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Acute - Renal Disorders (Exam 2) > Renal disorders > Flashcards

Renal disorders Flashcards

1
Q

serum creatinine

A

0.6 - 1.2 mg/dL
⇡ = kidney impairment
older adults = may be ↓

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2
Q

blood urea nitrogen (BUN)

A

10 - 20 mg/dL
⇡ = liver or kidney disease, dehydration or ↓ kidney perfusion, a ⇡ protein diet, infection, stress
↓ = FVE, malnutrition, or hepatic damage
older adults = 60-90 -> 8-23; >90 yrs -> 10-31

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3
Q

BUN/creatinine ration

A

6-25
⇡ratio = may be FVD, obstructive uropathy, catabolic state, or ⇡protein diet
↓ ratio = may be FVE

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4
Q

oliguria

A

< 100-400 ml/day

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5
Q

anuria

A

< 100 ml/day

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6
Q

azotemia

A

accumulation of nitrogenous wastes

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7
Q

uremia

A

azotemia w/clinical symptoms

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8
Q

kidney test/procedure using contrast medium - before

A
  • any reaction to contrast media?
  • hx of asthma?
  • allergy to seafood, eggs, milk, or chocolate?
  • hx of renal impairment
  • taking Metformin? (d/c 24 hours before any study using contrast media)
  • assess hydration status
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9
Q

nephrotoxic agents

A
  1. NSAIDS
  2. aminoglycosides = -micin antibiotics (vancomycin, amphotericin
  3. dyes used in x-rays
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10
Q

prerenal causes of AKI

kidney normal - impaired renal blood flow

A
  • renal artery stenosis
  • hypovolemic shock (blood or fluid loss)
  • BP drugs resulting in hypotension
  • infection
  • liver failure
  • use of aspirin, ibuprofen, naproxen or NSAIDS
  • analphylaxis
  • severe burns or dehydration
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11
Q

Phases of acute kidney injury (AKI)

A
  1. Initiation = insult to kidney –> oliguria
  2. Period of Oliguria
    - ↓ urine output
    - ⇡ BUN, creatinine
    - occurs 24 hours-week after initial insult
    - lasts 10-14 days
    NI - daily wt, I/O, hyperkalemia
  3. Period of Diuresis
    - ⇡urine output
    - lab values stop rising
    - may last 1-3 weeks
    NI - FVD, hypokalemia
  4. Recovery
    - ⇡GFR
    - BUN and creatinine stabilize
    - Renal function improves for up to a year
    NI - monitor for renal failure
    S/S - A/N/V, weight gain, malaise, HA
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12
Q

Fluid and electrolytes in AKI

A 
FVE
metabolic acidosis
K+ = ⇡
Mg+ = ⇡
Ca2+ = ↓
Phosphorus = ⇡
nitrogenous product accumulation = ⇡
BUN, serum creatinine = ⇡
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13
Q

AKI prevention

A
  • adequate hydration
  • prompt recognition and treatment of shock
  • manage hypotension (maintain MAP of 65 for perfusion of kidneys)
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14
Q

AKI treatment

A 
MONITOR
- weight, I/O, VS
- electrolytes (K+, Mg+, Na+, Phos)
- diuretics - Lasix
- treat hyperkalemia
- infection and ⇡ temperature
NUTRITION
- restrict protein; ⇡ carbs
- restrict fluids = get losses + 500 ml (to account fo insen
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15
Q

emergency treatment for hyperkalemia

A

IV

  • glucose
  • insulin
  • sodium bicarb
  • calcium gluconate
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16
Q

Acute Glomerulonephritis

A
  • usually caused by an infection (streptococcal)

- manifests about 10 days after infection

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17
Q

clinical manifestations of acute glomerulonephritis

A
  • malaise, HA
  • ⇡ BUN, creatinine
  • sediment, protein, blood in urine
  • CVA tenderness
  • ⇡ BP
  • ↓ urine output
  • specific gravity of urine = 1.010 (fixed no matter how much fluid)
    They are retaining fluids and toxins!
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18
Q

Treatment of Acute Glomerulonephritis

A 
Antibiotics
Balance rest and activity
Daily wts, I/O
Monitor BP
↓ protein in diet
↓ sodium in diet
may need dialysis
Diuresis begins 1-2 weeks after onset (as begin to recover)
19
Q

Teaching for acute glomerulonephritis pt

A

Recognize S/S of renal failure:

  • HA
  • N/V/A
  • wt gain
  • malaise
  • ↓ urine output
20
Q

Nephrotic syndrome - causes

A
  • bacterial or viral infection
  • NSAIDS
  • IV drug users
  • cancer or genetic predisposition
  • systemic disease == lupus, DM
21
Q

What is nephrotic syndrome?

A
  • ⇡ glomerular permeability that allows larger molecules to pass thru membrane into urine.
  • causes massive protein loss, edema (anasarca), and ↓ plasma albumin levels
22
Q

treatment of nephrotic syndrome

A
  • dialysis
  • ACE inhibitors (inhibits aldosterone, so Na+ not retained)
  • prednisone (will shrink holes so protein can’t leak out)
  • statins (lower lipids)
  • ↓ Na+
  • ⇡ protein
  • anticoags for up to 6 months (b/c lost alot of anticlotting proteins from blood - at risk for thrombosis)
  • diuretics (lasix)
  • albumin infusion (⇡ oncotic pressure in vascular space; will pull H2O from tissue)
23
Q

clinical manifestations of Nephrotic Syndrome

A
  1. protienuria
  2. hypoalbuminemia
  3. edema (anasarca)
  4. hyperlipidemia
  5. ↓ urine output
24
Q

uremia

A

azotemia with clinical manifestations

  • metallic taste in mouth
  • A/N/V
  • muscle cramps
  • uremic “frost” on skin
  • itching
  • fatigue and lethargy
  • hiccups
  • edema
  • dyspnea
  • paresthesias
25
Q

Diagnosis of CKD

A
  1. urine albumin
  2. ⇡ BUN and serum creatinine
  3. elevated BP
26
Q

Labs for CKD

A
  1. hyperkalemia
  2. ↓ Ca, so ⇡ phosphorus
  3. ⇡ Magnesium (excreted thru kidneys)
  4. Na+ usually ↓
  5. metabolic acidosis
  6. ⇡ triglycerides, ⇡ LDLs
  7. anemic (eurythropoetin is not being produced by kidneys)
27
Q

Treatment of CKD

A
  1. Hyperkalemia - IV insulin/glucose/sodium bicarb; calcium gluconate
    - restrict dietary K+
    - Kayexalate
  2. control HTN - CCB, ACE inhibitors (w/caution- ⇡K+)
  3. mineral and bone disorder - restrict phosphate intake, phosphate binders, Vit D, Cacitrol (keep Ca in bone)
  4. Complications of drug therapy - can’t be excreted thru kidneys; watch for toxicity
28
Q

CKD nutrition

A 
Restrict protein
Carbs - main energy source
Fats - adequate amt
Calories - 2000-2500/day
Ltd water (500ml + urine output)
29
Q

nursing care r/t fistula

A
  1. NO I/V, venipuncture, restraints, or BP in that arm
  2. Palpate for thrills Q4H
  3. Auscultate for bruits Q4H
  4. Assess distal pulses
  5. Assess for complications
  6. Encourage ROM
  7. Teach:
    - do not carry heavy objects or compress arm
    - do not sleep w/body wt on extremity
30
Q

which meds should be held before dialysis?

A
  1. antibiotics

2. vasodilators (BB, CCB, ACE inhibitors, ARBs)

31
Q

which meds can continue w/dialysis?

A
  • antiarrhythmics

- sedatives (versed, propofol, phenobarbitol)

32
Q

Disequilibrium syndrome

A

Due to rapid changes in ECF, urea, Na+ and other solutes ==> cerebral edema
S/S = N/V, confusion, restlessness, HA, fatigue

33
Q

hemodialysis complications

A
  • hypotension
  • muscle cramps
  • loss of blood
  • sepsis/Hep B and C
  • HIV
34
Q

Complications with Peritoneal Dialysis

A
  • infection /peritonitis (abdominal pain) = effluent would be cloudy
  • protein loss (so PD pt ⇡ protein!)
  • pulmonary complications (fluid pushes on diaphragm)
  • hyperglycemia (dialysate is ⇡ in glucose)
  • hernia
35
Q

kidney transplant - donor criteria

A
  • must be a match
  • no systemic diseases or infection
  • no hx of cancer
  • no HTN or kidney disease
  • adequate kidney function
36
Q

kidney transplant - immunosuppressive therapy

A
  • drugs used: prednisone, azithioprine (Imuran), cyclosporine, Prograf
  • continues for life of kidney
  • dosage may be tapered or altered
  • monitor for rejection/infection
  • leukocyte, platelet counts are monitored
37
Q

kidney transplant - rejection

A

3 types:

  1. hyperacute - w/in 24 hours
  2. acute - w/in 1 week - 2 years after transplant
  3. chronic - occurs over months-years
38
Q

Treatment of hyperacute rejection

A

remove kidney

39
Q

Treatment of acute rejection

A

more immunosuppressives

40
Q

Treatment of chronic rejection

A

treatment is supportive

41
Q

hyperacute s/s

A
  1. ⇡ temp
  2. ⇡ BP
  3. pain at site
42
Q

acute s/s

A
  1. oliguria or anuria
  2. ⇡ BP
  3. ⇡ temp
  4. enlarged, tender kidney
  5. lethargy
  6. ⇡ serum creatinine, BUN, K+
  7. fluid retention
43
Q

chronic rejection s/s/

A
  1. gradual increase in BUN and serum creatinine
  2. fluid retention
  3. changes in serum electrolyte levels
  4. fatigue

Acute - Renal Disorders (Exam 2) (1 decks)

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