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4-Fourth Semester > Exam 1- urinary/renal > Flashcards

Exam 1- urinary/renal Flashcards

1
Q

Raas

long term what

A

long term bp regulator

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2
Q

When what drops-what is formed

that converts what to what

then converts into what by what

RAAS

A

When bp drops- renin is formed

Renin converts angiotensinogen into angiontenin 1

Which is then converted into angiontesion 2 by ACE

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3
Q

what does angiotensin 2 do

promotes

releases

stimulates

A

promote vasocontriction,

releases ADH and aldosterone(, sodium/ water retention),

stimulates thirst

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4
Q

kidneys are what

process what

A

Human Body Regulator

Process waste products, drugs, and toxins and nutrients

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5
Q

responsibilities of kidneys

filters through what
regulates
regulates
helps
helps
produces

A

Filtrate through nephrons

Regulate electrolyte (salt) concentrations

Regulate amount of fluid within the body

Help regulate blood pressure

Help maintain acid-base balance

Produce hormones that affect blood and bones

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6
Q

What GFR

What urine output

kidneys

A

Must have a GFR between 120-125 mL/min

Urine output at least 30 ml/hour, if able to drink 8 glasses of water a day = urine output could be increased!

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7
Q

In order for filtration to occur- need 3 things-

functioning
permeability
proper

A

functioning nephron,

permeability of membrane

proper net filtration

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8
Q

if increase in bp

if decrease in bp

what do renal vessels do

A

If increase in blood pressure- renal vessels tend to contrict

If low blood pressure, renal vessels dialate

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9
Q

Erthyropietin can be reduced if patient is

h
has
low

A

is hypoxic,

has poor kindey function,

low red blood cells count,

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10
Q

what are regulated in small intestine

what vitamin
c
p

A

Vit d

, calcium

phosphate

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11
Q

where does kidneys regulate eelctrlyes

what is also released

A

Regulares electrolytes through loop of henle,

antidiaratic hormone (ADH) is also releases,

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12
Q

BNP-

released from where/ why

forces what/ increases

stops what hormone

A

releases from right atrium
When there is too much volume -

forcing the system to diuresis, which is increasing urine output

Stops adh hormone so tubes can excrete urine

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13
Q

Starlings law-

which is why what

A

the heart can only stretch so much- heart is like rubber band,

which is why you don’t want too much fluid

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14
Q

what do kidneys need to make urine

A

Without a functioning nephron, the kindeys are unable to make
urine

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15
Q

Renal problems means-
problems with-

eliminating
balanacing

A

eliminating waste products

, balance fluid, electrolytes, acids & bases

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16
Q

Renal problems affect other organs and can  life-threatening situations

what organs systems
n
c
h
r

A

Neurologic
Cardiac
Hepatobiliary
Respiratory

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17
Q

Renal disorders can be caused by:

c
o
I
t
t
n d

A

congenital,

obstructive,

infections,

trauma,

tumors,

neurologic disorders

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18
Q

Urinalysis

A

Ph –
Specific gravity –
Protein –
Creatinine (urine) –

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19
Q

Serum

A

GFR –
BUN-
Creatinine (serum) –
Creatinine clearance –

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20
Q

Urinary Tract Infections Risk factors:

what age
what gender
impaired what
bowel __
d
what active
p
b
c

A

Old Age

Female – short ureter
Obstructions (tumor, calculi, strictures)

Impaired bladder innervation

Bowel incontinence- e coli can get into urethra

Diabetes mellitus

Sexually active-unprotected

Pregnancy

BPH

CAUTI- most often e coli

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21
Q

how to prevent uti

what wiping

how much antibiotics

what activity

when follow up

frequent what

voiding when

increase what

decrease what

A

wiping front to back

full course of antibiotics

increase activity

follow up 2 weeks after

frequent bladder emptying

voiding before/after sex

increase fluids

decrease sugar

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22
Q

Cystitis- most common uti

what is it

A

Inflammation of the urinary bladder

Bladder mucosa becomes red & inflamed from a bacteria and pus will form

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23
Q

Cystitis

what happens
what forms

A

Bladder mucosa becomes red & inflamed from a bacteria

pus will form

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24
Q

normal manifestations of cystitis

d
u
n
what type of urine

A

Dysuria,

urgency,

nocturia,

hematuria or cloudy

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25
Q

older adults manifestations of cystitis

L
i
changes

A

lethargy

incontinent

and behavior changes

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26
Q

what do you want to get when dealing with cystitis

and why

A

Obrain a urine analysis and find out what bacteria is sensitive to,

so we can get right antibiotic

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27
Q

what type of meds do you start with before culture

after culture then what

A

broad spectrum antibiotics- ceftriaxone

after culture you get specific antibiotic

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28
Q

Cystitis meds

what med

what if pregnant x2

A

3 day oral quinolone (Flaxacins)

except if pregnant, then ampicillin or cephalosporin (ceft-)

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29
Q

Cranberry effectiveness:-in cystitis

might
be careful why

A

might help w uti because high in vitamin c-

be careful because juice is high in sugar and bacteria feeds on sugar

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30
Q

Pyelonephritis- what is it

A

Inflammation of renal pelvis and parenchyma (functional kidney tissue)

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31
Q

Pyelonephritis- why does it happen

results from

usually

A

Results from an infection that travels to the kidney.

(Usually E.coli

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32
Q

Pyelonephritis manifestations

f w/ c
m
what pain
c t
potential

A

Fever w/ chills,

malaise,

flank pain,

costovertebral tenderness (tender on kidney area),

potential n/v

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33
Q

Pyelonephritis

what iv antibiotics

a/g
c

Treatment

A

ampicillin/gentamicin

ceftriaxone

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34
Q

Pyelonephritis

what oral antibiotics
t
s
c

A

trimethoprim-

sulfamethoxazole

ciprofloxacin

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35
Q

Pyelonephritis treatment
iv fluids-

put what
what if possible
want to be
dont want

A

put multiple lines in-

18 gauge if possible-

want to hyperperfused-

don’t want dehydration

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36
Q

pyleonehritis
This is a very serious infection…

may need what
and place what for what

why treat asap- what does that look like

A

many times including hospitalization

the placement of a PICC line for long term antibiotic therapy

-Treat asap- risk of sepsis( decreased map/bp)

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37
Q

One way to differentiate between uti and pyelonephtiritis-

A

pylo will have extremely high wbc counts

pylo will also have kidney pain

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38
Q

Renal / Urinary Calculi-

majority caused by what

why might need hospitalization

what do they get if sent home

A

Majority of stones caused by calcium stones- painful

May need hospitalization if they have urinary obstruction

If sent home- w strainer and specimen cup(help prevent future stones)

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39
Q

foods to avoid in renal/urianry calculi

p
c
b t
w
b
s

A

potatoes

chohcolate

black tea

wheat

beans

spinach

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40
Q

what happens if urinary calculi is not fixed

how do you fix

inc or dec fluid

A

hydronephrosis

fix w/ receiving symptoms and removing stone

need to increase fluid

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41
Q

Renal surgery-Lithotripsy

what does it do

place what after/why

Indicated with: calculi, structural abnormalities, strictures

A

-sound waves that will bust up calculi that turns it into gravel so you can pass the stone-

also will place a uretral stent

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42
Q

why a stent after lithotripsy

does what

prevent what

A

dilate ureter and make it easier on way out

and prevent backflow urine

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43
Q

Renal surgery-Ureteroplasty-

what is it

pt return w x2

Indicated with: calculi, structural abnormalities, strictures

A

surgical repair of a ureter-

pt will return w a stent and a cathater

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44
Q

Renal surgery-
Ureteral Stent.-

how does it work
dont want kidneys to get what
and so you dont get what

Indicated with: calculi, structural abnormalities, strictures

A

dialates ureter used so urine doesn’t get occluded,

kindey doesn’t hydronephrosis

and you don’t get pylonephritis

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45
Q

uretral stent teaching

cant do what
give
increase
monitor
what feels like

A

cannot drive until stent is out,

give pain meds- non nsaids

increase fluids,

monitor i/o,

feels like burning and constant having to pee

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46
Q

ureteral stent meds x2

A

might be on anti inflammatorys ,

might be on phenazopyridine,

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47
Q

uretral stent

try to do what

give what

collect what

A

try to pass sentiment at home

  • give cup

collect any sentiment that comes out

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48
Q

Renal surgery-

Cystoscopy

what is it

Indicated with: calculi, structural abnormalities, strictures

A
  • camera that is inserted into meatus
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49
Q

Uti nursing actions- Releive acute pain-

assess
teach
encourage

A

assess pain,

teach comfort measures like warm baths, warm packs,

encourage fluids intake,

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50
Q

Uti-Restore normal urinary elimation

monitor what
avoid what
use what
use
provide

nursing actions

A

-monitor urine,

avoid all caffeinated drinks,

use aseptic technique,

use straight cath when possible,

provide peri care,

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51
Q

Uti nursing actions-Promote self management-

teach
develop what plan
schedule
teach ways

A

teach midstream clean catch ,

plan to take meds,

schedule appointemtns,

teach ways to prevent uti,

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52
Q

urinary tract tumor

factors-

what in bladder
chronic what

A

carcinogens in bladder

chronic inflammation

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53
Q

urinary tract tumor

difference between papillary lesions and carcinoma in situ

A

Papillary lesions (papillomas)-polylp like structure, bleed easily, prognosis is good

Carcinoma in situ- flat spots in bladder, poor prognosis, can become invasive

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54
Q

urinary tract tumor

manifestation

A

Intermittent painless hematuria (bleeding in urine) (cancer)

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55
Q

urinary tract tumor diagnosis

A

: UA,

urine cytology,

ultrasound,

IVP,

cystoscopy,

CT/MRI

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56
Q

urinary tract tumor- risk factors

what’s biggest one
exposure to
exposure to

A

Smoking,

exposure to checmicals/dye(plant workers and stuff)

exposure to agent orange are huge risks

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57
Q

urinary tract tumor- treatments
chemo-mitomycin

what type of chemo
do what w Cath
sent home w
have what

A

direct contact chemo

lock catheter so it stays contacted-

sent home w 3 way cath

have multiple rounds of chemo) ,

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58
Q

urinary tract tumor -another treatment

A

radiation,

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59
Q

urinary tract tumor surgery- TURBT

does what

A

resection of bladder tumor,

partial cystectomy,

It’s an operation to remove an early cancer in your bladder

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60
Q

radical cystectomy/urinary diversion- urinary tract tumor

does what

will have what

A

removal of bladder

and have chronic urinary diversion neph tubes in back)

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61
Q

Urinary tract tumor-Promote normal urinary elimination-

monitor what for how long
label what
secure w
encourage

A

monitor output closely for 24 hrs,

label all caths,

secure urethral caths w tape,

encourage activity

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62
Q

Urinary tract tumor- Reduce risk for impaired skin integrity-

assess for
ensure
change

A

assess for redness,

ensure gravity drainage,

change urine collection appliance

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63
Q

Urinary tract tumor-Reduce risk for infection-

maintain what
monitor s/s of infection-t/ what urine/ m/p

A

maintain separate closed drainage system,

monitor s.s of infection- high temp, cloudy urine, malaise, pain

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64
Q

Signs and symptom’s and risks for: infants

L
poor

Child with Genitourinary function disorders- Read maternal child book

A

lethargic,

or having poor feeds,

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65
Q

Signs and symptom’s and risks for: Toddlers-

verbalize
I
i

Child with Genitourinary function disorders- Read maternal child book

A

verbalize pain,

itching,

incontinence,

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66
Q

Signs and symptom’s and risks for:Young children

what bp means renal disease

Child with Genitourinary function disorders-

A

hypertension

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67
Q

Health Promotions for each age group- infants

frequent
how to

Child with Genitourinary function disorders- Read maternal child book

A

frequent diaper changes

how to provide peri care

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68
Q

Health Promotions for each age group- toddlers

dont want

wear

Child with Genitourinary function disorders- Read maternal child book

A

dont want super tight clothing

wear cotton underwear

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69
Q

why might little girls get multiple utis

also check for

Child with Genitourinary function disorders- Read maternal child book

A

Sometimes multiple utis in little girsl can be because medias is close to rectum before growth spurt so they can get infections there

If frequent look for potential abuse

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70
Q

teach kids what

avoid what

Child with Genitourinary function disorders- Read maternal child book

A

Teach kids how to wipe,

avoid bubble baths

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71
Q

loss of glomerulus tissue = what

Age-related changes in the renal system

A

decreased gfr

1/2 of what it used to be at age 30

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72
Q

loss of concentration ability=

inc risk of what
also at risk for what- like what

Age-related changes in the renal system

A

inc risk of dehydration

fluid/electrlytes imbalances like hyperkalemia

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73
Q

decreased drug clearance = what

Age-related changes in the renal system

A

increased drug toxicity

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74
Q

why inc risk for renal failure

Age-related changes in the renal system

A

nephrotoxic drugs

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75
Q

kidney damage stage

1- gfr number
2-gfr number
3-gfr number
4-gfr number
5-gfr number

Age-related changes in the renal system

A

1-90+

2- 60-89

3-30-59

4-15-29

5->15

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76
Q

Polycystic Kidney Disease - hereditary disease

characterized by what

and what else

A

Characterized by cyst formation

& kidney enlargement

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77
Q

how does polycystic kidney disease cause HTN

A

– cysts all around in/out of kindeys-

will block blood flow and cause vasocontriction(HTN)

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78
Q

2 types od polycystis kidney disease

A

: autosomal dominant

autosomal recessive

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79
Q

Manifestations of polycystic kidney disease

what bp
what pain
h
p
u
r c
poly

A

: HTN

flank pain,

hematuria,

proteinuria,

UTI,

renal calculi

polyuria

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80
Q

Treatment of polycystic kidney disease

increase
a
a
d
t

A

Increase fluids

ACE inhibitors

ARBs

Dialysis

transplant

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81
Q

Glomerular Disorders- leading cause of CKD

primary does what

secondary does what

A

Primary involving mainly the kidney

Secondary to a multisystem disease or hereditary condition

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82
Q

Glomerular Disorders

Glomerulus has increased permeability which causes classic manifestations:

h
p
what bp
a

A

hematuria,

proteinuria,

HTN,

azotenia

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83
Q

Primary: what
-why does that happen

Glomerular Disorders

A

poststreptococcal glomerulonephritis

– strep that is not fully treated, goes to kidneys and will attack kindeys

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84
Q

Glomerular Disorders-Secondary

d
untreated
l

A

: DM,

untreated HTN,

Lupus

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85
Q

Glomerular Disorders assessments

watch for
do they have
a
what urine

A
  • watch for imbalanced electrolytes-

do they have edema/ angiodeme(on eyes),

azotemia,

brown concentrated urine,

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86
Q

Antiglomerular basement membrane glomerulonephritis-

leads to what

manifestations-(w/n/v/what bp/e/h)

what med

Glomerular Disorders-Acute postinfectious glomerulonephritis-

A

leads to rapid decline in renal function-

weak, n/v, hypertension, edema, hematuria-

prednisone

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87
Q

Goodpasture syndrome (lung involvement)-

seen in what 2 age groups

causes what-s/s

what med

Glomerular Disorders-Acute postinfectious glomerulonephritis-

A

seen in men under 30 and adults in 60-70-

causes pulmonary hemorrhage, cough sob and bloody sputum are early s/s-

prednisone

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88
Q

Nephrotic syndrome-
massive :

p
hypo
hyper
e
t
what med

Glomerular Disorders-Acute postinfectious glomerulonephritis-

A

massive proteinuria,

hypoalbuminemia,

hyperlipidemia,

edema,

thrombolemboli-

prednisone

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89
Q

Chronic glomerulonephritis-

what s/s

Glomerular Disorders-Acute postinfectious glomerulonephritis-

A

all s.s found at once, usually will see hypertension w impaired renal function

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90
Q

Diabetic nephropathy-

seen when

will see what and what

Glomerular Disorders-Acute postinfectious glomerulonephritis-

A

seen 5-10 yrs within diagnosis of diabetes,

will see artieriosclerosis and pyelonephritis

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91
Q

Lupus Nephritis-

ranges from
need to do what
may need
what med

Glomerular Disorders-Acute postinfectious glomerulonephritis-

A

ranges from microscopic hematuria to massive proteinuria-

need to manage underyling disease,

and may need dialsysis-

prednisone

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92
Q

Primary glomerular disorder: Acute post infectious Glomerulonephritis
Patho:

pathogen does what
leads to what
cap membrane does what

A

a pathogen destroys the structure & function of the glomerulus

leading to problems with filtration.

Capillary membrane becomes more permeable to plasma, proteins, & blood cells.

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93
Q

Primary glomerular disorder: Acute post infectious Glomerulonephritis

manifestations

h
p
edema where
a
what bp
hypo
how bad of oliguria
what color urine

A

Hematuria,

proteinuria,

edema- in face(around eyes-periorbital),

azotemia

HTN,

hypoalbuminemia,

oliguria (less than 400ml in 24 hrs),

, urine that is brown/cola colored,

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94
Q

Primary glomerular disorder: Acute post infectious Glomerulonephritis
Watch for s/s that things are getting worse,

c
d
a
problems w
l
changes in

this is when kidneys are giving up

A

confusion,

disorientation,

angioedema,

problems breathing,

lethargic,

loc changes

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95
Q

Urinalysis-what see in

Glomerular Disorders-labs

A

RBCs, proteins

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96
Q

BUN

what = azetonia

what = severe renal disorder

Glomerular Disorders-labs

A

over 50 mg/dL = azotemia / over 100 mg/dL = severe renal

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97
Q

Serum creatinine

Glomerular Disorders-labs

A

over 4 mg/dL

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98
Q

Urine creatinine-what expect

Glomerular Disorders-labs

A

decreased

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99
Q

GFR

what is goal
when does it decrease

Glomerular Disorders-labs

A

healthy adult the goal is over 60 ml/min /

decreased w/ decreased renal function

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100
Q

Creatinine clearance- what is it

Glomerular Disorders-labs

A

amt. of blood cleared in 1 minute.

Normal is 85-135 mL/min

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101
Q

Electrolytes
what k
what calcium
what magnesium
what sodium

Glomerular Disorders-labs

A

Hyperkalemia,

hypercalcium,

high magnesium,

low sodium

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102
Q

what are some meds->

avoid nephrotoxic ones-
x2 (a/c)

Glomerular Disorders-Medical Treatments:

A

antibiotics (depending on cause)

Avoid any nephrotoxic ones (
aminoglycoside -mycins,
cephalosporins-ceft)

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103
Q

Immunosuppressive therapy

Glomerular Disorders-Medical Treatments:

A

: prednisone (not for poststreptococcal)-

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104
Q

oral what
what bp meds

Glomerular Disorders-Medical Treatments:

A

Oral glucocorticoids- predn”isone”s-inflammation

ACE or ARBs

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105
Q

what activity level
how much sodium in diet
how much protein in diet

Glomerular Disorders-Medical Treatments:

A

Decreased activity (initially )

NA restricted to 1-2 g/day (also fluid restriction)

Decreased dietary protein

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106
Q

Nephrotic syndrome puts you at risk for what

Glomerular Disorders-Medical Treatments:

A

risk of thromboembolism

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107
Q

Plasmapheresis-what does it do

used w what

Glomerular Disorders-Medical Treatments:

A

removes antibodies from plasma-

used w immunosuppressant therapy

treats anti gbm,and goodpastrure syndrome

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108
Q

what is final -if all else fails treatment

Glomerular Disorders-Medical Treatments:

A

Dialysis

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109
Q

excess fluid volume

assess-(v/l/m)

monitor what (h/b/c)

restrict

daily

Glomerular Disorders Nursing Care

A

assess vs/lungs/med effect

monitor electrolytes-h/h,bun, creatinine)

restrict fluids

daily wt

110
Q

Glomerular Disorders Nursing Care-Fatigue

provide what
assist w
teaching about
what meals

A

Provide adequate rest,

assist with ADL’s,

teaching about fatigue associated with disease,

small frequent meals- rice, pasta

111
Q

Glomerular Disorders Nursing Care-Risk for infection

assess for
monitor what lab
provide what
what procedures
teaching what

A

Assess for S/Sx of infection,

monitor CBC

Provide good nutrition,

sterile procedures,

teaching to minimize risk of infection

112
Q

Glomerular Disorders Nursing Care- Ineffective Role Performance

support
therapeutic
teaching about

A

Support coping skills,

therapeutic communication,

teaching about the disease & effects, support services

113
Q

vascular kidney disorder- HTN

damages
accelerates

decreases what

A

damages walls of arterioles

accelerates athleroscoris

decreased gfr and tubular function

114
Q

renal artery occlusion-vascular kidney disorder-

commonly from what

s/s- what pain, /, f, what bp

A

commonly from a blood clot

s.s of flank pain, n/v, fever, hypertension

115
Q

vascular kidney disorder- renal artery occlusion- how treat

s
a meds
b meds

A

surgery

anticoagulant meds

and bp meds like ace/arbs

116
Q

renal artery stenosis-vascular kidney disorder-

why narrowing
leads to what
will need what
what 3 meds are needed

A

narrowing due to atherosclerosis

leads to HTN

will need dilation/graft

need ace inhibors/arbs and statins and aspirin

117
Q

renal vein occlusion-vascular kidney disorder-

occlusion from what
from what

will need what x2

A

occlusion from blood clot

from nephrotic syndrome

will need thrombotic and anticoagulant

118
Q

renal vein occlusion-vascular kidney disorder- meds

cant give what
what thrombolytics

A

Cannot give aspirin

Thrombolytic like tpa, or streptokinase

119
Q

what is priority w vascular kidney disorder -do what w bp

allows what

diuretics need what to work

A

decrease bp

allows gfr to go up

diuretics need a functioning kidney/gfr to work

120
Q

Kidney Trauma

what causes trauma
kidneys may have what

A

Blunt/Penetrating injury causes trauma

Kidney may have a contusion -> potential shatter

121
Q

manifestations of kidney trauma

what is turners sign
what s/s of shock(bp/hr/loc)
o
h
what pain
monitor for what

A

turners sign(may not be initial)- start as slight bruising that is growing

( shock- low bp high hr, low loc)

,oliguria,

hematuria,

flank pain,

monitor for perfusion

122
Q

Diagnosis of kidney trauma

what h/h
what ast
what scan

A
  • low h/h,

high ast,

ct scan

123
Q

Treatment of kidney trauma

what do if bleeding is low

what do if bleeding is severe

what do if shattered

A

-typically monitor bleeding if low,

if severe attempt to control hemorrahe and prevent shock,

if shattered, only treatment is removal of kindey

124
Q

Renal Tumors

b/m
p/m

A

Benign or malignant

Primary or metastatic?

125
Q

Renal Tumors-manifestations

h
what pain
what in abdomen
potential
wt

A

hematuria…always contact your primary provider!- may be in morning only at first/////

flank pain,

abdominal mass,

potential fever,

wt loss

126
Q

Renal Tumors Diagnosis-Smoking is high risk for renal cancer

A

: ultrasound,

CT scan

, CXR,

bone scan,

MRI

127
Q

Renal Tumors- what inhibit new blood cell formation

what type of drugs

A

nib’ drugs

128
Q

Renal Tumors- main treatment

A

main is removal of kidney(nephrectomy)

129
Q

Nursing care following nephrectomy(removal of kidney)

Frequent assessments of what

monitor what lab

A

Frequent assessments of function of remaining kidney including hourly output

monitor cbc

130
Q

monitoring for ( h/ a i)
what are early signs x2

Nursing care following nephrectomy(removal of kidney)

A

Monitoring for hemorrhage & adrenal insufficiency:

early sign is hypotension and oliguria

131
Q

Nursing care following nephrectomy(removal of kidney)

care of what

no more what

A

Care of drains

No contact sports

132
Q

Nursing care following nephrectomy(removal of kidney)

what fluid intake

are all fluids the same

A

Fluid intake -2000-2500 mL/day

Are all fluids the same?- want water, not soda/alcohol

133
Q

nephrectomy- Releive surgical pain-

assess for
assess I
use measures like -p/ g I/ r

A

assess for pain,

assess incision,

use pain measures such as positioning, guided imagery, relaxation

134
Q

nephrectomy-Reduce risk of breathing pattern that increases risk for postoperatice respiratory complications-

what positions
what frequently
a
frequent what

A

semi fowlers,

changing positions frequently,

ambulation,

frequent deep breathing,

135
Q

nephrectomy-Maintain fluid balance-

assess what
maintain what
use what

A

assess dressings,

maintain fluid intake,

use aseptic technique,

136
Q

Acute Kidney Injury (AKI)

rapid what
causes what

A

Rapid ↓ in renal function

causes metabolic wastes accumulating in the body( like creatnin and BUN)

137
Q

Acute Kidney Injury (AKI)-These are further categorized as:

p
I
p

A

Pre renal injury

Intrinsic renal injury

Post renal injury

138
Q

how prevent Aki

may need to do what if Aki is present

A

To prevent aki’s- give lots of Iv fluids

May need to decrease fluids if there is a disease or injury present to kidneys

139
Q

Prerenal aki

what causes pre renal Aki

then causes what to kidney

will result in what

when is pre renal reversed

A

decrease in vascular volume or resistance, cardiac output

causes a decrease in renal blood flow

drop in GFR and possible necrosis & damage (with continued ischemia)-

will be reversed when blood flow is restored

140
Q

what can cause prerenal aki

what type of volume
what 2 organ failures

meds:
n
a
a

A

hypovolemia

CHF and liver failure

meds:
nsaids
arbs
ace inhibitors

141
Q

Intrarenal

what causes intrarenal Aki

affects what

A

: acute damage to different parts of the kidney due to disease or necrosis (problem may originate prerenal such as HTN, or problem may be dt nephrotoxic drugs)

, affecting: glomerular filtration, tubular reabsorption, and/or tubular secretion

142
Q

intrinsic aki causes

I
s
n
what bp

A

Ischemia

Sepsis

Nephrotoxins

hypertension

143
Q

post renal aki

what causes this

such as

A

obstruction to urine flow

such as BPH, kidney stone

144
Q

how to fix

pre renal

instrisic

post renal

A

pre- admisnter fluids

instric- removing cause and potential dialysis

post renal- bypass obstruction

145
Q

initiation phase

when does it happen
what are manifestations
what is treatment/prognosis

AKI phases/ characteristics

A

From event to tubular injury (hours to days)

Usually no manifestations or very slight (slight dehydration etc)

Treatment good prognosis- likely to reverse and go into recovery

146
Q

maintenance phase AKI

decrease in what
inability to do what

what is suppressed

A

decrease in GFR & tubular necrosis

inability to eliminate metabolic wastes, water, electrolytes, and acids

Erythropeoiten secretion is suppresed

147
Q

recovery phase of aki

what repair

what happens to renal function

what makes for best outcome

A

tubule cell repair & regeneration = normal GFR

Renal function improves rapidly (5-25 days) but continues for up to 1 year

Diagnose early for best pt outcome

148
Q

AKI-

who can it happen to

A

can happen to anybody

watch for in all patients

149
Q

manifestations of Initiation phase of aki

do not do what

A

Initiation: Few symptoms (catch it here!)-

do not negate slight changes in things

150
Q

Maintenance phase aki manifestations

what gfr
o
a
m a
e
what k
fluid retention causing what

A

Decreased GFR,

oliguria,

azotemia,

metabolic acidosis,

edema,

high potassium

fluid retention causing CHF, pulmonary edema , electrolyte imbalances,

151
Q

recovery of aki manifestations

what gfr
d
what electrolytes

A

Return of GFR,

diuresis,

all electrolytes improved

152
Q

Intravenous fluids- why

AKi meds

A

gives fluids to kidneys

153
Q

Inotropic (dopamine)-why

direct
increases

AKi meds

A

direct vasoconstrictor - (increase bp)

increasing cardiac output

154
Q

when do you give dopamine
(what down x2)

need what map for urine

need to give what w dopamine

A

when bp and urine output are down- give dopamine to raise bp and urine output

need a map over 70 to make urine (dopamine will fix map)

need to give fluids w dopamine

155
Q

Norepinephrine (vasopressor)-

what bp
helps what

AKi meds

A

raises bp and

can help perfuse tissue

156
Q

Fenoldopam-why

AKi meds

A

(vasodilator to increase kidney blood flow)

157
Q

Loop diuretic (Lasix)

Osmotic diuretic (Mannitol)-

why

AKi meds

A
  • to keep kidneys working and get rid of fluid/potassium
158
Q

ACE, ARBs or other anti-HTN meds-

how help

AKi meds

A

reduce bp by vasodialating

159
Q

Antacids H2 antagonists or PPI- pantoprozole- do what

AKi meds

A

protects gi tract from any gi bleeds

160
Q

increased potassium

put what on
check what lab
check what
assess what
frequent what

A

Put a tele monitor on,

check mg level,

check loc,

assess pain,

frequent assessments- needs eyes on pt a lot

161
Q

Calcium chloride (unless dig toxic)

reduces what

Increased K+ meds

A

calcium carb reduces the chance of V.fib(defib),

162
Q

Bicarb

how does this help-increases

Increased K+ meds

A

increases ph causing the K+ to shift intracellular

163
Q

Insulin 10 units (Remember ONLY regular is given IV!)

insulin does what

Increased K+ meds

A

Insulin will push the glucose into the cells along with k+ which will decrease the extracellular K

164
Q

Glucose (50% dextrose given IV)

stimulates what

Increased K+ meds

A

stimulates insulin secretion

165
Q

Nebulized albuterol

promotes what

Increased K+ meds

A

Albuterol promotes cell reuptake of K+,

166
Q

Sodium polystyrene sulfonate (kayexalate) orally or enema

how does this work

Increased K+ meds

A

Kayexalate binds to stool and allows K+ excretion.

167
Q

what is important w hyperkalemia

A

IMPORTANT SAFETY: This is done at an urgent time which increases the chance of a medical error.

STOP and do your checks!

DO NOT TAKE SHORT CUTS! Or trust some else to check

168
Q

Fluid restriction until when

how do you know

Acute Kidney Injury (AKI) Medical and Nursing treatments:

A

Fluid restriction until perfusion restored

(skin color, pulse ox, cap refil, bp, pulses)

169
Q

Diet-

low in
high in

Acute Kidney Injury (AKI)Medical and Nursing treatments:

A

low protein,

higher carbs- white bread, rice, no potato, pasta (not a lor of sauces)

170
Q

Fluid management:- how to calculate fluid intake

Acute Kidney Injury (AKI)Medical and Nursing treatments:

A

daily fluid intake is calculated by allowing 500-800 ml for insensible losses & then adding excreted as urine during the previous 24 hours.

If a patient with AKI excretes 500 ml of urine in 24 hours, the patient is allowed a fluid intake of 1000-1300 ml for the next 24 hours.

171
Q

when dialysis

what care

Acute Kidney Injury (AKI)Medical and Nursing treatments:

A

Dialysis- if things progress

Skin care

172
Q

monitor for what

Acute Kidney Injury (AKI)Medical and Nursing treatments:

A

Monitor for infection risk

173
Q

what are you avoiding in aki

Acute Kidney Injury (AKI)Medical and Nursing treatments:

A

Avoid anything nephrotoxic- myocin antibiotics, nsaids

174
Q

antibiotics that are nephrotoxic

a
t
f
p
v
s

A

aminoglycosides

tetracyclines

fluroquinolones

penicccilin

vancomyicun

sulfonamides

175
Q

chemo that is nephrotoxic

b

m

c

A

bisphosphanates

methotrexate

doxorucin

176
Q

immunosuppressants that are nephrotoxic

a
c

A

azathioparine

cyclosporine

177
Q

other meds that are nephrotoxic

n
a
a
m
s

A

nsaids-

allopurinol

ace inhibitors

mannitol

streopokinase

178
Q

what main meds need to know are nephrotoxic

what antibiotics
what nsaids
what other drug

A

mycin- antibiotic

nsaid- ibuprofen, ketololac, aspirin

chemo drugs

179
Q

Renal replacement therapy- dialysis

3 types

A

Hemodialysis (HD) via multiple lumen central line

Peritoneal dialysis (PD)

Continuous renal replacement therapies (CRRTs)

180
Q

Hemodialysis

what do prior
what do pre/post
assess also for what
what do if that happens

A

prior- austutate bruit over site

assess vitals pre/post

assess for dialysis disequilibrium syndrome- neurological symptoms

stop transfusion

181
Q

How to know if dialysis is “working”

what’s lowered
whats balanced
?
what bp
how often do you do this

A

Lowered creatinine

Balanced electrolytes

? Urine output

Normal or low b/p

Often chronic…3 days a week

182
Q

what are you watching for in dialysis

h

b

I

A

hypotension,

bleeding,

infection

183
Q

vascular access

what is short term

what is long term

A

Double-lumen catheter (short-term)- central line

Arteriovenous (AV) fistula (long-term)

184
Q

vascular access

cant do what

takes what

creates what

A

No BP or venipuncture on that arm

Takes time to mature

Creates a lumpy appearance

185
Q

vascular access
risk for

I
c
t

A

infection,

clotting,

thrombosis

186
Q

how do you know vascular access is functioning

what feel
what hear

A

palpable pulsation - “thrill”

and bruit (buzzing sound due to differences in pressure from artery to vein) on auscultation

187
Q

Prior to dialyisis- vascular access

might have :
what electrolytes
what bp
what urinr output

make sure what
make sure get what

A

might have high electrolytes,

some hypotension

Little to no urine output,

make sure they eat breakfast

, make sure they
Get insulin,

188
Q

when they return vascular access dialysis

get what
watch for what
s
v

A

get vitals,

watch for symptomatic hypotension

Sycope

vertigo

189
Q

Peritoneal dialysis-Predialysis care-

document what
what to pt
measure
what bladder
do what to solution

A

document vitals,

weight pt,

measure abdominal girth,

empty bladder,

warm solution

190
Q

Intradialysis care-

what technique
watch for
record what

Peritoneal dialysis

A

aspectic technique,

watch for repsitoartory distress,

record amount of dialystate used

191
Q

Peritoneal dialysis-Post dialysis care-

assess
time

A

assess vitals,

time meals w outflow

192
Q

how does it work

what is used to drain container

where can it be done

Renal Replacement Therapy: peritoneal Dialysis

A

Warmed sterile dialysate is instilled into peritoneal cavity through abd catheter

Gravity drains to drainage container

More gradual process, takes longer, can be done at home

193
Q

peritoneal dialysis Complications related to

what complication

what do you exactly need

what to do if volume in =/= volume out

A

complications such as peritonitis- lethal

exactly need I/o

change position if i doesn’t equal o

194
Q

peritonitis-

s/s-when pain/ what abdomen

how treat what meds/ what other

A

pain on rebound//. board like abdomen

need to get correct antibiotic and may need surgery

195
Q

Watch incision- for what in peritoneal dialysis

what imbalance
f
increased

A

for infection

electroyte imbalance

fever,

increased lethargy

196
Q

what type of dialysis is used for kids

risk for what

A

periotoneal dialysis

risk for peritonitis

197
Q

-aki - Restore fluid and electrolye balance

/
daily
place where
watch for (what k,na,phosphate)
what w fluids
what candies
what frequently

A
  • i/o,

weight daily,

place in semi fowlers,

watch for hyperkalemia, hyponatremia, hyperphosphatemia,

restrict fluids,

hard candies decrease thirst,

turn frequently

198
Q

Maintain adequate nutrition-

daily
meet
provide
what prior to meals

aki

A

weight daily,

meet w dietician,

provide frequent meals,

antiemetics and mouth care prior to meals

199
Q

Chronic Kidney Disease (CRD)

what is CRD
what is ESRD
GFR is maintained until when

A

Progressive, irreversible kidney injury

End-stage renal disease (ESRD): kidney function is inadequate to sustain life

GFR is maintained at normal rate until 70-80% of renal function is lost

200
Q

signs of Chronic Kidney Disease (CRD)

u f
what gain
o
a
legs
what syndrome
what w meds
what changes

A

uremic frost

weight gain

oliguria

anuria

restless legs

psychotic syndrome

meds toxicity

electrolyte changes

201
Q

Watch for Chronic Kidney Disease (CRD)

decreased
p
increased
watch for
watch for

A

decreased loc,

psychosis,

increased restlenses,

watch for med toxicity,

watch for fluid overload

202
Q

Id dialysis is no longer an option-

A

hospice/comfort care

203
Q

Chronic Kidney Disease (CRD): complications- Fluid & Electrolytes:
risk of

d
what k
what calcium

A

Risk of dehydration, hyperkalemia, hypocalcemia

204
Q

Chronic Kidney Disease (CRD): complications-
Cardiovascular

what bp
p e
p
c t

A

: HTN,

pulmonary edema,

pericarditis,

cardiac tamponade

205
Q

Hematologic

a
decreased

Chronic Kidney Disease (CRD): complications

A

: Anemia,

decreased platelets

206
Q

how does anemia happen in CKD

how do you treat anemia in CKD

A

decrease in renal function= decrease in erythopeitan = decreased rbc

treatment- give blood

207
Q

administration of blood

hand
open
all
spike/and
prime w
prepare/invert
spike
close
prime/ attach
regulate
monitor for

A

hand hygiene,

open y tubing,

all clamps in off,

spike ns bag and put on iv pole,

prime with ns,

prepare blood-invert2-3 times,

spike blood,

close ns,

prime with blood, attach to vad,

regulate blood flow- initial 15 minutes (rate 60-120 ml/hr)

montor for reaction

208
Q

what do you do if you suspect a transfusion reaction

stop
get
adminster
remain

A

stop the tranfusion

get new tubing

adminster normal saline

remain w paiteitn

209
Q

allergic rx to blood-i

febrile rx to blood-f

circulatory overload rx to blood-d/c

hemolytic rx to blood-b/b

infection rx to blood-bp/ /

A

allergic - itching

febrile- fever

circulatory overload -dyspnea/cough

hemolytic - burning/back pain

infection - hypotension, n/v

210
Q

Chronic Kidney Disease (CRD): complications- Immune system:

risk of
what decline
what’s impaired
whats suppressed

A

Risk of infection,

WBC decline

, immunity impaired,

fever suppressed

211
Q

Chronic Kidney Disease (CRD): complications-Gastrointestinal:

u-> leads to /
g
p
u f

A

Uremia leads to N/V,

gastroenteritis,

PUD,

uremic fetor (urine breath)

212
Q

Neurologic

Chronic Kidney Disease (CRD): complications

A

: CNS alterations,

fatigue,

psychotic symptoms,

uremic encephalopathy

, peripheral neuropathy,

motor impairment,

restless leg syndrome

213
Q

Chronic Kidney Disease (CRD): complications- Musculoskeletal

what phosphate
what calcium
what vit d
leads to what

A

: Hyperphosphatemia

& hypocalcemia,

decreased vit D

leading to renal rickets

214
Q

Chronic Kidney Disease (CRD): complications- Endocrine & metabolic:

risk of
increased
what’s affected
im

A

Risk of gout,

increase cholesterol,

reproductive function affected,

impotence

215
Q

Chronic Kidney Disease (CRD): complications- Dermatologic

what color skin
what skin
what turgor
what on skin

A

: Pallor & yellowish skin,

dry skin

, poor skin turgor,

uremic frost on the skin causing pruritus

216
Q

3 p’s and s restriction

Chronic Kidney Disease (CRD): Interventions

A

Protein Restriction

Sodium 3g then 2g

Potassium Restriction

Phosphorus Restriction

217
Q

what can people eat in CKD

yes eat

no eat

A

WHITE foods

yes eat- complex carbs- vegetables, pasta

no eat- tofu and eggs

218
Q

Vitamins

c
f
extra what

Chronic Kidney Disease (CRD): Interventions

A
  • calcium,

folic acid,

extra vitamin d

219
Q

Chronic Kidney Disease (CRD): Interventions-Watch for pulmonary edema!-

what in lungs
what 02
what manifestation
requires what
what hr/bp

A

fluid in lungs-

decreased o2,

wheezing,

pink frothy sputum-

, requires intubation,

rapid hr, high bp then drop,

220
Q

watch for what

dialysis how often

Chronic Kidney Disease (CRD): Interventions

A

Watch for weight gain

Dialysis – 3 x week

221
Q

potential what

watch for what stages

Chronic Kidney Disease (CRD): Interventions

A

Potential kidney transplant

Watch for stages and development of ESRD (Stage 5)

222
Q

what do you need to worry about mentally for pt with ckd

Chronic Kidney Disease (CRD): Interventions

A

Anticipatory grieving & major life changes (financial concerns)-

whole life has to change because of this- no vacations/ job

223
Q

Kidney Transplant Preop

start what
fix what

A

Start immunosuppression

Fix any hyperkalemia or other electrolyte disturbances

224
Q

post op kidney transplant

adminster what

remove Cath when

monitor what

A

Adminster dierutics

Remove cath 2-3 days after

Monitor electrolytes

225
Q

post op kidney transplant

Watch UO -> how to give fluid replacement

A

fluid replacement to be given equal to the previous 30-60 minutes of output

226
Q

Watch for s/s hemorrhage-

s
increased
what are s/s of shock( changes in what x2)

post op kidney transplant

A

swelling,

increased abdominal girth,

shock-changes in vitals/loc

227
Q

post op kidney transplant- Watch for renal thrombosis

abrupt
reduced

A

-abrupt hypertension,

reduced gfr

228
Q

post op kidney transplant- Watch for infection –

what changes
what urine
what drainage

A

loc changes,

cloudy urine,

purulent drainage

229
Q

transplant rejection- s/s

what over site
f
gain
what urine output

post op kidney transplant

A

sweeling/tenderness over graft site

, fever,

wt gain,

decreased urine output

230
Q

Monitor and support kindey function-

monitor what
report what
maintains blood glucose where
adminster what meds
allow what

A

monitor i/o,

report electrolyte imbalances,

maintain blood glucose 90-130,

administer antihypertensive,

allow rest periods

231
Q

Maintain adequate nutritional intake-

weigh when

when give antiemetics

what before meals/bedtime

small

CKD

A

weigh daily before breakfast,

administer antiemetics 30-60 minutes before eating,

assist w mouth care prior to meals and bedtime,

small meals and snacks,

232
Q

Reduce risk of infection-

what precautions
temp how often
monitor what lab
get what as needed
what changes
___ excercises
restrict who

CKD

A

standard precautions and good hygiene techniques,

temp every4 hrs,

monitor wbc,

get cultures as needed,

poisitonal changes,

cough and deep breathing,

restrict ill people

233
Q

what happens when vit d is low

what 2 things in low calcium

CKD

A

vit d- immune support- become sick and fatigued

calcium- tetany, osteoporosis

234
Q

what are you worried about in CKD

how do you prevent it

A

worried about clots, dvt, pe

prevent with activity and moving

235
Q

what happens in rhabdo

what build up

what type of aki is rhabdo

How does rhabdomyolysis affect kidneys

A

breakdown of muscle = myoglobin buildup

myoglobin buildup = kidneys are affected

rhabdo= intrinsic aki

236
Q

what fluids

what pain meds

what stomach protector

avoid what

tx of rhabdo

A

isotonic fluids

nonnsaid pain meds

ppi(pantoprozole) and h2(famotidone)- protect go system

avoid nephrotoxic drugs

237
Q

what diet

what type of labs in

rhabdomyolysis

A

low protein diet

check heart labs- troponin, echo, egg

238
Q

what does proteinuria look like

A

beer- foamy

239
Q

if pt is on iron in aki

causes what

need to get what

A

causes constipatipon

need to be active

240
Q

what teaching w pylonephritis

watch for what

treat that w what

keep what

low what w antibiotics

A

watch for c diff

treat that w metronidazole

keep clean w keeping dry

low sugar w antibiotics

241
Q

What ECG looks like on A flutter

what rhythm
what p qrs t
what in between

A

regular rhythm

regular p qrs t

just has a lot of waves/ lots of p’s in between the qrs

242
Q

What A fib looks like on ECG

what rhythm

what qrs

main idefitfies

cant get

A

irregular rythm

has a normal qrs

but time in between looks scribbly

cant get a proper p pr t

243
Q

What does SVT looks like on ECG

very

will not

A

Very narrow- high on tachycardia

will have a barely visible p or t wave

very pointy

244
Q

what does v tach look like on ECG

A

Big M’s

a lot of big m’s

245
Q

v fib on ecg

A

tiny m’s

246
Q

When can you defibrillate x3

A

pulseless pt

pulsless vtach

vfib

247
Q

when can you synchronized cardioverison x4

A

afib

a flutter

vtach w pulse

svt

248
Q

when do you external pacing

A

severe bradycardia w pulse

249
Q

Renal arteriogram

visualizes what

detects

A

visualize renal blood vessels

detect renal artery stenosis, renal thrombosis or embolism, tumors, cysts,

250
Q

Renal arteriogram
pre- assess

what allergies
discontinue what
npc how long

A

Allergies to iodine

Discontinue anticoags

Npo 8-12 hrs

251
Q

Renal arteriogram

restrict what
monitor what

A

Restrict activity

Monitor urine output

252
Q

Renal scan

evaluates what
assess what

A

evaluate kidney blood flow

assess kidney perfusion and urine production

253
Q

Renal scan
pre

do what
obtain what

A

Drink water prior to test

Obatin wt

254
Q

Renal scan

post

increase what

255
Q

Intravenous pyelogram (IVP)

visualize what

diagnose what

A

visualize the entire urinary tract

diagnose kidney disorders or to detect calculi (stones),

256
Q

Intravenous pyelogram (IVP)
pre

what allergy
npo how long

A

allergy to seafood

npc for 8-12 hrs

257
Q

Uroflowmetry

A

volume of urine voided per second.

258
Q

Uroflowmetry
pre

increase what
remain free

A

Increase fluid intake

Remain free from voifing to make sure full bladder

259
Q

Cystoscopy

visualisation of what

A

visualization of the bladder wall

260
Q

Cystoscopy

pre
take

261
Q

Cystoscopy
post

report
apply
what baths
increase

A

Report hematuria

Apply heat to lower abdomen

Sitz baths

Increase fluids

262
Q

Renal biopsy

determines what

A

Determines the cause of renal disease

263
Q

Renal biopsy
pre

npo how long

264
Q

Renal biopsy
post

pressure for how long
assess

A

Pressure for 20 mins

Assess bowels

265
Q

causes of kidney disease

what bp
d
L
what cells
chronic
repeated
what meds
what disease

A

HTN

diabetes

lupus

sickle cell

chronic glomerulonephritis

repeated pyelo

nephrotoxins

polycystic kidney disease

266
Q

how does sodium bicarbonate correct metabolic acidosis

is what

A

is alkaline so will raise ph

267
Q

how does regular insulin correct metabolic acidosis

does what

A

brings potassium into cell and will lower k

268
Q

how does IVF correct metabolic acidosis

increases what

A

increases fluid to help excrete waste

269
Q

how does dialysis correct metabolic acidosis

articifal what

A

artificial blood filtering which will get rid of waste and electrolytes

270
Q

renal impairment from meds (nsaids/ mycins)

what bun/ creatnine

what HCT

what electrolytes

f

e

I

what care

promote what

A

high bun and creatinine

low HCT

altered electrolytes

fatigue

edema

irritability

skin care

promote rest

4-Fourth Semester (3 decks)

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