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Nursing 220 Exam # 2 > Renal Disorders > Flashcards

Renal Disorders Flashcards

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0
Q

What does an increase in the ratio of BUN to creatinine of more than 20:1 usually indicate?

A

Dehydration

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1
Q

What are the 3 common complaints of of patients with Renal Diseases?

A

1) Fatigue
2) Pain
3) Voiding Changes (i.e., polyuria, oliguria, frequency, urgency, dysuria and hesitancy)

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2
Q

What are the 7 major symptoms of Glomerulonephritis?

A

1) Proteinuria and hematuria
2) Oliguria (from scarring & loss of glomerular filtration membrane)
3) Azotemia
4) Edema (peripheral or periorbital)
5) SOB (because of pulmonary edema)
6) Pain (flank pain)
7) Headache (secondary to hypertension)

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3
Q

What kind of diet (in regards to protein and carbohydrates) is prescribed to a patient with Glomerulonephritis?

A

1) Low Protein - Because the patient already has a build of of BUN in the blood. BUN is a byproduct of protein metabolism, so more protein in the diet will contribute to this build up.
2) High Carbs - Because they provide energy and reduce protein catabolism.

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4
Q

What are the 5 major Risk Factors for Glomerulonephritis?

A

1) Strep throat (Streptococcal infection in the upper respiratory tract)
2) Impetigo
3) Hepatitis
4) Mumps
5) Varicella zoster (chicken pox)

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5
Q

In which 3 ways are is Acute Glomerulonephritis managed?

A

1) Diet - Low protein/high carbs
2) Medications - Diuretics (for fluid retention) and Corticosteroids/immunosuppressants (because of the antigen/antibody production)
3) Fluid Restriction - Because patient is already retaining fluids

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6
Q

What is the difference between Azotemia and Uremia?

A

1) Azotemia - Refers to the accumulation of nitrogen compounds (BUN and creatinine) in the blood.
2) Uremia - Describes the clinical manifestations of the renal failure and the resulting buildup of wastes (i.e., altered fluid, electrolyte and acid-base balance, hypertension, anemia, pruritus, a yellowish-gray pigmentation and osteodystrophy).

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7
Q

What are urinary casts?

A

Proteins secreted by damaged kidney tubules.

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8
Q

What are the 8 F&E imbalances that commonly occur with Renal Disorders?

A

1) Fluid Volume Excess
2) Bicarbonate Deficit (kidneys unable to regenerate or reabsorb bicarbonate)
3) Protein Deficit - Due to ⬆ excretion (causes proteinuria)
4) Sodium Deficit (dilutional) - Because of fluid retention
5) Sodium Excess - If not enough fluid is retained
6) Potassium Excess - Due to ⬇ K+ excretion
7) Calcium Deficit - Due to ⬇ Phosphorous excretion (Ca and Ph have an inverse relationship)
8) Magnesium Excess - Due to ⬇ excretion
9) Phosphorous Excess - Due to ⬇ excretion

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9
Q

Explain why proteinuria causes edema.

A

If you are voiding all your protein (mainly albumin), there is little left in the blood vessels (colloid osmotic pressure) to pull blood back from the interstitial spaces. Therefore, blood pools and causes edema.

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10
Q

What is Anasarca?

A

Extreme generalized edema

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11
Q

Explain how proteinuria puts patients at risk for drug intoxication.

A

Proteinuria causes ⬇ serum albumin levels which results in ⬇ protein binding sites for medications. Therefore, the amount of free or unbound drug is increased in the blood.

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12
Q

Which 3 physiological changes are responsible for Pre-renal Failure?

A

1) Volume Depletion - Such as hemorrhage, dehydration, diuresis, or GI loss.
2) Cardiac Deficiency - Such as in MI, heart failure, dysrhythmias, and cardiogenic shock.
3) Vasodilation - Such as in sepsis, anaphylaxis, and anti-hypertensive medications.

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13
Q

What are the 5 physiological changes that cause Intra-renal Failure?

A

1) Pigmented Nephropathy - The breakdown of RBCs that contain pigments that occlude kidney structure.
2) Myoglobinuria (from trauma, crush or burn injuries) - Myoglobin is released from muscles and causes obstruction, renal toxicity and ischemia.
3) Hemoglobinuria - From transfusion reactions and hemolytic anemia.
4) Nephrotoxicity - From agents such as antibiotics, contrast dyes, NSAIDs, and ACE inhibitors.
5) Infections - Such as pyelonephritis, and glomerulonephritis.

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14
Q

Define Rhabdomyolysis

A

Rhabdomyolysis is the breakdown of skeletal muscle (from trauma, crush injuries or burns) that releases myoglobin into to blood and could cause kidney damage by blocking up the kidney vessels.

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15
Q

What is THE reason for Post-renal failure?

A

Urinary Tract Obstruction - Resulting from Calculi (stones), Tumors, BPH, strictures and clots.

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16
Q

What are the 4 clinical phases of Acute Renal Failure?

A

1) Initiation/Onset - Begins with initial insult and ends when oliguria develops.
2) Oliguric (average of 7-14 days) - Results in a build of of wastes in the body because output is < 400mL/24 hrs.
3) Diuretic - Urine output ⬆ and glomerular filtration has started to recover.
4) Recovery (average of 6-12 months) - Signals the improvement of renal function and energy level.

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17
Q

In regard to patients with ARF, which 4 mentioned potassium-rich foods and 4 phosphorous-rich foods are restricted?

A

1) Restricted Potassium-rich foods - Banans, citru, tomatoes and melons.
2) Restricted Phosphorous-rich foods - Dairy products, beans, nuts and legumes.

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18
Q

(T/F) Carbonated beverages and caffeine are restricted for patients with renal diseases.

A

True

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19
Q

What happens if caloric intake (carb intake) is insufficient inpatients with renal failure?

A

Protein breakdown will occur instead (for energy) and nitrogenous wastes will ⬆ and further increase uremic symptoms.

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20
Q

How does a Fever and an Infection worsen the Uremic state of an ARF patient?

A

Fevers and infections inches the metabolic rate which breaks down protein faster and contribute to the already ⬆ uremia. Bedrest may be indicated to reduce exertion and the metabolic state during the most acute stage of the disorder.

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21
Q

What are the 6 GI manifestations of CRF?

A

1) Anorexia
2) N & V
3) Hiccups
4) Ammonia/urine breath
5) Metallic taste in the mouth
6) Ulcerations and bleeding

22
Q

Patients with CRF may receive EPO therapy for anemia. What is the major contraindication to receiving this therapy?

A

Hypertension - Because ⬆ RBCs will further potentiate hypertension.

23
Q

Even though dietary protein is restricted for CRF patients, why should it be increased during dialysis?

A

In order to compensate for loss of protein and among acids in the dialysate.

24
Q

What kind of vitamins are lost during dialysis?

A

Water soluble vitamins

25
Q

What are the 4 Integumentary manifestations of CRF?

A

1) Yellow pigmentation - From retained urinary chromogens that normally give urine it’s yellow color.
2) Pruritus - From calcium phosphates that deposit in the skin.
3) Hair and nails tend to be dry and brittle
4) Uremic Frost - Urea crystals as a result of ⬆ BUN (late sign of CRF)

26
Q

In patient with CRF, what are the 3 phosphate binders commonly used to lower phosphorous level? What is the major side effect associated with them?

A

1) Calcium Carbonate (Tums) - Calcium-based
2) Calcium Acetate (Phoslo) - Calcium-based
3) Sevelamer (Renegal) - Non Calcium-based
* All three carry a risk of causing Hypercalcemia.

27
Q

Even though patients with renal diseases are on a restricted protein diets, when the do intake protein it should be proteins of high biological value (HBV). Which 6 mentioned foods are sources of HBV protein?

A

1) Eggs
2) Fish
3) Poultry
4) Soy
5) Milk
6) Meat

28
Q

How long should a fistula for Hemodialysis be allowed to heal before use? What can be done to promote healing faster?

A

The fistula should be allowed at least 14 days to heal and mature although 4-6 wks is preferable. The patient is encouraged to perform exercises, such as squeezing a rubber ball, to help the access mature and to increase the size of the vessels.

29
Q

What are the 6 important teaching points for patients with a fistula or a graft?

A

1) You should feel a thrill (vibration) or hear a bruit (swishing sound) when feeling/auscultating over the site
2) Do not permit blood to be drawn from the site
3) Do not allow an IV to be inserted in the site
4) Do not allow BP to be taken on the extremity
5) Do not wear tight clothing over the site or carry bags/pocket books on that extremity
6) Do not lie on or sleep on that area

30
Q

During Peritoneal Dialysis, what should the nurse do if upon draining the fluid from the peritoneum, the fluid drains slowly or the volume is less than the amount inserted?

A

The nurse should turn the patient from side to side, elevate the head of the bed, or reposition the patient to facilitate drainage. If fibrin clots prevent outflow, heparin may be added to the diasylate. The catheter itself should never be moved.

31
Q

Why is the left donor kidney preferred for a renal transplant?

A

Because the left renal vein is longer than the right one.

32
Q

After transplantation, the nurse should assess the patient for which 6 SxS of transplant rejection?

A

1) Oliguria
2) Edema
3) Fever
4) ⬆ BP
5) ⬆ Weight
6) Swelling and tenderness over transplanted kidney or graft

33
Q

What’s the difference between Grey-Turner’s Sign and Cullen’s Sign?

A

1) Grey-Turner’s Sign - Bruising of the flanks associated with kidney/retro-peritoneal bleeds.
2) Cullen’s Sign - Superficial edema and bruising in the pre umbilical are, associated with kidney bleeds.

34
Q

What are the normal ranges for the following lab values:

1) BUN
2) Serum Creatinine
3) Serum Uric Acid Level

A

1) BUN - 10 to 20 mg/dL
2) Serum Creatinine - 0.5 to 1.5 mg/dL
3) Serum Uric Acid Level - 2.5 to 8 mg/dL

35
Q

What are the 7 major factors that cause BUN to be elevated?

A

1) Dehydration
2) Poor renal perfusion
3) ⬆ Protein intake
4) Infection
5) Stress
6) Corticosteroids
7) GI bleeding

36
Q

Explain the process of how CRF can cause GI irritation and bleeding.

A

In CRF the kidneys are unable to excrete enough urea. Urea builds up in the bod and is broken down in the GI by bacteria, which produces ammonia. Ammonia irritates the GI mucosa, causing ulceration and bleeding.

37
Q

What are the 3 major cardiac manifestations of Hypermagnesemia (caused by CRF)?

A

1) Bradycardia
2) Peripheral Vasodilation
3) Hypotension

38
Q

What should be co-administered with Phosphate binders when giving them to treat CRF patients?

A

A stool softener or laxative because phosphate binders and constipating.

39
Q

Which 4 types of medications should be withheld until after dialysis treatment?

A

1) Antihypertensives - Contributes to further hypotension caused by dialysis, which reduces blood volume.
2) Water-Soluble vitamins - Will be removed from the bloodstream by dialysis.
3) Antibiotics - Will be removed from the bloodstream by dialysis.
4) Cardiac Glycosides (such as Digoxin) - PD can cause Hypokalemia which can cause digitalis toxicity if done when administered with digoxin.

40
Q

Since an Internal Arteriovenous Fistula takes 4 to 6 weeks to mature (before it can be used for dialysis), which 3 methods can be used for dialysis during this maturation period?

A

1) Subclavian catheter
2) Femoral catheter
3) External Arteriovenous shunt

41
Q

What are the 6 major disadvantages of an Internal Arteriovenous Fistula and an Internal Arteriovenous Graft?

A

1) Steal Syndrome - Too much blood is diverted to the vein and arterial blood perfusion to the hand is compromised.
2) Cannot be used immediately (4-6 wk maturation for fistula and 2 wk maturation for graft)
3) Needle insertion through tissue and skin required
4) Infiltration of needles can cause hematomas
5) Aneurysm - Balloon like dilation of blood vessel could form.
6) CHF - Can occur from increased blood flow in the venous system.

42
Q

What’s is Disequilibrium Syndrome?

A

Disequilibrium Syndrome is a possible complication of Hemodialysis that happens as a result of rapid change in the composition of the extracellular fluids when salutes are removed from the blood stream faster than from the cerebrospinal fluid and brain; fluid is then pulled into the brain causing cerebrospinal edema.

43
Q

What are the 7 major SxS of Disequilibrium Syndrome?

A

1) N & V
2) Restlessness and agitation
3) Confusion
4) Headache
5) Hypertension
6) Muscle cramps
7) Seizures

44
Q

What are the 5 appropriate interventions for a patient that is experiencing Disequilibrium Syndrome?

A

1) Stop the dialysis
2) Notify the Physician
3) Reduce environmental stimuli
4) Prepare to administer hypertonic, albumin, or mannitol solutions
5) Prepare to dialyze the patient for a shorter time and at a lower rate to prevent recurrence of Disequilibrium Syndrome.

45
Q

Define the following terms as they relate to Dialysis:

1) Fill
2) Dwell
3) Drain

A

1) Fill - The infusion of 1-2 dialysate as prescribed is infused by gravity into the peritoneal space, which usually takes 20-30 mins.
2) Dwell - The amount of time that the dialysate solution remains in the peritoneal space, which is determined by the physician and can last 20-30 mins to 8 hours or more, depending on the type of dialysis used.
3) Drain - The outflow of fluid from the body into the drainage bag.

46
Q

What are the 6 major Clinical Manifestations of Peritonitis?

A

1) Cloudy outflow
2) Rebound Abd tenderness
3) Abdominal pain
4) General malaise
5) Fever
6) N & V

47
Q

Explain the reasons for the following types of outflow from Peritoneal Dialysis:

1) Bloody (after the first few exchanges)
2) Brown outflow
3) Urine-colored outflow
4) Cloudy outflow

A

1) Bloody (after the first few exchanges) - Indicates vascular complications and bleeding.
2) Brown outflow - Indicates Bowel perforation
3) Urine-colored outflow - Indicated bladder perforation
4) Cloudy outflow - Indicates peritonitis

48
Q

What is the main cause of insufficient outflow during drainage of Peritoneal Dialysate and what is the appropriate intervention for this problem?

A

The main cause for insufficient outflow is a full colon. Encourage a high-fiber diet and administer stool softeners as prescribed.

49
Q

(T/F) Hemodialysis must be done at most 24 hours before kidney transplantation.

A

True

50
Q

What are the 3 different types of organ rejections associated with a renal transplant and what are the appropriate interventions for each?

A

1) Hyperacute Rejection - Occurs immediately at the time of anastomosis of the organ. Intervention involves removal of rejected kidney.
2) Acute Rejection - Most common type. Occurs within 6 wks postop. Intervention involves Immunosuppression with corticosteroids or monoclonal antibodies.
3) Chronic Rejection - Occurs slowly within months to years and mimics CRF. Intervention involves Immunosuppression and retrains plantation if necessary.

51
Q

What are the 8 major clinical signs of Renal Transplant (Graft) rejection?

A

1) ⬆ Temperature (greater than 100 degrees F)
2) Pain or tenderness over the grafted kidney
3) 2-3 lb weight gain in 24 hrs
4) Edema
5) Hypertension
6) Malaise
7) ⬆ BUN and Serum creatinine and ⬇ Creatinine Clearance
8) ⬆ WBCs

52
Q

What is Cytitis?

A

Cystitis is a UTI or inflammation of the bladder from an infection, obstruction of the urethra or other irritants.

53
Q

(T/F) Hematuria is more associated with Acute Glomerulonephritis while Proteinuria is more associated with Chronic Glomerulonephritis.

A

True

Nursing 220 Exam # 2 (2 decks)

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