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pipi&pi2 > (FE) Renal Disorders > Flashcards

(FE) Renal Disorders Flashcards

1
Q

What is acute kidney injury?

A
  • Sudden decrease in kidney function (usually over a few days)
    ~ Decreased excretion of waste products
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2
Q

What are the risk factors for AKI?

A
  • Old age
  • DM
  • HTN
  • Autoimmune diseases
  • Heart , liver or kidney disease
  • Cancer
  • Antibiotics
  • Heavy metals
  • Chemotherapy
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3
Q

What are the 3 types/causes of AKI?

A

1) Prerenal
- Decreased blood flow to the kidneys
~ Absolute loss of body fluid (hemorrhage, vomiting, diarrhea)
~ Distributive shock (fluid moves from BV to tissues, CHF where heart cannot pump blood so it pools in the venous side and does not get sent to the kidneys) ie amount of fluid in body stays the same
~ Decreased cardiac output
~ Narrowed renal artery (stenosis or embolus)

2) Intrarenal
- Damage to kidney
~ Glomerulonephritis
~ Damage by toxins
~ Prolonged ischemic injury

3) Postrenal
- Decreased outflow of urine from the kidneys
~ Compressed ureter (tumors, enlarged prostate, kidney stones)

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4
Q

What are the phases of AKI?

A

1) Oliguric (dec urine output)
- Leads to fluid overload, peripheral edema, weight gain and HTN
- Bounding pulse
- Distended neck veins
- May lead to pulmonary edema, dyspnea and tissue hypoxia
- Imbalanced electrolytes
~ Hyperkalemia -> muscle weakness and cardiac arrhythmias
~ Hyperphosphatemia
~ Hypocalcemia -> tetany
- Uremic encephalopathy
~ Confusion
~ Lethargy
~ Seizures

2) Diuretic
- Increase in urine output
- Resolution of fluid overload

3) Recovery

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5
Q

How to diagnose AKI?

A
  • Hyperkalemia, hyperphosphatemia, hypocalcemia
  • ^ BUN and creatinine
  • ABG
    ~ Metabolic acidosis
  • Urinalysis
    ~ Proteinuria, hematuria, casts
  • Ultrasound/CT scan to assess renal blood flow
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6
Q

Treatment for AKI?

A
  • IV fluids
  • Diuretics
  • Nutritional support
  • Dialysis (for those who do not respond to ^^)
  • If px is on ACE-inhibitors, replace with Calcium-blockers
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7
Q

What is (prerenal) azotemia?

A
  • ^ levels of urea and creatinine in blood due to kidney being unable to excrete them
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8
Q

What is the difference between azotemia and uremia?

A

Azotemia:
- Abnormal lab values + no/little s/s
- Can be experienced by AKI & CKD

Uremia:
- Abnormal lab values + s/s (N&V, fluid retention, itching, SOB, anemia)
- Not often present in CKD

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9
Q

What is the pathophysiology of azotemia?

A

Less blood flow to the kidney -> decreased GFR -> less blood filtered in kidneys -> less urea and creatinine filtered out -> ^ in blood (azotemia)

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10
Q

What are the complications of azotemia?

A

1) Oliguria (low urine production)
- Less filtered blood -> ^ aldosterone secretion -> ^ sodium + water reabsorption

2) BUN:creatinine 20:1
- ^ water reabsorption -> ^ urea reabsorption

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11
Q

What is chronic kidney disease?

A
  • Slow and progressive decrease in kidney function
  • GFR <60mL/min that develops over a minimum of 3 months
    ~ Healthy is 100-120mL/min
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12
Q

What are the risk factors for CKD?

A
  • DM
    ~ CKD is a microvascular complication of DM (damaged afferent arteriole and glomeruli)
  • HTN
  • Nephrotoxic medication
    ~ NSAIDs
    ~ Aminoglycosides
  • Obesity
  • Old age
  • CVS disease
  • Smoking
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13
Q

What are the 5 stages of CKD?

A

based on GFR

S1) Normal kidney function
S2) Function mildly dec
S3) Moderately dec
S4) Severe dec
S5) Function is completely lost
- Develop kidney failure + ESRD

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14
Q

What are some complications of CKD?

A
  • Uremic encephalopathy
  • Asterixis (tremor in hand when client attempts to extend wrist)
  • Ataxia (lack of voluntary coordination)
  • Pericarditis
  • Uremic frost (urea crystals deposit in the skin)
  • HTN
    ~ Due to sodium retention and activation of RAAS
  • Anemia
  • Hyperkalemia
  • Metabolic acidosis
  • Renal osteodystrophy (weak and brittle bones due to impaired calcium metabolism)
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15
Q

Diagnosis of CKD?

A
  • ^ BUN
  • Dec in GFR
  • Urinalysis
    ~ Proteinuria
    ~ Hematuria
    ~ WBC
    ~ Glucose
    ~ Casts
  • Abdominal ultrasound
    ~ Signs of scarring
    ~ Polycystic kidneys
    ~ Obstructive uropathy
  • X-rays
    ~ Renal osteodystrophy
  • Kidney biopsy
    ~ Inflammation, scarring or unusual deposits of protein
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16
Q

How is CKD treated?

A

Stage 1/2:
- Ensuring fluid balance
- Lifestyle modifications (smoking, stop nephrotoxic medications, normal BG)
- Treatment with ACE-I (enalapril) or ARB (losartan) to manage HTN
- Lipid lowering agents to reduce CVS risk

Stage 3:
- Address blood abnormalities (eg anemia) and electrolyte imbalances
- Calcium supplementation + phosphate binders given if px has renal osteodystrophy

Stage 4:
- Renal replacement
~ Hemodialysis
~ Peritoneal dialysis
~ Renal transplantation

Stage 5: (remaining kidney function not enough to sustain life)
- Kidney transplantation

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17
Q

What is the nursing care for CKD?

A
  • Monitor urine frequency, color and characteristics
  • Watch out for signs of fluid overload
  • High-Fowler position and oxygen if required
  • Monitor weight everyday at the same time, scale and same amount of clothing
    ~ 2kg change in 1 day is significant
  • Fluid restriction if fluid retention is present
  • Potassium-lowering medication (sodium polysterene sulfonate, insulin, calcium gluconate)
  • Assess long-term vascular access devices for any signs of infx
  • Assess for adequate circulation (distal pulses, capillary refill, thrills or bruits on arms, skin colour changes)
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18
Q

What are indications for urgent dialysis?

A
  • Pulmonary edema
    ~ Unresponsive to treatment
  • Life-threatening hyperkalemia (Potassium >6.5 mEq/L) + ECG abnormalities
  • Acidosis unresponsive to conventional treatment
    ~ Unresponsive to treatment
  • Signs of uremia (encephalopathy, pericarditis)
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19
Q

What are the locations for hemodialysis?

A

Temporary:
- Femoral vein
- Subclavian
- Internal jugular

Permanent (for chronic):
- AV fistula

20
Q

What are the principles of dialysis?

A

1) Diffusion

2) Osmosis
- Glucose creates osmotic gradient across the membrane to pull excess fluid

3) Ultrafiltration
- Water and fluid removal according to a pressure gradient
~ Water moves from fluid overloaded area to other side of dialysis membrane

21
Q

What are the components of the dialysis machine?

A

1) Dialysate
- Solution used in the dialyzer to create a pressure gradient

2) Heparin pump
- To allow for anticoagulation (prevent risk of blood clots
- Lower dose/ no anticoagulant if px is at risk of bleeding

3) Dialyzer (peritoneal membrane in peritoneal dialysis)

22
Q

What is the nursing care for peritoneal dialysis?

A
  • Assess weight, heart and lung sounds
  • Watch for edema
  • Avoid conducting tests and taking BP on affected extremity
  • Check for colour, presence of thrills and bruits, sluggish capillary refill
  • Check for patency and skin breakdown/infx if AVF present
  • Administer fluids to prevent hypotension during the procedure
  • Administer anticoagulants
  • If hypotension occurs, slow ultrafiltration rate and place px in Tredenlenburg position
  • Watch out for dialysis disequilibrium syndrome
  • Recommend Hep B vaccine
23
Q

What should be included in client teaching for dialysis?

A
  • Monitor for bleeding for at least 6 hrs
  • Dialysis care
    ~ Avoid tight clothes or jewelry on extremity
    ~ Avoid activities that compress the extremity
  • Need to feel a thrill or vibration over the access site (means it is intact and working)
  • Eat food low in sodium potassium and phosphorus and eat mid-protein meals
24
Q

Signs/symptoms of UTI?

A
  • Dysuria (pain)
    ~ Due to urethritis (infl of urethra)
  • Edema of bladder wall + suprapubic pain + need to urinate frequently and urgently
    ~ Cystitis (infl of bladder)
  • Cloudy and foul-smelling urine
    ~ Bacteriuria
  • Flank pain at costovertebral angle
    ~ Pyelonephritis (infl of kidney)
25
Q

Complications of UTI?

A
  • Scarring and narrowing of urethra (due to urethral stricture)
  • Urosepsis
26
Q

What are the risk factors for UTI?

A
  • Urinary stasis
  • Blocked ureters
  • Neurogenic bladder (from DM and spinal cord injuries)
    ~ Slows flow of urine
  • Urinary catheterisation
  • Intercourse
  • HIV/AIDS
  • Women
  • Pregnancy
    ~ Increased progesterone levels and the pressure from enlarged uterus tend to relax and dilate the ureters (increases the risk of urinary stasis and reflux)
  • Menopause
    ~ Decreased estrogen alters GU flora
27
Q

Diagnosis of UTI?

A
  • Urinalysis
    ~ Cloudy, foul odour
    ~ Nitrites
    ~ Leucocyte esterase (indicates presence of bacteria)
  • CT scan or MRI
    ~ Visualise urinary tract
28
Q

Treatment of UTI?

A
  • Antibiotics
    ~ Nitrofurantoin etc
  • Analgesics
  • Heat therapy on the abdomen
  • Avoid certain beverages
    ~ Alcohol, coffee, tea, soda
    ~ Increases acidity of urine (more painful)
29
Q

What are the 5 types of urinary incontinence?

A

1) Urge incontinence
- Overactive bladder

2) Overflow incontinence
- Pressure from filled bladder causes urine to leak out

3) Functional incontinence
- Physical, cognitive or environmental hindrance from reaching the toilet in time
~ Mobility problems
~ Dementia

4) Stress incontinence
- Urine leaks out due to intraabdominal pressure
~ Coughing, sneezing, laughing
- Usually caused by weakened pelvic floor muscles
~ Pregnancy/childbirth

5) Mixed incontinence
- Combination of >2 types

30
Q

What are the complications of stress incontinence?

A
  • Risk of UTI
  • Risk of skin breakdown from moist environment
31
Q

Diagnosis of stress incontinence?

A
  • Bladder stress test
    ~ Observe urine leakage upon coughing or sneezing
  • Pelvic floor muscle strength
    ~ Vaginal digital exam
32
Q

Treatment for urinary incontinence?

A
  • Pelvic floor strength training
    ~ Kegel exercises
  • Weight management (to relieve intraabdominal pressure)
  • Intravaginal estrogen cream (to reduce atrophy of pelvic floor tissues)
  • Intravaginal pessaries (supports bladder neck)
33
Q

What is benign prostate hyperplasia?

A

Noncancerous cells in the prostate gland increase in number and enlarge the prostate

34
Q

What is the pathophysiology of BPH?

A

Static:
- Prostate growth driven by androgen dihydrotestosterone formed from testosterone under the influence of 5-alpha reductase
- Hyperplastic prostatic tissue compresses urethra

Dynamic:
- Increased adrenergic nervous system and prostatic smooth muscle tone compresses urethra

  • As an adaptive change to overcome resistance, detrusor muscles undergo hypertrophy
35
Q

What are the risk factors of BPH?

A
  • Male
  • Obesity
  • Sedentary lifestyle
  • Family history of BPH
36
Q

What are the s/s of BPH?

A
  • Lower UTI symptoms
    ~ Difficulty initiating urine
  • Weak urine stream
  • Nocturia
37
Q

What are the complications of BPH?

A
  • Kidney damage/failure
  • Kidney stones
  • UTI, prostatitis
38
Q

Diagnosis of BPH?

A
  • Digital rectal examination
    ~ Finger inserted into rectum to feel the prostate against the anterior wall (feels smooth and rubbery)
  • ^ levels of PSA (prostate specific antigen)
  • Bladder scan
    ~ Determine post-void residual volume (>100ml considered retention)
  • Urinalysis and culture if infx is suspected
39
Q

What is the treatment of BPH?

A
  • Relieve obstruction and allow urine to flow normally
  • Lifestyle changes for mild symptoms
    ~ Avoid fluids 1-2 hours before bedtime
    ~ Urinating at fixed times
    ~ Limit caffeine, alcohol and artificial sweetener intake
    ~ Place feet solidly on floor (helps relax pelvic muscles)
    ~ Avoid decongestants and antihistamines if possible
  • Medications
    ~ Alpha blockers eg tamsulosin (relaxes muscles near the prostate)
    ~ 5alpha-reductase inhibitor eg finasteride (reduces size of prostate by inhibiting testosterone conversion into dihydrotestosterone)
  • Surgery
    ~ Transurethral resection /laser vaporisation of prostate (destroys prostatic tissue)
    ~ Transurethral incision (prostate tissue is untouched but urethra is widened)
    ~ Prostatectomy (all prostate tissue is removed)
40
Q

What is the nursing assessment for peritoneal dialysis?

A
  • Any discomfort during the procedure
  • Changes in sleep patterns, appetite or energy levels
  • Monitor vital signs, electrolytes and glucose levels
  • Assess catheter for signs of infx
  • Daily weight to monitor fluid balance
  • Assessment of dialysis adequacy + parameters (ultrafiltration volumes, fluid removal, color, clarity, presence of fibrin/debris)
  • Monitor for signs of complications
    ~ Peritonitis, hernia, catheter malfunction
41
Q

What is the nursing management for peritoneal dialysis?

A

1) Promoting fluid balance
- May occur if too much fluid is removed during the dialysis process
- Take I/O
- Assess HgB, Hct, serum sodium and glucose
- Weigh when abdomen is empty
- Maintain electrolyte and nutritional status

2) Promoting infection control
- Watch out for cloudy drainage and fever
- Monitor WBC of effluent

42
Q

What is the nursing management for Pre-Haemodialysis?

A
  • Vital signs + dry weight
  • Check AV fistula
    ~ Fistula flow
    ~ Signs of infx
  • Serve correct medication
43
Q

What is the appropriate care for AV fistula?

A
  • Arm and finger exercises to strengthen fistula after surgery
  • Keep fistula clean to prevent infection
  • Maintain proper blood flow through the fistula and to reduce the risk of blood clots
    ~ Avoid tight-fitting shirts and jewelry on access arm
    ~ Make sure handles or straps of bags do not tighten around the fistula
    ~ Take BP from other arm
    ~Avoid resting on fistula
  • Check blood flow daily
    ~ Feel motion of blood flowing through fistula when placing fingers over it
    ~ Listen for blood flow using a stethoscope (called a bruit)
    ~ Changes in pitch may indicate thrombolysis or stenosis of fistula (change from whooshing to a whistle-like sound)
44
Q

What is the patient education when undergoing haemodialysis?

A
  • May experience sleeping disorders so avoid sleeping in the day
  • Diet
    ~ Lean meat better
    ~ Avoid watermelon/excess water and banana/excess potassium)
    ~ Fluid restriction of <1L/day or as prescribed
45
Q

Should HTN and DM medications be served before or after haemodialysis?

A

After

46
Q

Why is creatinine used as a marker for AKI/CKD instead of urea?

A
  • Urea is not specific
    ~ Also ^ in dehydration

pipi&pi2 (16 decks)

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