Renal

Question 1

what is kidney, renal failure ?

Answer 1

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

Question 2

does kidney,renal failure, affect all body systems?

Answer 2

yes

Question 3

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

dont over think it

Answer 3

lifestyle, occupation, family relationships and self-image

Question 4

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

Answer 4

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

Question 5

acute kidney injury powerpoint

Question 6

acute kidney injury ranges from slight deterioration to what?

Answer 6

severe impairment

Question 7

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

Answer 7

rise in serum creatinine and or reduction in urine output

elevated bun and potassium

azotemia

Question 8

what does azotemia mean?

Answer 8

accumulation of nitrogenous waste products

Question 9

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?

Answer 9

in order to protect the kidneys

Question 10

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

what is important for bun?

Answer 10

creatinine (kidneys are fine)

dehydration

Question 11

if youre dehydrated how does your bun look like ?

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

Answer 11

high

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

Question 12

what is the best measure of kidney function?

Answer 12

urinary output

Question 13

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

what do these tell us ?

describe each

Answer 13

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

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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

Question 16

all cases of acute kidney injury are potentially what ?

Answer 16

reversible ( can potentially correct if caught early )

Question 17

what are the 3 phases of acute kidney injury ?

Answer 17

oliguric - very little urine
diuretic - lots of urine
recovery

Question 18

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

what does this tell us?

Answer 18

half of it

• you have to look at everything

Question 19

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

Answer 19

400

Question 20

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

Answer 20

10-14days

Question 21

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 ?

Answer 21

1-7 days

Question 22

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

Answer 22

electrolyte imbalance/ fluid overload

Question 23

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

Answer 23

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

Question 24

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

Answer 24

peripheral edema
crackles in the lungs

Question 25

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

Answer 25

casts, rbc and wbc

Question 26

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

Answer 26

1-3 liters, up to 5 liters

Question 27

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 ?

Answer 27

concentrate the urine

Question 28

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

Answer 28

hyponatremia - worried for seizures/neuro hypokalemia - dysrhythmias dehydration - from all the water leaving

Question 29

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

Answer 29

12 months ( 1 year )

Question 30

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.

Answer 30

D. Urine testing shows a specific gravity of 1.010.

Question 31

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

Answer 31

1.010 to 1.030 dehydration super hydrated

Question 32

why is metabolic acidosis a complication for acute kidney injury ? how does your body compensate?

Answer 32

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

Question 33

why is sodium balance a complication of acute kidney injury?

Answer 33

increased excretion of sodium - hyponatremia leading to cerebral edema

Question 34

why is potassium excess a complication for acute kidney injury ?

Answer 34

risk with large amount of tissue trauma or blood transfusion usually asymptomactic ecg changes

Question 35

why is infection a complication for acute kidney injury ? watch out for ?

Answer 35

its the most common cause of death increase white blood cell count

Question 36

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

Answer 36

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

Question 37

why is neurologic disorders a complication of acute kidney injury ?

Answer 37

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

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

metformin - holding it 48 hours before and after use

Question 41

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

Answer 41

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

Question 42

how are we going to fluid restrict these patients ?

Answer 42

total output of the last 24 hours, plus 600ml

Question 43

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

Answer 43

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

Question 44

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

Answer 44

dialysis or Continuous renal replacement therapy

Question 45

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

Answer 45

insulin - they push the potassium back into the cells

Question 46

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 ?

Answer 46

glucose

Question 47

why might we need to give calcium gluconate ?

Answer 47

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

Question 48

what is calcium gluconate the antidote to ?

Answer 48

magnisuem

Question 49

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

Answer 49

sodium polystyrene sulfonate (kayexalate)

Question 50

why might we give patiromer (veltessa) for hyperkalameia therpay ? what do we warn about this medication

Answer 50

binds to potassium in the gi tract take 6 hours before or 6 hours after since it can bind to other medications

Question 51

why do we put patients on renal replacement therapy ?

Answer 51

volume overload elevated serum potassium level metabolic acidosis fix volume overload

Question 52

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

Question 53

what is the diet for these patients ?

Answer 53

carbs and fat adequate protein restrict sodium, potassium, phosphate

Question 54

why is daily weight super important for these patients ?

Answer 54

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

Question 55

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

Question 56

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

Question 57

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

Answer 57

decreased dehydration, hypotension, infection

Question 58

chronic kidney disease section now

Question 59

when you have chronic kidney disease, its a what?

Answer 59

progressive, irreveserible loss of kidney function

Question 60

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

Answer 60

80

Question 61

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

Answer 61

diabetes (50%) hypertension (25%)

Question 62

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

Answer 62

cardiovascular disease

Question 63

what is chronic kidney disease for low glomerular filtration rate?

Answer 63

<60ml/min for longer than 3 months

Question 64

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

Answer 64

symptoms

Question 65

what is normal gfr ?

Answer 65

90-120

Question 66

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

Answer 66

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

Question 67

what is uremia ?

Answer 67

urine in your blood

Question 68

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

Answer 68

15ml/min

Question 69

what is happening in early stage in chronic kidney disease ?

Answer 69

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

Question 70

as your GFR decreases, your what two labs increase ?

Answer 70

BUN and serum creatinine increases

Question 71

what are some symptoms of increase BUN?

Answer 71

fatigue headaches confusion

Question 72

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

Answer 72

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

Question 73

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

Answer 73

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

Question 74

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

Answer 74

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

Question 75

how are we going to help manage their high cholesterol ?

Answer 75

statins and diet control

Question 76

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

Answer 76

most patients with chronic kidney disease die from cardiovascular disease

Question 77

clinical manifestations electrolyte imbalances hyperkalamia sodium hypermagnesemia what will we see with each ?

Answer 77

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

Question 78

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

Answer 78

anemia bleeding tendencies infection

Question 79

how do patients get anemia from chronic kidney disease?

Answer 79

due to the decrease in production of erythropoietin from the decrease of functioning renal tubular cells ( your body can not make it )

Question 80

how do patients get bleeding tendencies with chronic kidney disease?

Answer 80

defect in platelet function

Question 81

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

Answer 81

hypertension heart failure left ventricular hypertrophy peripheral edema dysrhytmias uremic pericarditis

Question 82

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

Answer 82

aggravated by sodium and water retention increases RAAS system from the kidneys trying to compensate

Question 83

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

Answer 83

blood pressure control because it can prevent left ventricular hypertrophy, heart failure

Question 84

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

Answer 84

friction rub chest pain fever

Question 85

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

Answer 85

kussmaul

Question 86

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

Answer 86

constipation ulcers gi bleeding diabetes gastroparesis

Question 87

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

Answer 87

uremic fetor ( breathe smells like pee )

Question 88

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

Answer 88

uremia in the blood sodium is out of balance

Question 89

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

Answer 89

hands and feet

Question 90

CKD mineral and bone disorder can happen how ?

Answer 90

extra phosphate so you end up losing bone density

Question 91

patients may get uremic frost, which is what? how do you manage this ? this will feel like that ?

Answer 91

urea crystalizes on skin - white powdery skin, waste products on the skin wash it off itchy, pruitisit

Question 92

notes infertility, decreased libido, sexual dysfunction can occur dont get pregnant during dialysis emotional lability, anxiety, fatigue

Question 93

what are your diagnostic studies for chronic kidney disease ?

Answer 93

urinalysis renal ultrasound dipstick evaluation of protein albuminuria

Question 94

how do we manage their hypertension ?

Answer 94

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

Question 95

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

Answer 95

1000mg/day

Question 96

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 ?

Answer 96

vitamin d

Question 97

how do we help with anemia ?

Answer 97

erythropoietin ( blood transfusion )

Question 98

what is the issue with erythropoietin ?

Answer 98

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

Question 99

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

Answer 99

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

Question 100

what is the chronic kidney disease nutritional therapy ?

Answer 100

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

Question 101

sodium and potassium and phosphate restriction how much ?

Answer 101

2-4g a day

Question 102

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

Question 103

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.

Answer 103

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