Renal 3

Question 1

describe nephrotic syndrome

Answer 1

• Nephrons are totally nonfunctioning (leak fluid)
• not holding in fluid
• Massive protein loss, edema and decreased plasma albumin levels

Question 2

how does a nephrotic syndrome pt appear

Answer 2

pt look very puffy, massive edema, swollen, HTN

Question 3

-Increased glomerular permeability that allows larger molecules to pass through the membrane into the urine

Answer 3

nephrotic syndrome

Question 4

what appears in the urine if nephrotic syndrome

Answer 4

• *PROTEIN loss in urine
• Proteinuria (lose 3.5 g of protein in a 24 hour period)
• may also have fat in urine

Question 5

nephrotic syndrome symptoms

Answer 5

**NAPHROTIC
N: Na decrease (hyponatremia)
A: albumin decrease
P: proteinuria >3.5 g/day
H: hyperlipidemia
R: renal vein thrombosis
O: orbital edema
T: thromboembolism
I: infection
C: coagulability

Question 6

treatment of nephrotic syndrome

Answer 6

• *protect kidneys
• Determine the cause
• ACE inhibitors, Statins to lower lipids
• Heparin to reduce vascular defects and improve function
• give fluid if output is low
• If GFR is normal, then can take proteins
• if GFR is reduced, then reduce proteins
• Mild diuretics and Na reduction

Question 7

what is a prisma machine

Answer 7

• used for CRRT
• Set blood flow to take off 150ml/hr, dialysate rate at 1L/hr
• this is a low amount only done in ICU (normal dialysis takes off many liters)

Question 8

dialysis catheters used for short term

Answer 8

Mahurkar catheters

Question 9

dialysis catheters used for long term

Answer 9

PermCath catheter

Question 10

prevention of AKI

Answer 10

1) Hydrate with fluids: when U.O. drops less than 200-500 ml/24 hours, increase fluids to 2L
2) Prevent exposure to nephrotoxins
3) maintain renal perfusion
4) Give loop diuretics, low dose dopamine
5) Renal replacement through dialysis

Question 11

hemodialysis is used in pts with…

Answer 11

Fluid overload
Pericarditis
Uncontrolled HTN
Uremic signs
Worsening anemia
Irreversible renal failure when other therapies are not possible

Question 12

describe the hemo filter used in hemodialysis

Answer 12

over 1 million fine hairs, act as nephrons

Question 13

what is important to remember about AV fistulas

Answer 13

• take about 4-6 months to mature/vein thicken
• as it matures, blood flow increases and it enlarges
• **Feel for the thrill and listen for bruits

Question 14

management of AV fistulas

Answer 14

Do not take BP or blood draws from that arm
Assess pulses
Palpate for thrill and listen for bruits
No lifting of heavy objects

Question 15

hemodialysis care

Answer 15

Weigh the patient before and after, know the “dry wt”
Measure BP, HR and Respirations
Watch for orthostatic hypotension
Watch for disequilibrium syndrome

Question 16

what is disequilibrium syndrome

Answer 16

• rare neurological syndrome that affects some pts on hemodialysis
• s/s: headache, N&V, change in LOC, cerebral edema, seizures
• if suspected, STOP the INFUSION, may need Ativan if seizure

Question 17

how to prevent disequilibrium syndrome

Answer 17

slowing down the fluid removal can prevent it

Question 18

why can bleeding occur with hemodialysis

Answer 18

from heparinization of the lines and low blood counts

Question 19

how does peritoneal dialysis work

Answer 19

• Dialysate is inserted, dwells for 3-4 hours, allowing fluid to mix with dialysate
• Effluent or outflow is then opened and waste products and water are removed
• Process is by diffusion and osmosis of products

Question 20

what is the biggest risk with PD

Answer 20

Run the risk for peritonitis (bacterial infection in peritoneum)

Question 21

what is CAPD

Answer 21

continuous ambulatory peritoneal dialysis

Question 22

complications of PD

Answer 22

• Peritonitis- contamination of catheter, cloudy outflow, fever, abdominal pain and cramping
• Pain
• Poor outflow and leakage- can be caused by constipation, fibrin clots in the catheter