Renal Flashcards
What is Glomerulonephritis
Inflammation in the glomerulus that causes scarring and decreases filtering abilities. Mainly caused by strep A.
What are the s/s of glomerulonephritis?
Flank pain Costovertebral Decreased U/O Hematuria Proteinuria Periorbital edema BP increased FVE -> Urine Specific Gravity Increased Azotemia Malaise and headache why?
What is the txt for glomerulonephritis
Get rid of the strep
I/O and daily weight checks
Diuretics
Monitor BP
Restrict Fluids - fluid replacement 24 loss + 500 ml
Increase the Carbs, decrease the sodium and protein
Dialysis
Activity and Rest
What do you teach with someone with glomerulenephritis?
Diuresis begins 1-3 weeks of onset
Blood and urine may continue for months
Teach them signs of renal failure and notify when it happens:
Nausea, vomiting, anorexia, weight gain, malaise, headache, decreased output
What is Nephrotic syndrome?
Inflammation in the glomerulus in which big holes allowing proteinuria = hypoalbumin, as a result fluid will go into the tissue the person becomes edematous and blood volume decreases, aldosterone is activated to retain sodium and water but since no protein/ albumin it cant be held in vascular space resulting in tissue and edema. (anasarca)
What are the problems with protein loss (Nephoritic syndrome)?
Blood clots , thrombosis
High chloest and trigly, liver will try to compensate making increase release of this.
Causes of Nephritic syndrome
Idiopathic: Bacteria viral infections NSAIDS Cancer and genetics Systemic disease such as lupus or diabetes
S/s of nephrotic syndrome
Massive proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia
What is the treatment for nephrotic syndrome
Diuretics
Ace inhibitors to block aldosterone secretion
Prednisone why?
Cyclophosmide it will decrease body’s immune response, shrink holes, immunosuppressed
Lipid lowering drugs
Anticoagulants for up to 6 months , to prevent thrombosis
Dialysis
Major complication of nephrotic syndrome is infection
Diet
Increase protein moderately 1-2 mg/day
Client is malnourished fast, so sm. frequent meals
Decrease sodium , so they dont retain fluid
What are your nursing considerations for nephrotic syndrome
Daily weight
I/o
Measure abdominal girth and extremity size
Good skin care
What is acute kidney injury ?
Sudden renal damage
Causes of AKI pre-renal failure
Blood can't get into the kidneys Hypotension HR decreased Hypovolemic Shock
Causes of AKI, intra-renal
Damage inside kidney
Glomerulonephritis and Nephrotic Syndrome
Malignant Hypertension, uncontrolled diabetes
Acute Tubular Necrosis
Hypotension, sepsis, drugs that damage kidneys
Dyes
Drugs - mycin’s
NSAIDS
Causes of AKI, post-renal
Urine cant get out of the kidneys Enlarged Prostate Kidney stone Tumor Ureteral Obstruction Edematous stoma (ileal conduit)
What are the four phases of AKI?
Initiation phase
oliguric phase (output is <100ml / 24hrs)
Diurectic phase
Recovery phase
** last two**
S/s of AKI?
Creatinine and BUN increased Specific Gravity increased, BUT may be fixed specific gravity HTN AND HF Anorexia, Nausea, Vomitting Uremic frost Retain phosphorus* Anemia* Hyperkal* metabolic acidosis
What are the nursing meds and treatmens for AKI?
Bedrest * meta and caloric TCBD Monitor i/o * Daily weights VS
Meds: Diuretics* IV glucose, insulin, calcium gluconate* Kayexalate to decrease potassium Phosphate binding* Give IV meds in low
Provide client and family support
Oliguric phase ends 10-14 days
What is the nutrition for AKI?
Increase carbs and fats
low protein diet
avoid foods and fluids high in phosphate
Avoid foods high in potassium
How to prevent infection in AKI
Good skincare Aseptic Technique Prevent pressure ulcer mouth care no catheter May need replacement therapy
Diuretic phase in AKI
When Diuretic phase begins watch for:
Output increase
Fluid and Electrolyte
Recovery Phase in AKI
It is the last phase, protein and calories increased
activity as tolerated
What is replacement therapy?
Takes over or replace kidney function. It starts when
Bun and creat cannot be decreased
FVE is compromising heart and lungs
Hyperkal and met acidosis cannot be treated
What is hemodialysis?
Filters glomerulus
3-4 times a week - eat and drink in between treatments must be monitored
Monitor suicidal
What meds and nrsg consideration for Hemodialysis?
Anticoagulants to prevent clots
Fluid status
Electrolytes and BP
