Renal Flashcards
what is glomerulonephritis and what can cause it
inflammatory reaction in the glomerulus
antibodies lodge in the glomerulus; get scarring and decreased filtering
what is the main cause of glomerulonephritis
streptococcal infetions
why is sore throat a symptom of glomerulonephritis
because streptococcal infections
what do you retain in glomerulonephritis? what symptoms does this cause
toxins
malaise and headace
what lab values do you look for to rule in glomerulonephritis
increased BUN and creatinine
can’t excrete creatine and urea
what do you look for regarding urine and glomerulonephritis
decreased output
urine specific gravity up
sediment/protein/blood in urine –> smoky, rusty or cola color
what type of pain is associated with glomerulonephritis
flank pain
what happens to BP with glomerulonephritis
increases
what kind of edema is associated with glomerulonephritis
facial
is a patient in fluid overload or fluid deficit regarding glomeruloneprhtis
overload
how is fluid replacement determined with glomerulonephritis
24 hour fluid loss + 500 cc (to account for insensible losses; sweat, exhalation)
what diet should someone with glomerulonephritis have
decreased protein, decreased sodium (since fluid volume excess) and increased carbs (give us energy and prevent us from breaking down protein
do patients with glomerulonehrptisi need dialysis
sometimes; to remvoe fluid and toxins
how long may prtotein and blood remain in the urine
monthts
what should you teach patients with glomerularitis about
signs and symptoms of renal failure malaise HA anorexia N/V decreased UO weight gain
what is the patho of nephrotic syndrome
inflammatory response to glomerulus –> big holes form so protein leaks into urine –>client is now hypoalbuminermic so can’t hold onto fluid in the vascular space –>patient becomes edematous –> BP decreases so kidneys try to help by initiating RAS –
> aldosterone is produced and causes the retention of Na and H2O but no albumin to hold it in vascular space so it goes into the tissues = total body edema
what is total body edema called
anasarca
what are two problems associated with protien loss
blood clots –>dont have proteins that typically prevent clotting
high cholesterol and triglycerides –> liver makes more albumin causing increase in release of cholesterol and triglycerides
what are 5 causes of nephrotic syndrome
linked to bacterial or viral infections NSAIDs and heroin cancer and genetic predisposition systemic disesaes such as lupus and DM strep
4 signs and symptoms of nephrotic syndrome
proteinuria
hypoalbuminemia
edema (ansarca)
hyperlipidemia
what drugs are used in treatment of nephrotic syndrome (4)
ace inhibitors –> block aldosterone secretion
diuretics
prednisone –> shrink holes so protein can’t get out
lipid lowering drugs for hyperlipidemia
what kind of diet is important for clients with nephrotic syndrome
decreased sodium –> b/c they have ansarca
increased protein
do patients with neprhotic syndrome require dialysis
they can –> pull excess fluid
For all kidney problems what is the only one we want to increase protein
nephrotic syndrome
what does renal failure require
bilateral failure
what are the three causes of renal failure
pre-renal
intra renal
post renal
what is pre-renal failure
blood can't get to the kidneys hypotension decreased hr (arrhythmia) hypovolemic any form of shock
what is intra renal failure
damage inside kidney
what are two conditions associated with intra-renal failure
glomerulonephritis
nephrotic syndrome
what type of damage can contrast dyes cause
intra-renal failure
what type of renal failure does uncontrolled HTN and DM cause? why?
intra; severe vascular damage
what happens in post-renal failure
urine can’t get out of the kidneys
an 18 month old has surgery for bilateral ureteral stents after sx, the nurse reports a drop in UP what would be the priority nursing intervention?
- call the piramy health care provider
- turn from side to side
- irrigate
- reassess in 15 mins
ANSWER 1
2 is wrong because it is onlyl good with peritoneal dialysis
- is wrong because you don’t irrigate anything after sx
- is wrong because it delays treatement
what lab values indicate renal failure
incrased BUN and creatinine
anemia (not enough EPO)
what happens with urine specific gravity regarding RF
initially concentrated so high specific gravity
later fixed specific gravity as you lose ability to concentrate and dilute urine
What cardiac problems are associated with RF
HTN and HF
what GI symptoms are associated with RF? why?
anorexia
N/V
b/c you are retaining toxins
T of F itching is associated with RF
False - itching occurs b.c of uremic frost; requires good skin care
what type of acid base imbalance is associated with
metabolic acidosis –> not able to excrete excess acid and manage bicarb
what can happen with potassium in RF
hyperkalemia which can lead to arrhythmias
what happens to phosphorus in renal failure? calcium?
phosphorus goes up as it is retained –> serum calcium decreases as calcium is pulled from the bones
what are the 2 phases of acute renal failure
oliguric phase
diuretic phase
what happens int he oliguric phase of RF regarding UO, fluid volume and potassium
UO is decreased
client is in fluid volume excess
potassium is increased since urine is retained
what is the urine output for the oliguric phase of RF
100-400 mL/24 hours
what happens to UO in diuretic phase of RF? are they in fluid volume excess or deficit? what happens to potassium
UO increases
fluid deficit
decreased potassium
how often is hemodialysis done?
3-4 times a week
since hemodialysis is only done 3-4 times a week what must the client be careful with
what they eat and drink between dialysis
what medication is given during dialysis and why
anticoauglant; usually heparin to prevent clots forming in dialyzer
what is watched constantly during hemodialysis
electrolytes and BP
can all clients tolerate hemodialysis? why or why not?
no, unstable cardiovascular system can’t tolerate hemodialysis —> can show sings of shocks
what classes of medication should you hold for a client going to dialysis
BP medications (could tank their BP)
water soluble vitamins (would just be dialzyed otu
antibiotics because they will just be filtered out
what is the rate that blood is being removed and cleaned in hemodialysis
300-800 mL/min
what are the 3 types of vascular access for hemodialysis
AVF (arteriovenous fistula)
AVG (arteriovenous graft - synthetic graft to join the vessels
temporary access internal jugular or femoral vein is used
what is important to remember about vascular access sites for hemodialysis
DO NOT USE FOR IV ACCESS
- no BP
- no needle sticks
- no constriction –> no watches no purses
What are the the two things you assess with a AVF or AVG
bruit and thrill
Feel the thrill…hear the bruit
what is used as the filter in peritoneal dialysis
peritoneal membrane
what is the process of periotneal dialysis
2000-2500 mL of dialysate is waremed and infused into the peritoneal cavity –> remains for a while –> bag is lowered and fluid and toxins are drained out
what is the name given to the time taht fluid is spent in the peritoneal cavity
dwell time
why do we warm the dialysate fluid
cold promovtes vasoconfstriciton and decreases blood flow –> also cold causes cramps
what should the drainage look like in periotneal dialysis
clear and straw coloured
what color of peritoneal dialysis drainage indicates infection
cloudy
what clients typically get peritoneal dialsysis
those that can’t handle hemodialsysi
what intervention is done if not all the fluid comes out
turn the patient from side to side
what are the two types of peritoneal dialysis
CAPD (continuous ambulatory peritoneal dialysis)
CCPD (continuous cycle periotneal dialysis)
what type of client would be good for continuous ambulatory peritoneal dialsys
good energy level and desire to be active in their treatment
ability to learn and follow directions
how often is conintous ambulatory peritoneal dialysis done`
4 times a day 7 days a week
would a client with disc disease or arthritis be able to do continous ambulatory peritoneal dialysis? why?
no, becasue fluid causes pressure on back
could a client with a colostomy do continuous ambulatory peritoneal dialysis? why?
no, high risk for infection
how is continous cycle peritoneal dialsysis done
connect their peritoneal dialysis catheter at night and their exchange is done automatically while they sleep. disconnect in the AM
what is the major complication of peritoneal dialsisi
peritonitis
what taste do peritoneal dialysis patients usually report? why?
sweet –> dialysis fluid has a lot of glucose in it to make it hypertonic
do people on peritoneal dialysis usually eat a lot
no, more prone to anorexia
what do peritoneal dialsysi patients need to increase in their diet
fiber –> have decreased perisatlsis due to abdominal fluid
protein –> pts. ahve big holes in peritonema and lose protien with exach exchagne
what procedure for renal failure usually happens in ICU
continous renal replacement therapy (CRRT)
what happens in renal replacement therapy
never more than 80mL of blood out of the body at one time being filtered and therefore does not stress the cardiovascular system as much
what types of clients get continuous renal replacement therapy
patients with a fragile cardiovascular status and acute renal failure
what is usually found in urine of patients with kidney stones
WBCs
hematuria
what should you collect anytime you suspect a kidney stone
urine specimen to check for RBCs
what are 2 other terms for kidney stones
urolitiaisis, renal calculi
what is the pharmacological treatment for kidney stones
ondansetron
NSAIDs or opioid narcotics
how are kidney stones treated
potential SX
urine is strained
extracorporeal shock wave lithotripsy (ESWL) crush stones
