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Med Surg II > Renal > Flashcards

Renal Flashcards

1
Q

What are the leading causes of kidney dz

A

Diabetes and hypertension

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2
Q

What is an eGFR

A

eGFR is a serum test to assess the amount of plasma filtered through the glomeruli (how well your kidneys are filtering)

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3
Q

What is a normal eGFR

A

GFR of 90 or higher

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4
Q

What is CrCl

A

Is a timed urine test to test the amount of creatinine the kidneys can clear in 24-hours

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5
Q

What is the reason for CrCl

A

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

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6
Q

Normal CrCl

A

Less than 30 mg/g

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7
Q

What is azotemia

A

Biochemical abnormality, defined as elevation or buildup of, nitrogenous products, creatinine in the blood, and other secondary waste products within the body

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8
Q

Normal BUN and creatinine levels

A

Creatinine: 0.6-1.2
BUN: 7-21

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9
Q

What is acute kidney injury

A

Rapid loss of renal function due to damage to the kidneys
50% or greater increase in serum creatinine above baseline

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10
Q

Caused of AKI

A

Hypovolemia
Hypotension
Reduced cardiac output and HF
Obstruction of the kidney or lower urinary tract
Obstruction of renal arteries or veins

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11
Q

Categories of AKI

A

Prerenal: volume depletion, impaired cardiac efficiency, vasodilation
Intrarenal: renal ischemia, nephrotoxins, infection
Postrenal: urinary tract obstruction

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12
Q

Phases of AKI

A

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

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13
Q

What is the most accurate indicator of fluid status

A

Weight
1 kg = 1000 mL

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14
Q

What is oliguria

A

Less than 400 mL in 24 hr

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15
Q

What is chronic kidney dz

A

Umbrella term that describes kidney damage or decreased GFR lasting 3 or more months
Prolonged acute inflammation
Can be subtle systemic manifestations

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16
Q

Causes of CKD

A

DM
HTN
Chronic glomerulonephritis
Pyelonephritis or other infections
Obstruction of urinary tract
Hereditary lesions
Vascular disorders
Medications or toxic agents

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17
Q

What is nephrosclerosis

A

Hardening of renal arteries (expected with aging)
Major cause of CKD

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18
Q

What is acute nephritic syndrome

A

Postinfectious glomerulonephritis, rapidly progressive glomerulonephritis, and membranous glomerulonephritis

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19
Q

Manifestations of acute nephritic syndrome

A

Hematuria
Edema
Azotemia
Proteinuria
Hypertension

20
Q

Medical management of acute nephritic syndrome

A

Supportive care and dietary modifications
Treat cause if appropriate
Antibiotics, corticosteroids, and immunosuppressants

21
Q

Nursing management of acute nephritic sydrome

A

Patient assessment
Maintain fluid balance
Fluid and dietary restrictions
Patient education
Follow-up care

22
Q

Causes of chronic glomerulonephritis

A

Repeated acute glomerular nephritis, hypertensive nephrosclorosis, hyperlipidemia, and other cause of glomerular damage

23
Q

What is chronic glomerulonephritis

A

Renal insufficiency or failure: asymptomatic for years as glomerular damage increases before signs and symptoms develop

24
Q

Nursing management of chronic glomerulonephritis

A

Assessment
Potential fluid and electrolyte imbalances
Cardiac status
Neurologic status
Emotional support
Education in self-care

25
Q

What is nephrotic syndrome

A

Any condition that seriously damaged the glomerular membrane and results in increased permeability to plasma proteins

26
Q

Manifestations of nephrotic syndrome

A

Results in hypoalbuminemia and edema

27
Q

Management of nephrotic sydrome

A

Drug and dietary therapy
Education

28
Q

What is polycystic kidney dz

A

Genetic disorder- most common inherited cause of kidney failure
May have cysts in other organs
No cure, supportive treatment

29
Q

Renal cancer

A

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

30
Q

What is kidney failure

A

Results when the kidneys cannot remove wastes or perform regulatory fx
Systemic disorder that results from many different causes

31
Q

Assessment of patients with kidney dz

A

Fluid status
Nutritional status
Patient knowledge
Activity tolerance
Self-esteem
Potential complications

32
Q

Complications of kidney dz

A

Hyperkalemia
Pericarditis
Pericardial effusion
Pericardial tamponade
Hypertension
Hypertension
Anemia
Bone dz

33
Q

Complications of kidney dz

A

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

34
Q

Goal for patients with chronic kidney dz and AKI

A

Maintaining IBW without excess fluid
Maintenance of adequate nutritional intake
Increased knowledge
Participation of activity within tolerance
Improved self-esteem
Absence of complications

35
Q

Nursing interventions for kidney dz and AKI

A

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

36
Q

Considerations with fluid status nursing management with kidney dz and AKI

A

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

37
Q

CKD Pt teaching

A

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

38
Q

Indication for hemodialysis

A

Used when patient is acutely ill until kidneys resume fx and for long-term replacement therapy in CKD and ESKD

39
Q

Goal of hemodialysis

A

Extract toxic nitrogenous substances from the blood and to remove excess fluid

40
Q

Vascular access for hemodialysis

A

Arteriovenous fistula
Arteriovenous graft

41
Q

Goal of peritoneal dialysis

A

Remove toxic substances and metabolic wastes and to reestablish normal fluid and electrolyte balance

42
Q

Complications of peritoneal dialysis

A

Peritonitis, leakage, bleeding

43
Q

Assessment of pt on dialysis

A

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

44
Q

Nursing interventions for pt on dialysis

A

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

45
Q

Postoperative nursing management for kidney transplant

A

Assessment: include all body systems, pain, fluid and electrolyte status, and patency and adequacy of urinary drainage system
Complications: bleeding, pneumonia, infection, and DVT

46
Q

Post-op nursing interventions for kidney transplant

A

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

47
Q

Pt education for kidney transplant

A

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

Med Surg II (7 decks)

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