Renal Disorders Flashcards
Causes of Chronic Renal Failure
- Diabetes mellitus
- HTN
- Chronic glomerulonephritis
- Pyelonephritis
- Urinary tract obstruction
- Medication or toxic agents
- Vascular disease, hereditary lesions, other infections
Clinical Manifestations of Chronic Renal Failure
- ⬇ GFR
- ⬆ BUN, ⬆ Creatinine
- ⬇ Calcium, ⬆ Phosphate
- Hyperkalemia
- Sodium and water retention
- HTN, HF
- Anemia (inadequate EPO)
- Metabolic acidosis (cannot excrete acid)
- Uremia
Treatment for Chronic Renal Failure
- Treat underlying cause
- Monitor labs
- Keep BP ⬇ 130/80
- Control cardiovascular risk factors
- Control blood sugar
- Low salt, K, phosphate & protein intake, high carb; no dairy
- Dialysis
Causes of Acute Renal Failure: Prerenal
Prerenal: reduced blood flow to kidneys
- Hypovolemia (dehydration, diuretic therapy)
- Hypotension (shock, cardiac insufficiency)
- Other: Burns, bleeding, GI losses, sepsis
Causes of Acute Renal Failure: Intrarenal
Intrarenal: damage to kidneys itself
- Ischemia
- Tubular necrosis
- Antibiotics, contrast dye
Causes of Acute Renal Failure: Postrenal
Postrenal: obstructs urine flow
- BPH
- Calculi
- Tumors
Clinical Manifestations of Acute Renal Failure
- Low GFR, oliguria
- Ill and lethargic
- Drowsiness, headache, muscle twitching, seizures (CNS signs)
- Azotemia (toxic waste in the blood)
Treatment of Acute Renal Failure
- Assess renal function (urine output, labs)
- Prevent and treat infections
- Hydrate (prevent hypotensive shock)
- Monitor BP
Describe the stages of chronic renal failure.
Normal GFR = 125 ml/min
Stage 1: >= 90 ml | kidney damage with normal or increased GFR
Stage 2: 60-89 ml | mild decrease in GFR
Stage 3: 30-59 ml | moderate decrease in GFR
Stage 4: 15-29 ml | severe decrease in GFR
Stage 5: < 15 ml | ESKD or CKD
Describe the stages of acute renal failure.
- Initiation: renal blood flow decreases, causing acute cell injury
- Oliguria: < 400 ml; increased serum concentration of substances usually excreted by kidneys (3 weeks); includes urea, uric acid, creatinine, K, Mg
- Diuresis: gradual increase in UOP, kidneys begin to recover, GFR improves (7-14 days)
- Recovery: continues until renal function fully restored (3-12 months)
Identify the most life-threatening effect of renal failure.
Hyperkalemia
Treatment: Calcium gluconate, albuterol, insulin with dextrose
Identify electrolyte imbalances & treatment (including meds) for the renal patient.
- Kayexalate (Sodium Polystyrene Sulfonate + Sorbitol): ⬇ K
- Sevalamer: ⬇ Phosphate
- Aluminum hydroxide: ⬇ Phosphate
- Vitamin D: ⬆ Calcium
Purpose of sodium polystyrene sulfonate (Kayexalate)
- Treat hyperkalemia, ⬇ K
- Pulls potassium into stool
- Long-term use
Furosemide: Action & Side Effects
Action: Increase renal excretion of water, sodium, Mg, K, Ca; Diuresis; Lower BP
Side Effects:
- Hypotension
- Hypovolemia
- Ototoxicity (give it slow)
- Hypokalemia (& other electrolytes)
- Metabolic alkalosis
Spironolactone: Action & Side Effects
Action: Potassium-sparing diuretic
Side Effects:
- Hyperkalemia
- Hyponatremia
- Arrhythmias
Identify the medication that assists in increasing hemoglobin levels in the renal patient and how to monitor its effectiveness.
Epoetin alfa (EPO)
- Administer IV or SubQ 1-3x a week
- Monitor Hgb & Hct (Target Hgb: 10-11)
- Monitor iron & transferrin levels
- Adverse effects: HTN
What is an AV fistula/graft?
Vascular access for dialysis
- Arterial segment: Outflow
- Venous segment: Reinfusion of dialyzed blood
Nursing Management for a patient with an AVF
- Assess site for patency, S/Sx of infection & uremia
- NO BP or blood draws (limb alert)
- Hold BP meds
- Address pain & discomfort
- Skincare (pruritus common) - give benadryl
- Catheter care
- Palpate for thrill & bruit before & after dialysis
How can we protect the kidneys when administering a medication/product that may have an impact on malfunctioning kidneys?
- Assess renal function (UO & labs)
- Manage HTN < 130
- Antidotes (i.e. acetylcysteine)
- Check labs prior to giving medications
- Do not give nephrotoxic medications (Aminoglycosides - Gentamicin)
- Do not give Demerol (opioid)
- Limit exposure to contrast
S/Sx of Kidney Rejection
- Oliguria
- Edema
- Fever
- HTN
- Weight gain
- Swelling or tenderness over transplanted kidney
- Increase in creatinine
Precautions to Reduce Infection from Kidney Transplant
Hyperacute: remove kidney (necrosis)
Acute: immunosuppressive therapy
- Hand hygiene
- Monitor S/Sx of infection, labs
- No visitors, flowers
Identify signs that a kidney transplant was successful.
Urine production = indicator success
- No elevated WBCs, low platelets
- No s/sx of rejection
