Renal Flashcards
What are the leading causes of kidney dz
Diabetes and hypertension
What is an eGFR
eGFR is a serum test to assess the amount of plasma filtered through the glomeruli (how well your kidneys are filtering)
What is a normal eGFR
GFR of 90 or higher
What is CrCl
Is a timed urine test to test the amount of creatinine the kidneys can clear in 24-hours
What is the reason for CrCl
Results shows how much creatinine has passed through your kidneys into your urine
Helps show how well your kidneys are removing the waste products from your blood
Normal CrCl
Less than 30 mg/g
What is azotemia
Biochemical abnormality, defined as elevation or buildup of, nitrogenous products, creatinine in the blood, and other secondary waste products within the body
Normal BUN and creatinine levels
Creatinine: 0.6-1.2
BUN: 7-21
What is acute kidney injury
Rapid loss of renal function due to damage to the kidneys
50% or greater increase in serum creatinine above baseline
Caused of AKI
Hypovolemia
Hypotension
Reduced cardiac output and HF
Obstruction of the kidney or lower urinary tract
Obstruction of renal arteries or veins
Categories of AKI
Prerenal: volume depletion, impaired cardiac efficiency, vasodilation
Intrarenal: renal ischemia, nephrotoxins, infection
Postrenal: urinary tract obstruction
Phases of AKI
Initiation: initial insult
Oliguria: increase in urea, creatinine, uric acid, phosphorous, potassium, magnesium
Diuresis: gradual increase in urine but GFR may still be abnormal
Recovery: improved renal function, may take 3-12 months
What is the most accurate indicator of fluid status
Weight
1 kg = 1000 mL
What is oliguria
Less than 400 mL in 24 hr
What is chronic kidney dz
Umbrella term that describes kidney damage or decreased GFR lasting 3 or more months
Prolonged acute inflammation
Can be subtle systemic manifestations
Causes of CKD
DM
HTN
Chronic glomerulonephritis
Pyelonephritis or other infections
Obstruction of urinary tract
Hereditary lesions
Vascular disorders
Medications or toxic agents
What is nephrosclerosis
Hardening of renal arteries (expected with aging)
Major cause of CKD
What is acute nephritic syndrome
Postinfectious glomerulonephritis, rapidly progressive glomerulonephritis, and membranous glomerulonephritis
Manifestations of acute nephritic syndrome
Hematuria
Edema
Azotemia
Proteinuria
Hypertension
Medical management of acute nephritic syndrome
Supportive care and dietary modifications
Treat cause if appropriate
Antibiotics, corticosteroids, and immunosuppressants
Nursing management of acute nephritic sydrome
Patient assessment
Maintain fluid balance
Fluid and dietary restrictions
Patient education
Follow-up care
Causes of chronic glomerulonephritis
Repeated acute glomerular nephritis, hypertensive nephrosclorosis, hyperlipidemia, and other cause of glomerular damage
What is chronic glomerulonephritis
Renal insufficiency or failure: asymptomatic for years as glomerular damage increases before signs and symptoms develop
Nursing management of chronic glomerulonephritis
Assessment
Potential fluid and electrolyte imbalances
Cardiac status
Neurologic status
Emotional support
Education in self-care
What is nephrotic syndrome
Any condition that seriously damaged the glomerular membrane and results in increased permeability to plasma proteins
Manifestations of nephrotic syndrome
Results in hypoalbuminemia and edema
Management of nephrotic sydrome
Drug and dietary therapy
Education
What is polycystic kidney dz
Genetic disorder- most common inherited cause of kidney failure
May have cysts in other organs
No cure, supportive treatment
Renal cancer
Rare but has increased in the past two decades
Tobacco use significant risk factor
Higher incidence in men with increased BMI and african americans
May be asymptomatic with only painless hematuria with dull back pain
What is kidney failure
Results when the kidneys cannot remove wastes or perform regulatory fx
Systemic disorder that results from many different causes
Assessment of patients with kidney dz
Fluid status
Nutritional status
Patient knowledge
Activity tolerance
Self-esteem
Potential complications
Complications of kidney dz
Hyperkalemia
Pericarditis
Pericardial effusion
Pericardial tamponade
Hypertension
Hypertension
Anemia
Bone dz
Complications of kidney dz
Anemia or low RBC, which can cause fatigue and weakness
Extra fluid in the body, which can cause high BP, swelling in the legs, or SOB
A weakened immune system, which make it easier to develop infections
Loss of appetite or nausea
Decreased sexual response
Confusion, problems with memory and thinking, or depression
Low calcium levels and high phosphorus levels in the blood, which can cause bone dz and heart dz
High potassium levels in the blood, which can cause an irregular or abnormal heartbeat and lead to death
Goal for patients with chronic kidney dz and AKI
Maintaining IBW without excess fluid
Maintenance of adequate nutritional intake
Increased knowledge
Participation of activity within tolerance
Improved self-esteem
Absence of complications
Nursing interventions for kidney dz and AKI
Fluid status
Nutritional status; weight changes, laboratory data
Nutritional patterns: hx, preferences
Provide food preferences within restrictions
Encourage high-quality nutritional foods while maintaining nutritional restrictions
Stomatitis or anorexia: modify intake related to factors that contribute to alterations
Adjust medication times related to meals
Assess pt and family responses to illness and treatment
Assess relationship and coping patterns
Encourage open discussion about changes and concerns
Explore alternate ways of sexual expression
Discuss role of giving and receiving love, warmth, and affection
Considerations with fluid status nursing management with kidney dz and AKI
Assess for s/s of fluid vol excess, keep accurate I&O, and daily weights
Limit flui to prescribed amounts
Identify sources of fluid
Explain to pt and family the rationale for fluid restrictions
Assist pt to cope with the fluid restrictions
Provide or encourage frequent oral hygiene
CKD Pt teaching
Keep your blood pressure below 130/80
If you have diabetes, stay in your target blood sugar range as much as possible
Get active- physical activity helps control BP and blood sugar levels
Lose weight if you’re overweight
Get tested for CKD regularly if you’re at risk
If you have CKD, meet with a dietician to create a kidney-healthy eating plan
Take medications as instructed
If you smoke, quit
Indication for hemodialysis
Used when patient is acutely ill until kidneys resume fx and for long-term replacement therapy in CKD and ESKD
Goal of hemodialysis
Extract toxic nitrogenous substances from the blood and to remove excess fluid
Vascular access for hemodialysis
Arteriovenous fistula
Arteriovenous graft
Goal of peritoneal dialysis
Remove toxic substances and metabolic wastes and to reestablish normal fluid and electrolyte balance
Complications of peritoneal dialysis
Peritonitis, leakage, bleeding
Assessment of pt on dialysis
Protect vascular access: assess site for patency, signs of potential infection, do not use for BP or blood draws
Carefully monitor fluid balance, IV therapy, accurate I&O, IV administration pump
s/s of uremia and electrolyte imbalance, regularly check lab data
Monitor cardiac/respiratory status carefully
Cardiovascular medications must be held prior to dialysis
Nursing interventions for pt on dialysis
Monitor all medications and medication dosages carefully
Address pain and discomfort
Stringent infection control measures
Dietary considerations: sodium, potassium, protein, fluid, individual nutritional needs
Skin care: pruritis, keep skin clean and well moisturized, trim nails, and avoid scratching
Postoperative nursing management for kidney transplant
Assessment: include all body systems, pain, fluid and electrolyte status, and patency and adequacy of urinary drainage system
Complications: bleeding, pneumonia, infection, and DVT
Post-op nursing interventions for kidney transplant
Pain relief measures, analgesic medications
Promote airway clearance and effective breathing pattern, turn, cough, deep breathe, incentive spirometry, positioning
Monitor UO and maintain potency of urinary drainage systems
Use strict asepsis with catheter
Monitor for signs and symptoms of bleeding
Encourage leg exercises, early ambulation, and monitoring for signs of DVT
Pt education for kidney transplant
Instruct both patient and family
Drainage system care
Strategies to prevent complications
Signs and symptoms
Follow-up care
Fluid intake
Health promotion and health screening
