abd hernias
- hiatal hernias
- hypovolemia/hypervolemia
- hyperglycemia
- pain
- resp distress
- self concept
what are some nursing interventions for peritoneal dialysis
- monitor dry weight
- assess vital signs
- assess catheter insertion site
- assess fluid color and consistency
- record amount of dwell removal and amount instilled
- patient/family education
this method is not as effective as hemodialysis and the pt may still end up on it
when assessing an AV graft the nurse should look at what?
- radial pulse
- cap refill
- bruit and thrill
what lab values would I expect to find after dialysis?
1) decreased BUN
2) increased Cr
3) decreased Hgb
4) increased phos
decreased BUN
what is the most common complication with PD?
peritonitis
define glomerulonephritis
inflammation and increased cells in the glomeruli in both kidneys caused by an abnormal immune response
describe the path of glomerulonephritis
- antigen antibody complex gets trapped in the glomeruli after infection
- can be acute or chronic
whats the main risk factor for glomerulonephritis
strep infection
what are some symptoms of glomerulonephritis
- recovery starts within 14 days
- hx of strep infection
- periorbital and generalized edema (anasarca)
- edema
- hematuria (cola colored)
- hypertension
- azotemia (build up on toxins in the blood)
whats used in the diagnosis of glomerulonephritis
- UA
- lab results (increased BUN and Cr)
- elevated strep titer
- decreased GFR
what are some nursing considerations of glomerulonephritis
- monitor weight, I+O, vitals
- maintain fluid balance and electrolyte balance
whats the treatment for glomerulonephritis
- reduce inflammation
- corticosteroids
- immunosuppresive agents
- diuretics/antihypertensives
- dietary restrictions (renal diet short term)
describe renal cancer
- develops in tissues that collect urine (renal pelvis and ureters)
- associated with bladder cancer
- usually found at late stage
what diagnostic tests are used for renal cancer
- physical exam (flank pain, decreased or bloody piss)
- labs (CBC, BUN, Cr)
- UA
- Xrays
- cystoscopy
- renal biopsy
- ultrasound
- CT
whats the treatment for renal cancer
- surgery (take whole kid or just a little)
- radiation
- chemotherapy
- combination of above
what are some nursing interventions/education for renal cancer
- comfort measures
- tube/drian management
- assess incision
- monitor for infection
- I+O
- cough and deep breath
a patient with a history of strep throat now complains of BLE swelling and dark colored urine. what condition may the nurse suspect?
glomerulonephritis
