Renal 3 Flashcards
describe nephrotic syndrome
- Nephrons are totally nonfunctioning (leak fluid)
- not holding in fluid
- Massive protein loss, edema and decreased plasma albumin levels
how does a nephrotic syndrome pt appear
pt look very puffy, massive edema, swollen, HTN
-Increased glomerular permeability that allows larger molecules to pass through the membrane into the urine
nephrotic syndrome
what appears in the urine if nephrotic syndrome
- *PROTEIN loss in urine
- Proteinuria (lose 3.5 g of protein in a 24 hour period)
- may also have fat in urine
nephrotic syndrome symptoms
**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
treatment of nephrotic syndrome
- *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
what is a prisma machine
- 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)
dialysis catheters used for short term
Mahurkar catheters
dialysis catheters used for long term
PermCath catheter
prevention of AKI
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
hemodialysis is used in pts with…
Fluid overload Pericarditis Uncontrolled HTN Uremic signs Worsening anemia Irreversible renal failure when other therapies are not possible
describe the hemo filter used in hemodialysis
over 1 million fine hairs, act as nephrons
what is important to remember about AV fistulas
- 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
management of AV fistulas
Do not take BP or blood draws from that arm
Assess pulses
Palpate for thrill and listen for bruits
No lifting of heavy objects
hemodialysis care
Weigh the patient before and after, know the “dry wt”
Measure BP, HR and Respirations
Watch for orthostatic hypotension
Watch for disequilibrium syndrome
what is disequilibrium syndrome
- 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
how to prevent disequilibrium syndrome
slowing down the fluid removal can prevent it
why can bleeding occur with hemodialysis
from heparinization of the lines and low blood counts
how does peritoneal dialysis work
- 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
what is the biggest risk with PD
Run the risk for peritonitis (bacterial infection in peritoneum)
what is CAPD
continuous ambulatory peritoneal dialysis
complications of PD
- 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