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M/S 3 > Exam 4 - Nephro > Flashcards

Exam 4 - Nephro Flashcards

1
Q

kidneys produce urine through these 3 process

A

glomerular filtration
tubular reabsorption
tubular secretion

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2
Q

the leading cause of chronic kidney disease

A

glomerulonephritis

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3
Q

primary glomerulonephritis can be ___ or ___

A

immunologic; idopathic

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4
Q

examples of causes of primary glomerulonephritis

A

acute/chronic glomerulonephritis
nephrotic syndrome

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5
Q

examples of causes of secondary glomerulonephritis

A

diabetic nephropathy
lupus nephritis

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6
Q

glomerulonephritis has an increase in ___, ___, and ___

A

hematuria
proteinuria
edema

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7
Q

decreasing GFR leads to ___ and ___

A

azotemia; HTN

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8
Q

increased aldosterone leads to ___ and ___ retention

A

salt; water

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9
Q

GFR range for dialysis to be considered

A

10-15

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10
Q

what can cause post infectious glomerulonephritis

A

strep or viral infections

often involves children but can affects adults

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11
Q

post infectious glomerulonephritis may resolve in __ to __ days

A

10-14 days

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12
Q

s/sx of post infectious glomerulonephritis

A

abrupt onset
hematuria
proteinuria
salt + water retention
brown, cola colored urine
HTN
edema (hands, upper extremities)
fatigue
anorexia
N/V

less apparent in older adults

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13
Q

what is anti-glomerular basement glomerulonephritis (anti GBM)

A

severe glomerular injury without specific cause

progresses to renal failure within months

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14
Q

s/sx of anti GBM

A

weakness
N/V
abdominal or flank pain
hx of URI
hematuria
proteinuria
edema
oliguria (ominous sign)
mild-life threatening pulmonary hemorrhage
Goodpasture’s syndrome

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15
Q

what is Goodpasture’s syndrome

A

antibodies have built up in the area and produces protein

attacks its own membrane

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16
Q

nephrotic syndrome is a group of ___ ___ as opposed to a specific disorder

A

clinical findings

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17
Q

nephrotic syndrome will have a massive amount of which 4 things

A

proteinuria
hypoalbuminermia
hyperlipidemia
edema

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18
Q

most common complication of nephrotic syndrome

A

thromboemboli

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19
Q

nephrotic syndrome diet

A

low fat
low cholesterol
1-2 G Na restriction

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20
Q

meds for nephrotic syndrome

A

ACE-I (reduce protein loss)
anticoags
diuretics
statins

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21
Q

chronic glomerulonephritis is typically the result of…

A

anti-GBM
lupus nephritis
diabetic nephropathy

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22
Q

is chronic glomerulonephritis alway able to be identified

A

No

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23
Q

slow, progressive destruction of the glomeruli and a gradual decline in renal function

A

chronic glomerulonephritis

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24
Q

goal of chronic glomerulonephritis

A

preserve renal function

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25
Q

s/sx of chronic glomerulonephritis

A

insidious
anemia
low Ca
elevated K
low albumin
mental changes
metabolic acidosis
gallop
cardiomegaly
CHF
crackles in base of lungs

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26
Q

what are you looking for in a UA with glomerulonephritis

A

CAST
protein

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27
Q

glomerulonephritis treatment

A

bedrest (acute stage)
1-2 G Na restriction
protein restriction (if azotemia is present)
plasmapheresis
dialysis

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28
Q

what to monitor daily with glomerulonephritis

A

I&O
daily weight
fluid restriction

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29
Q

what are the 2 types of vascular kidney disease

A

HTN
renal artery stenosis

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30
Q

this can be a result of or cause of kidney damage

A

vascular kidney disease: HTN

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31
Q

what is malignant HTN

A

DBP > 120

more common in African Americans

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32
Q

primary cause of VKD: renal artery stenosis

A

atherosclerosis

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33
Q

VKD: renal artery stenosis is suspected when…

A

HTN before 30 y/o OR after 50 y/o with no prior hx of HTN

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34
Q

s/sx of VKD: renal artery stenosis

A

epigastric bruit
s/sx of vascular insufficiency

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35
Q

how to dx VKD: renal artery stenosis

A

renal US
captopril test
renal arteriogram

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36
Q

what to assess with a renal arteriogram

A

consents on chart (invasive procedure)
DC anticoags, antiplt prior
assess distal pedal pulses
monitor for hemorrhage at puncture site

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37
Q

VKD: renal artery stenosis treatment

A

ACE, ARB
diuretics
low dose ASA
statins
percutaneous transluminal angioplasty
bypass graft

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38
Q

risk factors for VKD: renal vein occlusion

A

abd trauma
sx/angiography vessel trauma
aortic, renal artery aneurism
atherosclerosis of aortic or renal artery

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39
Q

s/sx of renal vein occlusion

A

asymptomatic (if developed slowly)
sudden, severe flank pain
N/V
fever
HTN
hematuria
oliguria

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40
Q

VKD: renal vein occlusion secondary to thrombus formation may be caused by….

A

nephritis
pregnancy
oral contraceptives
malignancies

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41
Q

kidney trauma is usually associated with ___ ___ trauma

A

blunt force

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42
Q

example of minor vs. major blunt force trauma

A

minor: contusion
major: laceration

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43
Q

example of minor vs. major penetrating kidney trauma

A

minor: laceration of capsule
major: laceration of parenchymavascular supply

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44
Q

kidney trauma s/sx

A

hematuria
abd/flank pain
oliguria/anuria
swelling, eccymoses in flank (Turner’s)
shock s/sx

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45
Q

minor kidney trauma interventions

A

bedrest
monitor

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46
Q

major kidney trauma interventions

A

control hemorrhage
prevent shock
surgery: partial, total nephrectomy; percutaneous arterial embolization

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47
Q

postop kidney surgery dressing changes are done under which technique

A

aseptic

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48
Q

nephrostomy tube interventions

A

inspect daily
keep dressing clean, dry, secure
assess for kinks
drain bag when halfway full

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49
Q

what to do if nephrostomy tube becomes dislodged

A

call HCP immediatley

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50
Q

nephrostomy tube education/when to call HCP

A

s/sx of infection
leak around tube
unable to flush tubing

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51
Q

sudden cessation of renal function when blood flow to the kidney is compromise

A

AKI/AKF

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52
Q

most common cause of AKI

A

ischemia
sepsis
nephrotoxins

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53
Q

AKI risk factors

A

trauma
sx
infection
hemorrhage
CHF
liver disease
UTI
drugs and radiologic contrast
old adults more at risk

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54
Q

prerenal/category 1 AKI causes

A

factors that reduce systemic circulation causing reduction in renal blood flow

severe dehydration
HF, decreased CO
decrease GFR

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55
Q

intrarenal/category 2 AKI causes

A

conditions that cause direct damage to the kidneys

prolong ischemia
nephrotoxins
Hgb released from hemolyzed RBCs
myoglobin released from necrotic muscle cells

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56
Q

intrarenal/category 2 AKI will lead to ___ ___ ___

A

acute tubular necrosis

57
Q

is acute tubular necrosis reversible

A

potentially, if caught early

58
Q

postrenal/category 3 AKI causes

A

mechanical obstruction of outflow

BPH
prostate ca
calculi
trauma
extrarenal tumors
bilateral ureteral obstructions

59
Q

what are the 3 major manifestion phases of AKI

A

oliguric
diuretic
recovery

60
Q

what occurs during initiation of AKI

A

whatever is causing the kidney to malfunction…

prostate, severe dehydration, etc

61
Q

what occurs during the oliguric phase of AKI

A

hyponatremia (can lead to cerebral edema)
hyperkalemia
leukocytosis
elevated BUN, Crt
fatigue
difficulty concentrating
seizures
stupor, eventual coma

62
Q

how much urine is be excreted during the diuretic phase of AKI

A

1-3 L/daily
can reach 5L +

63
Q

what to monitor for with diuretic phase of AKI

A

hyponatremia
hypokalemia
dehydration

GFR may begin to improve
putting out more urine but it is not being filtered

64
Q

how long can the recovery phase last

A

12 months

65
Q

AKI Dx test

A

UA
serum Crt, BUN, electrolytes
ABG
CBC
renal US
CT
IVP
renal bx

66
Q

what is key with AKI

A

F/E balance

67
Q

AKI meds

A

dopamine
lasix, bumex (1-2mg at most)
mannitol
ACE
PPI, H2 blockers, antacids
kayexalate (PO, NGT, enema)
Na bicarb

68
Q

what is increased in the diet with AKI and why

A

carbs to maintain calorie intake and protein sparing effect

69
Q

what types of food may be restricted with AKI

A

bananas
citrus fruits
dairy products

70
Q

what is dialysis

A

movement of fluid/molecules across a semipermeable membrane from one compartment to another

71
Q

when is dialysis used

A

correct F/E imbalances
remove waste products in renal failure
tx severe drug OD

72
Q

general principle of dialysis is ___ and ___

A

osmosis
ultrafiltration

73
Q

how is hemodialysis performed

A

3-4 x’s weekly as indicated

74
Q

hemodialysis contraindication

A

hemodynamically unstable

75
Q

complications of hemodialysis

A

hypotension
bleeding
infection
muscle cramps
hepatitis

76
Q

dialyzer and blood lines are primed with which solution and why

A

saline to eliminate air

77
Q

what to flush dialyzer when completed and why

A

saline to remove all blood

78
Q

what to do after removing need for dialysis

A

apply firm pressure

79
Q

nursing interventions prior to hemodialysis

A

assess fluid status
assess access
temp
skin condition
weight

80
Q

nursing interventions during hemodialysis

A

alert to changes in condition
VS q30-60 minutes

81
Q

can hemodialysis fully replace metabolic and kidney function

A

No

82
Q

when to administer meds re: hemodialysis treatment

A

after

83
Q

when to avoid BP meds re: hemodialysis treatment

A

4-6 hours prior

84
Q

how long does a fistula have to mature before use

A

minimum of 6 weeks

85
Q

dialysis disequilibrium syndrome s/sx

A

HA
N/V
altered LOC
HTN

86
Q

how many needs are placed in the AVF or graft for hemodialysis

A

2

87
Q

purpose red catheter/fistula needle and blue catheter/2nd needle re: hemodialysis

A

red: pulls blood from pt
blue; blood is returned to pt

88
Q

continuous renal replacement therapy for AKI is used if pts are ___ ___

A

hemodynamically unstable

89
Q

what occurs during continuous renal replacement therapy (CRRT)

A

blood is continuously circulated from an artery or vein through a hemofilter for a period of 8-12 hours

blood is pulled in a very low quantity

90
Q

CRRT can be used in conjunction with ___

A

hemodialysis

91
Q

contraindication for CRRT

A

uremia that requires rapid resolution

92
Q

how long is CRRT continued

A

30-40 days

93
Q

how often to change CRRT hemofilters

A

q24-48 hours

94
Q

CRRT ultrafiltrate should be what color

A

clear yellow

95
Q

what are the 2 types of CRRT access devices

A

venous *most common
arterial

96
Q

what med will be given with CRRT

A

heparin

97
Q

what are the 3 phases/1 cycle of exchange re: peritoneal dialysis

A

inflow (fill)
dwell (equilibration)
drain

98
Q

peritoneal access is where

A

catheter through the anterior wall

tenckhoff catheter

99
Q

after tenckhoff cath is inserted what is done

A

skin is cleaned with antiseptic solution
sterile dressing applied
secure to abd with tape

100
Q

waiting period after cath insertion for peritoneal dialysis

A

7-14 days

101
Q

can a pt bathe with peritoneal dialysis cath

A

no, only showers; must pay dry

102
Q

peritoneal dialysis solution temperature

A

warm (98.6), do not infuse cold
use low setting heat pad

103
Q

what occurs during inflow

A

Rx about of solution infused through est cath over about 10 minutes

after infused, clamp is closed

104
Q

what to do if pt c/o pain or cramping during inflow

A

reduce, slow the rate

105
Q

what must be done with the infusion bag before and after

A

weight

106
Q

what occurs during dwell

A

diffusion and osmosis occur between the pts blood and peritoneal cavity

duration of time varies

107
Q

how long is the drain time

A

15-30 minutes

108
Q

may be help with drain time

A

gentle massaging abd
changing positions

109
Q

automated peritoneal dialysis (APD) vs. continuous ambulatory peritoneal dialysis (CAPD)

A

A: timer; usually at HS; 2-3 exchanges while sleeping
C: manual; QID

110
Q

peritoneal dialysis complications

A

exit site infection
peritonitis
hernias
lower back probs
bleeding (pink first 24-36 hrs okay)
pulmonary complications
protein loss

111
Q

benefits of peritoneal dialysis

A

short training program
independence
ease of traveling
fewer dietary restrictions
greater mobility

112
Q

peritoneal dialysis pre treatment assessment

A

VS
abd firth
respiratory assessment

113
Q

what to record with peritoneal dialysis treatment

A

amount, type of dialysate
dwell time
amount, characteristics of return

114
Q

nephrotoxic drugs

A

aminoglycosides
PCNs
NSAIDS
cephalosporins
chemo agents

115
Q

progressive, irreversible renal tissue destruction and loss of function

A

chronic renal disease/chronic renal failure

116
Q

chronic renal failure is common in which 2 groups

A

African Americans
Native Americans

117
Q

leading cause of CKD

A

DM followed by HTN

118
Q

CKD is dx when GFR is < __ for longer than 3 months

A

60

119
Q

those with CKD are often ___

A

asymptomatic

120
Q

ESRD occurs when GFR is < __

A

< 15

121
Q

s/sx of CKD

A

uremia (urine in blood)
nausea
apathy, weakness, lethargy
confusion
F/E imbalances
effects: cardio, hematologic, immune system, GI, neuro, musculo, endo, metabolic, and dermatologic

122
Q

CKD Dx studies

A

UA
urine culture
BUN, Crt
Crt clearance
serum electrolytes
CBC
renal US
kidney bx

123
Q

CKD meds

A

Lasix
ACE, ARB
diuretics
Na bicarb, Ca carbonate
kayexalate
folic acid
MVI
epogen
amphojel: antacid used to reduce phosphate levels

124
Q

CKD will have a strict ___ intake

A

protein

125
Q

Na, K, and Ph strictions

A

Na: 2-4 G daily
K: 3-3 G daily
Ph: 1 G daily

126
Q

cadaver donor qualifications

A

< 65 y/o
free of systemic disease, malignancy, infection including HIV, Hep B and C

127
Q

when is a donor considered a perfect match

A

human leukocyte antigen test; 6 antigens = perfect match

128
Q

kidney transplant contraindications

A

disseminated malignancies
refractory/untx’d cardiac disease
chronic respiratory failure
extensive vascular disease
chronic infection
unresolved psychosocial disorders

129
Q

how soon before transplantation is a live donor taken back for sx

A

1-2 hours before recipient
takes about 3 hours

130
Q

kidney transplant recipient preferred location

A

right iliac fossa

131
Q

transplant recipient intervention before incision

A

cath into bladder
abx solution instilled:
-distends bladder
-decreases risk of infection

132
Q

how long does recipient surgery take

A

3-4 hours

133
Q

when can a person return to work post transplant

A

4-6 weeks

134
Q

meds commonly used in combination with prednisone

A

cellcept
imuran

135
Q

S/E of long term corticosteroid use

A

impaired wound healing
emotional disturbances
osteoporosis
cushings effects

136
Q

3 types of transplant rejection

A

hyperacute: minutes to hours after
acute: days to months after
chronic: years after

137
Q

how often to monitor I&O after transplant

A

q30-60 minutes

138
Q

most common infections observed in the first month after transplant

A

PNA
wound
IV line, drain
UTI

M/S 3 (17 decks)

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