Rena system Flashcards
AVfistula
Av fistula(requires several weeks to months to mature before it can be used). He grabbed a big AvGraft : (can be used to 2more 4weeks after placement). Maturing of the fistula is aided by having the client perform hand exercises, such as squeezing rubber ball, that increases blood flow through the vein.
 Nursing Consideration -dialysis
obtain consent , medication-might be on hold.
Assess vitals and lab works, obtain daily weight.
Assess patency of AV fistul/graft , presence of Bruit,palpable thril,distal pulses.
Restrictions on the extremity with AVF/G. Avoid taking blood pressure.
Do not administer injection through AVF/G
do not perform the vein puncher Or insert I/V lines.
 confrontational dialysis 
 assess for the following:
complications:hypotension, clotting vascular assess, headache, muscle cramps, bleeding. Indications :of bleeding and/or infection at the assess site .
Send some disequilibrium syndrome
Due to too rapid decreases in BUN and fluids- can result in cerebral edema, and ICP sign include nausea/vomiting, headache, fatigue, confusion, convulsion, coma.
Signs of hypovolemia, (hypotension , dizziness, tachycardia).
peritoneal dialysis 
Instill dailysate solution into Pétronille cavity and drain. The peritoneum serves as the filtration membranes.
The client may feel fullness when the dialysate dwelling
Continues ambulatory peritoneal dialysis
Continue ambulatory Pétronille dialysis is usually done 7 days a week, for 4 to 8 hours. client may continue normal activities during CAPD.
Continues cycle peritoneal dialysis CCPD-the exchange occurs at night while the client is sleeping. assist site care: strict sterile technique.
Peritoneal dialysis monitoring
Monitor weight ,serum electrolytes , creatinine,bun, and blood glucose (might need insulin).
Warm the dialysate prior to instilling. avoid the use of microwaves, which cause uneven heating. Monitor the color (clear light yellow is expected). And amount (expected to equal or exceed amount of dialysate inflow)of outflow.
Cloudy -infection.
Reposition the client if inflow or outflow is in adequate.
Movement of the client will help disseminate the fluid throughout the abdomen.
Acute renal failure (acute kidney injury)
Sudden cessation of renal function – when blood flow to the kidneys his significantly compromised
Acute Kidney injury compromised:four phases
Onset-begins with onset of the event ,ends when oligoria develops, and lasts for hours to days. oligoria-begins with the kidney insult, urine output is 100 to 400 ml/24 hours with or without diuretics, and lost for 1to 3 weeks.
Diuretics-begins when the kidneys start to recover,diuresis of large amount of fluid occurs, and can last for 2 to 6 weeks.
Recovery-continues until kidney function is fully restored and can take up to 12 months.
Acute kidney injury causes
Prerenal:hypoperfusion, obstructed renal artery blood flow. Hypovolemia,water and electrolyte loss. Hemorrhage, Loss plasma volume cardiac failure, PE hypertension, sepsis, shock. Intrarenal Renal: prolonged renal ischemia, (decreased urine output ,always products stay nephrotoxins:poisons,Radiation’s chemicals, cancer tissues intra-tubular obstruction/necrosis immunological damage, pyelonephritis  post renal: urethral obstruction, edema, tumor, stones, clots bladders outlet obstruction, BPH, you return structure, neurogenic bladder (stiff flaccid bladder, paralyzed)
Chronic renal failure in neuro, Cardiovascular
Neurologic-lethargy , decreased in attention span, slurred speech, tremors, seizures, coma.
Cardiovascular cardiovascular - fluid overload, hypertension, dysrhythmias, heart failure, orthostatic hypotension
Chronic renal failure respiratory, hematology.
Respiratory-uremic halitosis, (NHCO3- by product in saliva, urea). With deep sighing, yawning, shortness of breath, tachypnea, hyperpnea, Kussmaul breathing.
Hamatologyanemia -pallor, weakness, dizziness, Ekhymosis, petechiae, Melena.
chronic renal failure:body systems- gastrointestinal, muscular skeleton, renal, skin.
gastrointestinal -due to fluid electrolyte.-ulcers in the mouth and throat, foul breath, blood in stool, nausea, vomiting.
musculo skeletal-thin fragile bone due to low calcium
renal- urine contains protein, blood,particles; in the amount color ,concentration
Skin decreasing skin turgor, yellow cast tonskin, dry, pruritis,urea crystalline skin,uremic frost.
Special consideration for chronic renal failure
For anemia administer epoetin Alfa (epogen,procrit), Darbypoetin Alfa( Aranesp)
Administer blood transfusion if prescribed for anemia.
instruct the client to avoid antacids containing magnesium.
administration of acetylsalicylic acid (aspirin)or(NSAIDS) to prevent gastrointestinal bleeding.
Avoid administering anti-microbial medication (example aminoglycosides and amphotericin B),
angiotension-converting converting enzymes inhibitor and angiotensin receptor blocker’s, and IV contrast dye, which are nephrotoxic.
Nursing consideration for chronic renal failure
Monitor for signs of hypervolemia, hypovolemia,dehydration,signs of congestive heart failure, pulmonary edema, signs of infection, peripheral neuropathy.
Monitor for hyperkalemia – cardiac monitoring dysrhythmias. Provide low potassium diet if prescribed for hyperkalemia.avoid potassium sparing diuretics.
Diet for chronic renal failure
They stick the clients restrict the clients dietary sodium dietary sodium, potassium, phosphorus and magnesium.
Provide a client diet-that is high in carbohydrates, and moderate in fat.
low protein diet helps prevent kidney disease progression. But if the client is already on dialysis, liberal protein intake is recommended to prevent malnutrition.
protect the client eyes from ocular irritation
provide end of life care for a client with end-stage renal disease. Avoid diuretics for end-stage if possible. It increases destruction of the remaining nephrons in the kidney.
Glomerulonephritis and risk factors
 inflammation of the glomerular capillaries.
Group A Beta-hemolytic streptococcus infection of pharynx or skin.
History of pharyngitis pharyngitis and tonsillitis 2 to 3 weeks before symptoms.
Hypertension, DM, excessively high protein and high sodium diet.
types:Acute-usually has fever.chronic (cause not known)-usually has pruritus.
Glomerular nephritis lab studies
 labs: antistreptolysin-0(ASO)titter (positive indicating the presence of strep antibodies),
elevated RFT, urinalysis (proteinuria, hematuria, Casts, SP gravity increases (normal range 1.1.003to1.030).
renal symptoms
Decrease urine output, smoky or coffee colored urine (hematuria), proteinuria.
Fluid volume excess symptoms-edema, it will be, SOB,weight,crackles, hypertension, severe hypertension must be identified.
LOC changes, older adult client may report vague symptoms, (nausea, fatigue, joint aches)which may mask glomerular disease.
Glowmarulonephritis nursing care
Daily weight , Intake and output,urine pattern change. Labs-serum electrolytes, bun and creatinine, skin pruritus. Bedrest to decrease metabolic demands.prescribed to dietary restrictions fluid restrictions (24 hours output +500 ML to 600) sodium restriction (1 to 3 g per day )begins when fluid retention occurs. Protein restrictions (if azotemia(blood urea,nitrogen)is present= increased bun)
Glomerulonephritis other complications
Uremia: monitor the client for muscle cramps, fatigue, pruritus, anorexia, on the metallic taste in mouth.
Maintain skin integrity. drains encourage mouth rinses , chewing gum, or hard candy.
Pulmonary edema,congestive heart failure, pericarditis,and anemia.
Therapeutic procedures-plasmapheresis (filter antibodies out of circulating blood volume by removing the plasma)
weight the client before and after the procedure monitor hypovolemia administer replacement fluids- albumin.
Monitor for signs of tetany(muscle spasm)if to much calcium is removed.
Renal calculi
Urolithiasis(kidney stones)is the presence of calculi( stones) in the urinary track.
The majority of stone(75% )are composed of calcium phosphate,or calcium oxalate, but they may contain other substances( uric acid, struvite,cystine).
Explain most clients can expel stones without invasive procedure.
Renal caliculi symptoms
Renal stone: severe pain (renal colic) priority flank pain.
Pain intensifies as the stones move through the ureter.
Flank pain suggests are located in the kidney or ureter.
flank pain that radiates to the abdomen, scrotum,‘s testes,or Vulva is suggestive of stones in the ureter or bladder.
urinary frequency of dysuria(difficulty in the urination ,stone in the bladder or bladder spasm)nausea, vomiting,diaphoresis, Pallor, fever.
Oligoria/anuria (occurs with stones that obstruction urinary flow); urinary track obstructions is in medical emergency and needs to be treated to preserve kidney function.
Strain all urine to check for passage of the stone and save the stone for laboratory analysis.
Renal caliculi intervention
increase the water intake to 3 L/per day unless contraindicated.
Administered IV fluids as prescribed.
Encourage ambulation to promote passage of the stone.
Renal caliculi surgical interventions
Direct roast coffee ureteroscopy ( Dialte ureter using scope for passage of stone) ureterolithotomy – insertion of an ultrasonic or laser lithotriptor into the ureter or kidney to grasp on the extract the stone. Open surgery (large stone) therapeutic procedures: extracorporeal shock wave lithotripsy (ESWL). Uses leser, or shock wave energies, to break stones into fragments. Requires moderate (conscious) sedation and ECG one thing during the procedure.
Ileal deficit
Surgery:use a piece of the client’s aliens ileum to create an outlet (no bladder).
The client Ureters are connected to the ileal conduit-to abdominal stoma-bag-to pass urine.
A Healthy stoma should be pink to brick -red-and moist,indicating vascularity and viability.
Dusky are any shade of blue:Contact -impaired perfusion . Contact HCP immediately-medical emergency.
UTIurinary track infection
An upper UTI: (casts is present) Find pyelonephritis is an infection and inflammation of the kidney. Pelvis, calyces, and medulla. The infection usually begins in the lower urinary track which organism ascending into the kidney pelvis.
What are UTI symptoms
Fever, flank pain, nausea and vomiting.
administer antipyretics ,such as acetaminophen (Tylenol), as needed for fever and opioid,analgesic for pain associated with pyelonephritis.
UA: bacteria, sediment (proteins,urine,glucose,sodium), white blood cells (WBC)and red blood cells(RBC).
Positive leukocytes esterase and nitrates 68% 88% positive result UTI.
UTA nursing concentration
Fluid intake up to 3 L per daily, antibiotics, frequent voiding, urinate every 3 to 4hours, warm sitz bath-comfort.
Body hygiene:wipe from front to back after urination.Avoid urinary catheters if possible.
Hand washing.
Lower UTI: cystitis, bladder spasm,dySuria, frequency of urine,painful urinating.
Kidney transplant
Risk:immunosuppression, organ rejection.
Immunosuppressant (steroids, cyclosporine). Easy to early sign of organ rejection: fever,hypertension,pain. Report HCP
Post procedure sign of infection???
Other complications: cardiovascular disease,; recurrence; steroid side effects,malignancies.
nephrotic syndrome
Kidney disorder kidney disorder characterized by massive proteinuria, hypoalbuminemia, edema. No specific treatment. Might develop into ESRD (End stage Renal disease)
Can be genetic.
Assessment: weight gain, Peri-orbital and facial edema, dependent edema, oliguria,dark and frothy urine, abdominal swelling may occur . Blood pressure normal or slightly decreased, or hypertensive later.
 Nephrotic syndrome interventions
Monitor vital signs, intake and output, edema, daily weight, watch for ICP increase, to maintain to maintain group growth, hypertension and reducing sodium.
monitoring for protein, specific gravity. High protein, high calorie restricted sodium diet.
William tumor (nephroblastoma).
Kidney tumor that usually occurs in children age <5.
Usual sign:unusual contour (shape)/bulging/swelling in one side of the chailds abdomen.
Once the diagnosis is suspected or confirmed, the abdomen should not be palpated, as this can disrupt the encapsulated tumor.
**Post a sign “Do NOT PALPATE ABDOMEN” at the bedside.
Handle the child carefully during bathing .
nephrectomy, is usually performed within 24 to 48 hours diagnosis as it is a highly invasive tumor.
