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Med Surg > Fluid and electrolytes, Kidney Disease and Dialysis > Flashcards

Fluid and electrolytes, Kidney Disease and Dialysis Flashcards

1
Q

Hypovolemia and how to treat it

A

> 5% weight loss, decreased skin turgor, dry mucous membranes, low BP, increased Hg/HCT, decreased UOP, Elevated Na, Increased SG

Treatment includes IV fluids + NSS

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2
Q

Hypervolemia and how to treat it

A

> 5% weight gain, edema, crackles, SOB, JVD, decreased Hg/HCT, Decreased Na, Decreased SG

Treatment includes diuretics, fluid restriction, salt restriction, dialysis

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3
Q

Hyponatremia and how to treat it

A

nausea, lethargy, change in mental status, headache, seizures

Treat with NSS/ Hypertonic saline (fluid overload- diuretics)

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4
Q

Hypernatremia and how to treat it

A

Thirst, dry mucous membranes, weakness, change in mental status

Treatment includes sodium restriction, increasing fluids, change in mental status

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5
Q

Hypokalemia and how to treat it

A

muscle weakness/ cramping, EKG changes, lethargy

Treatment includes oral/ IV replacement, dietary supplementation

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6
Q

Hyperkalemia and how to treat it

A

Nausea and diarrhea, muscle weakness, EKG changes

Treatment includes Kayexalate, diuretics, IV insulin and glucose, calcium chloride, sodium bicarb, dialysis

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7
Q

AKI

A

sudden and rapid loss of renal function (decreased blood flow, nephrotoxicity, obstruction)

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8
Q

AKI characteristics + goals of treatment

A

increased creatine, decreased GFR, azotemia, oliguria

Goals of treatment include minimizing risk of lethal and long-term complications

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9
Q

Azotemia

A

increased BUN

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10
Q

Prerenal- definition and causes

A

decreased blood flow, caused by hypoperfusion, hypovolemia, dehydration, GI losses, hemorrhage, hypotension, low CO, sepsis, burns, thrombosis

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11
Q

Intrarenal- definition and causes

A

damage to nephrons, caused by ATN, rhabdomyolysis, nephrotoxic meds, IV contrast, autoimmunes, infection

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12
Q

Postrenal- definition and causes

A

obstruction of urine flow, caused by renal calculi, strictures, thrombus, BPH, prostate cancer, bladder cancer, trauma to strictures

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13
Q

4 Phases of AKI

A

Initiation, oliguria, diuresis, recovery

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14
Q

Symptoms of AKI

A

Lethargy, Weakness, Headache, Muscle twitching, Tremor, possible seizures, Nausea, vomiting, anorexia, SOB, pulmonary edema, HTN, Dysrhythmia

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15
Q

Assessment of AKI

A

elevated BUN and crea, decreased GFR, hematuria, low SG, hyperkalemia, hyperphosphatemia, anemia, metabolic acidosis

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16
Q

AKI management

A

eliminate underlying cause, optimize renal perfusion (fluids and dopamine), maintain fluid balance (fluids and diuretics), correct chemical abnormalities (fluids, diuretics, dialysis), minimize further risk

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17
Q

AKI monitoring

A

fluid balance, daily weight, I&O, IV fluids, electrolyte balances

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18
Q

AKI assessing

A

edema, lung sounds, JVD, HR and rhythm, EKG

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19
Q

AKI prevent

A

infection, hyperkalemia, fluid volume overload, CKD

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20
Q

AKI pt ed

A

disease process, diagnostic testing, meds and treatments, self-care, follow up

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21
Q

Glomerulonephritis

A

acute inflammation of glomerular capillaries, 2nd to strep A, Epstein Barr, varicella, Hep B, HIV

AB antigen complexes deposit in glomeruli, may progress to CKD

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22
Q

symptoms of GN

A

hematuria, edema, decreased UOP, elevated BUN & creat, HTN, flank pain (cola colored urine)

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23
Q

treatment of GN

A

steroids, control HTN, treatment of infection, dietary protein restriction w/ increase in carbs

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24
Q

CKD definition

A

decreasd GFR >3 months, decreased quality of life, may progress to ESRD, significantly increases risk of CV disease

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25
CKD risk factors
HTN, diabetes, cv disease, obesity, 60+, family history, use of nephrotoxic drugs, african americans
26
CKD Causes
Diabetes, HTN, chronic GN, PCKD, hereditary diseases, congenital diseases, renal artery stenosis/ thrombosis, cancer, nephrotoxic agents
27
Diabetic nephropathy
Glomerular damage & enlargement Kidney filtration decreased due to hyperglycemia Blood proteins leak into urine Affects afferent & efferent arterioles Affects 30% of diabetics Kidney disease is reduced when glucose levels are controlled
28
People at high risk for diabetic nephropathy
african americans, native americans and hispanics with T2DM
29
Diabetic nephropathy assessment
proteinuria, anasarca, HTN, acidosis
30
Diabetic nephropathy treatment
Control HTN * Ace Inhibitors * ARB’s * Calcium channel blockers * Eat moderate amount of protein * high quality * Low sodium & potassium diet * Control HgAIC
31
Nephrosclerosis
hardening of renal arteries, secondary to HTN and diabetes (decreased renal blood flow) major cause of CRF
32
Malignant nephrosclerosis
DBP >130, More common in young adults, Men > women, 50% >> death if untreated
33
Benign nephrosclerosis
more common in adults 50+, BP >160/110
34
Treatment of nephrosclerosis
ACE inhibitors/ ARBs
35
Polycystic kidney disease
Fluid-filled cysts in kidneys >>> destroy nephrons, Kidney enlargement, Can also occur in: liver, brain, heart
36
Symptoms of PCKD
HTN, abdominal/ flank pain, hematuria, constipation
37
Treatment of PCKD
BP control, pain control, antibiotics for infection, dialysis may be needed
38
Renal artery stenosis
Fibromuscular changes and atherosclerosis (thrombosis or renal aneurysm)
39
Assessment of Renal Artery Stenosis
difficult to control HTN, elevated creat, abd bruit, renal bruit, flank or upper abd pain
40
Renal Vein Thrombosis
Increased fibrinogen levels + increased platelet aggregation >>> hypercoagulation * Serious risk for thrombus & emboli formation * Renal vein = common site for thrombi * PE may occur in 40% of patients
41
Treatment of renal vein thrombosis
anticoagulants, thrombolytics, surgical intervention
42
Kidney cancer
Renal cell carcinoma * 5% of all cancers in U.S. * 25% metastasize to lungs, liver, bone, brain Risk factors include smoking, obesity, native americans
43
Symptoms of kidney cancer
often asymptomatic but may have palpable mass, hematuria, flank pain, weight loss, anemia
44
Treatment of kidney cancer
nephrectomy, radiation, chemotherapy, immunotherapy, renal artery embolization (for pts. w/ mets)
45
CKD has how many stages?
5
46
Clinical manifestations of CKD
Increased Creatinine * Decreased GFR * Anemia * Hyperphosphatemia * Hypocalcemia * Secondary Hyperparathyroidism * Hyperkalemia * Hypervolemia * HTN * Metabolic acidosis
47
CKD Assessment
fatigue, weakness, headaches, trouble concentrating, pruritis, increased BP, decreasing UOP, edema, nausea, decreased appetite, anemia, restless legs
48
CKD Treatment goals
Early referral to nephrologist * Early referral for RRT planning * BP < 130/80 * Control hyperglycemia * Management of anemia >> * epoetin (Procrit) injections * Management of hyperphosphatemia > * Phosphate binders * Reduced phos. diet * Reduced Na diet * Reduced K+ diet * Fluid restriction * Reduced alcohol use * Smoking cessation * Weight control & exercise
49
ESRD
end stage renal disease, GFR <15 ml/min, CKD stage 5
50
ESRD symptoms
inability to concentrate, confusion, tremor, asterixus * dry skin, pruritis * SOB, crackles * edema, HTN, hyperkalemia * nausea, decreased appetite, metallic taste, halitosis * muscle cramps, restless legs
51
ESRD Assessment findings
Increased BUN, Creatinine * Decreased GFR <15ml/min * Decreased or absent UOP * Hyperkalemia * possible dysrhythmia * Hypernatremia * Hyperphosphatemia, Hypocalcemia, Vitamin D deficiency, Elevated PTH * bone disease * Metabolic acidosis * Decreased Hg, HCT, RBC’s * Anemia of Chronic Disease * HTN, edema, increased weight * Pericarditis, pericardial effusion
52
ESRD Treatment
dialysis, renal transplant, diet (protein, restriction of sodium, potassium, phosphorus, uric acid, fluid restriction of <1L/day), use of phosphate binders, anti HTNs, Vitamin D, anti- anemics
53
Nursing Management of CRF and ESRD
Monitor * Fluid Balance * Daily weight * I&O * Electrolyte Balance * Na, K, Phos, Calcium, Mg * IV Fluids ≠ Assess * Edema * Lung sounds * JVD * Heart rate & rhythm * EKG changes Prevent Infection * Venous access care * CVC care Patient Education * Disease process * Diagnostic testing * Medications & Treatments * Diet * Fluid intake * Self-care * Follow up
54
Hemodialysis
removes excess fluid and waste products, individualized to pt needs, uses heparin to reduce clotting, is not curative
55
Complications of hemodialysis
bleeding, hypotension, muscle cramping, air embolism, weakness
56
Hemodialysis options
Incenter and home
57
How does hemodialysis work?
combo of diffusion of toxins, osmosis and ultrafiltration of fluids (uses the pressures)
58
Two different types of vascular access for HD
AV fistula, AV graft complications include stenosis, thrombus formation, infection, aneurysm development
59
Nursing care for AV fistula
assess for bruit and thrill, infection, clotting, no venipuncture, torniquets, BP cuffs or restrictive clothing
60
Catheter use in HD
double lumen, tunneled, subclavian or IJ assess for infection, sterile technique, occlusive, transparent dressing, do not use for IV fluids or blood draws
61
Nursing care before HD
Weigh patient * Obtain labs before HD ??? **Often done during HD * Early breakfast & morning care * Routine assessment of fistula, graft, or catheter * Medications: * Give daily drugs after HD * CV and HTN meds usually not administered before HD * Most antibiotics after HD
62
Nursing care after HD
Vitals * Routine access care * Observe for disequilibrium after patient stands * Monitor for bleeding – heparin was most likely administered during dialysis & LARGE needles used
63
CVVH
common with AKI * especially patient’s w/ hypotension and hemodynamic instability * requires double-lumen CVC * usually temporary * Intensive Care Unit * UF = continuous & slow fluid removal
64
CVVHD
added dialysate to filter out waste products
65
Peritoneal dialysis
Uses peritoneal membrane * Permanent PD catheter inserted * Interventional Radiology * Strict sterile technique * No heparin use * Multiple exchanges (cycles) daily * Requires independence * Increases freedom
66
3 stages of Peritoneal Dialysis
Infusion * 2-3 liters * 10-15 minutes * Dwell * 3-4 hrs. * Diffusion & osmosis occur * Drainage * 10-20 minutes * uses a closed system * colorless or straw-colored fluid
67
Peritoneal Dialysis options
Continuous Ambulatory- most common, at home, gravity Intermittent- hospitalized and hemodynamically unstable Continuous Cyclic- overnight, computer based cycler, pt or caregiver
68
Nursing care during PD
Vital signs * Warm dialysate --- DO NOT MICROWAVE * Hook dialysate bag to peritoneal catheter – sterile technique * “Fill” - allow fluid to flow by gravity * approx.10 min. for 2 liters * patients may c/o abdominal pain & cramping (may radiate to shoulder) * slow the rate to make patient more comfortable * Disconnect & start “dwell” - time depends on MD orders * “Drainage” – at end of dwell, connect drainage bag
69
PD education
Dietary education * higher protein diet * Increased fiber * Less restriction of Na & K * Fluid restriction * Less restrictive than HD * May produce urine * Support services * Prevention of infection * sterile technique * catheter care * Awareness of complications * peritonitis * rupture of membrane
70
Care of Hospitalized Dialysis pt
Protect vascular access * assess site for patency * assess for signs of potential infection * do not use catheter for BP or blood draws * Carefully monitor * fluid balance - IV therapy, accurate I&O, daily weight * cardiac & respiratory status * Lab results * Assess for: * signs of uremia * signs of electrolyte imbalance * pain & discomfort
71
Care of hospitalized dialysis pt continued
Medications: * Hold CV & HTN meds prior to dialysis * Antibiotics at end of dialysis * Monitor all medications and dosages carefully * Dietary considerations: * sodium, potassium, protein * sugar-free candy, lemon (to decrease thirst) * Skin care: * pruritus, moisturize skin, hygiene, trim nails, avoid scratching * CAPD catheter care * Stringent infection control measures
72
Kidney transplant
compatible ABO and human leukocyte antigens, donor can be related, unrelated or cadaveric
73
Recipient contraindications
malignancy, infection, COPD, severe PVD, inoperable CAD, BMI >35, current substance abuse, history of non-adherence
74
Tesio catheter
catheter that allows pts to recieve dialysis w/o needing a surgical shunt, it is placed under radiological guidance
75
Donor contraindications
same as recipient plus HTN, DM
76
Hyperacute rejection
immediate to 24hrs, thrombosis, necrosis, requires removal
77
Acute rejection
2-14 days, tenderness at site, fever, malaise, possible reversal
78
Chronic rejection
several months/ years, possible reversal
79
Signs of rejection
edema, oliguria, fever, tenderness at site, weight gain, HTN, elevated creatinine (≥ 20% rise = sign of rejection) 90% remain functioning at 1 year, treatment plan is individualized

Med Surg (15 decks)

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