renal Flashcards
glomerulonephritis patho
acute can lead to chronic
inflamed glomerulus
antibodies lodge in the glomerulus causing scarring and decreased filtering
main cause: strep
glomerulonephritis s/s
flank pain (CVA tenderness) low urine output (oliguria) hematuria proteinuria periorbital edema high BP FVE high urine specific gravity azotemia (high BUN and Cr) malaise headache
glomerulonephritis treatment
treat cause i and o weights daily diuretics monitor BP restrict fluids (fluid replacement = 24 hour fluid loss + 500) balance activity w/ rest high carbs high Na low protein dialysis
glomerulonephritis teaching
diuresis begins in 1-3 weeks after onset blood and protein may stay in urine for months teach s/s of renal failure: malaise headache anorexia n/v low output weight gain
nephrotic syndrome patho
inflamed glomerulus big holes form (protein leaks out in urine) hypoalbuminemic (low albumin in blood) without albumin cannot hold on to fluid in vascular space fluid goes to tissues edematous blood in tissues so circulating blood volume goes down kidney wants to replace the lost fluid renin angiotensin system kicks in aldosterone produced retention of Na and H2O anasarca
problems associated with protein loss
blood clots (thombosis)
high cholesterol
high triglycerides
nephrotic syndrome causes
bacterial/viral infections
NSAIDs
cancer/genetic predisposition
systemic diseases (lupus, diabetes)
nephrotic syndrome s/s
proteinuria
hypoalbuminemia
edema (anasarca)
hyperlipidemia
nephrotic syndrome treatment
diuretics
ACE (blocks aldosterone secretion)
prednisone (decrease inflammation)
cyclophosphamide (decrease body’s immune response):
shrink holes so protein cannot get out
immunosuppressed
infection
****diet moderate protein 1-2g/kg/day malnourished fast low Na **** limit protein with kidney issues except with nephrotic syndrome
lipid lowering drugs for hyperlipidemia
anticoagulation for up to 6months
dialysis
nephrotic syndrome considerations
daily weights
intake and output
measure abdominal girth or extremity size
good skin care
acute kidney injury
sudden renal damage
want to reverse chronic renal failure
causes of AKI
pre renal failure: blood cannot get into kidneys hypotension low heart rate hypovolemic shock
intra renal failure: damage inside the kidney glomerulonephritis nephrotic syndrome malignant hypertension (uncontrolled HTN) diabetes acute tubular necrosis (damage to the filtering bodies of the kidneys) caused by hypotension, sepsis, drugs dyes used in tests drugs (aminoglycosides are nephrotoxic) NSAIDs
post-renal failure: urine cant get out of kidneys enlarged prostate kidney stone tumors ureteral obstruction edematous stoma (ileal conduit)
four phases of AKI
initiation (injury occurs)
oliguric (output less than 100ml/24 hours
diuretic (kidney recovering)
recovery (3-12months)
s/s of AKI
high BUN/Cr high specific gravity HTN (retaining fluid) HF (retaining fluid) anorexia n/v (retaining toxins) itching frost (uremic frost) retain phosphorous (low serum Ca--pulled from the bone) anemia (not enough erythropoietin) hyperkalemia metabolic acidosis (cannot filter or retain hydrogen or bicarb)
treatment of AKI
bedrest (decrease metabolism and cal needs)
TCDB
monitor i and o
daily weights
monitor VS
1kg = 1000ml of fluid
renal replacement therapy
support
oliguric phase ends 10-14days
diuretic phase (when output increases and fluid and electrolyte replacement)
recovery phase (based on increased protein and increased cals)
AKI meds
loop or osmotic diuretics IV glucose and insulin (hyperkalemia) IV calcium gluconate polystyrene sulfonate (decrease K) phosphate binding (prevent low Ca)
AKI nutrition
high carbs high fat low protein avoid high phosphate avoid high K (bananas, citrus, coffee)
renal replacement therapy
take over or replace kidney function
started when:
BUN/Cr cannot be decreased
FVE compromising heart and lungs
hyperkalemia and metabolic acidosis cannot be treated
hemodialysis
machine is the glomerulus (filter) 3-4x/week anticoags during treatment to prevent clots (bleeding precautions) assess fluid status before electrolytes and BP watched constantly
vascular access to heodialysis
blood is being removed, cleansed, returned at a rate of 300-800ml/min
access to large blood vessel because rapid blood flow is needed
AVF:
arteriovenous fistula in the forearm with an anastomosis between an artery and vein
AVG:
arteriovenous graft synthetic graft to join vessels
both require surgery
two needles inserted (one allows fluid to be pulled and one is to the machine)
arterial end of the access will remove the blood and return it through the low pressure venous end
for temporary access the internal jugular or femoral vein can be used
care of access
***** do not use IV access (drawing blood, administering meds, etc)
no BP
no needle sticks
no constriction (watch, purse, blouse)
assessment of access
ensure patency
thrill (cat purring sensation–palpate)
bruit (turbulent blood flow–auscultate)
feel the thrill
hear the bruit
continuous renal replacement therapy
done in ICU
continuous
never more than 80ml of blood out of the body at one time
used for AKI
peritoneal dialysis
peritoneal membrane as a filter
dialysate infused into the peritoneal cavity
takes about 10 minutes and remains for an amount of time
lower bag and fluid which are drained (exchanged)
warm fluid to promote vasodilation
drainage should be clear, straw colored
turn side to side if fluid does not come out
two types of peritoneal dialysis
CAPD:
done 4x/day 7 days a week
not for those with disc disease or arthritis (causes pressure on back)
not for those with colostomy (infection)
APD:
connect at night
exchange done while sleeping
disconnected in AM
complications of peritoneal dialysis
exit site infection
peritonitis
s/s
abdominal pain
cloudy effluent
dietary needs for peritoneal dialysis client
increase fiber
increase protein
kidney stones (nephrolithiasis) s/s
sharp pain n/v WBC in urine ****hematuria: get a urine asap and checked for RBC
kidney stone treatment
Ondansetron NSAIDs opioids alpha adrenergic blockers (relax smooth muscle of ureter) increase fibers (forever) surgery to remove stone extracorporeal shock wave lithotripsy (ESWL) to crush stone strain urine (send stone for analysis)
