Quiz 6 Flashcards
What is glomerulonephritis? What can it lead to?
inflammation and scarring of the kidney
lead to end stage kidney disease
What are the risk factors of glomerulonephritis?
beta-hemolytic streptococcal infection
tonsillitis or pharyngitis
presence of systemic disease
What are the clinical manifestations of glomerulonephritis?
hematuria (blood in urine)
oliguria or anuria (decreased or no)
azotemia (increased BUN)
proteinuria (protein foamy)
dysuria (pain)
flank or abd pain
fatigue
HTN
weight gain
low grade fever
What are the diagnostic studies for glomerulonephritis?
increased BUN, CR, ESR, K, Phosphate
decreased GFR, albumin, CA
+ ANA, + ASO titer
urinalysis - hematuria, proteinuria, RBS, sediments, casts
kidney bx
What medications are given for glomerulonephritis?
PCN for strep infection
corticosteroids for inflammation
antihypertensives for increased BP
What are nursing interventions for glomerulonephritis?
bed rest
monitoring for F/E imbalance (potassium)
high-calorie, low-protein, low-sodium diet, restrict fluids
What is a priority for a patient with acute glomerulonephritis?
check the patient’s daily weight
What can be done to confirm a diagnosis of chronic glomerulonephritis?
bx of kidney to check for sclerosis
What lab value would decrease for a patient with chronic glomerulonephritis?
RBC
What do you expect for a male with chronic glomerulonephritis?
serum creatinine of 7mg/dl
over 1.3 is BAD
When does a pt with glomerulonephritis need further teaching about a sodium restricted diet?
when they say they can still drink 3-4 carbonated drinks daily
When can a patient with glomerulonephritis resume normal activities?
when HTN and hematuria are resolved
What is a ileal conduit?
ureters are implanted into part of ileum or colon that has been resected from intestinal tract
What is a cutaneous ureterostomy?
ureters are excised from bladder and brought through abdominal wall
What is a nephrostomy?
catheter is inserted into pelvis of kidney
What is acute kidney injury?
sudden short term loss of kidney function (curable)
can lead to chronic kidney disease
What are the classifications of acute kidney injury?
prerenal - blood not perfusing kidneys
intrarenal - damage inside
postrenal - obstruction in outflow of urine
What are the phases of acute kidney injury?
onset
oliguric phase
diuresis phase
recovery phase
What are the clinical manifestations of acute kidney injury during the oliguric phase?
LOW URINE OUTPUT
metabolic acidosis (below 7.35)
sodium HIGH
phosphorus HIGH
potassium HIGH
BUN/CR HIGH
fluid overload (edema)
What are the clinical manifestations of acute kidney injury during the diuretic phase?
up to 5L/day, electrolyte losses
decreased BUN, then normalizes
decreased specific gravity
normal kidney function back
What happens during the recovery phase of acute kidney injury?
return to baseline (30mL/kg/hr)
complete recovery may take 12 months
residual kidney dysfunction may be noted
What medications are given to decrease potassium as a result of acute kidney injury?
IV insulin (regular)
IV glucose
IV sodium bicarb (decrease acidity)
IV calcium gluconate
PO or PR sodium polystyrene sulfonate (used in less severe cases, BM = Rx working)
What medications are given to decrease phosphorus as a result of acute kidney injury?
phosphate binders
What medications are given for anemia as a result of acute kidney injury?
epoetin alfa
What are the nursing interventions for acute kidney injury?
monitor I&O, weigh daily
examine urine
monitor electrolyte balance
assess for HF or pulm. edema
review nephrotoxic drugs
What is the diet for a patient with acute kidney injury?
high calorie
fluid restriction
low protein
restrict potassium, phosphorus, sodium, magnesium
What is an expected blood gas for a patient with acute kidney injury?
pH below 7.35
HCO3 14
PaCO2 30
When does a pt with acute kidney injury need further teaching about potassium diet source?
when they say adding pecans will be a change that they can readily make
What indicates an increased risk of acute kidney injury?
creatinine over 1.3
What will indicate understanding for a patient with acute kidney injury about fluid restrictions?
i will make a list of my favorite beverages
What is chronic kidney disease?
irreversible damage to the kidneys
no cure
GFR <60mL/min for at least 3 months
What are the stages of chronic kidney disease?
GFR
greater than or equal to 90 - normal
stage 1: <90
stage 2: 60-80
stage 3: 30-59
stage 4: 15-29
stage 5 (end stage renal): <15
What are the causes of chronic renal disease?
uncontrolled diabetes
uncontrolled HTN
What are the clinical manifestations of chronic kidney disease?
uremic frost
similar to acute kidney disease
What are the diagnostic studies of chronic kidney disease?
urinalysis
cystoscopy
renal bx
albumin to creatinine ratio
What are the therapeutic procedures for chronic kidney disease?
dialysis
kidney transplant
What are the nursing interventions for chronic kidney disease?
strict I&O
monitor BP
monitor for s/s of FVO and hyperK
do not administer antacids w/ Mg
do no administer enemas w/ phosphorus
Avoid loop diuretics
What is the diet for someone with chronic kidney disease?
high carb
low protein
low potassium
low sodium
low phosphate
When would you take the daily weight of a patient with chronic kidney disease?
After they void
What is the most reliable measurement of fluid retention for a patient with chronic kidney disease include volume increase?
Daily weight
What are the expected findings of end-stage renal disease?
Slurred speech
Bone pain
Pruitis
What should be taught for a patient with chronic kidney disease about low protein diet?
A low protein diet reduces risk of uremia
What would you expect the blood gas to be for a patient with chronic kidney disease?
pH 7.25
HCO3 19
PaCO2 30
Why would aluminum hydroxide be given for a patient with chronic kidney disease instead of Pepcid?
Phosphorus levels lower when taking aluminum hydroxide
What is an adverse reaction of aluminum hydroxide?
Constipation
A patient with chronic kidney disease should limit which nutrients?
Protein
phosphorus
sodium
For a patient taking epoetin alfa, what would should be increased in their diet?
Iron
What is a manifestation of hyperkalemia in a patient with chronic kidney disease?
Decreased deep tendon reflexes
What foods that are high in potassium will you tell a patient with chronic kidney disease to avoid?
Tomato
Bananas
Raisins
What are examples of renal replacement therapy?
Peritoneal dialysis
Intermittent hemodialysis
Continuous renal replacement therapy
Describe hemodialysis
Requires vascular access
AV fistula or AV graft
Lifespan: 20-40 years, die from CLABSI
Duration: 3 to 4 hours
What are the nursing interventions for hemodialysis?
Before: assess fluid status, assess AVF/AVG, weigh the client, hold morning meds, report any symptoms during procedure
During: monitor BP
After: prevent infection, monitor, complications, weight, client, provide adequate nutrition, rest
Describe continuous renal replacement therapy
Alternative method for treating AKI
Uremic toxins and fluids are removed
Duration: 24 hours
Describe peritoneal dialysis
Catheter inserted through anterior abdominal wall - solution dwells for 4 hours - fluid comes out
More than inserted should come out
Once a day
More stable patients
Types: continuous ambulatory PD and automated PD
What does it mean if the dialysate is cloudy
Peritonitis
What are the phases of the peritoneal dialysis cycle?
Inflow (fill)
Dwell (equilibration)
Drain
What food is contraindicated for a patient who is taking bumetanide?
Ham sandwich
when do you administer phenytoin after a patient gets dialysis?
When they complain of headache and restlessness
When teaching a patient about continuous ambulatory peritoneal dialysis what should you tell the patient?
Require the patient to follow fewer dietary and fluid restrictions than hemodialysis
What should a nurse do prior to exchanging dialysate for peritoneal dialysis?
Warm the solution prior to insulation
What should be reported immediately for a patient who is undergoing peritoneal dialysis?
Purulent dialysis outflow
For a patient with a new AV fistula to the right arm, what would indicate venous insufficiency?
Cold and numbness distal to the fish site
What can low calcium in the blood cause?
Seizures
What are the discharge instructions for a patient who is going to do a peritoneal dialysis at home?
Anticipate pain the first week during the inflow of dialysate
What are the manifestations of peritonitis?
Nausea and vomiting
