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Med surg exam 2 > KIDNEYS > Flashcards

KIDNEYS Flashcards

1
Q

Emergent dialysis requirements

A

Elevated Potassium
Metabolic acidosis
Hypovolemia

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2
Q

Glomerulonephritis

A

Children, over 60
Chronic
atuoimmune, genetic, or drug use

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3
Q

Nephritic syndrome

A 
Inflammation of glomeruli
HTN
Hematuria
Oliguria
Berger's disease (most common cause)
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4
Q

Neprhotic syndrome

A

Hypoalbuminemia-> albumin excreted, reduction in oncotic pressure-> edema

Hyperlipidemia

Mega proteinuria

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5
Q

Nephrosclerosis

A

Benign: over 60, Vasc. changes w/ htn/atherosclerosis

Malignant: significant HTN, malignant HTN

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6
Q

Renal Artery Stenosis

A

Atherosclerosis of renal arteriies
Can be one or both branches

Cause of secondary HTN

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7
Q

Renal Vein Thrombosis:

A

Basically a DVT in kidneys

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8
Q

Polycystic Kidney Disease (PKD)

A

4th cause of ESRD
Genetic
Manifestations: Ruptured cysts, HTN, pain/heaviness

May need nephrectomy

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9
Q

Kidney Cancer

A

Renal cell carcinoma

Male
Smoker
Obese
Family Hx

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10
Q

AKI Acute Kidney Injury

A

Oliguric Phase
Diuretic Phase
Recovery phase

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11
Q

Oliguric phase (AKI)

A

Phase 1 of AKI

Oliguria- <400mL/day within 1-7 days of kidney injury
Urinalysis (specific gravity fixated at 1.010)
Metabolic acidosis
Hyperkalemia, Hyponatremia
Elevated BUN and Creatinine
Fatigue, malaise

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12
Q

Diuretic phase (AKI)

A

Phase 2 of AKI

Gradual inc. in urine output
Hypovolemia, dehydration
Hypotension
BUN and Creatinine normalizes

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13
Q

Recover phase (AKI)

A

Phase 3 of AKI

GFR increases
BUN and creatinine plateaus and then drops

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14
Q

Risk factors for AKI

A 
Pre-existing kidney disease
MODS/sepsis
Age
Trauma
Surgery
Burns
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15
Q

Rifle classification of AKI

A

R: RISK

I: INJURY

F: FAILURE

L: LOSS

E: ESKD

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16
Q

RIFLE (R)

A

Risk

Serum creatinine 1.5x baseline OR GFR decrease by 25%

Urinary output under .5mL/kg/hr for 6hr

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17
Q

RIFLE (I)

A

Injury

Creatinine 2x baseline
GFR decreases by 50%

Urinary output:

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18
Q

RIFLE (F)`

A

Failure

3x baseline serum creatinine
GFR decreases 75%

Or Creatinine aboce 354 umol/L with acute rise of 44umol/L

Urinary output >.3mL/kg/hr for 24hr
or Anuria for 12 hr

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19
Q

RIFLE (L)

A

Loss

Persistent acute renal failure= complete loss of kidney function for more than 4 weeks

20
Q

RIFLE (E)

A

End Stage Kidney Disease for more than 3 months

21
Q

Pre-renal issue causes

A

Hypoperufsion: Volume depletion, vascular issues, shock

Decreased filtration (Hypotension): most common in Peds

Cardiac Output: MI, HF

22
Q

Intrinsic renal issue causes

A

Glomerular: Acute glomerulonephritis

Vascular: Vasculitis, Atheroemboli, manipulation of aorta

Tubulointerstitial: Acute tubular necrosis

23
Q

MEDS that can cause pre-renal injury

A

Ace inhibitors
ARB (Angiotensin II blockers)

NSAIDS

COX-2 inhibitors (celecoxib)

Loop diuretics, thiazide diuretics

Immunomodulators: Cyclosporine

24
Q

MEDS that can cause ATN (Acute Tubular Necrosis)

A

Antibiotics

HIV meds

Statin (lovastatin): rhabdomyolysis

Biphosphonates

25
Q

Post Renal issue causes

A

10% of renal issues

Obstructions: 
Prostate
Intraperitoneal tumor
Stones
Trauma
26
Q

AKI nursing considerations

A

Volume status: watch for excess urine and edema, look for osmolality

Review labs: GFR, creatinine

Flank pain, muscle pain

Infection/sepsis

Cardiac: BP/EKG

Respiratory compensation

27
Q

Nursing considerations for Phase 1 AKI (Oliguric)

A 
Manage Fluid volume
Sodium balance
Acid/base balance
Hyperkalemia
Hematologic considerations (hypovolemia, hypoalbuminemia etc.)

Watch for waste accumulation
Neurologic disorders

28
Q

Nursing considerations for Phase 2 AKI (Diuretic)

A

High urine volume means watch volume management and electrolytes

29
Q

Nursing considerations for Phase 3 AKI (Recovery)

A

Look for GFR increases

Let them know it may take up to a year to heal fully

30
Q

Differences between AKI and CKD

A

Acute can turn into chronic

Chronic: 
Better tolerates wide lab ranges
Anemia, cachexia, gray skin
Low calcium
Stable (out of range) creatinine

Chronic normocytic anemia

Renal Ultrasound: Scars/large kidneys

Acute:

Hypotension, fluid overload, metabolic acidosis
Rapid increasing creatinine
Normal calcium

Renal ultrasound normal

31
Q

End Stage Renal Disease

A

Under 15mL/min GFR

Inc BP
Pitting edema
HF
Pulmonary Edema
Ammonia odor to breath
Anorexia
Anemia

Yellow/gray skin
Metabolic acidosis
Inc. potassium

32
Q

Chronic Renal failure stage 1 GFR

A

Kidney damage w/normal function

90+

33
Q

Chronic Renal failure stage 2GFR

A

Kidney damage w/mild loss function

89-60

34
Q

Chronic Renal failure stage 3A GFR

A

Mild to moderate loss of kidney function

59-44

35
Q

Chronic Renal failure stage 3b GFR

A

Moderate to severe kidney function loss

44-30

36
Q

Chronic Renal failure stage 4 GFR

A

Severe loss kidney function

29-15

37
Q

Chronic Renal failure stage 5 GFR

A

Kidney failure

under 15

38
Q

Nursing considerations for CKD

A

Dietary restrictions: High fat, low protein, low sodium, low potassium, low phosphorus. Fluid restrictions

Ostrosdystrophy: Give calcium/phosphorus balance-binders, PTH, Vit D

Anemia: ESA (erythropoeitin stimiulating agents), Iron, blood

39
Q

Pediatric considerations for CKD

A

Impeded physical growth/sexual maturation

Developmental issues

40
Q

Who needs dialysis (AEIOU)

A 
Acid-base problems
Electrolyte problems
Intoxications
Overload of fluids
Uremic symptoms
41
Q

Renal replacement therapies for ESRD

A

palliative care

Transplant

Hemodialysis

Peritoneal dialysis

42
Q

Peritoneal dialysis

A

CAPD 3-5 times/day
20-40 min at a time

CCPD done overnight

Catheter in abdomen STERILE TECHNIQUE

Diffusion dependent on time, volume, speed of transport

Osmotic gradient determined by dextrose solution % used
Adequacy measured by KT/V

Residual renal function lasts longer in PD

43
Q

Hemodialysis considerations

A

Fluid, sodium, potassium, phosphorus restricted
Encourage more protein (can be filtered now)
Phosphorous binders

Watch access management

Assess for thrills/bruits

NO BP, IV, NEEDLE STICKS on access limp

DON’T USE DIALYSIS CATH FOR GENERAL USE- only EMERGENCY

Take weights daily

Watch fluid management, I&Os

44
Q

Creatinine range

A

.8-1.2mg/dL

45
Q

BUN range

A

7-20mg/dL

Med surg exam 2 (7 decks)

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