Renal Flashcards
What is the function of the the glomerulus int he kidneys?
It filters
What happens during glomerulonephritis?
When is it developed?
The patient has a systemic infection and about 2-3 weeks later, they develop it.
Antibodies are produced in response to the infection and they lodge within the glomerulus causing scarring and decreased ability to filter properly
What is the main cause of glomerulonephritis?
Make sure we tell these patients what? Why?
Strep
Make sure to tell them to take all of their antibiotics or they are at risk for heart and kidney damage
How does strep affect the heart?
The bacteria attack the valves that essentially prevent back flow
NCLEX
Anytime there is is some sort of valvular disease, think what?
Heart failure d/t backflow!
In general, what is happening with the glomerulonephritis patient?
They are retaining fluid and toxins
Kidneys are not working correctly
S/S of retaining toxins
Malaise and headache
S/S glomerulonephritis
How will it start? Build up of toxins causes what? BUN and Creatinine \_\_\_\_ What will the urine contain? Why does the urine have this?
GLOMERULONEPHRITIS
Sore throat Malaise and headache ^BUN, ^Creatinine - can't excrete PROTEIN, blood, sediment There is damage / holes to the glomerulus so protein are able to leak out
S/S GLOMERULONEPHRITIS
Where is pain? Where is edema? Urine output \_\_\_\_ BP \_\_\_\_ Urine specific gravity \_\_\_\_ Fluid volume \_\_\_\_\_\_\_
GLOMERULONEPHRITIS
Flank pain - costavertebral angle tenderness
Facial edema
Decreased urine output
^BP
Urine SG increased (dilute blood d/t fluid retention)
Fluid volume excess
What does tapping over the kidneys tell the doctor?
If there is infection within them
May do if a patient has a UTI to see if is traveled to the kidneys
How do we treat glomerulonephritis?
What are we going to monitor?
How should their diet be?
Antibiotics
Dialysis
Balance activity and rest to conserve energy and avoid breaking down protein for energy
MONITOR
I/O, daily weight
Blood pressure
DIET
Decreased Protein
Decreased Sodium
INCREASE Carbs - for energy
How is fluid replacement calculated in glumerulonephritis?
Replacement = 24 hours fluid loss + 500 mL
*500 is for sensible fluid loss
In glomerulonephritis, when does diuresis begin?
What will stay in their urine for months?
What do we need to teach them?
1-3 weeks after onset
Blood and protein
S/S Renal Failure (HA, malaise, N/V/anorexia, decreased UO, weight gain)
When people have kidney problems, what it the general diet we want to follow? What is the only exception?
Low protein
Nephrite syndrome is the only exception!
What does protein do to the BUN?
Increases it
Major differences between Glomerulonephritis and Nephritic syndrome
G: lose protein, facial edema
NS: Lose LOADS of protein, total body edema, can be caused by more than just bacteria or strep
How does albumin work?
It holds onto fluid in the vascular space
How does the body develop Nephrotic Syndrome?
Ending result?
- Inflammation in glomerulus
- Protein leaks out A LOT
- Lose albumin in the blood
- Fluid fills up into the tissues
- 3rd spacing causes a decrease in circulating volume
- Kidneys sense this and RAAS signals aldosterone tot produce
- Aldosterone causes retention of Na and Water
- More fluid in the tissues occurs because there is no albumins to keep the Na and water in the vascular space
- Anasarca (generalized edema)
What are the complications associated with protein loss?
Blood clotting - They are losing proteins that usually keep the blood from clotting
Increased release of cholesterol and triglycerides due to the increase in albumin
What are causes of Nephrotic Syndrome?
Do we usually know the cause?
Usually idiopathic - don’t know the cause
Bacterial OR VIRAL infections NSAIDS Cancer and genes About 1/3 have a systemic disease (Ex: Lupus, DM) Strep
Basic S/S of Nephrotic Syndrome
Proteinuria
Low albumin in the blood
Anasarca
Hyperlipidemia - produced t replenish protein loss
How do we treat Nephrotic Syndrome—
Meds?
Diet?
Diuretics Prednisone - shrink holes so protein doesn't leak out ACE I - block aldosterone secretion Statins Anticoagulation for 6 months
Low Na, INCREASED PROTEIN
Dialysis too pull off excess fluids
How does giving Lasix and Albumin help the Nephrotic Syndrome patient?
Decrease fluid retention and keep the fluid in the vascular space and out of the tissue
*Risk for fluid volume excess when giving the albumin, so give Furosemide with it
What is Pre-Renal failure?
What are some causes?
Blood can’t get to the kidneys
Hypotension
Bradycardia - rhythm change
Hypovolemic
ANY form of shock!
What is Intrarenal failure?
Some causes?
Damage has occur INSIDE the kidneys
Glomerulonephritis, Nephritic Syndrome Dyes (heart cath, CT) Medication (Mycin drugs, Metformin) Uncontrolled HTN (malignant) DM - vascular damage
What is Post-renal failure?
Some causes?
Urine can’t get out of the kidneys (
Enlarged prostate Kidney Stone Tumors Ureter obstruction Edematous stoma
*There is back flow occurring
S/S Renal Failure
BUN and creatinine ___
RBC ___
Specific gravity ____
How can we check this?
BUN and Creatinine ^
RBC decreases –> Anemia
SG initially increased but it make become fixed and lose the ability to concentrate/dilute urine
Do a fluid challenge - bolus with 250mL NS and see if urine becomes diluted
*SG depends on UO!
What does renal failure fluid retention cause?
HTN and HF
Because we are retaining toxins in renal failure, what will be the S/S?
Anorexia, N/V
Renal failure skin
Make sure to do what?
Itching frost (Uremic frost) D/t a lot of urea that makes it to the skin
Good skin care
What Acid/Base and E imbalances are there in Renal Failure?
Increased K –> arrhythmias
Retain phosphorus causing decreased serum Ca leading to osteoporosis
Metabolic acidosis
What are the 2 phases of ACUTE Renal failure?
Oliguric phase
Diuretic phase
What happens during the OLIGURIC phase of Acute Renal Failure?
UO \_\_\_\_ How much output in 24/hr? Fluid volume \_\_\_\_\_ K \_\_\_\_\_ How long does this last?
Decreased UO 100-400 ml/hr --> Fixed SG Fluid volume excess*** Increased potassium*** 1-3 weeks THEN diuretic phase
Any time urine output has decreased or stopped, what is going to be retained?
POTASSIUM - aren’t getting rid of it and retaining
What happens in the DIURETIC phase of Acute Renal Failure?
Onset? UO \_\_\_\_\_ How much in 24 hours? Fluid volume \_\_\_\_\_ K \_\_\_\_\_
UO increases
Could excrete as much as 10L
Fluid volume deficit –> Shock
K DECREASE - d/t excretion
When educating a patient on acute renal failure recovery, what do you tell them?
What to monitor?
Recovery may take as long as 12 months
Keep their appointments
Monitor their BP and labs
Prevent chronic renal failure!
Hemodialysis - the machine acts as our what?
Glomerulus
How often if HD done?
What to tell the patient between treatments?
3-4 times a week
Watch what they eat and drink
What is given during HD?
What is watched constantly?
Anticoagulant - Usually Heparin
Electrolytes and BP
How long does Heparin stay in the body?
4-6 hours so we need to watch invasive procedures after dialysis and bleeding signs
What is the lifestyle like of HD patient?
What are they at risk for?
Confining, tedious
Risk for depression/suicide
What patients cannot tolerate HD?
Patients with unstable CV systems
These patients can’t handle the volume changes
What medications need to be held for a patient going to dialysis?
ACE I - don’t want VD
NTG - don’t want VD
Water soluble vitamines - just filtered out
Ampicillin - filtered out
- Kidneys don’t filter out Pepcid
What must a HD patient have?
What is this?
Vascular access - A site where they have access to a large blood vessel because very rapid flow is essential
How fast is the fluid removed, filtered, and returned back to the body?
300-800 ml/min
What are the 2 types of HD access?
How are these inserted?
When can they be used?
AVF (arteriovenous fistula) - anastomosis between artery and vein
AVG (arteriovenous graft) - synthetic graft to join the vessels
Both require surgery
Site takes weeks to mature and be ready for vent puncture
How are the HD sites accessed?
Which end does what?
2 needles are inserted (1 pulls fluid out, 1 puts it back in)
The ARTERIAL end removes the blood and the VENOUS end will return it through low pressure
What access sites are often used for temporary HD?
Need surgery for these?
IJ or femoral vein
No
Caution to the HD arm?
LIMB ALERT! No pokes, BP, constriction, so purse, no watch
What to assess in a HD access site?
Patency
Thrill - feel
Bruit - hear
What is the filter during peritoneal dialysis?
Peritoneal membrane
How is the dialysate used in PD?
It’s warmed and infused into the peritoneal cavity by gravity via a Tenckhoff catheter
How much fluid is dialyzes in PD in a given amount of time?
What is the term for how long the fluid is in the peritoneal cavity?
2000-2500 mL fills the cavity (takes about 10 minutes) and stays in the cavity for a prescribed amount of time (dwell time)
How si the PD fluid drained?
How long does this take?
What is this called?
The bag is lowered along with the filtered out substances
15-30 minutes
Exchange
Why is PD fluid warmed?
Promotes VD and more blood flow
What should PD drainage look like?
CLEAR or straw colored!
Cloudy = INFECTION
What type of patient gets PD?
Someone who can’t tolerate HD or just choses this way
What do you if all of the fluid that went in, doesn’t come out in PD?
Turn side to side
Reposition
How much fluid do we want to come out in PD?
More than what we put in
What are the 2 types of PD?
CAPD (Continuous ambulatory PD)
CCPD (Continuous Cycle PD)
How and how often is CAPD done?
Done manually 4x a day, 7 days/week
Who can’t do CAPD?
Someone who doesn’t have the energy or desire to be so involved in treatment
Has disc disease or arthritis - too much pressure on the back and too much pain
Patient with a colostomy - high risk for infection because of sterile access 4x a day next to a dirty stoma
How does CCPD work?
PD catheter is connected at night and the filtration is done while they sleep
*More freedom
Complications of PD
Most common? Taste? Might get what? Weight? Pain?
Peritonitis! - cloudy Constant sweet taste d/t dialysate Might get a hernia Anorexia Back Pain Altered body image/sexuality
Diet of PD patient
Increased FIBER - they have decreased peristalsis d/t abdominal fluid
Increased PROTIN - holes in peritoneum cause protein loss with each exchange
Where is CRRT usually done?
For what patients?
ICU performed on a patient with a fragile CV status and Acute Renal failure
Why is CRRT not stressful to the heart?
Never more than 80mL are being filtered at one time
Another name for kidney stones
Urolithiasis (ureter), renal calculi
S/S kidney stones
What’s in the urine?
Pain –> N/V
WBC, BLOOD!
Anytime you suspect kidney stones, what do you do?
UA asap and have it checked for RBC
Treatment of kidney stones
May do what to the urine?
What kind of surgery could be done?
Pain meds!!
Anti-emetic
Increase fluids FOREVER! prevent future stones!
Strain it
Extracorpeal shock wave lithotripsy
