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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
which food is included in a renal diet? 1) fish 2) tomato 3) pasta 4) milk
pasta
26
what are some interventions for ESKD
- peritoneal dialysis - hemodialysis - renal transplant
27
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
28
what does hemodialysis do?
- removes excess fluid - corrects acidosis - removes waste products - maintains safe electrolytes
29
how does hemodialysis work?
- "false" kidney - osmosis - diffusion - ultrafiltration
30
describe hemodialysis access
AV fistula or synthetic graft
31
what should you do when assessing hemodialysis access
- bruit and thrill - distal pulse - cap refill
32
whats used for temporary hemodialysis access
hemodialysis catheter (dual lumen)
33
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
34
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
35
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
36
what is dry weight
weight taken after dialysis, this is the goal weight
37
describe pre dialysis meds
- most will get cleared out during dialysis - can give insulin or nausea meds - dont give anything that will lower BP
38
describe patient/family education for hemodialysis
- big time commitment - exhausted afterwards - not a permanent fix - can only survive about 10-15 years on it
39
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
40
what meds should be avoided with hemodialysis
magnesium-based antacids
41
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
42
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
43
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
44
what are some acute complications for peritoneal dialysis
- peritonitis - bleeding - leaking
45
describe peritonitis
- inflammation of peritonium - results from poor technique, bacteria is introduced - can tell from cloudy stuff being drained, fever, and tender abd
46
what are some long term complications of peritoneal dialysis
- abd hernias - hiatal hernias - hypovolemia/hypervolemia - hyperglycemia - pain - resp distress - self concept
47
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
48
when assessing an AV graft the nurse should look at what?
- radial pulse - cap refill - bruit and thrill
49
what lab values would I expect to find after dialysis? 1) decreased BUN 2) increased Cr 3) decreased Hgb 4) increased phos
decreased BUN
50
what is the most common complication with PD?
peritonitis
51
define glomerulonephritis
inflammation and increased cells in the glomeruli in both kidneys caused by an abnormal immune response
52
describe the path of glomerulonephritis
- antigen antibody complex gets trapped in the glomeruli after infection - can be acute or chronic
53
whats the main risk factor for glomerulonephritis
strep infection
54
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)
55
whats used in the diagnosis of glomerulonephritis
- UA - lab results (increased BUN and Cr) - elevated strep titer - decreased GFR
56
what are some nursing considerations of glomerulonephritis
- monitor weight, I+O, vitals - maintain fluid balance and electrolyte balance
57
whats the treatment for glomerulonephritis
- reduce inflammation - corticosteroids - immunosuppresive agents - diuretics/antihypertensives - dietary restrictions (renal diet short term)
58
describe renal cancer
- develops in tissues that collect urine (renal pelvis and ureters) - associated with bladder cancer - usually found at late stage
59
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
60
whats the treatment for renal cancer
- surgery (take whole kid or just a little) - radiation - chemotherapy - combination of above
61
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
62
a patient with a history of strep throat now complains of BLE swelling and dark colored urine. what condition may the nurse suspect?
glomerulonephritis

adults (51 decks)

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