Renal Flashcards
Acute Glomerulonephritis
* Symptoms
* Causes
Symptoms:
* Hematuria – leads to cola-colored urine
* Proteinuria
Causes:
* Group A beta-hemolytic streptococcal infection of the throat may proceed glomerulonephritis by 2-3 weeks
* Repeated episodes of acute nephritic syndrome
What is acute glomerulonephritis?
Inflammation of glomeruli (filters in the kidneys)
When does acute glomerulonephritis usually occur?
2-3 weeks after a strep infection
List the GFR for each stage of Chronic Kidney Disease
Stage 1:
* GFR >/= 90
Stage 2:
* GFR = 60-89
Stage 3:
* GFR = 30 - 59
Stage 4:
* GFR = 15-29
Stage 5:
* GFR > 15
What are the 3 types of acute renal failure / acute kidney injury (AKI)?
1.) Pre-renal
2.) Intrinsic
3.) Post-renal
What 3 key factors increase a patient’s risk of chronic kidney disease?
- AGING
- Heart failure (& HTN)
- Contrast
What should be done to prevent kidney damage due to contrast in patients with AKI or CKD?
Pre-procedure hydration
What is Grey-Turner’s Sign and what does it indicate?
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purplish discoloration on the flank or near 11th / 12th rib
- indicates retroperitoneal bleed / kidney injury
What is Grey-Turner’s Sign?
Purplish discoloration on the flank or near 11th / 12th rib
What does Grey-Turner’s sign indicate?
Sign of kidney injury
What is normal Creatinine?
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0.6 - 1.2 mg/dL
What is normal blood urea nitrogen?
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8 - 20 mg/dL
What kind of disease is polycystic kidney disease & what can it lead to?
- Genetic disorder (autosomal dominant)
- Can lead to kidney failure
What is the main sign of acute renal failure (/ AKI)?
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Oliguria = < 300 mL / 24 hr of urine
What is acute renal failure (ARF) / acute kidney injury (AKI)?
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RAPID decline (over hours to days) in GFR
* leads to rapid ↑ in BUN & ↑ creatinine, & possibly ↓ urine output
What is the treatment for acute renal failure (ARF) / acute kidney injury (AKI)?
- Give fluid
- Treat electrolyte imbalance
What is nephrotic syndrome?
- Excess fluid volume
- Generalized edema
- body excretes too much protein in the urine (proteinuria)
What is acute tubular necrosis?
destruction / death of tubules in the kidneys
What are causes of acute tubular necrosis (ATN)?
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- Nephrotoxic medications
- Environmental exposures
- Sepsis
- Prolonged severe HTN
What type / classification of kidney injury is acute tubular necrosis (ATN)?
Acute Kidney Injury (AKI) – intrinsic
* within the kidney)
What are the stages of acute tubular necrosis (ATN)?
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1.) Onset phase: lasts hours to days
2.) Oliguric / Anuric Phase: 5-16 days
* nectrotic cellular debris blocks urine & damage is done to the tubular wall
3.) Diuretic Phase: 7 - 14 days
* ↑ GFR & polyuria
* Monitor for dehydration
4.) Recovery / Convalescent Phase
* even more ↑ in urine output
* BUN & creatinine either ↑ or stay at their new normal
What is the treatment for hyperkalemia?
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- Glucose (hypertonic)
- Insulin infusion
- Calcium
- Kayexalate can also be given – it will bind K+ in the bowel & eliminate K+ in the feces
What is the treatment for a creatinine level over 2?
Acetylcysteine
* make sure pt is hydrated before CT contrast is administered
What can hyperkalemia lead to?
- Peaked T-waves
- Widening QRS
- may cause V-tach
What are the dietary restrictions for patients with acute renal failure?
- ↓ K+
- ↓ Na+
- ↓ Phosphorus
- ↓ Protein
- ↓ fluids
What are common complications of acute renal failure (ARF)?
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- Hyperkalemia
- Metabolic acidosis
- Anemia & prolonged bleeding time
- Infections
- Cardiac complications (arrhythmias, pericarditis, pericardial effusion)
- Malnutrition
What leads to the development of nephrosclerosis & end-stage renal disease (ESRD)?
- due to prolong HTN & DM
What medication is given for renal patients with hyperphosphatemia?
Calcium acetate
- main sx of hyperphosphatemia = pruritus & it may lead to hypocalcemia
List the stages of GFR
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- Stage 1: GFR over 90
- Stage 2: GFR = 60-89
- Stage 3: GFR = 30-59
- Stage 4: 15-29
- Stage 5: 15 or less
Signs & Symptoms of acute glomerular inflammation.
- Edema around the eyes & flank
- B/l flank tenderness
What is Continuous Renal Replacement Therapy (CRRT)?
continuous dialysis over 24 hours
- usually done in the ICU
- need a quinten catheter to be done
What is peritoneal dialysis?
- Catheter is placed in the peritoneum (lining of the abdomen)
- Peritoneum serves as filtering membrane
- Can be done automatically at night during sleep
What is the most life-threatening fluid and electrolyte imbalance that can occur in patients with renal disturbances?
HyperKALEMIA (↑ K+)
An athlete is brought to the ER after blunt trauma injury from a game. There is suspicion that he has sustained injuries to his kidneys. The ER nurse receives an order to collect all voided urine & send it to the lab for analysis. The nurse understands taht this nursing intervention is most important because…
a.) Hematuria is common in renal trauma & the blood may be microscopic so lab analysis is essential.
b.) I/O calculations are essential & the lab will calculate the precise output.
c.) A creatinine clearance study may be ordered at a later time & the lab will hold all urine until it’s deemed if the test is necessary.
d.) There is risk of electrolyte imbalances & the lab will monitor for soidum concentration in the urine.
a.) Hematuria is common in renal trauma & the blood may be microscopic so lab analysis is essential
A patient waiting for a kidney transplant asks the nurse what signs & symptoms most likely indicate rejection. What is the nurse’s best response?
a.) Shortness of breath
b.) Oliguria
c.) Decreasing blood pressure
d.) Weight loss
b.) Oliguria
The nurse is caring for a patient in acute renal failure. THe nurse expects hypertonic glucose, insulin infusion, & sodium bicarbonate to treat what electrolyte imbalance?
a.) Hypernatremia
b.) Hypokalemia
c.) Hypercalcemia
d.) Hyperkalemia
d.) Hyperkalemia
A patient presents with acute renal fialure. If the cause is found to be pre-renal, which ocndition most likely caused it?
a.) Heart failure
b.) Glomerulonephritis
c.) Ureterolithiasis
d.) Aminoglycoside toxicity
a.) Heart failure
An ESRD patient asks for information about hemodialysis. What should the nurse include in the teaching?
a.) It’s required three times a week.
b.) It’s required daily.
c.) You will have surgery & a catheter will be inserted into the abdomen.
d.) It’s a treatment that is used for a few months until your kidneys heal & you produce urine again.
a.) It’s required three times a week
What is the most common complication with peritoneal dialysis?
a.) Blood loss
b.) Peritonitis
c.) Constipation
d.) Dehydration
b.) Peritonitis
The nurse is educating a patient about their procedure to get a fistula. What should the nurse include in the teaching?
a.) The arm should be immobilized for 4-6 weeks.
b.) One needle is inserted into the fistula for each dialysis treatment.
c.) A vein & artery in your arm are attached surgically.
d.) The fistula can be used immediately after surgery for dialysis.
c.) A vein & artery in your arm are attached surgically
A patient with ESRD is having his first hemodialysis treatment & asks the nurse what the most common complication is. How should the nurse respond?
a.) High blood sugar levels may occur
b.) Excessive bleeding & double vision may occur
c.) Confusion & diarrhea may occur
d.) Hypotension & cramping may occur
d.) Hypotension & cramping may occur
The critical nurse notices that a patient who is 1 hour post-operative from a kidney transplant is clammy & pale. The nurse recognize this as a sign of what?
a.) Urinary retention
b.) Shock
c.) Hypertension
d.) Expected symptoms from anesthesia
b.) Shock
A patient in the ICU develops acute renal failure (ARF). They are hemodynamically unstable but they need renal replacement therapy to manage their hypervolemia & hyperkalemia. Which treatment will they most tolerate?
a.) Hemodialysis
b.) Peritoneal dialysis
c.) Continuous venovenous hemodialysis
d.) Plasmapheresis
c.) Continuous venovenous hemodialysis
A 71-year-old patient has ESRD & is on the renal transplant list. The patient expresses that they are unsure if they want to undergo the transplant. What is an appropriate response from the nurse?
a.) “The decision is yours, just don’t make the wrong one”.
b.) “Kidney transplants in patients your age are as successful as they are in younger patients”.
c.) “I understand your hesitancy, it’s not as successful as it is in younger people”.
d.) “Have you talked this over with your family?”
b.) “Kidney transplants in patients your age are as successful as they are in younger patients”.
What should be included in the teaching plan for a patient who is post resection of a renal tumor?
a.) Signs & symptoms of rejection
b.) To inspect & care for the incision
c.) Post-surgical urine retention
d.) All of the above
b.) To inspect & care for the incision
The nurse is aware that bleeding is a major post-op complication of kidney surgery & may cause hypovolemic & hemorrhagic shcok if it goes undetected. What assessment parameters are necessary to assess for bleeding in the post-operative patient?
a.) Skin condition
b.) Pain
c.) Level of consciousness
d.) Oral intake
c.) Level of consciousness
As renal failure progresses & the GFR falls below 50 mL/min, which changes occur?
a.) Metabolic acidosis
b.) Hypokalemia
c.) Hypercalcemia
d.) Hypophosphatemia
a.) Metabolic acidosis
What 2 types of percussive sounds are heard with renal injuries?
KNOW THIS!!!!! IN RED
- Hyperresonance = Air
- Dullness = fluid
How is acute glomerular inflammation diagnosed?
KNOW THIS!!!!!
urinalysis
