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adults > disorders of the kidney > Flashcards

disorders of the kidney Flashcards

1
Q

describe AKI

A
  • 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
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2
Q

what are some pre renal causes of AKI

A

low BP

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3
Q

what are some intra renal causes of AKI

A

kidney infection or dye damage

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4
Q

what are some post renal causes of AKI

A

kindey stone or tumor blocking urine leaving the kidney

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5
Q

describe CKD

A
  • 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
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6
Q

define CKD

A

kidney damage or decrease in GFR > 3months

insidious, progressive loss of renal function

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7
Q

what are soem risk factors for CKD

A
  • diabetes (primary cause)
  • hypertension (second leading cause)
  • glomerulonephritis/pyelonephritis
  • polycystic kidney
  • heredity/congenital
  • renal cancers
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8
Q

what are some signs and symptoms of CKD

A
  • 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

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9
Q

what is the initial goal of CKD

A

prevent or slow progression of failure

treat underlying causes

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10
Q

what are some interventions for CKD

A
  • renal diet
  • control HTN
  • control glucose levels
  • assess meds
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11
Q

what is the goal of the renal diet

A

to decrease production of metabolic watses and regulate electrolytes

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12
Q

whats included in the renal diet

A
  • low protein
  • low potassium
  • low sodium
  • low phosphorus
  • fluid restriction (late stages) may be 1000-1500ml/day
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13
Q

what are some food sources that are high in potassium

A
  • salt substitutes
  • potatoes (unless dialyzed)
  • oranges and OJ
  • bananas
  • prune juice
  • tomato
  • dried beans and lentils
  • nuts, chocolate, coconut
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14
Q

what are some food sources that are high in phosphorus

A
  • milk
  • milk products
  • fish
  • chicken and beef liver
  • legumes
  • whole grain breads and cereal
  • peanut butter
  • colas
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15
Q

what are some nephrotoxic meds

A
  • diuretics
  • ace inhibitors
  • aminoglycosides
  • metformin
  • nsaids
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16
Q

describe the first stage of CKD

A
  • kidney damage with normal or increased GFR
  • treatment of underlying condition and comorbidities
  • no symptoms
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17
Q

describe the second stage of CKD

A
  • mild
  • estimate the rate of progression
  • no symptoms
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18
Q

describe the third stage of CKD

A
  • moderate
  • evaluate and treat complications
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19
Q

describe the fourth stage of CKD

A
  • severe
  • prepare for renal replacment therapy
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20
Q

describe the fifth stage of CKD

A
  • kindey failure, end stage
  • dialysis or transplantation
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21
Q

what are the multisystem effects of ESKD

A
  • 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)
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22
Q

what are some fluid/electrolyte imbalances that occur with ESKD

A
  • sodium retention
  • potassium retention
  • acidosis
  • increased phosphorus and decreased calcium
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23
Q

what is uremic frost

A

when the body tries to sweat urea out, causes salty coating on skin

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24
Q

true or false

intrarenal failure may be caused by meds such as metoprolol

A

false

metprolol is not nephrotoxic

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25
Q

which food is included in a renal diet?

1) fish
2) tomato
3) pasta
4) milk

A

pasta

26
Q

what are some interventions for ESKD

A
  • peritoneal dialysis
  • hemodialysis
  • renal transplant
27
Q

what are some indications for dialysis

A
  • 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

28
Q

what does hemodialysis do?

A
  • removes excess fluid
  • corrects acidosis
  • removes waste products
  • maintains safe electrolytes
29
Q

how does hemodialysis work?

A
  • “false” kidney
  • osmosis
  • diffusion
  • ultrafiltration
30
Q

describe hemodialysis access

A

AV fistula or synthetic graft

31
Q

what should you do when assessing hemodialysis access

A
  • bruit and thrill
  • distal pulse
  • cap refill
32
Q

whats used for temporary hemodialysis access

A

hemodialysis catheter (dual lumen)

33
Q

what are some important points to remember about hemodialysis catheters

A
  • 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

34
Q

what are some complications of hemodialysis

A
  • 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

35
Q

what are some nursing considerations for hemodialysis

A
  • monitor dry weight
  • assess vital signs
  • assess access site
  • monitor diet/fluid intake
  • pre diaysis meds
  • patient/family education
36
Q

what is dry weight

A

weight taken after dialysis, this is the goal weight

37
Q

describe pre dialysis meds

A
  • most will get cleared out during dialysis
  • can give insulin or nausea meds
  • dont give anything that will lower BP
38
Q

describe patient/family education for hemodialysis

A
  • big time commitment
  • exhausted afterwards
  • not a permanent fix - can only survive about 10-15 years on it
39
Q

what are some common meds given to people receiving hemodialysis

A
  • erythropoietin
  • vitamin D analog
  • renal vitamins
  • calcium and phosphate binders
  • iron replacement
  • electrolyte modifiers (kayexalate)
  • antihypertensives (just not before)
  • anticonvulsants
40
Q

what meds should be avoided with hemodialysis

A

magnesium-based antacids

41
Q

describe peritoneal dialysis

A

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

42
Q

what are the two primary type of peritoneal dialysis

A
  • continuous ambulatory peritoneal dialysis (CAPD) - can get up and go about your day
  • continuous cyclic peritoneal dialysis (CCPD) - plug into machine while youre sleeping
43
Q

what are some advantages to peritoneal dialysis

A
  • 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
44
Q

what are some acute complications for peritoneal dialysis

A
  • peritonitis
  • bleeding
  • leaking
45
Q

describe peritonitis

A
  • inflammation of peritonium
  • results from poor technique, bacteria is introduced
  • can tell from cloudy stuff being drained, fever, and tender abd
46
Q

what are some long term complications of peritoneal dialysis

A
  • abd hernias
  • hiatal hernias
  • hypovolemia/hypervolemia
  • hyperglycemia
  • pain
  • resp distress
  • self concept
47
Q

what are some nursing interventions for peritoneal dialysis

A
  • 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

48
Q

when assessing an AV graft the nurse should look at what?

A
  • radial pulse
  • cap refill
  • bruit and thrill
49
Q

what lab values would I expect to find after dialysis?

1) decreased BUN
2) increased Cr
3) decreased Hgb
4) increased phos

A

decreased BUN

50
Q

what is the most common complication with PD?

A

peritonitis

51
Q

define glomerulonephritis

A

inflammation and increased cells in the glomeruli in both kidneys caused by an abnormal immune response

52
Q

describe the path of glomerulonephritis

A
  • antigen antibody complex gets trapped in the glomeruli after infection
  • can be acute or chronic
53
Q

whats the main risk factor for glomerulonephritis

A

strep infection

54
Q

what are some symptoms of glomerulonephritis

A
  • 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)
55
Q

whats used in the diagnosis of glomerulonephritis

A
  • UA
  • lab results (increased BUN and Cr)
  • elevated strep titer
  • decreased GFR
56
Q

what are some nursing considerations of glomerulonephritis

A
  • monitor weight, I+O, vitals
  • maintain fluid balance and electrolyte balance
57
Q

whats the treatment for glomerulonephritis

A
  • reduce inflammation
  • corticosteroids
  • immunosuppresive agents
  • diuretics/antihypertensives
  • dietary restrictions (renal diet short term)
58
Q

describe renal cancer

A
  • develops in tissues that collect urine (renal pelvis and ureters)
  • associated with bladder cancer
  • usually found at late stage
59
Q

what diagnostic tests are used for renal cancer

A
  • physical exam (flank pain, decreased or bloody piss)
  • labs (CBC, BUN, Cr)
  • UA
  • Xrays
  • cystoscopy
  • renal biopsy
  • ultrasound
  • CT
60
Q

whats the treatment for renal cancer

A
  • surgery (take whole kid or just a little)
  • radiation
  • chemotherapy
  • combination of above
61
Q

what are some nursing interventions/education for renal cancer

A
  • comfort measures
  • tube/drian management
  • assess incision
  • monitor for infection
  • I+O
  • cough and deep breath
62
Q

a patient with a history of strep throat now complains of BLE swelling and dark colored urine. what condition may the nurse suspect?

A

glomerulonephritis

adults (51 decks)

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