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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
Q

CKD risk factors

A

HTN, diabetes, cv disease, obesity, 60+, family history, use of nephrotoxic drugs, african americans

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26
Q

CKD Causes

A

Diabetes, HTN, chronic GN, PCKD, hereditary diseases, congenital diseases, renal artery stenosis/ thrombosis, cancer, nephrotoxic agents

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27
Q

Diabetic nephropathy

A

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

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28
Q

People at high risk for diabetic nephropathy

A

african americans, native americans and hispanics with T2DM

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29
Q

Diabetic nephropathy assessment

A

proteinuria, anasarca, HTN, acidosis

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30
Q

Diabetic nephropathy treatment

A

Control HTN
* Ace Inhibitors
* ARB’s
* Calcium channel blockers
* Eat moderate amount of protein
* high quality
* Low sodium & potassium diet
* Control HgAIC

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31
Q

Nephrosclerosis

A

hardening of renal arteries, secondary to HTN and diabetes (decreased renal blood flow) major cause of CRF

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32
Q

Malignant nephrosclerosis

A

DBP >130, More common in young adults, Men > women, 50%&raquo_space; death if untreated

33
Q

Benign nephrosclerosis

A

more common in adults 50+, BP >160/110

34
Q

Treatment of nephrosclerosis

A

ACE inhibitors/ ARBs

35
Q

Polycystic kidney disease

A

Fluid-filled cysts in kidneys&raquo_space;> destroy
nephrons, Kidney enlargement, Can also occur in: liver, brain, heart

36
Q

Symptoms of PCKD

A

HTN, abdominal/ flank pain, hematuria, constipation

37
Q

Treatment of PCKD

A

BP control, pain control, antibiotics for infection, dialysis may be needed

38
Q

Renal artery stenosis

A

Fibromuscular changes and atherosclerosis (thrombosis or renal aneurysm)

39
Q

Assessment of Renal Artery Stenosis

A

difficult to control HTN, elevated creat, abd bruit, renal bruit, flank or upper abd pain

40
Q

Renal Vein Thrombosis

A

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
Q

Treatment of renal vein thrombosis

A

anticoagulants, thrombolytics, surgical intervention

42
Q

Kidney cancer

A

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
Q

Symptoms of kidney cancer

A

often asymptomatic but may have palpable mass, hematuria, flank pain, weight loss, anemia

44
Q

Treatment of kidney cancer

A

nephrectomy, radiation, chemotherapy, immunotherapy, renal artery
embolization (for pts. w/ mets)

45
Q

CKD has how many stages?

A

5

46
Q

Clinical manifestations of CKD

A

Increased Creatinine
* Decreased GFR
* Anemia
* Hyperphosphatemia
* Hypocalcemia
* Secondary Hyperparathyroidism
* Hyperkalemia
* Hypervolemia
* HTN
* Metabolic acidosis

47
Q

CKD Assessment

A

fatigue, weakness, headaches, trouble concentrating, pruritis, increased BP, decreasing UOP, edema, nausea, decreased appetite, anemia, restless legs

48
Q

CKD Treatment goals

A

Early referral to nephrologist
* Early referral for RRT planning
* BP < 130/80
* Control hyperglycemia
* Management of anemia&raquo_space;
* 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
Q

ESRD

A

end stage renal disease, GFR <15 ml/min, CKD stage 5

50
Q

ESRD symptoms

A

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
Q

ESRD Assessment findings

A

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
Q

ESRD Treatment

A

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
Q

Nursing Management of CRF and ESRD

A

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
Q

Hemodialysis

A

removes excess fluid and waste products, individualized to pt needs, uses heparin to reduce clotting, is not curative

55
Q

Complications of hemodialysis

A

bleeding, hypotension, muscle cramping, air embolism, weakness

56
Q

Hemodialysis options

A

Incenter and home

57
Q

How does hemodialysis work?

A

combo of diffusion of toxins, osmosis and ultrafiltration of fluids (uses the pressures)

58
Q

Two different types of vascular access for HD

A

AV fistula, AV graft

complications include stenosis, thrombus formation, infection, aneurysm development

59
Q

Nursing care for AV fistula

A

assess for bruit and thrill, infection, clotting, no venipuncture, torniquets, BP cuffs or restrictive clothing

60
Q

Catheter use in HD

A

double lumen, tunneled, subclavian or IJ

assess for infection, sterile technique, occlusive, transparent dressing, do not use for IV fluids or blood draws

61
Q

Nursing care before HD

A

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
Q

Nursing care after HD

A

Vitals
* Routine access care
* Observe for disequilibrium after patient stands
* Monitor for bleeding – heparin was most likely administered during
dialysis & LARGE needles used

63
Q

CVVH

A

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
Q

CVVHD

A

added dialysate to filter out waste products

65
Q

Peritoneal dialysis

A

Uses peritoneal membrane
* Permanent PD catheter inserted
* Interventional Radiology
* Strict sterile technique
* No heparin use
* Multiple exchanges (cycles) daily
* Requires independence
* Increases freedom

66
Q

3 stages of Peritoneal Dialysis

A

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
Q

Peritoneal Dialysis options

A

Continuous Ambulatory- most common, at home, gravity
Intermittent- hospitalized and hemodynamically unstable
Continuous Cyclic- overnight, computer based cycler, pt or caregiver

68
Q

Nursing care during PD

A

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
Q

PD education

A

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
Q

Care of Hospitalized Dialysis pt

A

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
Q

Care of hospitalized dialysis pt continued

A

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
Q

Kidney transplant

A

compatible ABO and human leukocyte antigens, donor can be related, unrelated or cadaveric

73
Q

Recipient contraindications

A

malignancy, infection, COPD, severe PVD,
inoperable CAD, BMI >35, current substance abuse, history of non-adherence

74
Q

Tesio catheter

A

catheter that allows pts to recieve dialysis w/o needing a surgical shunt, it is placed under radiological guidance

75
Q

Donor contraindications

A

same as recipient plus HTN, DM

76
Q

Hyperacute rejection

A

immediate to 24hrs, thrombosis, necrosis, requires removal

77
Q

Acute rejection

A

2-14 days, tenderness at site, fever, malaise, possible reversal

78
Q

Chronic rejection

A

several months/ years, possible reversal

79
Q

Signs of rejection

A

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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