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NCLEX > Renal > Flashcards

Renal Flashcards

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1
Q

what is glomerulonephritis and what can cause it

A

inflammatory reaction in the glomerulus

antibodies lodge in the glomerulus; get scarring and decreased filtering

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2
Q

what is the main cause of glomerulonephritis

A

streptococcal infetions

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3
Q

why is sore throat a symptom of glomerulonephritis

A

because streptococcal infections

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4
Q

what do you retain in glomerulonephritis? what symptoms does this cause

A

toxins

malaise and headace

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5
Q

what lab values do you look for to rule in glomerulonephritis

A

increased BUN and creatinine

can’t excrete creatine and urea

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6
Q

what do you look for regarding urine and glomerulonephritis

A

decreased output
urine specific gravity up
sediment/protein/blood in urine –> smoky, rusty or cola color

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7
Q

what type of pain is associated with glomerulonephritis

A

flank pain

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8
Q

what happens to BP with glomerulonephritis

A

increases

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9
Q

what kind of edema is associated with glomerulonephritis

A

facial

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10
Q

is a patient in fluid overload or fluid deficit regarding glomeruloneprhtis

A

overload

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11
Q

how is fluid replacement determined with glomerulonephritis

A

24 hour fluid loss + 500 cc (to account for insensible losses; sweat, exhalation)

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12
Q

what diet should someone with glomerulonephritis have

A

decreased protein, decreased sodium (since fluid volume excess) and increased carbs (give us energy and prevent us from breaking down protein

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13
Q

do patients with glomerulonehrptisi need dialysis

A

sometimes; to remvoe fluid and toxins

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14
Q

how long may prtotein and blood remain in the urine

A

monthts

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15
Q

what should you teach patients with glomerularitis about

A 
signs and symptoms of renal failure
malaise
HA
anorexia
N/V
decreased UO 
weight gain
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16
Q

what is the patho of nephrotic syndrome

A

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

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17
Q

what is total body edema called

A

anasarca

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18
Q

what are two problems associated with protien loss

A

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

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19
Q

what are 5 causes of nephrotic syndrome

A 
linked to 
bacterial or viral infections
NSAIDs and heroin 
cancer and genetic predisposition 
systemic disesaes such as lupus and DM
strep
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20
Q

4 signs and symptoms of nephrotic syndrome

A

proteinuria
hypoalbuminemia
edema (ansarca)
hyperlipidemia

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21
Q

what drugs are used in treatment of nephrotic syndrome (4)

A

ace inhibitors –> block aldosterone secretion
diuretics
prednisone –> shrink holes so protein can’t get out
lipid lowering drugs for hyperlipidemia

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22
Q

what kind of diet is important for clients with nephrotic syndrome

A

decreased sodium –> b/c they have ansarca

increased protein

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23
Q

do patients with neprhotic syndrome require dialysis

A

they can –> pull excess fluid

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24
Q

For all kidney problems what is the only one we want to increase protein

A

nephrotic syndrome

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25
Q

what does renal failure require

A

bilateral failure

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26
Q

what are the three causes of renal failure

A

pre-renal
intra renal
post renal

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27
Q

what is pre-renal failure

A 
blood can't get to the kidneys
hypotension
decreased hr (arrhythmia)
hypovolemic
any form of shock
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28
Q

what is intra renal failure

A

damage inside kidney

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29
Q

what are two conditions associated with intra-renal failure

A

glomerulonephritis

nephrotic syndrome

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30
Q

what type of damage can contrast dyes cause

A

intra-renal failure

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31
Q

what type of renal failure does uncontrolled HTN and DM cause? why?

A

intra; severe vascular damage

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32
Q

what happens in post-renal failure

A

urine can’t get out of the kidneys

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33
Q

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?

  1. call the piramy health care provider
  2. turn from side to side
  3. irrigate
  4. reassess in 15 mins
A

ANSWER 1

2 is wrong because it is onlyl good with peritoneal dialysis

  1. is wrong because you don’t irrigate anything after sx
  2. is wrong because it delays treatement
34
Q

what lab values indicate renal failure

A

incrased BUN and creatinine

anemia (not enough EPO)

35
Q

what happens with urine specific gravity regarding RF

A

initially concentrated so high specific gravity

later fixed specific gravity as you lose ability to concentrate and dilute urine

36
Q

What cardiac problems are associated with RF

A

HTN and HF

37
Q

what GI symptoms are associated with RF? why?

A

anorexia
N/V
b/c you are retaining toxins

38
Q

T of F itching is associated with RF

A

False - itching occurs b.c of uremic frost; requires good skin care

39
Q

what type of acid base imbalance is associated with

A

metabolic acidosis –> not able to excrete excess acid and manage bicarb

40
Q

what can happen with potassium in RF

A

hyperkalemia which can lead to arrhythmias

41
Q

what happens to phosphorus in renal failure? calcium?

A

phosphorus goes up as it is retained –> serum calcium decreases as calcium is pulled from the bones

42
Q

what are the 2 phases of acute renal failure

A

oliguric phase

diuretic phase

43
Q

what happens int he oliguric phase of RF regarding UO, fluid volume and potassium

A

UO is decreased
client is in fluid volume excess
potassium is increased since urine is retained

44
Q

what is the urine output for the oliguric phase of RF

A

100-400 mL/24 hours

45
Q

what happens to UO in diuretic phase of RF? are they in fluid volume excess or deficit? what happens to potassium

A

UO increases
fluid deficit
decreased potassium

46
Q

how often is hemodialysis done?

A

3-4 times a week

47
Q

since hemodialysis is only done 3-4 times a week what must the client be careful with

A

what they eat and drink between dialysis

48
Q

what medication is given during dialysis and why

A

anticoauglant; usually heparin to prevent clots forming in dialyzer

49
Q

what is watched constantly during hemodialysis

A

electrolytes and BP

50
Q

can all clients tolerate hemodialysis? why or why not?

A

no, unstable cardiovascular system can’t tolerate hemodialysis —> can show sings of shocks

51
Q

what classes of medication should you hold for a client going to dialysis

A

BP medications (could tank their BP)
water soluble vitamins (would just be dialzyed otu
antibiotics because they will just be filtered out

52
Q

what is the rate that blood is being removed and cleaned in hemodialysis

A

300-800 mL/min

53
Q

what are the 3 types of vascular access for hemodialysis

A

AVF (arteriovenous fistula)
AVG (arteriovenous graft - synthetic graft to join the vessels
temporary access internal jugular or femoral vein is used

54
Q

what is important to remember about vascular access sites for hemodialysis

A

DO NOT USE FOR IV ACCESS

  • no BP
  • no needle sticks
  • no constriction –> no watches no purses
55
Q

What are the the two things you assess with a AVF or AVG

A

bruit and thrill

Feel the thrill…hear the bruit

56
Q

what is used as the filter in peritoneal dialysis

A

peritoneal membrane

57
Q

what is the process of periotneal dialysis

A

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

58
Q

what is the name given to the time taht fluid is spent in the peritoneal cavity

A

dwell time

59
Q

why do we warm the dialysate fluid

A

cold promovtes vasoconfstriciton and decreases blood flow –> also cold causes cramps

60
Q

what should the drainage look like in periotneal dialysis

A

clear and straw coloured

61
Q

what color of peritoneal dialysis drainage indicates infection

A

cloudy

62
Q

what clients typically get peritoneal dialsysis

A

those that can’t handle hemodialsysi

63
Q

what intervention is done if not all the fluid comes out

A

turn the patient from side to side

64
Q

what are the two types of peritoneal dialysis

A

CAPD (continuous ambulatory peritoneal dialysis)

CCPD (continuous cycle periotneal dialysis)

65
Q

what type of client would be good for continuous ambulatory peritoneal dialsys

A

good energy level and desire to be active in their treatment

ability to learn and follow directions

66
Q

how often is conintous ambulatory peritoneal dialysis done`

A

4 times a day 7 days a week

67
Q

would a client with disc disease or arthritis be able to do continous ambulatory peritoneal dialysis? why?

A

no, becasue fluid causes pressure on back

68
Q

could a client with a colostomy do continuous ambulatory peritoneal dialysis? why?

A

no, high risk for infection

69
Q

how is continous cycle peritoneal dialsysis done

A

connect their peritoneal dialysis catheter at night and their exchange is done automatically while they sleep. disconnect in the AM

70
Q

what is the major complication of peritoneal dialsisi

A

peritonitis

71
Q

what taste do peritoneal dialysis patients usually report? why?

A

sweet –> dialysis fluid has a lot of glucose in it to make it hypertonic

72
Q

do people on peritoneal dialysis usually eat a lot

A

no, more prone to anorexia

73
Q

what do peritoneal dialsysi patients need to increase in their diet

A

fiber –> have decreased perisatlsis due to abdominal fluid

protein –> pts. ahve big holes in peritonema and lose protien with exach exchagne

74
Q

what procedure for renal failure usually happens in ICU

A

continous renal replacement therapy (CRRT)

75
Q

what happens in renal replacement therapy

A

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

76
Q

what types of clients get continuous renal replacement therapy

A

patients with a fragile cardiovascular status and acute renal failure

77
Q

what is usually found in urine of patients with kidney stones

A

WBCs

hematuria

78
Q

what should you collect anytime you suspect a kidney stone

A

urine specimen to check for RBCs

79
Q

what are 2 other terms for kidney stones

A

urolitiaisis, renal calculi

80
Q

what is the pharmacological treatment for kidney stones

A

ondansetron

NSAIDs or opioid narcotics

81
Q

how are kidney stones treated

A

potential SX
urine is strained
extracorporeal shock wave lithotripsy (ESWL) crush stones

NCLEX (10 decks)

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