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Nursing Semester 2 > Monica - Week 13 - Exam 4 > Flashcards

Monica - Week 13 - Exam 4 Flashcards

1
Q

Review: what are the 5 parts of the nephron?

A
  • glomerulus (bowman’s capsule)
  • proximal convoluted tubule
  • loop of henle
  • distal convoluted tubule
  • collecting duct
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2
Q

what are the three main functions of the kidneys?

A
  • regulatory
  • excretory
  • endocrine
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3
Q

what are the main characteristics of the regulatory functions?

A
  • regulates blood pressure via RAAS
  • maintains fluid and electrolyte balance through RAAS and anti-diuretic hormone
  • regulates acid-base balance excretes acid load and makes bicarb. to ensure 7.4 pH
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4
Q

what is the one excretory characteristic?

A

excretes waste products (filters out metabolic waste, excess ions, and water)

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5
Q

what are the three hormones made by the kidneys? what do they do?

A
  • erythropoetin (stimulates bone marrow → RBCs → ↑ hgb)
  • renin (helps regulate BP through RAAS)
  • calcitriol (active Vitamin D - absorption of calcium via GI; holds calcium in the kidneys and excretes phosphorus)
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6
Q

what stimulates the secretion of erythropoetin?

A

↓ O2 supply

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7
Q

what stimulates the RAAS system?

A

↓ blood volume, hemorrhage, dehydration

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8
Q

CKD is an _______, _________ disease.

A

irreversible, progressive

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9
Q

CKD develops over __________- to __________

A

months, years

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10
Q

people with CKD are unable to: (3)

A
  • excrete waste products
  • respond to acid-base imbalance
  • control blood pressure and fluid volume
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11
Q

T/F: CKD progresses to end stage renal disease

A

TRUE; 90 - 95% of nephrons are effected

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12
Q

what are the 3 non-modifiable risk factors for CKD?

A
  • family hx of kidney disease, DM, HTN, CVD
  • age > 60 (as we age, kidney function ↓)
  • ethnicity (African Americans and Hispanics)
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13
Q

African Americans - ____ times ↑ incidence of CKD - Incidence and complications r/t ____
Hispanics ____times higher incidence of CKD

A

2.7; HTN; 1.5

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14
Q

what are the two modifiable risk factors for CKD?

A

HTN and DM

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15
Q

what are three reasons HTN is a risk factor?

A
  • cause and consequence
  • kidney arteries narrow, weaken, and harden
  • gradual deterioration of glomerulus (not able to filter as well - non-reversible)
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16
Q

what are 4 reasons DM is a risk factor?

A
  • damage to glomerular capillaries
  • ↑ permeability of proteins → diabetic nephropathy
  • Small amounts of protein → microalbuminuria
  • Larger amounts of protein → proteinuria
  • *proteinuria on at least 2 occasions 3-6 mos. apart
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17
Q

DM is the ____ _____ of CKD

A

leading cause

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18
Q

what is the treatment for DM and HTN? Why?

A

ACE Inhibitors and ARBs (angiotension receptor blockers)

because they are ~renoprotective~

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19
Q

what are the names of the three lab data related to CKD?

A

BUN, Creatinine, and Glomerular filtration rate (GFR)

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20
Q

what is BUN?

A
  • urea nitrogen in blood
  • made when protein broken down by liver. excreted by kidneys (not specific to kidney)
  • used w/ Cr and GFR for kidney disease process
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21
Q

BUN is used to assess _____ and ______ function

A

kidney AND liver

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22
Q

what is creatinine?

A
  • waste product of muscle metabolism
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23
Q

creatinine is specific to ____________ function

24
Q

what is AKI?

A

acute kidney injury; sudden injury to kidney caused by dehydration, infection (shock)

25
what is the glomerulus and what is GFR?
- glomerulus - semi-permeable membrane | - GFR - amt of blood filtered per minute
26
glomerulus has the ability to _____ ______.
filter wastes; 90-120mL/min
27
what occurs when kidney disease progresses?
GFR ↓
28
what is the best indicator of kidney function?
GFR!
29
T/F: African Americans have higher GFR than other races d/t ↑ muscle mass
TRUE
30
how many stages are there of kidney disease?
5 stages
31
what are the characteristics of stage 1?
kidney damage w/ normal or ↑ GFR; GFR > 90; diagnosis/tx; asymptomatic
32
what are the characteristics of stage 2?
kidney damage with mildly ↓ GFR; GFR 60 - 89; estimating progression; asymptomatic
33
what are the characteristics of stage 3?
moderately ↓ GFR; GFR 30 - 59; evaluating and tx of complications; clinical and lab complications of CKD
34
what are the characteristics of stage 4?
severely ↓ GFR; GFR 15 - 39; prep for kidney replacement; dialysis, kidney transplant; clinical and lab complications of CKD
35
what are the characteristics of stage 5?
kidney failure; GFR <15; replacement; uremic symptoms become prominent and need to accept replacement tx
36
what is creatinine clearance?
- total amt of creatinine in urine
37
what does ↓ creatinine clearance mean?
↓ GFR and impaired renal function | **evaluate kidney function
38
what does 24 hr urine collection do?
- creatinine, proteins, and electrolytes excreted over a 24hr period - captures maximal excretion of substance
39
what are the 5 characteristics of the collection process for 24hr urine?
- keep container in ice - note start time on container - discard first void - end time 24-hr from start time - must restart if any void is discarded during 24-hr period
40
what are the 8 clinical manifestations of CKD?
``` mineral disorder hyperparathyroidism hyperphosphatemia hypertension proteinuria & diapetic nephropathy peripheral edema anemia of chronic disease metabolic acidosis & hyperkalemia ```
41
what occurs in mineral disorder?
- Less vitamin D converted to calcitriol - Can't absorb calcium → hypocalcemia → muscle twitching and osteoporosis - Calcitriol and hypocalcemia deficiency (PTH release → bone breakdown)
42
what is the treatment for mineral disorder?
calcitriol and calcium supplements
43
what occurs in hyperparathyroidism?
- parathyroid gland secrets more PTH (kidneys rid phosphorus; retain Cal+; GI retains Cal+) - Bone resorption → ↑ risk of bone fractures
44
what occurs in hyperphosphatemia? what is the treatment?
- ↓ phosphate excretion - Tx: phosphate binders PhosLo (contains cal+) and sevelamer - ↓ phosphate foods intake (dairy, nuts, meat, fish, poultry, beans)
45
what occurs in HTN? what is the treatment?
• renin release via RAAS (not enough perfusion → aldosterone release → Na+, H2O retention
46
what occurs in proteinuria & diabetic nephropathy?
* glomerular permeability ↑ * protein in urine * loss of colloidal osmotic pressure → edema and third spacing
47
what occurs in peripheral edema?
• hypervolemia and inadequate filtration
48
what occurs in anemia of chronic disease?
- erythropoietin production deficiency - bone marrow makes fewer red blood cells - normocytic and normochromic anemia - lower Hgb and Hct
49
what is the tx for anemia of chronic disease?
erythropoietin stimulating agents and iron supplements
50
what occurs in metabolic acidosis and hyperkalemia?
• impaired ability to excrete acid load • defective reabsorption and making of more HCO3 • shift of H+ into the cells and K+ out of the cell → hyperkalemia • Hyperkalemia d/t impaired kidney excretion • K+ foods, supplements, drug
51
what is pharmacologic intervention for hyperkalemia?
sodium polysterene sulfonate
52
what is the indication for sodium polysterene sulfonate ?
mild to moderate hyperkalemia
53
what does Na+ polysterene sulfonate do?
- exchanges Na+ for K+ ions in the intestine | - eliminated in feces
54
when is Na+ polysterene sulfonate contraindicated?
abnormal bowel function or history of bowel disorders
55
what forms does Na+ polysterene sulfonate come in?
PO and retention enema
56
what is the expected outcome for Na+ polysterene sulfonate?
normalized serum K+ levels
57
8 Collaborative Care & Lifestyle Modifications
- Managing HTN ( ACE-I and ARBs) - Diet: Low Na+, K+ Monitoring, Protein Intake (protein hard on kidneys), + Phosphorus Restrictions - Lowering cholesterol (statins) - Achieving optimal glycemic control (7% or less A1C) - Exercise routine (↑ insulin sensitivity) - Limiting or avoiding exposure to nephrotoxic drugs (antibiotics) - Avoiding alcohol (causes kidney to filter less) - Smoking cessation (vasoconstriction → ↑ BP)

Nursing Semester 2 (21 decks)

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