Renal Flashcards
inflammatory reaction in the glomerulus
glomerulonephritis
main cause of glomerulonephritis
strep infection
sx of glomerulonephritis
sore throat malaise/HA BUN/CR sediment/protein/blood in urine flank pain increased BP facial edema decreased UO increased urine specific gravity
with glomerulonephritis the patient is going into fluid volume _____
excess
treatment for glomerulonephritis
get rid of the strep
monitor BP
fluid replacement
how is fluid replacement managed for glomerulonephritis
24 hr fluid loss + 500 ml
protein in the urine only happens when _____ is damaged
kidney
dietary needs for glomerulonephritis
low protein
low Na+
increased carbs!
____ and _____ may stay in the urine for months after glomerulonephritis
blood and protein
teach the glomerulonephritis patient sx of renal failure….which are?
malaise HA anorexia N/V decreased output weight gain
think what about nephrotic syndrome
loosing lots of proteins
an inflammatory response in the gloemerulus which makes big holes in the glomerulus so protein starts leaking out in the urine (proteinuria)
nephrotic syndrome
total body edema associated with nephrotic syndrome
anasarca
problems associated with protein loss
blood clots
increased triglycerides and cholestrol
causes of nephrotic syndrome
idiopathic
bacterial or viral infections NSAIDs cancer and genetic predisposition systemic diseases such as lupus or diabetes strep
sx of nephrotic syndrome
proteinuria
hypoalbuminemia
edema
hyperlipidemia
treatment for nephrotic syndrome
diuretics ACE inhibitors prednisone lipid lowering drugs dialysis anticoagulation
diet for nephrotic syndrome
decreased Na+
increased protein
the rule is to limit protein with kidney problems except with ____ _____
nephrotic syndrome
renal failure requires _____ failure
bilateral
in pre-renal failure _____ can’t get to the kidneys
blood
causes of pre-renal failure
hypotension
decreased HR
hypovolemic
any form of shock
intra-renal failure is when damage has occurred _____ the kidney
inside
causes of intra-renal
glomerulonephritis nephrotic syndrome dyes drugs malignant HTN DM
in post-renal failure is when ____ can’t get out of the kidneys
urine
causes of post-renal failure
enlarged prostate kidney stone tumors ureteral obstruction edematous stoma
sx of renal failure
elevated BUN/CR increased specific gravity anemia HTN HF anorexia, N/V uremic frost
_____ could cause lethal arrhythmias with renal failure
hyperkalemia
which acid base imbalance is renal failure in?
metabolic acidosis
in renal failure they retain ____ and serum ____ goes down
phosphorus
calcium
two phases of acute renal failure
oliguric phase
diuretic phase
during the oliguric phase what happened to UO?
decreased
the UO in the oliguric phase is usually what in 24 hrs
100-400 ml/24 hrs
in the oliguric phase the client is in fluid volume ____
excess
what happens to the K+ in oliguric phase
increased
UO with diuretic phase of acute renal failure
increased (10L/day)
the client in the diuretic phase is in fluid volume ____
deficit
what will happen with the K+ in the diuretic phase of acute renal failure
decrease
the dialysis machine is like the ______ (filters)
glomerulus
hemodialysis is done __-__ times a week
3-4
to prevent the blood clots from forming in hemodialysis, the client is giving an _____ during dialysis
anticoagulant
what 2 things are watched constantly with hemodialysis
electrolytes and BP
which meds should you hold for a client going to hemodialysis
lisinopril
nitro
water soluble vitamins
ampicillin
(they can get famotidine bc its not filtered by the kidneys)
with hemodialysis, blood is being removed, cleansed, and then returned at a rate of ___-___ ml/min
300-800
the site where they have access to a large blood vessel because very rapid blood flow is essential for hemodialysis
valvular access
anastomosis between an artery and a vein
arteriovenous fistula (AVF)
a synthetic graft to join the vessels
arteriovenous graft (AVG)
when a client has an alternate vascular access, what is the associated nursing care for that extremity?
No BP
No needle sticks
No constriction
cat purring sensation that you can palpate over the area
thrill
turbulent blood flow you can auscultate over the area
bruit
in peritoneal dialysis they use the peritoneal membrane as a ____
filter
_____ is warmed and infused into the peritoneal cavity by gravity via Tenckhoff catheter
dialysate
how long does it take to infuse dialysate into the peritoneal cavity
10 minutes
the time the dialysate stays into the peritoneal cavity
dwell time
why do we warm the dialystate?
promotes vasodilation
what should the drainage look like from the peritoneum
clear, straw-colored
if the peritonal fluid is cloudy
infection
what if all the fluid doesn’t come out with peritoneal dialysis?
reposition client
two types of peritoneal dialysis
CAPD (continuous ambulatory peritoneal dialysis)
CCPD (continuous cycle peritoneal dialysis)
continuous ambulatory peritoneal dialysis must be done how often?
4 times a day, 7 times a week
who can’t do CAPD (continuous ambulatory peritoneal dialysis)
disc disease
arthritis
colostomy
peritoneal dialysis catheter to a cycler at night and their exchange is done automatically while they sleep.
CCPD (continuous cycle peritoneal dialysis)
major complications of peritoneal dialysis
constant sweet taste
hernias
anorexia
low back pain
most serious complication with peritoneal dialysis
peritonitis
1st sign of peritonitis
cloudy effluent 1st sign
increase what in the diet with peritoneal dialysis?
fiber and protein
continuous renal replacement therapy (CRRT) is typically done in the ____ setting and is continuous so that the client doesn’t have drastic fluid shifts
ICU
with CRRT there is never more than ____ mL of blood out of the body at one time being filtered and therefore does not stress the cardiovascular system as much
80 mls
CRRT is performed on a client with :
fragile cardiovascular status
acute renal failure
other names for kidney stones
urolithiasis
renal calculi
sx of kidney stones
pain
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 ____ ____ immediatley
pain medication
treatment for kidney stones
ondanestron NSAIDs opioids increase fluids maybe surgery strain urine
