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Adult Nursing Exam 5 > Renal Disorder Management > Flashcards

Renal Disorder Management Flashcards

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1
Q

What issues may arise if there are problems with the kidneys?

A

Fluid volume shifts
Protein deficits
Electrolyte Imbalances
Metabolic acidosis

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2
Q

Why does metabolic acidosis occur? What electrolyte imbalance is most likely to occur?

A

The kidneys can’t excrete the acidic H+ and cannot reabsorb bicarb leading to acidosis.
Hyperkalemia occurs with metabolic acidosis. So pay attention to cardiac issues and smooth muscle contractions.

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3
Q

Main categories or statuses of renal failure?

A

Acute Kidney Injury and End stage renal disease.

They are different but on the same spectrum.

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4
Q

What are chronic kidney diseases?

A

They are what they sound like. Kidney diseases that go on for a long time. It is an umbrella term. And yes, they can cause renal failure not managed properly.

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5
Q

Acute Nephritic Syndrome is what?

A

This is an umbrella term again.

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6
Q

Most common acute nephritic syndrome?

How many types are there?

A

Glomerulonephritis.

Can be acute or chronic.

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7
Q

What is glomerulonephritis?

What can happen if left unmanaged?

A

Inflammation of the glomeruli which leads to filtration issues.

If not treated it can make things a lot worse for the kidneys due to scar tissue

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8
Q

What are common infections that can cause glomerulonephritis?

A

Strep
Bacterial endocarditis
Hep B & C
HIV

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9
Q

Autoimmune disease that can cause glomerulonephritis?

A

Lupus

Goodpasture’s

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10
Q

Two very manageable diseases that cause glomerulonephritis?

A

Hypertension
Diabetes
(due to scarring)

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11
Q

What is vasculitis? Can it cause glomerulonephritis?

A

It is inflammation of blood vessels.

It too can cause glomerulonephritis.

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12
Q

How to describe symptoms of acute glomerulonephritis?

A

flu-like: lethargic and malaise

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13
Q

What will urine output appear as in the acute stages?

A

Low urine output with hematuria at this stage.

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14
Q

What will the BUN and creatinine levels be like in acute stage?

A

Azotemia or excess of these in the blood

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15
Q

Symptoms like edema, hypertension, headache, and vision problems are common for which type of glomerulonephritis?

A

They are actually found in both types. Acute and Chronic.

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16
Q

What labs are checked for glomerulonephritis?

What diagnostics?

A

Any that has to do with kidneys.

Protein
Electrolytes
ABGS
BUN & Creatinine
WBC
H&H
GFR
Throat culture (due to strep)

Basic diagnostics are used and Biopsy

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17
Q

Why do we use diuretics when treating glomerulonephritis?

A

Because diuretics allows us to control fluid balance and helps control electrolytes.
Just need to pick the right diuretic. Probably not going to pick a potassium sparring tho.

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18
Q

Why is it so important to monitor nutrition with a glomerulonephritis patient?
(or really any pt with kidney issues)

A

We don’t want a build up of compounds that can lead to toxicity.
We also don’t want to contribute to the illness that caused the patients status.

Be careful about the protein you give.
Be careful about salt.
Know which tests the patient has ordered and anticipate that they may need to be NPO

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19
Q

What medications might you give for glomerulonephritis?

A

These meds don’t treat the glomerulonephritis. But they help precipitant factors which is key

Antibiotics
Immunosuprresants
Corticosteroids (anti-inflammatory properties)

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20
Q

Education for the glomerulonephritis patient?

A

Need to educate on whichever condition landed them their current status.
HTN, Diabetes, strep, HIV, HEP, Lupus, Good pasture’s, etc

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21
Q

What is the main cause of Chronic glomerulonephritis?

A

Repeat episodes of acute glomerulonephritis

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22
Q

Why does Hypertensive nephrosclerosis lead to chronic glomerulonephritis?

A

If someone doesn’t control their HTN, nephrosclerosis can develop. And with that, glomerulonephritis can settle in.

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23
Q

Hyperlipidemia is associated with acute glomerulonephritis. T/F?

A

False. Hyperlipidemia is associated with chronic.

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24
Q

How do chronic glomerulonephritis symptoms present?

A

The symptoms can go unnoticed for years.

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25
Q

In chronic glomerulonephritis, what will the patient’s physical appearance look like?

A

They will lose weight and muscle, so thin.

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26
Q

Glomerular damage can cause chronic glomerulonephritis. What are some things that cause the damage?

A

Hypertension
Sclerosis
etc

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27
Q

What else happens in urination once someone has chronic glomerulonephritis?

A

Nocturia or peeing urge at night

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28
Q

Chronic glomerulonephritis can progress to Chronic Kidney Disease. Symptoms that overlap or occur?

A 
edema
anemia
dry skin
night cramps
mental status change
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29
Q

What labs do we do for chronic glomerulonephritis?

A

All the same ones as acute!

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30
Q

Chronic glomerulonephritis trend for potassium, phosphorus, and hydrogen

A

Increased.

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31
Q

Chronic glomerulonephritis trend for calcium, albumin, and bicarb

A

Decreased.

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32
Q

What will H&H results show?

A

Decreased which is related to anemia

33
Q

Management goals that also apply with chronic glomerulonephritis?

What might the patient have to do if the kidneys are really shot?

A 
Control 
HTN
Fluids
Electrolytes
Nutrition
Infections

Patient may have to go on dialysis.

34
Q

How to prevent Acute/Chronic glomerulonephritis?

Treat
Control
Avoid
Change

A

Treat this:
strep
impetigo

Control these:
HTN
Diabetes
Lupus
Good pastures

Avoid these:
HIV
Hep

Change these: 
salt intake
protein 
potassium
obesity
35
Q

What is Nephrotic Syndrome?

A

Glomerular disease that involves damage to glomerulus blood vessels. Not inflammation and not apart of acute nephritic syndrome

36
Q

Patho of Nephrotic syndrome?

A

Due to damage of vessels proteins escape into the urine. Edema occurs due to the lack of albumin and protein for oncotic pressure.

37
Q

Causes of nephrotic syndrome (5)

A

Chronic glomerulonephritis due to its ability to progress.

Diabetic Neuropathy which is also a cause for ^.

Glomerulsclerosis

Lupus

Multiple myeloma

38
Q

Risk factors of nephrotic syndrome

A

Diabetes
HIV
Hep
NSAIDS - due to toxicity with OD. Think of ibuprofen.

so basically the same as any kidney issue but with the addition of NSAIDS

39
Q

Nephrotic Syndrome symptoms

A

Edema
Ascites
Weight gain

Foamy urine
Fatigue

40
Q

Circumstances of nephrotic syndrome edema?

How to treat edema and ascites?

A

Periorbital or eye edema
Dependent edema or when legs are low.

Make sure to do skin care. You can also raise legs but make sure that doesn’t cause any issues. We can always deal with edema later. Can also administer diuretics.

41
Q

Diet needs for nephrotic syndrome patients?

A

low sodium
low protein
low cholesterol

42
Q

Complications that can occur with nephrotic syndrome

A 
high blood cholesterol and triglycerides
poor nutrition
HTN
acute kidney injury
renal failure
43
Q

What is renal failure?

A

When kidneys can no longer remove waste and do their job

44
Q

What are the different renal failures?

A

Acute kidney injury

End Stage Renal Disease

45
Q

What is acute kidney injury? Is it reversible?

A

It is an immediate & sudden decline of the kidneys that can lead to failure but it is reversible

46
Q

Criteria to be considered an Acute Kidney Injury?

A

Creatinine levels will be increased

UO will be less than 0.5 mL/kg/hr for 6 consecutive hours

47
Q

Due to loss of function what state occurs?

A

Azotemia or build up of nitrogenous waste products like BUN and creatinine

48
Q

Possible causes of acute kidney injury?

A

Loss of blood

Hypovolemia

Anaphylactic shock to radiology dye

49
Q

Elderly considerations for acute kidney injury

A

Are they dehydrated? Do they have access to water? Do they just drink soda? etc

50
Q

Staging acronym for renal failure

A 
Risk
Injury
Failure
Loss of Function
End stage renal disease

RIFLE

51
Q

Describe or sum up pre-renal acute kidney injury cause

A

Something that results in hypo-perfusion or less perfusion to the kidneys.

52
Q

Examples of triggers that cause hypo-perfusion & why? (4)

A

Diarrhea, Vomiting
NG Suction
Decrease CO
Sepsis

So if you lose fluids, that affects your blood. If you can’t give adequate CO, that affects perfusion. Sepsis due to decrease in venous blood return.

53
Q

Urine volume per day with pre-renal?
Sodium in the urine?
Specific gravity?

A

less than 400 ml/day UO

Urine sodium will be low

Specific gravity will be increased indicating dehydration.

54
Q

What is intra-renal acute kidney injury?

Common causes? (8)

A

When the damage is to the kidney itself.

Pylenophritis glomerulonephritis

Malignant HTN
eclampsia

ischemia from prolonged hypo-perfusion

nephrotoxic drugs
contrast media

Amino-glycosides antibiotics that end in
-mycin

55
Q

What is the main post-renal cause of acute kidney injury?

Examples?

A

Just an obstruction of urine.

Stone
Tumor
Enlarged Prostate
Stricture

56
Q

What are the phases of the acute renal injury?

A

Onset
Oliguric
Diuretic
Recovery

57
Q

What is the onset?

What does it cause?

A

The triggering event occurs.

A toxic or ischemic insult to the kidneys which causes UO to drop below 0.5/ml/kg/hr

58
Q

Oliguric phase urine output?

Labs?

Electrolytes? (easy now)

Fluids?

BP?

A

UO of less than 400 ml/day

Creatinine and BUN increased

Altered electrolytes

Fluid excess

BP is hypertensive

59
Q

Diuretic phase is when?

GFR rate?

UO?

BUN and creatinine?

Electrolytes and UO?

Renal tubules ?

A

It is when the AKI event is corrected.

GFR rate increases

UO increases to 4000ml/day

Slow increase of BUN and creatinine

Electrolytes depleted with more UO

Renal tubules scarred and edematous

60
Q

Recovery phase

edema?

F&E?

GFR?

A

edema is decreased

fluid & electrolytes return to normal

GFR is 70-80% normal now

61
Q

When in recovery phase, what must we do?

A

follow up with them to make sure things are going smoothly.

educate them on prevention

Diet
Hydration

Meds

62
Q

Meds for acute kidney injury?

4

A

diuretics
analgesics
vitamins
beta blockers

63
Q

Why might the patient go on dialysis?

A

It just depends on their state

64
Q

What is chronic kidney disease?

Is it reversible?

A

Known as chronic renal failure also.
Loss of renal function over a long period of time.
It is not reversible

65
Q

What does chronic kidney disease lead to?

What is required at that point?

A

End stage renal disease

Renal replacement therapy or transplant

66
Q

What is the most common cause of end stage renal disease?

A

Hypertension

Diabetes

67
Q

Why does hypoxia occur in chronic renal disease?

What does that cause?

A

Due to reduced capillary perfusion.

Causes fibrosis and cell injury

68
Q

Proteinurea in chronic kidney disease?

A

due to glomerular hypertension

69
Q

What to avoid to prevent chronic kidney disease (or even manage it)?

A

BG and HTN spikes

NSAIDS
UTI
Nephrotoxic agents

70
Q

if creatinine goes up, what does that mean for the GFR?

A

The gfr must decrease for creatinine to go up.

71
Q

How do we treat pulmonary issues?

pulmonary edema
pleural effusions
uremic pneumonitis or urea build up with creatinine

A

Diuretics for excess fluid in the heart and lungs.
Morphine for anxiety and pain.
BP drugs
Digoxin

72
Q

How to treat CV issues?

HTN
Dysthrymia
Pericarditis

A

administer anti-hypertensives
administer anti-dysthymics

Medication and procedures to drain fluid or remove pericardium

73
Q

Treating Hematological issues?

Bleeding and anemia

A

Erythpoetin injection

and Monitor bleeding

74
Q 
Treating GI issues?
Bleeding
anorexia
n/v
GERD
A

A lot of these can be fixed with the right meds.

anorexia addressed through working with patient

75
Q

Neuromuscular issues

sleep disturbances
muscle irritability
peripheral neuropathies

A

Sleep meds.
Muscle irritability - fix the electrolytes
control Diabetes

76
Q

possible skin issues?

A

pruritis
bronze/gray skin
uremic frost on skin

77
Q

Muscoleksletal issues

CA
PO
PTH
bone pain and fractures

A

replace vitamins and give correct hormone replacements

- watch and wait also an option

78
Q

Go review the dialysis slides on your kahoot

A

RN

Adult Nursing Exam 5 (6 decks)

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