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
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
26
what are you looking for in a UA with glomerulonephritis
CAST protein
27
glomerulonephritis treatment
bedrest (acute stage) 1-2 G Na restriction protein restriction (if azotemia is present) plasmapheresis dialysis
28
what to monitor daily with glomerulonephritis
I&O daily weight fluid restriction
29
what are the 2 types of vascular kidney disease
HTN renal artery stenosis
30
this can be a result of or cause of kidney damage
vascular kidney disease: HTN
31
what is malignant HTN
DBP > 120 more common in African Americans
32
primary cause of VKD: renal artery stenosis
atherosclerosis
33
VKD: renal artery stenosis is suspected when...
HTN before 30 y/o OR after 50 y/o with no prior hx of HTN
34
s/sx of VKD: renal artery stenosis
epigastric bruit s/sx of vascular insufficiency
35
how to dx VKD: renal artery stenosis
renal US captopril test renal arteriogram
36
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
37
VKD: renal artery stenosis treatment
ACE, ARB diuretics low dose ASA statins percutaneous transluminal angioplasty bypass graft
38
risk factors for VKD: renal vein occlusion
abd trauma sx/angiography vessel trauma aortic, renal artery aneurism atherosclerosis of aortic or renal artery
39
s/sx of renal vein occlusion
asymptomatic (if developed slowly) sudden, severe flank pain N/V fever HTN hematuria oliguria
40
VKD: renal vein occlusion secondary to thrombus formation may be caused by....
nephritis pregnancy oral contraceptives malignancies
41
kidney trauma is usually associated with ___ ___ trauma
blunt force
42
example of minor vs. major blunt force trauma
minor: contusion major: laceration
43
example of minor vs. major penetrating kidney trauma
minor: laceration of capsule major: laceration of parenchymavascular supply
44
kidney trauma s/sx
hematuria abd/flank pain oliguria/anuria swelling, eccymoses in flank (Turner's) shock s/sx
45
minor kidney trauma interventions
bedrest monitor
46
major kidney trauma interventions
control hemorrhage prevent shock surgery: partial, total nephrectomy; percutaneous arterial embolization
47
postop kidney surgery dressing changes are done under which technique
aseptic
48
nephrostomy tube interventions
inspect daily keep dressing clean, dry, secure assess for kinks drain bag when halfway full
49
what to do if nephrostomy tube becomes dislodged
call HCP immediatley
50
nephrostomy tube education/when to call HCP
s/sx of infection leak around tube unable to flush tubing
51
sudden cessation of renal function when blood flow to the kidney is compromise
AKI/AKF
52
most common cause of AKI
ischemia sepsis nephrotoxins
53
AKI risk factors
trauma sx infection hemorrhage CHF liver disease UTI drugs and radiologic contrast old adults more at risk
54
prerenal/category 1 AKI causes
factors that reduce systemic circulation causing reduction in renal blood flow severe dehydration HF, decreased CO decrease GFR
55
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
56
intrarenal/category 2 AKI will lead to ___ ___ ___
acute tubular necrosis
57
is acute tubular necrosis reversible
potentially, if caught early
58
postrenal/category 3 AKI causes
mechanical obstruction of outflow BPH prostate ca calculi trauma extrarenal tumors bilateral ureteral obstructions
59
what are the 3 major manifestion phases of AKI
oliguric diuretic recovery
60
what occurs during initiation of AKI
whatever is causing the kidney to malfunction... prostate, severe dehydration, etc
61
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
62
how much urine is be excreted during the diuretic phase of AKI
1-3 L/daily can reach 5L +
63
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
64
how long can the recovery phase last
12 months
65
AKI Dx test
UA serum Crt, BUN, electrolytes ABG CBC renal US CT IVP renal bx
66
what is key with AKI
F/E balance
67
AKI meds
dopamine lasix, bumex (1-2mg at most) mannitol ACE PPI, H2 blockers, antacids kayexalate (PO, NGT, enema) Na bicarb
68
what is increased in the diet with AKI and why
carbs to maintain calorie intake and protein sparing effect
69
what types of food may be restricted with AKI
bananas citrus fruits dairy products
70
what is dialysis
movement of fluid/molecules across a semipermeable membrane from one compartment to another
71
when is dialysis used
correct F/E imbalances remove waste products in renal failure tx severe drug OD
72
general principle of dialysis is ___ and ___
osmosis ultrafiltration
73
how is hemodialysis performed
3-4 x's weekly as indicated
74
hemodialysis contraindication
hemodynamically unstable
75
complications of hemodialysis
hypotension bleeding infection muscle cramps hepatitis
76
dialyzer and blood lines are primed with which solution and why
saline to eliminate air
77
what to flush dialyzer when completed and why
saline to remove all blood
78
what to do after removing need for dialysis
apply firm pressure
79
nursing interventions prior to hemodialysis
assess fluid status assess access temp skin condition weight
80
nursing interventions during hemodialysis
alert to changes in condition VS q30-60 minutes
81
can hemodialysis fully replace metabolic and kidney function
No
82
when to administer meds re: hemodialysis treatment
after
83
when to avoid BP meds re: hemodialysis treatment
4-6 hours prior
84
how long does a fistula have to mature before use
minimum of 6 weeks
85
dialysis disequilibrium syndrome s/sx
HA N/V altered LOC HTN
86
how many needs are placed in the AVF or graft for hemodialysis
2
87
purpose red catheter/fistula needle and blue catheter/2nd needle re: hemodialysis
red: pulls blood from pt blue; blood is returned to pt
88
continuous renal replacement therapy for AKI is used if pts are ___ ___
hemodynamically unstable
89
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
90
CRRT can be used in conjunction with ___
hemodialysis
91
contraindication for CRRT
uremia that requires rapid resolution
92
how long is CRRT continued
30-40 days
93
how often to change CRRT hemofilters
q24-48 hours
94
CRRT ultrafiltrate should be what color
clear yellow
95
what are the 2 types of CRRT access devices
venous *most common arterial
96
what med will be given with CRRT
heparin
97
what are the 3 phases/1 cycle of exchange re: peritoneal dialysis
inflow (fill) dwell (equilibration) drain
98
peritoneal access is where
catheter through the anterior wall tenckhoff catheter
99
after tenckhoff cath is inserted what is done
skin is cleaned with antiseptic solution sterile dressing applied secure to abd with tape
100
waiting period after cath insertion for peritoneal dialysis
7-14 days
101
can a pt bathe with peritoneal dialysis cath
no, only showers; must pay dry
102
peritoneal dialysis solution temperature
warm (98.6), do not infuse cold use low setting heat pad
103
what occurs during inflow
Rx about of solution infused through est cath over about 10 minutes after infused, clamp is closed
104
what to do if pt c/o pain or cramping during inflow
reduce, slow the rate
105
what must be done with the infusion bag before and after
weight
106
what occurs during dwell
diffusion and osmosis occur between the pts blood and peritoneal cavity duration of time varies
107
how long is the drain time
15-30 minutes
108
may be help with drain time
gentle massaging abd changing positions
109
automated peritoneal dialysis (APD) vs. continuous ambulatory peritoneal dialysis (CAPD)
A: timer; usually at HS; 2-3 exchanges while sleeping C: manual; QID
110
peritoneal dialysis complications
exit site infection peritonitis hernias lower back probs bleeding (pink first 24-36 hrs okay) pulmonary complications protein loss
111
benefits of peritoneal dialysis
short training program independence ease of traveling fewer dietary restrictions greater mobility
112
peritoneal dialysis pre treatment assessment
VS abd firth respiratory assessment
113
what to record with peritoneal dialysis treatment
amount, type of dialysate dwell time amount, characteristics of return
114
nephrotoxic drugs
aminoglycosides PCNs NSAIDS cephalosporins chemo agents
115
progressive, irreversible renal tissue destruction and loss of function
chronic renal disease/chronic renal failure
116
chronic renal failure is common in which 2 groups
African Americans Native Americans
117
leading cause of CKD
DM followed by HTN
118
CKD is dx when GFR is < __ for longer than 3 months
60
119
those with CKD are often ___
asymptomatic
120
ESRD occurs when GFR is < __
< 15
121
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
122
CKD Dx studies
UA urine culture BUN, Crt Crt clearance serum electrolytes CBC renal US kidney bx
123
CKD meds
Lasix ACE, ARB diuretics Na bicarb, Ca carbonate kayexalate folic acid MVI epogen amphojel: antacid used to reduce phosphate levels
124
CKD will have a strict ___ intake
protein
125
Na, K, and Ph strictions
Na: 2-4 G daily K: 3-3 G daily Ph: 1 G daily
126
cadaver donor qualifications
< 65 y/o free of systemic disease, malignancy, infection including HIV, Hep B and C
127
when is a donor considered a perfect match
human leukocyte antigen test; 6 antigens = perfect match
128
kidney transplant contraindications
disseminated malignancies refractory/untx'd cardiac disease chronic respiratory failure extensive vascular disease chronic infection unresolved psychosocial disorders
129
how soon before transplantation is a live donor taken back for sx
1-2 hours before recipient takes about 3 hours
130
kidney transplant recipient preferred location
right iliac fossa
131
transplant recipient intervention before incision
cath into bladder abx solution instilled: -distends bladder -decreases risk of infection
132
how long does recipient surgery take
3-4 hours
133
when can a person return to work post transplant
4-6 weeks
134
meds commonly used in combination with prednisone
cellcept imuran
135
S/E of long term corticosteroid use
impaired wound healing emotional disturbances osteoporosis cushings effects
136
3 types of transplant rejection
hyperacute: minutes to hours after acute: days to months after chronic: years after
137
how often to monitor I&O after transplant
q30-60 minutes
138
most common infections observed in the first month after transplant
PNA wound IV line, drain UTI