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Med Surg 2 > Renal > Flashcards

Renal Flashcards

1
Q

What do the kidneys do?

A

Maintain body fluid volume and composition and create urine for waste
filter in order to balance fluids & electrolytes
help make RBCs
help regulate BP

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2
Q

What do the kidneys help regulate?

A

Blood pressure, acid-base balance (produce erythropoietin for RBCs synthesis and convert Vitamin D to an active form)

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3
Q

What does aldosterone do?

A

Increases kidney reabsorption of sodium and water which restore BP, blood volume and blood sodium levels.
-Promotes excretion of potassium
-promoted the reabsorption of sodium in the DCT

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4
Q

What does vasopressin do?

A

increases tubular permeability to water, allowing water to leave the tube & be reabsorbed by the capillaries
-increases arteriole constriction

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5
Q

What happens to the kidney with age?

A

Loses cortical tissue and nephrons and gets smaller with age
-reduces ability to filter blood and excrete wastes

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6
Q

What can suggest kidney disease in patient’s older than 50?

A

Sudden onset of hypertension

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7
Q

What do you ask when assessing the function of the kidney?

A

-Changes in appearance (odor, color, clarity)
-ability to initiate or control
-changes in pattern
-changes in amount
-pain (flank, lower aBd, pelvic region, perineal area)

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8
Q

Symptoms of uremia

A

Anorexia, N/V, muscle cramps, pruritus, fatigue and lethargy

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9
Q

60.1- When obtaining a health history and physical assessment from a 68 year old male client who has a history of an enlarged prostate, which finding does the nurse consider?
A. distended bladder
B. absence of bruit
C. frequency of urination
D. dribbling urine after voiding
E. chemical exposure in the workplace

A
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10
Q

What pathologic conditions increase serum creatinine levels?

A

Just kidney disease!!!

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11
Q

What does it mean when serum creatinine levels double?

A

50% reduction of GFR

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12
Q

What happens with liver and kidney dysfunction

A

BUN is decreased
-this is due to the liver failure limiting urea production

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13
Q

What does it mean when both serum creatinine & BUN increase?

A

Kidney dysfunction
-not related to poor perfusion or dehydration

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14
Q

What happens when glomerulus filtration decreases?

A

Cystatin-C increases
(predictor of CKD)

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15
Q

High specific gravity indicates

A

-dehydration, decreased kidney blood flow, excess vasopressin: SIADH, stress, surgery, anesthetic agents, certain drugs

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16
Q

Low specific gravity indicates

A

high fluid intake, diuretic drugs or DI

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17
Q

Normal specific gravity

A

1.005 - 1.030

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18
Q

Normal microalbumin levels

A

less than 2.0 mg/dL

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19
Q

What indicates microalbuminuria

A

levels greater than 80mcg/24hr

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20
Q

CKD

A

gradual decline of kidney function

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21
Q

AKI

A

sudden onset of kidney function
(higher mortality rate)

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22
Q

Problems related to kidney function loss

A

waste elimination, fluid & electrolyte balance, disturbances in acid-base balance, build up of nitrogen-based wastes and loss of kidney hormone function

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23
Q

What lab value defines an AKI?

A

Increased serum creatinine by 0.3mg/dL or 1.5 times the baseline
or
urine volume less than 0.5mL/kg/hr for 6 hours
-creatinine can be used but too slow

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24
Q

Causes of AKI

A

reduced perfusion
damage to kidney tissues
obstruction of urine outflow

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25
Q

Risk factors for AKI

A

shock, cardiac surgery, hypotension, prolonged mechanical ventilation and sepsis

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26
Q

RF for AKI if hospitalized

A

older adults, DM, HTN, PVD, liver disease and CKD

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27
Q

Prerenal AKI

A

Source outside the kidneys creating conditions that impair renal perfusion

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28
Q

Intrinsic AKI

A

Inside of the kidney by disorders that directly effect the renal cortex or medulla

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29
Q

Causes of prerenal AKI

A

shock, dehydration, burns and sepsis

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30
Q

Causes of intrinsic AKI

A

allergic disorders, embolism or thrombosis of the renal vessels & nephrotoxic agents

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31
Q

Postrenal AKI

A

A urine flow obstruction

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32
Q

Causes of postrenal AKI

A

tumors, kidney stones or strictures

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33
Q

Pre & Postrenal compensations and what it does to the kidneys?

A

constricts kidney blood vessels, activating renin-angiotensin-aldosterone pathway and release of ADH
-increases blood volume and improves kidney perfusion but reduce urine elimination (oliguria and azotemia)

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34
Q

What to do with AKI?

A

ACT EARLY!
keep track of Is & Os over 2 hours
DW

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35
Q

What labs to monitor for kidney function?

A

creatinine, BUN, serum potassium, sodium, osmolarity, urine specific gravity, albumin-creatinine ratio, electrolytes

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36
Q

Immunity mediated AKI

A

Flu, colds, gastroenteritis & sore throats

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37
Q

What is prerenal?

A

Reduced perfusion

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38
Q

What happens during prerenal?

A

Shock, hypotension, anything that blocks blood flow to the kidney

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39
Q

What is intrarenal?

A

kidney damage

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40
Q

What happens during intrarenal?

A

glomerulonephritis, lupus, drugs that damage kidney, toxins, ischemia

41
Q

What is postrenal?

A

obstruction

42
Q

What happens with postrenal?

A

bladder cancer, kidney stones, prostate cancer or BPH

43
Q

How do kidneys compensate in prerenal and postrenal?

A

-Activating the RAAS manifests in high BP
-constricting kidney blood vessels
-releasing ADH- holds onto fluid, holds onto more water so less urine

44
Q

What happens to blood volume and kidney perfusion in prerenal and postrenal?

A

both increase

45
Q

What do prerenal and postrenal cause?

A

oliguria and azotemia (build up of nitrogenous wastes)

46
Q

What is included in a history assessment for AKI

A

drugs/toxins, DM, HTN, lupus, infection, dehydration, IV contrast, current condition

47
Q

Assessment findings for AKI

A

history
oliguria
fluid overload
pulmonary crackles
increased oxygen demand/ RR/ dyspnea
edema
N/V
confusion

48
Q

Diagnostics of AKI

A

increased serum creatinine
increased BUN levels
abnormal electrolytes
urine Na levels
metabolic acidosis
urine specific gravity
ultrasound
CT scans (no IV contrast)
MRI
xray/KUB

49
Q

What are interventions for AKI

A

Intervene early (low UOP, edema, rising creatinine)
maintain MAP above 65
monitor Is& Os
fluid replacement or restriction
medications
central venous pressure
CCB
Nutrition
Renal replacement therapy

50
Q

What are the nutrition interventions for AKI?

A

metabolic support
40g/day of protein (more if on dialysis)
potassium restrictions
fluid restrictions

51
Q

Stages of CKD

A

Stage 1-5

52
Q

Stage 1 of CKD

A

normal GFR/ increased

53
Q

Stage 2 of CKD

A

mild disease/ decrease in kidney function/ mild decrease in GFR (60-80)

54
Q

Stage 3 of CKD

A

moderate disease/ azotemia present/restriction of fluids/ GFR 30-59

55
Q

Stage 4 of CKD

A

severe disease/ cannot maintain A-B & F-E balance/ dialysis may be needed/ GFR 15-29

56
Q

Stage 5 of CKD

A

GFR < 15/ dialysis or death/ transplant

57
Q

Diagnosing AKI (4)

A

elevated BUN
elevated creatinine
elevated potassium
decreased UOP

58
Q

Assessment for CKD

A

fluid volume overload= breathing difficulty
elevated potassium = cardiac arrest

59
Q

What happens in CKD when 75% of kidney function is gone?

A

kidneys are unable to
-maintain urine production
-maintain homeostasis
-BUN rises
-urine production decreases

60
Q

What happens metabolically in CKD

A

-rise in BUN & creatinine
-increase phosphorus= decreases calcium so weak bones
Kussmaul breathing
renal osteodystrophy
metastic calcifications
vascular calcium deposits
itchy skin

61
Q

What happens with the heart in CKD

A

HTN
malfunction of RAAS
hyperlipidemia
HF
pericarditis
cardiomyopathies

62
Q

What are the hematologic impact of CKD

A

anemia
damaged platelets

63
Q

What happens to the GI system with CKD

A

PUD
uremia leads to stomatitis
colitis
BUN/ creatinine -anorexia
N/V
hiccups

64
Q

What are the skin changes with CKD

A

pruritis
bronzed skin
uremic frost
bruises

65
Q

Assessment for CKD

A

urinary changes
alterations in taste
weight loss
uremic halitosis
weight loss -> anorexia
N/V
fatigue
drowsiness
confusion-> seizures & coma
neuropathies -> due to uric acid
fluid overload
HTN
dysrhythmias
Kussmaul breathing
signs of anemia

66
Q

What are the signs of fluid overload?

A

crackles, JVD, edema

67
Q

CKD patients should not lose or gain

A

2lbs overnight
5lbs in a week

68
Q

CKD patients on dialysis should not gain

A

3lbs in between dialysis

69
Q

Pharm therapy for CKD

A

lasix & antihypertensives

70
Q

Interventions for CKD

A

DW
lasix & antihypertensives
fluid restrictions
nutrition
dialysis

71
Q

When would diuretics be given to CKD

A

mild to severe (up until stage 3)
no diuretics if on dialysis

72
Q

What do diuretics do?

A

increase UOP
decrease fluid overload
decrease BP
*monitor electrolytes & ototoxicity (lasix)

73
Q

CKD medications

A

diuretics
antihypertensives
CCB
angiotensin
BB

74
Q

Amount of protein a CKD patient should have

A

Less protein until on dialysis

75
Q

How much potassium for CKD patient

A

60-70 mEq/dialy (restriction)
** because potassium is typically high in these patients

76
Q

How much sodium for CKD

A

restriction
-b/c HTN, edema, HF (1-3 g/day) = early stages
-2-4g after starting dialysis

77
Q

What is done with phosphorus for CKD

A

phosphorus binder is given with meals

78
Q

Interventions/ teaching with CKD

A

infection prevention (avoid crowds)
injury prevention
be aware of meds processed by kidneys
high risk of fatigue -rest/activity balance

79
Q

How long does is take AV fistula to mature?

A

6 months

80
Q

Rules of fistulas

A

NO BP
NO venipuncture
feel thrill & listen to bruit Q4
assess distal pulses
assess for signs of infection
avoid pressure on fistula
-when accessed used sterile procedure
makes signs above bed so everyone knows there is a fistula

81
Q

What is the most common fistula complications

A

thrombosis

82
Q

What are the 4 fistula complications?

A

thrombosis
strictures
infection
ischemia

83
Q

What are the long term vascular accesses for CKD?

A

AV fistula
AV graft

84
Q

What are the short-term vascular accesses for CKD?

A

Vas cath
perm cath

85
Q

What is a vas cath?

A

non-tunneled = higher risk for infection
large bore central line
intended for short-term use
*big risk for clot

86
Q

What is a perm cath?

A

tunneled
large bore central line
intended for short term use
less risk for infection
cap with anticoagulants

87
Q

What is peritoneal dialysis?

A

utilizes peritoneal cavity for exchange of fluids, wastes and electrolytes

88
Q

What is lost in peritoneal dialysis?

A

protein

89
Q

When is peritoneal dialysis not an option?

A

extensive abdominal surgery/adhesions

90
Q

What are the complications of PD

A

infection
peritonitis
discomfort
bowel perforation

91
Q

How to avoid peritonitis

A

sterile technique
ensure the catheter is not leaking
monitor for cloudy outflow/ effluent
check for abdominal tenderness
fever

92
Q

What is the most commonly prescribed renal replacement therapy?

A

hemodialysis

93
Q

What are the signs someone needs dialysis?

A

no response to diuretics
symptomatic hyperkalemia
calciphylaxis (vascular calcification & skin necrosis)

94
Q

What are patients at risk for when receiving hemodialysis?

A

cardiac arrest and seizures - do to large volume shifts

95
Q

What are patients at risk for when receiving hemodialysis?

A

cardiac arrest and seizures - do to large volume shifts

96
Q

What is the care involved in hemodialysis?

A

warming
monitoring often

97
Q

What can happen as a result of hemodialysis?

A

fatigue
changes in LOC

98
Q

What is used for unstable patients?

A

continuous renal replacement therapy

99
Q

What is continuous renal replacement therapy?

A

hemofiltration- uses a filter with fine pores
-avoids large volume shifts with HD but provides
-runs continuously for 24 hours a day
1:1 nursing
ICU setting

Med Surg 2 (10 decks)

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