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NCLEX > Renal > Flashcards

Renal Flashcards

1
Q

Patho of glomerulonephritis

A

Inflammatory reaction in the glomerulus

Antibodies lodge in the glomerulus leading to scarring and decreased filtering

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2
Q

Main cause of glomerulonephritis

A

Strep

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3
Q

S/S of glomerulonephritis

A 
Sore throat
Malaise and HA-retaining toxins
Increased BUN and Creatinine
Protein and blood in urine (tea/rust colored)
Protein leaks out due to holes in glomerulus
Flank pain (CVA tenderness)
Increased BP
Facial edema
Decreased UOP
Increased urine specific gravity
Client will go into fluid volume excess
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4
Q

Treatment of glomerulonephritis

A

Decreased protein and Na, increased carbs to prevent breaking down protein for energy
Dialysis

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5
Q

How long will blood and protein stay in the urine with glomerulonephritis?

A

Months

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6
Q

When does diuresis begin after onset of glomerulonephritis?

A

1-3 weeks

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7
Q

How is fluid replacement determined?

A

24 hour fluid loss + 500cc = total replacement

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8
Q

Protein makes BUN do what?

A

Increase

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9
Q

Patho of nephrotic syndrome

A

Inflammatory response in the glomerulus, big holes form so protein starts leaking in urine, leads to hypoalbuminemia. Without albumin you can’t hold onto fluid in vascular space, so fluid goes into tissues. (edema) Since all fluid is in tissues, blood volume is decreased. Aldosterone is produced to try to replace blood volume, so Na and water are retained, but there is no albumin to hold it, so more fluid goes to tissues.

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10
Q

Total body edema

A

Anasarca, occurs with nephrotic syndrome

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11
Q

Problems associated with protein loss

A

Blood clots, protein keeps blood from clotting
Cholesterol and triglycerides are released from the liver compensation by making more albumin, causing an increased release of cholesterol and triglycerides.

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12
Q

Causes of nephrotic syndrome

A 
Bacterial and viral infections
NSAIDs
Cancer, genetics
Systemic dz like lupus/diabetes
Strep
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13
Q

S/S of nephrotic syndrome

A

Proteinuria
Hypoalbuminemia
Edema (anasarca)
Hyperlipidemia

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14
Q

Tx of nephrotic syndrome

A 
Diuretics
ACE inhibitors to block aldosterone
Prednisone to decrease inflammation and shrink holes in glomerulus-causes immunosuppression
Lipid lowering drugs
Decrease Na
Increase protein-give lasix, could go into fluid excess
Dialysis
Anticoagulation therapy for 6 months
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15
Q

One kidney dz when you have to have more protein in diet

A

Nephrotic syndrome

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16
Q

Renal failure requires what?

A

Bilateral failure

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17
Q

Causes of renal failure

A

Pre renal
Intra renal
Post renal

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18
Q

Pre renal failure

A

Blood can’t get to the kidneys

  • Hypotension
  • Decreased HR, arrhythmias
  • Hypovolemia
  • Shock
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19
Q

Intra renal failure

A

Damage has occurred inside kidney

  • Glomerulonephritis
  • Nephrotic syndrome
  • Dyes with heart cath and CT scans
  • Drugs (mycins, nephrotoxicity)
  • Malignant HTN (uncontrolled)
  • DM causes vascular damage
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20
Q

Post renal failure

A

Urine can’t get out of kidneys

  • Enlarged prostate
  • Kidney stone
  • Tumors
  • Ureteral obstruction
  • Edematous stoma (ileal conduit)
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21
Q

S/S of renal failure

A

Increased creatinine and BUN
Anemia
Initially: increased specific gravity
Fixed specific gravity: lose ability to concentrate and dilute urine, fluid challenge: bolus with 250 mL NS
HTN & HF, retaining fluids
Anorexia, n/v, retaining toxins
Itching frost (uremic frost)-take good skin care
Hyperkalemia
Metabolic acidosis
Retain phos leading to decreased serum Ca and Ca is pulled from bones

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22
Q

Why is there anemia with renal failure?

A

Not enough erythropoietin-stimulates RBC production

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23
Q

Two phases of acute renal failure

A

Oliguric

Diuretic

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24
Q

Acute renal failure

A

Kidneys have been damaged by one of the causes: this damage leads to the oliguric phase

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25
Q

Oliguric phase of acute renal failure

A

Decreased UOP 100-400 mL in 24 hours
Fluid volume excess
Increased K
*Good time do do the fluid challenge

26
Q

Diuretic phase of acute renal failure

A

Sudden onset
Increased UOP
Fluid volume deficit
Decreased K

27
Q

For hemodialysis, the machine does the work of what?

A

The glomerulus

28
Q

How often is hemodialysis done

A

3-4 x per week, so client has to watch what they eat and drink between treatments

29
Q

What med will clients get during hemodialysis?

A

An anticoagulant to prevent clots from forming. Usually heparin, so implement bleeding precautions

30
Q

Do you worry about suicide with hemodialysis pts?

A

Yes, they depressed. They may use methods like not going to their appointments or eating the wrong diet

31
Q

Why can’t all clients handle hemodialysis?

A

Decreased blood volume can lead to chock. Unstable cardiovascular system clients can’t handle it

32
Q

What meds do you hold before hemodialysis?

A

Lisinopril (already have decreased BP during)
Nitro
Water soluble vitamins
Antibiotics (won’t do any good if it’s filtered out)

33
Q

What med CAN you give before hemodialysis?

A

Famotidine, not filtered by kidneys

34
Q

Types of vascular access with hemodialysis (must have access)

A

Arteriovenous fistula
Arteriovenous graft
Both require sx, the site takes weeks to mature and be ready for repeated venipunctures

35
Q

What rate is blood removed, cleansed, then returned with hemodialysis?

A

300-800mL/min

36
Q

What is vascular access?

A

Site for access to a large blood vessel, very rapid flow is essential for hemodialysis

37
Q

Arteriovenous fistula

A

In forearm, anastomosis between an artery and a vein

38
Q

Arteriovenous graft

A

Synthetic graft to join artery and vein vessels

39
Q

How many needles are inserted into the vascular access during hemodialysis?

A

Two, one allows blood to be pulled form he circulation and set to machine, other is used to retune the filtered blood to client’s circulation

40
Q

Which end of access removes blood?

A

Arterial end

41
Q

Which end of access replaces blood?

A

Low pressure venous end

42
Q

Temporary hemodialysis access

A

The internal jugular or femoral veins are often used for catheter placement. Sx is not required

43
Q

Care of hemodialysis access

A

Do not use for IV access to draw blood, admin meds

No BPs, needle sticks, constriction, purse, jewelry

44
Q

Assessment of hemodialysis access

A

Ensure potency by palpating for a thrill-cat purring sensation
Auscultate for a bruit-turbulent blood flow
Feel the thrill, hear the bruit

45
Q

Peritoneal dialysis filter is what

A

Peritoneal membrane

46
Q

How to prepare dialysate for peritoneal dialysis

A

Warm to body temp and infuse into peritoneal cavity by gravity via a tenckhoff catheter

47
Q

How does the fluid for peritoneal dialysis work

A

2000-2500 mL fills peritoneal cavity (takes 10 min) and remains for a prescribed amount of time, called the dwell time

48
Q

Exchange during peritoneal dialysis

A

After fluid fills peritoneal cavity, the bag is lowered and the fluid, along with he toxins, are drained

49
Q

Why do we warm the fluid for peritoneal dialysis

A

Cold promotes vasoconstriction which limits blood flow. We want it warm to vasodilate for more blood flow

50
Q

What should the drainage look like with peritoneal dialysis?

A

Clear, straw-colored. Cloudy means infection

Should be able to read a newspaper through the drainage/effluent

51
Q

What type of clients get peritoneal dialysis?

A

Someone who can’t tolerate hemodialysis or someone who chooses it

52
Q

What happens if all the fluid doesn’t come out with peritoneal dialysis?

A

Reposition

53
Q

Two types of peritoneal dialysis

A

Continuous ambulatory

Continuous cycle

54
Q

Continuous ambulatory peritoneal dialysis

A

Client has to have energy and a desire to be active
Done 4 x per day, every day
Fluid causes pressure on back, so pt with disc dz or arthritis shouldn’t do this
Clients with colostomy can’t do this, infection risk

55
Q

Continuous cycle peritoneal dialysis

A

Connect their peritoneal dialysis cath to a cycler at night and their exchange is done automatically while the sleep. DC in AM. Client has more freedom

56
Q

Complications of peritoneal dialysis

A 
Peritonitis (cloudy effluent 1st sign)
Constant sweet taste
Hernia
Altered body image
Anorexia
Low back pain
57
Q

Dietary needs of the peritoneal client

A

Increase fiber and protein
They have decreased peristalsis due to abdominal fluid
Big holes in peritoneum and lose protein with each exchange

58
Q

Continuous renal replace ment therapy

A

Done in an ICU and is continuous so the client doesn’t have drastic fluid shifts
Never more than 80 mL or blood out of body at once so it doesn’t stress the heart as much
Performed on a client with a fragile cardiovascular status and acute renal failure

59
Q

S/S of kidney stones/urolithiasis/renal calculi

A

Pain, N/V
WBC in urine
Hematuria**

60
Q

Anytime you suspect a kidney stone, do what?

A

Get a urine specimen ASAP and have it checked for RBS

61
Q

If a kidney stone is present on specimen, do what?

A

Give pain meds immediately

62
Q

Tx for kidney stones

A 
Ketorolac
Ondansetron
Hydromorphone
Increase fluids
Maybe need s
Strain urine
Extracoporeal shock wave lithotripsy

NCLEX (14 decks)

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