Renal Flashcards
glomerulonephritis
acute can lead to chronic
- inflammatory reaction in the glomerulus
- antibodies lodge in the glomerulus: get scarring and decrease filtering.
- main cause: STREP THROAT
s/s of glomerulonepritis
sore throat malaise and HA BUN and creatinine UP sediment/protein/blood in urine flank pain bp UP facial edema UO DOWN urine specific gravity UP ----client is going into fluid volume excess
tx for glomerulonepritis
get rid of strep balance activity with rest I&O / daily weight monitor BP dietary dialysis diuresis begins is 1 to 3 weeks after onset blood and protein may stay in urine for months teach s/s of renal failure
how is fluid replacement determined?
fluid replacement = 24 hr fluid loss + 500ml
dietary needs for glomerulonephritis:
protein? __NA?___ Carbs?___
protein DOWN
NA DOWN
Carbs UP
Nephrotic syndrome
Losing A TON of protein.
- inflammatory response in the glomerulus–big hole so protein leaks out into the urine..then to the tissues
- client is edematous
total body edema =
anasarca
problems associated with protein loss:
- blood clot (thrombosis)
- -they are losing proteins that normally prevent their blood from clotting. without these proteins, the blood can clot and put them at risk for thrombosis - cholesterol and triglycerides will be high.
- –the liver compensates by making more albumin, causing an increased release of cholesterol and trig.
causes of nephrotic syndrome
idiopathic but has been related to : bacterial or viral infection NSAIDS cancer and genetic predisposition systemic diseases such as lupus or diabetes strep
s/s of nephrotic syndrome
proteinuria
hypoalbuminemia
edema (anasarca)
hyperlipidemia
tx for nephrotic syndrome
diuretics ace inhibitor to block aldosterone secretion prednisone to decrease inflammation lipid lowering drugs for hyperlipidemia sodium DOWN protein UP anticoagulation therapy dialysis
RULE: limit protein with kidney problems EXCEPT
with nephrotic syndrome
renal failure causes:
pre-renal failure:____
blood cant get to the kidneys
- hypotension
- decrease HR
- hypovolemic
- any form of shock
renal failure causes:
intra-renal failure:____
damage has occurred inside the kidneys
- glomerulonephritis
- nephrotic syndrome
- dyes used in test such as heart cath and CT scan
- drugs
- malignant htn
- DM
renal failure causes:
post-renal failure:____
urine cant get out of the kidneys
- enlarged prostate
- kidney stone
- tumors
- ureteral obstruction
- edematous stoma
s/s of renal failure
- creatinine and BUN UP
- specfic gravity (initially concentrated then may become fixed)
- anemia
- htn, hf
- anorexia,n/v –(retaining toxins)
- itching frost
- acid/base imbalances (hyperkalemia,metabolic acidosis, retaining phosphorus)
oliguric phase of renal failure:
UO DOWN UO of 100 to 400 ml/24 hrs this client is in a fluid volume excess*** potassium goes up! *** (hyperkalemia) (last 1 to 3 weeks)
diuretic phase of renal failure:
sudden onset
UO UP
this client is in a fluid volume deficit
hypokalemia (decrease potassium)
what are the 3 types of dialysis?
hemodialysis
peritoneal dialysis
continuous renal replacement therapy (CRRT)
hemodialysis is done 3-4 times per week so the client has to watch what they ________ between treatments.
eat and drinks
hemodialysis … the machine acts as ___.
glomerulus (filter)
hemodialysis.. what should you monitor constantly ?
BP and electrolytes
unstable cardiovascular system cant tolerate hemodialysis.
with hemodialysis, blood is being removed, cleansed and then returned at a rate of ____ml/min
300-800
what is a vascular access?
what are the types of vascular access?
a site where they have access to a large blood vessel because very rapid blood flow is essential for hemodialysis
AVF (arteriovenous fistula) in forearm with an anastomosis between an artery and vein
AVG (arteriovenous graft) a synthetic graft to join the vessels
both require surgery! takes weeks to mature and be ready for repeated venipuncutres.
important: care of access
-DO NOT USE _____.
NO ____,____,____/
do not use for iv access
NO blood pressures
NO needle sticks
NO constrictions (NO WATCH)
assessment of access:
to make sure patent
thrill- cat purring sensation (palpate)
bruit- turbulent blood flow (auscultate)
feel a thrill.. hear a bruit
peritoneal dialysis
use peritoneal membrane as a filter
- –dialysate is warmed and infused into the peritoneal cavity by gravity via a tenckhoff catheter.
- the fluid (2000-2500ml) fills the peritoneal cavity, takes about 10 mins, and remains in the cavity for a prescribed amount of time. this is called the dwell time!
What is the “exchange” consisted on with peritoneal dialysis?
what should the drainage look like?
when the bag is lowered and the fluid along with the toxins , etc, are drained.
clear, straw-colored. cloudy= infection
who gets peritoneal dialysis?
someone who cant tolerate hemodialysis or someone who chooses peritoneal.
what are the 2 types of peritoneal dialysis?
continuous ambulatory peritoneal dialysis (CAPD)
continuous cycle peritoneal dialysis (CCPD)
what is CAPD
continuous ambulatory peritoneal dialysis
must have a client that has the energy and the desire to be active in their treatment and that also has the ability to learn and follow instructions
- done 4x a day, 7 days a week (done during the day)
- if have disc disease, arthritis,colostomy do this? NO high risk for infection!
what is CCPD
continuous cycle peritoneal dialysis
connect their peritoneal dialysis catheter to a cycler at NIGHT and their exchange is done automatically while they sleep. disconnected in the AM . the client has more freedom
what are the complications of peritoneal dialysis?
major complication is peritonitis (cloudy effluent 1st sign) constant sweet taste may get a hernia altered body image/sexuality anorexia low back pain
what should the peritoneal dialysis increase in their diet?
fiber (have decreased peristalsis due to abdominal fluid) and protein (big holes in the peritoneum and lose protein with each exchange)
what is CRRT
continuous renal replacement therapy
typically done in an ICU setting and is continuous so that the client doesn’t have drastic fluid shifts.
never more than 80 ml of blood out of the body at one time being filtered and therefore does not stress the cardiavascular system as much.
CRRT is performed on a client with:
a fragile cardiovascular status and acute renal failure
kidney stones aka ___
urolithisasis, renal calculi
s/s of kidney stones
pain and n/v
wbcs in urine
HEMATURIA
anytime you suspect a kidney stone, get a urine specimen ASAP and have it checked for RBCs
if a kidney stone is present, the client will get pain medication immediately.
tx for kidney stones
ketorolac(tordol), ondansetron(zofron),hydromorphone (dilaudid)
maybe surgery
strain urine
extracorporeal shoch wave lithotripsy (ESWL)
