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NURS 313R > Exam 3: Urinary/Renal Diseases And Chronic Renal Disease Dialysis > Flashcards

Exam 3: Urinary/Renal Diseases And Chronic Renal Disease Dialysis Flashcards

1
Q

Chronic Kidney Disease

A

Involves the progressive, irreversible destruction of the nephrons of both kidneys.

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2
Q

End Stage Renal Disease

A

occurs when GFR is less than 15 mL/min

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3
Q

Clinical Manifestations of Chronic Kidney Disease

A

-Uremia
-Metabolic Disturbances
-Electrolytes/Acid Base Imbalances
Other symptoms listed on other cards.

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4
Q

Uremia

A

Syndrome that incorporates all s/s in CKD

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5
Q

Clinical Manifestations of Chronic Kidney Disease: Urinary System

A

..

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6
Q

Clinical Manifestations of Chronic Kidney Disease: Hematologic

A

..

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7
Q

Clinical Manifestations of Chronic Kidney Disease: Cardiovascular System

A

..

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8
Q

Clinical Manifestations of Chronic Kidney Disease: Respiratory System

A

..

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9
Q

Clinical Manifestations of Chronic Kidney Disease: GI System

A

..

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10
Q

Clinical Manifestations of Chronic Kidney Disease: Neurologic System

A

..

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11
Q

Clinical Manifestations of Chronic Kidney Disease: Musculoskeletal System

A
  • Renal osteodystrophy
  • Osteomalacia
  • Ostietis fibrosa
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12
Q

Renal Osteodystrophy

A

..

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13
Q

Osteomalacia

A

Lack of minerals.

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14
Q

Ostietis Fibrosa

A

Calcium reabsorption

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15
Q

Clinical Manifestations of Chronic Kidney Disease: Integumentary

A

Uremic frost

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16
Q

Clinical Manifestations of Chronic Kidney Disease: Reproductive System

A

..

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17
Q

Clinical Manifestations of Chronic Kidney Disease: Endocrine System

A

..

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18
Q

Clinical Manifestations of Chronic Kidney Disease: Psychologic System

A

..

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19
Q

Diagnostic Studies for Chronic Kidney Disease

A
  • History and Physical
  • Renal ultrasound
  • Renal scan
  • CT scan
  • Renal biopsy
  • BUN,Srum Creatinine
  • Serum electrolytes
  • U/A, C/S
  • Hemoglobin and Hematocrit
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20
Q

Collaborative Care Goals for Chronic Kidney Disease

A
  • Preserve existing renal function
  • Treat clinical manifestation
  • Prevent complication
  • Provide for patient’s comfort
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21
Q

Collaborative Care for Chronic Kidney Disease

A
  • Drug Therapy

- Nutritional Therapy

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22
Q

What nutritional therapy should be implemented in patients with chronic kidney disease?

A
  • Protein Restriction
  • Sufficient calories from carbs and fat
  • Water restriction
  • Sodium and Potassium Restriction
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23
Q

Nursing Therapeutics for Chronic Kidney Disease: Identify

A
  • Identify risk factors
  • Identify s/s of fluid overload
  • Identify s/s of electrolyte imbalance
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24
Q

Nursing Therapeutics for Chronic Kidney Disease: Assess/Monitor

A
  • Monitor Renal Function
  • Daily weight and BP
  • Hemodialysis or peritoneal dialysis
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25
Q

What should you teach a patient about chronic kidney disease?

A

Teach patient and family about diet and drugs.

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26
Q

Dialysis

A
  • Is the movement of fluid and molecules across a semipermeable membrane from one compartment to another.
  • A technique in which substances move from the blood through a semipermeable membrane and into a dialysis solution (dialysate).
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27
Q

Dialysis is initiated when

A

GFR (Creatine clearance) is < 15 mL/min

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28
Q

What are 2 methods of dialysis?

A
  • Peritoneal Dialysis

- Hemodialysis

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29
Q

What processes are involved in dialysis ?

A
  • Diffusion
  • Osmosis
  • Ultrafiltration
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30
Q

Peritoneal Dialysis

A
  • Obtained by inserting a catheter through the anterior of the abdomen.
  • Tip fo the catheter rests on the peritoneal cavity.
31
Q

What are 3 Phases of the Peritoneal Dialysis Cycle?

A
  1. Inflow
  2. Dwell Phase
  3. Drain
32
Q

Complications of Peritoneal Dialysis includes

A
  • exit site infection
  • peritonitis
  • abdominal pain
  • outflow problem
  • hernia
  • lower back problem
  • bleeding
  • pulmonary complication
  • protein loss
  • carbohydrate and lipid abnormalities
33
Q

Hemodialysis: Needs

A
  • a very rapid blood flow

* access to large blood vessel

34
Q

Vascular Access for Hemodialysis

A
  • Shunts

- Arteriovenous Fistula/Graft

35
Q

Shunts

A

U shape silastic tube divided at the mid-point and each of the two ends is palced in an artery and a vein.

36
Q

Arteriovenous Fistula/Graft includes

A

AVF and AVG

37
Q

AVF

A

Anastomoses between an artery and vein

38
Q

AVG

A

Synthetic graft is used.

Forms a bridge between arterial and venous blood supplies.

39
Q

Hemodialysis Procedure

A
  • 2 needles are inserted into the fistula or graft (1 to pull blood to the machine , 2nd to return blood back to the circulation)
  • Bruit / thrill created by arterial blood rushing into the vein
  • Do not take BP / IV insertion and venipuncture on the affected access.
40
Q

Complications of Hemodialysis includes

A
  • Hypotension
  • Muscle cramps
  • Loss of blood
  • Hepatitis
  • Sepsis
41
Q

Urinalysis

A

General examination of urine to establish baseline information or provide data to establish a tentative diagnosis and determine whether further studies are to be ordered

ASEPTIC TECHNIQUE

42
Q

Nursing Responsibilities for Urinalysis

A
  • Obtain specimen first urinated in morning- will be more concentrated
  • Ensure specimen is examined WITHIN 1 HOUR OF URINATING
  • Be sure to wash perineal area if soiled with menses or fecal material
43
Q

Creatinine Clearance

A

Measures waste product of protein breakdown.

44
Q

Nursing Responsibility for Creatinine Clearance

A
  • Discard first urination when test is started
  • Save urine from all subsequent urinations for 24 hr
  • Instruct patient to urinate at end of 24 hr and add specimen to collection
  • Ensure that serum creatinine is determined during 24-hr period
45
Q

Urine Culture

A

Must be clean-midstream catch

Done to confirm suspected UTI and identify causative organisms.

46
Q

Nursing Responsibility for Urine Cultures

A
  • Use sterile container for collection of urine
  • Touch only outside of container
  • For women, separate labia with one hand and clean meatus with other hand, using at least three sponges (saturated with cleansing solution) in a front-to-back motion
  • For men, retract foreskin (if present) and cleanse glans with at least three cleansing sponges
  • After cleaning, instruct patient to start urinating and then continue voiding in sterile container
  • The initial voided urine flushes out most contaminants in the urethra and perineal area
  • Catheterization may be needed if patient is unable to cooperate with procedure
47
Q

BUN

A

Measures concentration of urea in the blood.

Used to identify presence of renal problems.

48
Q

BUN: normal interval

A

6-20 mg/dL (2.1-7.1 mmol/L)

49
Q

High urea in the urine can indicate

A

Decreased kidney function.

50
Q

Blood Chemistries: Creatinine

A

-More reliable than BUN as a determinant of renal function.

51
Q

Creatinine is an end product of

A

Muscle and protein metabolism and is liberated at a constant rate.

52
Q

Creatine Clearance: normal range

A

0.6-1.3 mg/dL (53-115 mmol/L)

53
Q

BUN/Creatine Ratio

A

10:1
Reference interval: 12:1 to 20:1 (from the book)
If it is not balanced, then one or other is unbalanced.

54
Q

Elevated levels of potassium can lead to

A

Muscle weakness and cardiac dysrhythmias

55
Q

Calcium

A

Main mineral in bone and aids in muscle contraction, neurotransmission and clotting.

56
Q

In renal diseases, decreased reabsorption of Ca leads to

A

Renal osteodystrophy

57
Q

Calcium is associated with

A

Low levels of calcitrol which is essential to absorb Ca in the GI tract

58
Q

Normal Calcium Range

A

9-11 mg/dL

59
Q

Phosphorus

A

Balance is inversely related to Ca balance

60
Q

In renal disease, phosphorus levels are

A

Elevated because the kidney is the primary excretory organ

61
Q

Normal phosphorus levels

A

2.8-4.5 mg/dL

62
Q

Bicarbonate

A

Most patients in renal failure have metabolic acidosis and low serum bicarb levels.

63
Q

Normal Bicarbonate Levels

A

22-26

64
Q

Why should patients with significantly decreased renal function NOT have IVP?

A

Because contrast media can be nephrotoxic and worsen renal function.

65
Q

Intravenous Pyelogram

A

Visualizes urinary tract after IV injection of contrast media.

66
Q

Nursing Responsibility for IVP

A

Evening before procedure, cathartic or enema is given to empty colon of feces and gas
NPO 8 hours prior to procedure.
Warmth, flushed face and salty taste may occur after injection of contrast media.

67
Q

Renal Arteriogram

A

Visualizes renal blood vessels.

Must watch for bleeding in the groin.**

68
Q

Nursing Responsibilities for Renal Arteriogram after procedure

A

MAINTAIN BED REST WITH AFFECTED LEG STRAIGHT
Place pressure dressing over femoral artery injection site.
Observe for complications.

69
Q

Renal Biopsy

A

Done to obtain renal tissue to determine type of renal disease or to follow progress of renal disease.

70
Q

Osteomalacia: Demineralization that results from

A

Slow bone turnover

Defective mineralization of newly formed bone

71
Q

Osteomalacia results form

A

Parathyroid hormone suppression R/T:
Increased calcium intake
Increase vitamin D dosage
Presence of DM

72
Q

Ostietis Fibrosa: Decalcification of

A

Bone

Replacement of bone tissue with fibrous tissue (very fragile and easily broken)

73
Q

Ostietis Fibrosa: Results from

A

Elevated PTH that causes bone resorption and softening.

74
Q

Uremic “red eye”

A

Caused by irritation of calcium deposits.

NURS 313R (18 decks)

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