Renal

Question 1

glomerulonephritis

Answer 1

acute can lead to chronic

• inflammatory reaction in the glomerulus
• antibodies lodge in the glomerulus: get scarring and decrease filtering.
• main cause: STREP THROAT

Question 2

s/s of glomerulonepritis

Answer 2

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

Question 3

tx for glomerulonepritis

Answer 3

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

Question 4

how is fluid replacement determined?

Answer 4

fluid replacement = 24 hr fluid loss + 500ml

Question 5

dietary needs for glomerulonephritis:

protein? __NA?___ Carbs?___

Answer 5

protein DOWN
NA DOWN
Carbs UP

Question 6

Nephrotic syndrome

Answer 6

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

Question 7

total body edema =

Answer 7

anasarca

Question 8

problems associated with protein loss:

Answer 8

1. 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
2. cholesterol and triglycerides will be high.
   - –the liver compensates by making more albumin, causing an increased release of cholesterol and trig.

Question 9

causes of nephrotic syndrome

Answer 9

idiopathic but has been related to :
bacterial or viral infection
NSAIDS
cancer and genetic predisposition
systemic diseases such as lupus or diabetes
strep

Question 10

s/s of nephrotic syndrome

Answer 10

proteinuria
hypoalbuminemia
edema (anasarca)
hyperlipidemia

Question 11

tx for nephrotic syndrome

Answer 11

diuretics
ace inhibitor to block aldosterone secretion
prednisone to decrease inflammation
lipid lowering drugs for hyperlipidemia
sodium DOWN
protein UP
anticoagulation therapy
dialysis

Question 12

RULE: limit protein with kidney problems EXCEPT

Answer 12

with nephrotic syndrome

Question 13

renal failure causes:

pre-renal failure:____

Answer 13

blood cant get to the kidneys

• hypotension
• decrease HR
• hypovolemic
• any form of shock

Question 14

renal failure causes:

intra-renal failure:____

Answer 14

damage has occurred inside the kidneys

• glomerulonephritis
• nephrotic syndrome
• dyes used in test such as heart cath and CT scan
• drugs
• malignant htn
• DM

Question 15

renal failure causes:

post-renal failure:____

Answer 15

urine cant get out of the kidneys

• enlarged prostate
• kidney stone
• tumors
• ureteral obstruction
• edematous stoma

Question 16

s/s of renal failure

Answer 16

• 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)

Question 17

oliguric phase of renal failure:

Answer 17

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)

Question 18

diuretic phase of renal failure:

Answer 18

sudden onset
UO UP
this client is in a fluid volume deficit
hypokalemia (decrease potassium)

Question 19

what are the 3 types of dialysis?

Answer 19

hemodialysis
peritoneal dialysis
continuous renal replacement therapy (CRRT)

Question 20

hemodialysis is done 3-4 times per week so the client has to watch what they ________ between treatments.

Answer 20

eat and drinks

Question 21

hemodialysis … the machine acts as ___.

Answer 21

glomerulus (filter)

Question 22

hemodialysis.. what should you monitor constantly ?

Answer 22

BP and electrolytes

unstable cardiovascular system cant tolerate hemodialysis.

Question 23

with hemodialysis, blood is being removed, cleansed and then returned at a rate of ____ml/min

Answer 23

300-800

Question 24

what is a vascular access?

what are the types of vascular access?

Answer 24

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.

Question 25

important: care of access -DO NOT USE _____. NO ____,____,____/

Answer 25

do not use for iv access NO blood pressures NO needle sticks NO constrictions (NO WATCH)

Question 26

assessment of access:

Answer 26

to make sure patent thrill- cat purring sensation (palpate) bruit- turbulent blood flow (auscultate) feel a thrill.. hear a bruit

Question 27

peritoneal dialysis

Answer 27

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!

Question 28

What is the "exchange" consisted on with peritoneal dialysis? what should the drainage look like?

Answer 28

when the bag is lowered and the fluid along with the toxins , etc, are drained. clear, straw-colored. cloudy= infection

Question 29

who gets peritoneal dialysis?

Answer 29

someone who cant tolerate hemodialysis or someone who chooses peritoneal.

Question 30

what are the 2 types of peritoneal dialysis?

Answer 30

continuous ambulatory peritoneal dialysis (CAPD) | continuous cycle peritoneal dialysis (CCPD)

Question 31

what is CAPD

Answer 31

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!

Question 32

what is CCPD

Answer 32

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

Question 33

what are the complications of peritoneal dialysis?

Answer 33

``` major complication is peritonitis (cloudy effluent 1st sign) constant sweet taste may get a hernia altered body image/sexuality anorexia low back pain ```

Question 34

what should the peritoneal dialysis increase in their diet?

Answer 34

fiber (have decreased peristalsis due to abdominal fluid) and protein (big holes in the peritoneum and lose protein with each exchange)

Question 35

what is CRRT

Answer 35

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.

Question 36

CRRT is performed on a client with:

Answer 36

a fragile cardiovascular status and acute renal failure

Question 37

kidney stones aka ___

Answer 37

urolithisasis, renal calculi

Question 38

s/s of kidney stones

Answer 38

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.

Question 39

tx for kidney stones

Answer 39

ketorolac(tordol), ondansetron(zofron),hydromorphone (dilaudid) maybe surgery strain urine extracorporeal shoch wave lithotripsy (ESWL)