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Adults 2 > Exam 2 Renal > Flashcards

Exam 2 Renal Flashcards

1
Q

anuria

A

no urine output or less than 50mL in 24 hours

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2
Q

oliguria

A

less than 400mL in 24 hours or less than 20mL per hour

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3
Q

azotemia

A

accumulation of nitrogenous waste in blood; BUN and creatinine (nitrogen in blood)

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4
Q

uremia

A

accumulation of nitrogenous waste in urine

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5
Q

gerontologic changes with kidney and urine

A

aging kidney less able to compensate for fluid changes, solute load, and CO; number of functioning nephrons decrease; decreased renal clearance; creatinine slowly increases; enlarged prostate; incontinence d/t decreased bladder innervation and weakened muscular tone; risk for malnutrition; thirst suppression; confusion

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6
Q

normal renal functions

A

maintenance of blood volume or pressure (RAAS); concentrates ions like bicard and hydrogen; maintains long term acid base balance (become acidic without); metabolic gluconeogenesis (liver backup); excrete metabolic waste; produce erythropoietin and renin; convert vitamin D to active form

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7
Q

Kidney function: Very Clever People Make Exciting Explorers

A

Volume, Concentration, pH balance, make gluconeogenesis or change amino acids, excretion, endocrine creates erythropoietin and renin

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8
Q

types of AKI

A

prerenal: blood flow to kidney; intrarenal: problem in kidney; postrenal: ureteral blockage; overall 50% mortality with treatment

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9
Q

chronic renal insufficiency/Chronic renal failure

A

GFR < 60mL/min; ESRD < 15mL/min; need dialysis or kidney transplant

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10
Q

Acute kidney injury

A

sudden decrease in renal function resulting from injury or toxins; causes accumulation of nitrogenous waste; if not corrected then can cause irreversible tubular necrosis

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11
Q

risk factors for AKI

A

over age of 65, INFECTION/SEPSIS, cardiac failure, respiratory failure, HX of leukemia or lymphoma, HYPOTENSION, nephrotoxic agents, liver disease

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12
Q

labs associated with AKI

A

increased fluid, increased BUN, increased creatinine, decreased urine output (<400mL/day), acidosis

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13
Q

stages of AKI

A

initiation -> oliguric (1-7 days) -> diuretic -> recovery

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14
Q

interventions for AKI

A

dialysis if needed,

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15
Q

electrolyte changes with AKI

A

hyperphosphatemia, hypernatremia, hypermagnesemia, hyperkalemia (causes peaked T waves)

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16
Q

assessment for kidney function

A

HPI, questions like what did they come in for?, what are their daily meds?, what is the urine color?, any pain when urinating?, blood present?, recent antibiotics?, recent infections?; physical exam; diagnostic tests

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17
Q

diagnostic testing for AKI

A

CT, MRI, UA, C&S, KUB, ultrasound, cystography; these are looking for structural changes in kidney

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18
Q

assessing an AKI

A

urine output volume over 24 hours, GFR, BUN: creatinine ratio (usually 10-20:1)

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19
Q

BUN normal values

A

10-20mg/dL

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20
Q

Creatinine normal values

A

adult men: 0.74-1.35mg/dL
adult women 0.59-1.04mg/dL

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21
Q

early manifestations of AKI

A

decreased creatinine clearance; increased BUN and Creatinine values; proteinuria (protein passing through glomerulus NOT GOOD)

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22
Q

later manifestations of AKI

A

fluid retention causing edema and oliguria; anemia due to reduced erythropoietin, acidosis, increased electrolytes and waste products

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23
Q

best indicators of kidney function

A

creatinine and urine output

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24
Q

prerenal AKI causes

A

decreased perfusion to the kidneys causing decreased perfusion and O2; d/t cardiac damage, vasodilation, hemorrhage, burns, GI losses, stenosis, constriction

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25
Q

causes of intrarenal AKI

A

damage in kidneys caused by prolonged ischemia; d/t myoglobinuria, hemoglobinuria, rhabdomyolysis, nephrotoxic drugs (NSAIDs, dye, antibiotics ending in mysin), infections, acute tubular necrosis

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26
Q

postrenal AKI

A

damage after the kidneys; caused by obstruction or blockage of urinary tract causing increased pressure in kidney and decreased filtration; due to renal calculi, blood clots, retriperitoneal issues, BPH, tumors, neuro damage (stroke), spinal cord damage, occluded catheter, urethral strictures

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27
Q

treatment of prerenal AKI

A

IV hydration and PO intake; renal protection before IV contrast; avoid fluid volume deficit; trauma and stenosis need OR; treat infection

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28
Q

diagnosis of intrarenal AKI

A

creatinine > 1.3 (bad kidney)

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29
Q

treatment of intrarenal AKI

A

remove the underlying cause; supportive therapy consisting of IV fluids or dialysis; if caused by med then discontinue med

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30
Q

acute tubular necrosis

A

destroyed tubular segment of nephron causing uremia and renal failure; blood flow to kidney is disrupted; caused by ischemic injury, nephrotoxic injury, blood transfusion reaction, rhabdomyolysis, hypotension, major surgery (kidney transplant), septic shock

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31
Q

diagnosing post renal AKI

A

xray for finding calculi or hydronephrosis, US to look for obstruction, CT without dye for obstruction and viewing of renal perfusion

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32
Q

treatment for postrenal AKI

A

remove underlying cause if possible, IV hydration, supportive measures; urinary catheter, ureteral stent, nephrostomy tube, lithotripsy, cytoplasty, prostate resection

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33
Q

AKI nursing management

A

daily weights at same time and same clothing, monitor IOs, maintain map of 60-70, fluid or sodium restriction, avoid nephrotoxins, nutritional support for electrolytes and protein, skin care, monitor WBCs and temp

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34
Q

examples of nephrotoxins

A

vancomycin, gentamycin, amphotcerin B

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35
Q

treating volume overload

A

diuretics and dialysis

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36
Q

treating hyperkalemia

A

kayexalate to bind and excrete; unstable pt get D50, insulin, calcium

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37
Q

treating hyponatremia

A

give sodium

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38
Q

treating hyperphosphatemia

A

PhosLo binds to excess phosphate; give prior and after meals; calcium should increase as phos goes down

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39
Q

treating impaired drug clearance

A

renal dosed meds d/t decreased excretion

40
Q

treating metabolic acidosis

A

bicarb admin

41
Q

treating uremia

A

removal of toxins via dialysis

42
Q

indications for temporary dialysis

A

volume overload that is unresponsive to diuretics (high dose lasix 40-80), hyperkalemia, metabolic acidosis, progressive azotemia (BUN > 100)

43
Q

options for temporary hemodialysis

A

intermittent hemodialysis: done via fistula or port, done 3 days a week; continuous renal replacement therapy (CRRT): constant dialysis when in ICU, run through port; peritoneal dialysis: hypertonic saline into peritoneal cavity that sits for a while to remove waste and then is removed

44
Q

preventing AKI

A

recognize those at risk such as HTN and diabetics, maintain adequate circulating blood volume, limit exposure to toxins, minimize risk of infection

45
Q

CKD

A

gradual irreversible condition of the kidney that can lead to end stage renal disease (ESRD); kidney damage present for > 3 mo indicated by structural or functional abnormality of kidney with decreased GFR, abnormal components of blood urine or imaging; GFR < 60mL for 3 months with or without kidney damage

46
Q

kidney damage asymptomatic until…

A

> 40% of nephrons lost; dialysis begins when >90% of nephrons lost

47
Q

risk factors for developing CKD

A

diabetes, HTN, nephrosclerosis (exacerbates renal damage), ACE/ARBs, glomerulonephritis

48
Q

CKD casused by

A

untreated AKI, metabolic disorders, renal vascular disorders, immunological disorders like lupus, infections like UTI or pyelonephritis, primary tubular disorders, urinary tract obstruction, congenital disorders like polycystic kidney disease; most frequent causes are DM and HTN

49
Q

nephrotic syndrome

A

leaking of albumin into the urine; kidney is not filtering out albumin back into blood; leads to hypoalbuminemia and edema

50
Q

causes of nephrotic syndrome

A

bacteria or viral infection, cancer, genetic predispositions, systemic diseases like lupus or diabetes, NSAIDs; lupus causes direct renal damage

51
Q

signs and symptoms of nephrotic syndrome

A

hypoalbuminemia: causes edema, fatigue, loss of appetite, hyperlipidemia; Proteinuria greater than 3g/day, large amount of protein in urine; may see clots

52
Q

pathology of nephrotic syndrome

A

inflammatory response in glomerulus causes damage to membrane and causes loss of protein (albumin) that regulates oncotic pressure; leads to hypoalbuminemia

53
Q

signs ans symptoms of CKD

A

decreased UOP, proteinuria, hematuria, lethargy, altered LOC/confusion, seizures, HTN, hypervolemia, HF, anorexia, N/V, uremic fetor (ammonia breath), metallic taste, impaired immune/inflammatory response, anemia, increased risk of bleeding, amenorrhea, erectile dysfunction, decreased libido, uremic frost, pruritis

54
Q

CKD associated lab values

A

increase BUN, increased creatinine, increased K, increased magnesium, decreased calcium, increased phosphate

55
Q

different types of UTIs

A

upper: pyelonephritis (kidney), uretitis (ureter infection); lower: cystitis (bladder), urethritis (urethra), prostatitis (prostate)

56
Q

patho of UTI

A

can occur in any area of urinary tract; mostly acute (fast and serious), some can have chronic

57
Q

chronic UTI

A

3+ UTIs in 12 months, bacteria persistent after 2 weeks of treatment

58
Q

more at risk for developing UTI

A

women 4x more likely d/t short urethra and closer proximity of urethral opening to anus; diabetes increased risk d/t increased sugar and decreased WBC and decreased circulation (bacteria like sugar); pt who rely on catheters to void

59
Q

when male has UTI…

A

more likely to be structurally related and associated with impaired flow of urine

60
Q

signs and symptoms of UTIs

A

frequent painful urgent burning urine, urine is red dark milky or cloudy, foul smelling, flank pain if uretitis or pyelonephritis, pressure in pelvic area, fever, fatigue, altered mental status, confusion in older adults

61
Q

gross hematuria

A

visible blood in urine to the eye

62
Q

diagnosing UTI

A

UA with culture: will show 2 or more WBCs, 15+ bacteria in high powered field, >10000 colony forming units of one bacteria, + for nitrates, + hematuria, + proteins

63
Q

pharmacological treatment for UTI

A

simple- trimethoprim/sulfamethazine aka bactrim, nitrofurantoin; complex- ciprofloxacin (can cause tendon rupture); pyridium analgesic for pain (may cause orange urine)

64
Q

glomerulonephritis

A

bilateral inflammation of the glomeruli following a previous streptococcal infection; can be acute or can be chronic

65
Q

causes of glomerulonephritis

A

epithelial layer of the glomerular membrane is disturbed

66
Q

signs and symptoms of glomerulonephritis

A

pitting edema, increased BP, strep infection (common cause), electrolyte imbalance, sore throat, foamy/bubbly pink/red urine

67
Q

complications associated with glomerulonephritis

A

CKD, ESRD, fluid overload, pulmonary edemat

68
Q

treatment of glomerulonephritis

A

chronic treated with anitbx, diuretics, vasodilators, corticosteroids; may need plasmapheresis, dialysis, or transplant

69
Q

renal calculi

A

can occur anywhere in the renal tract such as renal pelvic or calices; risk for development when too much of stone component like Calcium

70
Q

renal calculi predisposing factors

A

dehydration, infection, obesity, exercise, male

71
Q

types of stones

A

calcium oxalate and phosphate (associated with high calcium), struvite (associated with UTI), uric acid, cystine (seen in cystinuria)

72
Q

signs and symptoms of renal calculi

A

N/V, agonizing flank pain that radiates to groin abdomen or testicles, sharp sudden severe pain, hematuria, dysuria, urinary frequency

73
Q

diagnosing renal calculi

A

ultrasound, IVP (intravenous pyelogram to look at ureter and kidneys), renal stone analysis, KUB xray (kidney ureter bladder scan), serum (calcium oxalate and uric acid)

74
Q

treatment for renal calculi

A

calculi </= 4mm have 80% chance of passing with vigorous hydration (will hurt), removal of stone via lithotripsy (ultrasonic waves to break up) or nephrolithotomy (invasive procedure going into kidney to break up or remove); admin analgesics, diuretics, thiazides (decrease calcium excretion in urine)

75
Q

after renal calculi has passed

A

want to determine composition of stone and consult dietary for change of diet

76
Q

hemodialysis

A

removal fluid, electrolytes, toxins from blood across a semipermeable membrane; loosens and separates impurities from blood; most efficient form of dialysis

77
Q

indications for hemodialysis

A

ESRD, metabolic acidosis, poisonings to clear drug or toxins, AKI, hyperkalemia unresponsive to therapy, FVE in anuric patient

78
Q

End stage renal disease

A

GFR < 5-10mL/min (GFR<15); BUN > 80-100mg/dL
Creatinine >/= 8

79
Q

Vascular access for hemodialysis

A

central venous line, AV fistula, AV graft

80
Q

central venous line for HD

A

acute access but temporary, use subclavian or internal jugular or femoral; cons- thrombosis, hematoma, not enough blood flow

81
Q

AV fistula

A

rapid blood flow that is surgically created; connects artery and vein; takes 2-3 months to mature and lasts 3 years; pros- long lasting, not prone to infection, excellent blood flow, can shower, less likely to form clots; cons- needs to mature before use and requires direct needle into skin

82
Q

AV graft for HD

A

used when unable to create fistula; inadequate blood vessel, 2-5 weeks to mature, lasts 2 years; pros- excellent blood flow, shower after heals; cons- less time than fistula, more prone to infection, 2 weeks before using, clotting

83
Q

fistula pt education

A

Do: lanolin for dry skin, check bruit frequently, report bleeding or oozing of patch, wear medic alert bracelet, hold pressure for 20 min following access; DONTs: no blood draw/IV/BP, no tight clothing/jewelry, no lifting heavy items, do not bump, no itching or picking scabs

84
Q

length of dialysis treatment

A

can be continued for 5-10 years

85
Q

requirements for HD

A

anticoagulation and BP sufficient enough to remove 1 pint of blood at one time

86
Q

peritoneal dialysis

A

dialysis takes place across peritoneal membrane; dialysate solution is warmed to body temp and infused into peritoneum; can be intermittent (3-5x a week for 8-12hr), continuous ambulatory (infused, dwells for 4-5 hrs, drains for 4-5 hrs), or cyclic continuous (intermittent night time cycling with day time ambulatory); collection bag must be below

87
Q

complications of PD

A

peritonitis or infection at site, obstruction of flow, abdominal or discomfort, bleeding, HTN encephalopathy, ESKD, electrolyte disorders, dysrhythmias, resp. distress

88
Q

continuous renal replacement therapy (CRRT)

A

used for hemodynamically unstable patients like those in ICU setting; slow continuous microfiltration; need A line for accurate pressure readings

89
Q

kidney transplantq

A

used for those who cannot receive dialysis; human donor to recipient; tissue matching and immunosuppression is essential (type and screen)

90
Q

tissue matching prior to kidney transplant

A

type and screen, Physical exam (papsmear), tissue typing, antibody screen, CXR, EKG, GI, cardiac workups, hep B, hep C, HIV, CMV

91
Q

post-op care of recipient (kidney transplant)

A

immunosuppression, monitor for and prevent infection, monitor incision, monitor vitals, assess cardiac and respiratory, monitor urine output and labs, maintain semi-fowlers, pain management, manage urinary catheter; surger is about 3-4 hrs

92
Q

kidney rejection

A

hyperacute- during surgery, acute- right after surgery, chronic- months to years after surgery; kidney will turn grey; detected via symptoms, rising creatinine, US for kidney size, biopsy

93
Q

ongoing concern with kidney transplant recipients

A

chronic immunosuppression put patient at high risk for developing infection

94
Q

contraindications to hemodialysis

A

inability to be anticoagulated, severe cardiac disease, hemodynamic instability

95
Q

peritoneal dialysis drainage should be…

A

light yellow clear drainage

96
Q

normal BUN, creatinine, GFR

A

GFR want >90mL/min; BUN normally 10-20
creatinine for men 0.74-1.35 mg/dL
creatinine for women 0.59-1.04 mg/dL; BUN to creatinine ratio usually 10-20:1

Adults 2 (7 decks)

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