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410 Patho Exam 3 > Renal > Flashcards

Renal Flashcards

1
Q

what is kidney, renal failure ?

A

partial or complete impairment of kidney function that results in inability to excrete metabolic waste products and water

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2
Q

does kidney,renal failure, affect all body systems?

A

yes

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3
Q

treatments and dietary changes are challenging to follow when you have kidney failure, it impacts what?

dont over think it

A

lifestyle, occupation, family relationships and self-image

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4
Q

there is a table she wants us to know between the difference of acute kidney injury and chronic kidney disease

aki vs ckd
tell me what it means for each
onset?
most common cause?
diagnostic criteria
reversibility
cause of death

A

sudden
gradual over years

acute tubular necrosis
diabetic nephropahty

acute reduction in urine output and or elevation in serum creatinine
gfr < 60ml/min for > 3 months and or kidney damage > 3 months

potentially
progressive and irreversible

infection
cardiovascular disease

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5
Q

acute kidney injury powerpoint

A
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6
Q

acute kidney injury ranges from slight deterioration to what?

A

severe impairment

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7
Q

when you have acute kidney injury you have rapid loss of kidney function with what 3 things?

A

rise in serum creatinine and or reduction in urine output

elevated bun and potassium

azotemia

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8
Q

what does azotemia mean?

A

accumulation of nitrogenous waste products

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9
Q

I know this is acute kidney injury, but I just want to make a note that, if a patient who has chronic kidney disease, we know that the 2 main causes for this is due to hypertension and diabetes.

why do we give patients with diabetes, even if they dont have hypertension, ace inhibitors?

A

in order to protect the kidneys

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10
Q

which one is more specific to renal function ?
creatinine or bun

what is important for bun?

A

creatinine (kidneys are fine)

dehydration

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11
Q

if youre dehydrated how does your bun look like ?

if youre creatinine is fine while youre bun is high, what does that mean ?

A

high

your kidneys are being perfused well and simply you should just drink more water

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12
Q

what is the best measure of kidney function?

A

urinary output

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13
Q

you can have pre-renal
you can have intra-renal
you can have post-renal

what do these tell us ?

describe each

A

where youre having the problem

problem before you even each the kidneys

the problem is in the kidneys

the problem is in after the kidneys

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14
Q

test questions
pre-renal main problem is what
intrareneal main problem is what
post-renal main problem is what

A

decrease perfusion/cardiac problem

ischemia that last long time, nephrotoxic medication ( NSAIDS, vancomycin, loop diuretics, lasix ), crush injury (myoglobin floating), acute tubular necrosis

urinary tract infection, kidney stone, obstruction, large prostate

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15
Q

tumor lysis syndrome, can also be another reason for inter-renal kidney injury, why is that?

A

in this case, you have a tumor, and the chemo is working so well that there is a massive rupture of tumor cells, so like youre healing, however after this massive rupture, your body can not filter all of this out cause of the amount of uric acid

so kidneys work over time and then you have acute kidney injury

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16
Q

all cases of acute kidney injury are potentially what ?

A

reversible ( can potentially correct if caught early )

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17
Q

what are the 3 phases of acute kidney injury ?

A

oliguric - very little urine
diuretic - lots of urine
recovery

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18
Q

most of the time the oliguric phase, we only see about how many people experience this phase ?

what does this tell us?

A

half of it

  • you have to look at everything
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19
Q

how much do patients in the oliguric phase release urine per day ?

A

400

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20
Q

how long does the acute kidney injury for oliguirc phase last?

A

10-14days

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21
Q

usually if a patient in the oliguric phase for acute kidney injury, we won’t see this phase until after how many days after the injury ?

A

1-7 days

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22
Q

what is two of the biggest problem for patients who are in the oliguric phase ?

A

electrolyte imbalance/ fluid overload

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23
Q

why are patients in the oliguric phase getting electrolyte imbalance / fluid overload?

A

because we normally produce 30ml and hour, but these patients are barely making 400ml a day. so the fluid is going to be retained and not release

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24
Q

what are we going to see?
what are we going to hear?
when a patient in the oliguric phase is holding onto fluid ?

A

peripheral edema
crackles in the lungs

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25
Q

in the oliguric phase, in the urinalysis can we se what 3 things?

A

casts, rbc and wbc

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26
Q

what is the daily urine output for patients in the diuretic phase ?

A

1-3 liters, up to 5 liters

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27
Q

most of the time, in the diuretic phase, we are able to excrete waste because we are producing and excreting so much urine, literally over 3 liters, however what can we not do ?

A

concentrate the urine

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28
Q

what are the 3 electrolytes imbalances when we are having a patient in diuretic phase ?

A

hyponatremia - worried for seizures/neuro

hypokalemia - dysrhythmias

dehydration - from all the water leaving

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29
Q

lastly the recovery phase, for patients with acute kidney injury, it may take up to how long for kidney function to stabilize ?

A

12 months ( 1 year )

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30
Q

Which assessment would indicate to the nurse that a patient has oliguria related to an intrarenal acute kidney injury?

A.Urinary sodium levels are low.

B. The serum creatinine level is normal.

C. Oliguria is relieved after fluid replacement.

D. Urine testing shows a specific gravity of 1.010.

A

D. Urine testing shows a specific gravity of 1.010.

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31
Q

what is normal urine specific gravity ?
what does less than 1.010 mean?
what does more than 1.030 mean?

A

1.010 to 1.030
dehydration
super hydrated

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32
Q

why is metabolic acidosis a complication for acute kidney injury ?

how does your body compensate?

A

serum bicarbonate level decrease
(kidneys are not making enough bicarbonate, meaning you have too much acid )

causes severe acidosis develops

compensation
- kussmaul respirations
- kidneys are not doing job, so lungs will try to take care of it

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33
Q

why is sodium balance a complication of acute kidney injury?

A

increased excretion of sodium
- hyponatremia leading to cerebral edema

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34
Q

why is potassium excess a complication for acute kidney injury ?

A

risk with large amount of tissue trauma or blood transfusion

usually asymptomactic

ecg changes

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35
Q

why is infection a complication for acute kidney injury ?

watch out for ?

A

its the most common cause of death

increase white blood cell count

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36
Q

why is waste product accumulation a complication for acute kidney injury
?

A

elevated bun and serum creatinine levels
- because nothing is being filtered out

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37
Q

why is neurologic disorders a complication of acute kidney injury ?

A

goes back to your sodium being so low, so seizures, faitgue and concentrating

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38
Q

what were in the complications we just mentioned for acute kidney injury ? (6)

A

metabolic acidosis
sodium balance
potassium excess
infection
waste product accumulation
neurologic disorders

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39
Q

what are some diagnostic studies for those who have acute kidney injury ?

A

urinalysis
urinary output
renal ultrasound
renal biopsy
serum creatinine, bun, electrolytes

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40
Q

what is a contraindications for contrast medium when trying to look at the kidney in patients ?

A

metformin - holding it 48 hours before and after use

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41
Q

for management of acute kidney injury, why are we doing fluid restriction ?

A

because they are in fluid overload, remember they are not even excreting anything out, its just retaining it

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42
Q

how are we going to fluid restrict these patients ?

A

total output of the last 24 hours, plus 600ml

43
Q

why are we going to give calcium and phosphate for these patients ?

A

because they have an inverse relationship, so we simply have to monitor for these patients

44
Q

depending on the cause of acute kidney injury, we may need to put these patients on what ?

A

dialysis or
Continuous renal replacement therapy

45
Q

we are going to need to help take care of that potassium excess, what is a way we can help with the potassium ?

A

insulin
- they push the potassium back into the cells

46
Q

remember, we are giving insulin in order to push that potassium back into the cells, not because they are diabetic, but simply with the potassium.

but remember insulin is going to help drop that blood sugar also, so what else are we going to need to give ?

A

glucose

47
Q

why might we need to give calcium gluconate ?

A

to help with the dysthymias that can come from being in a hyperkalemic state

48
Q

what is calcium gluconate the antidote to ?

A

magnisuem

49
Q

what is a medication that will help remove potassium from the body ?

A

sodium polystyrene sulfonate (kayexalate)

50
Q

why might we give patiromer (veltessa) for hyperkalameia therpay ?

what do we warn about this medication

A

binds to potassium in the gi tract

take 6 hours before or 6 hours after since it can bind to other medications

51
Q

why do we put patients on renal replacement therapy ?

A

volume overload
elevated serum potassium level
metabolic acidosis

fix volume overload

52
Q

types of RRT notes

Peritoneal dialysis (PD)
Not frequently used

Intermittent hemodialysis (HD)
Emergent therapy

Continuous renal replacement therapy (CRRT)

Cannulation of artery and vein
Continuously 24 hours

A
53
Q

what is the diet for these patients ?

A

carbs and fat
adequate protein
restrict sodium, potassium, phosphate

54
Q

why is daily weight super important for these patients ?

A

because we can see if they are retaining fluid by looking at their weight

55
Q

notes nursing manamgent

Nursing diagnoses
- Electrolyte imbalance
- Fluid imbalance
- Risk for infection
- Anxiety

Planning
- The patient with AKI will
- Completely recover without any loss of kidney function
- Maintain normal fluid and electrolyte balance
- Have decreased anxiety
- Adhere to and understand need for careful follow-up care

Health promotion
- Prevention and early recognition
- Identify and monitor high-risk populations
- Control exposure to nephrotoxic drugs and industrial chemicals
- Prevent prolonged episodes of hypotension and hypovolemia
- Monitor daily weight, intake and output, and fluid and electrolyte balance
- Replace significant fluid losses
- Provide aggressive diuretic therapy for fluid overload
- Use nephrotoxic drugs sparingly; monitor renal function

A
56
Q

Acute care notes

  • Accurate intake and output
  • Daily weights
  • Assess for hypervolemia or hypovolemia
  • Assess for potassium and sodium disturbances
  • Meticulous aseptic technique
  • Careful use of nephrotoxic drugs
  • Skin care measures/mouth care

Ambulatory care
- Monitor kidney function
- Regulate protein and potassium intake
- Follow-up care
- Teaching
- Appropriate referrals

The expected outcomes are that the patient with AKI will:
- Regain and maintain normal fluid and electrolyte balance
- Adhere to the treatment regimen
- Have no complications
- Have complete recovery

A
57
Q

gerontologic considerations
as you get older your gfr will what?

they are more susceptible for ?

they have a reduced ability to recover

RRT is still an option

A

decreased
dehydration, hypotension, infection

58
Q

chronic kidney disease section now

A
59
Q

when you have chronic kidney disease, its a what?

A

progressive, irreveserible loss of kidney function

60
Q

up to ___% of gfr may be lost before significant symptoms appear

A

80

61
Q

what are the 2 most common causes for chronic kidney disease ?

A

diabetes (50%)
hypertension (25%)

62
Q

what is the leading cause of death in chronic kidney disease ?

A

cardiovascular disease

63
Q

what is chronic kidney disease for low glomerular filtration rate?

A

<60ml/min for longer than 3 months

64
Q

most of the time patients with chronic kidney disease, they dont show what?

A

symptoms

65
Q

what is normal gfr ?

A

90-120

66
Q

why is it important to look at their gfr before you give a medication?

A

some patients won’t even be able to excrete out the medication, so it’ll just linger in there and causing more fluid retention

67
Q

what is uremia ?

A

urine in your blood

68
Q

uremia often occurs when GFR is less than or equal to what?

A

15ml/min

69
Q

what is happening in early stage in chronic kidney disease ?

A

no chance in urine output
polyuria may be present related to diabetes

however no change will be there, however overtime, you will have a decrease in urine output and increasing fluid retention

70
Q

as your GFR decreases, your what two labs increase ?

A

BUN and serum creatinine increases

71
Q

what are some symptoms of increase BUN?

A

fatigue
headaches
confusion

72
Q

patients who have chronic kidney disease may end up having an altered carbohydrate metabolism, which is and how do you get it?

A

impaired glucose metabolism
- from cellular insensitivity to normal action of insulin

type 2 diabetes because of insensitivity to insulin

so now that youre kidneys aren’t working, your body become resistant to insulin and you develop diabetes type 2

73
Q

patients with diabetes who develop uremia may require less insulin after onset of chronic kidney disease, why is that ?

A

because the insulin stays in the body longer due to the body not being able to excrete it out

74
Q

it is very common to see patients in chronic kidney disease to have elevated triglycerides, so high cholesterol due to what fact?

A

high amounts of insulin will stimulate hepatic production of triglycerides (cholesterol)

75
Q

how are we going to help manage their high cholesterol ?

A

statins and diet control

76
Q

remember we want to take care of any cardiac problems quick because of what ?

A

most patients with chronic kidney disease die from cardiovascular disease

77
Q

clinical manifestations
electrolyte imbalances

hyperkalamia
sodium
hypermagnesemia

what will we see with each ?

A

fatal dysrhythmias
edema, hypertension, neuro
absense of reflexes, confusion

78
Q

what are some clinical manifestations for hematologic system for chronic kidney disease ? (3)

A

anemia
bleeding tendencies
infection

79
Q

how do patients get anemia from chronic kidney disease?

A

due to the decrease in production of erythropoietin from the decrease of functioning renal tubular cells

( your body can not make it )

80
Q

how do patients get bleeding tendencies with chronic kidney disease?

A

defect in platelet function

81
Q

what are some clinical manfiestions of cardiovascular system for chronic kidney disease ?

A

hypertension
heart failure
left ventricular hypertrophy
peripheral edema
dysrhytmias
uremic pericarditis

82
Q

how do patients end up with hypertension with chronic kidney disease ?

A

aggravated by sodium and water retention

increases RAAS system from the kidneys trying to compensate

83
Q

what is one of the most important goals for patients who have hypertension in chronic kidney disease and why so ?

A

blood pressure control

because it can prevent left ventricular hypertrophy, heart failure

84
Q

patients who have uremic pericarditis can progress to effusion and tamponade, so what might we see in a patient ?

A

friction rub
chest pain
fever

85
Q

what type of respirations will we hear if a patient is having metabolic acidosis ?

A

kussmaul

86
Q

what are some clinical manifestations for gi system with chronic kidney disease?

A

constipation
ulcers
gi bleeding
diabetes gastroparesis

87
Q

what is the biggest complication or clinical manifestation for gi system in a patient with chronic kidney disease ?

A

uremic fetor
( breathe smells like pee )

88
Q

why do we see neuro changes in patients with chronic kidney disease?

A

uremia in the blood
sodium is out of balance

89
Q

peripheral neuropathy can occur
where are they going to feel it ?

A

hands and feet

90
Q

CKD mineral and bone disorder can happen how ?

A

extra phosphate
so you end up losing bone density

91
Q

patients may get uremic frost, which is what?

how do you manage this ?

this will feel like that ?

A

urea crystalizes on skin

  • white powdery skin, waste products on the skin

wash it off

itchy, pruitisit

92
Q

notes
infertility, decreased libido, sexual dysfunction can occur

dont get pregnant during dialysis

emotional lability, anxiety, fatigue

A
93
Q

what are your diagnostic studies for chronic kidney disease ?

A

urinalysis
renal ultrasound
dipstick evaluation of protein
albuminuria

94
Q

how do we manage their hypertension ?

A

antihypertensive drugs
- diureitcs
- calcium channel blockers
- ace inhibitors
- arb agents

95
Q

if a patient is on RRT, phosphate intake restricted to less than what?

A

1000mg/day

96
Q

remember we want to restrict phosphate because they can develop that mineral and bone syndrome, which causes bone loss.

so in order to lower phosphate, we should increase calcium, and what helps calcium being more ?

A

vitamin d

97
Q

how do we help with anemia ?

A

erythropoietin ( blood transfusion )

98
Q

what is the issue with erythropoietin ?

A

increase h&h in 2-3 weeks
- increase viscosity = more likely to clot

99
Q

we tell patents to try to avoid what two drugs?
dont over think it

A

nephrotoxic drug
narrow therpatuic window
- well stay in your blood and body very long

100
Q

what is the chronic kidney disease nutritional therapy ?

A

high carb
high protein
high calcium
low potassium
water restriction
sodium restriction

101
Q

sodium and potassium and phosphate restriction how much ?

A

2-4g a day

102
Q

Complete history of any existing kidney disease or family history
Long-term health problems
Medications: prescribed, OTC, herbal
Concerns with meds that: are nephrotoxic,  BP, interfere with absorption of other meds, or accumulate in the body
Dietary habits
Support systems

Overall goals
Show knowledge of and ability to adhere with therapeutic plan
Participate in decision making for the plan of care and future treatments
Have effective coping strategies
Continue with activities of daily living within physiologic limitations

Outcomes:
The patient with CKD will maintain
Fluid and electrolyte levels within normal ranges
An acceptable weight with no more than a 10% weight loss

A
103
Q

The nurse teaches a patient with chronic kidney disease about prevention of complications. What should the nurse include in the teaching plan?

A. Monitor for proteinuria daily with a urine dipstick.

B. Perform self-catheterization every 4 hours to measure urine.

C. Take calcium-based phosphate binders on an empty stomach.

D.Check weight daily and report a gain of greater than 4 pounds.

A

D.Check weight daily and report a gain of greater than 4 pounds.

410 Patho Exam 3 (5 decks)

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