Exam 4 - Nephro Flashcards
kidneys produce urine through these 3 process
glomerular filtration
tubular reabsorption
tubular secretion
the leading cause of chronic kidney disease
glomerulonephritis
primary glomerulonephritis can be ___ or ___
immunologic; idopathic
examples of causes of primary glomerulonephritis
acute/chronic glomerulonephritis
nephrotic syndrome
examples of causes of secondary glomerulonephritis
diabetic nephropathy
lupus nephritis
glomerulonephritis has an increase in ___, ___, and ___
hematuria
proteinuria
edema
decreasing GFR leads to ___ and ___
azotemia; HTN
increased aldosterone leads to ___ and ___ retention
salt; water
GFR range for dialysis to be considered
10-15
what can cause post infectious glomerulonephritis
strep or viral infections
often involves children but can affects adults
post infectious glomerulonephritis may resolve in __ to __ days
10-14 days
s/sx of post infectious glomerulonephritis
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
what is anti-glomerular basement glomerulonephritis (anti GBM)
severe glomerular injury without specific cause
progresses to renal failure within months
s/sx of anti GBM
weakness
N/V
abdominal or flank pain
hx of URI
hematuria
proteinuria
edema
oliguria (ominous sign)
mild-life threatening pulmonary hemorrhage
Goodpasture’s syndrome
what is Goodpasture’s syndrome
antibodies have built up in the area and produces protein
attacks its own membrane
nephrotic syndrome is a group of ___ ___ as opposed to a specific disorder
clinical findings
nephrotic syndrome will have a massive amount of which 4 things
proteinuria
hypoalbuminermia
hyperlipidemia
edema
most common complication of nephrotic syndrome
thromboemboli
nephrotic syndrome diet
low fat
low cholesterol
1-2 G Na restriction
meds for nephrotic syndrome
ACE-I (reduce protein loss)
anticoags
diuretics
statins
chronic glomerulonephritis is typically the result of…
anti-GBM
lupus nephritis
diabetic nephropathy
is chronic glomerulonephritis alway able to be identified
No
slow, progressive destruction of the glomeruli and a gradual decline in renal function
chronic glomerulonephritis
goal of chronic glomerulonephritis
preserve renal function
s/sx of chronic glomerulonephritis
insidious
anemia
low Ca
elevated K
low albumin
mental changes
metabolic acidosis
gallop
cardiomegaly
CHF
crackles in base of lungs
what are you looking for in a UA with glomerulonephritis
CAST
protein
glomerulonephritis treatment
bedrest (acute stage)
1-2 G Na restriction
protein restriction (if azotemia is present)
plasmapheresis
dialysis
what to monitor daily with glomerulonephritis
I&O
daily weight
fluid restriction
what are the 2 types of vascular kidney disease
HTN
renal artery stenosis
this can be a result of or cause of kidney damage
vascular kidney disease: HTN
what is malignant HTN
DBP > 120
more common in African Americans
primary cause of VKD: renal artery stenosis
atherosclerosis
VKD: renal artery stenosis is suspected when…
HTN before 30 y/o OR after 50 y/o with no prior hx of HTN
s/sx of VKD: renal artery stenosis
epigastric bruit
s/sx of vascular insufficiency
how to dx VKD: renal artery stenosis
renal US
captopril test
renal arteriogram
what to assess with a renal arteriogram
consents on chart (invasive procedure)
DC anticoags, antiplt prior
assess distal pedal pulses
monitor for hemorrhage at puncture site
VKD: renal artery stenosis treatment
ACE, ARB
diuretics
low dose ASA
statins
percutaneous transluminal angioplasty
bypass graft
risk factors for VKD: renal vein occlusion
abd trauma
sx/angiography vessel trauma
aortic, renal artery aneurism
atherosclerosis of aortic or renal artery
s/sx of renal vein occlusion
asymptomatic (if developed slowly)
sudden, severe flank pain
N/V
fever
HTN
hematuria
oliguria
VKD: renal vein occlusion secondary to thrombus formation may be caused by….
nephritis
pregnancy
oral contraceptives
malignancies
kidney trauma is usually associated with ___ ___ trauma
blunt force
example of minor vs. major blunt force trauma
minor: contusion
major: laceration
example of minor vs. major penetrating kidney trauma
minor: laceration of capsule
major: laceration of parenchymavascular supply
kidney trauma s/sx
hematuria
abd/flank pain
oliguria/anuria
swelling, eccymoses in flank (Turner’s)
shock s/sx
minor kidney trauma interventions
bedrest
monitor
major kidney trauma interventions
control hemorrhage
prevent shock
surgery: partial, total nephrectomy; percutaneous arterial embolization
postop kidney surgery dressing changes are done under which technique
aseptic
nephrostomy tube interventions
inspect daily
keep dressing clean, dry, secure
assess for kinks
drain bag when halfway full
what to do if nephrostomy tube becomes dislodged
call HCP immediatley
nephrostomy tube education/when to call HCP
s/sx of infection
leak around tube
unable to flush tubing
sudden cessation of renal function when blood flow to the kidney is compromise
AKI/AKF
most common cause of AKI
ischemia
sepsis
nephrotoxins
AKI risk factors
trauma
sx
infection
hemorrhage
CHF
liver disease
UTI
drugs and radiologic contrast
old adults more at risk
prerenal/category 1 AKI causes
factors that reduce systemic circulation causing reduction in renal blood flow
severe dehydration
HF, decreased CO
decrease GFR
intrarenal/category 2 AKI causes
conditions that cause direct damage to the kidneys
prolong ischemia
nephrotoxins
Hgb released from hemolyzed RBCs
myoglobin released from necrotic muscle cells
intrarenal/category 2 AKI will lead to ___ ___ ___
acute tubular necrosis
is acute tubular necrosis reversible
potentially, if caught early
postrenal/category 3 AKI causes
mechanical obstruction of outflow
BPH
prostate ca
calculi
trauma
extrarenal tumors
bilateral ureteral obstructions
what are the 3 major manifestion phases of AKI
oliguric
diuretic
recovery
what occurs during initiation of AKI
whatever is causing the kidney to malfunction…
prostate, severe dehydration, etc
what occurs during the oliguric phase of AKI
hyponatremia (can lead to cerebral edema)
hyperkalemia
leukocytosis
elevated BUN, Crt
fatigue
difficulty concentrating
seizures
stupor, eventual coma
how much urine is be excreted during the diuretic phase of AKI
1-3 L/daily
can reach 5L +
what to monitor for with diuretic phase of AKI
hyponatremia
hypokalemia
dehydration
GFR may begin to improve
putting out more urine but it is not being filtered
how long can the recovery phase last
12 months
AKI Dx test
UA
serum Crt, BUN, electrolytes
ABG
CBC
renal US
CT
IVP
renal bx
what is key with AKI
F/E balance
AKI meds
dopamine
lasix, bumex (1-2mg at most)
mannitol
ACE
PPI, H2 blockers, antacids
kayexalate (PO, NGT, enema)
Na bicarb
what is increased in the diet with AKI and why
carbs to maintain calorie intake and protein sparing effect
what types of food may be restricted with AKI
bananas
citrus fruits
dairy products
what is dialysis
movement of fluid/molecules across a semipermeable membrane from one compartment to another
when is dialysis used
correct F/E imbalances
remove waste products in renal failure
tx severe drug OD
general principle of dialysis is ___ and ___
osmosis
ultrafiltration
how is hemodialysis performed
3-4 x’s weekly as indicated
hemodialysis contraindication
hemodynamically unstable
complications of hemodialysis
hypotension
bleeding
infection
muscle cramps
hepatitis
dialyzer and blood lines are primed with which solution and why
saline to eliminate air
what to flush dialyzer when completed and why
saline to remove all blood
what to do after removing need for dialysis
apply firm pressure
nursing interventions prior to hemodialysis
assess fluid status
assess access
temp
skin condition
weight
nursing interventions during hemodialysis
alert to changes in condition
VS q30-60 minutes
can hemodialysis fully replace metabolic and kidney function
No
when to administer meds re: hemodialysis treatment
after
when to avoid BP meds re: hemodialysis treatment
4-6 hours prior
how long does a fistula have to mature before use
minimum of 6 weeks
dialysis disequilibrium syndrome s/sx
HA
N/V
altered LOC
HTN
how many needs are placed in the AVF or graft for hemodialysis
2
purpose red catheter/fistula needle and blue catheter/2nd needle re: hemodialysis
red: pulls blood from pt
blue; blood is returned to pt
continuous renal replacement therapy for AKI is used if pts are ___ ___
hemodynamically unstable
what occurs during continuous renal replacement therapy (CRRT)
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
CRRT can be used in conjunction with ___
hemodialysis
contraindication for CRRT
uremia that requires rapid resolution
how long is CRRT continued
30-40 days
how often to change CRRT hemofilters
q24-48 hours
CRRT ultrafiltrate should be what color
clear yellow
what are the 2 types of CRRT access devices
venous *most common
arterial
what med will be given with CRRT
heparin
what are the 3 phases/1 cycle of exchange re: peritoneal dialysis
inflow (fill)
dwell (equilibration)
drain
peritoneal access is where
catheter through the anterior wall
tenckhoff catheter
after tenckhoff cath is inserted what is done
skin is cleaned with antiseptic solution
sterile dressing applied
secure to abd with tape
waiting period after cath insertion for peritoneal dialysis
7-14 days
can a pt bathe with peritoneal dialysis cath
no, only showers; must pay dry
peritoneal dialysis solution temperature
warm (98.6), do not infuse cold
use low setting heat pad
what occurs during inflow
Rx about of solution infused through est cath over about 10 minutes
after infused, clamp is closed
what to do if pt c/o pain or cramping during inflow
reduce, slow the rate
what must be done with the infusion bag before and after
weight
what occurs during dwell
diffusion and osmosis occur between the pts blood and peritoneal cavity
duration of time varies
how long is the drain time
15-30 minutes
may be help with drain time
gentle massaging abd
changing positions
automated peritoneal dialysis (APD) vs. continuous ambulatory peritoneal dialysis (CAPD)
A: timer; usually at HS; 2-3 exchanges while sleeping
C: manual; QID
peritoneal dialysis complications
exit site infection
peritonitis
hernias
lower back probs
bleeding (pink first 24-36 hrs okay)
pulmonary complications
protein loss
benefits of peritoneal dialysis
short training program
independence
ease of traveling
fewer dietary restrictions
greater mobility
peritoneal dialysis pre treatment assessment
VS
abd firth
respiratory assessment
what to record with peritoneal dialysis treatment
amount, type of dialysate
dwell time
amount, characteristics of return
nephrotoxic drugs
aminoglycosides
PCNs
NSAIDS
cephalosporins
chemo agents
progressive, irreversible renal tissue destruction and loss of function
chronic renal disease/chronic renal failure
chronic renal failure is common in which 2 groups
African Americans
Native Americans
leading cause of CKD
DM followed by HTN
CKD is dx when GFR is < __ for longer than 3 months
60
those with CKD are often ___
asymptomatic
ESRD occurs when GFR is < __
< 15
s/sx of CKD
uremia (urine in blood)
nausea
apathy, weakness, lethargy
confusion
F/E imbalances
effects: cardio, hematologic, immune system, GI, neuro, musculo, endo, metabolic, and dermatologic
CKD Dx studies
UA
urine culture
BUN, Crt
Crt clearance
serum electrolytes
CBC
renal US
kidney bx
CKD meds
Lasix
ACE, ARB
diuretics
Na bicarb, Ca carbonate
kayexalate
folic acid
MVI
epogen
amphojel: antacid used to reduce phosphate levels
CKD will have a strict ___ intake
protein
Na, K, and Ph strictions
Na: 2-4 G daily
K: 3-3 G daily
Ph: 1 G daily
cadaver donor qualifications
< 65 y/o
free of systemic disease, malignancy, infection including HIV, Hep B and C
when is a donor considered a perfect match
human leukocyte antigen test; 6 antigens = perfect match
kidney transplant contraindications
disseminated malignancies
refractory/untx’d cardiac disease
chronic respiratory failure
extensive vascular disease
chronic infection
unresolved psychosocial disorders
how soon before transplantation is a live donor taken back for sx
1-2 hours before recipient
takes about 3 hours
kidney transplant recipient preferred location
right iliac fossa
transplant recipient intervention before incision
cath into bladder
abx solution instilled:
-distends bladder
-decreases risk of infection
how long does recipient surgery take
3-4 hours
when can a person return to work post transplant
4-6 weeks
meds commonly used in combination with prednisone
cellcept
imuran
S/E of long term corticosteroid use
impaired wound healing
emotional disturbances
osteoporosis
cushings effects
3 types of transplant rejection
hyperacute: minutes to hours after
acute: days to months after
chronic: years after
how often to monitor I&O after transplant
q30-60 minutes
most common infections observed in the first month after transplant
PNA
wound
IV line, drain
UTI
