Renal Flashcards
define anasrca.
generalized severe edema
define anuria
no urine output
define ascites
fluid volume overload and build-up, concentrated in the abdomen
where does edema typically form?
the lowest part of the body
define extracellular/intracellular fluid
fluid outside of the cell, inside the cell
what are the parts of the renal system?
kidney, ureters, bladder, urethra
list the primary functions of the kidneys
regulate volume: through urine production
composition of urine: electrolytes concentration
regulation of pH: through hydrogen ions
eliminating waste: meds, diet, muscle metabolism
BP regulation: RAAS, increase blood and oxygen flow
RBC production: stimulates erythropoietin
vitamin d conversion
how much of the body’s CO goes to the kidneys
25%
what is the general anatomy of the renal capsule
outer cortex: nephrons
inner medulla: the loop of Henle and collecting ducts
renal pelvis: transfers urine to bladder
afferent and efferent arteriole
What does the glomerulus do?
Filter. (Fluid and blood)
IN: sodium,potassium, and maybe protein
OUT: extra electrolytes, meds, etc
What are the three nephron functions
Glomerulus filtration, tubular secretions, tubular reabsorption
The glomerulus is under high pressure, 70mg, what is a healthy GFR
125 ml/min, if it is lower it shows damage
What is the passage of nephron
Glomerulus
Bowman’s
Tubules
Loop of henle/medulla
Renal pelvis
Where is the loop of henle found
The nephron
What conditions require diuretics
Cardiovascular (HTN and HF)
Renal — GFR effects
Hepatic
Burns
Trauma
Allergies
Inflammatory reaction
Fluid overload— increased hydrostatic pressure
Low plasma: decreased ontonic pressure
What is dependent, pulmonary and anasarca edema?
D: sets in lowest point
P: fluid overload in lungs
A: massive, generalized
True or false, edema occurs only when the heart no longer functions efficiently?
False
What is the main function of diuretics
Increases secretion of water, sodium, and other electrolytes
What are the main drug classes of diuretics
Loop diuretics - furosemide
Thiazide - HCTZ/metolazone
Potassium sparing- spironolactone
Osmotic - mannitol
Carbonic anhydrase inhibitor: acetazolamide
What diuretic does not work in renal tubules
Osmotics
What is used when a rapid diuretic is needed? Hint: it is also used for renal impairment
Loop diuretics
What is the main loop diuretics, how it is given, its MOA and when it is used?
Furosemide (bumetanide, toresemide)
Given: PO, IV, IM
MOA: inhibits Na and Cl reabsorption in ascending LOH
USE: pulmonary edema, CHF, hepatic, renal, HTN, critically ill, and for chronic conditions
What are the adverse reaction, contraindications and drug interactions for loop diuretics?
A: fluid/electrolyte imbalance, hyponatremia, hypokalemia, fluid deficit, ototoxicity (low plasma, hearing loss is main symptom)
C: Anuria, allergy to sulfonamides
D: Aminoglycosides, cephalosporins,(increased effect) corticosteroids, digoxin (hypokalemia)
What are the nursing implications and patient teaching for loop diuretics
N: slow IV push (20mg/min), checking labs, daily weight and I&O, vital monitoring (hypotension), give PO in AM
P: low sodium diet, high k diet, daily weight, orthostatic, take in AM
What is the main thiazide and thiazide like diuretic, how it is given, MOA and use?
Hydrochlorothiazide HCTZ) and metolazone (like)
Given: PO
MOA: decreases reabsorption of Na, H2O, Cl and HCO3 in distal convoluted tubule
Use: first line for HTN, edema for CHF, nephrotic syndrome, renal impairment
What are the adverse effects and contraindications for thiazide and thiazide like diuretics?
A: hypotension, weakness, dizziness, diarrhea/constipation, hypokalemia, hyperglycemia
C: allergy to sulfonamides, renal failure/anuria
What are the nursing implications and patient teaching for thiazide and thiazide like diuretics
N: check labs, weight and I&O, vitals, give in AM, monitor dizziness
P: low sodium, high k diet, daily weight, orthostatic, take in AM
What is hypokalemia, and the prevention and management of it?
K lower than 3.5
Signs: conduction, weakness, palpitations, GI upset
low dose diuretics — combo with potassium sparing/wasting
Supplements
Increase foods in potassium
Restrict sodium
What assessment finding in a patient with heart failure recovering furosemide would indicate an improvement in fluid volume status?
Absence of crackles in lungs
What is the main potassium sparing diuretic, how it works, MOA, and use
Spironolactone
-slow onset and peak (24-48 hrs)
-6 weeks for full effects
MOA: blocks aldosterone (RAAS)
Use: HF, ascites, hypokalemia, HTN, hyperaldosteronism
What are the adverse effects, contraindications, and drug interactions for potassium sparing diuretics
A: dizziness, diarrhea, androgen like (breast growth, irregular periods), increased GI bleed, BB: tumorigenic with chronic toxicity
C: renal insufficiency and hyperkalemia
D: ACE, ARB, K containing drugs (hyperkalemia)
What are the nursing implications and patient teaching for potassium sparing diuretics?
N: check labs, weight and I&O, dizziness
P: avoid salt subs, low k diet (no oranges, banana, spinach), weight, acites, orthostatic, take in morning WITH food
What is hyperkalemia and the prevention and management of it?
K greater than 5
Signs: muscle cramps, EKG changes, hypotension, arrhythmias, death
-potassium sparing and wasting meds
-no supplements
-no salt substitutes
-maintain urine output
What is the main osmotic diuretic, how it is given, MOA and use?
Mannitol
Given: IV (glass) in critical care
MOA: increases pressure of glomerular filtrate, pulls from extra vascular into blood (goes to kidneys), decreases reabsorption of H2O and electrolytes
USE: intracranial pressure, intraocular pressure, decreased renal circulation and GFR
(Not used in the loop)
What are the adverse effects, contraindications, and nursing implications of osmotic diuretics?
A: hyperosmolar non ketotic coma, confusion, headache, syncope, dysrhythmias, dehydration
C: dehydration, abdomen pain, appendicitis, pulmonary edema, cardiac decompensation (HF), older adults
N: physical and neuro exam, I&Os, vitals
INFILTRATION=hyaluronidase
What is the main carbonic anhydrase inhibitor, how its given, MOA, use and adverse effects?
Acetazolmide
GIVEN: IV or eye drops
MOA: inhibits CA to reduce formation of aqueous humor and lower IOP
USE: open angle glaucoma and secondary glaucoma
A: metabolic acidosis
IV ONLY: Steven Johnson’s, flaccid paralysis, blood dycrasias
What are the contraindications and nursing implications of carbonic anhydrase inhibitors?
C: renal/hepatic, Addisons disease, electrolyte imbalance, chronic non congestive angle closure glaucoma
N: vision exam, teach to give eye drops
Should a patient taking spironolactone use salt substitutes?
No, it will increase K levels
