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NURS 2360 Med/Surg > EXAM 3 > Flashcards

EXAM 3 Flashcards

1
Q

What is the normal GFR

A

90-120

it will DECREASE with kidney disease

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2
Q

osmotic diuretic

A

mannitol

causes osmotic diuresis

mostly for NEURO

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3
Q

loop diuretics

A

reduces the reabsorption of Na+, Cl-, and K+

decreases blood volume

water leaves body

monitor electrolytes especially K+

monitor BP

monitor for lightheadedness, dizziness

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4
Q

thaizaide diuretics

A

hydrochlorothiazide

inhibits soidum transport

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5
Q

spironolactone

A

do NOT use in reanl disease b/c kidney already strugglng to get rid of K+

potassium sparing diuretic

monitor Na and K+

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6
Q

carbonic anhydrase inhibitors

A

acetozalamide, brinzolamide

for glaucoma

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7
Q

nursing implications diuretics

A

monitor I & O

monitor electrolytes especially K+ and Na+

monitor V/S

if taking potassium sparing diuretics do not ue salt substitutes

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8
Q

urinary calculi risk factors

A

family or personal hx

immobility or sedentary life

gout

hyperparathyroidism

repeated UTI

dehydration

diet high in proteins and sodium

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9
Q

Urinary Calculi - Calcium

A

can detect on xray

oxalate most common

diet or phosphate

bone disease, hyperparathyroidism, dehydration,

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10
Q

struvite/magnesium ammonia phosphate stone

A

most commonly from bacterial UTI

gram negative bacteria

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11
Q

Uric Acid Stones

A

gout

diet high in purines: organ meats, anchovies, sardines, liver, beef, game meats, beer, legumes

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12
Q

cystine stones

A

genetic metabolic disorder

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13
Q

clinical manifestations urinary calculi

A

pain

blockage of urine flow

tissue trauma

N/V

pallor

hematuria

fever/chills

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14
Q

diagnostic tests kidney stones

A

Urinalysis - hematuria, bactiera, crystal fragments

24 hour urine - calcium, uric acid, oxalate

chemical analysis of of passsed stone

serum blood tests - calcium, phosphorus, uric acid, BUN, creatinine

xray, u/s, CT scan

may need IVP or cystoscopy

clinical picutre

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15
Q

kidney stone treatment

A

hydration, increase activity

morphine sulfate

NSAID: ibuprofen, acetaminophen, indomethacin

tamsulosin (Flomax) relax muscles in ureter

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16
Q

lithotripsy

A

1.5-2.0 sized stones

uses waves or sound waves to crush stones

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17
Q

prevent future stones

A

adequte fluid intake

calcium stones: reduce sodium intake, maintain normal blood calcium, reduce foods high in oxlate (spinach, nuts, wheat bran)

uric acid stones: limit animal protein, low purine

medications: thazide diuretics, allopurinol, antibiotics (stuvite)

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18
Q

glomerulonephritis

A

inflammation/infection of the glomular apillary membranes: acute or chronic

acute: immune response d/t infection. streptococcus most common

chronic: d/t vascular damage of nephrons d/t diabetes, HTN, systemic lupus erythematous

allows passage of protein from blood to urine, decrease in blood volume tirgers R-A-A-S causing retention of Na+ and h2o. Adds to amount of total body fluid - visous cycle

can lead to nephrotic syndrome

leaking into kidney is less than leaking out.

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19
Q

clinical manifestations of glomerulonephritis

A

may be asymptomatic or have abrupt onset

flank, mid-abdominal pain

malaise

fever

N/V

edema (periorbital, feet, ankles)

plueral effusion - crackles, cough, dyspnea

acute HTN

hematuria

nephrotic syndrome

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20
Q

nephrotic syndrome

A

problem w/ glomerular fuction “leak” glomerulous

result of increased glomerular capillary membrane permeability (glomeruli are kidneys filters)

protein can pass from blood through the glomerular capillary into urine so pt. has HYPOproteinemia

21
Q

S/S of nephrotic syndrome

A

hypoalbuinemia & hypoporteinemia

proteinuria, albuminuria

progressive edema

hematuria

hypertension

severe headache

22
Q

nephrotic syndrome diagnostic

A

clinical picture

cultures to identify infection

labs- BUN, creatinine, electrolytes, protein, albumin, ESR

urinalysis

kidney scan or biopsy

23
Q

nonpharmacological treatment of glomerularnephritis/nephrotic syndrome

A

identify underlying cause

bedrest during acute glomerulonephritis

fluid/electrolyte balance - monitor I&O, daily weights, BP, electrolytes

diet: low sodium, potassium, protein and pohphorus

24
Q

pharmacological treatment of glomerulonephritis and nephrotic syndrome

A

diuretics to reduce edema

antihypertensives (Hydralazine)

antibioitcs - KEY

ACE inhibitors cause a decrease in intraglomerular capillar pressure

steroids

25
Q

Acute Pyelonephritis

A

inflammation and infection of the renal pelvis and tissue

usually from UTI

small abcess form on surface of kidney

may lead to chronic pyelonephritis, perminant kidney damage, chronic kidney disease

could lead to sepsis

26
Q

Clinical manifestations of acute pyelonephritis

A

look very ill

fever, chills, N/V, flank pain, CVA tenderness, H/A, muscle pain, malaise

hematuria, pyuria, fould smelling urine

27
Q

pyelonephritis diagnostics

A

U/A, urine C&S

intervenous pyelogram, renal U/S, CT scan

WBC, blood cultures

28
Q

treatment pyelonephritis

A

antibioitcs

increase fluids

follow up UA and C&S

29
Q

Acute kidney injury

A

abrupt decline in GFR

inability to excrete wastes

maintain fluid/electrolyte balance

maintain hormone production, RBC production

30
Q

Cuase of AKI

A

ischemia and exposure to nephrotoxins

also major sx, sepsis, and severe pneumonia

31
Q

Causes of AKI

A

prerenal - hypoperfusion leads to AKI, does not directly effect kidney tissue

intrarenal - direct damage to kidney

postrenal - usually from obstruction

32
Q

prerenal AKI causes

A

anything that decreases vascular volume, cardiac output, systemic vascular resistence

ex. dehydration, hemorrhage, hypovolemia, renal artery stenosis/occlusion, hypotension, sepsis, medications

decreased perfusion leads to decersaed GFR

reverses rapidly when blood flow restored and renal parenchyma undamaged

33
Q

causes of intrarenal AKI

A

direct damage to kidney

nephrotoxins - aminoglycoside antibiotics: gentamycin, vancomycin, neomycin, tobramycin

NSAIDS

contrast dye

glomerulonephritis

rhabdomylosis

lupus

Acute tubular necrosis

34
Q

postrenal causes of AKI

A

obstruction of urinary tract

stones, fibrosis

35
Q

anuria

A

<100 mL in 24 hours

36
Q

oliguria

A

100-400 mL in 24 hours

37
Q

polyuria

A

excessie urine in 24 hours

38
Q

initiation phase of AKI

A

from insult to injury

begins w/ initiating event and ends with tubular injury

if intervene now can stop progress

often asymptomatic

39
Q

maintance phase AKI

A

unstable period, severe drop in GFR

urine output usually less than expected

oliguria, non-oliguria

salt/water retention causes: edema, hyperkalemia, imparied potassium excretion, metabolic acidosis, anemia, confusion

40
Q

recovery phase AKI

A

process of tubular cell repair

return of GFR to normal

intially abnormally large amounts of urine exceted (polyuria)

tubular function begins to recover

increased diuresis may cause low BP, low fluid volume, cloesly monitor

continues up to 1 year

41
Q

detecting AKI

A

always watch out for small changes in creatinine, urine output

42
Q

AKI treatment

A

fluid electrolyte balance - replace electrolytes if needed, fluid restrictions, treat eleveated electrolyte levels

monitor EKG related to hypokalemia: sodium polystyrene sulfonate, k cocktail

diuretics carefully

fluid management

maintain glycemic control

dialysis or CRRT

43
Q

chronic kidney disease

A

progressive reduction of functioning nephrons

irreversable

results in uremia and inability to remove nitrogenous wastes

44
Q

CKD causes

A

diabetes

HTN

chronic glomerulonephritis

chronic pyelonephritis

polycystic kidney disease

systemic lupus

45
Q

CKD patho

A

GFR falls

BUN/creatinine rises in blood

urine creatinine decreases

46
Q

stage 5 CKD

A

highest stage

azotemia - nitrogen in blood

uremia - urea in blood

47
Q

clinical manifestations of CKD

A

fluid/electrolyte/acid-base balance

cardiovascular effects

hematologic effects

immune effects

pruitits

48
Q

CKD collarboative care

A

control underlying disease

BP control - ACE or ARB (ACE kidney protective)

diet: low protein, low salt, low potassium

avoid nephrotoxins

keep hbA1C ~ 7

continue activity

49
Q

CKD medications

A

calcium preopations and phosphours binders - to precent renal osteodystrophy

sevelamer & calcium acetate - biind to and exrete phosphorus

supplemental calcium - vitamin D

nephrocaps

sodium bicarb

erythropeoietin for anemia

sodium ploystrene sulfonate

antihypertensives - ACE

diuretics - lasix

NURS 2360 Med/Surg (6 decks)

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