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nursing theory iv a- cindy's class > Problems Of Urinary Function: Acute Kidney Injury & Chronic Kidney Disease > Flashcards

Problems Of Urinary Function: Acute Kidney Injury & Chronic Kidney Disease Flashcards

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1
Q

What is renal failure?

A

Happens when the kidneys cannot remove wastes or perform regulatory functions

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2
Q

What is acute renal failure?

A

reversible syndrome that results in decreased glomerular filtration rate(GFR) and oliguria lasts less than 3 months

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3
Q

What is chronic renal failure?

A

progressive; irreversible deterioration of renal function results in azotemia prognosis fatal- renal replacement therapies
dialysis, transplantation

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4
Q

What are the three causes of renal failure?

A
  1. pre-renal
  2. intrarenal
  3. postrenal
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5
Q

What is the cause pre renal in renal failure?

A

sudden and severe drop in blood pressure(shock) or interruption of blood flow to the kidneys from severe injury or illness
- impaired blood leak to hypoperfusion of the kidney and a drop in the GFR: hemorrhage, renal losses(diuretics, osmotic diuresis)
- impaired cardiac efficiency resulting from MI, heart failure, dysrhythmias, cardiogenic shock
- vasodilation resulting from sepsis, anaphylaxis, antihypertensive meds (or vasodilation drugs)

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6
Q

What is the cause intrarenal in renal failure?

A

direct damage to the kidneys by inflammation, toxins, drugs, infections, or reduced blood supply
prolonged renal ischemia, nephrotoxic agents, infectious processes

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7
Q

What is the cause postrenal in renal failure?

A

sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tutor or injury
urinary tract obstruction: calculi, tumours, benign prostatic hyperplasia, strictures, blood clots

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8
Q

What is the cause of acute renal failure?

A

-obstruction of the kindness or lower urinary tract
- obstruction of renal arteries or veins
- Hypovolemia and hypotension
- reduced cardiac output and heart failure

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9
Q

What is the cause of chronic renal failure?

A
  • ** DM and HTN**
  • infections –> pyelonephritis
  • obstruction of urinary tract
  • heredity lesions
  • vascular disorders
  • meds or toxic agents
  • chronic glomerulonephritis
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10
Q

What is acute kidney injury?

A
  • varying and subtle degrees of renal impairment
  • changes in first 48 hours
  • 50% of cases have normal or increased urinary output
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11
Q

What is the etiology and pathophysiology of acute renal failure?

A

etiology: complex disorder, elevation in serum creatinine and anuric renal failure
pathological: hypovolemia and decreased renal blood flow, ischemia, tubules damages, edema and necrosis, globular filtrate leaks decreasing nitratubular fluid flow

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12
Q

What is the four phases of acute renal failure?

A
  1. onset
  2. oliguric-anuric
  3. diuretic
  4. recovery
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13
Q

What is the onset phase in acute renal failure?

A
  • can last several hours or days
  • gradual accumulation of nitrogen waste
  • oliguria
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14
Q

What is the oliguric-anuric phase in acute renal failure?

A

-rise in urea, creatinine, uric acid, organic acid, and intracellular anions (potassium and magnesium)
- decreased urinary output
- decreased renal function but excrete normal urine amount
- metabolic acidosis

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15
Q

What is the diuretic phase in acute renal failure?

A
  • gradually increase urine output
  • glomerular filtration has started to recovery
    -lab values stop rising and start dropping
  • renal function abnormal
  • observe pt for dehydration
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16
Q

What is the recovery phase in acute renal failure?

A
  • ct begins to return to normal levels of activity decrease energy level
  • renal function may never return to preillnesss levels
  • renal function is sufficient for a long healthy life
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17
Q

What is the collaborative care for acute renal failure?

A
  • fluid restriction, nutritional therapy, enteral nutrition, and dialysis if indicated
  • detailed treatment of hyperkalemia
    primary goal: to eliminate cause, manage symptoms, and prevent complications
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18
Q

What is age related considerations for acute renal failure?

A
  • more susceptible due to # of functioning neurons decrease with age
  • impairment of other organ systems can increase risk of developing an AKI
  • aging kidney less able to compensate for changes in fluid volume, soul load and cardiac output
  • mortality rate higher
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19
Q

What is chronic kidney disease?

A

progressive, irreversible loss of kidney function

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20
Q

What is normal GFR?

A

GFR 125 ml/min

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21
Q

What is kidney failure GFR?

A

GFR <15ml/min

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22
Q

What is the two leading causes of end stage renal disease(ESRD)?

A

DM and HTN

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23
Q

What is the clinical manifestations for chronic kidney disease?

A

psychological changes,
effects all bodily systems

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24
Q

What is the accumulated waste products in CKD?

A

increased BUN and creatinine

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25
Q

What is metabolic disturbances in clinical manifestations for CKD?

A

defective carb metabolism caused by impaired glucose
- elevated triglycerides

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26
Q

What is electrolyte/acid-base imbalances in clinical manifestations for CKD?

A

potassium–> hyperkalemia
sodium
calcium and phosphate, magnesium alterations
metabolic acidosis

27
Q

How is the hematological system effected in clinical manifestations for CKD?

A

anemia, bleeding tendencies, infections, increased incidence of cancer

28
Q

What is the treatment for electrolyte imbalance for renal failure? What is the biggest electrolyte imbalance?

A

monitor potassium levels, KAYEXALATe, dialysis, IV calcium gluconate, IV insulin with dextrose
Biggest imbalance: Hyperkalemia

29
Q

How is the cardiovascular system effected in clinical manifestations for CKD?

A

HTN, heart failure, left ventricular hypertrophy, peripheral edema, dysrhythmias, remix pericarditis

30
Q

How is the respiratory system effected in manifestations for CKD?

A

dyspnea, pulmonary edema, kussmaual respirations, ureic pleuritis, infections depressed cough, ureic lung

31
Q

How is the gastrointestinal system effected in clinical manifestations for CKD?

A

All parts affected
- N/V, anorexia, GI bleeding, ureic fetor (urine breath), stomatitis, mucosal ulcerations

32
Q

How is the neurological system effected in clinical manifestations for CKD?

A

altered mental ability, seizures, coma, restless leg syndrome, muscle twitching, irritability, unable to concentrate, encephalopathy, peripheral neuropathy

33
Q

How is the musculoskeletal system effected in clinical manifestations for CKD?

A

renal osteodystrophy, osteomalacia, osteitis fibrosa, metastatic calcifications

34
Q

How is the integumentary system effected in clinical manifestations for CKD?

A

yellow-grey skin, pruritus, ureic frost, brittle hair, thin nails, petechiae, ecchymoses

35
Q

How is the reproductive system effected in clinical manifestations for CKD?

A

infertility, decreased libido, low sperm count, sexual dysfunction

36
Q

How is the endocrine system effected in clinical manifestations for CKD?

A

hypothyroidism, low levels of t3&4

37
Q

What is the diagnosis studies for CDK?

A

renal ultrasound, renal scan, ct scan, renal biopsy

38
Q

What is the collaborative care for CKD?

A
  • drug therapy to treat electrolyte imbalances, edema, dyslipidema
  • restriction of sodium, potassium, protein, fluid, and phosphate
  • calcium supplementation
39
Q

What is the nursing implementation and ambulatory/home care for CKD?

A

nursing implementations: regular checkups and changes in urinary appearance, frequency, and volume, daily weights, BP, strict dietary, meds, fluid overload
Ambulatory/home care: consider HD, PD, or transplant when conservative therapies don’t work

40
Q

What is dialysis?

A

remove fluid and ureic waste products from body when kidneys cannot
- may also treat pts with edema, hepatic coma, hyperkalemia, hypercalcemia, HTN, and uraemia

41
Q

What is acute dialysis?

A

high and rising level of potassium, fluid overload, pulmonary edema, increasing acidosis, pericardia, or severe confusion
TO REMOVE CERTAIN MEDS OR OTHER TOXINS FROM BLOOD

42
Q

What is chronic dialysis?

A

chronic renal failure(ERSD)
Hyperkalemia: fluid overload not responsive to diuretics and lack of well being
- uremic S&S affecting all body systems: N&V, anorexia, lethargy, mental confusion

43
Q

What are two methods of dialysis?

A
  1. peritoneal dialysis(PD)
  2. hemodialysis(HD)
44
Q

What is peritoneal dialysis?

A

** not as efficient over hemodialysis**
- remove toxic substances and metabolic wastes and reestablish normal fluid and electrolyte balance
- choice for pt unable or unwilling to undergo hemodialysis or transplant
- fewer problems than hemodialysis

45
Q

How does peritoneal dialysis work?

A
  • catheter inserted through anterior wall working as a semipermeable membrane
  • urea and creatinine and other waste products are cleared through blood by diffusion and osmosis
  • surgery
46
Q

What is the complications of peritoneal dialysis?

A

exit site infection, peritonitis, abdominal pain, outflow problems, hernias, lower back problems, bleeding, protein loss, pulmonary complications, loss of ultrafiltration, carbs and lipid abnormalities

47
Q

What is hemodialysis?

A
  • prevents death for ESRD pt
  • 3x/week for 3-4 hours
  • artificial kidney that replaces the glomeruli
48
Q

How does hemodialysis work?

A

long plastic cartridge that contains thousands of parallel hollow tubes of semi permeable fibres

49
Q

What is the complications of hemodialysis?

A

clotting, narrowing, infection, bleeding

50
Q

What are the two type of vascular access sites for hemodialysis?

A
  1. arteriovenous fistula
  2. arteriovenous graft
51
Q

What are the types of access for vascular sites for hemodialysis?

A

shunts, interna; arteriovenous fistulas and grafts, temporary vascular access

52
Q

What is a fistula for hemodialysis?

A

preferred method more durable and resistant to infection
- joining artery to a vein
- when mature, vein increases in size and may look like a cord under skin
- takes 3-6 months
- once mature, it is ready for dialysis

53
Q

What is a graft for hemodialysis?

A
  • man made tube connecting artery to a vein
  • 2-6 weeks till healed
54
Q

What is vascular access care?

A
  • make sure it is functioning and properly taken care of by pt, maintop bleeding after dialysis
    restrictions: NO BP or VENIPUNCTIONS to affected arm, label, do not carry items, sleep on that arm, constrictive clothing
55
Q

What is the complications of hemodialysis?

A

hypotension, muscle cramps, loss of blood, hepatitis, sepsis, disequilibrium syndrome

56
Q

What is nursing management for hospitalized pt on dialysis?

A
  • monitor fluid balance, S&S of uraemia and electrolytes imbalances, BP, RR, HR, medications given
  • address pain and discomfort
  • provide skin care
  • Iv therapy
  • protect vascular site
57
Q

What is kidney transplantation donor sources?

A
  • blood relatives
  • compatible blood type decreased donors
  • emotionally related living donors
  • altruistic living donors
58
Q

What does the kidney transplantation surgical procedure look like?

A
  • live donor
  • nephrectomy
  • begins an hour or two before recipients surgery is started
  • rib may need to be removed for adequate view
  • takes 3 hours
59
Q

What are kidney transplantation complications?

A
  • rejection
  • infection
  • cardiovascular disease ( increased incident of atherosclerotic vascular disease, immunosuppressant can worsen HTN and hyperlipdemia)
  • malignancies
60
Q

What is hyperacute (antibody-mediated, humoral) rejection for a kidney transplant?

A

occurs minutes to hours after transplant

61
Q

What is acute rejection for a kidney transplant?

A

occurs days to months after transplant

62
Q

What is chronic rejections for a kidney transplant?

A

Process that occurs over months or years and is irreversible

63
Q

What is age related considerations for CKD?

A
  • ESRD pt are 65+
  • comorbid conditions to treat as well
  • dialysis decision and withdrawal

nursing theory iv a- cindy's class (17 decks)

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